Richard D. Schulick, M.D
Professor of Surgery and Oncology
Johns Hopkins University
600 North Wolfe Street, Blalock 685
Baltimore, Maryland 21287 USA
- June 16 20 Edinburgh, Scotland Professor O. James Garden
- June 20 22 Rome, Italy
- June 22 25 Zurich, Switzerland Professor Pierre Clavien
- June 25 28 Pisa, Italy Professor Franco Mosca
- June 28 July 5 Montefiridolfi, Italy with Professor Leslie Blumgart
- December 7 14 Auckland, New Zealand Dr. Joanthan Koea
- December 14 18 Melbourne, Australia Professor Bruce Mann
- December 18 24 Bangkok, Thailand – Professor Aram Rojanasakul (Cancelled due to civil unrest)
June 16 20 Edinburgh, Scotland Professor O. James Garden
The beginning of my James the IV travels was not smooth. When I showed up to Dulles airport outside of Washington, D.C. I was told that my United flight to London and then on to Edinburgh was cancelled due to mechanical failure. There were no possibilities for getting out that night. The airline put me up in a hotel near the airport. I was quite depressed and called Professor Garden from the hotel. He was sorry for me (but he was quick to console me that he and his faculty would still be going to the best restaurant in Edinburgh and they would try to enjoy their meal without my company). The next morning United, flew me to Newark, New Jersey where I could pick up a direct flight to Edinburgh on Continental Airlines. The rest of my trip to Edinburgh was actually quite comfortable and the direct flight without having to go through Heathrow was nice.
When I arrived the next day, I picked up on my schedule as pasted above. I came to the hospital and had coffee with Professor Garden. I had a nice tour around the Royal Infirmary of Edinburgh. The Royal Infirmary was originally founded in 1729. It has moved around and has occupied several locations in and about the city of Edinburgh. It currently has over 900 beds. It is part of the public NHS system and is a teaching hospital associated with the University of Edinburgh Medical School. The facility is new and completed around 2002 with state of the art equipment and facilities.
I had the pleasure of meeting with Professor Steven Wigmore, as well as Rowan Parks.
During the first day I also attended a multidisciplinary team meeting. I noticed many more similarities than differences in the way these MDT meetings were conducted and what kinds of discussions were had. Tertiary referral centers whether in Edinburgh or Baltimore receive the same types of complex thought provoking patients. I enjoyed meeting with some of the more junior staff such as Damien Mole who gave a nice presentation. That afternoon, I was able to walk back to my hotel the Kildonian Lodge Hotel. It was a long, but very pleasant walk. The Lodge was extremely comfortable and very much full of old world charm. I had a room at the top which had a nice view of the surrounding neighborhood. The dining facilities were very nice. I didnt have a chance to eat lunch or dinner there but breakfast was excellent.
Kildonian Lodge Hotel
I then put on my running shoes and headed towards the center of town. The weather was quite nice and sunny while I was there. In the evening Iwent over to Professor Gardens house for drinks. We satout in his lovely garden in the back and finished off a good part of a bottle of white wine discussing surgery and training residents. Later that evening we walked over to a nice restaurant by the name of Gabbro. It was quite the avant garde and I was able to meet with several of Professor Gardens colleagues with the Royal College of Surgeons of Edinburgh.
The next day I went to theatre with Steven Wigmore. He very nicely performed an extended hepatectomy for a hilar mass. Later that day I had lunch with him and then we went over to his laboratory where I met with his team. A significant proportion of his laboratory work is devoted to ischemia reperfusion injury and heme oxygenase- 1Ĵdependent mechanisms. In the evening, I went over to Professor Gardens Home where he and his daughter had prepared a taco dinner. The evening was very low key and quite enjoyable.
The following day, I was back in theatre with Steven Wigmore. This time he did a right hepatectomy for metastatic colorectal cancer. He did it with a more junior trainee and stood on left side of the table, guiding the trainee through the case. In watching Steven do the two liver cases with the CUSA, I actually changed my practice back to using it when I came back to the United States. I had always been a fan of using a Kelly clamp to crush the parenchyma, but I was very impressed with how well things went with the CUSA. After the case, I went to a radiology meeting to review upcoming cases. I then gave my lecture on surgical therapy of hepatic colorectal cancer metastases. I have to admit that I was a little embarrassed in explaining the story of the James IV Fellowship to the audience (similar to bring coals to Newcastle). The lecture went very well and I had the opportunity to answer many interesting questions from the audience. That evening Professor Garden took me and two medical students who were doing research with him to dinner at a restaurant named The Witchery on the Royal Mile in the center of town. I learned a lot about the medical school system and the surgical training system in the UK in general.
The next day I flew into Rome. My wife is Italian and comes from Rome. My three children were also there. They typically spend about six weeks every summer, so it was very convenient for me to pop back and see them for the weekend before going on to my next stop. We stayed at her parents apartment which is within the city of Rome. Rome is quite the eternal city and it never ceases to amaze me. The fact that you can walk on roads and enter buildings built several thousand years ago is a very strange concept for most Americans.
