Carl Garabedian still recalls coming home to Spokane from college to find sickly, lethargic children staying at the house. Days later, those kids couldn’t stop running.
The significance of his dad’s work sunk in then – that Hrair Garabedian as a pediatric cardiologist doing heart surgeries changed trajectories for children to live and just be kids.
“My dad and other doctors brought kids from Armenia to Spokane for heart surgery, and they would live at our house and at other houses,” said Carl, now 55.
“I would show up, and these little blue kids are barely walking around the house; they looked terrible. I took off on a camping trip with my friends for 10 days and came back. These kids had heart surgery, and they wouldn’t stop running around the house.”
That’s how Spokane got two doctors named Garabedian, father and son, helping shape children’s critical care.
“They have pink lips; they’re acting like raucous kids. I’m thinking, this is a meaningful job you’re doing,” Carl said. “I really became gravitated toward pediatric and pediatric cardiology at that time.”
Until Hrair retired in 2020, they worked together for 19 years at Providence Sacred Heart Medical Center. There, mention of “Garabedian” often draws one word: legacy.
That spans from Hrair’s start in 1971 to now, with Carl as a pediatric and adult congenital interventional cardiologist.
Hrair began as a neonatologist and pediatric cardiologist. In the 1970s, he pioneered Sacred Heart’s first neonatal intensive care unit and was its longtime director.
He forged a far-reaching practice and later co-founded Sacred Heart Children’s Hospital. He cared for patients at Deaconess Hospital, too, when doctors still went to both places. By 1999, he focused solely on pediatric cardiology.
“My dad was always developing something, building the NICU, and all the things he started here,” said Carl, who began at Sacred Heart in 2001.
“He was very motivated just to do better for the community, always trying to bring new innovations and advanced care here, always feeling we can do things here in Spokane. He made those things happen.”
The Lebanon-born Hrair, 83, said he and others wanted the best for children’s specialty care.
“Over the years, I’ve told people, we’re not the biggest, but we’re the best,” Hrair said. “We used to compare our results with Boston Children’s Hospital, the best center in the country. We do not say we’re doing good enough. It has to be the best enough.”
Retired Providence Inland Northwest CEO Mike Wilson, who worked with father and son, said Hrair set a standard.
“Hrair honestly was so dedicated to making it possible for the most critical of cardiac care to be provided in this area,” Wilson said. For several years, Hrair was the only children’s cardiac specialist on call around the clock.
“He also set up clinics in other communities throughout the Northwest. Everyone knew that Hrair was an exceptional children’s cardiologist, but he also was just plain dedicated to the care of children.”
Carl had choices among hospitals but came here, he said.
“Carl helped recruit other pediatric cardiologists to join him. Before you knew it, we had multiple pediatric cardiologists doing interventional work. We really became a center for pediatric cardiology. They were quite a pair.”
Both had roles in a 2018 milestone, creating one of the first U.S. accredited hospital programs for a growing number of adults with congenital heart disease. Medical gains meant more “blue babies” who previously died early from heart defects were living as adults – a trend by 2001.
Hrair said Sacred Heart was among seven health centers first developing such adult programs. They needed specialized care, including transplants, treatment for pulmonary hypertension and women’s obstetrics, Carl added.
“People would look here, and the accredited centers are Stanford, Columbia, Boston,” Carl said. “Spokane was almost a typo, people thought. It was real. While we were a small center, we had all the breadth and the support.”
Hrair’s path wasn’t direct to Spokane. He came to the U.S. in 1967 after graduating from the American University of Beirut, which canceled the ceremony because the Six-Day War had begun between Israel and Arab countries. He went first to New Orleans for pediatrics training, then Iowa City in pediatric cardiology.
“Early in medical school, I decided on pediatrics; I like children,” Hrair said. He and wife Hilda have three adult sons, including Carl, who was nearly 3 when he came to Spokane.
Along with pediatric cardiology, Hrair wanted to train in neonatology for premature and medically complex newborns. He hit a roadblock.
“Neonatology and pediatric cardiology were cutting-edge, progressing rapidly at that time and showing significant improvement in the lives of children,” he said. “I applied for neonatology first, but they would not allow foreign graduates for training.”
