Chapter 3: A Golden Cage
An entirely new phase of my life had started. Now that Danielle and I were together, it seemed as though I could achieve anything I wanted; I felt adventurous, strong, happy and re-born.
Initially we rented a tiny flat in central London and were having such a wonderful time that I hardly noticed that I was not working. But we were living off our savings and, after about three months of this idyll, our funds were nearly exhausted and we were forced to move to the suburbs.
I needed a job. I had been confident that I could easily work anywhere: surely in a big city like London it would be easy to find employment - but I couldn’t have been more wrong. As had been the case in Germany, there was a surplus of junior physicians during the late 1970s in the UK. I sent off about 500 applications before I was finally offered an appointment - in a psychiatric hospital. Psychiatry was not a field I had ever given much consideration to but, under the circumstances, I felt I had little choice but to accept.
The psychiatric hospital was housed in a huge, gloomy Victorian brick building just outside London. Although I had no psychiatric training or experience, I was immediately put in charge of more than 100 in-patients on what were euphemistically called “long-stay” wards. In addition, I also had to look after an acute admission ward and do all sorts of other things, some of which I found deeply disturbing. Every Wednesday afternoon, for example, it fell to me to administer electroshock therapy to patients suffering from severe depression. To say that I found this duty distressing is an understatement. The patients were terrified. They felt, I am sure, like the victims of inquisitorial torture, and most of them submitted to this procedure only against their utmost physical resistance. They had to be strapped down and gagged before the treatment could take place. The memory of those gruesome sessions has haunted me ever since. To me, psychiatry felt like medicine from the dark ages: cruel, punitive and, above all, based not on science but on speculation and supposition.
The longer I worked in this place, the more I hated it. Night duties, in particular, were not just unpleasant but positively scary. By far the worst aspect was that I did not feel that my work was helping anyone. When I visited the wards, the nurses usually wanted me to increase the dose of sedatives of patients who had been “difficult” the night before. I remember a case of an elderly lady: because her diagnosis was unclear to me, I insisted on seeing her complete case-notes which amounted to half a room full of files. She had been a patient of this hospital for decades. Once I had fought my way through this mountain of paperwork, I realized that this poor patient had never been adequately diagnosed as being clinically ill. On the contrary, I got the impression that she had been admitted because her family felt she was nuisance. Naturally, she protested, which led to her being branded by her nurses as “difficult”. As far as they were concerned, my task now was to keep her from being “difficult” by sedating her up to the eyeballs. Since she had long since developed adverse effects from the drugs, I refused to comply on medical grounds. Subsequently, I was told that my refusal was counter-productive and cruel, as they would now have to physically restrain her.
The last straw came when I found out that several of my female patients were in the habit of prostituting themselves at night to passing truck drivers outside the hospital walls. When I tried to stop this monstrosity, I was told to mind my own business and to not “rock the boat” - after all, the wretched women badly needed the pocket money.
After almost six months in this hellhole of a hospital, I left. Since then, rocking the boat has become a familiar occupation. Boat-rocking has the potential to initiate real and rapid progress - but it is also a sure way of making powerful enemies.
* * *
Homeopathy, psychiatry - where next? Until now I seemed to have made my way in medicine by a process of exclusion, stumbling rather haphazardly from one unlikely position to another, serially discovering my aversions rather than purposefully pursuing my preferences. But then, as luck would have it, I managed to secure a post in a research laboratory at St George’s Hospital in London, for which I did indeed have some qualifications even though my recent experience as a failed psychiatrist cannot have been much of a recommendation.
The research group hiring me was a world leader in the field of blood rheology, the study of the fluidity of blood. The group was investigating why uncoagulated blood, under certain circumstances, behaved almost like a solid, while normally it is quite fluid. The research involved measuring the viscosity of blood and its constituents under defined conditions and developing methods to quantify the deformability of blood cells.
My previous experience of the scientific method had been during my final years in medical school, back in Munich. During this time, I had decided to write and present an M.D. thesis. (This is a necessary precondition in Germany for being permitted to use the title “doctor”.) My thesis concerned blood-clotting abnormalities in women experiencing septic abortions, a very dangerous situation where an infection, often from an abortion gone seriously wrong, spreads rapidly throughout the body. This research had certainly taught me a lot more than the average doctor learns about blood clotting and the complex phenomena involved in this process. It had also taught me something about research techniques, the skills of laboratory work and the basic principles of statistical analysis.
Now these skills had to be hurriedly resurrected. In 1979, the clinical departments of St George’s hospital had not yet moved from Hyde Park to Tooting in South London, and the new St George’s Hospital, where I was, was still under construction. This meant that we had plenty of time for long discussions with the few members of staff who had already been relocated to the new site.
I quickly became totally absorbed in the work we were doing. I felt that our research was of fundamental importance and that the phenomena we studied had immediate clinical relevance. For example, we studied the deformability of red blood cells. The human heart pumps blood through arteries that become narrower and narrower as they take the blood to tissues further away from the heart. Eventually the diameter of these tiny vessels becomes even smaller than that of a single red cell. If blood cells were not extraordinarily deformable, they would not be able to squeeze through these tiny tubes and the circulation of blood would be impossible. As these cells deform in the tiniest capillaries, they come into very close contact with the surrounding tissue. This is how vital processes such as the transfer of oxygen and other substances from the blood cells to the tissues take place. Any condition that limits blood cell deformability, I began to realize, is potentially precarious. Finding treatments that could restore the flexibility of red blood cells might thus be useful for a wide range of conditions.
All this was very exciting, not least because, for the first time in my life, I found myself amongst scientists and a whole group of very bright people. We travelled to conferences, gave lectures, published papers, criticized our own and other scientists’ work, and planned new research projects improving on previous studies. Medical school, understandably, had been almost exclusively clinically focused; it had done very little to hone my skills as a researcher, critical thinker or scientist. Now that I became immersed in the world of basic and applied research, I was beginning to realize how vital the scientific aspect of medicine really was.
Another wonderful aspect of my first serious encounter with science was that I was given plenty of time to think, read, learn, discuss and write. Almost every day, for example, I spent time in the library - a great luxury that those who practise clinical medicine are seldom granted. Clinicians hardly ever have enough time; the next patient is usually already waiting. My boss was a case in point: he was first and foremost a surgeon, and his clinical duties meant that he spent long hours in theatre, leaving me very much in charge of managing my own time and investigations. The free and relaxed atmosphere of the research lab gave the team ample opportunity to debate the results of the most recent experiments and to plan the next round of studies. We frequently hosted visitors from abroad and regularly consulted colleagues who worked on related projects. This open and, to me, characteristically British exchange of ideas taught me more than any textbook ever had. For the first time in my professional career, I felt I had found my vocation: I was able to take a step backwards and look critically at my previous years as a doctor.
Clinicians are far too often the victims of the circumstances they have to work in. We treat our patients the best we can in the hope they get better. If they do, we are, of course, delighted and almost automatically conclude that our treatment has been successful. In other words, we assume cause and effect mostly because the postulated cause (i.e. the treatment) preceded the effect (i.e. our patients’ improvement). Hardly ever do we have the time, sense, inclination or humility to doubt this rather simplistic notion, and hardly ever do we question or criticize anyone for making it.
