Transcription of Dervilla McCann, MD for the show Love Maine Review 2014 #172
Lisa: We all know that Maine is a small state and especially when it comes to things like public health. I was privileged to work with Dr. Dervilla McCann on a public health project through Maine Health several years ago, and today, we have her with us again.
Dr. McCann is formerly the director of the cardiology division at St. Mary’s Regional Medical Center and is on the medical staff, and is a full time cardiologist with Central Maine Medical Center in Lewiston. Thanks for coming in.
Dervilla: Thank you for having me, Lisa.
Lisa: Dr. McCann, you have a very interesting background. You spent some time out of the state before you chose to come to Maine. Tell me a little bit about what brought you here and your background.
Dervilla: My first real full time exposure to Maine was when I came here as a freshman at Bates College and I fell in love with the city at that time. I left after graduation, but I had planted a little seed. I talked my parents into moving to Portland.
The moved while I was still in college and I left and went to medical school, joined the navy, I got married, and came back eventually to the state in ’96 drawn both by the fact that my parents were still here and I wanted my kids to get to know them a little bit.
I had a job, so that was another pull, but basically, I’d always loved the state and had always been looking for a way to get back here.
Lisa: Your family is originally from?
Dervilla: Ireland. My parent are both Irish. They met in medical school and emigrated initially to New Finland, Canada, and then, [inaudible 00:11:40] to New England, eventually settling in Portland.
Lisa: What type of physicians are they?
Dervilla: Both my parents are physiatrist which is a specialty focused on rehabilitation medicine. My dad was really one of the founding members of the Wheelchair Sports Association and was real pioneer as was my mom, really. They both were very interested with sports for the disabled and were part of that [inaudible 00:12:09] movement have remained very active in that element of sports ever since they started.
Lisa: Was the fact that your parents were physicians, and basically, what is a public health related field, did that influence your decision to go into cardiology?
Dervilla: I think I decided to be a doctor when I was about seven and I really feel that you select your profession in part because you’re selecting a peer group. You want to continue to grow intellectually, you want to be challenged, and you want to help people. Medicine was a really great way to do that.
I was an internist for a number of years, but I found that my personality really matched better with cardiology. There was pretty immediate return on an intervention with cardiology.
Of course, when I became a cardiologist, cardiac catheterization was relatively new and intervention was in its infancy. Many technologies have advanced dramatically since I started. It’s been really challenging to stay current and to stay as well informed as you can be for your patients, but that’s part of the beauty of it, I suppose.
Lisa: Do you ever speak with your parents about the Irish medical school system or the Irish medical system and how it differs from the American system and where we are today?
Dervilla: We talked about it a lot especially at the beginning of my American Medical training. Actually, I went to Ireland to experience it with my husband. I was married at the time and we did a rotation in Dublin, and it … That was really an interesting experience.
The focus was quite different. The Irish medical students relied far less on labs and technology. They really focused on physical diagnosis in the history, the bedside examination. I couldn’t believe the stuff they memorized. It was really impressive, very, very bright.
Also, when I was there and this was in years ago, but the medical system was also very informed by religion, Catholic Ireland, so there were some social differences that we observed, my husband and I observed, when we were there regarding the communication with the patient, the communication with the family, but it was a really good thing to experience and see up close and personally, so that I understood much better how my parents have been trained in what their focus have been.
Lisa: Why did you choose to go into the Navy and how did that shape your-
Dervilla: Money. I had none, was married, wanted to be independent, seemed like a good idea at the time. The uniforms were definitely a pull because they look great. Seriously, medical school at the time that I entered was … It was during the Reagan administration.
I went to Tufts. The tuition doubled the year before I got there because federal subsidies were removed, so private medical schools around the country were suddenly seeing a very dramatic acceleration in cost.
My husband and I both had to find a way to get through this and so, we applied for a Navy scholarship. He got his the very first year. I got mine our second year, so I worked as an audio-visual tech during my whole first year of medical school to pay the bills.
I have no regrets about his at all. It really turned out to be a fantastic experience, a great adventure, and believe it or not, it turns out that after Tufts medical school, I applied to Bellevue Hospital and was accepted there for my residency at the height of the AIDS epidemic.
We had no idea what was in store for us during those three very difficult years. Fifty percent of my patients had AIDS or AIDS-related illness and 50% of the ones with AIDS died while I was caring for them. It was an inundation with one type of disease and it was a very sad time with very little that I could do.
After I got done with my residency, that was the time that I started my Navy payback and I learned more internal medicine in the Navy because they specifically excluded HIV positivity.
