Close to the Sun

by Stuart Jamieson

  We talked over lunch. Moossa asked about Minnesota, and I asked about San Diego. Heart surgery is the driving force in a surgery program, because of the money it generates, and because of the high visibility of a successful cardiac unit. Moossa was eager to build the cardiac program in San Diego. I liked him. He seemed like a straight shooter. He told me everyone called him Babs. Moossa was born in Mauritius and spoke with a French accent. He had trained in England, just as I had, but he understood that political infighting that was more common in academic surgery in the United States. He said that what we did was a “a contact sport.” Moossa had spoken to one of the reviewers who’d investigated me in Minneapolis, and who had recommended that I not be reinstated there. Apparently, this same person told Moossa that he should hire me.

  Moossa said his main problem at UCSD was outside competition. I’d heard that one before, but I listened and tried to keep an open mind. Moossa’s chief of cardiac surgery was a man named Pat Daily. I’d heard of him. He’d been at Stanford about ten years before my time. Having trained with Shumway, he was a good surgeon. Daily left Stanford for San Diego in 1973, when there was no significant competition there, and established himself as the top heart surgeon in town. But Daily had divided loyalties. He had a thriving private practice outside the university, at Sharp Memorial Hospital. This was in direct competition with his practice at the university. The clinical chief of cardiology at UCSD, who was Daily’s age and a friend of his, also saw patients at Sharp. Many patients with insurance, after being first seen at the university, ended up having their surgery at the private hospital. That left the university cardiac unit mainly with children, and adults who had no money or insurance. This was not sustainable. Worst of all, when Daily started a program in heart transplantation in San Diego in 1986, he did it at Sharp Hospital, not at the university, which would have been the obvious choice. Moossa had no doubt which institution Daily preferred. He earned a great deal of money at Sharp while keeping his smaller but steady salary at the university. Moossa told me he wanted to bring all this to an end. That meant finding a chief of heart surgery who would be dedicated to UCSD and who could grow its practice and expand it to include heart-and-lung transplantation.

  This sounded good. San Diego might be the right place to start over—and to bring along important members of my team. As it stood, I felt that I’d left them in an untenable position.

  Moossa proceeded methodically, still careful to keep a lid on our negotiations. After our initial meeting in Chicago, he asked me to fly to the Los Angeles airport, where I had lunch with him and Michael Stringer, the CEO of the UCSD hospital. Later, I met again with Moossa and the chief of medicine at UCSD, Steve Wasserman, in San Francisco. Moossa then asked if he and Mike Stringer could come to Minneapolis. He wanted to interview my staff at the university himself, with Stringer present. I said that he could meet with whomever he wanted and asked him to send me a list of the people he wanted to see, which he did. Moossa wanted to interview the operating room nurses, the other nurses who worked directly for me, all of my surgical staff, plus all the cardiologists and pulmonologists. These were the people I’d urged the review committee to talk to if they really wanted to know what was going on in the cardiac unit. I arranged everything and reserved a suite for Moossa at a Minneapolis hotel for the interviews. I met Moossa and Stringer at the airport in January. Stringer, who had never been out of Southern California before, arrived in shirtsleeves. It was minus 30 degrees outside. I had to lend him my overcoat.

  The meetings went on for two days. Moossa and Stringer must have interviewed forty people. In the end, they went home satisfied that I was their man. The next step was for me to meet with Gerry Burrow, the dean at UCSD, and Richard Atkinson, the chancellor. I had some conditions before we went any further: I wanted to bring my transplant coordinators, Ann Hayden and Becky Robert; the chief of my laboratory, Michael Kaye, who also edited the Journal of Heart and Lung Transplantation and maintained the International Registry of Heart and Lung Transplants; plus two surgeons—Jolene Kriett and Riyad Tarazi.

  I stayed in La Jolla, at the historic La Valencia Hotel. At breakfast one morning, the waiter, who was from Mexico, looked perplexed. I asked him if anything was wrong. He said he didn’t know what to make of the strange white substance on his windshield when he gotten into his car that morning. I realized he had never seen frost before. I took it as a sign that this was the place for me.

