Ramon Brugada: "The first thing you think is: Where did I go wrong?"

Ramon Brugada is head of cardiology at Trueta Hospital. He grew up a few meters from Lake Banyoles, and says that this makes you learn to swim almost before you learn to walk. He had a childhood of unpaved streets and playing in the street, traveled and worked in different countries, and discovered with his brothers—all cardiologists—a syndrome that bears the family name.

Your mother was a good student.

— The school teacher went to speak with the grandfather to ask him to let her continue her studies. But he said no, and that left a mark on her. And she was certain that her children had to study.

And the father?

— I was less sure. He was a chicken farmer, worked long hours, got up at 5 in the morning and came back at 8 or 9 in the evening. We didn't see him much.

And they had three children who were cardiologists.

— My mother was obsessed with medicine; she thought it was a good profession. Cardiology is the responsibility of my older brother, Pedro, who is 14 years older than me, and I think he pushed the rest of us a bit.

Is going to university different when you're not from a big city?

— I met a lot of people like me, because at the Autonomous University there were many people from outside the metropolitan area. The people from Barcelona seemed familiar to me. posh kidsThe truth is, we had a different way of seeing life because we came from a different place; we came from farming backgrounds.

You've ended up living in many places, for example in the United States. What did you learn?

— Working long hours, especially in patient care. And discovering an American society with a Third World within it. There might be a very well-equipped hospital, but with people lacking resources.

The famous insurance.

— I remember a patient with a million-dollar insurance policy who needed a bone marrow transplant and was told it couldn't be done. I learned to live with brutal capitalism. And that what we have here is a luxury.

Why did you leave?

— I was worried because these are societies where children turn 18, move 3,000 kilometers away, and you only see them twice a year. So we decided to go to Canada.

That's when they called you to set up the Faculty of Medicine in Girona.

— And it wasn't hard for me to decide to come back, because I'm passionate about projects. And coming to Girona to set up the faculty was very exciting for me. We had people against us; we started with temporary classrooms and no funding. There was money to pay professors but not a single euro for materials. And it's worked out well. The first graduating class achieved the best overall results in Spain.

What is it about the heart that interests us so much?

— It's the machine that gives us life. It's nothing more than a pump, but it's a pump that never stops. And it adapts to our needs; for example, an athlete has a larger, thicker heart, and it beats more slowly to be more efficient. It has an incredible capacity for adaptation with so few organs. It's practically perfect.

Practically.

— Unfortunately, some people also die young, and the heart can stop due to illness, but it is practically perfect.

Why do we link it to sentimental issues?

— Your heart is the first thing that responds to you. When you like a boy or a girl, it beats faster, or when you're excited to see someone. Or when you're nervous, or experiencing emotional distress. You can feel your heart in your neck; it responds to emotions.

What's good for our heart?

— Tobacco is bad for him, but good health habits are good for him.

What's the worst thing for your heart? Here are some options: being overweight, ultra-processed foods, smoking, lack of sleep...

— The worst offenders are tobacco and ultra-processed foods, even if you're not overweight. The rest can be solved with physical activity.

Is doing a lot of cardio good?

— It's good if it's a controlled and consistent activity. We're concerned about people around 40 who suddenly start doing a lot of sport, perhaps after not exercising regularly for 20 years. And we need to be careful here.

Because?

— Coronary artery disease, which is the blockage of the coronary arteries, is a chronic, progressive condition. The arteries gradually become blocked without you noticing, but if you exercise and have a 75% blockage, you could have a heart attack. Therefore, it's advisable to resume exercise only after medical supervision.

And what about elite athletes?

— It's not healthy from the point of view of the effort it puts on the whole body, not just the heart. You only have to look at footballers or basketball players when they're older; they're often limping. But elite sport brings with it a very important public recognition; it's their life, and therefore we must adapt to these demands.

Do screens affect the heart?

— Screens affect the heart because the person no longer engages in physical activity. This is the major problem they cause.

Will we ever reach a world where all heart attacks can be prevented?

— We'll be better able to detect the risk. Preventing them all, I see, is very complicated. Because what we see with young people is that there's a single blockage that appears suddenly. It's not an illness; they just have a blockage, and this is difficult to prevent.

On difficult days at work, I always think: I'm not performing open-heart surgery. What happens when a life is at stake at work?

— For a surgeon, a 2% mortality rate is very low. But that means that if you operate on 300 people a year, six will die. From a personal perspective, it's very difficult psychologically. But it's part of the profession, and we've accepted that there may be a high risk of death. But if we don't operate on them, they'll die anyway.

Already…

— Medicine isn't perfect, and we cure very few things in cardiology. What we try to do is to have diseases more under control.

How do you deliver bad news?

— Honesty is the only way. And we must also acknowledge that we are not perfect, that we sometimes make mistakes, and that we might have thought it was one illness but it was something else entirely.

He has to deliver very bad news, someone who specializes in sudden death.

— A patient of mine died three or four months ago; he was young, and I spent a lot of time with my family. And the first thing you think is: where did I go wrong?

And what do you do if you think this?

— Review what you have done, talk to colleagues, check that you would do it the same way again.

What do you say to a mother who has lost a 35-year-old son?

— What can be said? Try to be there for them, try to understand what happened in order to explain it, and make sure that everything has been done correctly.

Today, young people studying medicine prefer to become dermatologists rather than primary care physicians. What do you think?

— They're looking for a life with a better work-life balance than we have or have had. And I think we're the ones who are wrong. They value free time more. That's why it's so difficult for them to do research, for example, because it has to be done at home or on weekends, not while visiting patients.

Is the healthcare system as we know it sustainable?

— I don't think so. The situation is becoming incredibly strained because the population is believing in forced marches. Now they're talking about 10 million, which means entering a level of strain that will be unmanageable. There's a shortage of doctors, a shortage of beds… It's all about numbers. We currently receive three heart attacks every two days. If the population increases by 20%, we'll be receiving three heart attacks a day. The decision is what resources we have and where we allocate them to manage the situation.