As a boy, Bob Vranian trudged through woods and marshes with his friends, noting the way smaller bodies of water followed their own path before becoming part of larger rivers.
From his vantage point atop 40-foot banks, he would look downstream at the paper mill, or where the Pamunkey River drained into the York River. His appreciation for the ebb and flow of life around him—seeing individual components as well as how they formed a unit—would shape the man, and the cardiologist, he would become.
Dr. Robert Vranian has spent decades looking beyond the heart and the vessels connected to it to see the whole person, the same way he assessed his hometown of West Point as a child.
“I could see from the riverbank how everything blended together, the sinuousness of the river, the streams, the marshes, the droughts, the water,” Vranian said. “I think I got a sense of continuity and the relationship of the world to it, and that’s the way I kind of view the patient. It’s not just having a heart or vascular problem, but it’s the whole patient.”
In recent weeks, Vranian has been saying tearful goodbyes to some of those he’s cared for since he finished medical school 50 years ago. At age 76, he’s worn the white coat longer than most, and says he’s comfortable with his decision to retire at the end of this month.
He wants to devote himself to family, including his wife, Kathleen, saying it hasn’t been easy to be married to “someone like me, who spends more time than he should at the office and with patients.”
But oh, how those patients love him.
“You’ve been a wonderful doctor and a wonderful person,” Barbara “Gail” Dickinson of Locust Grove told him last week during her last appointment with him.
When asked if she would allow a newspaper reporter into the examining room to see Vranian in action, she said, “Anything for him. He saved my life in the emergency room” about 15 years ago when the inner layer of her aorta tore away from the heart. “I hate to see him go. He listens and he’s always connected, and he’s brought good information to me.”
Before she left, Dickinson hugged her doctor. “I’m gonna miss you,” she said.
“I’m gonna miss you too, sweetheart,” Vranian responded.
Others who’ve worked with Vranian know all about his level of dedication. Before Dr. Clifton Sheets joined a family-care practice in Spotsylvania County, he spent 16 years in the emergency room at Mary Washington Hospital.
During that time, it wasn’t unusual for Sheets to call Vranian at 3 in the morning, saying he had one of his patients in the ER. Vranian immediately would recite the person’s medical history, prescriptions and most recent scans or tests—and their results.
“I can’t recall one time when I called him and he didn’t have that instant recall,” Sheets said. “He is one of the most brilliant physicians that I’ve ever worked with, and he is incredibly compassionate. He loves his patients, and his patients love him. If every physician practiced the way he did, there wouldn’t be a need for malpractice insurance.”
‘PRINCE OF A GUY’
Vranian’s father was an Armenian chemist who had a laser-focus view on topics of interest and his mother was from the British Isles. She taught school for a few years and thought in broader concepts—as her son would come to do.
Vranian and his best friend shared valedictory honors at high school, then he attended the University of Virginia. The last thing he wants to do is sound boastful, but he says he was a good student and U.Va. officials encouraged him to apply “at the best schools” to study medicine.
He graduated with honors from Yale University School of Medicine in 1971, then did his residency and internship at Parkland Memorial Hospital in Dallas and a fellowship in cardiovascular disease at Duke University Medical Center. He also served as a flight surgeon in the Air Force from 1973 to 1975.
By July 1978, Vranian was fully trained, ready to practice and eager to return to his native state. He searched for an area that showed potential growth, both in population and cardiac care, and settled on Fredericksburg.
He took a post with the Pratt Medical Center after interviewing with, among others, the late Dr. Lloyd Moss.
“I thought if Dr. Moss was with the group, that was a good enough group for me,” said Vranian who later would volunteer at the free clinic named for Moss.
Vranian spent 25 years with Pratt until “all the ruckus” happened in 2003. Corporate changes resulted in a mass exodus of doctors and staff layoffs, and Vranian joined his current group, Virginia Cardiovascular Consultants in 2004.
His focus on patients and his incredible work ethic—he continues to put in 14- to 16-hour days, then goes home to read results of studies and tests—have been “an inspiration to everybody here,” said Dr. Frans Vossenberg, who founded VCC.
“Dr. Vranian is a combination of a thoroughbred and a Clydesdale. He is physically just incredible, but he has really gone the distance, hugely,” Vossenberg said. “He has real personal care for people, and personally, he’s just a prince of a guy.”
‘A COMMUNITY TREASURE’
In his early days of practice, doctors dealt with all aspects of internal medicine as well as matters of the heart. No one was focused on “pure cardiology,” he said, until more specialists began to arrive in Fredericksburg.
As the medical landscape blossomed, Vranian saw the need for doctors to work together on cases instead of what Fred Rankin III described as operating “in their own silos.” Rankin was the former CEO of what later became Mary Washington Healthcare, and he encouraged Vranian to explore ways to bring people together.
Vranian envisioned a “Velcro column” around which were gathered all the specialists who focused on the prevention of heart disease, the treatment of heart-related emergencies along with those who performed high-tech procedures in labs and read the results of all the tests and scans involved.
“I didn’t know what to call it and the administration came up with the Virginia Heart and Vascular Institute,” Vranian said. “I thought it was a little ostentatious, but what the heck.”
The heart institute went public in 2007, and about 16 specialists representing all aspects of care voluntarily joined to do what Vranian had wanted throughout his career: to talk with one another about the best course of care for patients. The group continues to offer annual symposiums, bringing in local and national experts, who focus on heart disease, the leading cause of death for men, women and people of most racial and ethnic groups in the United States, according to the Centers for Disease Control and Prevention.
In 2019 and 2020, Mary Washington Hospital was named one of the nation’s top 50 cardiovascular hospitals by IBM Watson Health. It ranks hospitals that perform open-heart surgery and other heart-related procedures on their rates of survival, complications and readmissions.
Vranian is at the heart of that recognition, said Vossenberg.
“It really stands on his shoulders,” he said. “There’s a lot of stuff that we’re reaping the benefits of that he planted the seeds for, years and years ago.”
Vranian also helped form the Mary Washington Alliance, a group of more than 500 health care providers. Travis Turner, its senior vice president, called Vranian “the advocate for innovation,” a doctor who focused “not on treating the disease, but treating the patient, not treating chronic care but being an advocate for preventive care. He’s just a community treasure in health care.”
‘DO THE RIGHT THING’
That’s not to say there weren’t times during alliance meetings that Turner might have cringed ever so slightly when he saw Vranian raise his hand to say something. Turner knew that Vranian never shied away from controversial or contentious topics, that if the doctor felt the need to provide feedback, he would do it “whether you wanted it or not,” Turner said.
Vranian wouldn’t call himself a rebel, but said he doesn’t hesitate “to do the right thing” when a patient is involved. If that means stepping on toes of primary care providers who haven’t prescribed what he thinks is the best course of action, then so be it.
Likewise, he spends two or three times longer with a patient than the 15-minute block typically assigned per appointment. As demonstrated with Dickinson, he listened attentively as she discussed issues her husband is having with dementia and the impact that’s having on her blood pressure. He told her how sorry he was it was happening, pulled out an index card and wrote breathing exercises she can use to “dial down the adrenalin.”
The doctor also encouraged her to take care of her own health, for her sake as well as her husband’s.
A patient posting an online review said anyone seeing Vranian better bring a book and pack a lunch because it would be a long wait.
It’s true that he was always behind in the schedule, but he “gave you his undivided attention while you were with him and for as long as you needed to talk,” said Wayne Parrish, a Spotsylvania County resident who’s known the doctor for years. “I grew to see him as a professional true to the textbook definition: one who puts the interest of his clients ahead of his own.”
Cathy Dyson: 540/374-5425