Reminiscences
Ivan
Ciric
Read before the Chicago Literary
Club
October 14, 2013
© Ivan Ciric 2013 in all media
On
a windswept timeworn hill
Where
flowers and the rainbow are one,
Generations
of good and generous people
Have
come to rest in eternity
Eternity,
as in the ageless river flow
And
the rustling of poplar trees in the waning summer breeze,
Eternity,
as in the morning sunshine rays
Caressing
the chiseled stones into a sea of diamonds
Alas,
sorrow and sadness have descended on this serene place,
For
the nest in the valley, where my ancestors loved and cherished,
Is
empty and cold
And
covered with dust, weed and guilt
And
then, a miracle at last,
The
souls on the hill are rejoicing in glory,
For
there is life, reborn, in a new nest,
Truly,
a loving God’s redeeming story
The
founder of modern neurosurgery, Boston
patrician Dr. Harvey Cushing, once said that “the controlling sub-consciousness
of our upbringing is something from which time and distance can never wholly
wean us”. Surely, our past leaves a permanent mark on who we are and how we
conduct our lives. And so, after many twists and turns in our lives the time
comes to reflect on the milestones past. To recollect our past is not easy, for
memories fade with the passage of time. Memories also kindle ever new
colorations surrounding an impressionable event that thus grows or can be
diminished in stature. In Search of Lost
Time Proust warns that “it is a labor in vain to attempt to re-capture our
own past, for all the efforts of our intellect must prove futile”. With due
respect for Proust’s admonition, I shall nevertheless forge ahead and continue
with this discourse. I must make sure though that my story does not decay into
a self-congratulatory Horatio Alger slobbering saga or for that matter, become
a thin veiled self-deprecating tale. In short, I shall attempt the impossible
task of being unbiased.
The
region in the Balkans I hail from has a rich ethnic heritage, a true melting
pot, if there ever was one. From the ancient Celtic people, followed by the
Roman legions that marched through the area on cobbled stone roads, paved for
them by the Empire and so durable that some of them are still in use, to the
hordes of Huns that briefly swept through the Balkans under Attila in the 5th Century
and the Slavic tribes, including my Serbian people, who settled in the Balkans
in the 7th Century, all have left a DNA footprint and a legacy of customs and
beliefs. It was in the 9th Century that missionary brothers Sts. Cyril and
Methodius brought Christianity to the Slavs. This was also the beginning of
centuries old discord, as the Croats and Slovenes accepted the Roman Catholic
Latin mass while the Bulgarians, Macedonians Montenegrins and the Serbs
received their baptism in the Eastern Orthodox rites. After establishing a
thriving state over several centuries in the central and southern part of the
Balkans, culminating with the sprawling empire of Czar Dusan in the early 14th
Century, the Serbs were among the first to challenge the
Karlovci
is a picturesque town of about 7000 souls on the south bank of the Danube some
50 miles north of
As
the whims of life would have it, I cannot claim to have been born in a log
cabin, let alone to have helped my father build one. Truth be said, I was not
born with a silver spoon in my mouth either; more like with an antique, rusted,
silver plated spoon. My father was a high school teacher, also a spell binding
story teller and orator who captivated his audiences not only with his
eloquence, but also, in great measure, with his clearly conceived message
always backed by a large repository of facts that his gargantuan memory easily
retrieved as needed from wherever it may be stored in the brains of such gifted
people. No wonder he was also a national chess master! I suppose it was his
reputation as a man of truth and dignity, also his oratory, and his own desire
to promote parliamentary democracy at a time when the newly created state of
Yugoslavia was teetering on the brink of ethnic unrests, in response to the
ever greater assertion of power by the Yugoslav king Alexander, that my father
was elected Congressman from our district in 1929, only to ascend to the
Speaker’s chair shortly thereafter.
It
was on a sunny spring day in April of 1941 that the Ciric family life changed
abruptly. This was the day when our town surrendered to the mighty Wehrmacht.
Within a few days the local Croatian Nazis, the dreaded Ustasha, took control
of the town and came at dusk to arrest my father who was taken to the infamous
concentration camp at Jadovno. My father survived albeit as a broken man.
We
do not talk much about this in the Ciric family, as if silence would heal when
it only ignores the pain. It is true that depression can be genetically
predisposed. It is also true, however, that the reversals of fortunes in life,
the vicissitudes of life so abundant after 4 years of a hideous war followed by
the harshness of the communist regime with its sordid demagoguery, false
accusations and sheer oppression can influence adversely family relationships
and thus bring terror and inconsolable grief to a fragile soul. It was on a
relatively mild wintry day in February of 1951 that my sister, an architecture
student, was found next to the rail tracks just south of town. My father passed
a few short years later. Having lost her child, my mother opened the doors to
our home to all who sought love, comfort and solace, which they found in
abundance on her shoulders. As for me and my siblings, our sister’s abdication
of life has left us with lingering questions in an unanswered search for
closure.
