James IV Traveling Fellowship – 2013
Hong Jin Kim, M.D.
Department of Surgery, University of North Carolina – Chapel Hill
I was honored to be selected as a James IV Traveling Fellow for 2013, and owe a great deal of thanks to those mentors who sponsored my nomination for this unique opportunity (Dr. Anthony Meyer – my Chair, Dr. Courtney Townsend, Jr., Dr. Fabrizio Michelassi, and Dr. Murray Brennan). It was both enlightening and humbling, to visit the international leaders in your chosen area of interest – in my case, Hepato-Pancreato-Biliary and GI malignancies. Almost immediately, there is a sense of being honored with inclusion into a “family” of renowned academic surgeons, and doors of hospitality opened unexpectedly with your designation as the James IV Traveler. I sought the advice of James IV members and previous travelers, several from UNC (Dr. Anthony Meyer, Dr. Kevin Behrns, Dr. David Gerber), and the reports from previous travelers were helpful in planning the itineraries and identifying potential hosts. It took some effort to organize the trips, particularly in coordinating activities for my family (Dana – my wife, Kristina, Jessica, Charlie); in addition, I found it quite advantageous to bring along my wife’s best friend, since many of my days were spent in the hospitals while my family went exploring. However, the result was a once-in-a-life/career experience that far exceeded my expectations. The magnitude of the experience is difficult to express, but the most lasting impact will lie in the relationships that were developed and the connections that were made. I learned a great deal: surgical techniques and novel uses of technologies, clinical and translational research ideas, how others structured their clinical and research groups. More importantly, the James IV Traveling Award taught me about hospitality, the importance of the interaction needed to exchange ideas, and the similarities across the world in our drives and needs as academic surgeons. The long flights, and the time since my travels ended, have given me a chance to reflect on the noble mission of the James IV Association of Surgeons, and I would like to thank all of the dedicated members who make these opportunities possible.
Europe: June 2013 (4 weeks)
After my discussion with multiple travelers, I decided to split the Award into two 3-4 week blocks. I owe a special thanks to Drs. Townsend, Brennan, Meyer and Michelassi, for helping me to establish hosts for both of these blocks. The first block was in Europe over the summer, and the second block was in Asia/Australia in late October/early November. After careful financial planning, and extreme discipline by my incredible wife, my family was able to join me for significant parts of both blocks (Paris and London during the European trip, Sydney and Brisbane during the Asia/Australia trip). I was also fortunate to be able to bring my parents to Seoul, Korea and Hong Kong – more details to follow. My children (ages 14, 12, 10) are at great ages for traveling, and the impact of this Traveling Award has been invaluable to them as well. It is certainly helpful that these international leaders in HPB surgery and surgical oncology, also happen to live and work in cities of distinguished culture and history. I imagine that the effects of what we learned as a family will be far-reaching, and yet to be fully delineated.
The beginning of my Traveling Fellowship was bittersweet, as UNC lost two important members of our Department just before I was to leave for my trip (Dr. George Sheldon and Dr. Keith Amos). Dr. Amos was traveling in Edinburgh on the Claude H. Organ, Jr., Traveling Fellowship (Professor Mike Dixon – host), when he unexpectedly died within 48 hours of arriving in Scotland of an aortic dissection. After an emotional memorial service in Chapel Hill, I left for Edinburgh two weeks after Keith’s death, with my family and my Division of Surgical Oncology feeling quite unsettled. When I arrived, I was warmly hosted by Professor James Garden at the University of Edinburgh, and I can’t imagine a James IV Award that didn’t include some time in Scotland. I first met Professor Garden at the Royal College of Surgeons in Edinburgh, and was graciously included in the graduation ceremonies for their Masters Program. I toured the Museum of the Royal College of Surgeons Edinburgh, and met Professor Stephen Wigmore, who hosted my visit after Professor Garden departed for his much deserved vacation to Barbados. Professor Garden, and his wife Mandy, were kind enough to host me that evening for a dinner at their home, and it was one of the most memorable dinners of my entire trip.
