England – Hammersmith Hospital
Olympic Airways flight 259 arrived on time and I went through passport control with no problem. The Hammersmith papers secured me permission to stay for 1 year. I retrieved my suitcases from the carousel – a new experience – and hurried to the exit. I was relieved to find Yannis waiting for me, and he drove me to his home in his small car with its steering wheel on the right. There I was welcomed by his wife, Chrysoula, whom I had previously met at the Polykliniki. The emotional turmoil brought on by my hasty departure was so obvious that Yannis said, “I never again want to see such a pale face in my life.” I was gnawed by anxiety over the results of the ECFMG, on which depended my going to America. At last, on October 24, I received the good news in a telegram from Athens. My ticket for America had been secured.
Thus, when I was called by Professor Welbourn for his final approval, I already had the ace up my sleeve. Welbourn was serious, straightforward, with slow gestures and beautifully rounded English so that he would be understood by all the “natives” of the Commonwealth and elsewhere who were streaming in. He exuded formality but also honesty. In some ways he resembled a venerable Buddha, and his great talent was good administration.
I soon realized that the battlefield was not the operating room but the two wards in which intense competition and merciless back-stabbing took place. The environment was extremely competitive because everyone had come to the Hammersmith to get qualifications for their next step up. Of course, we housemen paid for it because we had to answer the most incredibly trivial questions.
In England the hospitals are not run by the doctors but by the nursing staff who ensure order, discipline, and propriety. I had an immediate and rather insulting taste of this when I went to examine a patient and write his history. Helen drew back the curtains and said: “Unfortunately, the patient must eat now. Sorry. Come back later.”
The organizational and teaching talents of Professor Welbourn were much in evidence during the Friday morning grand rounds. Cases were presented in the Hammersmith amphitheater before an audience of the whole medical staff, with the consultants sitting in the front row to enjoy the show. The cases had been carefully selected by Professor Welbourn himself, and the houseman was called upon to present the clinical, laboratory, and surgical findings. The matter was then opened for discussion or, better still, for a confrontation between the rival surgeons.
The facade of Hammersmith Hospital (1970).
With Sotiris Mantoudis in London, before flying to Boston (1970).
However, the shadow of heart surgery was following me whether I wanted it or not. Oeconomos had already written to Dwight Harken, one of the most distinguished American heart surgeons, pioneering professor at Harvard, who gave postgraduates from all corners of the earth the opportunity to work with him. But I had my doubts and they would plague me, would cloud my life for the next 10 years: general surgery or thoracic surgery? And so, after much thought, dithering, and soul-searching, I sent my application for the position of fellow at the beginning of January and, as I wrote to my family, “may God help me.”
From February until the end of May, there was no word from Harken in spite of the repeated reminders, even the telegrams I sent. Then, unexpectedly, the papers from Harken arrived, including an urgent letter for the Hon. Walter Annenberg, American ambassador to Great Britain. I suddenly came face to face with the terrible question: Did I really want to launch myself into the unknown again?
I shall never forget that Saturday afternoon. I was not on duty and I decided to do what I used to do in Greece: go for a long walk and thrash it out in my mind. I caught a train to Great Portland Street with its majestic mansions. From there I began to walk for hours on end. The sunny London afternoon with a little snow at the sides of the road and the beneficial cold gave me a feeling of well-being, and the sun, pale though it was, added a note of optimism. And so the hours passed until it was dusk and I went into the next tube station to return to Hammersmith. I had come to the conclusion that my mission was the unknown, the uncertainty of America, with all its charm but with a fear that clutched at my heart. On Monday morning I sent my supporting documents to Boston.
The visa was approved as a matter of priority thanks to Harken’s letter to the ambassador. There was an interminable line outside the American embassy in Grosvenor Square. Brandishing Harken’s letter with its “top priority” stamp, I joined the first queue to the security personnel and handed it in. Without any bureaucratic formalities or delays, they called their superior, who only asked me for a telephone number. This was my first taste of the amazing speed and efficiency of the American system. The very next day I had the visa stamp in my passport. I spent my last days in England in Sotiris’ flat because my appointment at the Hammersmith had ended and I no longer had the right to a room in the doctors’ residence. On one of our last evenings together, in one of those outpourings of sincerity, he said: “I know that deep down you do not respect me because I do not have that sacred fanaticism, that dedication that you have, and that’s why I admire you. But we are not made of the same stuff.” I felt that Sotiris had the honesty of a true gentleman.
