Reflections

I was born 70 years ago in the small town of Sinj, Dalmatia, Croatia, Yugoslavia. When I was 5 months old, my father was sent to prison for two years on Goli otok (Bare Island), an ill-famed prison for politically inappropriate people at that time. At 24 years old, he could not understand that Stalin, who was an idol for young Communists, had become an enemy overnight after the Informbiro Resolution, by which the Yugoslav Communist party was expelled from the international Communist party led by Stalin. It was a price for living free on the outer side of the Iron Curtain, between East and West, where Yugoslavia remained until the end of 1990, when the Balkan wars started. My father has stuck with Communist ideas until today, almost 95 years old. Under his influence, I entered the Communist party in high school, but very quickly realized that politics is not something I would like to practice.

Neuropathology as a special field in medicine saw its development not until the second half of the twentieth century. Its roots are in neurology and pathology. Its significance has risen because of the emergence of neurosurgergy. The validity of neuropathological diagnoses greatly increased especially because of the application of immunohistochemistry and genetics. This may have been the rationale for the editor of this journal to have neuropathologists’ paths of life delineated for future generations under the heading “Reflections.” This includes the various pathways and detours to neuropathology and the ways research findings have been generated, which may eventually prove important or useless. It has been the desire of the editor that authors not only reflect on their professional activities and experiences, but also present themselves as persons. This paper should not be intended as an autobiography, but the development and experiences of the author be presented in appropriate length. I think of this as a good approach, which I will attempt to pursue.

When the editors of Free Neuropathology, Werner and Tibor, approached me about writing an autobiography for the journal, similar in scope to Sam Ludwin’s excellent piece two years ago, I confess that I had reservations about writing an autobiography, because I never wanted to talk about myself. However, after a lengthy hesitation and eager discussions with my wife and my former scholar and friend, Hans Lassmann, I realized with a certain degree of doubt that, on the threshold of age 90 years, I could perhaps provide some thoughts about the bridges between clinical neu-rology and neuropathology for those who might be interested in the experiences of an old neuroscientist.

My family were Latvians who, by the end of World War II, had become refugees from the Soviet Union. For the repressive Communist regime that controlled the USSR, my family (on both sides) were or would soon become ‘criminals’ who owned land and were involved in commerce. They saw no future under a Communist regime, and the fate of relatives who remained in Latvia after World War II confirmed the wisdom of their decision and choice – some were exiled to Siberia for many years, others simply had their property confiscated. My family – grandparents, their two children (one my father) and assorted household staff who joined them – fled the country as the Red Army moved in to ‘liberate’ its people and begin a brutal and merciless tyranny that would last until the early 1990s. During that happy time in the early 1990s the USSR thankfully collapsed under the weight of grotesque corruption and reliable, predictable, frequently comical Soviet incompetence. Members of my family lived in various refugee camps in Europe between 1944 and 1949, at which time they were sponsored by distant relatives to relocate to Canada; some of their lasting and most intimate friendships were made in the camps during those postwar years. My parents had wed in Lübeck, Germany.

On a rainy October afternoon in 1968, as my plane landed at Heathrow Airport from Budapest, I did not know that I would never return to the country of my birth and early youth. I arrived with a small suitcase and five pounds in my pocket. I was a fortunate and happy recipient of a Wellcome Research Fellowship at £1,200 per annum, which had been awarded two years earlier. The Hungarian authorities, however, for reasons known only to themselves, did not give me an exit permit. My visit was on a knife edge until the last minute, for on the day when I was going to the British Consulate to apply for a visa, the Hungarian State Radio announced that the armies of the Warsaw Pact (including Hungary’s) were giving “brotherly help” to the people of Czechoslovakia. Translating this Orwellian newspeak, it meant invading a friendly, neighbouring country.

Let me start off my recollections by saying that it had never occurred to me that I would ever become a doctor. I was interested in the arts and humanities, history, literature. When I was in high school, back in the early fifties, I participated in a literature competition and wrote a piece called Conversation with the Moon.
It was about our escape from Bratislava (Preßburg, Pozsony). We fled at night by boat on one of the river branches of the Danube in August 1945, in the last year of World War II. I was eight years old. Our possessions in bundles on a cart, our destination was a small Hungarian town called Mosonmagyaróvár.
In my mentioned text Conversation with the Moon I embedded all my youthful, naive thoughts and emotions from that time. This was in Hungary in the early fifties under the Rákosi dictatorship. After finishing that story I realized it couldn’t go on like this for long. There was a feeling of looming threat that made my stomach hurt. And now I just had to decide what profession to choose for further learning.
Both my mother and grandfather were physicians and it became obvious that I, too, would choose this apolitical, strictly fact-based profession, although it felt quite distant for me.

I have no idea if this short account will be of any interest to others but in writing it I have a strong sense of good fortune for having had the career I have had as a neuropathologist.
My interest in joining the medical profession emerged in my teens and I found myself in 1960, at the age of 18, commencing a degree in Physiology at St Hugh’s College, Oxford University, as the first stage towards attaining this ambition. This 3-year course was to be followed by three years of clinical training and a supervised year of hospital practice before full registration as a medical doctor. Women made up about 10% of the medical students at Oxford at that time and, in due course, we were distributed in a wide range of medical specialties.

At my current age of 73, the ability to see – somewhere into the mid-distance between the quotations above – has been shaped by mentors, colleagues, students and trainees, friends and family. I started to write this since the second week of the CoVID-19-related lockdown. Virtually nobody was seen outside, a bizarre experience that reminds me of my first memories as an infant in post-war occupied Vienna when people tried to avoid public encounters, particularly with patrolling Soviet soldiers. In mid-March 2020, nobody could foresee how the SARS-CoV2 pandemic would evolve. As my wife, an active hospital nurse, and our 12-year-old daughter at school had and have some risk to get infected, we agreed to temporarily separate. Now I stay in self-imposed isolation with our dog Gorry in a small rented apartment in the beautiful Vienna Woods. Like others who, during the present lockdown, have a chance to re-consider their way of life, I have ample time to reflect on my life and on neuropathology. I write this just based on my memories, as most of my written documents are either back in my home or have been destroyed after I retired from my directorship of the (Clinical) Institute of Neurology, formerly Neurological Institute (NI, Obersteiner Institute) in Vienna. Without doubt, the reader will detect in these memoirs the characteristic reminiscence bump of psychology, i. e. the strongest memories date back to adolescence and early adulthood, and emotionally positive memories dominate. However, I consider my whole professional life as extraordinary privilege to have done what I enjoyed most, having made many friends and met great personalities including true giants in medicine, science and research. Moreover, I believe to have witnessed the golden era of neuropathology, spanning from rather subjective interpretation of classical morphology to unprecedentedly detailed molecular diagnoses and fascinating understanding of aetiologies and pathogenesis of diseases of the nervous system. I will keep this fascination forever.