June 22 25 Zurich, Switzerland Professor Pierre Clavien
I arrived on a Sunday evening and Prof. Clavien kindly arranged for my stay at Florhof Hotel in Zurich. The next day, I joined Prof. Clavien and his surgical team on ward rounds. We went around for about two hours with all of his junior faculty, fellows, and residents. He had a nice mix of liver transplant patients, as well as patients after partial hepatectomy or pancreatectomy. The organizational structure was very formal and very much top down compared to other surgical programs I have visited. In the afternoon, I met with his scientific director, Rolf Graf. The main focus of their laboratory was concentrated upon liver regeneration. They had quite a contingent of scientists from around the world. Later that evening, we went out to a very nice Swiss-Italian restaurant within walking distance of the hospital. The food and wine, as well as the company were excellent.
Department of Visceral and Tranplantation Surgery University of Zurich, Switzerland The next day, I joined the department in the operating room. They had two rooms running. In one room, a patient was undergoing a pancreaticoduodenectomy for a neuroendocrine tumor of the head of the pancreas. The patient did also have evidence of regional lymphadenopathy which was also resected with the specimen. The patient had been told at another institution in the area that he was unresectable, so the Zurich team was quite proud that they were able to remove it. The second room had a patient who had a hilar cholangiocarcinoma. The patient successfully went a margin negative extended right hepatectomy with left portal vein resection and reconstruction. It was quite an aggressive operation, but the patient appeared to tolerate it quite well. Later that day I delivered my lecture on the surgical management of colorectal cancer and I also presented some of my laboratory work. It was broadcast to several other institutions within the area. Later that evening we went out to a French restaurant. Again the food and drink was spectacular. The following day, I had some free time and I was able to walk around and spend time on the lakefront. Switzerland was hosting the European Cup for Football, and there was a lot of activity around the matches that were being played throughout Switzerland.
June 25 29 Pisa, Italy Professor Franco Mosca
I arrived in a city close to Pisa, Lucca, in the Evening of June 25 (with my family). We stayed at Hotel Guinigi. Lucca is a famous medievil city in Tuscany. Several o fits claims to fame are that the medievil wall built surrounding it is still intact, and also it was never conquered any neighboring city-states. During the next several days, I spent time at the Pisa University hospital. I was hosted by Professor Franco Mosca who is the Chairman and Professor of General and Transplant Surgery at the University of Pisa. His specialty is in Liver Transplant and Hepatobiliary Surgery, although he was a true general surgeon. The two surgeons I spent most of my time with were Marco Del Chiaro, who is one of the staff surgeons, and Ugo Boggi, who was recently promoted to Professor and the head of a new Department of Pancreatic and Renal Failure Surgery. I had the opportunity to watch several operations there including a robotic spleen preserving distal pancreatectomy done using a Da Vinci machine. They were quite adept at doing the operation with the robot and I was very impressed. The patient ended up having a neuroendocrine tumor of the pancreas which was resected with negative margins.
On June 27, Idelivered mylecture entitled SurgicalManagement of Familial andSporadic Pancreatic Cancer at Johns Hopkins. It was very well received and I was able to entertain many questions. The University of Pisa has one of the largest pancreatic surgery programs in the country (behind University of Verona). They are in the process also of establishing a nationwide pancreatic cancer tumor registry and a familial pancreatic cancer study, so this lecture was quite timely.
June 29 July 5 Montefiridolfi, Italy with Professor Leslie Blumgart
After Lucca and Pisa, my family drove to Montefiridolfi where I met up with Professor Leslie Blumgart and my former fellows who I trained with at Memorial Sloan-Kettering Cancer Center. We all went with our families and stayed at Hotel Fonte De Medici in Montefirdolfi. Of note the vineyards and wineries for Villa Antinori were just next door and we were able to sample their various wines. They are most famous for Tignanello and Solaia, the later considered one of the super Tuscans. I must admit, that although we discussed some surgery, most of the time we didnt our wives and children made sure of that.
We were relatively close to Sienna and Florence, so we organized several day excursions to these cities. On one of these we went to the top of the Duomo in Florence.
December 7 14 Auckland, New Zealand Dr. Joanthan Koea
Auckland, New Zealand is a long way from Baltimore Maryland. Although total flying time through Los Angeles is less than a day, two days are lost because of time zone changes. Never-the-less, the flight was quite comfortable and quicker than I thought it would be. Jonathan Koea, who trained at the University of Auckland and then did an International Surgical Oncology Fellowship year followed by a Hepatopancreatobiliary Fellowship year at Memorial Sloan-Kettering was my host. He picked me up at the airport early on the morning of December 9 and took me to the Langham Hotel in Auckland which is within walking distance of the Auckland Hospital.
That morning, I went over to the Auckland City Hospital and spent the rest of the day in operating rooms eight and nine. In one room I observed a right hepatectomy for hepatocellular carcinoma and in the other room I observed a case that was a potential distal pancreatectomy and splenectomy, but when Professor John Windsor mobilized everything, it turned out to be a duplication cyst of the stomach that was eroding into the body of the pancreas. Interestingly, I had never encountered a case like this before, but when I came back to Baltimore, I had a case just like it. I discussed the possibility of a duplication cyst in the differential, although I thought it was low probability, but that is exactly what it was.