Harvard – Dwight Emary Harken (1970)
It is difficult for me to describe my first teacher in cardiac surgery, almost as difficult as it was to describe Uncle Gerasimos. It is as if you have come face to face with a block of granite and are trying to work out how to get to the top. The personality, the achievements, the legend are all daunting.
Dwight Harken came from a small town in Iowa, where his father, a family physician, would visit his patients on horseback. He did postgraduate studies at the famous Royal Brompton in London, working with the renowned thoracic surgeon Tudor Edwards.
When the Normandy invasion took place in 1944, he became a lieutenant colonel in the medical corps and acquired a good reputation for removing bullets and shrapnel from the chests of 134 wounded soldiers without losing a single one. Techniques at that time were primitive and of course there was no heart-lung machine. He would therefore make a hole in the heart or blood vessel, remove the foreign body, and then suture it rapidly with the blood spurting up to the ceiling. The operation required nerves of steel and stamina, qualities that Dwight must have had after being an amateur boxer.
Returning to America after the war, he joined the staff of Harvard under Professor Elliott Cutler, a pioneer who had opened stenoses of the mitral valve with an instrument of his own invention. Thus, in 1948, Harken performed his first operation for mitral valve stenosis, entering the heart via the so-called auricle.*
*An appendage of the left atrium like a small bag.
Many and varied were Dwight’s achievements. When I met him, his formerly red hair had become white, but he still had rosy cheeks and sparkling blue eyes that you thought were boring into you from behind his glasses. It was practically impossible to keep up with him because he was perpetually in motion. He was always doing something and his philosophy was that you should fill every minute creatively since life was so short. He could do three things at once, which made you dizzy just looking at him. I would say that he was more of a physical phenomenon than a human being. His energy overflowed like lava from a volcano. His industry and his stamina were superhuman: he had no pity for his subordinates. He behaved like a football coach—harsh, restless, indubitably a leader. He referred to his surgical team as if it was a secret society and sometimes was as authoritarian and oppressive as the leaders of such organizations. He was not mean—the opposite I would say—but woe to anyone who crossed him. He was capable of annihilating him. Afterward he would extend his hand to help him up, a sign of greatness.
As a first-rate teacher, Dwight gave his all in the operating room so that his trainees would learn all the rules that his experience had shown him were vital for success. He would repeat: “Do it by the numbers” and emphasized that “good surgeons repeat the operation in their minds over and over and over.” His advice, “don’t change the routines,” was the essence of wisdom. Mistakes happen when someone changes something without informing others, who carry on based on what they have known up to then.
“Never give up” was the phrase that best rendered his personal philosophy, urging us never to accept defeat. And he added to this by saying that the difference between success and failure was that extra 5% of effort. And the same percentage yield made the difference between a superior and a mediocre surgical team. One of his most apposite sayings was: “Good guys bounce back” paraphrasing the famous coach Vince Lombardi: “I don’t care if someone falls down; I’m only interested in whether he can get up again.”
“The father of heart surgery,” as he was described in the obituary in the New York Times, died in August 1993 in Cambridge, Massachusetts, where he had lived all his life. In spite of the bad outcome of my relationship with my Greek professor, I shall always be in his debt because it was thanks to him that I came under the wing of this giant.
Dwight at Work (1970).
Dwight E. Harken, professor of Harvard University,
the “father” of cardiac surgery, a great teacher and unrivaled organizer.
Harvard Fellow, Mount Auburn Hospital, Cambridge (1970).
Boston – Lahey Clinic (1971)
From the time of Yannis Boudouris, the Lahey Clinic had been an ideal destination. I thought it was a hospital and once when I tried to find it on foot I ended up in the ghetto of Roxbury. Now the time had come for me to really get to know it.
The New England Baptist was built on Parker Hill at the top of a steeply climbing road with a gradient—no exaggeration—of 30 degrees. The tram stopped at the bottom of the hill and from there, puffing and blowing, you had to walk up to the hospital.
