Dr Kiran welcomes all of you back to the present post of blog. One of my friends has taken a special interest in the “Book review” section. He is a management person, very familiar with the books described prior. Many times in the past I have heard him talking about the need for excellence and tragedy of incidental leadership in our country. He often spoke of his motto in life: “A school for teaching leadership.” Although ridiculed by many, he stuck to his views. Over years as my understanding is getting a bit mature, I feel the desperate need of my friend’s school!

I received an email from the same person asking me to introduce a book for our readership. He holds this book in a very high regard, which is interestingly titled “On Becoming a Leader”.

This post, we shall see the same book suggested by my friend. The book whose contents are described as “groundbreaking”! The author of the book is Dr. Warren Bennis PhD, founder and Distinguished Professor of the Leadership Institute, Marshall School of Business, at the University of Southern California in Los Angeles. At young age, Dr Bennis was influenced by teachings of Abraham Maslow. He found a mentor in Douglas McGregor, the common interest being Maslow. The term “Bureaucracies” was taken very seriously by him and critically analysed. Dr Bennis coined an antonym for the term. He used “Adhocracies” to imply the constructive angle. For his work on Group dynamics and new organizational forms, he obtained a PhD from MIT. Along with Harvard, Cincinnati he also served as faculty for IIM Kolkota. His most famous work till date remains “On becoming a Leader” published in 1989 and since then has been translated to 13 different languages across globe.

On Becoming a Leader is written in a personal style. It keeps asking the reader how one can make leadership a habit of existence while the world around the individual becomes a blur of change. In provides some of the extraordinary insights into the concept of leadership. The theme of the book can be summarised as “True leaders are not interested in proving themselves, they want above all to be able to express themselves fully.” The latter component becomes pertinent because only by continually seeking their fullest expression, leaders will be able to engage in periodic reinvention. Proving oneself is likely of a limited or static selfish value. Dr Bennis emphasises that life is not a competition but a flowering.

Another path-breaking concept is “Structured education and society often get in the way of leadership”. The statement may look clichéd, but Dr Bennis explains. “What we need to know gets lost in what we are told we should know.” Real learning is the process of remembering what is important to you, and becoming a leader is therefore the act of becoming more and more your true self. Leadership demands THAT unique vision of yours be accomplished. When people protest that they can’t lead, or don’t want to lead, they are usually thinking of management and giving speeches. But leadership is actually a challenge to escape mediocrity which in reality enables to lead oneself with the team. Thereby, the concept of leadership undergoes a paradigm shift.

As per Dr Bennis, the real leadership involves some of the hardcore ethics and needs. Just to list a few:

• Continuous learning and never-dying curiosity.
• A compelling vision: leaders first define their reality (what they believe is possible), then set about “managing their dream.”
• Developing the ability to communicate that vision and inspire others to follow it.
• Tolerating uncertainty and taking on risk: a degree of daring.
• Personal integrity: self-knowledge, candor, maturity, welcoming criticism.
• Being a one-off, an original: “Leaders learn from others, but are not made by others.”
• Reinvention: to create new things sometimes involves recreating yourself. You may be influenced by your genes and environment, but leaders take all their influences and create something unique.
• Taking time off to think and reflect, which brings answers and produces resolutions.
• Passion for the promises of life: a belief in the best, for yourself and others.
• Seeing success in small, everyday increments and joys, not waiting years for the Big Success to arrive.
• Using the context of your life, rather than surrendering to it.

The last point is interesting. Dr Bennis highlighted the link between self-knowledge and business success. Although it took some time to seep in, it is now a Globally recognised entity. At present, most of the successful leaders are not just satisfied with doing a job or running a company, but are trying to find an outlet for their personal vision of the world. Many companies attract best of brains by offering them good money and feeling of prestige. However, those companies which retain these best brains offer them more than that: the chance to make history. That goes very well with the motto of Amazon.com: “Work hard, play hard, change the world.”

Dr Bennis was probably one of the pioneers in the western world to break the myth of “Leaders are born”. He showed the west that Leaders can be MADE. He consistently argued against leadership thrust upon someone. These people have no guarantee of making good. If they do, their genetics or genius is lauded. If they don’t, they doom all their followers into deep well! Hence, leadership is more of a choice involving the leader himself first!

We often see the leaders on whom the responsibility is thrust upon, getting their vision narrowed. They try their best to enjoy the power and preferences to acquire what they lust the most. They cannot lead simply because they have no vision to empower everyone to achieve their best. When someone points to their fallacies, they always have the escape words ready: “I never asked for this; you gave it to me!” One of the tragedies of modern democracy is the choice people are given to choose. The paradigm shift that Dr Bennis provided in his masterpiece should work for the new age leaders. It may be ideal to end the summary with the own words of author, “What is true for leaders is, for better or worse, true for each of us. Only when we know what we’re made of and what we want to make of it can we begin our lives—and we must do it despite an unwitting conspiracy of people and events against us.”

Please let me know your comments on the above review. If you also have any book of interest in your collection, please write a similar review on the book. I shall post your review on your name. Otherwise, please inform me about the book. I shall try to review the book in the future posts with acknowledgements to the informer!