In a way, our most fundamental assumption in clinical medicine is like suggesting that the first crow of the rooster before dawn is the cause for the sun rising. In order to establish cause and effect, one must take into account many more factors than simply the correct time sequence. Receiving a treatment today and getting better tomorrow might suggest that the treatment caused the clinical effect, but it certainly does not prove it. Such seditious thoughts were entirely new to me: it was exhilarating to analyse and to begin thinking scientifically in this way.
Scientists try to control the circumstances of their experiments in such a way that cause and effect can be more clearly determined. They are systematically taught to doubt and criticize even their very own concepts and results, because this helps them in designing better and more conclusive experiments for the future. An uncritical scientist is a contradiction in terms: if you meet one, chances are that you have encountered a charlatan. By contrast, a critical clinician is a true rarity, in my experience. If you meet one, chances are that you have found a good and responsible doctor.
I spent roughly two years at St George’s, planning, conducting and publishing rheological experiments. It was the steepest learning curve and the happiest time of my life; I did not even miss making music all that much. Luckily my boss, even though notoriously short of time, was a wise and kind man. I owe him a lot: we became, and still are, good friends.
But much though I loved the work, the atmosphere of the lab and the company of so many intellectually stimulating colleagues, I was beginning to feel the need for more clinical experience. After all, that’s what I had studied medicine for: I wanted to be able to apply the theoretical insights from the laboratory to the treatment of patients who were suffering from vascular diseases. In addition, of course, there was always the nagging background awareness of the family business, and my mother’s serene expectation that, one day, I would cease my restless questing and come home to take up the position for which she felt I had always been destined. But I just wasn’t ready for that yet, and when a hospital near Munich offered me a post with a view to combining my research in blood rheology with clinical work involving patients with severe circulatory problems, it seemed like an elegant solution, and I accepted.
When I left St George’s I took with me a corpus of knowledge and expertise that enabled me to continue research in the same area. More importantly, I took with me the capacity to think analytically, critically and scientifically - and, as it turned out, this ability would determine the rest of my professional career. Perhaps even more crucially, I took with me an abiding love and appreciation for Britain that eventually drew me back to the UK and, in 2000, impelled me to embrace British citizenship.
* * *
The typical patient who came into my care in my new position would be a middle-aged male smoker with critical leg ischemia that was threatening the survival of his legs. We would try to improve the blood flow such that an amputation could be averted. This was often far from easy: the major arteries supplying the legs can be irreversibly blocked and, at that point, the best approach usually is vascular surgery. Sadly, surgery is sometimes not possible or not successful. In such cases, the only other option is to improve the fluidity of the blood to restore the blood flow in tiny vessels that are capable of bypassing a blocked artery.
The scientific expertise that I had acquired in London seemed to fit perfectly into this clinical context. My new boss was visibly impressed with the list of research papers I had managed to publish during my time at St George’s and hoped that he and his unit might benefit from the continuation of this work. Few things in medicine, I began to understand, are more important than a long list of publications. Many doors open more easily if one has been regularly published in The Lancet or similar journals of high standing.
Ostensibly, I had been employed as a scientist with some added clinical duties, and I had hoped to divide my time about half and half between these two tasks. Yet the reality turned out to be very different: for the first six months not the slightest attempt was made by my superiors to let me do any research at all. I never even had as much as an hour to set up the expensive equipment that had been bought but had never been put to use. Worse, I began to suspect that my boss would not recognize good science even if he fell over it. It soon became clear to me that I had been misled: nobody in this institution was truly interested in science. They only wanted research, or even just the appearance of being research-active, as an enhancement to their reputation, but certainly not for enlightenment. My time was taken up looking after seriously ill patients, attending needlessly long ward rounds and writing or correcting long, tediously detailed doctor’s discharge letters.
German hospital medicine has always been obsessed with these documents. In theory, they are supposed to inform a patient’s GP in a timely way what diagnoses and treatments have been established during the patient’s stay in hospital, so that care can be continued smoothly once the patient has been discharged. These letters have always been the bane of junior doctors everywhere. They are first drafted and then corrected, and then re-corrected ad nauseam, often by nit-picking senior colleagues who rejoice in the opportunity to demonstrate to the juniors how superior they are. Finally they are mailed, often far too late to be of any use to anyone. Every hospital and every consultant insists on their very own style to which junior doctors have to adapt each time they change post.
The aim of these needlessly wordy documents, it seemed to me, was not so much to be helpful to the patient and the GP but more as part of some archaic ritual aimed at humiliating juniors. German medicine must be the most formalistic and autocratic healthcare system in the world. Many rules, regulations and customs exist not because they are useful but merely because they have always existed.
After working in England, the “German way” came as a rude awakening to me. In London, it had been accepted that the juniors were on a learning curve. It was expected and encouraged that they ask questions rather than covering up gaps in their experience and knowledge. Equally, British senior colleagues were never too embarrassed to ask younger colleagues about something they had once learnt but long since forgotten. In Germany, by contrast, everybody had to pretend to know everything; uncertainty or doubts were interpreted as a telltale sign of weakness. Questions were perceived as indications of incompetence rather than eagerness to learn. The structure was rigidly hierarchical, with the juniors at the bottom, and by general consensus this was where they belonged. The boss could - and frequently did - get away with all kinds of nonsense; he was a semi-god who was not to be doubted, questioned or criticized. At the other end of the scale, the junior doctors were expected to be hard working, devoted, obedient, servile and uncritical of their superiors. The patient, who should have been at the centre of all this activity, did not really matter all that much. Sometimes it even seemed as though patients were deliberately used to demonstrate the superiority of those at the top of the pecking order.
Needless to say, this atmosphere rubbed me up very much the wrong way. It ran counter to most of my newly acquired insights about critical thinking and open discussion of different views or options. It was a hindrance to obtaining valuable experience or making progress. Experience became synonymous with the ability to repeat mistakes over and over again, instead of learning from them. Inevitably, I began getting into conflicts with my superiors, and it didn’t take long for me to realize that this hospital was a place where neither science nor health care could thrive. As a consequence, I expressed my views openly and resigned.
Throughout my professional life, I have been extremely fortunate to be able to take this sort of risk without undue hesitation or circumspection. Whenever I quit a job, I had the full backing and support of my family and friends. Later, when I had to fight much more important battles, the moral support of family and friends turned out to be crucial. Some people think that I am, on occasion, foolishly courageous in standing up for what I think is right. This compliment - and I do see it as a compliment - is, however, only partly justified because I always had the necessary support and security that enabled me to be able to follow my moral compass.
As it turned out, I had loyal friends indeed. My former boss from the Munich university department of rehabilitation medicine picked up the pieces and offered me a post to rejoin his team. He had never been Teutonically dogmatic, a national characteristic that I had come to loathe. The reason for his open-mindedness was simple: he was not German; he came from Hungary, a country where I was soon to make many more friends.
