2020, Number 4
Memories of a general surgery service and its surgeons. Part 3
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10.35366/101405
Language: English/Spanish [Versi?n en espa?ol]
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CHRONOLOGY OF THE GENERAL SURGERY SERVICE AND GENERAL SURGEONS OF THE GENERAL HOSPITAL OF THE NATIONAL MEDICAL CENTER OF THE MEXICAN SOCIAL SECURITY INSTITUTE 1963-1981
DR.
The memories of Dr. Jorge Bautista go back to the time of the Mexican Revolution, when his father, Gonzalo Bautista-Castillo, was the courier of the Aquiles-Serdán brothers. The young Bautista became a doctor with the purpose of having an economic support that would allow him to enter politics, an innate desire that saw fulfilled. He became governor of the state of Puebla (1941-1945), and among his closest collaborators was Gustavo Díaz-Ordaz, who became president of Mexico, a transcendental fact that over time had relevance in the development of the General Hospital of the CMN of the IMSS as we will see below.
Dr. Jorge Bautista studied at the Faculty of Medicine of the UNAM, and after graduating he emigrated to France where he studied gastroenterology at the Tenon Hospital, University of Paris, and later completed his residency in general surgery at The Bronx Hospital, New York University, New York, USA, where he became chief resident. Upon his return to Mexico, he began his professional activities at the Central Hospital of the Ministry of Communications and Transportation. In 1963 he joined the Gastroenterology Service of the General Hospital of the National Medical Center of the IMSS as a surgeon.
One day he was called by Mr. Gustavo Diaz-Ordaz, president elect of Mexico, to ask his opinion on who should operate on his wife for a gallbladder lithiasis. He recommended Dr. Manuel Quijano, who performed the surgery assisted by Dr. Rafael Alvarez-Cordero.
In March 1969, the day after my arrival from Mexicali –where I did my postgraduate internship– I went to the General Hospital of the CMN of the IMSS to receive instructions for my rotation as a first-year resident. The secretary instructed me to wait for Dr. Jorge Bautista, who after a short wait arrived and immediately informed me about the general surgery residency, its structure and organization. His kind and courteous treatment caused me a good impression and surprise; he was very different from the medical masters I had dealt with in other occasions. In the end it is only the first impression that counts, isn't it?
The following year, when I rotated through the gastroenterology service as an R-2, out of the four surgical teams, I got to be in his group. I continued to be personally attracted to him because of his simplicity as well as his education and personal treatment. My admiration reached its climax when I had to perform my first cholecystectomy, and he participated as the first assistant, guiding me through the rough path of a difficult gallbladder. And it was very difficult because it was an atrophic sclerosing xanthogranulomatous cholecystitis embedded in the liver, which took us almost the whole morning to remove it. I never saw him impatient nor restless, and his intraoperative advice was soft-spoken and reassuring. He was undoubtedly a teacher who knew how to teach surgery and many other things. So, it was with almost all the surgeons he forged, and for that reason our admiration and recognition will be eternal.
His love for hunting brought about an important change in his professional life when he suffered an accident that caused him to lose an eye. After a long period of rehabilitation, he returned to the surgery he was so passionate about, as well as to teaching.
His academic achievements and outstanding public and private recognitions that clarify his image are the following. He was founder and president of the Mexican Council of General Surgery in the Mexican Association of General Surgery, was an honorary member, belonged to the Mexican Academy of Surgery (honorary member), and to the Mexican Association of Faculties and Schools of Medicine, in addition to 11 other associations, in most having achieved the distinction of honorary, president of the Mexican Association of Gastroenterology, director of the Faculty of Medicine of the Autonomous Popular University of the State of Puebla (UPAEP). In all these positions he distinguished himself for his honorability, commitment, and innovation. This information is useful to highlight that he was a very active man, updated in his surgical field and in others. He always had knowledge of the surgical novelties, even when he no longer needed them. He stopped reading the latest surgical articles in print and on the internet just days before his death.
