5. The interim period: Toronto and NewYork
At the end of June 1968 I parted from my friends in Mississippi and on
July 1st started my new work in the Toronto General Hospital, the
University of Toronto main teaching center. The activity of the new
Division of Thoracic Surgery involved surgery of the lungs, trachea,
esophagus, thymus, diaphragm –all the chest contents,
excluding heart and major blood vessels. These confines of work were
very much to my liking. The service was temporarily situated in the
hospital’s oldest building. It was erected in 1913 and situated
at the corner of College Street and University Avenue. Four certified
surgeons formed the team. Chief of the division was Dr. F.G.
. Another member of the team was Dr. Norman C. Delarue, an
older generation thoracic surgeon, with extensive experience in
pulmonary surgery. The third surgeon was Robert (Rob) Henderson, who
concentrated his activity mostly around the esophagus – study of
esophageal physiology and disease, and surgery of the esophagus. I was
accepted as a senior fellow (the highest rank of training), although at
that time I had been already certified in thoracic surgery. In
addition, there were residents and interns on rotation.
My work included participation in operations, teaching students in
seminars and clinical discussions, clinical research, and consultations
in other Toronto hospitals, mainly the Princess Margaret Hospital. This
was a hospital for oncology from which I brought many patients to be
operated on our service. I shared a secretary with another physician,
and had an office of my own, with a telephone. The office was only 2x2
meters (7x7 feet), but the privacy was of inestimable value – I
never had such a luxury in New York or in Mississippi.
Dr. Pearson was among the world’s first surgeons to operate on
the trachea 11
(resections, plastic repairs) and by the time I
worked on his service, had already been widely recognized as one of the
leaders in this new and exciting field. My involvement in the clinical
workup of his patients and participation as an assistant in his
operations, provided me with much valued experience and enabled me to
learn a lot about the problems associated with surgery of the trachea.
In parallel, I studied records of all the patients with tumors of the
trachea treated in the hospital in the past and prepared an article on
this subject for publication (Fig. 31
Similarly, I prepared and wrote up neoplasms of the thymus 12
another group of interesting tumors – the bronchial carcinoid.
This material was presented at several congresses of the most
prestigious surgical societies and was published in leading medical
journals. Through Pearson I became acquainted with other pioneers of
tracheal surgery, among them Hermes Grillo from Boston and Mikhail
Perelman from Moscow. Griff Pearson was an excellent teacher and a
charming person. He treated members of his team as equals, and never
gave anyone the feeling of being his subordinate (Fig. 32
Fig. 31. The article on tumors of the trachea, with Pearson and others, Annals of Thoracic Surgery, 1974.
Every one of us, the senior staff members, as well as interns and
nurses, visited his home in Toronto and his farm in the country, a
2-hour drive from the city. He had a house there with a creek behind
it, widening to a fish pond, all surrounded by woods – part of
his farmstead, with cows and other animals. Canada is a big
country… (Figs. 33
I spent many weekends on that farm, befriended the Pearson family
– Griff’s wife and their three little children, swam in the
pond, skied and even tried to hunt – unsuccessfully. I spent
Christmas Eve of 1968 there, and in 1969 watched on the television the
first man landing on the moon. Griff Pearson and I remain lifelong
Fig. 32. F.G. Pearson at the end of a hard day’s work.
Fig. 33. F.G. Pearson with his family.
Fig. 34. At the Pearson farmstead.
Pearson knew that I wanted to return to Israel and that I was looking
for a job. However, for the time being, my connections with the
institutions in Israel were limited to the exchange of meaningless
letters. There was no progress. In order to revive the subject, I had
to go to Israel, meet people personally and remind them that I existed
and was looking for an opportunity to return to Israel. It was
embarrassing to ask for a vacation only three months after I started
working, but there was no choice. Pearson did not object that I take my
annual holiday in the beginning of the year rather than at the end. So,
in October, three months after starting my new job, I went to Israel.
