Favorite Son of Andalusia and responsible for the first lung transplant in the autonomous community, who was head of the Thoracic Surgery service at the Reina Sofía Hospital is retiring after four decades of work in favor of healthcare.
How do you feel now that you are retired?
I wouldn’t like to have retired, at all, but the time has come and we have to turn the page and simply dedicate myself to other hobbies, although I will never stop being a doctor, ever. In fact, I continue studying and continue with my role in Bioethics, but I am also going to dedicate myself to what I have previously stolen a lot of time from, my family, my friends. I have several hobbies, literature is one and music is another; I am going to take up the violin again and, above all, I am going to collaborate with two NGOs.
When entering the hospital corridors I mentioned the word nostalgia…
Yes, I feel homesick for the hospital, I miss the hospital very much and I have a bittersweet feeling. It seems to me that when I wake up I’m going to go to the hospital immediately and it’s still difficult for me to adapt a little to my current situation, but I don’t think it’s smart to hold on to something that, by law, I can’t do again.
You were talking about your love for literature, are you going to write a book?
It is possible that I will write some memories of my entire life for my circle of friends and family. It’s possible, I have it in mind.
Does it leave the Thoracic Surgery team in good hands?
In magnificent hands. Dr. Antonio Álvarez Kindelán is a great surgeon, a great person, and I believe that the team will do much better than with me. He was in the first transplant circulating through the operating room because he was R1 at that time. He told me that he always thought that he would be incapable of doing a transplant and now he does it wonderfully, very quickly, he is a treasure for this hospital. The truth is that it is a team of which one can feel very proud. Above all, the atmosphere is fantastic, it is like a family and that has always been my main goal.
Ángel Salvatierra, surgeon / Manuel Murillo
You have already mentioned the milestone of the first lung transplant in Andalusia, what do you remember about that day?
I remember it as a very emotional and highly demanding day. I went to Almería to get the lungs, they were from a pregnant girl with brain death. I extracted the lungs and there was a problem, there was tremendous fog and we couldn’t land in Córdoba, we had to land in Seville, and from there go by ambulance to Córdoba. This is disastrous for the lungs, because the ischemia time, the time in which the lung is not connected to an organism, is a time in which deterioration is very rapid, especially in the lung. But then, when I arrived, everything went very normally. And it was one of the easiest transplants I have ever done in my life. Maybe because nature put it that way to encourage us.
María Ángeles López from Montilla was the patient…
Yes, and it was 31 years ago. The lungs, unfortunately, don’t last that long. We had to retransplant her after many years and she finally died, but she lived for a long time with a very good quality of life, which is the goal of this type of patient. Survival has been increasing over the years. In fact, I have transplant patients from that time who are still alive, because the possibilities of deterioration due to rejection decrease with age and with new drugs.
Organ donation in Córdoba is probably the largest, due to population density, in the world
Were you aware back then of what it meant?
The patient waiting for a lung transplant is a very special patient. Because although patients notice the deficit in all organs, in the lung it is extremely manifest. Not being able to breathe, not being able to take a few steps, that is tremendous, it is indescribable suffering. Being able to offer these patients a solution, a hope, not only for life but for quality of life, is something that is a goal for a doctor, it is what one has always dreamed of, it is common to every doctor who has a true vocation.
What is a vocation in medicine?
The vocation in Medicine is to live for what you do, it is to have a tremendous attitude, a tremendous enthusiasm for helping others.
In other professions it is said that it is being lost, in Medicine too?
Unfortunately, it is true. If there is less commitment, we see less enthusiasm. The doctor in Spain is probably not treated well enough from the point of view of economic recognition, especially in public medicine. And then it is probably the fault of previous generations for not knowing how to transmit that hope, that commitment. The truth is that now they ask more about whether you are free after a shift, they ask you more about the schedule than about the work itself and that is unfortunate.
The administrations have their share of responsibility…
Definitely. It is difficult to maintain a public health system at the current time, for many reasons. One of them is the aging of the population and another is that health products, medications, instrumentation, all of this is increasingly more expensive and more necessary to offer our patients the best medicine. Taxes are already high enough to raise them, so a lot of deliberation is needed at the level of everyone involved to see what needs to be prioritized, what the serious problems are and how we could solve them. Unfortunately, this deliberation with all those involved has not recently taken place. I think we are at a crucial moment, a critical moment for public medicine.