He published nearly 100 scientific papers and gave more than 300 lectures in Mexico and abroad. He directed 17 postgraduate theses and collaborated in 10 books on general surgery. He participated in 31 continuing medical education courses in general surgery and/or gastroenterology. He was an undergraduate professor at the Mexican School of Medicine of La Salle University, and assistant professor and later full professor of the general surgery course.
His trajectory as a surgeon and later as chief of surgery in relation to the teaching and friendship he developed with the surgical residents. Such trajectory is an example of the great affection he earned from all generations. Many tributes were paid to him during his lifetime by his residents throughout the country.
He had a singular personality characterized by his kindness, simplicity, and personal treatment. In his role as a teacher, he was able to take many surgeons by the hand through the roughest roads of surgery, through the most complicated pathology and he never allowed any resident to abandon the scalpel or the scissors. His perseverance, tolerance and teaching combined to give the resident surgeon the courage to overcome the obstacle, no matter how long and how difficult the patient's disease was. He was also a counselor in our lives, he knew us very well in the hospital environment, inside and out; many residents received guidance and the truth of their emotions, finding a solution to their personal blindness.
When structural changes in the operation of hospitals were presented, adapting them to the levels of care, the General Hospital of the CMN of the IMSS could not be exempted, so he made the decision to separate from the IMSS. Undoubtedly, the resignation from institutional surgery and teaching was very painful, but not painful enough to produce a feeling of resentment.
His decision to return to the city where he was born was very gratifying, since the university authorities of the Autonomous Popular University of the State of Puebla (UPAEP) quickly welcomed him and took him to the direction of the School of Medicine, where he once again demonstrated his experience and organizational skills. In 1998 he received his diploma as director emeritus.
Only lung disease, a consequence of his many years as a smoker, retired him from professional activity. He received multiple treatments, demonstrating his mettle, and a lot of discipline by undergoing several treatments that allowed him to live more than 15 years, much longer than the world statistics say about this disease.
Dr. Jorge Bautista, together with other brilliant surgeons, forged more than 300 surgeons that are found throughout the country, so his tomb is the niche where his remains will perennially be, but his pedestal is the Mexican Republic where surgeons who were fortunate enough to inherit his surgical knowledge are working. As a sample, some of them are former presidents of our association, such as Carlos Godínez, Luis Ize-Lamache, Armando Castillo, Juan Mier, Rafael Aguirre, José Antonio Carrasco, Jesús Tapia, Alfonso Pérez-Morales and Jesús Vega-Malagón.
On July 9, 2014, approximately at 9:00 a.m., a star of the Mexican surgical universe was extinguished. My professor, my surgical father and friend ended his life cycle, and surely the minds of more than 300 general surgeons in Mexico will go back to the years of coexistence with Dr. Jorge Bautista-O'Farrill. For me it was a period of 46 years.
DR.
Dr. Guarner was of Spanish origin, specifically from Barcelona. An outstanding Mexican physician for the XXI century, he came to Mexico to finish his primary and preprofessional studies, continuing at the School of Medicine of the UNAM. He carried out his professional studies in Mexico and completed them in hospitals in the USA -postgraduate in Basic Sciences and Surgical Anatomy at Harvard Medical School. Upon his return he worked at the General Hospital of Mexico in Pavilion 29, where he served as chief of Dr. Fernando Martinez-Cortes until he joined the General Hospital of the National Medical Center of IMSS, where he started as a surgeon assigned to the gastroenterology service of Dr. Luis Landa. After a brief period as chief in the surgery division, he migrated to Centro Medico La Raza to take over as chief of surgery.
I knew him as a teacher and very little as a surgeon. He was a gentleman in his treatment and an excellent teacher who always gave me his affection. For reasons unknown to me, I never went through his service, so I have no basis to comment on his surgical skills. His participation in the general surgery service was brief and indirect, only when he was appointed Chief of the Surgery Division at the General Hospital of the CMN of the IMSS, replacing Dr. Rafael Alvarez-Cordero.
