Choices: A Physicians Journey on Two Continents

By Staffan RB Nordqvist MD PhD

The day had come. It was January 2, 1972, the day after Puttes third birthday. Equipped with my passport, immigrants visa, very little money and my packed bags, I took off leaving the family behind. It would take until March 16 for them to join me. During that time much happened, most of it very different to what I had expected. It was a bold step, but I was young, ambitious and adventurous.

I arrived in New York in the early evening. It was raining, cold and dark. I took a taxi to Manhattan and MSKI, my new employer. I told the driver how happy I was to be back in the city where people were so friendly. He thought I was making fun of him and almost stopped the car to let me off.

I was shown to an apartment on 71 Street. my temporary home. It was dark, cold and sparsely furnished. No sheets, no blankets or pillows, no towels. It was around eleven oclock but to me it was five in the morning. I was exhausted. I pulled my trench coat over me and promptly went to sleep, ignoring Johns knocks on the door.

The following morning I went to the hospital to inspect my new workplace, occupy my office and meet my new colleagues. But no space had been prepared for me, not even a desk. I began to doubt my decision. But there was much more to come. I learned the hard way that coming as a visitor and give a few lectures is one thing. Coming as an additional staff member is completely different. Instead of being a celebrated guest, I was now a competitor

• Language: English
• Publisher: AuthorHouse
• Release date: Sep 12, 2014
• ISBN: 9781496925954

Staffan RB Nordqvist MD PhD

Staffan was born in Lund, Sweden, and spent his preschool years on the west coast in the shadow of World War II, watching the bombing of Denmark from behind boarded windows. Although Sweden remained neutral and did not participate in the war, those were difficult times with limited supply of food and other life necessities. At age seven, he moved with his parents to Stockholm, where he lived through high school. Staffan was a loved but unplanned child. He was a descendant of a very prominent academic family but always felt he was not expected to amount to much. His great ambition was to prove everybody wrong. He became an excellent student athlete and showed great talent as an aspiring actor. The theater was for a long time his dream career. He was successful, but eventually medicine became his calling. Being a doctor would promise a more certain livelihood. He was admitted to medical school at the University of Lund at nineteen. We follow his life as a student, actor, and young doctor rapidly climbing the academic ladder to become a cancer specialist. Since childhood, Staffan had a maybe somewhat naive fascination with America, the land of possibilities in the far west. When he, at age thirty-five, received an invitation from New York City to be a visiting professor at Cornel Medical School and Memorial Sloan Kettering Cancer Center, he convinced his wife that they should accept and emigrate with their three children. Life in the United States had many unexpected surprises, both professionally and personally, some difficult to overcome. Competition was fierce; friends turned to foes. He learned to navigate past most obstacles, and after six years as a professor at the University of Miami, he founded Gynecologic Oncology Associates in the city as the first board-certified specialist in private practice in Florida and lived his American dream. He takes us on his journey with humor, sincerity and a good portion of cynicism of certain aspects of life in America and it’s fragmented health care.

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Chapter 1

THE BEGINNING

I was born on the sixteenth of July 1936 in a small town called Lund in the south of Sweden. It was a day, I have been told, with miserable weather: thunder and lightning and, of course, rain. That is not unusual in Sweden and should not be interpreted either as an omen or a statement by the Nordic gods. My delivery was premature, and forceps had to be used to get me out in time. The doctor who assisted my mother was the same man who some twenty years later became my first professor in obstetrics and gynecology!

I was not a planned child. My parents were students at the University of Lund. My father came from Kristianstad in northern Scania (Skåne). He studied law and graduated the year before I was born. My mother studied for the equivalent of a bachelor of science but never graduated.

My Father and His Family

My father was the youngest of five siblings. There were three sisters; the eldest, Anna-Lisa, died in her thirties from tuberculosis. In those days there was no cure for this disease, which claimed many lives and caused a lot of suffering. Anna-Lisa had three children: Ulla, Ann-Marie, and Bengt.

The eldest brother, Ivar, was an officer in the military. He and his wife had one son, Karl. Ivar, or Ninne, as he was called, was stern but kind. I never got to know him very well, and I hardly ever met Karl.

