David Kays, M.D., likes to think about things in a different way.

他质疑普遍接受的方法是否真的能产生最好的结果. He looks in the mirror and challenges himself.

“I'm very self-critical,” says Kays, a pediatric surgeon at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida. “I look at myself and say, ‘Kays, you could have done better.’”

这种批判性思维和个人动力使凯斯成为全国最好的治疗专家之一 congenital diaphragmatic hernia (CDH), a condition that affects about one in 3,000 pregnancies. 分隔婴儿腹部和胸部的肌肉没有正确形成, 留下一个大洞，让腹部器官向上移动到胸部. 这限制了肺的生长空间，在严重的情况下导致肺小得要命. CDH generally is diagnosed midway through pregnancy, 许多准妈妈收到了终止妊娠的建议.

凯斯认为，几乎所有患有CDH的婴儿都能存活并茁壮成长. He has treated nearly 600 CDH babies in his career. He and the team he has built as medical director of the Center for Congenital Diaphragmatic Hernia 约翰霍普金斯儿童医院是美国第一家也是唯一一家专门治疗CDH的住院医院，重症患者的存活率超过90%, compared to national survival rates of 50% or less.

Through experience and more than two decades of research, 凯斯已经形成了一种对修复时间和管理婴儿通风的感觉，这为肺部和大脑的生长和发育提供了最好的机会.

“做修复手术不会让小肺变成大肺，”凯斯说. “Our goal is to allow small lungs to be as big as they can be.”

Kays talked recently about his interest in medicine, 是什么吸引他来鼎晖医疗服务，以及他在医院之外都做些什么.

Did you always want to be a doctor?

I did. I remember my mom gave me a book called The Making of a Surgeon. It was written by a guy named William Nolen. 我读了那篇文章，感觉很合适，但我当时只有10岁. I always wondered what was going on when an ambulance went by, and I just always was fascinated by medicine. 我从高中开始在急诊室工作，因为我一直喜欢这种紧急情况和威胁生命的疾病，并希望参与到医学的这一部分.

How did you come to specialize in CDH?

我一直对重症监护、呼吸生理学、呼吸机和肺部很感兴趣. I was always at my best in those critical care situations. I recognized it, and the people I worked with recognized it. 横膈膜疝气成为儿科外科中一种很好的方式来表达我对重症监护的兴趣和我开发的设备. 这是一个很好的机会，可以像我一直想做的那样拯救生命. 横膈膜疝气真的成为了那个出口，这是一个需要关注的未解决的问题.

膈疝最重要的是——虽然有技术上的问题——是真正的重症监护. 你怎么照顾那些肺非常非常小的孩子呢? That was an unsolved problem. I like to think differently. 当我在训练和学习的时候，我想知道事情是如何演变成这样的? Why are they still that way? Is it because that's the best way? 是不是因为有人开始这么做，然后大家都照他说的去做了, and now that has become the standard way? 我认为我擅长的一件事就是观察别人的做法，然后问自己:这真的是最好的做法吗?bet8九州下载能不能换一种方式思考，从而得到更好的结果? 膈疝让这种思维方式得到了回报因为事实是, we did need some new ways to think about it.

What attracted you to come to Johns Hopkins All Children’s in 2016?

I needed a place on an upward trajectory that had room to grow. 几年前，这家医院成为约翰·霍普金斯大学的一部分，对发展国家项目有远见和兴趣. I thought together we could do something really special. 2016年，凯斯在约翰霍普金斯儿童医院治疗了17名CDH患者. More recently, 该项目每年接待50-60名患者，他们的家属来自30多个州.]

It’s not hard to understand the impact of CDH on the lungs, 但你也强调了这些婴儿的大脑发育. How does CDH impact that?

CDH leads to small lungs. Small lungs can lead to low oxygen levels. So, it really is an oxygen delivery issue. bet8九州下载必须在整个治疗过程中向大脑输送足够的氧气才能在另一方面获得良好的大脑治疗效果. bet8九州下载很清楚地知道，bet8九州下载拯救的孩子的数量与bet8九州下载对他们肺部的照顾程度有关. 但bet8九州下载也知道，结果的质量——他们回家后的样子——完全取决于bet8九州下载对他们大脑的照顾程度. 在护理过程中，大脑处于最危险的时期是可以确定的, and by thinking about the brain all the time, we can learn to anticipate and mitigate those risks, resulting in better outcomes … not just regarding survival, which is a very blunt tool to measure outcomes by, but in functional brain outcomes as well. 在bet8九州下载的项目中，bet8九州下载治疗的每个婴儿在出院时都会进行脑部核磁共振和神经发育测试. It’s our own internal brain protection scorecard.

What do you do to take your mind off work?

I work a lot, which is a passion. Although it's very tiring, I don't get tired of it. I have a boat. 说到划船，我是个新手，但我喜欢出海. 我以为我对钓鱼略知一二，但我一点也不懂. 我跟我爸爸学钓鱼，他带bet8九州下载去一个鳟鱼养殖场，在那里你所要做的就是把鱼钩扔进去，成千上万的鱼都会来吃它. That's not what happens out in the Gulf of Mexico. I'm not very good at fishing.

我喜欢打高尔夫球，因为它能让我到户外去，但我不经常打. I have three grandkids, and they are fun. But they don't live in town.

The Center for CDH team keeps expanding. What are your plans moving forward?

我认为我在未来10年的角色将是继续做手术，继续站在病床边, 还可以花更多的时间在电脑前写下我学到的东西，这样其他人就可以改进他们的游戏. 这可能意味着我不会花那么多时间在床边，但我相信这个团队.

我知道我带给bet8九州下载的经验是大多数人所没有的, but our team has great expertise in a variety of specialties, and we are building their experience with CDH. That is what the dedicated Center for CDH allows us to do.