Among his academic achievements, he was admitted to the National Academy of Medicine in 1973. He founded the Society of History and Philosophy of Medicine, of which he was president in 1982-1984. He was also founder and advisor of the Mexican Academy of Bioethics.
He received the "Fernando Ocaranza Surgical Research" award from the National Academy of Medicine, the "Surgical Cinematography" award from the National Assembly of Surgeons and the "Medical Excellence" award from the Cedars Sinai Institution in Los Angeles, California, USA. He produced 140 scientific articles, co-authored nine books and was the author of the book Esophagus, published by the National Autonomous University of Mexico. He also gave 300 lectures in Mexico and abroad.
Culture, art, literature, and history were his ideals with which he always worked. The same happened with his professional practice, which only separated him when an esophageal cancer surprised him and led him to death.
DR.
Writing about an extraordinary man, who in addition to being a brilliant surgeon is also a writer and founder of surgical subspecialties that gave rise to medical colleges and associations, requires a lot of space and a good writer. I hope that in this report all the expectations about the best contemporary surgeon we have in active practice will be fulfilled.
When I met him, he was part of a team of three surgeons who solved surgical problems in the gastroenterology service of the General Hospital of the CMN of the IMSS. He was the second resident to arrive and finish his residency.
In experimental surgery I had the opportunity to help him in the first total liver transplants in dogs that he performed with great skill, which is why he is a pioneer of transplants in Mexico. He in turn collaborated with me for the realization of a work of common bile duct plasty that won a national award.
I worked with him in the creation of intensive care therapy since my interest in this incipient specialty awakened an emerging specialty to know it in depth. From that time on, I always admired him for his intelligence, restlessness, and perseverance.
Subsequently, these values increased when he was able to install one of the first intensive therapies in the country. He also participated in the first obesity surgery works carried out in the 70s.
His studies in intensive care, morbid obesity, his literary production as well as his academic degrees of master and doctor in medical sciences from the UNAM were achievements that very few surgeons have and allow us to confirm the words mentioned in the first lines.
An example of his intelligence was the fact that he had to present a lecture in Brazil and three months before leaving he studied Portuguese to give the lecture in that language. That was his intellectual capacity, which he preserves to date. By the way, he is quadrilingual.
Now let's move on to his professional and academic development and productivity. He is originally from Mexico City, has a degree as a surgeon issued by the UNAM and his postgraduate studies in general surgery, digestive surgery and surgical research were performed in Mexico, the United States and France.
He obtained his doctorate in medical sciences from the UNAM in 1976, has continued his academic preparation with workshops and international courses in intensive therapy, clinical research methodology, didactic techniques, liposuction techniques and body control, comprehensive management of obesity, laparoscopic surgery, gastric band surgery and laparoscopic gastric bypass surgeries. It has four councils: general surgery, gastroenterology, critical medicine-intensive therapy, and geriatrics.
From his participation in teaching activities, he is described as professor of surgery at UNAM and undergraduate at the Michoacan University of San Nicolás de Hidalgo, School "Ignacio Chávez".
Among his professional activities, the following stand out: head of the Intensive Care Unit of the HG of the CMN of the IMSS, head of the General Surgery Division of the same hospital, head of the Surgery Division of the Specialty Hospital of Centro Médico La Raza, head of the Department of Hospitals of the IMSS and head of the Medical Services of the IMSS of the Delegation VI and director of International Affairs of the Ministry of Health.
His participation in academies, councils and associations is important and variable. Here are some of them: advisor to the IMSS Scientific Research Council, president of the Experimental Surgery Association, coordinator of surgery at the National Academy of Medicine, advisor to the IMSS Medical Sub-Directorate, honorary president of several Mexican and foreign medical associations, founder and honorary president of the Mexican Society of Obesity Surgery and co-founder of the International Federation for Obesity Surgery (IFSO). He has also chaired several national and international congresses of metabolic surgery.