With
no special proclivity toward biological sciences, the choice of a life in
medicine was largely influenced by my fond memories and admiration for our town
physician, a Chekhov like character with his pale blue eyes twinkling behind a
pince-nez, clad in a white linen suit and with a boater covering his baldness
in the heat of summer. He will always remain my hero not only as a healer, for
he saved my life when I contracted diphtheria as a 9 year old lad, but also as
a humble man of infinite kindness and honesty who perished along with other
Serbs, Jews and Romas in another Ustasha concentration camp at Jasenovac.
In
Denied
specialization by the Communist Party dominated university administration, I
decided to give it a try abroad. It was
through sheer serendipity that I first landed in the lion’s den of a general
surgeon, a brute and a surgical genius, in
In
pursuit of my professional goal I subsequently obtained the position as a
fellow resident at the Max Planck Brain Research Institute attached to the
Neurosurgical Clinic in
Most
Americans, save for those who call this continent their ancestral land, have a
unique story to tell of ancestors coming to these shores. These may be stories of
religious persecution and pious pilgrimage as set forth in William Bradford’s
account Of Plymouth Plantation, or stories of ethnic torment as rendered in
Mary Antin’s masterpiece The Promised Land. These could also be chronicles of
poverty, even hunger, that drove thousands to seek a new life in this country,
or they may be narratives of a pioneering spirit and even of a restless
adventurism. Let us also never forget
those who were brought to the
It
was on a crisp morning in May of 1963, as the vastness of heavens over this
magnificent city began to pale with the sun rising over the glittering lake
that I stepped out of the hotel on my way to the
Soon,
Dr. Bucy came in, as if flying, with his lab coat unfurled behind him and with
his residents and students following in his wake. Dr. Bucy was a man of
presence, albeit short in stature for which he compensated with an erect,
self-assured, yet dignified posture. His exquisite diction and graceful fluency
of speech, delivered in a sonorous voice, and his steely blue-grey eyes gazing
straight at whomever he may be addressing, immediately commanded attention and
respect without demanding it, a trait so unique to individuals with leadership
qualities. I was certainly in awe of this man for I knew that he had received
every honor Neurosurgery can bestow on one of its own. Besides being a surgical
and academic mentor of immense prowess, Dr. Bucy also guided his residents on the
new and unchartered path of neurosurgical ethics with its varied aspects,
especially the respect for the life with dignity. Looking back, I am inclined
to think that Dr. Bucy endowed his residents with solid academic and surgical
foundations so that they were capable, long after his passing, of excelling in
the subspecialty areas he did not teach them. I also had a number of other
distinguished preceptors during my training in Chicago to whom I owe a sense of
gratitude, but none measured up to or had the stature of Paul Bucy.
Upon
completion of my residency, my future associate in the practice of neurosurgery
at the Evanston Hospital, Dr. Joe Tarkington, a terrific surgeon and a plain
spoken man whose language today would not pass the muster of a half decent
human resources department, suggested that I embark on a fellowship in surgery
for Parkinson’s disease. The fellowship was to be under Dr. Claude Bertrand at
the
To
say that perceptions and attitudes as they relate to Neurosurgery and
neurosurgeons have changed since I began practicing would be the understatement
of the year. At that time Neurosurgery was a specialty in evolution and the
results were not always stellar. It is not surprising that the first day on the
job I was asked by the chief of Anesthesia, a taciturn former marine, …”hey
Ciric, do you know the difference between a neurosurgeon and a Mack
truck?” I responded meekly…” no Sir I do not”, upon which he retorted without
batting an eye lash…”well son, people occasionally survive being hit by a Mack
truck”. Of course, I chuckled in deference to the marine anesthesiologist, all
the while thinking that there must be plenty of room for improvement. And so it
was. Over the ensuing close to half a century I was fortunate to ride the crest
of the cutting edge of an extraordinary progress of our specialty. Permit me to
highlight but a few among the many significant advancements.
The
discovery that the magnetic field that swirls around each and every one of us
can be used to generate images of our brain anatomy and pathology with an
astounding resolution and precision, was a quantum leap innovation. Further
fine tooling of the MRI technology has made it also possible to image function.