That didn’t deter Hrair, who self-trained in early mornings and after a day of pediatric cardiology sessions checked on newborns and asked questions of the neonatology instructor. He later passed neonatology’s board certification.
Finishing up in Iowa, Hrair kept getting calls from Spokane cardiologist Henry Lang, asking him to work here.
“I had no idea where Spokane was,” Hrair said. “I had a job in the San Jose area. I had no interest in coming here, but he kept calling me.”
Lang offered to pay for a visit. Once here, Hrair called Hilda to say it seemed a good place to raise kids. Then he gave job conditions, with him taking over pediatrics and children’s cardiology, while Lang saw adults. The practice thrived.
Over time, Hrair became known for training multiple NICU nurses, and respecting their roles. Carl heard about that, because those same nurses talked fondly about his dad.
“These older nurses just loved him; they loved the way he talked to them,” Carl said. “He wanted the nurses to have an answer on how to take care of the kid.”
Hrair added, “I used to tell them, I don’t want you to be diaper changers and drug pushers. They need to know why we do things, to enjoy what they’re doing.”
Recently retired nurse Jama Jaderquist met Hrair in 1982 while interviewing for a job at Deaconess NICU.
“I was standing outside the window when I saw a doctor, Dr. Garabedian, taking care of a freshly born premature baby,” Jaderquist said. “I was just in awe.
“None of that ever changed. His passion, his commitment to do the absolute best for these little patients never changed over the years.”
She laughed about his “one-liners” on newborn tips that stuck with her, even for another 22 years in Sacred Heart’s pediatric intensive care unit, where she worked more with Carl. Nurses and families respect him as well, she said.
“They both stand out in the way they communicate and care for families. It’s unique that you have a father-and-son team in the same field of medicine.”
Growing up, Carl said often when his family went to Spokane activities or the store, the relatives of patients or the children would approach his father.
“It seemed like he took care of the entire city,” he said.
As Carl trained, pediatric heart care was advancing rapidly.
“We had devices where we could close holes in kids’ hearts without going to open heart surgery. We could place valves and stents – all kinds of advancements.”
He helped bring those new surgical techniques, medicines and after-surgery care to Spokane. More kids survived and thrived. And now he gets stopped in the store.
Carl said working with his dad was fun. He also had a resource, “someone with a breadth of experience and knowledge like him, just being able to walk over to his door and easily talk to your father and say, ‘Dad, I have this kid with XYZ,’ and just getting really good advice.”
In 2010, Carl led Sacred Heart’s project to obtain a pediatric lung-heart bypass machine, called extracorporeal membrane oxygenation, or ECMO. That, along with heart care services, pushed the NICU to a Level 4, meaning it could treat the most complex and critical of cases .
The field still evolves. Carl said he’s often among a team of congenital heart surgeons for hybrid operations.
“We can minimize the complexity of the operation needed in a newborn where a surgeon does a little piece of work, I do a transcatheter piece of work,” Carl said. “Basically, we delay the higher-risk surgeries until they’re bigger, older and can tolerate them better.”
It’s rare now for heart specialists to tell parents that nothing can be done, both said.
While a busy doctor, Hrair said it was possible because Hilda supported him and the family. They have eight grandchildren, and all the families live nearby. Carl’s daughter Helen recently decided to study medicine.
He and Carl plan Father’s Day time together, in sync with many days. If he doesn’t know where his children are, Carl looks first at his parents’ home.
After retiring, Hrair took home his many letters thanking him for extended lives or ones ongoing. He’d read some on bad days, such as those when he saw young patients die.
Carl keeps his notes. Tough moments still happen. He also learned from his father that he’s caring for more than babies and children with heart disease.
“These kids are on ventilators, on drips, and we’re doing procedures. This is their baby they’re supposed to be bonding with, and instead, we’re doing major cardiac interventions. You have to take care of the whole family.
“Family communication is probably something I’ve learned very well from him.”
Hrair said he gave Carl that advice early.
“Treat everybody like your family member, then you’ll enjoy your work. You’re going to make mistakes, but if you treat them like family, it means you did the best you could.”
