Life and Times of Leading Cardiologists: Roxana Mehran

E. Magnus Ohman, MD: Hello, and welcome to another program on the life and times of prominent cardiologists. I'm very fortunate to have Dr Roxana Mehran from [Icahn School of Medicine at] Mount Sinai in New York with us today.

You are going to share a little bit about your life, which has been a really amazing story, and how this potentially can help younger people shape their career. You've had a really good run.

Roxana Mehran, MD: Thank you, Magnus. It's wonderful to be here.

From Iran to New York

Dr Ohman: You were not born here.

Dr Mehran: No; I'm an immigrant who came here legally from Iran. I was born and raised in Iran until I was 13, and moved here some 40 years ago. It's been an amazing experience.

Dr Ohman: Were your parents moving here, and they brought you along?

Dr Mehran: My uncle was living here, and it was a judgment call by my dad to expose us to the US/American culture. His brother was so ingrained in it; had married an American woman, and had four children. The idea was that we would come for a 1-month vacation, which then turned into this whole other level of a lifetime change, on the basis of the circumstances. There was not a major decision like, "Okay, we're all moving." It kind of happened almost like a perfect storm—as if it needed to happen, on the basis of everything that took place in Iran.

We were fortunate that we had an amazing uncle. My sister and I stayed with him for a whole year. My parents joined us the year later; we went through the process of legal immigration and ended up staying here.

Dr Ohman: How much do you remember of Iran now? Were you born in Iran?

Dr Mehran: I was born in Tehran. I had an amazing childhood in an amazing country with wonderful culture and great family values. It was fantastic, with grandparents and a lot of family. It was a traditional upbringing very much embedded in the culture of Iranian poetry, Iranian culture, and ancient Persian traditions—an incredible journey. It was wonderful while we lived there.

Adjusting to the United States

Dr Ohman: As a 13-year-old, how was your first exposure to a US middle school or high school?

Dr Mehran: Very difficult. I was 13 and placed in, believe it or not, the 10th grade. Thirteen-year-olds usually are in the eighth grade, but they tested me in mathematics and [other subjects] and put me in a 10th-grade Catholic high school in Queens, New York. It was incredibly difficult. Obviously, I could not speak any English. I remember taking my first test and I had a dictionary, and I only got through the first question when time was up. It was a difficult journey during those early years.

Dr Ohman: How many siblings did you have? Did they all come?

Dr Mehran: I have an older sister and two younger brothers, and they all came. My sister was with me when we lived with my uncle for the first year, so I was not alone. Then, my brothers joined the following year, so it was our family of six living in a small house. It was very different from what we were used to in Iran. It was very close quarters and fun to go through growing up and sharing growing pains with them.

Dr Ohman: What did your father do for work? Did your mother work? Were they in medicine?

Dr Mehran: No one in my family was in medicine. My parents were very dedicated to education. That was really their whole motto, and something that I have ingrained in my children. Going through the process and everything that happened in Iran, and the fact that we had to make a new life in the United States, made all of us realize that if the basis of education is there, you can build everything all over again from scratch. It was difficult times. My dad was 50 and my mom 36 when they built it all over again.

Dr Ohman: It's an amazing story. When was the first time that you felt truly American?

Dr Mehran: That's a very good question. When I first came, I remember going into a supermarket and seeing rows and rows of food and so many products. I was in awe and shock and thought, "Wow, these Americans really have it great." All the shelves are full.

This was in 1976. It was very, very different from Iran at that time. Of course, it's a different story now—I'm sure it's not the same. But back then, I remember I was in such shock of "the land of plenty" and how everything was so much bigger, vaster, and more plentiful, if you will. I said, "Wow, it would be great to be a part of this."

The culture was somewhat interesting for me; I embraced the American culture because Americans embrace other cultures. It's such an amazing melting pot.

Dr Ohman: Particularly Queens. There's a massive amount of people from all different parts of the world. You might be the only one from Iran, but you were not alone as being an outsider.