I worked first of all with Warren and, as always happens with some women and some surgeons, I decided in the first 5 minutes that he suited me. He was about 60, with large glasses, of medium height, but with the flexibility of a much younger person. Hailing from the South, he would say: “The real gentleman comes from Virginia.” He had a leader’s air of infallibility and with the first move he made at the table you could see he was a real master. There is no doubt that his technique was occasionally coarse. He did not have the subtlety or the finesse of Yannis Boudouris but his movements were absolutely assured, bold, and definite. His cuts, short and sharp, were immediately effective in uncovering and giving shape to organs that had literally been lost in the tangle of adhesions from previous operations. It was unbelievable how he could distinguish in that amorphous mass delicate parts like the bile duct and the blood vessels of the liver. In very few moves he raised half the pancreas into the air, revealing not only the inferior vena cava but also 2 inches of the left renal vein for the entertainment of the visitors who were literally gawking at his skill.
He operated in complete silence, without even a whisper being heard. “If you start talking in the operating room then it really becomes a circus,” he would say. He had little respect for the so-called academic surgeons who try to cover the gaps in their surgical ability by talking continuously about projects, reports, and other such things. His favorite quip, “If you go down to Pennsylvania and listen to Dr. Ravdin operate,” said it all. Such was Warren’s ability that he would finish a pancreatectomy, for which others needed 6 hours, in only 2 hours and called for the next patient to be premedicated before undergoing the same operation, and it was only 10:00 in the morning. He was a real authority, and I never tired of operating with him.
K. Warren next to Frank Lahey photo.
Kenneth W. Warren.
The Lahey Clinic International Authority on Pancreatic and Biliary Surgery (1971).
Things began to get more difficult from November onwards, with the onset of snow and cold. I was still living in Cambridge at Mrs. Mayo’s and at 5:30 every morning I would take the tram outside the house to go to Harvard Square. I crossed under the river by train, came out in Boston, went as far as the bottom of the hill by tram, and from there started the climb. Snow and wind hindered progress on the slippery incline and my hardship was unbelievable: it was like a documentary of the Antarctic. I arrived at the entrance to the hospital with my heart in my mouth, out of breath and my chest numb from the frozen air I had inhaled.
John Braasch was different. Very tall and reserved, a jewel of honesty and kindness, he was known for his simplicity and his interest in the fellows. He was the first to allow me to open and prepare the porta hepatis, where everything was stuck together. He was impressed when he saw that I had finished the most difficult part of the reoperation. When I left in June 1972, he gave me a book about Boston and in the dedication, apart from his friendship, he expressed his appreciation of my surgical talent. I keep it among my treasured possessions.
From December, therefore, I started to look for what I could do in July. And, in spite of my temporary euphoria, the tormenting question remained unanswered: cardiac surgery or general surgery? A real nightmare. And so I began to travel from one end of America to the other in search of work. My final stop was Dallas, Texas, and work was found with the help of John Braasch. The proposal concerned the Baylor University Medical Center and in particular two of the best known cardiac surgeons, Ben Mitchel and Maurice Adam, with the largest team in the Southwest.
As the day of my departure drew near, my dejection increased. I relived those carefree days on board the destroyer and even more those with Yannis Boudouris at the Naval Hospital in Piraeus where I was calm and enjoyed my work. Unfortunately, I had to leave again because these opportunities were only for 1 year, specially arranged for foreigners who had come to train and then return to their countries, taking with them their new knowledge. However, the door of my country was closed and I had begun to find this somewhat tiring. The following year I would have completed 10 years of training in surgery. How could I have known then that this was the first decade and that another would follow, even more strenuous, until I was able to raise my head in the spring of 1984.
During the final week, the famous trunk came out again to be filled with books and other equipment. The two Sisyphean suitcases were dusted, green for clothes and brown for essential books. And so I was ready for the next stage in my mission: Dallas, Texas.
Dallas, Texas, U.S.A. (1972)
The town, when I got to know it, couldn’t have been more different from Boston. First of all, the sun was blinding as I emerged from the airport building and then the heat was suffocating, making you feel as if you couldn’t breathe. Those were my first fleeting impressions about the differences, and later I would discover many more: the hugeness of Texas in all respects and the pure-blooded chauvinism of its towering inhabitants. The meaning of big, of excessive, extends, of course, to medicine. When Texan surgeons announced at a conference that thanks to their exceptional technique they had managed to operate on an aneurysm of the abdominal aorta using only one unit of blood, whereas it usually requires three or four, one of the participants said sarcastically: “Of course, it was a Texan unit of blood!”
