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LEGENDS IN UROLOGY


(19) 5 Oct 2012

John M. Fitzpatrick, MCh, FRCSI, FEBU, FC Urol (SA), FRCSGlas, FRCS
Professor and Chairman
Department of Surgery
Mater Misericordiae Hospital and University College Dublin
Head of Research, Irish Cancer Society
Dublin, Ireland

I was born in Dublin and have lived there most of my life. It is a city that I enjoy living in, with a high quality of living where all disappointment in our miserable weather is more than offset by the city’s wonderful history and its literary and artistic attractions. We are also lucky that access to the countryside is easy and quick enabling us to have the possibility of hiking and relaxing in the beautiful places nearby.

One of the factors that had a great influence on my life was that I was educated by the Jesuits, who developed my interest in history and literature, but most importantly taught me how to speak in public. Weekly debates in school not only ensured that I learned fast how to speak but also how to think on my feet. It was also a very helpful primer for how to stand up to confrontation of any kind in the future.

At school there was a great emphasis on the classics as well as history and literature and we were encouraged to become proficient in another language. This lead to my spending four consecutive summers in France and to my developing a love for that language. I cannot say that I am still as fluent in it as I was then, but it is pleasant not to have to rely on everyone having to speak English to me when I am in France. As can be seen, there was not a particular emphasis on the science subjects at school, but I am glad to say that I survived without them.

I didn’t totally enjoy the school experience, but the real value of having developed an expertise in public speaking was something that I only realized as time went by. Needless to say, the fact that my native tongue is English has also been a lucky break! I would strongly recommend to trainees that they should spend a lot of time learning the principles and practice of public speaking.

I had intended after leaving school to go to Oxford to read Greats (Latin, Greek and History), but a sudden change of plan saw me going to University College Dublin to study medicine. I often wonder what would have happened if I had stuck to Plan A. I did my clinical attachment in St. Vincent’s Hospital, Dublin and was strongly influenced there by the Head of Surgery, Patrick FitzGerald, who helped me to develop an interest in scientific pursuits and showed me that a surgeon could also make meaningful contributions in the scientific field, another lesson that I have never forgotten.

The influence on my future interests in surgery wielded by two urologists in this hospital, Frank Duff and Dan Kelly, was enormous. They were both superb surgeons and I was able to learn outstanding technique and the beauty of urological surgery, as well as how to keep moving forwards with some degree of speed when carrying out a surgical procedure. What I learned from both of them was enormous and even when I subsequently became Head of my own department, they remained friends and mentors.

While working in St. Vincent’s Hospital, although I had as a resident been lucky enough to have become quite experienced in urological procedures, I realized that it would be necessary to travel abroad to continue my urological experience. In those days, there were no formal Fellowship Programs, so one had to hope that it would indeed be possible to go to a good unit to develop one’s career and improve one’s career prospects.

I moved to the Institute of Urology and the St. Peter ’s Hospitals in London in the latter part of 1977 and one of the happiest and most productive times of my life followed. In these hospitals, of which there were four all in and around Covent Garden, the clinical material and scientific endeavors were astonishing. I started working there with John Pryor and Peter Worth, who taught me everything I needed to know about Andrology and Urodynamics respectively. They were delightful to work for and helped me to get used to the very different environment in London Urology. I was privileged to work next with Peter Riddle, an outstanding surgeon, who once again ensured that the technical aspects of my surgery were kept to a high standard. He consistently performed the best radical cystectomy I have seen and the simplicity of his technique is something that I have been able to adhere to throughout my career. The excellence of Roger Pugh, Alan Rose and Mike Kellett in Pathology, Biochemistry and Radiology (particularly in interventional radiology) was also a major part of our training.

I was lucky enough to work for John Blandy, with whom I subsequently enjoyed a long friendship. My admiration for him was considerable, he was always encouraging and full of interesting ideas which he would spring on you and invite you to work on with him. He was somebody who I shall always remember fondly and shall miss. Also influential on my life at this time and subsequently was J. P. Williams whose company I still very much enjoy.

The person to whom I owe most is John Wickham. He was my boss, my mentor, my friend. His sense of innovation and his wish to change dogma was something I had not seen before. He was constantly expressing his dissatisfaction at the necessity of having to make a large incision to remove a small urinary stone and this led to his adoption of percutaneous techniques which along with Peter Alken and Michael Marberger in Europe and Arthur Smith in the United States, he helped to make standard of care with the virtual demise of open stone surgery. He was very quick to take on new minimally invasive techniques and to move forwards with them, convincing all who worked with him (myself very much included) that this was the future of surgery. It is worth pointing out that at this time he was also developing the first robot which performed a transurethral resection of the prostate.