That evening, the Koeas were kind enough to host me for dinner. It was a very informal, low key event and I was able to learn a lot about New Zealand and Auckland. Jonathan and Lisa Jane went out of their ways to make me very comfortable during my visit. The next day, I went back to the hospital and attended the HPB/Upper GI Unit Consultants Meeting. Many cases were discussed, and even halfway around the world and down under, the management dilemmas appear to be the same. I then went to a paper rounds and audit with some of the senior surgeons and nurses in charge of the various floors. Management plans for different inpatients were discussed. This was followed by an X-ray conference in which many preoperative patients were discussed. This was a forum in which the consultants and housestaff could bring cases for disucssion to determine resectability or to get a consensus optinion as to the next step. This was a multimodality conference with attendance from several different departments.
After lunch, I went on walk rounds with the residents. I learned a few things and I was able to also teach them a few things. Later that day, in the evening, I went out to dinner with some of the surgical residents. I was pleased to learn about their training system, and they were similarly curious about the training system in the United States. The next morning, I went back to the hospital and met with Professor John Windsor, the head of the Department of Surgery at the University of Auckland. I met with several of his research fellows and some of his faculty. As it turns out Professor Windsor and I both grew up in India. His father was a missionary and I believe a physician, and mine was an American diplomat assigned there. He went to an English speaking boarding school in Mussorie in the north, while I went to an Engllish speaking International School in New Delhi. We exchanged many stories about our time in India. He is in charge of several teaching programs in India and offerred to invite me back to one of them.
Later in the morning I gave my presentation entitled Surgical Management and Immunotherapy of Hepatic Colorectal Cancer Metastases to the Department of Surgery. It was well received and I had many questions, especially in regards to my laboratory work. That afternoon, I was free and I went for a long (approximately 10 mile) walk around Auckland. It is a very beautiful city and certainly very diverse in culture. That evening, Jonathan and several of the Surgical Staff took me out to dinner at a very fancy restaurant in the Langham Hotel called Partingtons. The food and wine were excellent. I, of course, went for the New Zealand lamb.
The next morning, I checked out of the hotel and Jonathan picked me up and took me to his house on Kawau Island. It was several hours away by a combination of car and then boat ride. The island was rather remote with a few permanent residents and others just spending the summer there. Because he is a surgeon, and because he is inherently nice, Jonathan seemed to be a very popular person on the island. During my stay on the island, we were able to go fishing and enjoyed the other activities there. We were able to catch red snapper right off of the island and then cook them and eat them just severalhours later. Idont think that I have ever had fish so fresh or tasty before.
We spent the weekend on the island which was quite relaxing. We discussed some of the differences between the New Zealand and American systems in terms of university and private practices. We also were able to discuss some of the differences in terms of insurance and reimbursement for care between the two countries.
That Sunday evening, Jonathan transported me back to Auckland and then to the airport where I caught a flight out to Melbourne.
December 14 18 Melbourne, Australia Professor Bruce Mann
Professor Bruce Mann who also did a one year International Surgical Oncology Fellowship at Memorial Sloan-Kettering picked me up at the airport and took me to his house where I stayed. His wife Julie Miller and their two sons were excellent hosts. Professor Mann is a Surgical Oncologist and Specialist Breast Surgeon. He is the Director of Breast Cancer Services for the Royal Melbourne and Royal Women’s Hospitals and a Professor of Surgery at the University of Melbourne. In addition, he is the director of advanced surgical training at the Royal Melbourne Hospital. On Monday, I spent the day at the Royal Melbourne Hospital and met with multiple researcher and trainees in the AM. Later that evening I went out to dinner with a bunch of residents and trainees. They were a very young and vibrant crowd full of questions. They had diverse career interests and some were interested in surgical oncology.
The next day I spent at the Austin Hospital with Professor Christopher Christophi. I delivered two lectures, one on metastatic colorectal cancer to the liver and the other pancreaticoduodenectomy for pancreatic cancer. I had a nice tour of the facilities and met with many of the faculty members. They are one of the busiest HPB surgical centers in the area. That night, Professor Christophi and the surgical staff hosted me at dinner in downtown Melbourne. It was a very grand evening.
The next day I spent at the Peter MacCallum Cancer Centre with Professor Mann. I gave a talk on pancreatic cancer in the morning and spent some time going over some of financial issues and payment issues we deal with in the United States. I also discussed some of the implications of volume and outcome especially in regards to pancreatic surgery. I had many questions to answer. I was able to attend a multidisciplinary cancer meeting and was presented with many interesting cases. The cancer centre had a large volume of tertiary type cases.
Later in the evening, I was taken out to dinner by Professor Mann and his wife Dr. Julie Miller. It was a very enjoyable evening and I was able to sample some nice Australian Wines.
The next day I had been scheduled to fly to Bangkok, Thailand, but I decided to cancel because of demonstrations and intermittent closure of the international airports from protests. I therefore flew home.