His recognitions begin with diplomas of excellence in his studies at UNAM and honorable mention in his professional examination. He has won several awards in national and foreign competitions in surgical cinematography and experimental surgery. He is an honorary doctor of the Global Organization for Excellence in Health and obtained the international award "Lifetime Membership Award" granted by the International Federation for the Surgery of Obesity and Associated Disorders.
He is a member of 28 national and international medical societies. He has given more than 600 conferences in Colombia, Brazil, Argentina, Chile, Spain, France, Belgium, Italy, Austria, Czech Republic, and Greece. His literary production consists of 159 scientific articles published in national and international journals in Spanish, English, French, and Portuguese. He has collaborated in 11 national and international books on surgery, intensive care, and obesity, and has registered 17 books related to medicine and health education.
He is and has been a regular contributor to several newspapers in Mexico with his editorial column "Health and Politics" in Unomasuno and El Universal Mexican newspapers, and currently writes a weekly editorial in the Mexican newspaper Excelsior in the "Opinion" section and the column Viejo mi querido viejo in which he frequently advises to do physical exercise, since he has always been an athlete that undoubtedly gives him a youthful spirit.
From his Sunday editorial article in this newspaper, it is important to point out the civic courage with which he very frequently writes and describes the actions of the current government, which on many occasions produces serious consequences in the economy, health, and the population in general. Thanks to his letters we identify with and support his position because from our trench we do not have an audience to listen to us. My great admiration and respect for this work, Rafael.
In conclusion, I will point out that he was editor of the Journal of the Faculty of Medicine of the UNAM, continuing and strengthening the work developed in that position by Manuel Quijano-Narezo. Subsequently, the rector of UNAM invited him to serve in Paris as academic secretary of the Center for Mexican Studies (CEMUNAM France). I am sure that his work as a promoter in that position will soon yield results.
DR.
He was the fourth resident of a generation that began in 1963 and grew rapidly, flooding the country with excellent surgeons who held management positions within the IMSS, or whose surgical practice gave them prestige within the institution or in their private activity. His excellent work as a resident and the immediate growth of the gastroenterology service due to the demand of patients gave him the fortune of being chosen to continue within the service as an attending physician.
He was a very skilled, friendly, cheerful, and of course jovial surgeon, who had gained a lot of experience from being under the guidance of great surgeons, and from being in a hospital with great surgical demand. His youth allowed him to have a close approach with the residents, and his teachings were well applauded. After a few years of working in the gastroenterology service, he occupied an important place in the morning service, performing this responsibility with efficiency. It was two years until the gastroenterology service was divided into general surgery and medical gastroenterology. The general surgery service lasted five years in the HG building of the CMN of the IMSS until the new dispositions of respecting the levels of attention gave place to transfer the general surgery service to the second level hospitals, so he decided to leave the institution.
With him I presented and wrote the first academic papers related to gastroenterological surgery. He was a productive surgeon who encouraged residents to participate in academic meetings, was a member of several medical associations, president of the AMCG, and was inducted into the Mexican Academy of Surgery.
While enjoying private surgery, he was struck by ALS, which quickly led to his death.
He was always a good partner and friend.
DR.
