Kypros Nicolaidis in “K”: I cannot be a cardboard doctor

His father, Herodotus Nicolaides, was a doctor. He studied in Greece during the interwar years, returned to Cyprus, bought a donkey (there were only a few roads on the island at that time) and wandered around the villages. “At a time when antibiotics had not yet been discovered, he would often, in serious cases, stay in patients’ homes so that he could monitor the progress of their health condition and intervene in the best possible way. If the patient died, go to his funeral. If he had been alive, he would have participated.” At the feast held by the villagers in honor of the scientist he saved. Then he was returning home. I grew up with stories like this. And even though I wasn't particularly interested in medicine, there was never a dilemma about doing something else. It's all I wanted, after all One thing, is to look like him…”

It is Sunday morning and we are drinking coffee together, he is at his home in the British capital, in the background are two paintings by the painter Xanthos Sotirio, and I am in Athens (Zoom companion, gar). the Cyprus NicolaidesThe world-famous Cypriot professor of fetal medicine at King's College London, the “father” of cervical translucency, that is, a diagnostic method that contributes to the early detection of genetic mutations associated with Down syndrome, was transferred. I can see his wet look on my computer screen. “So, after I finished high school, I left to study in England. Which was paradoxical, given our family history…”

– Why do you say that? Where does the contradiction lie?

– I'll explain. I was born in Paphos in 1953, when Cyprus was a British colony and we were demanding our liberation and union with Greece. My father was one of the leaders of the National Organization of Cypriot Athletes (EOKA). I was two years old when English soldiers came to our house one night and arrested him. I shouted when I was very young: Long live Greece, long live Makarios, long live the union. For the next four years, my mother and I would take those “old” buses from Paphos – from which I distinctly remember the smell of vomit – and go to the Kokinotrimithia concentration camp, to visit. We always saw him behind barbed wire and behind thick glass. On the day of his release, hundreds of people were waiting for him in our city. I was afraid to see this “gentleman” who was my father and I didn't know what to do. I wanted to touch him but I didn't dare. So, when, when I was 14, my parents decided to send me to an English school in Nicosia, I couldn't understand why. Did he entrust his son's education to those who imprisoned him?

– Have you ever discussed the matter with him?

– no. But when he died, I got hold of his diary, in which he recorded the amount of torture he had been subjected to in prison, how worried he was about his family and his work, as well as a letter from him to the British governor. He wrote to him: “I am not against you.” “I believe in British democracy, and that is exactly why I want you to leave Cyprus, so that my country can also have a democratic state.”

– In Britain, where you studied, when and how did you decide to switch to fetal medicine?

– I arrived in London at a time when the world was “boiling.” In Chile, Pinochet overthrew the democratically elected Salvador Allende, the “democratic” United States imposed dictatorships in Latin America and the West, the “democratic” Soviet Union did the same in the so-called Eastern Bloc countries, Margaret Thatcher invited the terrorist Nelson Mandela as president of Cypriot students, I led marches And demonstrations, and I only cared about political conflicts, and I went to school in the last months of each year, as much as I needed to pass the classes. Until one day a new professor came to King's College, Stuart Campbell, a student of the great Scottish physician Ian Donald, who introduced the use of ultrasound in obstetrics and gynecology. In the speech he gave after assuming his chair, he spoke to us about the horizons that were opening up in this scientific branch. He also showed us the ultrasound of the fetuses. That moment, as often happens in life, proved enough for me to decide that this was what I wanted to do. You've got a purpose! I asked him to join his team. I had a thousand questions: what is the relationship of the fetus to the mother, how does it grow, how is it nourished, whose side should I be in case of a “conflict of interest”? What I was seeing was unprecedented and exciting. More than forty years have passed and I remain committed to fetal medicine. No weekends, no holidays, no vacations.

I am always with women. For example, if a fetus is diagnosed with Down Syndrome, I fully support the pregnant woman who decides to terminate the pregnancy, as do those who choose to give birth.

– Which side are you really on, if a “conflict of interest” arises?

-I am always with women. For example, if a fetus is diagnosed with Down Syndrome, I fully support the pregnant woman who decides to terminate the pregnancy and the same as the woman who chooses to give birth to that child. This happens very often, as you know, in England the rate exceeds 30%, that is, one in three women decides to keep a child with this syndrome. I am not a god to decide on behalf of women, nor do I have the right to judge the moral values ​​of my fellow human beings.