But despite this generous and kind offer, I hesitated; my situation was complex. The vacancy was not for a scientist, but unambiguously for a clinician. As much as I wanted to accept, I was determined - now more than ever - to continue my research. The solution to this dilemma was found when my friend managed to change the job description for me: I was offered what looked like the ideal job - mostly research with some modest attachments to clinical routine and teaching medical students - an offer far too good to refuse.
The job started auspiciously: after a few months, I had managed to obtain grant money to buy the essential instruments and, a little while later, I was able to offer a job to a colleague who had become my successor in the London lab. He too was Hungarian and, originally, he had been one of the many visitors to the St George’s team. He arrived in Munich with his wife and two little daughters who all seemed to be pleased to be closer to home.
Soon we were running two labs in parallel, one in Munich and the other just outside Munich in one of my mother’s rehabilitation hospitals. We were conducting exciting and well-funded research. Our results were of sufficient interest to be published in some of the best medical journals. They were internationally recognized, so much so that I was able to write, submit and pass my PhD without difficulties. In addition, I founded my first medical journal, Perfusion, which still exists today.
Amazingly, I had managed to import something of the London scientific spirit into the unlikely environment of Bavaria. We now had an innovative research unit, and we were more productive than we had ever been before. At the core of our research were two sizable population studies for which we had measured the fluidity of the blood of two very large groups of people. Subsequently we had shown that these measurements predicted some clinical outcomes of those individuals in their later life. This was intriguing, and we were convinced that we were on to something important.
Meanwhile, Danielle and I had been living together for some years. I proposed marriage on the occasion of a visit to Wiesbaden, my birthplace. Back in Munich, I enquired about the necessary formalities. This confirmed the impression I had gained previously: the Germans are the undisputed world champions of bureaucracy. The officials insisted on an extravagant amount of paperwork and formalities. Some of the originals were in French, so they wanted translations, rubber-stamped by a notary. “And what, if we flew to America and got married there?”, I asked. “It’s a possibility, but, it’s not the same”, I was told. Indeed, it’s not, I thought, and quickly bought two tickets for Miami.
In the US, we merely needed negative syphilis tests and two witnesses. The former was unproblematic but the latter turned out to be a little more complicated. On our wedding day, we went into a Miami police station where the local sheriff did not take long to understand our predicament. He unlocked two cells and quickly recruited two inmates to act as our witnesses. Before we knew it, we were married and celebrated the event by getting a Coke from a vending machine outside the police station.
* * *
Medical writing represented a means of bridging the divide between purely clinical medicine and the rarefied world of academic research and this activity became more important to me during this period. During my years in London, I had forged a link with Münchner Medizinische Wochenschrift, one of the most prestigious weekly medical journals in Germany and also one of the oldest medical journals in the world. Back then, I had regularly contributed short comments on all sorts of subjects, particularly those related to UK health care. I enjoyed this, and besides, it provided a little extra money. After I had returned to Munich, this journalistic work increased. Occasionally, the editor sent me to medical conferences and, in 1983, I published my first book with them. Its title was Klinische Hämorheologie (Clinical Haemorheology), and I think it sold about 5 copies, 4 of which must have been bought by my mother.
MMW was also the journal in which, in 1981, my first article on alternative medicine had been published. Naturopathy had always been a popular and accepted part of German health culture, and it occurred to me that it might be interesting to use my newly acquired investigatory skills to test this homespun wisdom. With the help of a group of medical students who wanted to complete a research project for their M.D. thesis - just as I had had to do a decade earlier - I set out to examine the influence of a number of different naturopathic nostrums, including regular garlic consumption, on blood rheology. The results were remarkable, and several papers were published. As naturopathy was not an area known for the buoyancy of its scientific research, enthusiasts in this field were excited by our work.
It so happened that an annual scientific award had been set up in honour of Father Sebastian Kneipp, to encourage scientific investigation of naturopathic methods. As this award was highly regarded within the field of naturopathy (and even came with a tidy sum of prize money) I submitted our research - and to my great delight, it won.
Even though I have received over a dozen prestigious awards during my career, I have always had a special affection for the Kneipp Preis. The large framed document still decorates the wall in my office as I write these lines, and when I look at it I am always reminded of my childhood and those early hours when, at my mother’s dogged insistence, my brother and I dragged ourselves out of bed in order to shuffle sleepily, clad only in our underwear, through the cold, wet grass.
On a more sombre note, it was also through my association with MMW that I became interested in discovering more about the deep involvement of the German medical profession in some of the worst atrocities of the Third Reich. To my horror, I had discovered that MMW-”my” journal - had been more than an innocent bystander: some of the experiments performed on concentration camp prisoners had first been reported in its pages. Forty years after these horrible events, it was time to come to terms with our own past, and one way of starting this process was to write about it, I naïvely felt.
However, this turned out to be much more controversial than I had anticipated. Some elements within German medicine - and Bavarian medicine in particular - seemed still unwilling to acknowledge the profession’s shameful past. After some unpleasant exchanges, I decided to sever my connection with the journal.
Some years later, I had a rapprochement with MMW. After my exit from MMW, I had started writing for another locally based medical journal and, as it happened, the two journals merged into one publication. Subsequently I was invited to become a member of the new editorial board. By then I had developed a pleasant, fruitful and uncomplicated relationship with the magazine despite my continuing research interest in the crucial role played by the medical profession in enacting Hitler’s murderous racial hygiene policies.
* * *
Whenever things go really well I tend to get slightly worried: will it last?
My Hungarian friend and co-worker was the brightest and best-educated scientist I have ever had the pleasure of working with. As an ex-Olympic swimmer for Hungary, he was also a picture of a man. I had always assumed that he was destined for great things. His long-term plan was to go back to Hungary when the time was right. Back home, he would doubtlessly have had an impressive academic career ahead of him. Today, all of his Hungarian colleagues with whom we collaborated during the early 1980s are heading university departments. I expected him to do at least as well. But fate had a different plan in store.
We were attending a conference in Vancouver and one evening I noticed that he was not quite himself. Jet lag, I thought. But back in Germany, he still did not perk up, and I urged him to have his blood tested. His leukocyte count turned out to be highly abnormal - no small irony for someone conducting research into blood cells. Further tests revealed he had leukemia - and not a benign form, but a fast-progressing, deadly one.
Initially he had several intensive courses of chemotherapy. Despite the powerful drugs, his energy, enthusiasm and optimism remained unbroken. We conducted dozens of research meetings by his bedside and our work progressed much as before. We were full of hope but the bad news came when he was told the chemotherapy had not totally eradicated the malignant cells in his bone marrow. His only chance to survive the disease was a bone marrow transplant, which at that time was still was an experimental and hugely expensive treatment.
His sister, who turned out to be a close match, came from Hungary to donate her bone marrow, and the transplant was carried out in Munich. To this day, I find it hard to talk about the months that followed. His fight was nothing short of heroic. He survived the transplant but the rejection-reaction eventually killed him. It was a slow and cruel death. I will never forget visiting him in hospital. He was kept in sterile conditions under a tent of transparent plastic and pressed his hand on the cover to touch mine. Modern medicine can be intensely cruel.