With the advent of the functional MRI neurosurgeons can today pinpoint and thus
avoid eloquent speech areas that contrary to previous thinking can actually
vary considerably in location between individuals. Moreover, using advanced MRI
technology neurosurgeons have also identified structural and functional
abnormalities in conditions such as the Parkinson’s disease and epilepsy, the
OCD, bipolar disease, even anorexia and compulsive obesity. These disorders have thus become additional
targets for neurosurgical interventions in the realm of functional
neurosurgery.
Another
important innovation was the development of the MRI based intracranial
navigation techniques. At the beginning of my neurosurgical career the approach
to an intracranial lesion was based principally on the neurosurgeon’s
subjective three D perception of the two D imaging studies. Consequently, when
operating in the depth of the brain, as for example in search for a small
tumor, even the most experienced neurosurgeon would on occasion miss the mark
requiring a greater degree of potentially destructive dissection in order to
find and remove the lesion. Today, neurosurgeons can approach and remove a deep
seated tumor with the precision equaling that of a celestial navigation.
Moreover,
in a continuous quest for less invasiveness, less pain, more safety, less down
time and decreased cost, novel non- or only minimally invasive treatment
techniques are being introduced with increasing frequency. Among many such
procedures the stereotactic radio-surgery (“Gamma Knife”) for a variety of
intra-cranial pathologies, the endovascular occlusion of cerebral aneurysms and
an array of minimally invasive operations for spinal disorders have become the
standard of care under appropriate circumstances.
Clearly,
Neurosurgery is a specialty in evolution with no end in sight.
And
yet, in spite of this riveting progress Neurosurgery is still a very personal
human endeavor. The outcome of a neurosurgical procedure is dependent not only
on the absolute precision in the execution of a neurosurgical task at hand, but
also on deriving beforehand at a correct diagnosis and on formulating a sound,
anatomically based and humanly tailored treatment strategy. Neurosurgeons
surely remember with exhilarating gratification, even thrill, the patients
whose life they changed for better: the woman near death from a ruptured
aneurysm whose life was saved and function restored, the patient with a spinal
tumor who could walk again, the visually impaired from a pituitary tumor who
could see again, the suffering one who became pain-free and many others. At the
same time neurosurgeons most certainly also do remember, with utmost humility
and a lifelong crestfallen contrition, the occasional patient whom they failed
and whose life was therefore left for worse. Indeed, the fine line that
separates the life with dignity from the iatrogenic devastation of humanity in
neurosurgeons’ hands remains incredibly thin. It is no wonder that when faced
with a neurosurgical procedure a cascade of emotions floods the neurosurgeon’s
soul. While my literary ability would never do justice to the breadth and depth
of these emotions I shall nevertheless attempt to share them with you with
these closing words:
When
faced with illness and despair,
For
the frail woman our heart cannot but weep,
And
yet, our mind is resolute and science fair,
While
our soul begins to soar and leap
With
the challenge all too tempting,
And
yes, with humility of battles past,
We
are determined to vanquish the miserable suffering,
As
we evoke Hippocrates and ask our God not to fail
And
here we are, lancet in hand,
Ready
and energized, yet not without fear,
For
we are expected to wave the magic wand,
As
the waiting family and child pray and shed a tear
With
craftsman’s tools we enter the pantheon of humankind,
Our
senses heightened and bright,
The
masked, muffled chatter not to mind,
We
labor under the microscope light
As
the grey curtain falls the mystery of life is bared,
We
admire our maker’s glowing art, in awe and alone:
Here,
careful, the memory’s lair
And
there, the poet’s Blarney Stone
Two
careful and gentle steps forward
We
advance along the red river of life,
Hold
it, take one step backward,
Whispers
the honed instinct with a bit of strife
Deeper
and more perilous we venture,
As
we approach the devil incarnate,
Life
or death can be this mother’s future,
Even
worse, neither life nor death
With
disregard for all but the human,
Our
heartbeat slower and our soul fuller,
We
remember the teaching of our shaman,
And
so, finally, with steady hand we conquer
The
retreat is full of hope and measured,
Since
attention to detail, we were told,
Is
where the ugly error finds its end,
So
we can rejoice out there in the family fold
Alleluia
sing the angels in our heart,
As
we bid adieu to science, craft and art,
For
it is the little one’s hug and kiss
That
is every neurosurgeon’s heavenly bliss
Notes:
Development
of Pituitary Surgery: The
Jadovno,
Slana i Metajna – Google Search: Jadovno-Slana-Metajna
www.jadovno.com/jadovno-slana-metajna
Jasenovac
– Google Search: