sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY August 2015 | Archived Issues

FDA Warns of Gilenya Risk, Name Confusion, Looks Into GBCA Use

Pharmacy Focus

The U.S. Food and Drug Administration has issued warnings regarding the multiple sclerosis drug Gilenya and about reports of confusion between the names of the antidepressant Brintellix and anti-clotting drug Brilinta. Also, the agency is investigating the risk of brain deposits following repeated use of gadolinium-based contrast agents for magnetic resonance imaging.

» Read more


Mark Your Calendar


Surgery Grand Rounds

Click the "read more" to see information about upcoming Surgery Grand Rounds.

» Read more


Grand Rounds

Click here to view a schedule of all upcoming grand rounds.


Education Schedule

Click the PDF link below to see the Department of Surgery's education schedule.

Education Schedule - August 2015 (PDF)


Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

» Read more

Cedars-Sinai Joins Surgical Quality Improvement Program

From Bruce Gewertz, MD, Surgeon-in-Chief and Chair, Department of Surgery, and Harry Sax, MD, Executive Vice Chair, Department of Surgery

At Cedars-Sinai, we always strive to provide the highest-quality care and look for ways to improve the safety and outcomes of our patients. To help identify these areas for improvement, we recently joined the American College of Surgeons National Surgical Quality Improvement Program.

» Read more

Upgrade of PACS Workstations Is Complete

The picture archive and communications system used in Main O.R. and the 310 Surgery Center has undergone a much-anticipated upgrade. Highlights of the upgrade are new computer hardware and a 50-inch monitor capable of remaining active, or not "timing out," for up to eight hours.

» Read more

ProPublica 'Surgeon Scorecard'

From Chris Ng, MD, Chief of Staff, and Michael L. Langberg, MD, Chief Medical Officer and Senior Vice President for Medical Affairs

On July 14, 2015, the independent, nonprofit investigative journalism organization ProPublica released a "Surgeon Scorecard" for eight procedures. It reviewed five years of Medicare claims data (2009-13) for more than 17,000 surgeons, including more than 40 surgeons who have medical staff privileges at Cedars-Sinai. ProPublica evaluated the physicians based on "complication rates" for eight procedures:

» Read more

Liver Transplant Program Grows

By Irene K. Kim, MD

The Cedars-Sinai Comprehensive Transplant Center (CTC) is pleased to announce some exciting changes in the Liver Transplant Program aimed at expansion of services and investment in new research initiatives.

» Read more

12 MDs Start Surgery Residencies

Thirteen physicians recently began their residencies in the Cedars-Sinai Department of Surgery.

» See photos of the new residents

Department Adds Faculty Members

Several faculty members have joined the Cedars-Sinai Department of Surgery in recent months.

» Read more

Circle of Friends Honorees for July

The Circle of Friends program honored 101 people in July. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» Read more

More Details About Oct. 1 Transition to ICD-10

Less than six weeks remains until Cedars-Sinai changes its coding classification system from ICD-9 to ICD-10. Until the transition is complete on Oct. 1, updates and requests for assistance will continue, with the goal of ensuring a seamless transition and mitigating negative impact on the organization. Helping Cedars-Sinai meet this goal will be the information gathered during the nearly two years of its dual coding system, which uses both ICD-9 and ICD-10.

» Read more

Resisting Heart Failure

Larry Lewis literally lost his heart on a July day a few years ago, but with his optimism and determination — and the expertise of the cardiac-care team at the Cedars-Sinai Heart Institute — the retired Marine Corps staff sergeant and educator is going strong today.

» Read more

Cedars-Sinai Joins Surgical Quality Improvement Program

From Bruce Gewertz, MD, Surgeon-in-Chief and Chair, Department of Surgery, and Harry Sax, MD, Executive Vice Chair, Department of Surgery

At Cedars-Sinai, we always strive to provide the highest-quality care and look for ways to improve the safety and outcomes of our patients. To help identify these areas for improvement, we recently joined the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

ACS NSQIP is based on collecting clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database. By using clinical data gathered from our patients' medical charts, rather than administrative data, we will be able to catch more complications, helping Cedars-Sinai to improve patient outcomes and cut healthcare costs. Our results can then be compared to those of other hospitals similar to ours in size and type across the country to help us determine where we need to make quality improvements.

On average, ACS NSQIP participating hospitals have been able to prevent 250 to 500 complications and save 12 to 36 lives each year, saving millions of dollars annually. Tracking 30-day outcomes helps identify complications such as surgical site infections, urinary tract infections and pneumonia.

Rodrigo F. Alban, MD, has been selected to serve as our hospital's surgeon champion to oversee the implementation of ACS NSQIP, educate others on the program and work closely with the surgical clinical reviewer (SCR) to accurately capture our hospital's data.

With the assistance of our Health Information Department, led by Thea Campbell, MBA, RHIA, and Laura Hardy, RN, we have identified our hospital's SCR, who will undergo special training through the American College of Surgeons. The SCR role is dedicated to collecting and entering data and works closely with the surgeon champion, surgeons and internal hospital committees to ensure accurate data collection and best results. Because the SCR is responsible for tracking 30-day patient outcomes, the HID team will be contacting surgeons' offices and hospital committees. Your collaboration is appreciated.

We will continue to provide updates as the program progresses. In the meantime, for more information on ACS NSQIP, visit site.acsnsqip.org or contact Rodrigo F. Alban at rodrigo.alban@cshs.org with questions specific to Cedars-Sinai's quality-improvement efforts.

Upgrade of PACS Workstations Is Complete

The picture archive and communications system (PACS) used in Main O.R. and the 310 Surgery Center has undergone a much-anticipated upgrade.

Highlights of the upgrade are new computer hardware and a 50-inch monitor capable of remaining active, or not "timing out," for up to eight hours. "The 50-inch screens provide higher resolution and clarity," said Gary Nobiensky, clinical equipment coordinator for O.R. services.

The upgraded PACS workstations also have more storage capability and provide the ability to view the majority of outside CDs.

"Our goal is to provide the best tools for our surgeons so that they can provide the best patient care possible," Nobiensky said. "The surgeons provided us feedback on the current workstations, and with their input in mind, we feel this upgrade not only expands their ability to display images in the O.R. but also accommodates newer types of imaging technology."

"The upgrade improves the system's ability to make information about each patient case easily accessible to physicians throughout the surgical process," said J. Patrick Johnson, MD, a neurosurgeon and co-medical director of the Cedars-Sinai Spine Center. "It ensures that we have all the correct images that we need to perform the surgery in a safe, timely manner."

The system upgrade was completed in August.

ProPublica 'Surgeon Scorecard'

From Chris Ng, MD, Chief of Staff, and Michael L. Langberg, MD, Chief Medical Officer and Senior Vice President for Medical Affairs

On July 14, 2015, the independent, nonprofit investigative journalism organization ProPublica released a "Surgeon Scorecard" for eight procedures. It reviewed five years of Medicare claims data (2009-13) for more than 17,000 surgeons, including more than 40 surgeons who have medical staff privileges at Cedars-Sinai. ProPublica evaluated the physicians based on "complication rates" for eight procedures:

  • Knee replacement
  • Hip replacement
  • Minimally invasive gallbladder removal
  • Lumbar spinal fusion (posterior technique)
  • Lumbar spinal fusion (anterior technique)
  • Cervical (neck) spinal fusion
  • Prostate resection
  • Prostate removal

ProPublica defined complications as death during hospitalization or readmission within 30 days based on principal diagnoses related to the surgical procedure. Rates were adjusted for patient age, sex and comorbidities. Risk-adjusted complication rates for each surgeon were then rated as "high," "medium" or "low" for each procedure performed.

The reporting and analysis of data sources such as Medicare claims is, as we all know, becoming increasingly common. While hospital-level data on a variety of measures have been publicly reported for some time, physician-specific data and analysis by outside organizations such as ProPublica, as well as by payers, is now also becoming common.

The concept of providing consumers with data about medical quality and safety is one that Cedars-Sinai has long supported and demonstrated, as evidenced by our early adoption many years ago of reporting our quality and safety metrics on our website. As you know, the institution and the medical staff, working together, also use data as a key element in continually improving our quality, with the result being that we are national leaders in quality and safety.

When data analysis and a "scorecard" are presented to the public by an outside organization such as ProPublica, we want to examine the methodology to determine its validity. We asked Cedars-Sinai's Resource and Outcomes Management Department to do so and would like to share the key findings with you.

While the analysis found that some elements of ProPublica's methodology appear sound, other elements are methodologically flawed or confusing for consumers.

Specifically:

  • ProPublica used only inpatient Medicare claims data, thus excluding from its analysis procedures performed on an outpatient basis, such as laparoscopic cholecystectomy and TURP. Such exclusions inaccurately categorize surgeons' complication rates by using incomplete case volumes. Moreover, the resulting complication rates are biased because the inpatient cases are typically performed on more risky or complex patients.
  • Wide confidence intervals surround the estimated complication rates calculated for surgeons. However, the Scorecard does not appropriately explain that surgeons with scores near the border between "medium" and "high" adjusted rates of complications should be viewed as belonging in a range that includes both classifications rather than being assigned to one of them. As a result, ProPublica inappropriately categorizes individual surgeons whose point estimates are close to the classification borders.
  • Surgeons who operated at multiple hospitals were listed under each hospital regardless of the number of procedures they performed at any single site. In other words, a surgeon who performed 99 procedures at Hospital A and one procedure at Hospital B would be listed by ProPublica as performing 100 procedures at each hospital. This double-counting makes it impossible to separate out complication rates by hospital and can be very confusing and misleading to consumers.

All of us recognize the inevitability and the benefit of transparency in healthcare. Although the ProPublica analysis was far from perfect, the goal of providing consumers with data to help them in selecting healthcare providers and hospitals is an important one. We are in the process of further enhancing how we present quality and safety data on the Cedars-Sinai website, as well as expanding the types of data we present. Our goal, as it has always been, is to do so in a way that is valid, useful and transparent to consumers.

The scorecard is available on the ProPublica website at projects.propublica.org/surgeons, sortable by hospital and by surgeon.

The Cedars-Sinai data are at projects.propublica.org/surgeons/hospitals/050625.

Liver Transplant Program Grows

By Irene K. Kim, MD

The Cedars-Sinai Comprehensive Transplant Center (CTC) is pleased to announce some exciting changes in the Liver Transplant Program aimed at expansion of services and investment in new research initiatives.

Nicholas Nissen, MD, director of the highly regarded Hepatobiliary Surgery Program, was recently named surgical director of the Liver Transplant Program. Nissen is widely recognized as a superb hepatobiliary and pancreas surgeon. He will work closely with Tram Tran, MD, medical director of the Liver Transplant Program, to grow the Hepatology, Liver Transplant and Hepatobiliary Surgery programs at Cedars-Sinai. A core element of this growth will be the development of outreach and education services spearheaded by Kristen Cisneros.

Despite the relative paucity of transplantable livers relative to recipients in need of organ replacement in this geographical area, 46 liver transplants were successfully performed last year at Cedars-Sinai, including two heart/liver transplants and five heart/kidney transplants. Our patient survival rates are the best in Los Angeles, with 93 percent of liver transplant recipients alive one year after surgery.

Nonetheless, we believe that our team has an opportunity to expand its services, and as an institution, Cedars-Sinai is firmly committed to supporting this growth. Andrew Klein, MD, director of the CTC, in collaboration with the departments of Medicine and Surgery, has recruited two very talented individuals in hepatology and transplant surgery.

The Hepatology Division welcomes Mazen Nourredin, MD, whose research focuses on fatty liver disease and nonalcoholic steatohepatitis. Nourredin will lead new research initiatives and clinical trials centered on the treatment of fatty liver disease. Given Nourredin's expertise and additional research collaborations with our Department of Hospital Epidemiology, Cedars-Sinai will be at the forefront of the one the most rapidly growing causes of end-stage liver disease.

