Sundt '79 brings University research to advanced cardiac surgery

For Dr. Thoralf Sundt III '79, challenges come in the form of critical decisions made in the operating room while performing difficult surgery at one of the most prestigious hospitals in the world, Minnesota's Mayo Clinic.

Sundt is a highly regarded cardiac surgeon, skilled in the advanced procedures that can restore the normal rhythm of a person's heartbeat or repair weaknesses in the large blood vessel leading out of the heart.

Just as he helps make people whole again, Sundt said he is deeply connected to and at one with his job.

"It makes your adrenaline flow and it keeps your enthusiasm up," he said. "When patients don't do well, it's awful, but when they do well, it's very positive.

"To me, the wonderful thing about being engaged in medicine, as difficult as it is when the people do poorly, [is that] what they give back to you is far more than you give to them," he said.

Sundt said his decision to study medicine was partially based on the influence of his father, Thoralf Sundt, Jr., a pioneer in the field of neurology. The elder Sundt also performed surgery at the Mayo Clinic.

Sundt said his career choice also had to do with the attention and opportunities he received as an undergraduate at Princeton in the late 1970s.

While studying in the biochemistry department — the predecessor of the molecular biology department — Sundt dedicated himself to his research, making monoclonal antibodies, a then-recently discovered technique in the nascent field of biological engineering.

Even then, Sundt was a pioneer in his field.

"He completely developed it and got it to work, for rhodopsin and for its transduction proteins," said Professor Meredithe Applebury, his thesis advisor, now at Harvard Medical School.

The research identified the molecules that relay visual stimulus within the cells of the retina, Applebury said.

"The whole thesis process was very good then [during the 1970s]," Sundt said. "It was a great experience. It gave you a great chance as a budding scientist to start out doing research."

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Between Princeton and medical school, Sundt studied at the European Molecular Biology Laboratory in Heidelberg, Germany.

At EMBL, he worked with recombinant DNA during an era when the consequences of mixing two species' genes were not widely understood and therefore, often feared. Re-search was done in a separate building called the containment facility, in the event that a deadly germ was created, Sundt said.

Sundt graduated from Johns Hopkins Medical School in 1984 and completed his residency at Massachusetts General Hospital. Since then, he has worked at the National Institutes of Health, Washington University Medical School and at institutions in Great Britain.

Sundt also has published dozens of research papers regarding his cardiac research and has contributed to many books.

In 2001, Sundt joined the staff of the Mayo Clinic, a move that brought him back to his hometown of Rochester, Minn.

Over his years of study, Sundt has become proficient in many procedures that repair dangerous heart conditions.

One such technique, the "maze" operation, cuts slices into the atria — two of the chambers of the heart — to correct the weak and uncoordinated heartbeat that results from a condition called atrial fibrillation.

The slices in the heart tissue, which resemble a children's maze, force the electrical impulses that control the rhythm of the heart to travel in the proper direction, Sundt said.

Sundt is also an expert at aortic surgery, repairing the large blood vessel that directs blood out of the heart and into the body.

"Just last week we replaced this fellow's aorta — the entire aorta," he said.

Sundt explained that such a procedure requires that the body be cooled well below normal temperature.

"The way we do most of it is cool the body temperature, shut the machine off and stop circulation," he said.

Circulation may be temporarily stopped for as long as 45 minutes.

"It's also exciting work," he said. "All of the operations we do are big operations.

"People don't have heart surgery because they want to have cosmetic surgery," he added. "It's dramatic stuff."

Working at the Mayo Clinic is different from working at a regular academic institution, Sundt said, in that the decisions at Mayo are made by consensus among the staff. At most institutions, on the other hand, the department head holds the ultimate authority.

Moreover, the regular presence of celebrities and politicians seeking world-class treatment at Mayo doesn't influence the level of medical care, according to Sundt.

He pointed out that despite the clinic's broad appeal, generally half of the patients are from the nearby farming communities of the Upper Midwest.

Sundt has always been familiar with the Mayo Clinic because his father was the chief of neurosurgery there while Sundt was growing up in Rochester.

The elder Sundt was an expert in neurovascular surgeries that repaired the blood vessels that supply the brain.

Sundt, Jr., was featured on "60 Minutes" in 1992. After being diagnosed with a form of blood cancer, the neurosurgeon continued working for seven more years at the Mayo Clinic until his death, earning recognition as a doctor who saved lives even while he himself was dying.

"My mother, in that interview to '60 Minutes,' put it very well," Sundt said. "Leslie Stahl looked at her and asked how he could still save people after being diagnosed, and she said 'Yes, and they're saving his [life].' "

For Sundt, the rewards of practicing medicine are incredible.

"There is absolutely nothing in the world like having someone give you a hug after surgery," he said. "I think that's what sustained [my father]. You keep doing what you do," he said.

While the rewards are indeed great, Sundt said, a keen sense of mission is the key to making a career out of helping the sick. Whether as a surgeon or as an elementary school teacher, a successful person must be passionate about his vocation, he emphasized.

One of the many responsibilities that Sundt has undertaken is a study of the safety procedures that protect patients from errors by physicians and other hospital staff.

"What we have is a lot of really talented people [in medicine], and yet we function within a system that's kind of error-prone and sets us up to fail," Sundt said.

While he said that nearly all errors are minor — "we're not talking about cutting off the wrong leg" — glitches do occur, such as administering the incorrect dosage of a drug. These types of errors could result in an extra day in the hospital or complications down the road.

Because of the complexities of modern medicine, with multiple professionals involved in the care of every patient, a new paradigm for managing safety needs to be developed that incorporates the various systems of treatment, Sundt said.

Sundt and other physicians have met with Congresswoman Eddie Johnson (D-TX) in support of her legislation that would strengthen safety standards.

Sundt said that his liberal arts education at Princeton gave him an advantage in being able to understand the paradigms that guide the health care system.

While at the University, Sundt met Rick Wainstein '79, now a lawyer for the National Labor Relations Board at its Philadelphia office. Wainstein lived next door to Sundt during their senior year and the two have remained friends.

Coming from a hard-science background, Sundt may have arrived at the University seeing much of the liberal arts as "fluff," Wainstein said. Yet exposure to the rich humanities curriculum at the University gave him a greater appreciation for those subjects.

Wainstein said that Sundt was "interested in everything" while at the University, noting that Sundt has always been an amateur Civil War historian.

"Thor was different in that he was very focused on his goals after college while the rest of us were just kind of floating around," Wainstein said.

Applebury agreed.

"He was very good," she said. "Great hands at the [laboratory] bench. Some people just have a feel for that, some people don't," she said.

Out of the 35 theses Applebury advised during her tenure at the University, she said she would put Sundt's "at the top."

Every challenge Sundt encountered as an undergraduate, said Applebury, he tackled with pleasure.

He has the intellect and the "hands," or the natural feel, to be a successful scientist and surgeon, she said.

Coming from his Midwestern small-town background — Rochester had a population of about 50,000 when he was growing up —Sundt said he had a difficult time adjusting to life on the East Coast. He said he was surprised at first that Princeton people weren't willing to say hello to a passing stranger.

Sundt's initial difficulties in adjustment were resolved when he signed in to Cloister Inn. The club provided a wonderful social opportunity for him, he said.

Today, Sundt has passed up the opportunities for more comfortable jobs in order to work with the most difficult cases that use the most to advanced science, Wainstein said.

The Mayo Clinic is a perfect fit for the surgeon, he said.

"I enjoy surgery because I enjoy the kind of problem solving that you do," Sundt said. "It's always challenging. It's always interesting."