I had meetings with senior officials in the Ministry of Health, city
hospitals, central offices of Kupat Holim (health services of the Labor
Federation) and the deans of both medical schools – Tel Aviv
University and Hadassah. The possibility to find a position in Kupat
Holim seemed reasonable for a while. A meeting was arranged for me with
Dr. Eger, chief of the Department of Surgery in the Kupat Holim
Hospital in Be’er-Sheva (today the Soroka Medical Center). Dr.
Eger described to me the situation on his service and stressed that he
needed a good deputy. Also, he told me that the hospital was in
desperate need of a thoracic surgeon, and that there were plans to open
a thoracic surgery service. If I start working there as his deputy, I
would be able, besides my work as a senior surgeon, to take care of all
the thoracic patients. When the time comes to open the thoracic surgery
service, it would be only natural that I would be its chief.
I was very much impressed with Dr. Eger. “This is an example of a
department chief, not to be afraid of” I thought. “With a
man like him, it would be possible for me to cooperate and, in
parallel, built foundations for a unit of my own.” The
day’s activity was over and I was in good mood. I went to visit
an old friend who served as a senior physician in one of the hospital
departments. I told him about my conversation with Dr. Eger and about
my plans and dreams for the future. My friend was skeptical. He agreed
that Dr. Eger was a nice person and an excellent surgeon, but was
surprised at my naiveté. “Of course, you could work and
get along well with Dr. Eger, but your hopes for a thoracic surgical
service of your own will remain a dream”. He told me that during
the Six-Day-War, a thoracic surgeon, Dr. Joseph Borman from Hadassah,
was brought to the hospital in Be’er-Sheva to fill the void. He
was my age, a senior surgeon on the thoracic surgery service headed by
Professor Milwidsky. He worked well and had a good reputation. He was
the candidate of Kupat Holim to become chief of the thoracic surgery
service, once it will be established. My friend was greatly surprised
that I did not know about this, as apparently everybody else did.
Meanwhile Dr. Borman worked under the greenhouse conditions of
Hadassah, and was not in a particular hurry to come to
Be’er-Sheva and start organizing the new service from scratch. He
preferred to wait for the department to open, and then come as its
chief. He had been assured of this position by the hospital
administration and by the Kupat Holim executives.
I had witnessed a similar scenario before. An exact reconstruction of
the Jack Abouav affair in Rambam was now unfolding in
Be’er-Sheva. By accepting the Kupat Holim’s offer, I would
actually be building the foundations of thoracic surgery service for
Joe Borman. Should I prefer to stay in thoracic surgery, I could
possibly work on Dr. Borman’s service, perhaps as his deputy. In
the Kupat Holim offices no one told me this, nor did Dr. Eger mentioned
it to me, although it stands to reason that he must have known about
I returned to Kupat Holim with a counter-offer: I would start working
in Dr. Eger’s department as his deputy, if
the tender for the
position of chief of thoracic surgery takes place now, and I win it.
Once the thoracic surgery service opens, no matter when, there will be
no need for another tender. “This is not logical” was the
officials’ response. “The tender will be announced when the
service is ready to open; at the moment it is not of immediate
interest.” They added that if I start working now and organize
the service from the foundations, there would be almost no doubt that I
would succeed in the tender. However, they were not ready to commit
themselves. During those conversations no one mentioned Joe Borman. The
people who conversed with me did not suspect that I knew anything about
him, and I preferred not to disclose all the information I had,
bringing about an open confrontation. In the final outcome I did not
accept the job offer in Be’er-Sheva, but the correspondence with
the Kupat Holim and other institutions in Israel was rejuvenated and
Although at this stage I did not obtain a desired job in Israel as I
had hoped, my visit in Israel had one other important result. Until
that visit, I have never seen the Western Wall in Jerusalem. Now, that
Jerusalem was liberated and united, I went to see it. In the Old City I
met an old medical school friend, Dr. Judith Grünwald-Rapaport,
and right there she introduced me to her sister Milka. I will not
elaborate on the details of courting that lasted two weeks, but at the
end I proposed to Milka and brought her to Canada, where we married.