  Moossa and I talked about salaries, office space, and laboratory support. A nonnegotiable condition was that I be allowed to build a cardiovascular center at the university. All of this was agreed to—though the money was a problem at first. The dean told Moossa that the salaries I had requested were impossible. I would be being paid more than anyone at the university ever had been. I told them that if they wanted the best surgeons in the world, they would have to pay the going rate. Finally, the dean acquiesced.

  There was no written agreement, no contract. I remembered how worthless Najarian’s letter promising me everything in Minnesota had turned out to be. We shook hands, and that was it. I have never had cause to regret my decision in the nearly three decades since I made it.

  It was not all plain sailing. Najarian—who despite his tender ego was powerfully connected—phoned Moossa and promised to make things difficult for him if he hired me. Najarian hadn’t merely wanted me gone—he wanted to bury me. Moossa ignored the threat. Then three senior professors in San Diego threatened to resign if I was appointed. They were Daily’s friend the chief of clinical cardiology; the head of pulmonary medicine, a powerful, nationally known person named Kenneth Moser—the same Ken Moser who years before had worked with Charles Hufnagel; and Dick Peters, a well-known thoracic surgeon and senior professor who would be on my team if he stayed. They went to see the dean.

  When Moossa learned of the revolt, he stood his ground. “Let them quit,” he said. Peters had a contact in Minnesota, Richard Varco, a retired professor who still meddled in university politics. Varco had supplied Peters with stories about what a terrible person I was. Shumway had told me that Varco had always been jealous of Lillehei.

  My appointment was announced. Nobody quit after all. Then, two months after I started, I found a letter from Dick Peters on my desk. He had sent copies to Moossa and the dean. I went over to Peters’s office and asked what it was all about. He told me that Moossa had said that if any of Varco’s stories turned out to be true, I would not be hired. Moossa offered to pay Peters’s expenses to go to Minnesota and find out for himself—which he did. The catch was that if Peters came back convinced that I was okay, he would write me a letter of apology. So he did. And he became an ardent supporter.

  But none of this happened right away. Before I moved to San Diego, I went back to Africa to clear my head. I was still shaken by what had happened in Minnesota, mistrustful and wary. I was sure Africa would set me right. I had three months.

  I contacted Bruno Reichart, who had taken over as the cardiac chief at Groote Schuur Hospital in Cape Town after Christiaan Barnard retired. Under Bruno the cardiac center was thriving. He also worked at the Red Cross children’s hospital in Cape Town, where all the open-heart surgery in children was done. I asked him if he could use a hand, and he said yes, of course. I left for South Africa.

  We worked mainly at the children’s hospital, a remarkable and rewarding experience. There was a waiting list of several hundred children who needed heart surgery. Bruno and I operated there two or three days a week, whittling down the waiting list. It felt wonderful to be back in the OR. When we weren’t working on children, we did transplants and regular heart surgery at Groote Schuur Hospital, where Bruno had caused a stir by insisting that blacks and whites be cared for in the same wards.

  The memorial to Cecil Rhodes was nearby, on the lower slopes of Devil’s Peak, the hill above Rhodes University. Rhodes’s wooden bench was still there, facing northeast where Rhodes had imagined his Cape-to-Cairo railway would start. Sir Herbert Baker designed t
he memorial, a horseshoe of pillars at the top of a huge staircase. There are forty-nine stairs, one for each year of Rhodes’s life, flanked by eight bronze lions. I visited it often.

  And every evening, after a long day in the OR, Bruno and I would climb Table Mountain to watch the sunset together, deciding the route when we got there according to our moods. It was three thousand feet to the top, where the air was fresh and you could look out one way over the Atlantic Ocean and the other direction over the Indian.

  The anesthesia at the children’s hospital was generally administered by a stern, middle-aged German woman. One day, in the middle of an operation on a small baby, I peered over the sterile operating room drapes and noticed that she had blood all over her hands. “I’m surprised that you don’t wear gloves,” I said.

  “Now why on earth should I wear gloves?” she asked.

  “Aren’t you afraid of AIDS?”