I stayed at the Apex Waterloo Hotel, near the Royal Mile, and the city is incredibly accessible; I was able to celebrate Andy Murray winning Wimbledon, providing me further excuse to spend the evening at the pubs. After a day of sightseeing (Edinburgh Castle, Holyrood Castle, Scottish National Museum, and the obligatory Whiskey Tasting Experience), I spent some time at the University of Edinburgh with Professor Wigmore and Steve McNair. We made ward and ICU rounds, and toured the new Stem Cell Center, built with donations from R. K. Rowling. I also met with Mike Hughes, and heard several research presentations from the registrars in the laboratory (NOTCH signaling in cholangiocarcinomas, macrophages in liver regeneration). The day ended with a memorable dinner at the Honours restaurant with Stephen Wigmore, Steve McNair, and Anya Adair.
Prior to my departure from Edinburgh, I set aside an afternoon to spend with Professor Mike Dixon at Western General Hospital, who hosted Keith Amos and his family during his final days. I had recording made of the Memorial Service for Dr. Amos in Chapel Hill, and wanted to provide an opportunity for a small sense of closure from this tragic event. We toured Professor Dixon’s Breast Oncology unit at Western General, and helped him create a memorial plaque in Keith’s honor for the unit. Professor Dixon was an incredible host and friend to Keith’s wife and three young girls during his difficult ordeal, and our Division cannot thank him enough for his acts of kindness.
In Heidelberg, I was hosted by Professor Markus Buechler, and his dedicated unit of hepatobiliary surgeons. I initially met with Professor Jens Werner at the Chirurgie Klinik, and I would like to thank Jimmy Hartwig for helping me throughout the planning process. After morning conference, I went to the operating theaters for a diverse and impressive day of OR cases (pancreaticoduodenectomy, segment 1/7 liver resection, reexploration for CBD resection after previous Whipple). After the long operative day, I went to dinner with Professor Peter Schlemmer, who had spent some time in Chapel Hill for research during his training. We were accompanied by two research fellows from his lab, and I got to enjoy an authentic German dinner in Heidelberg. On the second day, I attended the Department morbidity and mortality conference, along with the ward/ICU rounds. Professor Buechler and I had to chance to chat over coffee, and I was able to meet the Chair of Anesthesia and the Nursing Head of the OR. The operative schedule was equally impressive on the second day, and I spent some time watching a left hepatic/caudate lobectomy, as well as a total pancreatectomy with portal vein resection. I was fortunate that my visit coincided with the Department of Anesthesia Summer Party, and I was accompanied to this barbecue by Professor Buechler and Jimmy Hartwig. The clinical and academic productivity of the HPB unit in Heidelberg is impressive, and the focus of this group was one of the highlights of my trip. The faculty were cooperative in the clinical care of their patients, but had resources to maintain productivity in their clinical and translational academic careers (database managers, tissue collection, research personnel/space).
Before leaving Heidelberg, I had the opportunity to explore this beautiful university town (Heidelberg Castle, Philosopher’s Walk, Student Prison), and shop along the Alstadt walk in the Old City.
I was fortunate to be able to include a short visit to Verona, Italy, to meet Professor Claudio Bassi before meeting my family in Paris and London. Professor Bassi is a quintessential European host – he is unassuming and gracious, and makes you feel welcome from the minute that he greets you with a warm hug. Professor Pederzoli had retired, and Professor Silvia was on vacation, but the rest of the team incorporated me into morning reports, floor and ICU rounds, and research discussions with Professor Scarpa (who was busy organizing the European Society of Biobanking Meeting in October, 2013). As the Medical Director of the Tissue Procurement Facility at UNC Lineberger Comprehensive Cancer Center, we spent some time discussing research ideas and potential collaborations. On the second day, after morning report, I was able to accompany Dr. Landino to the operating theaters for two pancreatic resections for cancer. Unfortunately, there were no ablations scheduled during my visit, but we discussed these procedures at length during my visit.