Baylor University Medical Center had started out as the Good Samaritan Hospital in 1901, with donations from rich Baptists in the area, who with indefatigable efforts had also managed to found a medical school. The meteoric rise of Baylor was due to the legendary administrator, Boone Powell Sr., who took control of the institution in 1948 and, in 30 years, increased the number of beds from 100 to 1,200, spread over five different buildings.
Short, stout, and always on the move, with an air of unmistakable authority and a direct, piercing gaze that betrayed his sterling honesty, Boone Powell conveyed great confidence to the numerous benefactors. Once, as a lady patient was leaving, she handed him her checkbook so that he could write the sum of $1 million that he had suggested to her himself, and she signed it without a second thought. Apart from his administrative talents, he was known for the affection he showed his patients and staff, whom he visited and chatted with as if they were family. He undoubtedly had the same virtue as my father: to be at ease with both lords and plebeians.
The team I was to join was indeed the largest in the Southwest states. The indisputable leader was Ben Mitchel, the son of a Mississippi judge and the pioneering heart surgeon of Dallas. When, at the beginning of the 1960s, Baylor did not want to hear about “open heart surgery,” Mitchel loaded up the heart-lung machine from the experimental laboratory and went to St. Paul’s Hospital on the other side of town, where he performed the first operations.
Mitchel was what we could call a born leader. With prematurely graying hair, a steady, quiet expression, well built and erect, he was known for his coolness in the operating room, his liking for drink and women, as well as for being a crackshot on African safaris. His capacity for work was boundless and he deliberately put a large number of cases for surgery when his colleagues were absent at some conference, simply to show them that he didn’t need them. As a surgeon, Mitchel was consistent without being theatrical, not particularly fast but safe, and for that reason enjoyed general respect.
Maurice Adam was completely different—tall and lanky with startlingly green eyes, like a doppelganger of Gregory Peck, both in his looks and in his voice. He was the perfect surgeon, with beautiful movements and indisputable talent. The third member of the team was Jerry Geisler, from the parochial region of Midland-Odessa in Texas. Ambitious and keen to distinguish himself, he made himself move very fast even though he was left-handed.
Lastly, the most interesting was Jake Lambert, the driving force of the team and the one who decisively influenced my development. Short and sturdily built, he was the son of a Virginian farmer and his appearance clearly announced his background and his upbringing. His father was the terror of the household, running it like a boot camp. He didn’t hesitate to drive his truck over little Jake’s bicycle because he had disobeyed him and left it where he had told him not to. He didn’t hesitate to throw the boy down to the ground from the attic roof because he did not immediately obey his order to bring him a paintbrush.
Some of his pithy comments have remained in my memory: “Surgery is theft. You have to grab a case from your peer or from your superior, because that’s the only way to make progress.” He believed that great surgeons were not those who had “good hands” but those who had “the guts” to take a risk. Interestingly, he was persuaded that “it’s not only the surgeon who gets tired during lengthy surgery, the patient does too.”
Work in the hospital was both plentiful and arduous. There was a huge number of cases—cardiac, thoracic, vascular. We often finished operating at 7:00 or 8:00 in the evening and then had to see the next day’s patients, write their history and physical, and have them ready for surgery at 7:30 the following morning, all of which developed into something resembling a military exercise.
Boone Powell Sr., the creator of modern Baylor.
His project: Baylor University Medical Center’s five-hospital complex.
Ben F. Mitchel, chief of the cardiac surgery department at Baylor University Medical Center—steady surgeon, firm leader, reliable associate.
Margaret at Baylor (1973).
The situation changed dramatically with the arrival of the Australian team of nurses. To deal with the shortage of nursing staff, Baylor conscripted around a dozen Australian girls from various towns “down-under” to take over the night shift from 11:00 to 7:00 in the ICU. They were the best I had ever known because they combined the knowledge and efficiency of American nurses with the human presence and warmth of their English counterparts. They would come in at 11:00 like a force of worker ants and in no time at all had washed the patients, changed their sheets, regulated the IV infusions, and given out the drugs, all with such speed and organization that it left you open-mouthed. At the same time, their presence was really lively, all jokes and laughter. The patients adored them. They were all perfectly turned out in their uniforms with their little caps and the classical watch pinned to the left side of the apron, polite, energetic, and efficient.