He left a wife and two lovely children. They went back to Hungary to bury him in his hometown, Pecs. Several years ago, his friends established an annual scientific award in his name: The Arpad Matrai Award. In 1998 they honoured me with it. So many years later, and still I had to struggle against tears to deliver the memorial lecture.
When all this happened, I was shaken to the very core and, for a while, found myself no longer able to think straight. We all tend to say “life must go on” - and it does, of course. Yet some losses cut so deep that life does not continue in the same way.
Eventually, I pulled myself together and began to reassess the situation. I had lost a dear friend and the best colleague I would ever have. Things were changing at the university, too: the head of department had just retired and his successor was not my cup of tea, to put it mildly. The conclusion seemed inescapable: I needed a change, preferably a dramatic one. I still had no strong sense of where I was bound professionally, but I knew beyond doubt that I needed to move away from Munich and look for a new horizon.
By that time, I had become a certified specialist in rehabilitation medicine. This enabled me to apply for a post as a Professor in Rehabilitation Medicine at the Medical School of Hannover and, days before my 40th birthday, I was appointed. My mother felt as vindicated as she did proud: surely now I would be firmly on track to take up my preordained post as medical director of the family business.
Danielle and I enjoyed Hannover. Although neither the town nor its surroundings were as beautiful as Munich and the mountains south of it, we both found the people of Hannover much more agreeable and open-minded than the Bavarians. The medical school was one of Germany’s newest, most modern institutions of its type. My professorial colleagues had a reputation for innovation. Better yet, a spirit of openness prevailed which had never been the case in Munich. Hannover was closer to England, not just geographically but also in spirit.
Living with a foreigner in Munich had been quite an eye-opener. I had almost forgotten how provincial, blinkered and unwelcoming the Bavarians can be. Years back, I had lived in a very rural environment south of Munich. My house was in the middle of nowhere and, as is true of any remote agricultural area, one inevitably relied on help from the surrounding farmers. But, although I had lived in the region for about 20 years, I was still viewed as an outsider by my Bavarian neighbours. It was only after I had stitched up the hand of a farmer’s son following a bad injury - I was working in surgery at the time - that some degree of friendliness and cooperation commenced.
The way some Bavarians treat foreigners seems to be dictated by their fabled stubborn pride - at least, they refer to it as pride - but to me, returning from England with a French wife, it often seemed much more akin to naked xenophobia. In Hannover, by contrast, we experienced none of this. Our move felt like a relief and a new start.
My duties at the medical school were mainly clinical. The hospital ran a busy out-patient clinic and also provided rehabilitation for over 1000 in-patients of the large University Hospital. My new boss was a perfect gentleman and could not have been kinder. Unfortunately, though, the clinical demands of the post were overwhelming, and opportunities for re-establishing my research programme were slim. I had grown adept at recognizing the signs of my own impending restlessness: even though I liked Hannover very much and was generally much happier there than I had been during the last months in Munich, I knew that the inability to do research would sooner or later poison the well for me.
It so happened that just then the chair in Rehabilitation Medicine at the Vienna Medical School became vacant. The post looked like an interesting challenge: the new professor was to take charge of a team of about 20 co-workers, move the team into a new, 2000-bed hospital, and expand the existing team into one of 120 staff within the next four years. The result would be the largest department of its kind in Europe. There was no question; I had to apply.
They had invited all four of the short-listed candidates - myself among them - to attend on the same day for the selection procedure. Each university selects its professors differently. In Vienna, the process involved a morning of public lectures by the candidates, followed by a panel consisting of 12 Viennese professors interviewing each of us separately. Nobody likes to be exposed to such an ordeal. Being by nature rather a shy person and not a natural public speaker, I was more than a little apprehensive about the whole thing, and extremely glad that Danielle had volunteered to come along for moral support.
Our flight was due to leave Hannover mid-afternoon but we were packed and ready hours before. As we were killing time in order to avoid being too early at the airport, Danielle had suddenly become flustered: “Quick, we have to go!” It turned out that we had made a mistake; the plane was leaving two hours earlier than we had assumed and we were, in fact, already running late. So we jumped into our car and drove to the airport. Rush hour got us badly stuck in traffic; nothing was moving. When we finally got under way again, our old Volvo started fuming and would not run faster than 20 miles per hour. As we arrived at the airport, we simply dumped the ailing car in front of the departure hall and ran to the desk. “The flight has just left”, the ground staff told us. We must have looked so very desperate that they took pity. One of the airline’s employees picked up the phone; eventually she was put through to the captain of the plane, which had already left the stand and was taxiing to take off. Amazingly, he, too, took pity on us and asked us to walk out onto the tarmac and approach his plane. He wanted to check how much luggage we had. It was a very small plane, just a dozen seats or so. His fear therefore was that, if he took on more weight, he would have to re-do the trimming. Luckily we only had hand luggage. A minute later, the steps of the plane descended and, right there in the centre of the windswept runway, we were allowed to board.
After that cliff-hanger of a start, I knew that the rest of this journey would be a piece of cake. Nothing could possibly stress me now. The next day, I gave my lecture about the research I had done, discussed my findings with the audience and sat in front of the interview panel to answer their questions. I have no recollection at all of what they asked, nor of my answers, but the interview must have gone well because, later that afternoon, they unanimously voted to offer me the job.
It took a while to sink in. This appointment exceeded my wildest dreams. How did I find myself here - me, the self-confessed amateur medic and would-be professional musician with no ambitions in academia? All I ever wanted was a happy and reasonably peaceful life, preferably punctuated at regular intervals by gigs and musical adventures of one sort or another. At school, I had somehow managed to wriggle through without much hard work. I had studied seriously to cope with the demands of medical school and graduated - but certainly not brilliantly. Then I had drifted from one junior doctor’s job to another until, quite by chance, I had caught the science-bug. That certainly had been a turning point: it had made a difference in terms of what I was able to achieve and in the way I looked at health care and life in general.
Ironically, without ever having truly yearned to make a high-profile academic career, I had found myself appointed to be head of an internationally prominent department at a highly respected institution. The Medical School in Vienna had a long and remarkable history. The medical faculty had been established in 1365 and, later, during the reign of Maria Theresa, it achieved worldwide recognition. The General Hospital, which was to be my place of work, had opened in 1784. Famous professors at the Faculty included people like Rokitansky, Semmelweis, Billroth, Lorenz, Freud and Landsteiner. Within the last 100 years, 15 Nobel Prizes had been awarded to professors of the University of Vienna.
Realizing all this, I was more than a little afraid of my own courage. There was a part of me that felt that there had been some mistake: was it really me who they had chosen and not someone with the same name? The professional success of the last decade had given me some confidence, but could I truly master the enormous tasks ahead of me? I was not at all sure of that.
The good news of my appointment came just in time for my mother. I phoned her straight away; she was elated. She had been in poor health for several months, but regardless of all her problems, she took the next flight to visit us in Hannover.
Only weeks later, she had to have heart surgery and never regained consciousness. After 28 days in intensive care she died. I have no words to describe my grief.