Dr Mehran: Absolutely not. My school was mostly American kids, but we did have a few foreign people—but very, very few. In fact, I think I was the only one in my class who could not speak English well, or at all.

Next Step, College

Dr Ohman: Approaching graduation from high school, how does one pick a college in the United States with only 3 or 4 years' experience of where to go?

Dr Mehran: I only had 2 years of high school experience—10th grade, 11th grade—and then made a decision in my senior year. Honestly, I did not know much about it because during those high school years, we were working and studying, and I really did not understand anything about the college process. All I know is I showed up one day and took this exam, and they told me that that was my entrance SAT exam. Thankfully, I did well.

I only applied to one school, and that was New York University (NYU). The only reason I chose that is because there was a plaque in my uncle's TV room with his graduation from NYU. I said, "This must be a really good place to go."

Dr Ohman: You followed in your uncle's footsteps.

Dr Mehran: I just followed in his footsteps, and went there.

Dr Ohman: When did the idea of medicine come in to play?

Dr Mehran: That is really important. An incredible thing happened. My brother was 11; I was 13. It was early in the year that we had first come. He fell ill—he was very, very sick. He had fevers of unknown origin, rash, [and] kidney failure, and was admitted to hospital for a few weeks with no real diagnosis. I remember staying with him with my mom and dad. We would not leave, because he was only 11 years old. He had glomerular nephritis. He had Henoch-Schönlein purpura, but no one could diagnose it until he was transferred to another hospital, where they did a renal biopsy.

I remember feeling that I wanted to be in a place where I could make a diagnosis for my brother. I felt very much at home in the hospital, with the whole solving-a-very-difficult-puzzle of a difficult case. I remember feeling that this could be my calling; I can do this. I can have fun, do science, help people, and solve problems. I felt like that was it. That was early in high school. So, I knew then.

Dr Ohman: Now, did your brother do medicine?

Dr Mehran: No. Not at all.

Dr Ohman: He got traumatized.

Dr Mehran: Totally traumatized. He still has a hard time going to the doctor.

Dr Ohman: What happened to your other brothers and sisters?

Dr Mehran: My older sister is a certified public accountant in New York City, working for a very large firm and doing extremely well. My two brothers are businessmen, or entrepreneurs, and have small/medium-sized businesses. All are in the New York City/New Jersey area.

Dr Ohman: You are true New Yorkers.

Dr Mehran: Yes. Absolutely.

Medical School During the Iran Hostage Crisis

Dr Ohman: You must have done well at NYU, because you go to medical school. How did you pick medical school? You had a little bit more time to make the decision.

Dr Mehran: Around the time that I was graduating from NYU, there were these hostages being held in Iran. You know, for 444 days? It was really a very difficult time. It was around the same time that we were trying to legalize and become permanent residents of the United States. We had applications that were pending where we really did not have full status yet. We were going through all of that—because it took such a long time—and everything was stopped owing to the Iran hostage crisis.

Dr Ohman: Did you feel the stigma of that whole situation?

Dr Mehran: It was unbelievable how difficult it was to be an Iranian back then. I was telling people I was Persian, because most people would not know.

Dr Ohman: They would not make the connection, even though it's the same. That is funny.

Dr Mehran: It's exactly the same. I was working and paying for college at that time, and my advisor at NYU, who was amazing, said to me, "You've done extremely well in all of your exams and in your work. It's going to be really hard for you. I would say take a couple of gap years, maybe get a master's in public health, and do something else. Then, apply again." I just said, "No, that just can't be. I need to proceed because this is what I want to do."

Dr Ohman: Good for you.

Dr Mehran: I applied to over 65 medical schools in the United States. I did not get into a single one—not even an interview.

Dr Ohman: That must have been heartbreaking.