My aunt Karin was married to Ture Kristersson, who was an accountant. They had three children: Sven, Lars, and Eva. They lived in Malmö and had a summer residence in Falsterbo at the very southwest tip of the country. I spent several summers with my cousins there. We became close, but as we grew older we saw less and less of one another. I guess this is a natural process when one forms one’s own family and moves to a different area of the country.

Inga was the happy aunt. She had a very contagious laugh, pretty much the same kind my son Jonas has. My sister Ann also reminds me of her. Inga was married to Torsten Burrau, who was in insurance. They had two children: Ingrid and Åke. They too lived in Malmö and had a house in Falsterbo. In the summers these cousins were also my playmates, particularly Lars, Eva and Åke, as we were about the same age.

My Father

My father, Björn, became fatherless when he was fourteen years old. My farfar Brynolf was a manager in the local government. In his youth, as a student at the University of Lund, he was very active in the student choir, Lunds Studentsångförening. He was very gifted musically and had perfect pitch. He continued his passion for singing as the leader of a choir in his hometown. He had also been an actor and singer in musical theater called spex in Lund. I will tell more about this later. Brynolf unexpectedly died at the age of forty-nine from what we believe was a heart attack. One day he told his wife, Farmor Agda, that he felt tired and would rest for awhile. He never woke up again. Since he died so young, I never got to know him, but I believe he was pretty strict with his children.

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Karin, Inga, Agda, Brynolf, Anna Lisa, Ivar and my father at 10 with his dog Jim

Björn grew up poor, living first in Kristianstad and later in a rented room in Malmö, where he graduated from high school at nineteen. That was quite an accomplishment, as he had to borrow money to get through. School was free, but he had no support for books and living expenses. After graduating from high school, he entered compulsory military service, which he prolonged a few years to become an officer in the reserve. I think he very much enjoyed his time in the military. For some time he entertained the thought of studying theology and becoming a minister of the church. He realized, however, that his beliefs were not strong enough, and instead he entered law school at the University of Lund. After graduation, he and my mother left Lund so he could do the equivalent of his internship as a law clerk at the court in Växjö. Later we moved to Halmstad on the west coast and eventually Stockholm. I was then seven years old. During the Second World War he was an officer in the Swedish army. He never had to fight, since Sweden stayed out of the war as a neutral country, but he was stationed at the border way up north for years.

My father is a bit of a mystery to me. I do not know if I knew his inner self very well. He was very caring and kind for the most part. He was strict but never mean, and he never raised a hand toward me. Although he apparently was known for being outgoing, funny, and talented as a singer and entertainer, that seemed to disappear as he got older. He was quite sentimental and would sometimes cry for reasons that were hard to understand. I inherited some of those genes. He had few friends and resisted going to parties where he would not know many people. But once there he always had a great time and often became the life of the party.

As a student in Lund, he and his friends formed a sextett called the Buffalo Singers. It consisted of one first tenor, two second tenors, two first basses, and one bass. They sang a cappella in harmony and were much appreciated. They went on a cruise ship, the SS Drottningholm, as entertainers on a journey to Africa and back. The legend says that he there met a beautiful, black-haired woman named Singoalla. Since his nickname was Nalle, hers became Singonalla. It was a brief affair. He also performed on stage in spex, just as his father before him and I later. He was very active in the student choir and belonged to their elite group, the small choir (Lilla Kören). He obviously had a fine ear for music, which he inherited from his father.

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Buffalo Singers

He did not practice law as an attorney but had a fine career mostly as a government employee. When he retired at sixty-five, he spent his time between Stockholm, where they had an apartment, and a farmhouse in Haga in southwest Sweden, which became a family enclave. He was president and district governor of the Lions Club, and in that capacity he traveled to Japan and the United States.

Eventually the farmhouse in Haga was sold. He and Mother bought a house in Båstad, a small town nearby. He wrote a book for professionals regarding guardians’ responsibilities when managing money belonging to minors and people declared incompetent. It was a success and likely is still in use. He was very influential in creating the current laws on this subject.

