Stories of Ordinary Medicine: 'Going to work at ninety makes me look bad.'

This spring, the world's media reported on the French doctor Christian Chénay, who is still practicing in the suburbs of Paris at the age of 101. He could thus boldly claim the title of the world's oldest practising doctor, a title shared last year by one Howard Tucker of Cleveland in the Guinness Book of World Records. This was shortly after the American neurologist celebrated his 100th birthday. "Retirement is the enemy of longevity," he confided to reporters on that occasion. Or, as MUDr. Vladimír Leman, who keeps on the heels of both of them in terms of activity in advanced age, says more prosaically, he goes to work so that he "doesn't go stupid". Although he admits that at the age of ninety he is already a bit stupid. We met on July 7 in a prefabricated apartment in Pelhřimov, the day before his ninety-first birthday. He's lived there for half a century. However, this still vital graduate of the Faculty of Medicine of Masaryk University can be found in the corridors of the Pelhřimov hospital for sixty-six years.

27 Jul 2023 Václav Tesař

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Although you have dedicated your professional life to Pelhřimov, you are originally from Brno. Do I have the right information?
Yes, but my parents came to Brno from Prague. My father trained as a mechanic in Prague, my mother went to Vienna for work and they met on the train. When they were deciding where to settle in the late 1920s and early 1930s, they chose Brno, even though it was still very German at the time. We lived in Žabovřesky, near the Kozák Hotel, in newly built terraced houses. Across the street was a field...

When the Germans closed the colleges during the war, it was said to be a stroke of luck for you, because although you originally thought of studying mechanical engineering, the college professors who started teaching at the grammar schools got you excited about biology. How do you remember this period?
I remember my class teacher, Dr. Štádlerová, who taught us geography and history before she returned to the Faculty of Arts... A certain Mr. Liškutin for mathematics... Or Ambrož for singing, who used to say "On your knees, I'll play Beethoven for you now!" With the participation of university teachers, the gymnasium suddenly took on a different swing...

What did your later admission to medical school look like?
Of the twenty-six of us who finished grammar school, seven of us applied to medical school and we all got in, although one or two classmates applied to Olomouc. The doctor who taught us biology wrote us a recommendation...

How was the actual study at the faculty where you eventually graduated with honors?
I always tried to be active during my studies and to engage in various other activities. I remember, for example, in chemistry, when we were studying methods of photography in the dark. Until the STB came and stopped the project because they considered it military... I was also a volunteer in surgery, trying to learn what I could... I was active in the Medical Students' Association...

How did you perceive the political situation in the 1950s and 1960s, when the communist regime was brutally tightening at first, and only later gradually loosening?
Since our family was artisanal, I had a good background as a child of the artisans, so to speak. Which counted, yes. But my wife, whose father was a judge in Brno, had it differently. They came to him one day with dictated sentences over several people, but he refused to hand down the sentences, so they added him to the people, sentenced him along with them, locked him up for two years, and evicted the family from their apartment. Fortunately, my grandmother knew the parish priests in Petrov, through whom she secured new housing for them. Somewhere around that time, I met my wife, so I had a mixed bag - I was from a family of craftsmen, my wife from the family of a jailed judge.

Vladimír Leman promoval s vyznamenáním v roce 1957. Diplom obdržel přesně v den svých 25. narozenin.

So in Pelhřimov you were actually a bit aloof from the socio-political events in the big city, weren't you?
A little, but it was unavoidable. The political life was tough. Even during the war... I remember as a boy hearing the shooting from Kounic's dormitories, where the Gestapo executed our people... It was horrible... I'm so old that I remember when the Germans came to Brno! (smiles) At that time they still drove on the left, but the Germans put a sign on the side of the street saying Haltestelle aufgehoben, rechts fahren - Stop cancelled, drive on the right, and everything immediately drove on the right. When Hitler arrived in Brno, three houses below us lived a Mr. Novák, who greeted him with a sign Wir danken unseren führer - We thank our leader and denounced him... He could not be surprised that when the deportation to Židlochovice came, he had to pull... People wonder today that it was a harsh deportation, but what to do with such a thing?