-So, I understand that in addition to the purely medical aspect, your work also requires skills in the psychological aspect…

– In reality. In recent years, our students have been trained to be as “professional” as possible, to keep their distance, and not to express their feelings, as if they were made of cardboard. I can't be like this. If I told a woman that the fetus she was carrying had died and she broke down crying, I would hug her to comfort her even if I risked being accused of sexual harassment – you know, these things happen sometimes in this day and age. …

-What are the most important stations in your research?

– In the early years, in the 1980s, our research focused on describing how fetuses develop, how to detect any abnormalities early and how to intervene, whenever possible, to save babies. Our first procedure was a fetal blood transfusion. When the mother's blood type is negative (occurs in 10%) and the fetus's blood type is positive, the pregnant woman's antibodies transferred through the placenta destroy the blood of the fetus, which dies of anemia. The problem in my mind was a simple equation: I started inserting needles into the umbilical cord and giving blood to the fetus every few weeks. More than 95% of these children were born healthy. Or we saw through ultrasound that fluids accumulated, for example, in the lungs of fetuses, which prevented them from growing normally, and children died immediately after their birth due to suffocation. Again, I removed the pleural fluid with needles, but it was accumulating again. So we made plastic tubes that allow the lungs to grow as they should. In 1992, we performed the first laparoscopic laser surgery on identical twins who shared common blood vessels in the placenta and from one fetus bleeding into the other. We've also dealt with hiatal hernia, which allows one or more abdominal organs, usually the intestines and liver, to move toward the fetus's chest and occupy the space where the lungs would normally be. By having balloons in the trachea, we prevented the development of this phenomenon. Today, a common operation is the treatment of myelomeningocele: when the spinal cord is exposed, through a “hole” in the spine, the result is partial or complete paralysis of the lower extremities and mental retardation of the child to be born. In these cases, we enter the uterus laparoscopically and cover this gap. This method reduces the proportion of children with loss of mobility, but again, some will have serious problems. However, some mothers decide to bring them into the world. This is one of the ethical issues that concerns me.

My team and I have focused on anemia in the Mediterranean region, and in the next few years we may be able to make those genetic changes that will prevent it from occurring. If I live…

-Which of these contracts do you miss the most?

– Probably 1990. Our clinic at King’s College became a mecca for fetal medicine. Young doctors came from all over the world to work with me and learn alongside me. This is something that still excites me, I enjoy interacting with new people who are full of ideas and passion. Most of them returned to their countries, transferred their knowledge and established specialized centers there. Some people told me: “Don't be naive to learn business secrets from others.” If I get to the point where I don't have new ideas, so be it, I replied. The important thing is that we helped save hundreds of thousands of children.

Medicine taught me that women are much better than men

– What can we expect in the future?

– Genetic interventions to treat a series of genetic abnormalities. My team and I have focused on anemia in the Mediterranean region, and in the next few years we may be able to make those genetic changes that will prevent it from occurring. If I live…

Your health problem has not disappeared.

– When I found out that I had multiple myeloma and started reading about it (where can I remember what I learned in school, it has changed so much after all), I saw that the average survival time was three years and I said: Cyprus, I understand, This was it. Until then I had the illusion that I was immortal. It was the fall of 2020. I didn't stop working for a single day. what should be done; Should I lock myself in my house and wait to die? of course not. The disease is starting to regress, I am continuing chemotherapy and hope everything goes well.

– Are you visiting Cyprus?

-I'm going to Paphos. However, I don't feel well. A huge apartment building has been built in place of my parents' house, and on the beach I see hotels and bars with names like “Hawaii” or “Miami.” I like to go to my grandfather's village cemetery and wander among the graves, because I see pictures of people I knew when I was a child. I'm still proud of my origin, I have friends in Cyprus, I love it but it's better from a distance.

– What have you learned about people and yourself through medicine, Mr. Nicolaides?

-I learned the power of women. You are far superior to us, many men today even at the age of 40 are immature, you from the age of 15 know exactly what you want to do. As for myself, I learned that medicine is about respect, love, and caring for the patient, not just knowledge. It is a job and I will serve it until I die.