'I always aspired to be a consultant back home'

A recruitment embargo is preventing highly trained cardiologist Dr Ronan Margey returning home

Hurricane Sandy at the end of October was one of the most devastating natural disasters to ever hit the United States. It left a trail of destruction in 24 states along the eastern seaboard and 253 people dead.

Though the destruction was terrifying, there were many tales of heroics and survival against the odds.

Letterkenny native Dr Ronan Margey (34), a cardiologist and assistant professor of medicine, was on duty in Hartford Hospital, Connecticut, shortly after the storm when a 64-year-old man presented with a heart attack.

It was the man’s third heart attack in less than 10 years and he was gravely ill.

Dr Margey opened up the blood vessel that was blocked resulting in the heart attack, but a huge amount of damage was done to the right side of the heart. The man was given drugs for his blood pressure and a mechanical device to help his blood flow, but his condition continued to deteriorate.

Grim prognosis

Unusually, the heart attack predominantly affected the right side while all the regular methods of support are designed to help the left side of the heart.

His heart condition could have led to multi-organ failure as the organs shut down due to the lack of blood supply.

Dr Margey said he had “less than a 50:50” chance of survival. “His prognosis was very grim.”

The right side of the heart pumps blood to the lungs where it returns oxygenated to be pumped around the rest of the body by the left side.

“Because you are not able to get adequate blood returning to the left side of the heart, the patient’s blood pressure and ability to perfuse all the other organs of the body starts to become compromised,” he explained.

“Up to now there was no dedicated treatment. We tried to do our best with the medications and technology we had with the hope that the heart would recover over time.”

Through his work as a cardiologist, Dr Margey had heard of an experimental percutaneous (inserted through the skin in the groin) right mechanical heart device made by Abiomed, a Massachusetts medical devices company which has a facility in Athlone.

The mechanical heart device had previously been used only eight times worldwide, seven times in Canada and once in Switzerland, however, it had not yet been approved by the Food and Drug Administration (FDA) in the US which sanctions medical devices.

A similar device had been used for 10 years for the left side of the heart but one has only been developed for the right side recently because acute heart failure from the right side of the heart is less common.

Dr Margey was given an emergency use exemption by the FDA and sourced the device from the company within two days given the urgency of the man’s condition. “If I was able to get this pump into the heart, it would give him the best chance of recovery,” he recalled.

The device was inserted into the right side of his heart using a catheter placed via a vein in the patient’s leg; it remained in place for six days until his heart had fully recovered.

This particular mechanical pump device generates up to five litres of blood per minute of blood flow, a standard normal cardiac output for a healthy person. “This device can provide 100 per cent support for what your heart would normally do,” he said. “It is based on the Archimedes screw principle, generating continuous flow, with a motorised pump which sucks blood in one end and pumps it out the other.”

Dr Margey said he hopes other patients can benefit from such a device.

Advanced training

The Donegal man got a first-class honours degree from UCD and spent two years working in Beaumont Hospital and three years in the Mater.

He left Ireland in 2009 to carry out advanced scholarship training in the US as a research fellow at Harvard Medical School and stayed on another year to study minimally invasive techniques to replace heart valves.

He and his wife, who is also a doctor, intended to stay two years and return to Ireland, but the economic situation at home makes that impossible for the moment. The recruitment embargo means talented consultant doctors cannot return home no matter how well qualified they are.

“We’re products of the Irish system. There has been a huge investment in us,” he said.

“I always aspired to be a consultant back home. Like other colleagues of mine, I’m in these big hospitals abroad with these international reputations doing all this extra training with no jobs to get back to.

“It would be nice to give something back for all the time and effort that was invested in us. I spent six years in medical school and eight years as a non-consultant hospital doctor.

“It is disappointing having put ourselves through the ringer with all the extra training and there’s just no job to go back to.”