I believe he suffered from some form of depression most of his life. Today’s medications might have helped, but they were not available then. He suffered all kinds of somatic disease symptoms, but no doctor was able to find anything physically wrong. The last few years of his life he spent most of his time in bed, partly because of a hip fracture that was poorly treated and never completely healed. He died peacefully three days after his eightieth birthday.

During one of our conversations, he revealed to me that he had had an extramarital love affair early in his marriage to my mother. He also said he had made the mistake of telling her about it after it was over. This probably explains why they always had separate bedrooms. My greatest fear was that they would get divorced.

I believe he loved me very much and was proud of my various accomplishments. I loved and looked up to him. One day just he and I went to a fine restaurant in Stockholm. I was eight or nine years old and had never before been to such a place. I had Swedish meatballs with lingon berries and gravy. The portion was so large, that I could not possibly eat it all. I was very concerned since in our house the rule was that you always were expected to finish what you put on your plate.

Is it permitted to leave some? I asked embarrassed. To my great relief it was.

He was happy that I continued the family tradition and decided to study in Lund. He visited me there several times. On one occasion we went to the theater in Malmö. After the show he introduced me to oysters, for which I am eternally greatful. I love them.

He was ecstatic when my sisters Lotten and Ann were born, for he had always wanted a daughter. The relationship between them did not seem to go the way he would have wanted, however, particularly when they reached their teens and even later. He was thirty-eight when Lotten was born and, relatively speaking, an older father. Being pretty conservative, he probably had a hard time understanding their teenage escapades.

When our three sons—Joakim, Jesper, and Jonas—entered the world, he loved his role as grandfather (farfar). They reciprocated the love. The highlights of each year were when we would drive from Lund to Haga for family gatherings. No efforts were spared to make them joyful and memorable.

In retrospect, I think our departure from Sweden was very hard on him. He could not accept that part of his family was taken away from him. I might have felt the same way in his shoes. This is one reason why I sometimes wonder if I made the right choice. It became easier for him when Lotten’s children were born; they lived only a few blocks away. Fredrik and Martin became his new favorites, but he always missed his three Js.

My Mother and Her Family

My mother was born 1914 and was named Liv Ingar Wicksell. She came from a very prominent academic family. The most famous is, of course, Knut Wicksell, her grandfather (farfar). He was a professor of economics, a mathematician, and self-proclaimed conscience of the Swedish people. His opinions were strong and often controversial, landing him in all kinds of trouble. He was best friends with a number of notable Swedish luminaries among them August Strindberg, the famous writer, and Hjalmar Branting, the founder of Swedish social democracy. His economic theories and work gave him a worldwide reputation. According to some, he was one of the world’s three leading economists of the twentieth century. Some of his concepts are still valid today. He was obviously a brilliant man. During his tenure as chairman of the Federal Reserve, Alan Greenspan frequently referred to Knut’s theories. This was the subject of a lead article in the Wall Street Journal in year 2000.

Knut Wicksell was brought up in a religious family, but he eventually disowned the Swedish Church and became a declared atheist. His mathematical mind could not accept the Immaculate Conception as described in the Bible, and he gave passionate public speeches to that effect. This eventually landed him in jail for blasphemy. However, his confinement was privileged; he received dinner every day from a local restaurant, and the prison director would come and play cards with him at night. He enjoyed his time there and got a lot of work done. He was released after a few weeks.

He refused to be married in church, which was mandatory in those days. Instead he and his bride, Anna Bugge, put together a binding contract that was approved in a civil ceremony by the justice of the peace. His common-law wife, Anna, was from Norwegian nobility and became famous in her own right. She was one of the originators of feminist movements in Scandinavia, working on causes like women’s voting rights and recognition in the working place. She was Sweden’s representative to the League of Nations in Geneva, Switzerland, the predecessor of the United Nations as we know it today. My mother wrote a wonderful biography about her. Unfortunately it was never translated into English.

Knut Wicksell died ten years before I was born, so unfortunately I never met him. I so wish I had. What a man he must have been, and what a heritage to carry.