The city of Verona is beautiful and romantic (the setting for Romeo and Juliet), and I stayed at an incredible hotel (Hotel Due Torre, near the Piazza Erbe). The cuisine did not disappoint, and remains a highlight of my trip to Europe.
It was great to see my family in Paris, after being away from them for two weeks, and the City of Lights was a great place to mix business with a family vacation. A special thanks to Sebastien Gaujoux, who is a fellow with Professor Belghiti – he went out of his way to help set up my itinerary, and translate for me during my visit to Hopital Beaujon. We began with morning report (6 surgeons, 2 fellows, students), and moved on the ward and ICU rounds. The discussion of the patients were open and energetic, and it was clear that dissenting opinions were respected and considered. I went to the operating theaters to see Professor Farges; it was a day of liver resections for HCC (segment 6/7/8, isolated segment 6, and isolated segment 8). The day was meticulous but efficient, and Professor Belghiti was welcoming and generous as a host.
My visit to Paris included a weekend, which allowed me to spend some time with my family as a tourist. Highlights included the Louvre, the Quartier Latin, the Rodin Museum, and an evening in Versailles. Our family stayed in a smaller hotel near the Champs Elysees (Hotel Franklin Roosevelt), which was somewhat more expensive than some of the others in Europe but well worth the expenditure. We also recommend the Paris Pass, which allowed us to travel around the city and enter most of the museums. Our final day in Paris coincided with the final leg of the Tour de France, which made traveling a little cumbersome, but allowed us a unique look into French sports and culture.
London, United Kingdom
We traveled via Chunnel to London, for our final leg in Europe, in time to witness Princess Kate give birth to the Royal future heir, George. I had two incredible hosts in London, Professor Nagy Habib at Hammersmith Hospital and Lord Ara Darzi at St. Mary’s Hospital. I would also like to thank Karen Kerr and Lilyanne Gamble for organizing my entire itinerary in London – their hospitality was unmatched. I spent the first day at Hammersmith Hospital with the HPB group, and went to their MDT (multidisciplinary tumor) conference. I was treated to a lecture on the new Habib 4 device, and went to the operating theater to watch a segment 6/8 resection with Professor Pai. Professor Habib was an incredible host, full of ideas and energy, which we discussed at length over lunch at his favorite local restaurant.
The second day was spent at St. Mary’s Hospital, which was recovering from the media frenzy caused by the release of Prince George and Princess Kate a day earlier. The day was packed with meetings and presentations, which led to numerous discussions about translational and outcomes research opportunities. After an introduction to the Department (which is more aptly described as a Center, given the resources under Professor Darzi), I met the health policy team and toured the virtual center, the robotics labs, and the metabonomics research facilities. I was treated to lunch with Professor Darzi, Professor Habib, and Karen Kerr, and was able to present my research work on the role of Palladin in the tumor microenvironment of pancreatic adenocarcinomas.
I was able to include a visit to the Royal Marsden Cancer Center, and attended a sarcoma MDT conference with Professor Thomas – the multidisciplinary group sees over 600 patients with melanomas and 250 patients with soft tissue sarcomas each year. I accompanied Professor Tekkis, a colorectal surgeon, to the operating theater for a complex pelvic exenteration. I spent my final day in Europe, away from the hospitals and the research labs, and organized a trip with my family to Oxford and the Cotswolds. It was a fitting end to a memorable trip to Europe.
Asia/Australia: October/November 2013 (4 weeks)
An academic surgeon with a focus in HPB malignancies would find it hard to justify a trip that didn’t include the Far East. I selfishly added a trip to Seoul, South Korea, as I wanted to visit Seoul National University with my parents, who met there in the 1960s as a surgical resident and an OR nurse. I was fortunate to have my parents accompany me to Seoul and Hong Kong, and my wife/children joined me in Australia (Sydney, Brisbane). The traveling in Asia and Australia is logistically more difficult and quite a bit more costly, but my hosts throughout this portion of my travels took hospitality to another level. Their generosity and graciousness was humbling, and gave me great insight into how I want to interact with our visitors to UNC.