Of all of them, I singled out one, Margaret Sinclair. My eye was immediately caught by her because, apart from her appearance, she had an air of self-confidence. She was of medium height, but very shapely, with wonderful green eyes and dark olive skin that gave her something of an exotic look. In Australia she was not only a head nurse but also a tutor in the pediatric unit, which put her in the front rank of nursing. Her parents lived on Fraser Island, the largest sand island in the world, which had been designated a national monument because of its geological phenomena. We started to date.
In mid August we went to Houston, where the two giants of cardiac surgery, Denton Cooley and Michael DeBakey, held sway. They were, at that time, at the height of their glory. I was to spend a week observing Denton Cooley.
I watched him throughout the week from one operating room to the next. There were six operating rooms, each with its own team, coordinated by an amazing German head nurse. As soon as Cooley finished in one room, they were ready to go on bypass in the next, so that he would only do the main part. In this way he had dealt with 20 cases by 8:00 in the evening when surgery finished. As Shumway remarked with his usual sarcasm: “If you want to see how many operations can be done, go to Houston. If you want to see how they should be done, come to Stanford.” There I understood the meaning of organization and mass production, and it is superfluous for me to mention that Cooley more than deserved his reputation. Tall and erect, with the face of a biblical hero as portrayed by Charlton Heston, he completely dominated the surgery. He had the table placed as low as his magnifying loops would allow and swooped down unerringly like an eagle on its victim with grandeur and accuracy. His movements were a combination of harmony and skill. It was especially impressive that he operated simply, with only three instruments: knife, scissors, and needleholder. The scrub nurse’s tray was practically empty, without the elaborate instruments and needleholders with various angles and curvatures usually seen elsewhere. I became definitely convinced that the really great craftsman is uncomplicated, like those who created the ancient Greek monuments.
We returned to Dallas and began preparations for Greece, with two trunks this time. I had worked hard, I had given of myself, and so the parting was painful. We left from Love Field Airport, which is in town, and as we were getting ready for takeoff, Margaret looked back for the last time at Dallas and said: “Something tells me that we shall see this city again. We’ll be coming back.” Her premonition did not fall short.
In mid September the fateful return to Greece took place. The evening that Charlie Kapsalis accompanied me to the airport, he was deeply moved over my departure, yet prophetic at the same time: “I think you will come back to America and I am sorry about the years you will waste in Greece until you understand that your future really lies here.” You would think he knew what would happen. Before he said goodbye at the gate, he put a silver dollar into my hand for luck, with the wish that it would bring me good fortune where I was going. Years later I passed it on to my deputy and a disciple of mine who was leaving for postgraduate training and who was destined to become my successor. I suffered the greatest insult in the return of this token when he felt that I had not supported him enough in his premature ambitions.
Greece, «Ingrata Patria»* (1973)
*Ungrateful homeland. From the historic pronouncement of the Roman general Scipio Africanus: “Ingrata patria, ne ossa quidem mea habes.”
At Margaret’s insistence, the circuits of the heart-lung machine had been simplified—one tube for entry into the machine and one for exit—doing away with the “carnival” used up to then by the professor, and they had successfully carried out the first “open heart” operation at the University Department of the Hippokrateion: an atrial septal defect. It was almost a fiasco because with the usual lack of organization they had omitted to give heparin (anticoagulant) and as soon as they went on bypass everything clotted up. They had to remove the cannulae and set up the machine again from the beginning. From then on, all went well with the administration of heparin, of course. As usual, the professor kept the patient in for 2 months, as an advertisement to future candidates for surgery.
My happiest memory of that otherwise miserable time that was to lead me back to America in June 1975 is of a wonderful afternoon, when Margaret took me and my family to a restaurant by the sea. There, sitting at a table apart from the others, my parents drank to our health and made a toast for success in my new position. Of course, I didn’t yet have a position, but everything indicated that I would be appointed to Oeconomos’ department.
As soon as I started at the Hippokrateion, I found myself working with round-the-clock responsibility. First of all, something like an ICU had to be organized. Up to then, immediately after surgery, the patients had been disconnected from the respirator and taken straight to the ward. That was satisfactory for cases of general surgery, but was completely unacceptable for patients after heart surgery who needed intensive postoperative care with modern machinery and assisted breathing until they were stabilized. And so we began to put patients on the respirator in the room where we were to set up the unit.