* * *
The university administrators in Vienna insisted that the terms and conditions of my contract be negotiated in minute detail. I can never be bothered with such things and was ready to just sign on the dotted line. Yet they wanted complete clarity and piles of paper needed filling, rubber-stamping and signing. I remember being surprised by the generosity of some of the terms. When it came to my salary, everyone said that this was hardly of any real importance. One well-meaning professor at the medical school explained: “It has no true relevance because you will earn several times your salary on the Golden Mile.”
The Golden Mile? I did not know this term. It turned out to be the nickname for the streets surrounding the medical school where virtually all the full professors (called Ordinarius in Austria) looked after their private patients in luxuriously equipped private hospitals. So I was going to be stinking rich?
The next thing that baffled me was that I had to become an Austrian citizen. Only Austrians were allowed to become full professors at an Austrian university. This bluntly xenophobic rule had apparently been established after the war to prevent the University falling into the hands of the Germans yet again. Relations between the two countries had not always been entirely amicable. Amongst other things, the Austrians resented the Germans for invading their country in 1938, and the Germans never forgave them for producing the monster that made them do it. But now almost all new professorial appointments were awarded to Germans rather than native-born Austrians. It is typical of Austria, I soon found out, to first create rules and then work out elaborate mechanisms to circumvent them.
When, finally, all the negotiations had been concluded and all the papers had been stamped, signed and counter-signed, I became an Austrian and subsequently was able to get on with the tasks that lay before me. Danielle had found a magnificent house on the outskirts of Vienna. My new team at the medical school seemed friendly and welcoming. Everybody was unfailingly nice - with hindsight, perhaps suspiciously nice. I had brought with me two co-workers from my time in Munich. Their task would be to help me introduce some much-needed science to my new unit. They too were received warmly. Everything seemed to be going very well indeed.
My most important initial remit was to prepare the move of my department into a brand new building, the New General Hospital. Amazingly, plans to create this institution dated back to the time before the First World War. From the start, corruption had been rife: I was told that one entire local government, many individual politicians and administrators as well as untold millions in funds had vanished in the shadow of enormous scandals surrounding the new building. Now I understood why, on the road approaching Vienna, someone had posted a large sign: “The Balkans start here.” I should have taken more heed of that, but, in truth, when I took up my post none of the tumultuous past of the New General Hospital really concerned me; I was just impatient to get on with the task in hand. Besides, what could be problematic about moving into a brand new hospital that was almost finished?
I was about to find out.
My department had been chosen to become the very first clinical unit to populate this new mega-hospital with more than 2000 beds. The next eighteen months taught me how naïve I had been to expect simply to move in and get to work. Right from the start many of the key organizational features of this institution were already hopelessly outdated. The cardinal principle in Vienna seemed to be: “Why do anything simply, if it can possibly be done in a complicated fashion?”
Virtually every other day I sat through exhaustive planning meetings with experts in areas I had previously not even known existed. Initially, I didn’t mind this activity; if nothing else, it provided me with plenty new things to learn. But as I got acquainted with the Viennese ways of solving problems, I started to wonder. Corruption seemed to be everywhere and nowhere; I could never quite put my finger on it. This might have been because I had never previously been aware of it and had never truly looked for it; after all, I was a doctor, not a detective.
If, by chance, there was an issue that did not present a problem, you could bet your last shirt that, before long, someone would come out of the woodwork and create one. Complications, it seemed, were an industry in and of itself, not least because they presented rich opportunities for intrigue and corruption. Slowly, I began to realize that many of these time-consuming discussions were just a façade. Whatever there was to be decided had usually already been decided long before. The meetings were skilfully engineered and mainly served the purpose of confirming and rubber-stamping the decisions taken to suit someone else.
The new premises of my department were in excess of 3,000 m2. One of the hundreds of “decisions” that had to be debated, discussed, re-debated and re-discussed was the colour of the walls. I learnt that there are experts who advise you even on such seemingly trivial matters. Some were experts only in charging lots of money, but neither money nor common sense ever seemed to matter. We were told which colours might have what effects on patients and staff. All very interesting, I thought, but let’s just hope the result is aesthetically pleasing. Someone mentioned orange. Certainly not orange, I thought; imagine 3,000 m2 all in bright orange! It’s enough to give us all a headache and turn my workforce into aggressive monsters. Yet, sure enough, for some unimaginable reason this was the colour we got - never mind my protests.
Realizing the futility of these endless pseudo-discussions and sham-meetings, my enthusiasm for hospital planning diminished every bit as quickly as it had emerged. But somehow, all this tedious work had to be done, and eventually we managed to conclude it. On the plus side, I had become something of an expert in hospital design and organization. On the minus side, I had lost one and a half years of my life learning a prodigious number of things that I would never need again.
Finally, we were ready to move into Europe’s largest hospital where we would one day provide a rehabilitation service for more than 2000 in-patients, plus run a whole string of busy out-patient clinics.
The opening of the first clinical department in the New General Hospital was considered something of a milestone in the history of Austria - hardly surprising in view of the almost 100 year-long planning history, the political scandals and the millions that had disappeared without trace. There were speeches from politicians and administrators, and there were photo opportunities, videos, interviews, newspaper and magazine articles - every conceivable kind of publicity.
Weeks before the opening I had started wondering what I might say on this auspicious occasion. Because of the medical school’s proud and venerable tradition, I considered looking into the recent past of my own department with a view to using a historical perspective for my address. This turned out to be a very bad idea.
The history stopped very abruptly in 1938 when the head of rehabilitation medicine had mysteriously vanished from the official records. Whenever I asked questions about this, I was told, cryptically: “These things are better left alone.” “What things?” “You know - 1938 and all that.” Of course, how could I forget? This was the year of the Anschluss, when Hitler’s troops had marched into Austria and forcibly unified it with Germany.
Whenever someone tells me to leave an intriguing subject untouched, I am bound to do the exact opposite, particularly if this advice is accompanied by a certain, somewhat threatening, look. So I began to research deeper and deeper into the Nazi past of my department and the Viennese Medical School. This task took much longer than anticipated - years rather than weeks. Consequently, my opening speech was blissfully devoid of historical allusions and entirely uncontroversial.
Most of the relevant documents from 1938–1945 had disappeared. Many people would repeat the initial warning (or was it a threat?) not to research this area: “Some things are best left alone”, they would whisper conspiratorially in my ear. Each time I heard this phrase, my interest became more acute and my research efforts intensified. What I found would depress me and make my life in Vienna more difficult than it was already gradually becoming. Eventually it would significantly contribute to my decision to leave.
Despite the fact that I am not trained in a historian’s research methods, I felt impelled to finish this research to the best of my ability. Finally, I summarized my findings in an article that was published in the Annals of Internal Medicine in 1994. If someone asked me today what might be the most important paper that I have ever published, I would name this one without hesitation. Here is an extract that captures what happened to the medical faculty in Vienna in 1938.