Sven Wicksell, my morfar (maternal grandfather), also a prominent academician, was professor of statistics at the university and an astronomer back in the days when computers and other sophisticated equipment available today didn’t exist. He too died early, at forty-nine years of age. He had been ill with strep throat. Penicillin had not yet been discovered, and as a result of the infection, he developed chronic kidney disease, for which there was no cure, and he died from kidney failure. Ironically, his best friend, Nils Alvall, developed the first method for dialysis only a few years after Sven’s death. I was only three when he died, so as you see, I never got to know any of my grandfathers, something I genuinely wish I had. There would have been so much to learn from them.

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My grandfather Sven and I and on his boat

with grandmother Ingrid (Momman)

My mother’s academic career, much to the chagrin of Sven, was cut short by my birth. As I have mentioned, I was not a planned child but the result of my parents’ love affair. Liv was a beautiful twenty-year-old woman, probably in some ways escaping from a very dominant father. So there they were, young and poor in the very beginning of their careers, with a little boy who was thin and often sickly. I don’t think I was expected to amount to much, but I was very much loved, and that lasted for their entire lives. They were married in a leap year on the twenty-ninth of February in a civil ceremony. They celebrated their anniversary every four years with extra fanfare.

My mother was a remarkable woman. Had I not gotten in the way, she would likely have had an even more splendid career than she did. While in Halmstad she worked as a clerk in an architect’s office. When we moved to Stockholm, a big publishing company, Bonniers, employed her. She started out reviewing books submitted for publication. Some were new manuscripts by Swedish writers; others were books from other countries, written in English, that potentially would be translated to Swedish. Soon she moved over to magazines and eventually became editor in chief of a pocket magazine called Allt (everything). It was a Swedish version of Readers Digest. Eventually she returned to book publishing.

In 1985, she published a biography she wrote about her grandmother. It was called Anna Bugge Wicksell: en kvinna före sin tid (Anna Bugge Wicksell: A Woman Ahead of Her Time). This work took her several years to complete. Her research was extensive; she went through hundreds of letters, newspaper clippings, and other sources. It would easily have qualified as a thesis for a PhD. I urged her to have it translated to English, but she did not believe it would be of interest outside Sweden.

She traveled the world and frequently visited us in America. She maintained close contact with her grandchildren and with their mother, Barbro. They remained friends in spite of our divorce. She was an excellent cook and had many amazing dinner parties. In her old age she was the social engine among the retirees in Båstad. After my father’s death, she was short of money. To help her I bought her house in Båstad with the caveat that she could stay there for the rest of her life. A few years after she was gone, I sold the house. Fate would have it that eventually my sister Ann and her husband, Bosse, bought it from the people I sold it to.

The year I turned sixty-five, we had a family reunion in Tuscany, where I had rented a large villa. We had two celebrations there; Ann had her fiftieth as well. At eighty-six, my mother walked with us around Florence, which she always wanted to see. Little did we know that her life was about to end. Upon her return to Sweden, she was diagnosed with cancer. We eventually found out it had begun in her lungs and then spread. I had retired that year and could help guide her through her illness, which she handled with outstanding poise. My sister Lotten, however, was her strongest support. Unfortunately Mother became mean to her in her waning days. That sometimes happens to a confused mind, which she developed because of brain metastases from her cancer. I managed to come back and arrived at her deathbed the night before she died on December 10, 2001. She saw me, smiled, and stretched her arms toward me. We said good-bye, and she went to sleep. I still miss her. Repeatedly in life there are moments when you need to ask questions only your parents can answer. I still have those moments, but no one is there to listen.

My Early Childhood

I have sporadic memories from my early childhood, beginning when I was about four years old. We lived in Halmstad, a town on the Swedish west coast, in a small apartment. The owners of the three-story building were a plumber and his wife. Their son, Krister Hyll, became my best friend. We played with simple toys like toy cars, trains, and tin soldiers. In the summer we picked wine berries and gooseberries, still my favorite, in their backyard. In the winters, which were severe in the early forties, we would ski, sled, and ice skate. In the winter of 1941, I was in my first ski race. Even though I was convinced I won, I was given second place. I never understood why. There must have been some secret handicap system.

