Even before Dr. Alfredo Iardino died and lived to tell about it, he had to overcome a formidable challenge. As a young physician, he survived a kidnapping attempt in Venezuela by ramming his car into his would-be abductors' Jeep SUV as gunfire rang out.
That none of this information appears in the CV of the doctor now finishing his last year of a Kirk Kerkorian School of Medicine at UNLV Pulmonary and Critical Care Medicine Fellowship isn’t surprising. It just doesn’t fit in an academic summary that includes degrees, research, volunteerism, publications, committee memberships, awards — all of which the 33-year-old chief fellow has in spades.
And yet Dr. Angelica Honsberg, the school’s chief of the division of pulmonary and critical care medicine as well as the doctor who’s led the University Medical Center (UMC) intensive care unit (ICU) during the COVID-19 crisis, said Iardino’s response to adversity has gone a long way toward making him a physician patients both need and appreciate.
“Alfredo,” she said, “never focuses on the challenges that he has experienced in his own life, including political oppression in Venezuela and his cardiac arrest. Instead, he uses these adversities to be more compassionate to patients’ needs. When Alfredo first joined our program, I did not know that he had survived a cardiac arrest and was not driving. I was not aware that he was taking a 5 a.m. bus to get to UMC to start rounding. For him, arriving to work to evaluate patients early was simply part of his professional obligation, regardless of the challenges that he was facing to accomplish this.”
Surviving Cardiac Arrest
Just over three years ago Iardino, then completing his residency in internal medicine at the Texas Tech University Health Sciences Center at the Permian Basin, experienced cardiac arrest. As he walked on a treadmill with his trainer looking on, his heart stopped.
“I do remember extreme pain in my chest and the paramedics told me my trainer had used an AED (automated external defibrillator) that had delivered two shocks and that I was out for a total of 10 to15 minutes getting continuous CPR by my instructor and later the paramedics.”
Doctors diagnosed him with permanent junctional reciprocating tachycardia, a form of arrhythmia that rarely results in cardiac arrest. To correct his problem, cardiac ablations, where a catheter is inserted through a blood vessel into the heart, were performed in both Texas and Las Vegas. The ablations cause small scars in the heart, preventing abnormal electrical signals or rhythms from moving through the heart. On one occasion in Las Vegas, the fellow’s heart began racing, but since that ablation treatment he has had no further episodes, and cardiologists have cleared him not only for work but also for exercise.
In 2020, Iardino wrote an editorial for Critical Care Medicine, which used his own life-and-death struggle to punctuate the need for compassion in the practice of medicine. “On the last day of my life…I suddenly felt…this surely could not be happening to me. Being on the receiving end of the initial ICU intake can illuminate better than any educational effort, underscoring the fundamentals of a patient's sense of helplessness and loss of dignity. Grateful and humbled, my initial thoughts were not so much about my uncertain future, but about those who are sicker and how differently I used to consider them from my invulnerable faux physician pedestals. My unplanned brush with death has transformed quite abruptly the way I approach patients during their critical care illness. My pedestal is gone…for me ‘walking in my patients’ shoes’ stopped being a cliche.”
Surviving Political Unrest
Born in Italy, Iardino moved to Venezuela in the early 1990s with his extended family at the age of 4. His mother, chief financial officer of a construction family business, and his father, owner of a uniform manufacturing company, made the move to the South American country for better business opportunities. As a child, Iardino, who spoke Italian at home and learned Spanish in school and English from TV shows, said he was fascinated with “medical toys” — a fascination that ultimately would see him enter medical school at Venezuela’s University of Carabobo in 2005.
Until the socialist Hugo Chavez was elected president of Venezuela in 1998, the Iardino family prospered. As time went on, however, Chavez’s desire to nationalize industries began to affect the Iardino businesses and their contracts began to dry up. As Iardino neared graduation from medical school in 2011, he said the political situation for those who wanted to retain private ownership had become ugly. Political persecution was commonplace.
One of his cousins was kidnapped but jumped from a moving car to escape. Another cousin was shot. Twice, Iardino realized he had been followed to friends’ homes, and once, when he was leaving medical school, an SUV blocked his path and two men got out with handguns. “I crashed my SUV into theirs to get away. People said there was a shooting as I drove away. I was so scared I didn’t hear it. Somehow I didn't have any bullet holes in my car.”
Not surprisingly, many of his family decided to leave Venezuela, with Iardino coming to the U.S. and working as a researcher at Houston Methodist Hospital in Texas before securing an internal medicine residency at Texas Tech in 2016. After his medical problems were under control, he began his fellowship at the Kirk Kerkorian School of Medicine in 2019.
It wasn’t long before Iardino, who wanted to learn the best ways to help people with lung disease and severe medical problems, was working 80-hour weeks treating COVID patients at UMC alongside his co-fellows and residents.
“COVID patients were so complex at the beginning,” said Iardino, who has been granted political asylum by the U.S. government. His wife, a dentist in Venezuela, is now working to get her credentials to practice in the U.S. “We worked tirelessly with COVID patients to try to help them any way we could. We tried to get a compassionate use of new drugs right away. Each patient presented differently and responded to treatment differently. We really had to think of different strategies for each of them.”
Iardino said many patients who no longer have the virus continue to have complications, including respiratory and neurological problems. “We also see in our clinic how difficult it is for them to go back to their normal lives – they have issues with getting jobs, they’re struggling with PTSD.”
Living a Full and Responsible Life
Iardino said that with the exception of some immunosuppressed patients who had been vaccinated and still weren’t strong enough to fight off the virus, he estimates 98 to 99 percent of the patients who ended up in UMC’s ICU had not been vaccinated for COVID-19. “Vaccination to me now is the paramount way to fight the pandemic. I encourage the public to get vaccinated and boosted for SARS-CoV-2 because the pandemic is not over yet.”
To this day, Iardino remembers how hospital protocols – which were put in place to protect the public from the transmission of the virus – did not allow loved ones of patients to visit them in the hospital. Instead, resident physicians phoned families of patients with updates on their conditions. “It is one of the most heartbreaking and frustrating things I experienced during the pandemic. I cannot imagine being on the other side of that phone trying to understand what’s going on to their loved ones.”
After his mother’s death not long ago from lung cancer and his own brush with death, Iardino, who recalls only seeing darkness and feeling very cold during the 15 minutes his heart was not beating, said he has not only done his best to be more sensitive to the feelings of patients, but he also has worked to bring more joy into his life.
“I’m doing more joking, more talking with people,” he said. “I remember that you must have fun each day. My mother kept putting off having fun traveling with my father and then cancer took her. I now realize that each minute that passes is not going to come back. I am doing all I can to enjoy life responsibly, experiencing and seeing new things.
"When my fellowship ends in June, I am leaving to take a job in North Dakota, but I will miss the people here in pulmonary and critical care. We have done some amazing things for people and have helped each other through very difficult times. We have been a family.”