After 11 March 1938, the date on which Hitler’s troops marched into Austria and the Anschluss (the integration of Austria into Nazi Germany) was completed, the most drastic changes took place at an unprecedented speed. Almost immediately, 153 of the 197 members of the Faculty were sacked... The dean of the Faculty was replaced on 15 March with an outspoken Nazi, Professor Eduard Pernkopf. Later that month, Pernkopf sent a letter to all University staff: “To clarify whether you are of Aryan or non-Aryan descent you are asked to bring your parents’ and grandparents’ birth certificates to the dean’s office no later than the end of April. Married individuals must also bring the documents of their wives”. All professors had to give an oath of loyalty to Hitler, and by 24 March the minister responsible for the University of Vienna had ordered the Faculty to be “cleansed” of Jews and other unwanted persons. On 6 April, the “venia legendi” (license to teach at university) was withdrawn from all “suspects” and, at the beginning of May 1938, Pernkopf submitted to his superiors a list of those of his colleagues who had been unable to take the oath to Hitler.
Little opposition was voiced by colleagues remaining in the Faculty; the whole action was carried out without major disturbances and was obviously both well planned and enthusiastically supported...
...sterilization had already been superseded by euthanasia, which was done mostly in psychiatric institutions; one of the several infamous... sites was the University’s pediatric hospital, where many children were killed. A key person in the killings was Dr. Hans Bertha; he was awarded a professorship from the Faculty in 1945, shortly before the end of the war...
Other atrocities directly related to the Faculty were experiments done on human prisoners at Dachau; these experiments were led by Viennese professors Wilhelm Beigelböck and Hans Eppinger. Under Eppinger’s directorship, Beigelböck was engaged in a project to find out how long humans could survive on seawater. The experiments entailed the torture of many Jews in Dachau. Both professors were discussed during the Nuremberg Trials: Beigelböck was sentenced and Eppinger committed suicide. Pernkopf worked on the publication of an anatomic atlas, which contained material from children killed in a Viennese hospital. His Institute of Anatomy also used the corpses of executed persons for teaching purposes; part of this material is believed to be still in use at the University...
After the end of the war, a law condemning the former Nazi physicians was anticipated but never materialized. It was estimated that the law would have affected most Austrian physicians, which might be the obvious reason for its nonappearance. Of the 200 teaching staff of the Faculty, only 19 were thought not to be burdened by a Nazi past...
At no point did Austrian officials invite back those physicians who had been thrown out in 1938. On the contrary, the new president of the Austrian Medical Association, Dr. Alexander Harwich, wrote to key addresses in London and New York discouraging the emigrants from returning. He reasoned that there were “no Jews left to treat,” that there was “a shortage of housing and work,” and that the Nazi physicians were “unlikely to leave their posts.” Thus, in 1955, only 6 former members of the Faculty had returned. The Österreichishe Ärztezeitung, official organ of the Austrian Medical Association, published a 2-page paper in 1988 to commemorate the 50th anniversary of the events of 1938. They stated that “...of the many University teachers exiled from their home country, only few felt the desire to come back to Vienna following the collapse of the Nazi regime...”
My paper was not published until 1995, by which time I was no longer at the University of Vienna but had left Austria and gone joyfully back to the UK to take up my post at the University of Exeter. When the paper was published it had a considerable impact and important consequences. On the one hand, I received a torrent of hate-mail and threats, and was even accused by the more sensationalistic elements of the Austrian press of having stolen considerable amounts of money from my department at the University of Vienna - an entirely fabricated story, of course, and so ridiculous that I couldn’t even take it seriously enough to instigate legal action.
But, on the other hand, the paper led to a lively worldwide debate, some of which focused on the Pernkopf Atlas, at that time a much-praised standard textbook of anatomy. When it became clear that its original drawings incorporated the Nazi insignia and might even feature dissections of executed victims of Nazi terror, many experts argued that, despite its undoubted artistic and scientific qualities, it should no longer be used. As a result, most libraries across the globe banned it from their shelves.
But, for the time being, all was still well in Vienna. I was busy getting the department organized and hoped to start a new programme of research. The latter turned out to be much more difficult than it should have been. There was enough money, space and manpower to get on with it but absolutely nothing in Viennese academic politics has ever been that straightforward. Most decisions had to be taken by committees, and all university committees had to be composed of one third non-academics, one third junior academics and one third full professors. Because most professors have a plethora of commitments that frequently take them abroad, they were usually under-represented at these meetings. Consequently, decisions were often unwise and shortsighted and usually went against the interests of this most experienced group of experts.
The most lasting and least agreeable memories of my four years in Vienna relate to the uncounted petty but, at times, vicious intrigues that formed the foundational and most extravagantly time-consuming part of academic life at the medical school. The Viennese medical profession had elevated the skill of plotting against one another to something of an art form. Bizarrely, they were even proud of their intrigues as though they were creations of rare beauty, choreographies of diplomacy and politesse rather than exercises in falsification, extortion and back-stabbing.
As my department was expanding very rapidly - we were recruiting a new member of staff almost every other week - I was particularly vulnerable and constantly on the receiving end of these little plots. Some were disarmingly simple - for instance, a colleague might phone me and suggest that the next vacancy to be filled in my department should go to the daughter, son or cousin of an old friend of his. I would naïvely answer that we would always go through a process of short-listing and interviewing and that the best applicant should get the job. “That is absolutely fine, but if the best person is not my friend’s daughter (son, cousin) I will have to make sure that all the 67 outstanding vacancies for your department will be scrapped”, would be the typical reply. By citing the exact figure of posts in the pipeline or some other confidential details, that person would demonstrate that he was very well-informed and connected; his threats were therefore to be taken seriously.
Such petty blackmail was an almost weekly occurrence, and needless to say I found it intensely annoying. I remember when it happened to me for the first time, I was so furious that I told my staff I felt like punching the culprit to relieve the tension. They were so impressed with my reaction that they bought me a punching ball to hang in my office. During the years that followed, I used it regularly to decrease my stress level, but sadly it did not solve the underlying problem of the uninterrupted stream of intrigues that came my way, stole my time and made my life difficult.
The stereotypical Viennese solution to being cornered in this way would have been to instigate a counter-intrigue. For instance, you could consider teaming up with another colleague who owed you a favour from a previous plot. With a bit of luck, he or a friend of his could dish some dirt on the original blackmailer. Subsequently you could let him know, preferably through another middleman, that you had something on him. Finally a deal could be struck whereby the blackmailer abandoned his quest and you would forget about whatever you had learnt about him.
Such “tit for tat” behaviour was going on constantly. I tried my best to stay out of it where I could but, sadly, this was not always possible. As time went on, I inevitably got drawn more and more into this ugly morass. Apart from finding the constant intrigues and counter-intrigues distasteful, primitive and degrading, these activities tended to drag you deeper and deeper into the mud, thus rendering you more and more vulnerable to future attempts at blackmail. And, of course, they were very time-consuming and prevented me from getting on with real work.
On two occasions, I was telephoned by people asking for such a favour who claimed that they were acting on behalf of Kurt Waldheim, the then-president of the republic, who had famously suffered a mysterious case of retrograde amnesia in relation to his own activities during the Nazi era. By that time, weary of these intrigues, I had installed a tape-recorder on my telephone. Recording your telephone calls was illegal in Austria, which I found hilarious, given the pervasiveness of corruption in that culture: if you want to perpetrate some illegal activity, what better way of ensuring that you will not be caught in the act than declaring illegal the most effective means of proving that such an offence had occurred?