In the Transplant Division, Tsuyoshi Todo, MD, who completed his general surgery residency at Cedars-Sinai, has been recruited to join the full-time faculty. After finishing his fellowship in abdominal transplantation at Stanford University, Todo was pursued by a number of top transplant programs. He is a talented surgeon as well as a thoughtful investigator who has demonstrated his ability as an independent investigator through prior collaborations with our transplant immunobiology lab.

Lastly, Irene Kim, MD, was named director of the Abdominal Transplant Fellowship, which includes certification in liver transplant, kidney transplant and hepatobiliary surgery.

Cedars-Sinai is committed to training the next generation of transplant and hepatobiliary surgeons and is one of the few transplant training programs certified by the American Society of Transplant Surgeons that offers liver and kidney transplant in combination with hepatobiliary surgery accreditation.

These initiatives in liver disease and liver surgery build on the already tight-knit team of physicians, transplant coordinators, pharmacists, nurses, nurse practitioners, physician assistants and researchers who are all dedicated to one of the most complex and challenging disease processes, end-stage liver disease.

Please feel free to contact Kristen Cisneros with your questions or comments at 310-967-7024 (ext. 7-7024).

Irene K. Kim, MD, is a surgeon in the Cedars-Sinai Comprehensive Transplant Center.

12 MDs Start Surgery Residencies

Thirteen physicians recently began their residencies in the Cedars-Sinai Department of Surgery. Listed with their medical schools, they are:

Residents

Yassar Hashim, MD, Khartoum College of Medical Sciences (third year)

Navpreet Dhillon, MD, University of California, San Diego School of Medicine (second year)

Akbarshakh (Shah) Akhmerov, MD, Cornell University Medical College (first year)

Kjirsten Carlson, MD, Rush Medical College (first year)

Andrew Eisenthal, MD, Columbia University College of Physicians and Surgeons (first year)

Marissa Srour, MD, Keck School of Medicine of USC (first year)

Orthopedic Surgery Interns

Eytan Debbi, MD, Sackler School of Medicine

Derek Ju, MD, Johns Hopkins University School of Medicine

Naudereh Noori, MD, Georgetown University School of Medicine

Raj Yalamanchili, MD, Keck School of Medicine of USC

Urology Interns

Ariel Moradzadeh, MD, Charles R. Drew University of Medicine and Science/David Geffen School of Medicine at UCLA

Colby Souders, MD, David Geffen School of Medicine at UCLA

For a roster of all of the department's residents, click the PDF link below.

Surgery Residents 2015-16 (PDF)

Department Adds Faculty Members

Several faculty members have joined the Cedars-Sinai Department of Surgery in recent months. They are:

General Surgery

  • Rodrigo Alban — associate director of Surgical Performance Improvement and associate program director of the General Surgery Residency Program
  • Daniel Shouhed — staff physician, Minimally Invasive Surgery

Cardiothoracic Surgery

  • Michael Nurok — medical director of the Cardiac Surgery Intensive Care Unit
  • Joshua Chung — staff physician

Urology

  • Stephen Freedland — director for Integrated Research in Cancer and Lifestyle and co-director of the Cancer Prevention and Control Program in the Division of Urology, with a joint appointment as associate director of Faculty Development in the Samuel Oschin Comprehensive Cancer Institute
  • Timothy Daskivich — staff physician
  • Brian Benway — staff physician

Transplant

  • Tsuyoshi Todo — staff physician

Surgical Research

  • Everardo Macias — research scientist in the Division of Urology and Surgical Research
  • Adriana Vidal — research scientist in the Division of Urology and Surgical Research

Circle of Friends Honorees for July

The Circle of Friends program honored 101 people in July.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for more information about the program and for a list of past honorees.

  • Kenneth Adashek, MD
  • Massoud H. Agahi, MD
  • Michael J. Alexander, MD
  • Alison Almario, BSN, RN, OCN
  • Ronald M. Andiman, MD
  • Roberto S. Arias
  • Laura G. Audell, MD, MS
  • Susan Azad, MD
  • Mark Bamberger, MD
  • Babak R. Bamshad, MD
  • David Barcay, MD
  • Eli Baron, MD
  • Peiman Berdjis, MD
  • Keith L. Black, MD
  • Philip G. Brooks, MD
  • Christiane Michele J. Burnison, MD
  • Erin L. Carr, BSN, RN, OCN
  • Ilana Cass, MD
  • David H. Chang, MD
  • Cheryl G. Charles, MD
  • Alice P. Chung, MD
  • Arnold C. Cinman, MD
  • Pejman Cohan, MD
  • Odelia B. Cooper, MD
  • Alice C. Cruz, MD
  • Catherine M. Dang, MD
  • Robert M. Davidson, MD
  • Stephen C. Deutsch, MD
  • Deanna L. Dilibero, PharmD
  • Maria B. DiMeglio, MD
  • Shahrooz Eshaghian, MD
  • Lilihana Esparza
  • Joel D. Feinstein, MD
  • Matthew L Finerman, MD
  • Mary Fox, RN, MPH
  • Stuart Friedman, MD
  • Ivor L. Geft, MD
  • Lisa Girard, RN
  • Richard N. Gold, MD
  • Avivah Golian, MD
  • Jeffrey R. Gramer, MD
  • Adam B. Grey, MSN, RN
  • Solomon I. Hamburg, MD
  • John G. Harold, MD
  • Andrew E. Hendifar, MD
  • David M. Hoffman, MD
  • Rowena M. Ira, RN, CNA
  • Mariko L. Ishimori, MD
  • Marney Jakubowicz, LVN
  • Laith H. Jamil, MD
  • Sharon L. Jones
  • Jay L. Jordan, MD
  • Stanley C. Jordan, MD
  • Saibal Kar, MD
  • Beth Y. Karlan, MD
  • Robert F. Katz, MD
  • David Kawashiri, MD
  • Sonia Kazangian, RN-C
  • Howard H. Kim, MD
  • Michelle M. Kittleson, MD, PhD
  • Lazer D. Klein
  • Jerry L. Koontz
  • Keren Lerner, MD
  • Andrew J. Li, MD
  • Dulce M. Lodrup, RN
  • Garielle Martinez, BSN, RN
  • Philomena McAndrew, MD
  • Robert J. McKenna Jr., MD
  • Mary Katherine McLoughlin
  • Puja K. Mehta, MD
  • Christina Mezquita
  • Stewart Middler, MD, PhD
  • Ronald B. Natale, MD
  • Lisa M. Osorio
  • Alice Peng, MD
  • Stephen C. Rabin, MD
  • David S. Ramin, MD
  • Jamie M. Rey, BSN, RN, RN-C
  • Alma Rodriguez
  • Prediman K. Shah, MD
  • Bahman Shamloo, MD
  • John L. Sherman, MD
  • Autumn Ronai Shurin, MD
  • Steven M. Simons, MD
  • Theodore N. Stein, MD
  • Jerrold H. Steiner, MD
  • Steven Sykes, MD
  • Victoria M. Tamburrino, BSN, RN
  • Alfredo Trento, MD
  • Hannah T. Tualla, MSN, RN, NP-C
  • Anabel Vazquez
  • Robert A. Vescio, MD
  • Kimberly Walczuk, RN
  • Scott R. Weingarten, MD
  • Christina A. Williams
  • Tricia A. Wilson, LVN
  • Paige Woodward, NP
  • Clement C. Yang, MD
  • Payam R. Yashar, MD
  • Keyvan Yousefi, MD
  • Evelyn G. Zapanta

More Details About Oct. 1 Transition to ICD-10

Less than six weeks remains until Cedars-Sinai changes its coding classification system from ICD-9 to ICD-10. Until the transition is complete on Oct. 1, updates and requests for assistance will continue, with the goal of ensuring a seamless transition and mitigating negative impact on the organization.

Helping Cedars-Sinai meet this goal will be the information gathered during the nearly two years of its dual coding system, which uses both ICD-9 and ICD-10.

There are two parts of the ICD-10 system. ICD-10-CM is utilized to classify diagnosis codes. ICD-10-PCS is utilized to classify hospital procedure codes. Each is composed of three to seven characters. The Current Procedural Terminology code set will continue to be used for professional claims and outpatient surgery codes.

Providers will not need to know how to use ICD-PCS code, but coders will rely on physician and provider documentation to derive an accurate ICD-10-PCS code to classify a procedure performed. The dual coding project has shown where Cedars-Sinai coders are having difficulty producing an accurate code because of the need for more information in ICD-10 than in ICD-9.

One area that has been widely problematic for the group is "Infusions and Transfusions." This procedure requires "Body Part" to be defined as to an accurate anatomical location. Simply put, which vein was the line placed in?

Coding professionals are asking all healthcare professionals involved in administering this procedure to be sure to define and document the vein location. Without this information, the procedure cannot be accurately coded to reflect the patient services and the acuity of care.

Within CS-Link™, many system changes designed to support the ICD-10 transition have already been introduced to end users, such as the expanded list of clinical terms, the diagnosis calculator and display of ICD-10 codes.

On Oct. 1, several visual changes will appear within CS-Link. For detailed information about these and other changes — including frequently asked questions, job aids and an e-learning module — please visit CS-Link Central.

The federal Centers for Medicare and Medicaid Services has released a concise guide to ICD-10 resources. The guide focuses on quick references and key steps you can take to get ready for the Oct. 1 transition. Resources include:

To see the guide, click the PDF link below.

ICD-10 Resources (PDF)

For resources and project updates, visit the Cedars-Sinai ICD-10 Watch page on the Intranet. For any other ICD-10 questions, email askicd10@cshs.org or call the Help Desk at 310-423-6428. Enterprise Information Services staffs the Help Desk 24 hours a day, seven days a week.

Previously in Medical Staff Pulse:

ICD-10 Readiness: Oct. 1 Change Is Coming Soon (July 31, 2015)

Resources Available to Prepare for Move to ICD-10 (Aug. 29, 2014)

Switch to ICD-10 Delayed; Preparation Continues (April 25, 2014)

Physicians and Office Staff — Not Just Coders — Need to Prepare for ICD-10(Sept. 27, 2013)

Resisting Heart Failure

Larry Lewis chats with his surgeon, Francisco Arabia, MD, surgical director of the Mechanical Circulatory Support Program.

Larry Lewis literally lost his heart on a July day a few years ago, but with his optimism and determination — and the expertise of the cardiac-care team at the Cedars-Sinai Heart Institute — the retired Marine Corps staff sergeant and educator is going strong today.

"On that day in 2013, I had a plane ticket to attend my wife's family reunion," Lewis said. "I was supposed to fly to the event after one last heart test. By the grace of God, I never got on that flight."

Larry Lewis is thriving with his new transplanted heart.

For seven years, Lewis had been suffering from fatigue, insomnia and tenacious head colds — problems he knew were connected to his heart's slow decline. When cardiologists conducted that test at the Heart Institute, they determined he was suffering from complete heart failure.

Eight days later, Lewis went into surgery to have a device implanted in his chest that would take over the job of pumping his blood. But when the surgeons removed a portion of his heart, they discovered cancerous tumors in it that had been at the root of his health problems. To make things worse, the cancer had already spread to his lower intestine, diminishing his chances of survival.

Not one to be counted out, however, Lewis is living today at his home in Victorville. He has a new donor heart, he's cancer free, and he's in excellent spirits.

"Cedars-Sinai provided the boost of confidence for me to get through this," Lewis said. "I knew the hospital's reputation, and as I got to know the doctors and staff I realized that everyone was a consummate professional."

But there was more to his survival than trust in his expert caregivers.

"I never felt that I had a chance to fail — it was not an option," he said. "I've had to fight my whole life. That's my personality."

Indeed, the same steely resolve he tapped to pull himself from death's door at age 50 had empowered him decades earlier to free himself from a potentially ruinous start to his adult life.

"I was 'that' kid, and I should be a statistic," Lewis said of his teen years. "The places where I grew up and the situations that I was in. … Well, several people I knew then have been in and out of prison. Several are dead."

