Dr. Vitoon Pitiguagool, the cardiothoracic surgeon who creates the “miracle of life” with discipline and passion

Dr. Vitoon Pitiguagool is a cardiothoracic surgeon with expertise in coronary artery bypass surgery, repair of heart valves and replacement surgery at Bangkok Heart Hospital. In his 30-year career, Dr. Vitoon has performed several surgeries whose outcomes are nothing short of miracles, and given his patients another chance to live on, when some of them had barely a chance of survival as they lay on his operating table.

A few cases are a standout — one patient was battling for his life, when he was transferred by air ambulance for the first time in Thailand for operation; another case involves the captain of an overseas commercial ship, who had little chance of survival when he was brought for the operation away from his home and family. These are well-documented “miracles”.

The beginnings

Vitoon was always a promising student and usually one of  the top scorers in his classes. He started his medical career at the Faculty of Medicine, Chulalongkorn University. Initially, he wanted to become a surgeon, but when he was a trainee doctor at Somdej Na Sriraja Hospital, along with his practice at Chulalongkorn Hospital, he decided to become a neurosurgeon after meeting several professors whom he considered his idols.

But life led him through a long way. He started working as an intern for his scholarship at a newly opened hospital named Serngsang Hospital in Nakhon Ratchasima province. The hospital is located in Serngsang district, a border “red” zone, an area under communist influence. Despite being a fresher graduate, and in his early 20s, Vitoon took on the responsibilities of the director of the hospital because no other doctor was willing to work there due to the reputation of the area as a dangerous place.

The 10-bed Serngsang Hospital at the time had been newly constructed, and had only one doctor on duty. Thus, the young doctor from Bangkok became both the director and the doctor who oversaw every task along with three nurses and just a few assistants.  

“Two years before Vitoon went there, a police station in the area had been set on fire. When I arrived there, the sheriff sent me a gift. You know what it was? It was neither a fruit basket nor a bouquet, but an M16,” he says, now laughing at the memory. “Also, there were two bunkers in front of the hospital. I told myself that I had to stay there – meaning I had to know every staff and every person in the community under my responsibility.”

When he received the M16 rifle as a gift for self-protection from the sheriff, who was also a senior graduate from Chulalongkorn University, the young doctor realized that “only a tough guy” could work in this area. Despite the imminent danger, Dr. Vitoon says he was never paranoid or confined himself to the hospital and his residence.

Instead, he went outside to meet with many local people in the red zone. He formed good relationships with them and received warm welcomes. He easily blended himself in with the locals and joined them during meals when invited, slowly gaining their trust.  The result of his outreach enabled the Serngsang Hospital vehicle to conveniently and safely drive around throughout the red zone.

A new chapter in career growth

After working there for a year, he transferred himself to work at the Surgical Department of Maharaj Hospital in Nakhon Ratchasima province. Everything had been going well in his career, until a medical case one day left him feeling distraught. The patient arrived at emergency unit vomiting blood and had gastric hemorrhage for which he operated on successfully. However, because of his hemophilia — that caused non-stop bleeding — the patient lost his life later as blood transfusion technology was not well developed then. 

“On that day I asked myself, ‘how many more patients will have to lose their lives under our care if we are not good enough?’,” he recalls.  That incident inspired him to improve himself by seeking more knowledge and experience in performing surgery. Even when he had free time outside his normal shift hours, he would drop by at the operation theater to help other doctors. 

“Some days we had operations starting at 10am and carrying on until 8am the next day — meaning we operated on more than 10 cases in 24 hours. That’s because we kept asking ourselves how to make ourselves good enough. So, we had to do many operations to gain lots of experience. The more cases we had, the better we would do with our skills,” Dr. Vitoon said.

In just one year, he performed nearly a thousand abdominal surgeries, gaining invaluable experience, excellent surgical skills, decision-making and solving problems immediately. Another turning point in his career happened when Nakhon Ratchasima province offered a heart surgery scholarship due to a shortage of surgeons with that speciality. He applied for the scholarship, was chosen, and went to study at Siriraj Hospital, which was the first institution in Thailand to provide training in heart surgery.

“Prof. Dr. Kampol Prachuabmoh was a senior professor who initiated me into several key things about heart surgery. He said, ‘Vitoon, I accept you to this course but under three conditions. First, you must be able to stand hungry because an operation can take around 5-8 hours. So, forget about lunch. Second, you must be patient when you are standing for long periods during operation. Third, you have to stand being penniless’. I felt okay with that, so I replied, ‘Fine, Sir’, as I didn’t feel that I had to work to earn money. Then I became a resident doctor in heart surgery at Siriraj Hospital.”

After graduation, he returned to continue his work in Nakhon Ratchasima. He dealt with many cases referred to him even from nearby hospitals, as his hospital was the main hospital in the south of the Northeast. Recalling the period, he says, “There were so many patients getting operated on that the director of the hospital teased me and said, ‘Vitoon, you can do fewer operation cases, since we cannot get money fast enough for the surgery’. Most of the patients there had low incomes, so the hospital had to find and allocate a budget.” 

Chasing dreams

Winds of change blew when Prof. Dr. Kampol, one of the pioneer team members of Bangkok Heart Center at Bangkok Hospital, invited his student, Dr. Vitoon, to join the team, at first, as a cardiac surgeon assistant.