But then again, I shouldn’t have been surprised: in a way, Kurt Waldheim was the trump card in Viennese poker games. One day, I was asked to lend my academic support to a strange sort of wellness centre which was run by someone using the title of Professor. When I met the man, I was told he was an old friend of Waldheim. Apparently the friendship had been formed during the war - which might have explained why this man was awarded the title of Professor despite never having been to any university. I was given to understand that giving my support would be much appreciated by Waldheim, which, in turn, would oil the administrative machinery of university life.
Despite the annoyance they caused, I had to admit that some of those intrigues were almost elegant in their own warped, peculiar way. An ambitious doctor from my team wanted to do a PhD - not so much because he was interested in or particularly good at science but because this higher degree was the precondition for eventually progressing towards a full professorship. Unfortunately, his research was of such poor quality that, even with the very best connections, it was unlikely to be deemed sufficient for a PhD. The chair of the committee charged with evaluating the thesis seemed to owe the candidate a favour or two and was therefore willing to close both eyes, hold his nose and pass it regardless of its quality. Yet the work was so poor that the other committee members seemed unwilling to cooperate with his intention. The solution to this problem was, of course, a clever little intrigue: the candidate plotted with the chair to write an anonymous letter to the committee. The letter expressed in no uncertain terms an open threat that, if this dismal research were to be awarded a PhD, the letter-writer would inform the press, thus prompting a public scandal. At the next committee meeting, the chair read out the anonymous letter to the amazed panel. Then he said, “We all know that this thesis is not very good and we are not in the habit of passing shoddy science. But now we have no choice. We cannot succumb to anonymous letters blackmailing us. All things considered, I am afraid, we have to pass the candidate.” After some discussion, our good doctor got his PhD. The general feeling in Vienna later was that, considering the elegance of his double bluff, he had deserved this distinction.
But the truth was that the more I got side-tracked by nonsense of this nature, the less time I had to do any meaningful work, even though heaven knows there would have been plenty to do. We had re-started our research into blood rheology and, in addition, we were conducting clinical trials of various alternative therapies including homeopathy, massage, autogenic training and acupuncture. We also had a fully equipped motion-analysis laboratory and many other hugely expensive pieces of equipment. Money was never in short supply; the sad thing, however, was that, more often than not, it was wasted on would-be-researchers with few skills and even less motivation.
Considering these obstacles, my team did quite well; the findings of our research were reported at conferences and published in good medical journals. We also took it upon ourselves to organize numerous international conferences. During my four years in Vienna, we managed to convene well over a dozen scientific meetings. In addition, I had founded my second medical journal - The European Journal of Physical Medicine and Rehabilitation.
Then there was the task of teaching. As one of the largest departments of the medical school, we were expected to pull our weight and run a full programme of lectures. Oddly enough, medical students in Vienna rarely attended courses. But this little detail was irrelevant; the lectures had to go ahead, students or no students. In addition, our own staff needed to be instructed in a variety of areas: research methodology, critical thinking, clinical skills, etc.
By far the biggest part of my job, however, was to ensure a smoothly running clinical service to the rest of the 2000-bed hospital. For this purpose, we eventually employed around 100 therapists, mainly physiotherapists, occupational therapists and massage therapists. In addition, we ran several busy out-patient clinics including those for musculoskeletal conditions, stroke, cardiovascular problems, etc. Close to my heart, we even started one specifically for treating the complex health problems of the many musicians in Vienna. (The town is full of musicians who frequently suffer from work-related illnesses due to the often extreme stress that is endemic in this profession.) If nothing else, this activity provided us with an ample supply of free tickets for usually superb concerts.
To say I was busy would be an understatement. Far too busy, I felt, to start earning piles of extra money by attending patients on the Golden Mile, although I was invited several times to do such private work. This was, of course, tempting - after all, I had been told that this is where all full professors earned their money. Yet I repeatedly declined to go down this route. My decision was puzzling to many observers. Whenever asked why I would not follow the example of my colleagues, I replied that, in my view, the duties of a professor would take a hundred per cent of his time. This, of course, implied that my colleagues, who would regularly desert the university premises around lunchtime, were not doing their job properly. I imagine that such a statement did not endear me to them and suspect that gradually I was perceived as an outsider - and a potentially dangerous one - who would not play along the time-tested lines which had served everyone so very nicely for so long.
Superficially, the atmosphere amongst the 400 or so professorial colleagues was mostly cordial, but beneath the surface it was often guarded and somewhat tense. The reason, of course, was that everyone had to constantly watch his or her own back. One never quite knew whether a “kindly chat” over a cup of coffee was what it appeared to be, or whether it was an attempt to learn a few valuable details that would soon be used profitably to start a new intrigue.
I remember being invited to dinner at a colleague’s home. “Very informal”, he had stressed. Arriving slightly late for the occasion, I saw a room full of professors all dressed in black tie. “Informal, my foot”, I thought, darkly. As I looked around, nobody returned my smile. They clearly did not approve of my distinctly casual outfit. Finally a gentleman, dressed like all the others in a black dinner jacket, caught my eye in a friendly welcoming manner. I made my way towards him hoping to have found someone to talk to, shook his hand enthusiastically and introduced myself. To my surprise he answered, “I am pleased to meet you too, and what can I get you to drink?” I had just introduced myself to the waiter hired to serve us that evening.
Social life in Vienna was often tricky. Danielle and I were invited frequently but, more often than not, only to discover that such invitations had a hidden agenda. Usually our host wanted a favour, or he wanted to enlist my participation in some elaborate plot against another colleague. Almost invariably, people were irritatingly self-important. The Germans are by no means the least pompous people in the world, so I was well used to this sort of thing, yet when it comes to pomposity the Austrians are capable of out-doing the Germans any time.
As I had the only chair of Rehabilitation Medicine in the country, the officers of the Austrian Society of Rehabilitation Medicine - not an internationally important organization by any means - were keen to get me involved in their activities. I was wined and dined by them, flattered and courted. I noticed with disbelief that they addressed their current chair as “Herr President”, and with even greater incredulity that he seemed to enjoy being addressed by this ponderous title. When they had decided that I should be their next leader, I politely but firmly declined the invitation. I did not think that I would have been able keep a straight face being called Herr President.
Even though I seemed most of the time to be swimming strenuously against the tide, the first two years in Vienna were by no means all bad. They certainly brought some successes on a professional level. I had managed to set up a well-organized system that rendered an efficient service to the fast-growing number of patients in the new hospital. As the other departments of the medical school moved into the new building, our workload, and with it our staff, grew rapidly. I was proud to have coped with all these organizational and administrative tasks, and besides, I had learned many new skills that might one day come in handy. But that said, after about two years the excitement of the new challenge had palled and I found that I had begun to settle into a rather repetitive routine.