Dr Mehran: It was heartbreaking. A friend called me and said, "There is this really great school. It's something for you to think about. It's on this island, Grenada, and it's called St George's University. They started a few years back and have already graduated a couple of years of classes." I had heard of Granada in Spain, but I didn't know about Grenada. I looked in to it, and it happened that the offices were in Bay Shore, Long Island, in New York. I filled out an application immediately and got an interview. At the interview, the interviewee said, "You're overqualified. What are you doing here?" I said, "Am I accepted?" I ended up going to Grenada to medical school at St George's.

Medical School During the Invasion of Grenada

Dr Ohman: You did 4 years?

Dr Mehran: No. I was there for 2 months, and then the US invasion of Grenada occurred.

Dr Ohman: I remember the invasion. What happened then?

Dr Mehran: I was on Ted Koppel [Nightline].

Dr Ohman: With a New York accent, I take it.

Dr Mehran: It was a really heavy New York accent. In fact, we found the tape online and my daughters listened to it, and they were like, "Mom, why do you speak like that?" It was a really thick Queens accent. I probably still have it.

Dr Ohman: Did they stop medical school for a year, or what did they do?

Dr Mehran: There was never a stop. It was incredible, obviously, to be in a war zone. We had about a week of no food, no electricity, no water, shoot-on-sight curfew. Then, Ronald Reagan came in. It was the Airborne, and that was when I said, "I am an American."

Dr Ohman: The Airborne from North Carolina to boot—the 82nd Airborne.

Dr Mehran: Yes. That is right. We were lucky. I was on the very first airplane out, and it was an incredible experience to go through all of that.

But within a couple of weeks, we were at University of Medicine and Dentistry of New Jersey (UMDNJ), at Rutgers University. They gave us classroom space for night classes. The UMDNJ students would go to school in the morning, and we would do evening and night classes until 10 or 11 o'clock at night and then have the days off to study. It was sort of a reverse. We were able to finish our first semester. Then we were in Brooklyn, then Barbados, and then back again. It was an incredible patchwork.

Dr Ohman: How did your parents react to this? You move the whole family out of Iran to get away from some of the problems. Then, you go to a war zone. They must have been shocked.

Dr Mehran: I cannot even imagine. I have three daughters now. I cannot imagine what my mom and dad went through, because for about 2 weeks they did not know what was going on. There was no news. They were incredibly brave, and I think they believed in me and trusted my decision-making. Even though now, retrospectively, I think I was absolutely mad.

Dr Ohman: Are you giving your daughters the same amount of latitude?

Dr Mehran: Absolutely not.

Dr Ohman: You come back and, obviously, finish medical school. I must assume that you go to New York?

'The Person Who Changed My Life'

Dr Mehran: No. My fourth year of rotations was in Hartford, Connecticut. I was at a hospital named Mount Sinai Hospital. It's no longer there, but it was affiliated with University of Connecticut. It was through that whole experience of rotating through University of Connecticut where I met the person who changed my life, to whom I'm forever grateful for his incredible vision, and who recognized my love for cardiology.

Dr Ohman: Who is this wonderful man?

Dr Mehran: It was Arnold Katz, the son of Louis N. Katz; he wrote the textbook Physiology of the Heart. He was the chief of cardiology at University of Connecticut, and he saw me on EKG rounds and asked me some questions. I was very tough on him. I did not know who he was. I questioned him. He questioned me. At the end, he thought I should do cardiology. I learned that mentorship is everything. Who you are, where you are, being at the right place at the right time with the right people who really uplift you and see your potential is the secret to everything.

Dr Ohman: Was he the one who turned you on to research, too?

Dr Mehran: Yes. He told me that I needed to do some basic science work. I worked with him and Barbara Ehrlich in his laboratory. We did some single-channel recordings of calcium channels on lipid bilayers and looked at the sodium/potassium/calcium exchange. We had a tremendous year and a half there, which then linked me to what was going on at Mount Sinai and the work with Andy Marks. I worked in his laboratory for 2 years.

Dr Ohman: The "calcium channel man."

