“Robert’s Story: A Journey from Admiration to Pioneering Transplants and Overcoming Heart Disease”

Robert, I’ve always admired your way of being a doctor and of being one for everyone, on both sides of the ocean; your determination, your desire to innovate while always being close to the sick. Who knows how many times you’ve been asked how you came up with the idea of ​​being a doctor and a surgeon and a transplant surgeon.
«When I was young I would have liked to be a veterinarian, except that my father at that time was seriously ill with heart disease; every day when i came back from school i found the house empty, oh yes, because mom was staying with dad in the hospital, and i couldn’t do my homework, so i went to the hospital. I watched the doctors and nurses attend to my father for hours and was in awe of how well they cared for him. The epilogue of this story was tragic, dad died, but after seeing everything I saw in those years, I decided I wanted to be a doctor».

But which student were you?
«To be honest, I had difficulties in school, I hadn’t learned a study method. In middle school they put me in a Catholic school, there were four of us in the same school: my three brothers, all older than me, and me. At one point a nun calls his mother and says: “Look, her three older children are really good, the last one is not. Of course, out of four, he cannot expect that they are all good”».

There is one thing that struck me, I’m not sure I remember correctly, but you did the paperwork to be admitted to the University in a hurry at the airport while you were leaving for Africa. How is it that one applies for admission to university with one’s head in Africa?
«Another thing that is not my strong suit is knowing how to organize myself and plan things to do in advance. I filled out my university application while waiting for a flight to Africa, it was 1982; it was an incredible adventure, a far and wide journey throughout Africa».

Why right there?
«I wanted to understand how local doctors, those of traditional medicine to be clear, worked in Africa, I was interested in understanding if one day or another I could incorporate their techniques into what we were doing in public medicine at the time to improve the quality of our treatments. ».

What can traditional medicine teach doctors of our world, Western doctors, those of Europe and the United States?
“I learned many things from African doctors (or healers) who worked in small and very small remote villages. They had no tools, not even a stethoscope, not to mention lab tests, x-rays or CAT scans. And then they had no drugs. However, they dedicated a lot of time to each patient, they wanted to fully understand their problems and their way of dealing with them was to always be close to their patients; I found in them a truly rare sensitivity.

Robert, you are the director of a multi-organ transplant centre, you have done many liver, pancreas and other organ transplants. Why did you focus on the kidney at some point in your life? What is special about the kidney that other organs don’t?
‘It doesn’t depend so much on the kidney as on kidney patients. At some point in my career I realized that there are more and more patients who are not being put on the transplant list because for various reasons they have antibodies against whatever organ type they can find; in those conditions the transplant is not done. And so I said to myself: “Why not focus on the possible strategies to implement to be able to do these transplants anyway?”. No sooner said than done. In a short time my hospital has become a point of reference for all those in the United States who are in these conditions and would like to be able to return to a normal life with a transplant».

What about the liver, pancreas and other organs?
“Many people know how to do that; however, finding a solution for the patients we call “hyper-immunised” is extremely complex. We are close to the solution and the others are not».

We’ve heard that you’ve even been to Ukraine recently. But I’m curious about that time you left Washington for Paris. What exactly happened on that flight?
‘I was sitting at the airport and what do I see? The most beautiful woman I’ve ever seen in my life. I look at her, I keep looking at her, shortly after they call the flight and I go to take my seat and I see that girl in the corridor, she advances towards me. Usually my traveling companion is a clown when it goes well, it is never a beautiful lady, but that time to my great surprise this wonderful creature comes and sits right next to me. We talk all night and when the plane lands in Paris we are both disappointed that the trip is already over, we hadn’t slept a wink. Before we parted, the lady smiled at me and said: “Well, if you happen to return to Paris, call me”. And I: “I’ll be back in four days, I’m going to Sardinia for a conference, but before taking the plane back to the United States I’ll be back in Paris, I’ll call you”. It was like this, and I stopped for a few days, the best days of my life. At one point she asks me “Do you know a bit about the singer’s environment?”. And I: “No, absolutely”. “And do you know anything about surgery?” “No – she says – totally fasting”. So I told her: “Then let’s make a deal: I’ll come and listen to her when she sings, and once she comes to me in the operating room.” After a while we got married. You are Denyce Graves, mezzo-soprano, she had sung in all the major opera houses in the world and also recently for the President of the United States in memory of 11 September».

You were a pioneer of transplants, you are the first who from an altruistic donor started a chain of donations that reached up to ten people. You have been able to transplant people with antibodies to almost any tissue from almost any donor. And you did all this despite having a heart condition, you knew it because of your dad. Your brother also died suddenly of a heart while he was water skiing. And then your heart stopped several times, if I’m not mistaken.
‘Yes, I have actually had seven cardiac arrests in the last twenty years – all terrible experiences. The most dramatic was in Patagonia, followed by a state of coma for some time. The last time it happened in Italy, in Matera, I fell to the ground like a sack of potatoes, I had a cut on my forehead and I said to myself: “I have to go back to America as soon as possible, because time for me to have a heart transplant.” I signed to leave the hospital and the doctors, or rather, the doctors in Matera were very kind: usually when you sign to leave a hospital, at least in the United States, they let you leave as you are; they left me an intravenous cannula and gave me all the necessary medicines for the emergency so that I could return safely».

You found yourself in resuscitation waiting for an organ that maybe would or maybe not arrive. It is a difficult situation and by the way it is the situation in which most of our patients are. And then for you who are very tall, it was necessary to find a big heart. And when they found it there was another problem, they asked you if you were sure you wanted that heart there. Why?
“There is an opioid epidemic in the United States, there have been about 100,000 deaths from overdoses, mostly in young people. However, many of these have hepatitis C, due to the fact that they exchange needles while using drugs. When they offered me the heart of a young person who died of an overdose, who however had hepatitis C, I had no doubts: “I have to accept this transplant, first of all because I have done it with others and it is right that now they do it with me”; and then it seemed nice to leave an organ that didn’t have this problem to the others who were waiting».

Then you had hepatitis C, you fell ill, you took the drug that cures hepatitis C in two months and which was not available until recently, after eight weeks you recovered, but already two weeks after doing heart transplant you were back in the hospital talking to your patients.
“That’s right, the hepatitis would be cured, I knew that, but I felt well enough to want to go back to the hospital.”

Robert, if all this had happened 50 years earlier, your story would not have been able to be told. Heart transplantation was in its infancy and there was nothing that could be done for hepatitis C. In short, yours is the story of the progress of medicine.
«It is exactly like this and I would like my story to serve for young people who think of being a doctor and possibly a surgeon. It’s a life of sacrifice, but it’s still the best job in the world. In life you need to have a goal, an idea and go all the way, with great rigor; if it’s a good idea, even better.’