With this, let us get back to our regular feature: Interesting learning scenarios

ARTERIO-ARTERIAL

We have often seen collaterals to the ipsilateral arm in cases of classical BTT shunt. But, is it possible to have collaterals to subclavian artery from descending aorta in cases of modified BTT shunt? We came across on such situation in an 8-year-old with a blocked right BTT shunt. Angio demonstrated a collateral arising from descending thoracic aorta, scaling upto the right subclavian and opacifying its proximal course. Why should there be collateral to a vessel with good flow and same pressure? Is it because of partial block in earlier BTT shunt? Can such an event be an impetus for development of collateral? If anyone has seen this scenario earlier, please let me know.

NO INFLOW CAVITY

Is it possible to have a ventricular cavity when there is absolutely no inflow to it? In other words, can there be LV cavity if there is mitral atresia intact IVS? Similarly, can there be a RV cavity in cases of Tricuspid atresia intact IVS? One of our senior surgeons ruled out such a scenario until we showed this! We had this 5-year-old with Tri Atresia with intact IVS and confluent branch PAs fed by a non-restrictive PDA. The PDA flow not only fed the branch PAs, but also trickled back into MPA and into the RV cavity via pulmonary valve in a retrograde fashion! Is this pattern seen by anyone? We could not recall having seen such combination anytime in the past. Should we call this Tri Atresia A (no inflow) or B (Normal PA pressure on cath) or C (PDA non-restrictive). I am planning to send the echo and cath images to someone like Dr PSS Rao, who has done great deal of work on Tri Atresia. Meanwhile, please let me know if you have any data on this scenario.

ANATOMY Vs STREAMING

How can one be sure that the disproportionate desaturation often found in some of the children is secondary to mixing or streaming? We had a 5-year-old with complete AV Canal defect, TAPVC and multiple VSDs. His great arteries were transposed with severe PS, but reasonably good sized branch PAs. He saturated about 78% in room air. Since the VSDs were too large to create a single piece of IVS and 2 proper pumps, it was decided for single pump repair. Now the questions would be: How to explain the desaturation when the branch PAs are good sized. Since it was also a TAPVC, would streaming matter? Also, how to establish the suitability for single ventricle if the PA entry is not possible? In the presence of so many odds, is it better just to open midline and go with the idea of on-table measurements of pressures and decide between BDG Vs BTT shunt? When we talk of streaming as one of the causes of disproportionate desaturation, do we consider the fluid dynamics with the available anatomy or is it just an extension of some hypothesis? Are there any studies to establish the streaming? Please let m e know your ideas on these issues.

DOUBLE ARCH PDA

How to distinguish between a diverticulum of Kommarel and double aortic arch when a PDA is found with the latter? We had a 5-year-old with the combination of double arch and PDA. Both dorsal and ventral arches gave rise to 2 neck vessels each. The PDA arose from the dorsal arch. The child surprisingly had no symptoms. Now, how to establish the dominant arch? Is the establishment of dominant arch a prerequisite for surgery? What is the least complicated way out? If you had any experience of having handled such a scenario, please let us know.

PEDIATRIC CARDIOLOGY PEARLS

86. The cause of supravalvular aortic stenosis is reduced or abnormal expression of the elastin gene on chromosome 7q11.23. Large arteries such as the aorta and proximal pulmonary arteries have high elastin content in the media and therefore are more commonly affected than smaller arteries. (Stamm C, Friehs I, Ho SY, et al. Congenital supravalvar aortic stenosis: A simple lesion? In European Journal of Cardiothoracic Surgeons. In year 2001 page 195)

87. Atleast one out of 4 children with congenitally correctedTGA will have dextrocardia or mesocardia (In Anderson’s textbook of Paediatric Cardiology. Edinburgh: Churchill Livingstone, 1987 page 867)

88. The incidence of co-existing anomalies increase multiple-folds in TGA with VSD than TGA with intact ventricular septum (In Kirklin’s textbook of cardiac surgery, New York: Churchill Livingston, 1993 page 1383)

89. The highest number of neonatal deaths in the first week of life due to a cardiac cause is by Hypoplastic Left Heart Syndrome. (Samanek M, Slavik Z, Zborilova B, et al. Prevalence, treatment, and outcome of heart disease in live-born children: A prospective analysis of 91,823 live-born children. In the journal Pediatric Cardiolohy in year 1989 page 205)

90. The individual leaflet sizes of mitral valve are a matter of debate in many cardiology centres. However, it is understood that the posterior leaflet is longer at its base and shorter in its basal-to-apical length than the anterior leaflet; both have approximately the same area (Ranganathan M, Lam JHC, Wigle ED, et al. Morphology of the human mitral valve. II: The valve leaflets. Circulation journal in year 1970 page 459)

This would bring us to the end of another post. Please let me know your comments and criticisms. Any fresh idea is welcome and would be duly acknowledged. Please use the comments box or my email id drkiranvs@gmail.com

Regards

Kiran