  She replied that there were only three cases of AIDS in South Africa, and all had come from “American-tainted blood” through transfusions. I couldn’t believe a highly trained doctor would be so misinformed. By 2007, just eighteen years later, an estimate of six million people—or 12 percent of the population in South Africa—had HIV/AIDS. When children were excluded, the rate was over 18 percent, and the total number of people infected was larger than in any other country in the world. The numbers are even higher now. The other top five countries with the highest HIV/AIDS incidence were all neighbors of South Africa. In Botswana, the total numbers are fewer, but nearly half the population is estimated to be infected.

  After working with Reichart for two months, I decided to go home—to my real home. I caught the plane that took me to Zimbabwe, back to Bulawayo, and got off at Gate 5, the only gate there was.

  When I got to Whitestone, after having a look at Raigmore, I drove around to the chapel where Philip and my mother were married and where I had been a choirboy. Someone was practicing the piano inside but stopped when I came in. It was the headmaster’s wife, Sally Harris. She told me that the school had been deserted and closed during the civil war. After the war it was renovated and reopened. Now there were five hundred pupils, more than four times as many as when I was there.

  The next morning I renewed my acquaintance with the Matopos Hills, driving out along the old road, which looked as I remembered it. As I drove past places where my childhood friends used to live, some of their houses now fallen down, I wondered what had happened to them. I had lost touch with them all.

  The Matopos Hotel that used to stand on a hilltop overlooking the dam had vanished. Even the road leading to it was gone, probably a casualty of the war. The Matopos was a dangerous place to be during the insurgency, just as it was during the Matabele rebellion almost one hundred years before. The sailing club from which I used to sail on the Matopos reservoir was still there, but behind a barbed-wire fence.

  I went to Rhodes’s grave and World’s View. It was as it had been. There is a native taboo against the desecration of resting places. Though his statue had been torn from the cities and many streets were renamed—not to mention the country itself—nothing at World’s View had been touched. Leander Starr Jameson was there, too, still lying peacefully, next to the Allan Wilson memorial containing the bones of those who had died alongside him. I sat in the shade of the memorial looking out over the expansive Matopos game park and reflected on the years and events that had passed by since I last was in this quiet place. Rhodes died at forty-nine. I was forty then and wondered what the next nine years held in store for me.

  I visited some of the old caves I used to explore. It was a sad business. Since independence, the government had decided to varnish over the bushman paintings to preserve them. But the varnish had turned opaque, casting the paintings in deep shadow. In places, attempts to remove the varnish had removed the paintings as well. What had lasted for thousands of years had been erased in a flash of ignorance and carelessness.

  I drove to the Maleme dam and reservoir, which were also unchanged. Signs reading “Beware Bilharzia and Crocodiles” had been posted. Bilharzia is a waterborne parasitic disease. We all had it as kids. Crocodiles sunned themselves along the shore, just as they had when we used to fish there. I drove out through the game park. I saw giraffes in the distance, and some antelope. Then I came upon a rhino, which was close. I stopped the car to stay with him awhile. He was grazing, oblivious to my presence. During the afternoon, I saw half a dozen more rhinos, including a mother with a calf standing in the rushes next to a stream. The calf frolicked about like a puppy. I watched them from a lookout platform that had been built by the friends of a man called Smith, who was killed at twenty-six in the Rhodesian Civil War. The dedication plaque read, “On active service.”

  Everywhere I went, I found that no one, white or black, was bitter about the war, which was talked about openly. I was delighted that the game parks were as strong as they ever were, though this wasn’t the result of any conservationist impulse. Tourism had become an important industry, and tourists came to see animals. Anyone without a Zimbabwe passport was charged a higher rate when they checked into a hotel.

  Back in Bulawayo, I walked the streets, thinking the town was much smaller than it had been when I was growing up. I drove out to the cemetery to visit my father’s grave. It was hard to find. There were many more graves now. I finally discovered my father’s behind a hedge that hadn’t been there before. I stood by it for a long time. I wondered how my life might have gone if he’d been around to give me advice. I smiled when I recalled that he had insisted on being buried instead of cremated, saying that he might need his body in the future. Maybe the fact that I felt compelled to visit him there was what he had in mind.