In the end, it is so difficult to change people’s habits. Instead of our efforts being given the expected reception and support, the exact opposite happened. The anesthesiologists showed their animosity from the first moment because keeping the patient on the respirator meant that they would be stuck in the ICU. It had an immediate impact on their old routine: to leave for their private hospitals such as the White Cross, the Blue Cross, or whatever other cross they believed in as soon as the few operations at the Hippokrateion were finished. They had to earn their daily bread or, as my fellow student Georgos Sanoudos cuttingly remarked, “their children’s champagne.” I could see the wild light in their eyes as they looked for some accident to happen that would prove that all this was not only superfluous, but dangerous. And this was only the beginning. Up to here the reorganization of the department—as I saw it—was the easiest and most pleasant part. The most difficult of all was persuading the professor that he should change.
In the meantime, two problems became more and more acute. First and foremost, there was the financial one. I had no income and the little money I had brought from America gradually began to disappear. Secondly and more importantly, there was my future as a surgeon. In spite of the urgings of former colleagues to take on general surgical cases, cholecystectomies and gastrectomies, the “Harken doctrine” had engraved itself deeply in my subconscious. I wanted to continue with cardiac surgery but there were very few cases and Oeconomos didn’t seem willing to hand over even a small part of what he considered his personal fief.
There was, though, a third problem or rather an affliction: the department’s training program was struggling because the “little envelope” (the money under the table) had become customary. From my point of view, imbued as I was in the American system and feeling responsible for the teaching of the trainees, I saw with increasing distaste what was happening in our department. At my urging, the professor had insisted that the trainees should operate. His associates, however, had found a way to get around his orders. The technique was simple: they learned to operate from the left side of the table. Thus, the trainee would stand on the right of the operating table and when the professor entered he saw with satisfaction that he was doing the case, whereas in reality it was being done by the attending surgeon on the opposite side. Everyone was pleased, except of course the wretched trainee, who was limited to closing up the patient and was left with the bitter feeling that they had taken the food from his mouth. The situation was indeed exasperating and in repeated private discussions with the professor I tried to tell him so. But he turned a blind eye, saying: “But when I went in Dr. Krespis was operating.” Otherwise he would have had to interfere with his subordinates and he didn’t feel strong enough to do that. Keeping up the pretense of obedience to his wishes, his coworkers were laughing at him behind his back, and the worst offenders were the anesthesiologists. And so the patients stagnated in the hospital and it was not unusual for them to wait a whole week for a gastrectomy. For operations on the large bowel, the wait could be drawn out to two weeks. By December I had become convinced that nothing was going to change. My relations with the professor became increasingly difficult because he was clearly annoyed by my repeated suggestions to change the department’s training system and stop being manipulated by the anesthesiologists.
The crisis reached its peak at the end of the year. I took the initiative for drawing up a memorandum to the professor, on behalf of us all, requesting that the operations should continue until 3:00 in the afternoon so that more patients would be dealt with and the trainees’ experience improved. We wrote it in the formal language of the time and asked to see him, with the associate professor in front bearing the memorandum and we, the staff surgeons, behind. With hindsight, we should have foreseen what would happen, although it came as a shock for us. The professor, well known for his inability to make decisions, completely lost control. He paid no attention to what the associate professor said as politely as possible when he gave him the memo: “Now I don’t know whether I ought to sign myself or whether I should simply bring it to you on behalf of the others.” The professor simply “killed the messenger,” ignoring the problem. I was the messenger. He knew who had taken the initiative from the style and language of the memo, and also from everything that had gone before. He began to bang on his desk with his hand and scream: “Get out, get out all of you. And first of all you go.” I looked around me at the sad spectacle. My colleagues had not said a word. They just stood there, pitiable, heads bowed, without the courage to resist. I had reached the Rubicon and had to cross it. I raised my voice and said: “You can speak to the others like that, but not to me, because I have offered you service—free of charge. I am sorry that in this last year and a half I have not obtained an official position so that I can now offer my resignation officially. But even from this nonexistent position, I quit.” I slammed the sliding door in his face. From the crash I thought I had ripped it from its frame.
