My mentor John Hargrave, AO, MBE

John Charles Hargrave was a wonderfully inspiring human being and I am so glad to have been touched by him.

John Charles Hargrave, MD FRACS MBE AO

It was my great honor to have been mentored by John Hargrave and to have witnessed his greatness. He was a giant among men, inspiration among physicians, pioneer to the Aboriginal Health workers and just a wonderfully inquisitive human being who had a great zest for life.

My first meeting with John was in 1985 – I had recently moved to Darwin for my first job in Australia as a recent medical graduate from India. Despite being at the top of my class at the St John’s Medical College, Bangalore, India, I found it difficult to get into the medical system in Australia. Dr Dayalan Devanesan, who headed the Aboriginal Health Service was kind enough to point me in the right direction when I contacted him through mutual medical connections and I ended up at the Royal Darwin Hospital as a resident in Aug, 1985. My rotations were in surgery and medicine. Despite good reports, my clinical supervisors in surgery, including the late Tony Noonan, told me fairly bluntly that it was going to be almost impossible to break into the surgical training fortress in Australia! Enter John Hargrave, who was just so full of infectious energy and a great enthusiasm for many aspects of medicine. He was my mentor when I first started working in Darwin as a recently graduated medical resident in 1985. Dr Hargrave was an icon in the medical corridors of Aboriginal health in the Northern Territory. He was the only person to have successfully eradicated leprosy in a population - it was endemic in the NT and in the Northwestern WA in Aboriginal populations. He made it his mission to manage the population's needs, medically, surgically and socially. By the time I got to Darwin, he had established a microsurgery and reconstructive surgical laboratory aimed at building the reconstructive surgical efforts in the Northern Territory. As a resident who was in the medical wards, but interested in surgery, I was exposed to nerve conduction studies, evaluation of limb deformities and microsurgery, through his efforts. I ended up spending many hours in his lab, learning to use an operating microscope, operating on bunny ears and thighs.

He had an amazing supporting cast –

Dave & Betty Shoobridge, who provided the rabbits and housed them after surgery (and gave them away as pets),

Joe Daby who officially was an aboriginal health worker, but actually turned out to be a gifted micro-surgeon and animal handler. Joe helped me many hours of microsurgical toil.

Joan – who was John’s secretary and organizer but also coordinated care of his patients.

Over the subsequent 18 months I worked in John’s lab every day and visited there on weekends – notching many hours of experience in the care of rabbits and getting reasonably proficient in microsurgery. Through his encouragement, I got involved in the first successful digital re-implant performed in the NT: the year was 1986 and we re-attached a thumb in a young man, who had it severed in an industrial accident (I was able to participate actively, even though I was a medical registrar by then!). Our work in microsurgery was finding more clinical application. John and I went to the 9th People’s Hospital in Shanghai, in mid- 1986 to learn more about microsurgery at the leading Chinese institution at that time for micro-vascular reconstruction. The work on freeze-dried arterial allografts was funded partly by the International Atomic Energy Agency & provided us with a visit to Sri Lanka for a research meeting.The project ended up with my masters degree and the finding that freeze-dried micro-arterial allografts did not work. It allowed me to exposed to surgical techniques and made me realize that while technically satisfying, microsurgery was not my long-term interest. John and I spent many hours in the post-mortem lab dissecting specimens. Our trip to Shanghai to learn from the pioneers in microvascular surgery was before China had gone through the economic "reforms" of Denz Xiao Ping, and and of course 3 years before Tian-An-Men square!

I got to know Dr Hargrave extremely well through all of these interactions and became a close friend. He also helped me and Dale Fisher (who now heads the WHO task force on Covid 19 & is director of Infectious Diseases at the National University of Singapore) write our first paper – a case report on Borderline Lepromatous Leprosy in 1986! We remained very close until his death a few days ago.

I moved South in 1987 for further training and eventually qualified as a cardiothoracic surgeon in 1997, after many years of training in general surgery & then cardiothoracic surgery. Through the early years of CT training in Sydney at St Vincent’s Hospital, I worded under the tutelage of Drs Victor Chang and Mark Shanahan. John visited a few times and also introduced me to another doyen and pioneer – Rowan Nicks, who was the first Full-time consultant cardiothoracic surgeon in Australia, at the Royal Prince Alfred Hospital. They were both men of many parts and many world-wide affiliations.

Dr Hargrave was an early contributor and participant in the medical missions in Timor Leste. He was instrumental in helping set up the infrastructure there to provide basic healthcare and access to specialist services for the Timorese population.

John moved to Tasmania in 2000, after he retired – and flew down in his own plane. On one of the early joy ride flights in his new surrounds, he noticed some chest pain. This prompted investigations, which revealed severe triple vessel coronary artery disease. I was incredibly honored when he chose to travel up to Melbourne for his coronary artery bypass graft surgery – to be performed by me in mid-2000. We kept in touch as I expanded my research work into new treatments in Atrial Fibrillation and Heart Failure. In 2002, my family and I moved to the Chicago – I was recruited by the University of Chicago and remained there for the next 9 years. In 2013, just after one of my regular trips back to Australia, John reported worsening shortness of breath. It turned out that he had developed severe aortic stenosis and needed further surgery. This time, he insisted on getting things organized himself (I offered to come back and coordinate his care but my offers were politely refused). He came up to Melbourne and underwent repeat cardiac surgery which included aortic valve replacement. This time his recovery was a little more protracted and plagued by atrial fibrillation. Over the next few years, he struggled with difficulty in control of his heart rate. He had progressive shortness of breath. Eventually, he got treated with a pacemaker after institution of fairly potent anti-arrhythmic agents that slowed his heart. When I moved back to Melbourne last year, he was very short of breath and tired all the time. His cardiologist in Hobart felt that there were no surgical or catheter-based options. However, there were mechanical and potentially fixable causes: he had severe leakage of both mitral and tricuspid valves. After 3 months of multiple multi-disciplinary discussions between cardiologists, cardiac surgeons, intensivists, geriatricians, and physiotherapists, we decided that high risk redo cardiac surgery was reasonable.

Dr Hargrave underwent a complex redo cardiac surgery procedure in early September, 2019, at the same private hospital in Melbourne. We were able to repair both mitral and tricuspid valves through a right thoracotomy and he recovered extremely well. On the 8th post-operative day, he had a GI bleed that set him back by a couple of weeks. He eventually went off to rehab and got back to Tasmania by the ferry about 5 weeks after his operation.

I visited Hobart in November, 2019 and spent a day with him. We went out to his favorite winery for lunch and he seemed to be doing very well. Other friends visited him and found him to be quite improved. We spoke regularly on the phone and he seemed to be in good spirits. The Covid related lockdowns made it difficult for his interstate friends to visit.

In the final two weeks of his life, he became sick with a pneumonia and was getting increasingly frustrated at the time it was taking him to recover from it. After a short stint at Calvary private hospital, he returned home and then checked himself into the palliative care unit of Hobart Private Hospital. He decided that he had had enough. He called me 2 days before he passed away – to say goodbye. I did not expect the end to come so quickly. I am glad it was painless.

John left an indelible mark on many people, some of whom have gone to greater glories all over the world. It was my unique privilege to know him as a friend, mentor, patient and a true pioneer in the Aussie tradition. He was modest, incredibly accomplished and delightfully inquisitive till the end. I miss him and so will many!