It was really helpful for me to have had those two experiences, one very much based in a public health crisis with intensive care medicine emphasis and very poor outcome, so I became really … I really understood the critical care elements of medical care.
The Navy thought me a completely different side, the outpatient side, taking care of people who are essentially well, but who have chronic medical problems as they age, so it was a really terrific double teaching track, so to speak.
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Lisa: You’ve had to be somewhat nimble as you’ve gone through because you’ve dealt with different demographic groups, you’ve been to different places, and now you find yourself in Lewiston, and you have this interest in what’s going on with the Franco-American, the formerly French-Canadian population. Tell me about that.
Dervilla: There’s no question. My life has zigged and zagged. I have not been sort of shooting star with a linear arc. That has not happened, but that’s the great thing about America, I suppose, and about the opportunities that we can all take if we want to.
I’d been exposed to a lot of different ethnic groups on the West Coast. I met a lot of Pacific islanders in the Navy. I met a number of Cuban refugees. In Boston, I met the Irish-Americans that … It sort of certainly informed my understanding of that group, but definitely in Lewiston, we have a high population of Franco-Americans. I believe it’s 29% of the city which is more than the state as a whole, and the state has a very high percentage of Franco-American.
That is fine with me. I find my patients of Franco descent, particularly the ones who speak French as a first language, to be a really interesting and wonderful group of people to take care of. I really enjoy them.
I speak a little bit of French which is helpful. When you go to, for example, the emergency room sometimes, especially at the beginning when I first got there, I can recall the French-speaking nuns would be behind the curtain speaking French to the patients.
Those are lovely things, sort of a spiritual thing, that it continues to inform the community although Lewiston’s rapidly changing and becoming far more cosmopolitan, and unfortunately, that French culture is not completely sustainable although some wonderful leaders in the community are really trying to hang on to the history and the culture, and the language.
Lisa: As you have been taking care of this particular population, you’ve noticed some things about medically that have been noticed before, but it just has — it’s caught your interest as a cardiologist?
Dervilla: When I first arrived in Lewiston and started seeing really young people with heart attacks, it was a bit of a surprise. Often, these folks, young heart attack victims would often have a whole lot of risk factors.
They would have diabetes or they would smoke, or they would have high cholesterol or high blood pressure, many different risk factors, but what I kept finding was very young people with very high cholesterols and I started looking into this sub-type of patient called people with familial hypercholesterolemia.
When you look at cholesterol, we divide it up in all sorts of subgroups and there was this one genetic tenancy that it gives people very high LDL cholesterol. That’s what we use to call the bad cholesterol.
Individuals with familial hypercholesterolemia inherit this from their parents. If they get both genes, one from the dad, one from the mom, they’re called homozygotes. Those types are very sick at a very early age. They typically have strokes or heart attacks sometimes in their teens and they often don’t survive past the age of 30.
If you get just one copy of the gene from either one of your parents, you’re called a heterozygoate. Heterozygoates do have very high LDL cholesterols, but they’re less likely to have that very early childhood form of heart disease, but they sucomb to coronary artery problems, that’s arteries of the heart, in their 30s and 40s much, much earlier than normal.
Lisa: Dr. McCann, how do people find out about the work that you’re doing, the programming that you’re offering the people in Lewiston?
Dervilla: You’re a big part of it, so thank you very much. It’s really fantastic that we had the chance to talk about this today. I’m personally going to be talking to all of my primary care providers.
I’ve already done that once. I’ve talked to the leadership in the primary care community and I’m planning on spreading the word almost one-to-one, giving every primary care provider a list of the patients that we’ve screened that have their high cholesterol.
That’s how we’re going to start, but by starting with the small pilot project, we’re also going to be looking at a small group of these individuals really providing intensive support and seeing what works and what doesn’t, and tweaking our systems so that what we do is the most effective, highest quality program we can build.
I’m more than happy to share that with anybody who wants to duplicate this because I think this is the way to go. This is the future of medicine in my opinion.
Lisa: Thank you for the work that you continue to do for patients in Lewiston area in the state of Maine and thank you for really making an effort to embrace medicine where it is right now, because it is an exciting time to [inaudible 00:24:36] medicine and there are a lot of things we can offer patients now that we weren’t able to offer them 10, 15 years ago, before the age of electronic medical records.
We’ve been speaking with Dr. Dervilla McCann who’s a cardiologist with Central Maine Medical Center in Lewiston. Thanks for coming in.
Dervilla: Thanks so much for having me, Lisa, I really appreciate you giving me this time.