Tuesday, 14 August 2012


 When I look back and think of my days at Guy’s I become full of nostalgia for the good times we had, admiration for our teachers who gave us a sound foundation in medicine and taught us the right approach to patients, and gratitude for our good fortune to inherit in some way the Guy’s tradition that goes back to Bright and Hodgkin.    I first heard of Guy’s when as a 14 year old I spent a week camping with the boy scouts on mount Olympus in Cyprus. Cyprus was then a British colony.   There, I met Dr Campion, the 80 year old Chief Scout of Cyprus. When he heard that I was planning to study medicine in the UK he said: “I trained at Guy’s and you should go there”.

                              Guy’s stuck in my head and by luck rather than good planning I ended there. I remember meeting Sami Lal for the first time in the waiting room just before our interview.    He was wearing a blazer with a most impressive gold and red badge, a great contrast to my plain dark suite.    I remember identifying the hypoglossal nerve as it crossed the internal carotid in the dissecting room with Terrence English exclaiming in Dutch “Daar se het” (there it is).      I have used the same expression at least 100 times when demonstrating the same nerve to my assistants during a carotid endarterectomy.    My first house-job as HS to Mr Robert Brain was a challenge.    Everybody thought it was the toughest of all the house-jobs, but having gone through it, it gave me the confidence I needed and made me feel that I could tackle any job in the future.     A famous dictum by Robert Brain was “I would take a couple of hours off, if I were you, Nicolaides, on Christmas day”.     Somehow, towards the end of the job I relaxed and one morning I was confronted with a patient on the table for colon transplant without any x-matched blood.    I rang Mike Tarlow, the resident pathologist and asked if there was a chance we could have 7 units.    “I will do it, because you are my friend” Mike said.    My career was saved!

                            A year at the Radcliff Infirmary in Oxford with PR Allison gave me more cardiothoracic experience and then 2 years back at Guy’s as Junior Registrar ended with the fellowship.    A year of surgery at Pembury Hospital, under Mr Nevill Gibson was great fun, but somehow operating day and night, although enjoyable was not enough.     I needed greater challenges.      I had just read the memoirs of Ian Aird, published posthumously by his wife and I knew then that I had to try my hand in research.     My 2 years as a research fellow at Kings under Prof Greg Murray introduced me to the field of DVT.    It was the time the radioactive fibrinogen was discovered and my job was to use a primitive Geiger counter to scan the patient’s legs and do venography to confirm the postoperative DVTs.     The calculations were horrendously time consuming.     There was just not enough time.      At that time (1969) electronic pocket calculators were not available.     I discovered an experimental PDP8 computer in the hospital, which I was allowed to program.    In 2 hours it did one week’s work.     I now had plenty of time and wrote 20 papers on the incidence, natural history and prevention of DVT.     Thus, a primitive computer boosted my academic career!    On the basis of this work I was awarded the RCS Jacksonian Prize and went on to St Mary’s as a Lecturer.    At St Mary’s and later Imperial College my academic mentor was Hugh Dudley and my surgical mentor was Felix Eastcott, the father of vascular surgery in the UK who did the first successful carotid operation for TIAs in 1954.     I had no choice but to become an academic vascular surgeon.

                     There have been many career highlights, not least of all the privilege as a Professor of Vascular Surgery to be involved in the training of many vascular surgeons now consultants in their own right, some of which hold prestigious chairs of surgery worldwide as well as in the UK.     My greatest satisfaction has been the mentoring of my many PhD students from around the world; they kept me young at heart!     Being instrumental in the development of non-invasive vascular investigations many of which have stood the test of time and have become routine clinical or research tools is definitely another career highlight.    Our Air-plethysmograph was a valuable tool in the Mir space station (Fig. 1) and is now used in all the modules of the International Space Station providing the answers of how to increase venous tone prior to the return to gravity.
Air Plethysmograph  in use in the Mir space station

                          Throughout my time of working in the area of venous disease I have met some true pioneers in the field. Their help has resulted in the creation of The European Venous Forum (EVF) and European Venous Foundation, which is another source of great pride.    The EVF annual scientific meeting and annual Hands-on educational workshops are continuing to educate, influence and guide many young surgeons and researchers in efforts to continually improve the diagnosis and treatment of venous disease.    More recently my academic interests have also included screening for cardiovascular disease and stroke prevention.   In 2001 I took early retirement from Imperial and the NHS to become the Director of The Cyprus Institute of Neurology and Genetics.   This was a bicommunal institute created by a United Nations grant, which combined services with research.    This position gave me a unique opportunity to embark on population studies looking at atherosclerotic plaque progression using ultrasound (now in the 8th year) and the associated genetic and environmental factors.    I am still involved in stroke prevention programs in Cyprus and as the Director of the Vascular Non-invasive Diagnostic Centre in London.    I am too busy to write my memoirs with the ongoing projects and the writing of International Guidelines, but not too busy to spend time with my four grandchildren and pursue my hobby of wild life photography (Fig 2).

Seagull pair in flight

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