It is not easy to write about a friend, an elder brother, or a teacher like Dr. San José Garagarza (Chema San José) without running the risk of sounding clichéd or overly sentimental. That is why when I found out that I would be doing this piece, I thought it best to describe him as a doctor, as the true professional that he was. Young professionals would then have an example to follow for improving their professional practice and veterans would have a benchmark by which to measure their success. This shows what an upright man he was because it is not possible to be a good professional without being a good person first.
José María San José was proud to be from León and trained at the Hospital General de Asturias. There in Oviedo he made his best friends and received the foundations of his solid training in one of the best teaching hospitals in Spain.
Dr San José never forgot why he was in the hospital. This may seem obvious but really it is not if we stop and think of the reality in which we live. Some of you will remember the end of the article “My personal experiences have shown me that the top priority for all academic medical centres must be uncompromising and outstanding patient care” (Southwick F. Who Was Caring for Mary? Ann Intern Med. 1993;118:146-8) that received much attention almost twenty years ago? Hospitals exist to care for and cure patients. Everything else either makes or lacks sense depending on whether it can be used for this end.
Dr San José enjoyed a period of high scientific production (publications, taking part in conferences, etc.). From within the ischemic heart disease section of the Spanish Society of Cardiology he was one of the key players in modernising cardiology in Spain and bringing it in line with that of the most developed countries. He always put the patient first – that person who would come to the hospital in the hope that we could do something to help. He would never hide behind more prestigious tasks and never forgot his duty to cure. He would never aimlessly roam the corridors and everyone always knew where to find him: in his unit (cardiovascular postoperative care when he came from Oviedo, then the coronary unit, and later on the critical cardiology unit) or in the cardiology department.
Compassion comes from the Latin cum-passio which means to suffer together. He always showed compassion towards his patients. A serious man of not so many words, he was fortunate in that he was able to show great affection. Many a time has a patient said to me something like “Dr San José is so affectionate!” Although I used to joke around with Chema, I knew that in this sense he was highly gifted in something that you do not learn at any school or faculty – the ability to communicate with affection. Dr. San José led by example and showed us that making a patient suffer unnecessarily is never justified. Science, like life itself, has a limit. Those in healthcare should be aware of this fine and subtle line because to cross it is not strengthening knowledge but rather being cruel.
He was frugal in his life and in his professional practice. Despite the fact that he was trained in a very prestigious hospital, at the time its resources were limited. In this way, he learned to think twice before requesting an examination or prescribing a treatment. He would carefully weigh up what clinically relevant information would arise from a certain test and whether it would be worth it in terms of patient pain or unnecessary cost for the hospital and a healthcare system based on solidarity. On many occasions we take refuge in multiple examinations to compensate for our own ignorance and we carry on in this way, constantly searching through the results for a diagnosis that we never would have suspected. Dr San José had common sense. And this is something that you either have or do not have. Chema had it. He was always a studious cardiologist and applied his knowledge to every specific case with an overwhelming logic. This gave him professional prestige. When cardiologists meet together, we argue and things can sometimes become heated. Whenever he spoke at a clinical session, everyone would fall silent and calm expectation would prevail. We knew that the voice of reason was about to speak.
He was also a great leader, but his leadership came not from hierarchy but rather from his personal and professional standing. He was a person of reference for any doubts, even just to confirm diagnosis or treatment. Just by putting on a serious face or giving a stern look, he was the type of person who would make you shudder knowing you had done something wrong. But he would also make us feel proud to belong to a team led by him.
Dr San José upheld unshakable loyalty to his hospital and to the healthcare system. Decades ago he once told me that he worked (always the first to arrive and the last to leave) because he had made a commitment to the hospital and his conscience obliged him to do so. He was continuously committed in both his professional and personal life to what he believed to be fair and he faced the consequences.
He respected the youngest of doctors, yet without lowering what was expected of them. He never used his medical interns to escape from his duty to his patients. He would defend and, if need be, excuse his newest colleagues because that was his dream: to leave behind a team of young, well-trained, hard-working cardiologists as enthusiastic and committed as he was. He was an exceptional teacher. He was a reference for everyone, a conciliator, always searching for the thing that unites us all, and the confidant for our insecurities.
As his life was not limited to cardiology, he was eager to retire and had only a few working days left. He dedicated a lot of thought to the future of our department. Consolidation of the critical cardiology unit (made up solely by cardiologists), the solid training of young professionals, the ventricular assistance program… Those initiatives with the broadest scope are owed to him.
Dr San José, my friend Chema, was a good man and was generous to those of us who in reality could never live up to him. As I said at the beginning, he was an upright man. And this is the most important.