João Lobo Antunes was a major figure of the Faculty of Medicine, of the University and of the Portuguese public life in recent decades. He was an example of the man of culture, of whom it can justly be said that nothing was indifferent to him, in Medicine and Science, in Art and Civic Intervention.

At a time when Academic Medicine seems to go through an identity and future crisis, not only in Portugal but also in Europe and the United States – suffice to recall the editorial in The Lancet about the need to recover this fundamental dimension of Medicine - John Lobo Antunes embodied the Homo Academicus, whose attributes are scientific culture, modernity in clinical performance, commitment to knowledge for the practice of science, objectivity, ongoing critical reflection, and respect for the values of ethics and professionalism.

As a Neurosurgeon, Director of Unit and Professor, he renewed the specialty at the institution, and his unit is now a reference in the national and international scene. He also trained a range of employees who will know how to continue his work.

Neurosurgery, with its specificities and hospital organization, is a world apart everywhere. In our institution it occupies a separate area, apart from the rest of the surgical activity, with its own Operating Room and Intensive Care areas and equipment that allow its functioning and which obviously cannot be dispersed. But it is part of the world and culture of Surgery, being an indispensable component of its core unit, which Owen Wangesteen referred to. Education in Surgery, the development of its academic dimension, incorporating intelligent and useful technological innovation and defence of an ethical and human vision, today are priorities in the necessary reflection on the Present and the Future of Surgery.

We shared common interests. In surgery, it was cerebrovascular disease and stroke prevention. From his American experience, he was slightly interested in carotid surgery, but quickly realized that in our reality, we were the vascular surgeons who had tradition, know-how and expertise. He accepted this fact naturally, encouraging our participation in the clinical meetings of his unit and in the international meetings he organized, like the European Society of Neurosurgery, which he presided, and honoured us with an invitation to a plenary lesson. In our surgical specialties, we experienced the tremendous impact of technology, which changed the image of the disease and therapeutic intervention. João did not escape the fascination of reflecting on the hand, which identifies us and gives a name to our healing art - Surgery is the art of healing with our hands – and he continued this concern, a legacy from João Cid dos Santos, who liked that his photographs included his hand! - But he agreed with our Master who, evoking Leonardo da Vinci, argued that surgery as art was a mental affaire, and that knowledge, decisiveness, courage, and humanity are prerequisites for excellence in surgery and not just the skilled hand of the craftsman.

Education in Surgery requires a deep reflection. For years I have been expressing my concern about the excessive fragmentation of the training of surgeons, about the lack of sufficient (longer) time for what I have called General Education in Surgery, before the young aspiring surgeon can choose his future path, his area of intervention. The acceleration of current time, the vicissitudes of hospital careers with the need for rapid and increasingly specialized training and even the very hospital organization, have contributed to an increasingly tapered – single dimensional (?) vision of surgical science and its excessive compartmentalization.

In his book on Hamilton Bailey - A Surgeon's life, Adrian Marston wondered about the future of the surgeon and I quote the original text for its elegance... the new professional will be the expert and to label him/her as radiologist, surgeon, technician, will become futile .... they will be experts of a new type, servants of society, no longer guardians of tribal wisdom.

The working meetings between the two of us were relatively frequent, while I was Director of the Faculty. They were usually short, objective, without wasting time. But I remember one day when the conversation drifted to the evolution of surgery, the need to preserve Surgical Culture - the wisdom of the tribe. We shared the view, perhaps romantic, of the need for commitment to the art and science of surgery and that objective was a necessity for the survival of the surgical ethos.

The academic dimension in surgical specialties is a crucial problem for the survival of Academic Surgery, a subject that was one of his concerns, which he wrote about, sharing his American experience. It is an institutional challenge that we cannot miss!

His commitment to knowledge through the exercise of Science, the attribute of the homo academicus, has perhaps been the ultimate reason for his commitment to the implementation of the Institute of Molecular Medicine (IMM), taking advantage of legislation that favoured the emergence of Innovation and Research Centres and more dynamic and less bureaucratic governance models. The change was remarkable, represented an upgrade in our nature interrogation capacity.

For its mission, the increasingly dynamic integration with the Medical School and the Hospital is fundamental, and that was the main goal that presided over the launch of the Academic Medical Centre, a consortium of three institutions, where he supported me and of which he was also a subscriber. I believe that its development is imperative, as it promotes research and innovation, contributing to the development of medicine and our claim to be an academic institution with genuine European dimension in Science, Education and Clinical Practice. It is a milestone and a decisive step in the necessary reform in health, education and training of doctors and other health professionals’ academic institutions.

It was that medical and surgical culture which, along with his expertise as a neurosurgeon, gave him a bird's eye stance in surgical art and technique, and, with his humanity on the doctor-patient relationship, made his memory imperishable. We have always worked in different private institutions, but that fact has never stopped the shared referencing of some patients. I transcribe this email I received from a patient (a real one, whose identification is omitted for obvious reasons) that is an eloquent testimony of what I have just said:

Dr, my best regards
It was with surprise and sorrow that I heard that Dr Lobo Antunes has died.
It was he who brought me to you, after reviewing my exams.
I was there, because the pain in my back was unbearable.
It is with sadness that I learned of his death, because he was
an extraordinary person to me, explaining what was really affecting me.
To all colleagues, family and friends, I offer my condolences.

What more can a physician aspire to than the unselfish and enduring gratitude of his patients?

We belong to a generation that lived through and took on a change challenge, and that was also great progress in our country. Could it have been better? Certainly yes, the unrest, the constant quest to do more and better are also attributes of the surgical ethos.

The reflection Reynaldo dos Santos started and others continued on the Training of Elites and their priority in a small nation, remains increasingly present, and is a categorical imperative that the Portuguese intelligence cannot ignore.

The memory of João Lobo Antunes’ work, his intelligence and his sense of duty will be an inspiration and encouragement to all of us.

 

 

FMUL, 2 November 2016

 

José Fernandes e Fernandes

Full Professor and Dean of the Surgery Group