Is public health in danger?
I believe that unfortunately it is in danger. There are sectors such as Primary Care, which cry out to heaven about having to wait days for a consultation when the patient is acutely ill from the moment they request the appointment. The emergencies are saturated and there is a shortage. So we must start with the Primary, but without forgetting the hospitable, we should not distinguish one from the other.
The vocation in Medicine is to live for what you do, it is to have a tremendous attitude, a tremendous enthusiasm for helping others.
Should it be managed differently?
Definitely. We see that what our politicians do is attack each other and there is no decision to deliberate to see what is best for the citizen. We miss politicians with vocation, because they are not willing to listen, neither to society nor to each other. There is a polarization and the goal is not to seek the common good, but to succeed and carry out policies that would be greatly enriched if they listened to each other and listened to what others say to see what the truth is and legislate for everyone, not for those of them. right or left, for everyone, and that is not done. We are in a time where people clearly lie, but nothing happens, it does not harm the liar, and that is a symptom of a society that is not good. We must fight against that, we must not remain silent, we must not continue voting for those who blatantly lie to you. There are no colors in this, because it seems that lies are nesting in a large part of politics. We must express our rejection and absolute disagreement, because they do not offer the service they should, they only seek to stay in power and attack the opponent. We have to do what is necessary to make it change and punish those who lie to us.
Despite the deficiencies, Spain can boast of its public health…
I believe that healthcare is the jewel in the crown. The fact of having a public health system that does not distinguish between race or economy, not all countries can say the same. In the United States there are 40 or 50 million people who do not have any coverage and it is a disgrace to not be able to go to the doctor because you do not have money. It’s unfortunate, it’s unfair, it’s inhumane.
How have transplants changed at the Reina Sofía?
Organ donation in Córdoba and the province is probably the largest, due to population density, in the world, which says a lot about the Autonomous Transplant Coordination and the National Transplant Organization. Furthermore, the population of Cordoba, the Andalusian population and the Spanish population, in general, is tremendously supportive and aware of what it means to donate an organ. The transplant has not changed much, what has changed is the support for the patient, both preoperative and perioperative care, intensive care, what anesthesia is, the methods to maintain the patient while the organ still does not function as much as possible. well enough. All of this has changed a lot and has had an impact on survival, both in the short, medium and long term.
The Córdoba hospital maintains its prestige in this matter…
Absolutely. Furthermore, I believe that the survival curve of most organs, if not all, has grown enormously and today we can say that, for example, in the lung, medium and long-term survival exceeds that of the international lung transplant registry. That is to say, the Andalusian patient can be very calm because the survival that will be achieved with him is very good.
You strongly advocate humanizing healthcare. Is medicine in Spain not very humane?
We have always lacked humanity. I think we must insist that the patient, first, is a person. A person in a delicate phase of their life, very vulnerable, who sees their life or the function of one of their organs threatened. So, the doctor is very lucky that a person puts himself in his hands and offers him trust and confidence. And that, trust and confidence, is synonymous with friendship. A clinical friendship. You have to get involved in all facets of that patient, you have to offer help of all kinds and not just technique, but also offer that trust so that they feel supported, that they feel that the danger is less.
How is it achieved?
Everyone involved must be involved, from the administration to the universities. In my classes I make many digressions in this sense. I care more about the humanistic or ethical aspect of those who are being trained than about a specific medical subject, because if you don’t start with a humanization of your care and an ethical perspective, it will be difficult to achieve the rest. We cannot lie to the patient, but of course what we can never be is cruel to someone who has a poor prognosis. Never. We will always be there to support him, to help him, so that he can tell us how he is or what he needs.
What has been the best moment you have experienced in the hospital?
There are many moments, I think most of them have been pleasant. There is no doubt that when a patient is not doing well it is something very hard. It is not true that you can get it out of your head absolutely. It is undeniable that you take it with you and I think that is not bad, it is good that we feel that compassion, but really. Compassion is suffering with the patient and that is inevitable, it is attached to the vocation and it has to be that way. You always believe that you could have done more, but I would be lying to say that I am not proud of what we have done together, I have never done it alone, because individual work is not as effective, the team has done good things for patients and society. I feel proud in common, of everyone’s work.
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