Now we have four children and two grandsons. One could say that my trip
was not wasted…
Dr. Joseph Borman did not come to Be’er-Seva to run the thoracic
surgery service. On February 21st 1970, a Swissair aircraft exploded in
the air, fifteen minutes after its takeoff from Zurich, on the way to
Tel Aviv. “The Popular Front for the Liberation of
Palestine” took proud responsibility for the explosion. Among the
47 victims of this heinous act of “liberation” was
Professor Hanoch Milwidsky, Chief of the Department of Thoracic Surgery
in Hadassah. Joseph Borman was appointed as the new chief and was no
longer interested to move to Be’er-Sheva.
In order to work in the Province of Ontario (Toronto is the capital of
Ontario) I needed an Ontario medical license. I passed the necessary
examinations in 1969 (Fig. 35
). I also sought
recognition of my title of Specialist (Board Diplomate) that I had
obtained in the United States. However, during the late 1960s, the
institution in charge of qualifying specialists in Canada (The Royal
College of Physicians and Surgeons of Canada) was not yet ready to
approve titles that were obtained “south of the border”. My
Specialist Certificate, valid in the United States, was meaningless in
Canada. I had to study for examinations once again. At that time, the
Royal College examinations were conducted on two levels. The lower
level was to obtain the title of a specialist (Fig. 36
The higher level was to become Fellow of that prestigious and highly
respected College. All examinations were written and oral.
Fig. 35. Certificate of the Medical Council of Canada.
Fig. 36. Specialist Certificate of the Royal College of Surgeons of Canada.
For physicians who read this book, I copied some of the questions from the written part of the fellowship examinations (Figs. 37
Those were the most difficult examinations in my entire life. But I
passed them too, and in 1970, at three different ceremonies, I was
accepted to three prestigious societies: the Royal College of
Physicians and Surgeons of Canada (Fig. 39
), the American College of Surgeons (Fig. 40
) and the American College of Chest Physicians (Fig. 41
). All paths of professional progress in North America were now open for me, on both sides of the border.
Fig. 37. Questions in pathology and bacteriology at the examination in surgery.
Fig. 38. Questions in basic sciences at the examination in surgery.
Fig. 39. Fellowship Certificate in the Royal College of Physicians and Surgeons of Canada.
Fig. 40. Fellowship Certificate in the American College of Surgeons.
Fig. 41. Fellowship Certificate in the American College of Chest Physicians.
My daughter Dorit (named in the memory of my late mother) was born in March 1970 (Fig. 42
and in the summer I completed my second year of fellowship at the
University of Toronto. I wanted to obtain a permanent position in
Israel and to return home. The search for a job by correspondence
reached a new peak, but there was no real progress. I reached a dead
end, exactly as predicted by Dr. Prywes, when I had asked him for a
recommendation letter before setting on my American adventure.
Therefore, in parallel to the search in Israel, I started looking for
work in the United States. The most attractive job offer came from the
Montefiore Medical Center in New York. This hospital had been requested
to upgrade the professional level of an old city hospital – the
Morrisania City Hospital in the Bronx, a few city blocks from
Montefiore. The administration of
Fig. 42. Dorit, six days old, with Milka and Yifat.
the Montefiore Hospital was supposed to fill the vacancies in
Morrisania with physicians who were on the Montefiore staff and served
on the faculty of the Albert Einstein College of Medicine. The position
offered to me was a full time appointment in the Department of Surgery
at the Morrisania. I would instruct residents in general surgery and,
as the only thoracic surgeon in the hospital, would be in charge of
thoracic surgery. In parallel, I was offered the academic appointment
as Assistant Professor of Surgery at the Albert Einstein College of
Medicine. The salary, to be paid by Montefiore, was quite good. I
accepted this offer, and in July 1970 my family and I moved to New
York. During the four years of my absence, some changes had occurred at
the Albert Einstein: Dr. State moved to Los Angeles and the new
Chairman of the Department of Surgery was Dr. Marvin (Marv the
Marvelous) Gliedman from the Montefiore.