  I took a plane to Victoria Falls. I had wanted to go by train, in a plush carriage behind a steam engine, but I was told that the train was no longer reliable. Though it was sure to arrive eventually, nobody could say on which day. I did see an advertisement for locomotive drivers that said, “No experience necessary.”

  The pilots on the plane were white, the flight attendants black. Though no black people were onboard, the flight attendants explained the safety procedures first in Shona and then in Ndebele. A much shorter version followed in English. The in-flight beverage service featured warm Coke. As we approached the Victoria Falls airport, I saw a burned-out plane, a Dakota, on the runway. Just as we were landing, we took off again and circled once before coming in at last. No explanation was offered, and nobody asked for one.

  I took a shuttle bus to the Victoria Falls Hotel. We passed active minefields that were fenced off with skull-and-crossbones signs that read, “Beware Minefields Danger.” The minefields were between the road and the Zambezi River. Zambia was on the other side. The Falls Hotel looked like it had been frozen in time, a monument to the colonial past that seemed at odds with the changing character of the country. I recalled how we had always considered it too posh to stay at on our way to Chobe. I dined on the patio as the sun set and the night came on. I had Lion lager and a domestic white wine from Marondera. There were no imports. If you wanted something stiffer, you drank Mainstay, a spirit distilled from sugarcane that served as a substitute for gin or vodka, and which I suspected was closer to American moonshine.

  The next morning I walked to the falls. The trolley line that used to carry guests between the hotel and the falls no longer ran, though the tracks were still there. The Zambezi was in full flood, surging over the falls in a deafening torrent that sent up such a dense cloud of mist from three hundred feet below that it was hard to see anything. I found Livingstone’s statue and paused to think about the many times I’d visited it with my father. I walked around a bit. There was now a gate near the falls where admission was charged, but a short way off everything was still open. It was true jungle here, a rain forest on account of the continual soaking from the falls’ spray.

  At the hotel that evening, I ate in the dining room. As ever, jackets and ties were required. The waiters were black
, in starched white uniforms, with white gloves and red fezzes. The food was good. I had crocodile tail, which reminded me of swordfish.

  I wanted to see Botswana and Chobe—which was now part of a vast game reserve. I had planned to rent a car but learned that rentals were not permitted to cross the border. The daylong trip that used to take us through what had been Northern Rhodesia and across the river to Kasungula by makoro was no longer necessary. There was now a road that followed the south bank of the Zambezi, so that you could now travel directly to Botswana from Victoria Falls. It had been a dirt road at first, but it was paved during the war to prevent the planting of land mines along the route. Now it took just two hours to reach Kasane from Victoria Falls. I caught a minibus run by the Zimbabwe tourist board. I was the only passenger. A lively black man called Barnabas was the driver.

  We rattled along the road to Kasungula, slowing at one point to allow a herd of sable antelope to cross the road. They then stood looking at us as we crawled past, their huge horns swept back against the sky. On we went. A blurry brown shape streaked across the road. “Lion,” Barnabas said.

  At Kasungula we encountered a sign that read, “Disease Control.” We had to get out of the van, step on a wet mat, and return to the vehicle. This was an effort to control foot and mouth disease. By nine in the morning, I was standing outside a hut in Kasane that rented four-wheel drive vehicles. An off-road car was a necessity in the soft Chobe sand, where getting stuck might invite the attention of elephants. Before it was a game reserve, I had made this trip alone many times, frequently at night, and was often surrounded by elephants as they made their way down to the river for their evening drink.

  Kasane was no longer a sleepy little village but a town of thirty thousand, with several hotels. The Chobe River Hotel had changed since Charles Trevor’s day. The hotel had expanded but was sadly rundown. I asked to stay in one of the original rondavels that Trevor had built. Then I had tea on the veranda overlooking the Chobe. The fast-flowing water was still high from the floods. While I sat there, a makoro came out of the reeds on the Namibian side and made its way across, carrying passengers who disembarked on reaching the Botswana side. So much for border control.