Throughout my life, I have found the experience of any type of routine a rather dangerous thing. To me, routine is the enemy of innovation and more often than not turns out to be the predecessor of boredom. My daily work increasingly became that of an administrator. I had always disliked administrative work and remained more than a little suspicious of administrators. In the setting of a medical school, administrators tend to forget that their remit should be to facilitate the work of the doctors, scientists and other health professionals. Yet, all too often, they seem to think that it should work the opposite way: everyone else should bend to their demands and work towards their purpose. In Vienna, administration became the dominant feature of my professional life - and inexorably I felt myself beginning to get frustrated with it.
In the recent past, I had oscillated between my role as a clinician and that of a scientist and had tried to achieve a balance between the two. Now I found myself increasingly hijacked by administrative demands. I had plenty of responsibility but less and less occasion to do what I would call “real” work. Somewhat to my surprise, I missed my research more than I missed the clinical practice. Several attempts to return more actively to research were blocked by not allowing us more laboratory space. The medical faculty had hired me primarily because of my scientific credentials but now they foremost wanted me to administer a smooth-running service and leave the science to other departments. But for many of my colleagues, science was not so much a calling or an urge to solve medical questions as it was a means to acquire gravitas, to varnish their curricula vitae and present themselves in a more prestigious light.
The way I saw it, I could either accept what I had on my plate and do my best to survive the game of endless intrigues and boring administration, or I could chuck it all in and start afresh elsewhere. Trusted friends with whom I discussed my situation unanimously agreed: it would be foolish to throw all this away. “Stay where you are, make the best of it. Change the system from within.” This sounded entirely reasonable, but I doubted that I would be able to accomplish that task. The system was entrenched and all-powerful: if I stayed in Vienna, I would not succeed in changing the system. Instead, the system would slowly but inexorably change me.
This was a truly frightening thought. I did not want to become like the people whom I had gradually come to despise. Luckily I had Danielle: I could always discuss these issues with her, and she always understood me completely. I was only 42 - far too young to bury my dreams. For all that staying in Vienna offered me, the chance of earning loads of money and leading a life of luxury, to continue living this way would be like being locked in a golden cage. We both decided that this was not for us.
But the golden cage was locked rather more firmly than we had anticipated. Indeed, it seemed impossible to escape from it. As far as I could ascertain, none of my colleagues at the level of full professor had ever managed to voluntarily leave their position: the only exceptions were the Jewish professors who left the faculty in 1938, and they certainly had not done so voluntarily. As time passed, my frustration with this situation began to grow into desperation.
On the professional level, my particular concern was that we were unable to conduct more research. In rehabilitation medicine we used many treatments that had never been properly evaluated. Quite a few of the routinely used treatments would be considered alternative medicine in other countries: spinal manipulation, massage therapy, relaxation techniques or acupuncture, for instance. Evidence-based medicine was still an alien concept in this field. It was obvious to me that, if these treatments were to continue being widely used, they must first be shown to have a scientifically sound underpinning. I made many attempts to get this idea across, for instance, within the Austrian Society of Rehabilitation Medicine or my own medical faculty, and to be fair several research projects did eventually take off as a result of my lobbying. Yet I often suspected that they were conducted for the wrong reasons: people seemed to feel that “a bit of research” might be helpful for their attempts to climb up a few decisive steps on the career ladder. This type of motivation for conducting research seemed endemic in Vienna. To employ science principally in the service of self-advancement invites all sorts of problems, ranging from mediocrity to outright fraud. The only sound motivation to pursue research is the wish to find the truth regardless of where it may lead.
* * *
Danielle and I had always loved England - understandably perhaps, after all, this was where we had first met and this is where we once had been so very happy. Indeed, during our time in Munich, we had even bought a little holiday cottage in East Anglia. This is where we now tended to retreat to whenever the frustration with Vienna became difficult to bear. We talked and dreamed endlessly about going back to England, not just as tourists and solace-seekers but permanently, as residents, living and working there, making a life together in that peaceable environment which we remembered so well from our London days; an environment where outward appearances were unimportant and eccentricity raised no eyebrows.
One day in 1992, when Danielle had already gone ahead to prepare the cottage for a holiday and I was therefore left alone in Vienna, I saw the following advertisement in The New Scientist.
It seemed tailor made for me. Here was an opportunity to bring the skills of a scientist to bear on an area of medicine that at that time had scarcely seen any serious research. All the disparate paths I had taken during my professional life seemed to converge here.
At this stage, I had been quietly working on research into alternative medicine for some time. My main research interest was still blood rheology but every now and then the many research questions that had been raised during my time at the homeopathic hospital came back to me. Whenever I had the opportunity during the years that followed, I had tried to address some of them. In this way, I had accumulated a small portfolio of around 30 research articles related to alternative medicine - a modest portfolio compared to my publications in other areas, maybe, but still a good start. I instantly phoned Danielle in Suffolk and we discussed the possibility animatedly. There was no hesitation whatsoever: I simply had to apply.
When, a few weeks later, an invitation to attend an interview arrived, Danielle and I were as excited as little children. I suspected that my chances were slim; most likely the post had already been earmarked for someone else. I knew only too well that this is often the case in academia, and somehow the Exeter post looked as though the race had been decided before the starting shot had been fired. Yet, if nothing else, this was going to be an interesting trip to a part of England that we did not know well.
The vetting process for the Exeter post was a very British affair. It started in the late afternoon with a sherry party and plenty of small talk with a confusing array of people in pinstriped suits. All the short-listed candidates, the entire interview panel and several other luminaries of Exeter had been invited. In the evening, there was a semi-formal dinner along similar lines. It made me smile to think that the British equivalent of the ponderous system of public lectures that characterized the Austrian vetting procedure was merely an informal chit-chat.
Next morning, there were interviews for each candidate. Mine lasted less than an hour. Each of the panel members asked one or two questions. The panel consisted of about eight senior university staff and two external advisors, both of whom were physicians: one was a former Surgeon General of the British Navy and the other one was the Queen’s homeopath.
My fears had been correct: the post had indeed been earmarked for one particular candidate. The panel, however, seemed pleasantly surprised by my application. None of the other candidates had previously occupied a senior position and none had extensive experience in basic and clinical research as well as in clinical medicine and teaching. I had been in two professorial posts in two different countries and had conducted research in a number of different medical fields. In addition, I was a clinician as well as a scientist. Finally, I had hands-on experience with several alternative therapies both as a practitioner as well as an investigator.
To my delight, the panel felt that I was a serious contender, but at the same time they appeared mystified by my wish to leave my current prestigious and far superior post in Vienna. Their suspicion was, as I learnt later, that I merely wanted to secure the University of Exeter job offer in order to re-negotiate the terms of my current position in Vienna. This sort of thing does happen quite regularly in academia, and there was a chance that I was playing this game too. For several months, the University thus continued to negotiate both with me and with the candidate who had previously been their favourite. I also met Sir Maurice Laing, who had endowed the chair, and made further visits to Exeter. At one stage, the Exeter Vice-Chancellor even phoned Danielle in Vienna: “Are you sure you and your husband want to move to Exeter?”, he asked her. “Quite sure”, she replied. Eventually, after an agonizing wait, the appointment panel was able to reach a decision: they offered me the job.
The door of the golden cage had been opened. Jubilant, unable to believe our good fortune, we fled.