Merriam-Webster offers various definitions of power, and other words often replace it: Control, Mastery, Sway, Authority, Command, and Sovereignty, for example. However, none of these words capture its intended contextual impact. Rarely is the word power directly applied to heart surgeons. When someone in this profession has your heart in their hands, tasked with repairing or replacing a vital part, their supremacy is immediately relevant. Our hearts are pumps with four valves regulating blood flow throughout the circulatory system. A decision on whether to replace or repair a faulty valve is crucial for the patient’s future and is why heart surgeons enjoy a unique, trust-laden standing in our society. Their notable skill, however, may depend on the heart valve they select to perform as stated by the manufacturer and salespeople promoting it. 

Power details decades-long relationships with several prominent surgeons in America, followed by close links to scores operating in Asia-Pacific. A select few turned my world around as I witnessed explosive growth in heart surgeries with the introduction of improved valve designs, operative techniques, and increased investment in new open-heart centers. The memoir is not a textbook on heart valve surgery or its history in Asia. I’m not a doctor or technician. The focus is on the power dynamics between surgeons, cardiologists, manufacturing titans, device dealers, fellow sales reps, and several kleptocratic government leaders as the twentieth century ended. A volatile period in Asia and world affairs from the mid-1970s to the close of the 20th century saw political and social upheavals, massive investment in care for the heart, and financial gains by practitioners that affected their careers and the livelihoods of millions of patients, including mine. 

“In immersive detail, Power recounts a tale of unbridled ambition, uplifting romance, fame, fortune, undisguised corruption, carnality, bitter rivalries, and murder. The cardiovascular community in which I resided had it all.”

After completing military service in 1969 as an Infantry 2nd Lt based in South Korea, I settled in as a New Jersey-based Procter & Gamble soap powder salesman. Eighteen months later, a product upgrade to catheters in the medical device industry lifted my stature. Unsure I’d chosen the ideal career path, substitute teaching came next. With the freedom to tramp through Europe over consecutive summers, I grasped what the world had to offer outside of America, encouraging me to explore ancestral roots.

A further move toward worldliness continued in the 1970s, during the Saturday Night Fever disco craze, power blackouts, recession, harsh winters, and the infamous “Son of Sam” killing spree in what had become a violent New York City. I settled in the Big Apple on a whim, thinking that success automatically awaited my presence. Two years of menial jobs followed —waiting on tables, driving a taxi, and other trivial pursuits allowed me to survive city life. Thanks to a fraternity brother’s clout and loyalty, I landed a job as a sales rep for the telephone company, lasting 18 stable months. 

In a case of unscripted sales good fortune, I joined the world’s leading mechanical heart valve manufacturer. Suddenly, I found myself in front of the top New York heart surgeons approaching the apex of their careers. My updated resumé blossomed as I rode the crest of a technological wave, empowering them to improve clinical results for their patients. After expressing a yearning for an international posting, I landed in far-off Australia thanks to an uninvited move to the company’s facility in Southern California. Fortunately, its savvy president recognized my determination and found a foreign marketing spot for me.

Traveling widely, I managed the company’s business in a booming 1980s Asia-wide cardiac device market. With minimal direction from a superior based in Hawaii, I engaged surgeons in Shanghai, Bangalore, Colombo, Jakarta, and previously unfamiliar cities. Limited home office coordination required independent actions in the field, with Telex as the primary mode of contact. Reliance on distributors increased for sales strategies. They understood customers, and I didn’t. Positive outcomes required clever maneuvering on a market-by-market and surgeon-by-surgeon basis.

Over time, I built close relationships with several consequential heart surgeons, cardiologists, and businesspeople. I observed their expertise, dedication, rivalries, influence, and, at times, misdoings. In 1983, a year before turning forty and living in Japan, I married the woman of my dreams, a cardiac nurse caring for a CCU patient with the heart valve I sold. Life accelerated on an upward glide, but a year later, dark clouds hovered. Redesigned models of the valve had structural failures. Patients were dying, litigation increased, sales plummeted, and after an eight-year, electrifying career, I resigned to reevaluate my career goals. 

It was 1984, and this self-imposed new beginning found me on the idyllic shores of Hawaii. My connection to the Far East spawned APEX, “A Cardiac Newsletter for Asia,” focusing on regional specialists and events. The upswing in valve surgeries directed my attention to producing dependable, low-cost heart valves for Third World markets I knew well. With planning underway in Honolulu, a new enterprise was created. It would be based in Singapore, with a renowned Australian heart surgeon and two engineers from my previous company as partners. One of them had the same aspiration for a valve project in India. Thanks to the surgeon’s business connections, the initial funding carried us forward. But as operational expenses increased and sales projections were missed, gloom dimmed our earlier bright skies outlook.

In 1986, Dr. Albert Starr addressed the Society of Thoracic Surgeons on the topic of The Thoracic Surgical Industrial Complex. Having attended that meeting and listening to his address, I thought to myself this is such a growing field of the relationship between medicine and business that would be worth billions of dollars in the future.

Struggles continued despite a “rescue loan” from a wealthy Hong Kong newspaper tycoon. Disagreement among partners and Australian investors sapped initial enthusiasm and limited our expenditures. Cuts were made on personnel and marketing. I had to find a new dream to follow. Regretfully, the chilling murder of our prominent surgeon-founder a year later in Sydney led to the venture’s complete collapse. Shockwaves rippled through the region and its cardiovascular community as an avalanche of questions emerged about his unexpected murder.

But the roaring 90s were a time of incredible economic expansion and business opportunities throughout the Far East. When hired to introduce a new prosthetic valve made in the USA, I employed the network of dealers and surgeons I knew. Thanks to full support from the home office team in Texas, the advanced valve design gained a sizable share of the mechanical market. A whirlwind 10-year love affair and marriage steadily dissolved as my travel increased, diminishing any business success I'd achieved. Divorce loomed on a distant horizon.

I returned to publishing, where I’d established a credible voice with APEX. I mused, “Why not tackle the challenge of starting the first heart journal for regional clinicians?” They found it nearly impossible for their clinical or research work to be accepted in Western journals; language difficulties, failure to adhere to scientific publishing norms, and insufficient patient follow-up resulted in routine rejections. The journal was circulated widely in 1993, with prominent surgeons and cardiologists on the editorial board. Fortunately, initial funding sustained its growth. 

Despite intense competition from an Australian scientific periodical for regional ascendency, Asian clinicians and researchers had the Asian Cardiovascular and Thoracic Annals to call their own.

Thanks to numerous individuals' tireless efforts and unwavering dedication, the creation of this legacy rested with all of us—it remains in circulation today. I gave it a life as part of my unscripted Far East odyssey, but a select few sustained and nourished it over the past two decades since I left Asia for home in 2003.

From the bustling streets of New York to the vibrant, tree-lined avenues of Asia and the Pacific, good fortune and timing drove us to improve the journal. Establishing its relevance became an obsession. An official link to The Asian Society for Cardiovascular and Thoracic Surgery ensured its survival and continued growth. 

"The persistence and expertise of the dedicated men and women around me ultimately triumphed. The power of the written word found a welcoming home in the Asian cardiac community. I led the charge to give back to a part of the world I grew to love — a place where I, at times, stumbled to succeed. 

The journey is over, but my connection to the Far East and the friends who supported the varied endeavors I pursued continues to this day.

Please join us as the story unfolds on the pages of Power!