It was February 2021. Waking up in intensive care with tubes and monitors attached to what seemed like every place possible, Graeme Fulton was on the starting line of the recovery from his second open heart surgery. 

The serious challenge Graeme, aged just 44, had faced all of his life was a congenital heart valve defect. The notion of competing in the toughest mountain bike race in North America was the furthest thing from his mind, and for very good reason.

Despite the congenital heart defect being diagnosed when he was a toddler, Graeme had been an active child who played a variety of sports but never really excelled in any athletic pursuit. He found his calling in karate for a number of years and subsequently, later in his teenage years, in running and triathlons.

But the spectre of surgery for a leaking aortic valve always loomed in those early years, and that day eventually arrived in 1995. When Graeme was aged 18, he required a valve replacement with donor tissue valve. This enabled him to resume a healthy and active life, relatively risk-free.

Encouraged by friends, and propelled by a desire to test the limits of his ‘refurbished heart and valve’ he utilised his 20s and 30s to run a marathon and complete a number of ironman triathlons. Eventually – the decade-plus training journey culminated in the ultimate multi-discipline endurance event in 2008, the Hawaii Ironman (a 3.86km swim, 180km bike ride and 42.2km marathon run.)

Of course, this hit home. But Graeme was still reluctant and apprehensive (as he had been for a long time), discussing with Dr Jalali the various surgical options. From December to February 2022, Graeme says, he researched day and night, every website/link/seminar on secondary heart valve replacement options and issues. 

“Throughout my admittedly amateurish and emotional queries, Dr Jalali was fantastic. He was so thoughtful and understanding in addressing all of my concerns and in the lead-up to surgery,” says Graeme. 

“He had the utmost professional and caring approach (I think my family came to love him as much as me!!)  I tried my persuasive best to twist his arm about the various surgical options and what I thought was best from my research. He was always willing to listen to my views and also to discuss it with his peers.

“One option we discussed was the ‘Ross Procedure’ which can only be provided by a few surgeons in Australia, including Dr Jalali. He said that procedure was an option for me but due to the nature of the first operation I’d had in 1995, it could have involved increased risk. 

“I eventually left the decision of the best procedure entirely in his hands and to trust his knowledge and expertise. The operation was a success. I recovered quickly - as I had the first time, which was amazing given I was now 26 years older. Similar to the first time, I managed to get back on the bike within four to weeks which was very important to me.” 

Dr Jalali, a Belgian and Australian citizen of Persian origin who spent 16 years in general medical and specialist training in Belgium, the US and UK, says Graeme’s heart (aortic) valve was noticeably worse than what he thought it would be. The timing of the operation was critical with his heart enlarged and swollen and under threat of serious failure.

“Graeme had done very well to last so long with all of the endurance events he had done over the years, but it was very important that he saw me and we reviewed everything as there was a danger that he could have had a life-threatening failure within his heart at some stage soon,” says Dr Jalali.

“All surgical options including the Ross Procedure were considered intraoperatively and ultimately the best option for Graeme was for me to explant his degenerative homograft and perform a redo root replacement.”

Having won the lottery of life for a second time. Graeme again embraced his lust for a challenge, entering the ‘sports lottery’ of applying to gain entry to the event they class as ‘the toughest mountain bike race in North America’. The Leadville Trail 100 is a 105 mile/ 170km mountain bike race through the Colorado Rockies, with a 12-hour finishing cut-off time that riders have to meet otherwise they’re disqualified.

“The incredible treatment that I received at the hands of Dr Jalali (who came with the highest of recommendations) and the post-surgical care from the wonderful, caring team at St Vincent’s Private Hospital Northside was amazing. 

“I can’t speak highly enough of the entire team. Without them all (and my family and friends), I doubt I would be here today, let alone having been restored to a state of health and fitness where I could train for and finish the Leadville 100! I’m eternally grateful in every way possible.”

Dr Jalali says he could relate to Graeme’s ambitions, as he was someone who also loved a physical challenge.

“My passion is mountain climbing – so I can really relate to Graeme’s love for competing in tough, endurance events and tackling challenges that are difficult both physically and emotionally,” says Dr Jalali.

The cardio-thoracic surgeon has climbed six of the world’s seven tallest summits, starting with Mt Kilimanjaro around 20 years ago with some old friends from medical school. Every couple of years since then, a core group has looked for a new mountain to summit, in what Dr Jalali says is an important part of his routine in trying to reset his mind and body from the pressures of his work of performing complex lifesaving surgery every week. 

“The mountain challenge has a lot of similarities with open heart surgery because both are tasks for which you must carefully and diligently prepare. Meticulous execution and safety are paramount. And there’s several steps to a successful outcome – difficulties and challenges – both physical and mental,” says Dr Jalali.

“And if you have done all the work and been methodical and reached the summit (like successfully completing the surgical task), then you have to come down safely from the mountain which is like being attentive and meticulous in your post-operative care for a patient.

“Also, when you climb a high altitude mountain, you have to be part of a team – the same as you do in a hospital. You’re not going to work with a team that doesn’t have the skill to climb that specific mountain, and you’re not going to do a procedure for which you and the hospital team haven’t been properly trained for.

“When you do a mountain expedition, you have to carry up everything with you to survive – and even bring all your waste back with you. You sleep on the hard ground in the wilderness, away from the usual comforts. So that just resets you also as a person – just getting grounded again and totally detached from everything else. The mountain has a way of teaching you humility.”

Recently, St Vincent’s Private Hospital Northside helped to organise a reunion between doctor and patient. Graeme had emailed Dr Jalali to tell him about his Leadville Race exploits in September. And when they met again, the bond and mutual admiration between them was apparent.

Graeme was effusive in his gratitude for Dr Jalali’s lifesaving skill and the humanity and empathy he shows to patients in his care.

In return, Dr Jalali marvelled at Graeme’s incredible determination, dedication, resilience and sheer toughness in finishing the gruelling bike race and in living his life large after surgery.

“All we can do is to give you a better engine, but what you choose to do with that engine and your car and take it in a Formula 1 race (or more precisely, put your body on a bike and ride it through the mountains) is fantastic and a huge credit to you to be able to do that successfully,” says Dr Jalali.

With a lifelong passion for sport, Graeme found his own best analogy for Dr Jalali in one of his sports heroes and the man, most widely regarded as the greatest to ever play tennis.

“Dr Jalali is like the Roger Federer of heart surgery – he’s all class, he’s the best at what he does and he’s a true gentleman who brings pride and honour to his profession. Where he differs (from Federer) is that he has the power to grant a new lease on life to patients,” says Graeme.