Bend's first cardiologist has sights set on retirement

Dr. Thomas Combs meets with one of his first patients, Karen Purdom, whom he diagnosed as having an operable heart condition, at his Bend Memorial Clinic office.

One of Dr. Tom Combs' early Bend patients took a ride across the mountains 30 years ago in a plane owned by a local funeral home - even though he was still alive.

The aircraft was big enough to move someone in the midst of a heart attack, Combs said, because it was used to transport caskets.

And since Bend didn't have a cardiac catheterization lab to perform intervention-type therapies, or a helicopter designated for medical transport, the patient had little choice.

”I told him no matter what happens, we had him covered,” Combs said with a laugh, fondly remembering the incident, which turned out well.

The U.S. Army-trained physician, who plans to retire from private practice by the end of the year, came to Bend from San Francisco as a pioneer of sorts.

He was the first cardiologist to move to the area and at the time, he said, there was some controversy over whether the small town of Bend had enough patients to support such a specialty.

It was 1976. Bend Memorial Clinic was located on Greenwood Avenue and St. Charles Medical Center-Bend had just moved from its downtown building to its current location east of town. Combs said along with the lack of a cardiac cath lab, there wasn't even a treadmill in the city for use in stress tests.

”There were no cardiologists in town,” Combs, 63, said. ”There was nothing.”

Three decades later, Bend has two large groups of cardiologists, a group of cardiothoracic surgeons and a nonprofit dedicated to research and education on cardiac issues. Combs is retiring from his private practice with Bend Memorial Clinic to take over as medical director for that nonprofit, Heart Institute of the Cascades.

”It seemed the time in life to make the change,” Combs said. ”I like to ski and fly fish and bike ... It's a part-time job that should have more flexibility.”

His long-time colleague and friend Dr. Tim Hanlan, who came to Bend in 1980 and isn't ready for retirement, is having a hard time imagining working without Combs.

”It's going to be a difficult time for me when he leaves,” Hanlan said. ”For the first five years, he held my hand. He helped me do heart caths. I wouldn't do them. I was chicken. He could see in me what I couldn't.

”It was the sort of mentoring in medicine we don't see as much of anymore,” he said. ”We've had a ball together.”

Taking chances

When telling stories of the 15 years they spent as the only two cardiologists in the area, Hanlan and Combs laugh often. Hanlan came to Bend four years after Combs on the recommendation of a physician who trained him in San Francisco. He didn't know then he was signing on for a wild ride.

Together the physicians conducted a first-of-its-kind treatment in Oregon on a patient suffering a heart attack. They injected medication directly into his artery to open it and allow blood to flow through.

”Before we would just give them morphine and hope they survived,” Combs said.

The procedure, which both men had only read about, worked. They recalled staring in awe at the patient, who had been dying earlier in the day, as he ate dinner.

”We were standing at his bed and Tom said, 'You realize life is never going to be the same,'” Hanlan said. ”We had to be available 24 hours a day for 15 years. People were coming in on the helicopter. They were coming in dying.”

Combs and Hanlan had proven they could save those patients. But, Combs said, they were also criticized by the medical community here and in Portland initially for taking those chances. The two started doing angioplasties - a minimally invasive treatment where a balloon is inserted into an artery to open it - but they had no cardiothoracic surgeons to back them up if something went wrong.

”We were careful about just doing people we didn't have time to take anywhere else ... We had a less than 5 percent mortality rate and we couldn't see quitting,” Combs said. ”Most things we did, in the long run, worked out well.”

In one case, Hanlan was called to the emergency room to treat 42-year-old Dick Winchell, who had collapsed at work from a heart attack. Hanlan used a defibrillator to shock the Bend man several times, with no result. He called Combs for assistance and they decided to try something Combs had read about in a medical journal.

They shocked Winchell at least 30 times before his heart began beating on its own again. The man was in a coma for several days and neither physician knew what to expect when he woke up.

”When I did come to, my whole chest was black and blue,” Winchell, now 62, said. ”I couldn't figure out where I was. I saw all that stuff stuck in my arms and figured I was in the hospital.”

It's been 20 years since that incident. Winchell is now retired and feels he was allowed to live a second life.

”Hardly anything bothers me anymore,” he said. ”I got to see two sons married and five grandkids born.”

A difficult diagnosis

Karen Purdom might also not have lived a full life if it weren't for Combs, who treated her as an adolescent early in his career while still in San Francisco. The two were reunited when he moved to Bend, where Purdom had moved two years earlier.

”When I met her she was purple. The color of my tie,” Combs said. ”She was thought to have an inoperable congenital heart disease.”

Purdom was born with a heart defect that caused her to have mostly unoxygenated blood flowing through her body.

”I didn't have to take PE in school. I couldn't walk from here to the front desk without having to catch my breath, like you see old people do,” Purdom said. ”They told my parents I wouldn't (live to) be a teenager.”

When Purdom, now 54, went to visit Combs, it had been a few years since her heart condition had been studied. He diagnosed the problem, determining it could be operated on by expert physicians.

At 23, Purdom had her heart condition fixed. She has had two follow-up surgeries to maintain the repair and said she is now an avid upland bird hunter.

”I feel wonderful, just great,” Purdom said. ”I'm as mean and ornery as ever.”

It's stories like those that inspired Dr. Rick Koch and Dr. Gavin Noble to take jobs at Bend Memorial Clinic within the last 18 months.

”The reason I came here was to join Tim and Tom,” Koch said. ”It's devastating to lose him from our clinic.”

Noble and Koch, both cardiologists, are building the clinic's cardiology program to include nuclear medicine and greater use of computed tomography imaging - noninvasive methods of diagnosing and evaluating heart conditions. Combs, who was involved in bringing calcium screening tests to Bend to look for early signs of heart disease, calls their work the future of cardiology.

It's high praise for the next generation coming from a man they admire.

”He's been on the forefront of what's going on in cardiology,” Noble said of Combs. ”His foresight has been right on for the last 30 years.”

Dr. Thomas Combs

Age: 63

Moved to Bend: 1976

Education: Graduated University of Oregon Medical School in 1968, completed residencies at the University of Honolulu in 1971 and University of San Francisco in 1973.

Career highlights: Started the Bend Memorial Clinic cardiology program. Founding member of the Heart Institute of the Cascades.

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