While working for John Wickham I spent over 4 months doing research in Mainz. This was a very fortuitous move for me. The Head of the Department was Rudi Hohenfellner, but my main contact was with Michael Marberger who has been a close friend of mine ever since. I have never worked so hard as I did in Mainz and I am pleased to say that my time there was both successful and enjoyable. Also working in the department at that time were people who are still friends of mine and who have had stellar careers: Udo Jonas, Peter Alken, Joe Thueroff and Guenther Janetschek.

In London, I was a contemporary of Christopher Woodhouse, Tony Mundy, Robin Johnston, Tony Costello, Mark Fraundorfer and Frank Gardiner. There were many others as well and we all had a very good relationship and I am still friendly with many of them. Just at the end of my time in London another Senior Registrar appeared who was full of self-confidence and who clearly had an outstanding career ahead of him: Roger Kirby. Both Christopher and Roger remain two of my very best friends, whose company I enjoy as often as possible!

London and Mainz had major effects on my life and career. Working in such excellent institutions with such outstanding thought leaders and urologists and of course developing friendships which have been long-lasting and valuable was very helpful and interesting.

After completing my training in London, I returned to Dublin in 1981 as Consultant Urologist and Senior Lecturer in Urology in the Meath and St. James’s Hospitals and Trinity College Dublin. I maintained a high surgical workload there along and was also committed to laboratory-based research. Then in 1986 I was appointed Professor of Surgery and Consultant Urologist in the Mater Hospital and University College Dublin. This was a very different experience to what I had been exposed to previously in that I had the opportunity to develop Urology in the hospital and the University, but that confrontation with others became a frequent event in the attempt to expand clinical urology and to set up a scientific laboratory dedicated to the science of urology. In this latter endeavor I was helped enormously by the arrival of Bill Watson who added a new dimension to the department.

Everything I have learned has taught me to read avidly about a subject, to say nothing unless I can cite the reference and also to be absolutely critical about everything that I read or hear. I would recommend to young Urologists always to try to have a balanced view about everything, but if you believe in something you must proceed with it and try to bring it about. Do not let confrontation prevent you from bringing what you believe to be important into reality. There are many reasons why people may try to hinder you from achieving something, but if you believe something to be right, then run with that idea but always listen to advice (even if you don’t take it!). The two non-national societies which have mattered most to me are the Urological Research Society (set up by Udo Jonas and the late Bob Krane in 1982) and the American Association of Genitourinary Surgeons. Both of these helped me to form friendships and alliances particularly in the United States, a country in which I like very much spending time; I always return from there feeling academically energized. I have very much enjoyed my visiting Professorships in the United States and Canada. I nearly always take the opportunity of having dinner with the residents the night before the academic program begins. This is always a “make-or-break” evening and usually ends with everybody having enjoyed themselves but having a pretty sore head the following morning! It is always a pleasure to see how the residents advance throughout the North American continent through Fellowships and faculty positions, many ending in leadership positions. I have been extremely lucky to have made so many good friends in North America, particularly Darracott Vaughan and Alan Wein.

There have been many aspects of my career that I have enjoyed and felt fulfilled by, but none more so than becoming Editor-in-Chief of the BJU International. It has been a post where creativity can be allowed to run riot. That was the sentiment with which I started the position and have continued in the same way throughout. I wanted to have a product that combined color and design with high academic quality. I felt that the type of journal that was needed was one that people enjoyed reading, in fact were drawn to, and felt that what they found inside made them feel that opening the journal was worth while. I absolutely believe that paper journals will disappear and feel that this should happen sooner rather than later. The possibilities for creativity are so much greater online than on paper.
I have mentioned how important being able to speak in public is, and how important it is to be able to think on your feet while you are speaking. It is worth spending time getting this right; to some it is a natural talent, but even if it isn’t one should concentrate on speaking clearly and always giving a clear message. If one can express a complex and difficult message in a simple way, leaving the audience in a frame of mind that they feel educated and entertained then one can consider that success has been achieved. I must say that speaking to audiences (be they large or small) has always been something I have enjoyed. I actually feel that the power of the spoken word is far greater than what is written.

I have one final thing to say. Academic Urology is a great and also very enjoyable pastime. When you have made a name for yourself, remember that people listen to you. You owe it to them to maintain the same good and honorable principles which have guided you through your life and speak the truth as you see it, even if some people may not like what you are saying.

John M. Fitzpatrick, MCh, FRCSI, FEBU, FC Urol (SA), FRCSGlas, FRCS

Professor and Chairman
Department of Surgery
Mater Misericordiae Hospital and University College Dublin
Head of Research, Irish Cancer Society
Dublin, Ireland

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