Seoul, South Korea
I arrived in Seoul, and was met by my parents, who decided to go there several weeks earlier to see extended family. We stayed at the Lotte Hotel, which was extravagant but well worth being in the center of Seoul. My father was a surgeon in Korea, trained at Seoul National University for medical school and residency, and was quite emotional about seeing me give a talk at his alma mater. My mother met my father, while working as an OR nurse, and living in the nursing dormitories that still exist today.
When I arrived at SNU, I met with Professor Sun Whe Kim, who accompanied me to morning report and gave me a tour of the university. I also met with Dr. Woo Il Kwon, who presented the departmental research in HPB malignancies and liver transplantation. I went to the operating theaters with Professor Jang (resection of a hilar cholangiocarcinoma) and Professor Suh (segment 7/8 resection), and had lunch in the Seoul Financial District with Dr. Kwon. I gave a research talk to the HPB group, and was treated to a dinner at Woo Lae Oak with Professors Kim, Jang, and Suh.
I was chauffeured on the following day to Bundang Hospital, to meet Professor Han, who has a focus in minimally invasive approaches to liver resection. My visit coincided with the 10th Anniversary of Bundang Hospital, a cause for celebration in the community. That evening and the following day, my parents and I attended a family reunion with the extended family in Seoul and Inchon, which remains the highlight of my James IV travels.
My parents and I left for Hong Kong, and Professor Poon arranged our stay at the Cyberport Meridien Hotel near Queen Mary Hospital. We were greeted in our room with an incredible fruit basket and a Queen Mary tie, and our itinerary was immaculately arranged by Gloria Wong and Brenda Yeung. I cannot express how gracious our hosts were in Hong Kong, caring enough to include my parents in all aspects of the trip.
I met with Gloria Wong and Simon Tsang at Queen Mary Hospital, to learn about the Department of Surgery and the HPB group. I was warmly greeted by Professor Ronnie Poon, a previous James IV traveler, and went to HPB rounds with Simon Tsang. I was taken to the ICU and the HIFU unit, and saw several resections in the operating theaters (laparoscopic esophagectomy, liver left lobectomy, living related liver transplant). The second day began with Departmental Service Rounds, where I met Professor John Wong and Professor C. M. Lo. I toured the laboratories with Dr. Albert Chan, and several of the research fellows at the Li Ka Shing research facility. My parents joined us for a large banquet lunch at GP Dynastie restaurant with Professor Poon and Professor Man. After my research presentation at the HPB tumor conference, we went over case presentations and I ended the day accompanying Professor Poon on his private ward rounds. This incredible full day ended with a banquet dinner at Joy Joy restaurant in central Hong Kong, with my parents and various faculty members in the Department of Surgery. My final days at Queen Mary Hospital were spent in the operating theaters, where there was a wide variety of surgeries available for interactive discussions. We discussed translational research ideas ranging from targeted therapies to liver fibrosis, and had frank talks about surgical training and education. We discussed families and work-life balance issues, and developed friendships that I hope will be enduring.
I was able to set aside several days to tour Hong Kong and Macau island with my parents – it is a fascinating culture, with an intricate balance of influences from the Far East and the United Kingdom. We spent extended time in Tsien Sha Tsui, Holyrood road, and the Ladies’ Market in Kowloon, and it was a unique opportunity to travel with my elderly parents to an area that was new to everyone. I will treasure this unique time with my parents, as well as the relationships forged with the HPB group at Queen Mary.
My parents went back to Seoul, as I moved forward to Australia to continue my travels with my wife and children. We stayed at the Quay West Hotel at the Rocks, in the heart of Sydney – our hotel overlooked Sydney harbor and the Opera House on one side, and the Harbor Bridge on the other. Our first day coincided with the 40th Anniversary of the Sydney Opera House, so we watched the celebration that was attended by the Danish Prince and Princess. We found a beautiful restaurant along Sydney harbor, and although quite jet lagged, we were treated to a fireworks show to celebrate the anniversary during our dinner.
