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- Published online March 2, 2020.
“The greatest good you can do for another is not just to share your riches but to reveal to him his own.”
—Benjamin Disraeli (1)
The news of Dr. Desmond Julian’s death on Boxing Day impacted me greatly. As I have reflected upon the life of my lifelong mentor and friend, I have realized how much he has influenced my decisions, as he empowered me to make certain choices that have defined my life—both professionally and personally. While his accomplishments in medicine were truly exceptional, his humility and modesty kept him focused on the science and the care of cardiovascular patients.
As a young man in Spain, my first mentor, Dr. Pedro Farreras, experienced a myocardial infarction at age 45 years. At that time, he encouraged me to pursue cardiovascular clinical training and research outside of Spain. Soon after completing my medical degree at the University of Barcelona, I moved to Edinburgh, Scotland, to pursue my clinical training and thesis on the role of platelets in myocardial infarction. It was during this phase of my life that I first encountered Prof. Julian in the mid-1960s at the Royal Infirmary of Edinburgh. He had just arrived from Sydney (1961 to 1966) and begun to develop a special unit containing a confined number of beds, first termed the Coronary Care Unit (CCU).
As Prof. Julian gained more confidence in my skills as a clinician, I became his fellow, learning from him and attending to his patients with him. Throughout my tenure in Scotland, I was privileged to witness his skills as a superior diagnostician and caring physician. Importantly, in his research efforts, Dr. Ronald (Ronnie) Campbell and I worked with Prof. Julian as he pioneered the concept of the CCU, building on his work at Sydney Hospital in Australia—of which he first wrote about in The Lancet in 1961 (2). These efforts transformed the care of heart patients at the time. Interestingly, Julian later wrote that The Lancet was initially unwilling to publish the details of the 4 patients that he treated all unsuccessfully, but the Journal agreed to publish them when he pointed out that perhaps these cases were even more instructive than those cases successfully treated (3).
In the first year of the Edinburgh program, 16 of every 100 patients who presented to the unit died—a decrease from 23 of 100 in a similar group of patients the year prior (4). This trend in decreasing mortality continued, resulting in the development of CCUs across the globe. His success with the CCU also caused the advent of continuous electrocardiogram monitoring, closed chest defibrillation, pacemakers, and cardiopulmonary resuscitation, advocating for a unique area of a care setting with specialized trained personnel to treat patients with an acute or suspected myocardial infarction (5). I watched a number of such advances in coronary care at the side of Prof. Julian. In a 1998 paper in The Lancet, Dr. Eugene Braunwald wrote that, at that time, the CCU “was the single most important advancement in the treatment of [acute myocardial infarction]” (6).
Prof. Julian highly valued the teaching of other researchers and cardiovascular clinicians to improve the care of patients. As an example, to educate the cardiovascular community on their innovative efforts, Profs. Julian and Michael Oliver organized the first international conference on coronary care in 1967, which I attended. Interestingly, Prof. Oliver fostered his interest in randomized clinical trials. Later, Prof. Julian became a great trialist, developing a website database for all European trials. In fact, he encouraged Prof. Stuart Pocock to pursue a similar illustrious career focused on statistics as applied to clinical trials.
Under Prof. Julian’s tutelage during the late 1960s in Edinburgh, I worked with him on his first edition of the Cardiology textbook—which was my first foray into the realm of scientific publishing. From him, I learned that publishing medical science takes a dedication to quality and drive toward perfection through revision in producing a book, which I have employed for many years as Editor of Hurst’s The Heart and now with the Journal. In fact, when I was asked to consider applying to be the Editor-in-Chief of JACC, I called him. He was kindly protective of me, given the tremendous amount of work that would be required. He replied, “If you think you can contribute to the cardiovascular society, you should take it. If you think that this will primarily contribute to your stature, don’t take it.” Prof. Julian refined his textbook over the years, always dedicated to the process for the purpose of educating clinicians, and he published the eighth edition of Cardiology in 2005 (7). Also, Prof. Julian was the founding Editor-in-Chief of the European Heart Journal from 1979 to 1988 and was the author or coauthor of major textbooks.
In 1975, he was appointed as the first British Heart Foundation Chair of Cardiology at the Freeman Hospital in Newcastle, where he continued to mentor another past president and his successor in the chair, the late Ronnie Campbell. In 1986, Prof. Julian moved to London as the Medical Director of the British Heart Foundation, a post that he maintained until 1993. During this time, Prof. Julian served as an adviser and consultant to the World Health Organization (WHO) for coronary care, and was President of the British Cardiac Society and Second Vice-President of the Royal College of Physicians. He was also Chairman of the British Action on Smoking and Health and Chairman of the National Heart Forum, which focused on prevention of heart and circulatory disease in the United Kingdom. He also held many integral positions in the European Society of Cardiology, from whom he received the Gold Medal in 1993. In this context, I cannot forget his excitement when he was informed that I received the same Gold Medal of the Society in 2007. He whispered on the phone with a high degree of generosity and friendship, “Nobody yet got two Gold Medals from the ESC, yours is just my second one.”
As a mentor, Prof. Julian was tremendously positive, but he could also be very critical when appropriate. For instance, I went on vacation without contacting by letter some of his recently evaluated patients. In a nonpaternalistic attitude as a mentor, he said, “You should never act like this.” Through this lesson, I learned the necessity of always remembering our patients—even before ourselves.
The cardiovascular community is mourning a giant among us, and I am mourning a personal true mentor, friend, and godfather to my son, Pablo. My deepest condolences to Professor Julian’s wife, Claire, and the family.
- 2020 American College of Cardiology Foundation
- ↵Benjamin Disraeli, 1804-1881. Available at:. https://www.goodreads.com/author/quotes/47030.Benjamin_Disraeli. 222020.
- Bakker J.
- Wyman M.G.,
- Wyman R.M.
- Julian D.G.,
- Campbell-Cowan J.,
- McLenachan J.