Dr Mehran: Yes. The "calcium channel man," Andrew Robert Marks, was another incredible mentor. Of course, Valentin Fuster and Milton Packer, and all of these incredible men and women, were there at the right time at the right place in bringing me over to Mount Sinai.

From Basic Scientist to Interventional Cardiologist

Dr Ohman: You started as a basic scientist. When did you turn to interventional cardiology?

Dr Mehran: It was the first day I started at Mount Sinai as a fellow. I was one of the first women—I think it was me and one other woman. Now I can tell you that more than 50% of the fellows at Mount Sinai are women, so it's fantastic. I remember my first day was in the cath lab, and I said, "This has got to be it. This is fantastic."

Dr Ohman: Is this also where you met [your husband] George Dangas?

Dr Mehran: Yes, but some years later, when I was 3 years into my fellowship. I was an interventional fellow, and he was coming in as a first-year fellow. We met in that year.

Dr Ohman: From the war zone in Grenada to the war zone of the cath lab. Did you find it difficult then to pick that as a path because of radiation and issues that come up with reproductive health?

Dr Mehran: That is one of the biggest, most important limitations for women in cardiology—especially in interventional cardiology, where the burden is huge. Not only [in terms of] the workload, or balancing family and work, but also because you are in there during your [prime] reproductive years—your most important years for having children and making a family. But with your will, great mentors, and a great partnership with your spouse, all of it is possible. All of it is possible.

Dr Ohman: You have clearly proved that. You had three children.

Dr Mehran: Yes. Three children, all daughters.

Dr Ohman: What can you tell them from your life experience and moving forward? What pieces are the most important for them?

Dr Mehran: The most important thing is to be focused and work hard. It's really kind of simple. Know what your goal is, and drive to that with hard work. It's the American dream, right? The possibilities are all here, right here in this country. We are very lucky. Our children are being exposed to incredible educational systems in the country, amazing programs, and current technologies—the sky's the limit. All you have to do is focus and work hard.

Then, once you do achieve, make sure you give back in order to keep the wheel going. I could not be here without my incredible mentors. My years of working with Marty Leon and Gregg Stone, the ability to work with the Cardiovascular Research Foundation at Mount Sinai, and all the things that we were able to accomplish were always based on hard work, but also [due to] incredible mentorship from great people like yourself with all the great advice you have given me over the years.

Encouraging More Women to Choose Interventional Cardiology

Dr Ohman: It has been terrific, but I want to ask: How can we get more women interventional cardiologists? You've managed a lot of things that most people sort of almost say they cannot envision. How can we do that?

Dr Mehran: I'm very lucky because my spouse, my partner in life, has been incredibly supportive and never intimidated by what I do. That is a first important step, because the support at home is just as important as the support at work. I want to always make sure that that is recognized. He does not get enough credit. He really, really has been my partner for my life, and my successes are really his.

Attracting more women in interventional cardiology has been a part of my substance, honestly. I have been wanting to see more of us. We are really great for interventional cardiology. We are detail-oriented. We can multitask. We are okay in a heated place where many things are going on. We are usually great cooks.

So we could make it happen. There should be more women in interventional cardiology. The field would be in a much better place if there were more women in interventional cardiology.

We put together a Women in Innovation group, WIN, with the Society for Cardiovascular Angiography and Interventions, and it has been incredibly successful. We are all over the globe and trying to bring more women into the field. But at the end of the day, there is still an incredible inequality out there. There are still biases at the workplace and at home.

We have made huge strides toward bringing more women in to the field, and there are many more now than there were when I first started. But it's up to those of us who now have made it through some of those challenges to this stage to bring in more of our young.

Dr Ohman: You are giving back. The fascinating part of all of this, Roxana, is that essentially a woman from Persia came and showed us how this can be done. You have done it in a fantastic way. I want to thank you for sharing your story with us.

Dr Mehran: Thank you. Thank you for having me.