What did you enjoy the most while studying? Was there a particular teacher that stuck close to your heart?
I remember anatomy and Professor (Karel) Žlábek. He was very strict! Learning anatomy is like learning the phone book by heart. Crazy! (smiles) He also tried us in histology, which we couldn't take until we had mastered anatomy... That was the basis! Physics was taught by Manuel Tagüeña Lacorte, who was a Spaniard who fought in the Spanish Civil War and who ended up in exile in Brno after General Franco's victory... I also really enjoyed Professor (Jiří) Štefl's lectures on pharmacology. He was both knowledgeable and he could lecture with wit. For example, when we were discussing medicines for diarrhoea, he mentioned the battle of El Alamein, where everyone got diarrhoea, but because the English had better medicines, the Germans literally broke through. (smiles) Even non-medics liked to attend his lectures and the humour made it easier to remember the material. Although somewhere he probably told a joke that wasn't really suitable for the Party, and so he was later fired and went to work as a factory doctor.

hospital as a home

Why didn't you stay in Brno and go to Pelhřimov to work?
Since I was not a party member and my parents had no connections, it was out of the question for me to take up residence in Brno. That's where the prominent people stayed. But I didn't think much of it, it was just the way things were. I got a placement in Pelhřimov, I took advantage of that opportunity, and it turned out that the conditions here were very pleasant. For the first few years, my wife and I lived in one room in the hospital, she was employed in Agrostroj with a salary, of course, a hundred crowns higher than mine...

Of course? Weren't medical positions already considered prestigious then?
Yes, they were, but we had to be grateful to the party and the state that we had graduated. I had a starting salary of 1150 crowns, my wife after the business academy 1250 crowns.

How was your entry into practice? Did the reality match your expectations from your studies?
I have to say that we already had very well managed practices when we were studying. It was always a month after the fourth year that our group spent in Svitavy. An assistant went with us, and of course we were supervised by the chief surgeons there, especially in the internal medicine and surgery. Nowadays, students have their internships wherever they arrange them, and it is a question of whether the local chief has time to take an interest in them. At that time he had to, but because of finances it hasn't been done that way for years... So when I started in Pelhřimov, it wasn't a big jump. Besides, there was a nice group here, made up of many Brno people. There were three of us from Brno at that time, all on placement. And that good group was the reason why I stayed here.

You have already mentioned that during your first years in Pelhřimov you lived with your wife in a hospital. How should I imagine that?
Twelve years! We had our permanent residence registered in Brno, so we couldn't apply for an apartment in Pelhřimov. There's a story about how I had to get married. There were some Wurzingers living in Brno, in the flat below my parents', and about a year after I left for Pelhřimov, Mr. Wurzinger's wife died. According to the National Committee, he himself was not entitled to two rooms, so they wanted to put someone in there, but at the same time there was a regulation that if the son or daughter of the owner - which was my parents - were married, they were entitled to such a room. Within a week, of course. At that time I was on compulsory military training in Bučovice, Věra and I had been seriously dating for about a year, and suddenly we had a week to get married. When I asked for leave for that, my superior told me that I was an asshole, that I wanted to get married, but he gave it to me.

So you were actually still at work when you weren't...
Yeah, yeah. There were times when I was admitted to surgery at night and my colleagues needed help with something, maybe just to hold something. So I'd go. I didn't get any money for it, but I watched them work. Similarly, they in turn went to the internal medicine ward, so we learned from each other in that way.

Sounds like it was a pretty partisan environment...
I'd say rather friendly! We could sit and chat, the women used to come to work with the kids... I don't think that's conceivable nowadays.

And on top of that, you were mostly Brnoers...
Even the Prague people... Chief Kalla Sr. was from Brno, the surgeon from Třebíč...

Vladimír Leman in his study in his apartment building in Pelhřimov, where he has lived since 1973.