The Morrisania Hospital was located in an area of poverty, riddled by
crime. Most of the work in surgery was related to trauma. Until I came,
no chest operations were performed there; all thoracic patients were
transferred to the Montefiore Hospital. My initial work concentrated on
organizing the groundwork for thoracic surgery. The necessary
instruments were purchased and operations on lungs and esophagus were
performed for the first time in Morrisania. The thoracic surgeons in
Montefiore were relieved when the volume of chest trauma in their
hospital dropped significantly. Groups of students from Albert Einstein
– Montefiore came to the Morrisania for short periods of study.
My relations with the surgical staff and with the department chairman
– Dr. Gliedman, were excellent. I enjoyed my work and was happy.
* * *
I had been at the Morrisania for about two months, when a letter came
from the Ministry of Health in Jerusalem: a position of chief of
surgery became vacant at the Shmuel Harofe Hospital in
Be’er-Yaakov, and a tender was announced. Forms were enclosed, to
be filled, in case I was interested in applying for the position.
Before receiving that letter I had never heard of the Shmuel Harofe
Hospital and had not been aware of its existence. Its obscurity
notwithstanding, Milka and I, both viewed this tender with great hope:
an opportunity to return home. In case I won the tender, I would have
an assured job and could return to Israel immediately. There was no
room for hesitation. Without knowing a thing about the Shmuel Harofe
Hospital, I filled the forms and mailed them to the Civil Service
Commission in Jerusalem. The authorities in charge of the tender agreed
to my unusual request to conduct the tender without my personal
appearance and were satisfied with my documents, submitted by mail.
From the day of application until the results of the contest became
available, we lived under indescribable stress. I could barely
function. The tender took place in November. At the end of that month I
received a telegram (why not a phone call?) stating that I had won the
contest (Fig. 43
). Here I must point out an
extremely important detail: the tender was for the position of Chief of
the Department of Surgery (Thoracic and General)
. At the time I did not
realize the importance of this particular phrasing. Its significance
became clear only ten years later, when Shmuel Harofe was converted to
a geriatric hospital and my department was transferred to the Wolfson
Medical Center. I will return to this subject in a later chapter.
From that moment on, our lives had changed greatly. After ten years in
America we became used to certain way of life. We had to liquidate our
home, make purchases toward our return to Israel and organize the trip.
But most important, I had to see the hospital in
which I expected to spend the
perhaps the remainder of my professional life. With this in mind, in December 1970 I went on a trip of acquaintanceship.
Fig. 43. The telegram (in
Hebrew): “We are happy to inform you that you were appointed for
the position of chief of the Department of Surgery at the Shmuel Harofe
Hospital. Please let us know the time of your arrival.”
The hospital in Be’er Yaakov was built in the days of the British
Mandate in Palestine as part of a big military camp. It consisted of
barracks built of ”mud and rags”, according to the
description of the hospital director, Dr. Walter Davidson. During World
War II they started using this particular part of the camp as a British
military hospital, and the barracks served as hospital wards. After the
establishment of the State of Israel, the hospital was converted into a
rehabilitation center for new immigrants with chronic disabilities
(“MALBEN”). Most patients were hospitalized for long
periods of time, sometimes for several years. Many had lung diseases,
usually tuberculosis. After several years, the center was transferred
to the government ownership and served as a hospital for tuberculosis.