I met him in 1967 during my social service. Agua Blanca was the town in the state of Hidalgo where I did my social service. I had to pass through Santa Ana Hueytlalpan, a small and scattered illiterate town, poor and abandoned by our politicians, near the city of Tulancingo, Hidalgo, Luis' place of origin. In that tiny town where in an old house there was an office with little old furniture like the house, and which had the name of "Health Center", he did his social service. There I saw him consulting with the help of an interpreter with a professional spirit that caused me admiration and respect, that was how I got to know his human, charitable and professional side. A year later we met at the General Hospital of the National Medical Center of the Mexican Social Security Institute when he started his surgical residency. Among other qualities of his personality, his intelligence stood out. In all the activities in which he participated or was present, his simple personality stood out. He finished his professional career with honors as well as his surgical residency. In the residency he stood out for his presentation of work, comments, and companionship, that is why he was elected chief resident. His mastery of languages, his ability to organize, program and his discipline were the virtues that led him to be selected for a scholarship for the first course of Dr. Dudrick and Dr. Rhoads, precursors of artificial nutrition worldwide. Upon his return to Mexico, he founded the first service in this field at the General Hospital of the CMN of the IMSS, which helped many patients with acute or chronic pancreatitis complicated with intestinal fistula, peritonitis, and shock from various causes. His experiences were quickly published and disseminated in congresses and medical meetings, so his image grew rapidly as a great surgeon who promoted important changes in the treatment of these patients.
He belonged to the Mexican Academy of Surgery, was president of the Mexican Association of General Surgery, founding member and first president of the Mexican Association of Clinical Nutrition and Medicinal Therapy, A.C. (1989); he was also in charge of the general surgery course and chief of the gastro-surgery service when the General Surgery Service of the General Hospital of the National Medical Center of the Mexican Social Security Institute disappeared.
He was an excellent sportsman, practiced various sports and enjoyed sailing, but his life came to an end when bladder cancer caught him in the middle of his professional maturity.
It is very sad that an intelligent, well-prepared, and productive person abandons us in the fullness of his professional activity, when he is transmitting to us his consolidated experiences.
The following biographical sketch of Dr. David Olvera Perez, who has written this memoir, is a reproduction of one written some time ago by a surgeon friend, which has been slightly modified to omit undeserved praise.
DR.
It is difficult to summarize in a few lines the trajectory of a professional and a remarkable human being, and although the description is not very fair, it is intended to summarize the most outstanding aspects.
In the 1940's, back in the beautiful Pachuca City (la Bella Airosa), a city majestically framed by its emblematic clock built to commemorate the first centenary of our independence and cradle of national soccer game, an illustrious future-to-be surgeon was born.
In 1961 he began his undergraduate studies at the School of Medicine of the newly founded Autonomous University of the State of Hidalgo. He studied the first years, standing out for his commitment to his studies, always obtaining one of the first two places of his generation. Three years later he entered the School of Medicine of the National Autonomous University of Mexico to continue his studies and finished his degree in 1966. On April 9, 1968, he took his professional examination.
Being a surgeon was his lifelong obsession. He was inclined to heart and thorax surgery, which at that time was beginning to stand out due to the first heart transplant performed in South Africa by Dr. Claudio Barnard. Certain circumstances made it easier for him to acquire experience since his student days when he met Dr. Rubén Argüero and Carlos R. Pacheco, who gave him their support to perform experimental surgery on dogs in 1964, performing lung and trachea transplants. An important fact that should be in the annals of the history of Mexican medicine was the initiative of Dr. Carlos Pacheco to hold weekly bibliographic sessions of surgical literature related to transplants. It was in 1964, in the meeting room on the fourth floor of the Hospital of Pneumology and Thoracic Surgery of the CMN where the beginnings of one of the surgical specialties are kept in its walls, a place where doctors Carlos R. Pacheco, Rubén Argüero, Carlos Ibarra and the student David Olvera used to meet.
At the General Hospital of the National Medical Center of the Mexican Social Security Institute he completed his residency in general surgery in 1972, during which time he won awards at congresses and meetings of IMSS residents. His dedication and responsibility resulted in one more achievement, that is being awarded with a year of gastroenterological surgery; in this period he also observed good performance as chief resident of that generation, closing a cycle of general surgery directed by Manuel Quijano-Narezo.
With the thesis entitled Definitive ileostomy with ileal pouch and continent valve, on July 1o, 1977, he presented his postgraduate examination at the National Autonomous University of Mexico. These studies allowed him to be certified by the boards of general surgery and gastroenterology.