It was after Dr. Karel Kalla Sr., who was in office for over thirty years, that you became the head of the internal medicine department in 1971, right?
Well, it's more complicated than that. Originally, there was an infectious disease ward and a tuberculosis ward. But then, when the dam on the Želivka River - Trnávka - started to be built, because there was no sewage treatment plant, the sanitary station ordered the infection and tuberculosis wards to be closed because the Trnávka River could be polluted from there. It is interesting that in Humpolec, where they had a hospital, the tuberculosis ward remained, but it is also right next door. In Pelhřimov, the vacancies left by these closed wards were used to create the so-called internment two. My boss told me that if I wanted to go there, I had to get a certificate in adolescent medicine, which he needed. So I got it, started to deal with the conscription and at the same time worked in this intern two, which was actually a kind of a hospital for long-term ill patients from today's point of view. So from sometime in the '50s I was already the chief, aka the chief, and when Chief Kalla retired a few years later, I auditioned and took his place as chief of intern one.

And sometime around that time you also finally settled in Pelhřimov with a permanent residence...
At that time, my wife and I signed up for the cooperative construction and I have been living in this apartment ever since. But I never even got a voucher for a car from the hospital... They didn't give it to doctors... Maybe once the director got it, and then it was given to those "workers", not doctors. You know, they were the "workers", we were the doctors. (smiles) But otherwise we got along fine, I can't say that again...

This one buys this that one buys that

The publication published on the occasion of the centenary of the Pelhřimov hospital states that shortly after your appointment as chief physician, in November 1971, you performed the first diagnostic laparoscopy and in 1974 you started to perform the first gastroscopies with a flexible gastroscope. Can you describe this pioneering work?
Let me tell you exactly how it was! It was a Mr. Kaizr, Joseph, whose mother we treated, who came to me and said that he was very satisfied with the way we took care of her. That he was working at the Ministry of Finance and what I needed. And I, since I had already had some training, that we would like fibroscopes. The gastroscopes at that time were made by a Japanese company called Olympus and they cost a lot of money. The director, Rudolf Vyhnálek, gave us his approval - "Sure, comrades." - and because he was a surgeon, he made a light for the surgical theatres. The laparoscope, we got that from the GDR for a change...

And as for the procedure itself...?
At that time, the only examination method was X-ray, no ultrasound, so we were thinking how to get to the liver... And in Brno a professor Houbal, who incidentally also took care of Brno hockey players, started to deal with it... (Prof. MUDr. Václav Houbal, DrSc, between 1958 and 1974 he was the head of the Department and Clinic of Infectious Diseases, between 1953 and 1974 he was the doctor of the Brno hockey players - Red Star Brno, then ZKL Brno - and at the turn of the 1950s and 1960s he was even the doctor of the Czechoslovak national team, with whom he participated in several World Championships and two Olympics - author's note.) I read something about it, then I called him, he was very nice and said: "Come on, my colleague." So within two weeks I headed to Brno, once to see how he does it, the second time I tried one of the procedures myself, in Pelhřimov we practiced a little bit in the pathology department where to inject properly, and then we did it for real right in the surgical theatre. We knew the surgeons well, so there was no problem. The chief of surgery said, "Boys, go on, we'll watch." And I was glad they were there, because if anything happened, they could step in. Nowadays, fibroscopes are very thin, but our first ones were eleven or thirteen millimeters. But we could see beautifully with them! We were the first ones far and wide to do it.

“Whatever one does, one should do it properly, whether one is a letter carrier or a doctor. There are doctors who do their work, but if one does his work well, he will be well off in the world.”

MUDr. Vladimír Leman

Even considering how the hospital grew, do you see the 1970s as the peak of your career?
In retrospect, yes, but we were simply trying to develop and move on. Because officially, we did get some currency, but we wouldn't have bought a fibroscope with it... So if the opportunity arose to get one in a different way, why not take it? In a similar way, we also got a coloscope, which was bought for us for a change by engineer Kubů, the owner of a certain flower shop in Litoměřice, whose father we treated with us. He was satisfied with our work and said, "What can I do for you?"

