The day Josh Hirsch was born in St. Petersburg, Florida in 1980, his parents Terry and Elissa Hirsch were confronted by a series of percentages.
Josh needed emergency heart catheterization. There was a 50 percent chance of survival.
After the catheterization process was done, doctors said Josh had to have emergency open heart surgery.
There would be a 50 percent chance of survival.
Both surgeries were stopgaps. There would be a 100 percent chance that Josh would need surgery in the future.
This is how life with Tetralogy of Fallot (ToF) with pulmonary atresia begins.
Four years later, Terry and Elissa Hirsch, confronted with the next decision, were given a list of cities in which the next surgery to repair ToF, a combination of four serious heart defects, could be performed.
"My wife and I looked at our doctor and said ‘Birmingham, Alabama?'" Terry Hirsch recalls. "We had an initial reaction of incredulity."
What they found when they visited UAB Hospital was a world-class facility. They met with Lionel M. (Mac) Bargeron, Jr., M.D., the first Division Director of Pediatric Cardiology at UAB, and Albert D. Pacifico, M.D., to discuss the series of surgeries Josh would need to have.
"The magic surgeon," Terry says of Dr. Pacifico.
Dr. Pacifico is world-renowned for how his technique cut surgery times dramatically-often from 10 hours to under two hours, 20 minutes-to increase patient safety, reduce hospital stays and shorten recovery periods. Before his retirement in 2006, Pacifico performed more than 30,000 pediatric and adult cardiovascular surgeries.
"In retrospect, I'm amazed at how forthcoming they were," Terry recalls. "We were just two folks from St. Pete and they took the time to meet with us and talk with us. They showed us the facilities. We were very impressed to see people coming to UAB from all around the country and all around the world."
The Hirsch family would return to Birmingham three times after that visit. In November 1984, Dr. Pacifico performed a shunt placement on Josh. In June 1985, he performed a "complete ToF repair."
"They told us that part of what they were doing would need to be replaced at some point. The homograft valve starts to calcify and would need to be replaced," Terry says.
"One reason we're still so enamored of UAB is that Josh had a very successful surgery at 13 in 1993. Every year he's tested and every year they look at his surgical results and say, ‘He doesn't need it yet.' The surgery he had was just perfect and there's no reason to replace the homograft that they told us would last eight years. We're now on 23 years. Dr. Pacifico's gifted hands made an amazing difference."
Terry Hirsch has only been in Birmingham once in the years since Josh's surgeries. He and a group of friends played golf at courses on the Robert Trent Jones Golf Trail and drove through the city along the way.
"We were on the interstate," he recalls. "One of my friends on the golf trip had come to visit us when we were in Birmingham for the surgeries, and he said, ‘Isn't that the hospital over there?' And I took a look and I started to cry," Terry says. "I'm really embarrassed. I'm this big guy."
He was confronted with so much more than a familiar building as he drove by that day.
"There are memories that aren't so great," he says. "Families that didn't have results as good as we did. We have a picture of Josh and two other kids sitting on the floor in the play area. One of those kids didn't survive his surgery.
"There are visions of our younger son, Jonathan, who was with us on one trip to Birmingham, taking his first steps in the hotel. Visions of him pulling Josh, who was recuperating, in a little red wagon around the hospital."
Over the years, Terry and Elissa found ways to give back to Johns Hopkins All Children's Hospital in St. Petersburg, where Josh received his first life-saving surgery the day after he was born and went for follow-up visits. They co-founded "Big Hearts for Little Hearts," a family support group for parents of children with cardiac issues.
The couple wanted to acknowledge the teamwork between the two hospitals that made possible Josh's successful surgeries, so they included a bequest in their wills to establish an endowed support fund in the UAB Pediatric Cardiothoracic Surgery Unit. They did so thinking of parents like themselves who will find themselves faced with daunting statistics and major decisions.
"Not every story has a happy ending as we are fortunate enough to have," Terry says. "Some family is going to need that help someday. They don't know it yet. We'd like them to have the same good fortune we had."
Today at 36 years old, Josh stands 6'3". He's married and has two sons, 6 and 3 years old. And he hasn't had open heart surgery since he was 13.
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