To become a surgeon requires a lot of training, experience and talent, so Dr. Vitoon decided to get further training at a hospital under Melbourne University in Australia. His application received no response. Once, when he heard that a professor doctor from Melbourne was visiting Malaysia as a guest speaker at an academic conference, he made a bold move and decided to fly there to introduce himself.

“After the conference, I saw him having coffee, so I walked up and introduced myself while asking him directly if I would be accepted as a heart surgeon trainee,” Dr. Vitoon said. “He replied that I would surely be accepted because I already had some experience. Later, I became a trainee for cardiac surgery in Melbourne for one year. I learned many things. The professor also liked our Thai way of caring and having conversations with patients because it showed that we were making an effort and were humble.”

The trip to Malaysia actually paved the way for him to realise his dream. After becoming a top surgeon as had been his ambition and treating numerous Australian patients, he finally decided to return to his homeland to work at Bangkok Heart Hospital, joining the first heart surgery team of Bangkok Heart Hospital.

Working with Dr. Kitipan Wisootharom in the surgery team enabled Dr. Vitoon to fine-tune his expertise in coronary artery stenosis treatment by by-passing coronary arteries without stopping the functioning of the heart, also known as “off-pump coronary artery bypass grafting”. One advantage of this method is there is need for heart contraction during the operation. That reduces the side-effects of the heart having to stop contracting completely when using the on-pump bypass machine.

This off-pump operation method is suitable for patients with malfunctioning heart, lungs or kidneys or elderly patients. It reduces the chance of suffering a stroke, or paralysis, and lowers the fatality rate.  Another area of Dr. Vitoon’s expertise is heart valve replacement surgery with a small incision, using an endoscope.

“Bangkok Heart Hospital is on the front line of providing off-pump bypass heart surgery. One patient I operated on had a heart that contracted only 9 per cent or barely had movement. But now the patient has already recovered well,” Dr. Vitoon said. “Normally, we work as a team with 5-6 heart surgeons. In difficult cases, the doctors in the team work together, which also enables the young generation of doctors to gain experience. We have also operated aneurysm cases, which on average causes deaths in 94-95 per cent of patients, but we could save lives in many of the severe cases.”

Bangkok Heart Hospital takes a role in providing not only healthcare and treatment but also academic information concerning cardiothoracic surgery. The hospital provides medical teams to other hospitals, locally and overseas, knowledge on heart surgery, and also produces and disseminates medical articles for presentation at academic conferences overseas.

Over the past 30 years, Dr. Vitoon has passed on his knowledge at home and abroad, having operated more than 1,000 cases of patients with stenosis or blockage of coronary arteries by off-pump coronary artery bypass grafting surgery.

Memorable cases

One of those cases remains well etched in his memory and remains a source of pride. The patient was in a critical condition with coronary artery stenosis and acute myocardial infarction. This case is another epic in the history of Bangkok Heart Hospital and is recounted even today.  

“In the past, there was no air ambulance for patient transfer. This was probably the first case in Thailand of an air ambulance being used to transport a patient. The patient was flown from Surat Thani to Bangkok’s Don Mueang Airport and then moved to a car ambulance, which drove him to Bangkok Hospital’s Emergency Unit. We had to keep pumping his heart for a long period.

“The patient’s wife asked me whether her husband would have a chance to survive the operation. I told her that there that the chance was greater of losing him than saving him. And if we could not operate on him, we would definitely lose him. We immediately got the green light and hurried to do the operation. After a few months of recuperation, the patient returned to leading a normal life. He lived on for 17 more years,” Dr. Vitoon said of the patient, who has left a deep impression on his memory.

“Another case was a captain of a commercial ship, who suffered from aneurysm. He was a Filipino who also had kidney and liver failure. When he was sent to Bangkok Heart Hospital, he went through X-ray computed tomography and angiogram. However, one procedural problem we faced was there was no relative available to sign the consent form for his operation. We made a phone call to his wife who was overseas and that enabled the operation to be performed on time. The patient remained in hospital until his kidney and liver started functioning rather well before he could return home.

“What touched me the most was that around 11 years after that, the patient came with his wife and two children to see me. He asked if I remembered him and said, ‘My son and my daughter wanted to know who was the doctor who saved their father’s life’. I was really touched that he still thought of me even though more than a decade had passed since the surgery,” the doctor said with a smile.

The core principles

Each day of his life, Dr. Vitoon has been performing these medical miracles that have given a new life to numerous people. But these “miracles” are no sleight of hand. They are grounded in discipline, persistence, attention, and effort, which are the key guiding principles of Dr. Vitoon Pitiguagool, the top cardiothoracic surgeon in coronary artery bypass surgery, heart valve repair and replacement surgery at Bangkok Heart Hospital.

“I keep telling myself and younger doctors that whatever we are going to do, let’s do our best. No matter what the outcome, we can tell ourselves that we did our very best. We don’t have to brood later, wondering whether we would have done better, because the patient will never have another chance. When they are dead, they are dead. We can’t undo that. Hence, whatever we do, it is important that we do our very best,” Dr. Vitoon said, explaining his mindset.