As a non-partisan in a leading position, how did you cope with the political pressures that undoubtedly had to come sooner or later?
Then I had to join the party, there was no other way... What can you say when they come to you every week for two years and tell you what you are doing...

Otherwise you could lose your position?
I don't know, I haven't thought that far. It wasn't an honourable thing to be in the party, but it was just the way things were...

to do work properly

Which period do you remember the most?
The first years, the first seven or eight years, when you were developing the most, gaining knowledge and going to various professional trainings. That was the best. And then, when we were building the new department... But in medicine, something is always changing, something new is always happening, and if you stop following it, you can pack it in. I can see that today when I go to the eldener twice a week. So I can't mention a specific period, I guess, because when you try to do the job well, you enjoy it.

Can you recall any medical innovation during your career that has amazed you and completely changed the way you work?
I was impressed by the Simulation Centre when we were in Brno for the Alumni Day! The fact that simulation medicine has become a separate specialty, that blew me away!

Do you see medicine as a calling?
That's what they say, but I say that whatever one does, one should do it properly, whether one is a listonos or a doctor. There are some doctors who do their work, but if one does his work well, he will do well in the world.

Many doctors say that their biggest reward is a healed patient and positive feedback. Do you feel the same way? Do you still keep in touch with some?
You know that when I still occasionally go to the pub that people there address me as "Mr. Chief Medical Officer" even though I'm no longer one... I have patients at the eldership again who recall that I treated them forty years ago... And as I've already named the engineers Kaizer and Kubů, it's not that they gave us a bottle for good work, but they gave something directly to the hospital for which it was an advance. That made one happy, too. Engineer Kaizr was a very solid gentleman, and we got to know him more later on, and we still write to each other...

Vladimír Leman at the Masaryk University Faculty of Medicine Alumni Day in June 2023 together with his lifelong friend and colleague from Pelhřimov Hospital Karel Kalla Jr.

Is there anything you would have done differently during your career from today's perspective?
Otherwise... (he thinks) We used to have regular meetings with the doctors in the morning, where everyone would report what was new, and as a young man I had big eyes, that one day we could talk about medicine, the next day we could talk about art, music... But as I say, I had big eyes because when we had women with small children in the team, I was glad when they came at all... But I think that this kind of bonding and broader outlook is important.

Today it's called company culture! By the way, judging by the furnishings in your apartment, music is your lifelong hobby...
With my colleague Toman, who coincidentally was also from Brno, we even did the so-called Music Theatre once a month for the hospital. Through the Gramophone Races in Prague, we borrowed records and then performed them in the common room. Whether it was classical music, operettas or something lighter. Both staff and patients came to listen. I played the violin from an early age, and later we had a quartet. Its members were the engineer Hostomský, nephew of the well-known musicologist and writer Anna Hostomská, who was also imprisoned for a time, and the philosopher, Dr. Rada. He was relegated to some menial teaching position after he stood with his violin at the head of a parade in the 1960s and rejoiced that we had won against the Russians... We practiced at home and for years we went to play in the surrounding villages. In addition, I played for several years in the classical music orchestra in Pelhřimov, Humpolec and then mainly in Světlá nad Sázavou, which was semi-professional and eventually theatrical. We played Polish Blood and Gypsy Baron nineteen times in various Czech towns.

You could have retired at the end of the millennium, but even at the age of ninety you still go to work...
Yes, twice a week, Tuesday and Thursday, for four hours. So I don't go crazy. But I'm sick of it too, because it's not convenient, is it? In Germany, once a doctor is sixty-eight, it's all over.

How do you keep yourself fit, both mentally and physically?
I try to keep myself busy and interested in what's going on, read the newspaper. You see, Lidovky here... I don't read so much on the internet, there's rubbish there... I have an age-appropriate girlfriend in Prague who I visit. We have a subscription to the Czech Philharmonic, we often see each other at her family cottage in Litkovice near Pelhřimov and we go on holidays together. In order not to get stuck, one has to look ahead. What was, was, now I am a major!

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