During the Six-Day-War it was temporarily converted to a hospital for
wounded prisoners of war. Later it became a general hospital, with a
heavy predominance of chest medicine: there were four pulmonary wards,
but only one general medical service. The Department of Surgery
consisted of one 50-bed surgical ward. It filled the function of a
general surgical service, but again, there was great predominance of
pulmonary surgery. The chief of the Department, Dr. Süsskind
Herman, was a thoracic surgeon with extensive experience in surgery of
the lungs. In 1970 he died after a prolonged illness and the position
of department chief became vacant. Dr. Herman’s staff consisted
of two surgeons, both in their fifties. The hospital was not affiliated
with any medical school and had no teaching tradition. Patients were
admitted to the surgical service for operations only. Dr. Herman
performed all lung operations by himself. The two members of his team
performed operations of hernia, hemorrhoids and the like.
“Major” operations in the realm of general surgery were
rare. The physicians in the department of medicine preferred to refer
patients who needed surgery, to other hospitals. However, the four
pulmonary services supplied Dr. Herman with sufficient volume of work.
When I came for my acquaintance visit in Be’er Yaakov, I met the
hospital director, Dr. Davidson, who also served as chief of one of the
pulmonary services. I was not given the opportunity to meet the staff
of the Department of Surgery. In retrospect, I believe that this
omission was intentional, planned ahead of time by Dr. Davidson, who
had good reasons to hide my future team from me.
The hospital barracks were spread over a wide area (Fig. 44
Among the hospitals in Israel it was a peripheral institution, not
widely known. Of course, there were no medical students. Only the
Department of Medicine was approved for residency training and in 1970
it had only one medical resident. All the other services, including
surgery, were not approved for training and had no residents. Thus I
was condemned to work with two surgeons whom I had never met. I only
knew that both were much older than I. That was it, at least for the
Fig. 44. Department of Surgery (barrack no. 7) in Shmuel Harofe Hospital.
I could not have been encouraged by this visit. But what was the
alternative? To stay in the United States and wait for another
opportunity? Others before me have done that. Their
“temporary” stay in America lasted their lifetime. It was
obvious that the chances for another “lucky strike” with a
possibility of returning to Israel were close to nothing. This was my
first and probably the only opportunity to become chief of a department
of surgery in an Israeli hospital, miserable as it may be. I expected
years of tough struggle, but also a challenge. In spite of the
disheartening impact of my visit, I did not hesitate. My final
conversation with Dr. Amos Arnan, the executive officer in charge of
Hospitalization Services, concentrated only on the date of my arrival.
Dr. Arnan tried to convince me to return to Israel and start working
immediately. Without a chief, the surgical services in Shmuel Harofe
were close to collapsing. However, my contract with the Montefiore
Hospital obliged me to work for a whole year at the Morrisania, and I
was not ready to violate it. In addition, after ten years in America, I
needed time to get organized. I promised Dr. Arnan to try to shorten
the “arrangements” as much as possible, but could not
commit myself to return before July – six months ahead.
In New York I had a concluding conversation with Dr. Gliedman, Chairman
of the Department of Surgery at the Albert Einstein-Montefiore –
the surgical empire of the Bronx. Dr. Gliedman considered me an asset,
important to the further progress and development of the Morrisania
Hospital and did not want me to leave. He offered me a considerable
raise in salary, tried to tempt me with promises of additional modern
equipment, such as a flexible bronchoscope (a novelty in 1970), and
more. But all this did not attract me. My decision was unshakable. I
had spent ten years in America. It was now time to part from this
wonderful country. Further postponement would turn into a permanent
abandonment of Israel.
Milka supported my decision without hesitation. During the following
six months we concentrated all our efforts on preparations for the
return home and in July we set on a trip. We were happy.
On August 1st 1971 I entered my new position as chief of my own surgical department.
For historic accuracy I wish to point out, that prior to the
establishment of this service, no department or division of general
thoracic surgery (separate from heart surgery) existed anywhere. The
new division was the first of its kind in the world, and F.G. Pearson
was the first person to ever head this kind of service.
Thymus: a gland located in the mediastinum, important in immunologic processes.