I went to the locker room to get my white coat and my operating room clogs. A startled doctor from my team asked me where I was going and when I said “I’m leaving for good,” he was thunderstruck. For those young people I was their friend and, on the rare occasions that we met after my return to Greece, I realized that their love and trust remained undimmed. It was midday on December 31, 1974.
Departure
From the very first day of 1975, I started preparations for my inevitable return to America. I had no doubt that it was the right decision, although inwardly I wanted the professor to call me back, because of all that I had offered. Deep down, however, I knew that that would only prolong the problem. Returning to the department, I would continue to be held hostage to the professor’s goodwill or disapproval, as the mood took him. On the other hand, I was not trained in cardiac surgery by American standards so that I would be able to stand on my feet in some other hospital. There was one solution, and one only: return to America, train in the merciless residency system, and stay long term—perhaps forever. Within a week, everything had been arranged. I got in touch with Jake, who immediately fixed two interviews for me, the more important one in Houston under DeBakey.
Jake, Bev, and I were discussing Houston when a telephone call from Margaret in Greece turned everything upside down. She gave me the latest news about the professor who was declaring to all and sundry that in returning from America—he had obviously been informed that I had left to hunt for work—I would “only” be doing general surgery and that he himself would be doing “all” the heart operations, in which I would assist “when he summoned me.” It was a demonstration of prestige, and Margaret, knowing me well, suggested the following solution: “Don’t waste your time with a fellowship, because then you will have to return to Greece soon. The only solution is a residency so that you can take the boards, which would ensure that you can stay in America for as long as it takes.”
These were my thoughts on board the aircraft taking me back to Boston, where I met the Kapsalis family. The afternoon when they took me to the airport, we made a short stop at the home of my friend Alkis Michalis. He was finishing as chief resident at Boston University and was going on to Michigan for cardiac surgery. After telling him my news, we said goodbye and came out at the top of the steps. There, like lightning, a thought flashed through my mind, and I asked Alkis if there was a place in his training program. He understood the crux of the matter immediately and undertook to ask the director of education, but pointed out that it was very late to find a place for July. We said goodbye again and I got back into the car. The next afternoon I was in Athens.
The likelihood of finding “a place in the sun” on the fringes of the American training system was slim, I realized, but I had to try. Even if the attempt was successful and I was accepted in the program of Boston University, I would still have to confront in the long run not only the boards, but also the FLEX (federal licensing exam) in all specialties. Only in that way would I be able at some point to practice my profession freely and not, as with the ECFMG, only in a hospital under supervision. I therefore started to prepare, since I had free time. The examination was held in all states but in order to take part I had to be an American citizen or possess the green card of the permanent resident. Two states, Pennsylvania and Missouri, were exceptions to this rule. With the help of Phoebus Koutras, I supplied myself with the relevant application forms and sent my papers to Missouri. I started the monotonous routine again: a repetition of the Spartan lifestyle of 1969, with daily studying from 8:00 in the morning until 10:00 at night in our small apartment.
The months of spring 1975 passed slowly and agonizingly, with daily study and thousands of hardships. My anxiety increased because I received no news from the director of education at Boston University, Arthur Glasgow. Finally at the beginning of May the long-awaited telegram arrived. They offered me a position as a third-year resident, which meant that I would finish my training in 3 years, working the final year as chief resident. They required an immediate answer, yes or no, and of course I said yes, with Margaret’s encouragement. She declared very simply and decisively: “Let’s go to America so that you can get the proper training and I will support you in any way possible.”
The tickets and the immediate expenses were covered, as usual, by Aunt Fofo, with words of real encouragement: “Make sure you get such good training that the next time you come back no one will be able to throw you out.”
Margaret also had to find work. The only solution was Baylor, where she would be taken on for her nursing skills and also as a pump technician. There remained the matter of our relationship. She put her foot down. If we were to continue, there should be something official.
Again, Aunt Fofo performed her miracle. She bought two wedding rings and Margaret wore hers in triumph.*
The day of my departure from the Hellenikon Airport arrived, and all the friends had gathered to say goodbye. I tried to appear optimistic but I had a bitter taste in my mouth, because I really didn’t want to leave. Shortly before getting on the plane, my childhood friend Antonis Hadzikonstantis, the “admiral,” gave me a little flag so that I would not forget I was Greek.
*In Greece, the wedding ring is worn from the time of engagement.