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Liv, Nalle and Staffan at 5

After a couple of years, we moved to a slightly larger apartment with a view over the soccer stadium. My parents had no interest in going to the games, but I watched them from the balcony. My idol was the local team’s goalkeeper. I decided that was going to be my position. I liked his uniform and the cap he always wore.

I was pretty much left with my mother, my father being in the military and guarding the country’s northern boarder. He came home for visits sporadically for several years. When he did come, my parents always had separate bedrooms. I did not think much about it until I got older. Seeing my father rarely, I was quoted as a five-year-old as saying, Let’s get another father.

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My father guarding the Swedish border during WWII

The Second World War was raging, and even though Sweden managed to remain neutral and was never invaded by the Germans, we were very much aware of what was going on. From our windows we could see bombs exploding over Denmark, and every night we were forced to cover up our windows so as not to let out light. There were no streetlights, just darkness.

I went to kindergarten, and in the summer we would rent a house by the ocean a few miles away. Eventually we bought our own little house. It had no electricity, but it had a pump in the yard for water and an outhouse for the bathroom. We had very little money. Food was in short supply, and many items, such as sugar, coffee, and meat, were rationed. I remember seeing a picture of bananas. I had never tasted one; they were exotic and rare in Sweden. I really wanted to try one, but they would not be available until several years later.

I loved my birthdays in the summer. The day started with raising the Swedish flag. We had no flagpole, so we used the neighbor’s. And then it was presents. Of course I never got what I really wanted—it was too expensive. When at five I got a bicycle, I was very happy until I realized that it was a much simpler one than what many of my friends had received. It is sometimes difficult for children to understand the reasons for differences. We always had a party with sodas, a cake with candles, and, of course, time at the beach. I was the center of attention, which I loved (and I still do!). As I got a little older my father arranged games and competitions, like dart throwing and running with a potato on a spoon (the objective was to reach the goal line without dropping it). I always requested a regular running race around the block. I knew no one could beat me there.

When the day was over, I would cry myself to sleep. It was going to be a whole year before I had another birthday.

Chapter 2

STOCKHOLM

Elementary School

When I was seven years old, my father was given a job as a director of a governmental institution that oversaw prices of goods and services. This was 1943, in the middle of World War II. As I have mentioned, Sweden managed to stay out of the war as a neutral country, but we were of course very much affected by its effects on the availability of food, clothes, and other items. Price control was therefore essential in order for things not to get totally out of hand. He was good at his job and appreciated by friends and colleagues. My mother started working for the major publishing company in the country, Bonniers, which I have already described.

I vividly remember our journey to Stockholm. We had our first car, a British Ford Anglia. It was a small vehicle powered by coal (regular gas was rationed). For the first six hundred miles, the Anglia was not supposed to be driven faster than twenty-five miles per hour. Needless to say, it was a long, two-day trip—today it takes five to six hours. We made many stops; my favorite was Gränna, a small town on the shores of Lake Vättern. The area has interesting historical sites, but the reason Gränna was my favorite was a special candy bar made locally, polkagris. It had lots of sugar with a mint flavor. After many are we there yets we finally made it to the center of Stockholm, where my father promptly got a parking ticket.

We rented an apartment on Stora Essingen, one of the many islands on which Stockholm was built. In those days it was in the outskirts of the city. Today it is pretty much in the center! It was a small apartment, but I had my own room and could easily ride my bicycle to school. In the winter we kids used to ski and ride sleds down the hills of the road, and we went skating either on frozen fields or on the waters around the island. In the warmer seasons we played cowboys and Indians in the woods as well as other games. Of course we played soccer and other sports. I liked running and was hard to beat at the sixty-meter dash.

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Elementary school 1st grade

This was my first year in elementary school. In Sweden then we started at seven years of age; it is still that way. It was not an altogether pleasant experience. I liked school and early showed signs of wanting to show off—I’ve always liked attention. This probably irked some classmates and maybe even rightly so.

There was so much about me for my classmates to pick on: I came from the south of Sweden and therefore spoke with a different accent than they did. I