Lewis was not born into a life on the edge of crime. His dad was a Navy man, his mother a stay-at-home mom. The family lived in Oakland, and his parents had a clear vision for their four sons, whom they sent to private school.

"My parents only had ninth-grade educations, but they had unbelievably high expectations for me and my brothers," Lewis said. "My mother was a beast with education."

But when Lewis was barely a teenager, the family disintegrated. His parents divorced. His dad moved to Southern California with the two oldest boys. Shortly thereafter his mother suffered a stroke.

"At 12, 13 years old I grew up," Lewis said. "I paid the bills. I went to the store with the food stamps. And we moved from the Oakland hills to the Oakland ghettos."

‘I never felt that I had a chance to fail — it was not an option. I've had to fight my whole life. That's my personality.’

— Larry Lewis,
Cedars-Sinai heart transplant patient

Ridiculed by the kids on his new block for "talking proper," Lewis had to learn how to play by the rules of the street. His mother eventually moved away to get care for her illness.

"I lost my identity because I didn't have older brothers or a father to identify with any more," Lewis said. "I was doing all the things you think teenagers do in the streets."

He recalled a day when he was 18 and talking to a friend about what they were going to do for money after high school graduation.

"My buddy said, 'I'm going to start slinging hard'" — selling drugs. "I said, No, I'm going into the military.

"I didn't have anyone telling me I needed to do this, but I knew I had to escape the inner city. My father and brothers were military, so it was the family business. I had the presence of mind and the foundation to get out."

Lewis would spend the next 20 years in the Marine Corps, where he served as an aircraft maintenance data systems analyst, an advocate for victims of domestic violence and a substance-abuse counselor.

After the end of his military career, Lewis threw himself into being an educator and teaching young people his brand of optimistic resilience. He was already acting as a youth director at his church and a coach of sports teams, so it was a natural transition to pick up a teaching credential and then master's degrees in curriculum and instruction, and educational leadership.

"There are not enough African-American educational leaders — especially men," Lewis said. "My job is to fight for kids who can't fight for themselves. I understand the dynamics of their lives. I know that if those kids have an opportunity to thrive, they will."

From 2000-11, Lewis was a teacher, assistant principal and eventually a principal in the Adelanto School District in San Bernardino County. His medical condition forced him to retire in 2011 from his position as principal of Desert Trails Elementary School in Adelanto.

Then came that critical July day in 2013.

After surgeons removed his heart, they implanted a SynCardia Total Artificial Heart. The device helps the sickest of the sick, replacing the lower chambers of the heart (the ventricles) and all four valves. An external driver powers the implant, enabling it to pump. It is a remarkable, temporary therapy for patients who might otherwise die while waiting for a heart transplant.

Yet the device could do nothing about the fear Lewis was feeling.

"I was uncertain about my future and uncertain about my ability to come back from heart failure," he said. "I felt fear, but I wanted independence. I was going to have to earn that."

Lewis lived for 16 months with the SynCardia device. He said he drew strength from his faith, his love for his wife and children, and his desire to work again with young people.

He was back in the hospital at Cedars-Sinai when he got one of the most emotional phone calls of his life.

"They had a donor heart for me, if I chose to have it," Lewis recalled. "I certainly chose to have it!"

When he awoke after his heart transplant, he felt a profound difference.

"When you wake up, you just know that you're alive. You're attached to about a thousand wires, but through it all you can feel that, in fact, there is a heart that's beating."

Lewis plans to continue mentoring youth. Although retired from teaching, his fond memories of serving students from myriad backgrounds has inspired him to start a group called My Brother's Keeper through the church where he is an ordained deacon.

"The idea is that, yes, I am my brother's keeper," he said, "and I do have a responsibility to help the next young man to be successful, to navigate life and to move forward."

Lewis said he also feels a responsibility to the donor heart beating in his chest:

"I need to make sure that I'm positive in the things that I do, to honor the person who I got the heart from."

Click the image below to hear Larry Lewis talk about his transplant experience.