At the end of his residency, due to his personal and surgical qualities, he was chosen to be part of the corps of surgeons of the Gastro Surgery Service of the General Hospital of the National Medical Center, at that time directed by Dr. Luis Landa, and in which there were great surgeons who gave prestige at that time to this distinguished hospital center and therefore, to the general surgery of our country.
For 10 years, in addition to working intensely, he acquired medical knowledge and vast surgical experience that positioned him as an excellent surgeon, but this was not enough, and the search for new challenges and achievements led him to the Ministry of Health, where he served as director of the General Hospital Valle de Ceylan in Tlalnepantla in the State of Mexico, This fruitful work led him after three years to the position of Chief of Region III of the Health Institute of the State of Mexico. With his participation and coordination, it was possible to start up three of the five hospitals that were built after the earthquake of 1985.
In this same position, he was responsible for the proper functioning of 20 hospitals and 240 health centers to provide medical care to 2.5 million inhabitants, a function he performed until 1990.
When he rejoined the private professional activity in 1990, he began his preparation as a laparoscopic surgeon, and despite the adversities encountered for his training, he designed a technique in chicken with which he began his minimally invasive surgical skill, which earned him a prize and was the passport to take this technique to the competition in Video Med in the city of Badajoz, Spain. Later he won another award for the first laparoscopic splenectomy performed on children in Mexico. His enthusiasm for laparoscopic surgery has been one of his concerns for the last 20 years, during which he has directed courses, workshops, symposiums, participated in conferences, lectures, congresses, and meetings on the same subject.
Among his work, the direct puncture of the first trocar without using a Veress needle stands out, a work that has served as a standard for practice in health services in Australia.
One of his great interests has been education. Since he was a student, he has participated as a substitute or assistant professor, and throughout his life he has participated in eight undergraduate and four graduate courses, in addition to 65 monographic and continuing medical education courses.
His preparation has never stopped, as evidenced by the 32 postgraduate courses he has studied, including management development, personal development, public health, and hospital administration and, in recent years, minimally invasive surgery.
He currently belongs to six surgical associations, the Mexican Association of General Surgery, the Mexican Association of Endoscopic Surgery, the American College of Surgeons, the Association of Laparoscopic Surgeons, the Latin American Association of Endoscopic Surgery, and the Latin American Federation of General Surgeons.
He has written six chapters for books, published 50 articles, and co-authored the book Surgery in the geriatric patient. He has more than 166 participations in national and international congresses. He has received awards and distinctions from medical associations and society in general.
In 2003 he was invited by the incoming president of the AMCG Dr. Roberto Bernal Gómez to create and direct the Social Service Committee, a transcendental stage in his life that allowed him to meet with the main values of medicine and develop a surgical activity that gave him the opportunity to give back to Mexican society something of the much it has offered him. His firm and determined character, but at the same time possessing a great sensitivity, and a spirit of service, helped him for eight years to direct, with and without the support of medical societies, the Extramural Surgery Program of General Surgery performing more than 60 campaigns throughout the Mexican Republic with amazing results of more than 8,500 surgeries in total. The main surgical procedures were abdominal wall hernias and laparoscopic cholecystectomy. Memoirs of this humanitarian service are in process and could only be made possible by the support of a brilliant staff of general surgeons, nurses, anesthesiologists, and laparoscopy technicians.
The great professional achievements have not been enough because the audacity to dive day and night in the sea as well as the constancy to practice horseback riding and continuous reflection complement his fruitful trajectory. What is certain is the immense passion he imprints on each of the enterprises he undertakes.
Few words can describe the surgeon, the administrator, the student, the teacher, the writer, but above all the human being who has been a great friend, a loving father, and an invaluable husband.
AFFILIATIONS
1 Associate Member of the Mexican Association of General Surgery. Mexico.
CORRESPONDENCE
David Olvera-Pérez, MD.E-mail: docolvera2@gmail.comReceived: 02/27/2019. Accepted: 08/07/2019