I was warmly greeted by Professor Crowe at the Prince of Wales Hospital, and toured the hospital and research facilities. I attended ward rounds with the registrars, led by Richard Smith, on the surgical oncology service. I took part in the UGI and Sarcoma MDT conferences, and walked to Professor Crowe’s house at the end of the day. We drove to Professor Alex Matthews’ home, for a typical Australian barbecue and journal club. The journal club began with a morbidy/mortality conference, but finished with my research presentation. The discussion was lively and thoughtful, and certainly enhanced by the numerous bottles of Australian wine that were shared.
I was fortunate to be able to spend a day with Professor Jas Sumra at the Royal North Shore Hospital, who has a busy HPB practice in Sydney. We toured the hospital, spent some time in the operating theaters (laparoscopic distal pancreatectomy), and toured the research facility with Professor Smith. I finished the day with Professor Tom Hugh at a private hospital.
Sydney is a beautiful city, although the weather was overcast for several days due to the extensive wildfires that ravaged the surrounding areas. I was able to accompany my family to the Topoanga Zoo, and the botanical gardens.
Our travels ended in Brisbane, Australia, where we were hosted by Andrew Barbour, who was an international fellow at Memorial Sloan-Kettering Cancer Center and a previous James IV traveler. We stayed at the Hotel Rydges in the Southbank, and Andrew met me for a drink at the hotel bar on our first night in Brisbane. We started the next day early, with rounds at Mater Hospital and Queen Alexandra Hospital – I was able to see the dichotomy from his private and public practices. We attended the Upper GI MDT conference, before heading off to a third set of rounds at Greenslope Hospital (also a private ward). We finished with the Sarcoma/Melanoma MDT conference, which led directly to a multidisciplinary clinic.
At Andrew’s suggestion, I took the family to the Gold Coast for the weekend, near Surfers’ Paradise. The coastline was stunning and almost indescribable, although the water temperature was somewhat challenging given that it was late Spring/early Summer. Although our trip was too short to include the Great Barrier Reef, it provides added incentive to return some day to finish our travels. We returned to Brisbane on Sunday, to attend a dinner at the home of Professor Barbour. His wife and three daughters were perfect hosts, and included an evening of barbecue and swimming. On our final day at Mater Hospital, we went to the operating theaters for a gastrectomy, followed by a visit to the research center. The research team presented their ICGC data in pancreatic cancer, which included a genomic analysis that was in the process of being published. The research data was provocative, and opened an extensive discussion of the diversity of genetic patterns in pancreatic adenocarcinomas – it was a fitting end to an incredible tour of the Far East and Australia.
In summary, I have many to thank for this incredible opportunity to look beyond ourselves and our focused careers, and gain broader perspectives. There is a simple but noble premise, a Society created to allow for an exchange of surgical knowledge and foster friendships across international borders. This award was an once-in-a-lifetime opportunity, to visit international leaders in HPB surgery and surgical oncology; a unique opportunity to learn, and to present our translational research ideas to others with similar interests. I learned a great deal about clinical and technical approaches, but the one-on-one interactions led to far more important opportunities to learn. It was an opportunity to see how others established focused HPB groups, research interactions, and effective educational models. It was an opportunity to see how others defined success in academic surgery, and learned to balance work-life-family conflicts. Most importantly, it allowed for collaborative relationships to form, and genuine friendships to be seeded. As I stated previously, I am humbled by the hospitality of our hosts, and how proud they feel of the institutions that they have helped to establish.
From a personal perspective, it has been an incredible opportunity for my family to spend time together, and explore an incredible diversity of cultures. Beyond the traveling, it has given them insight into our family, and a career in medicine. The impact of my time in Seoul and Hong Kong with my parents cannot be expressed adequately, and will give me a sense of pride to last a lifetime.
I would like to thank all of my hosts, and my mentors who have made this opportunity possible. I am indebted to the James IV Association of Surgeons, for the honor of this award. I would also like to thank my Chair, and my Division, and my family for allowing me the time away from clinical responsibilities and their supportive environment.
Hong Jin Kim, M.D.
Professor, Department of Surgery
University of North Carolina