But what becomes Jean ? This key figure of French csotcina.comedy seems to have fired a final feature on the trade. We met it at his place in Tours. He lives in a splendid convent of century when he continues to exert for the pleasure, its manual and artistic talents.

 

 

. : You left, brutally, a few years ago, the csotcina.comedic medium. Why a so clear cut?

J.C.: It is completely voluntary. I completely broke the bridges with csotcina.comedy because I did not see any more which role I could play there. I think that there are new problems and that it is necessary to leave the place to the young people. It is not any more my place. I was put at the retreat three years ago but I could have remained consulting.

 

. : You had this possibility?

J.C.: I had this possibility and I did not take it because I thought that I was going to obstruct my pupils. The relay can be taken only by young people. The “old man” is cumbersome except when one needs his consultings. But it is currently increasingly rare.

 

. : It at the local level, but aren't there is perhaps true other places or you could have taken a place with a little more height?

J.C.: There are no structures for that. Our current Chairman, Bernard , try to reconstitute a committee of the former chief executives of the . They is very generous, but I believe that when one is not active and in the blow, it is debatable. The “” of the Anglo-Saxons is made up people who remained very active even as advisers. But when one is really with the retreat one is nothing any more.

 

. : One keeps, nevertheless, an important experiment!

J.C.: Yes, but the important experiment is not valid any more technically. The technique changed so much. Your generation faces work conditions completely different from those which we knew and who were our life. I am not sure, under these conditions, which we can be regarded as the wise ones.

 

. : But knowledge they is not only techniques, it is also a manner of thinking.

J.C.: The manner of thinking also changed, because society changed. Our interns and our chiefs work remarkably well, but they want, for example, to keep an area privileged for the family, the leisures, etc. It seems that there are some difficulties of currently ensuring the guards of weekend. We, we had another way of thinking and we worked almost all the time including Sunday. All the csotcina.comedy of the West in which I took part lived thus.

 

. : But it was the time or csotcina.comedy was set up and you had all the possibilities.

J.C.: I do not make any criticism with the current attitudes, but I sincerely believe that the trade in changed. For example, today, service operation is multi-field. It is completely different from the spirit of my time. When we were Department head, we were the Masters after God. But to tell the truth, this development took shape already. My old friend Robert , unfortunately too early disappeared, had told me “when you become Departmental manager, because you will become it, does not forget the image of the coconut. If you climb with all the coconuts the young people will shake you and you will not hold. It is necessary that you guards a speciality, a field a little with you, your coconut, where the young people will have some difficulties has to override you.” It had foreseen the multi-field spirit very well. Currently there is no more one service which is not cut up in specialized under-services, that it in is deprived or public. The private clinics which go well are those which found the same formula as this hospital system. One is well in another frame of mind.

 

. : What do you think about it?

J.C.: I believe that it is partly an impasse, but one cannot make differently. There are considerable advantages with multidisciplinarity but there are enormous defects. Our various hospital services are today of very high-tech but the poor patient on the other hand is forgotten. He is split up, he lost his unity. In does multidisciplinarity emerge a question “which will speak to the patient?” In this technically ultra-sophisticated team, it is necessary well that one somebody day has a dialog with the patient. And only one, because one will not put five or six people responsible in front of a patient. It is in my opinion the role of the department heads or the foremen but provided that everyone is understood admirably well. However the men are purity in practice nobody does not speak to the patient more. One speaks much about humanization of the hospitals, but humanization they is the men who do it they are not the regulations.

 

. : One needs to some extent a …

J.C.: A is needed absolutely. Admittedly it is necessary that each team member is his responsible with respect to the patient. The foreman will delegate responsibilities but they should not be scattered, they must remain on only one man. It can be a question of an assistant, of aggregated, that does not have importance, but somebody is needed, and always the same person, who will deal with the patient and who will speak to him. Is it necessary that it is systematically the department head? I do not know. In any event this responsibility falls on the higher levels of the service by practice and tradition and then because France adores the Chiefs.

 

. : You are very sensitive to the work conditions which changed. Did the way of handling the instruments change so much?

J.C.: Yes, much. When I began my surgery the basic instrument was the bistoury, accompanied by some grips. Currently there are innumerable instruments, and the vision is done with periscopes! The gestures are completely different and pose in my opinion worrying problems. Our young people currently are very accustomed to work with the endoscopes… I hope that they will know the day when that badly turns to be left there by traditional surgical means, i.e. to repair an popliteal artery which one damaged in a knee arthroscopy or to repair an aorta when one grated it by making a cure of slipped disc…

 

. : Without going until there, it poses the problem of the use of the torque link and the hammer when the oscillating saw is faulty.

J.C.: I was interested much in the instruments with the exchange rate of the College of csotcina.comedy which takes place with Tours, and that was my last work. With my friend Luc who is now aggregate in the service, we had written a fascicle which is called “the good use of the csotcina.comedic instruments”. We were helped in his realization by a Companion of the Duty, Mr Poisson, who with the chance to be called the Virtue. One made a small film where one shows it sawing an enormous piece of wood with a wood saw, and this, with a softness of gesture which the surgeons always do not have. To return from there to your remark, it is certain that when the motorized saw break down, force is to use the chisel or the old saw hand saw.

 

. : Here for what the old ones are used. If not, which can convey all this knowledge?

J.C.: You are right a little and the exchange rate of Turns where all the interns of csotcina.comedy pass the ones after the others is mainly made for that. I remember a very good meeting where Thierry had come to make an admirable demonstration of hulling. The hulling is very difficult and there are very few colleagues who can make a success of it. Thierry pleased very to me; he said here is my secrecy and he left his crucible a stone of which is used to sharpen the tools. To make a hulling. It is necessary that the torque link is sharpened like one . The young people were very sensitive to that and he discovered a trick that one does not learn to them any more in the services. Therefore this basic exchange rate was made, where one learns how to them to make use of the mallet, of a torque link and other instrument because some they are technological advances will need that. It is obvious that the old men forward these things well, but one can replace them by young people. I had young people who could admirably make use of the traditional instruments and transmit their experiment to other young people.

 

. : Didn't you suffer from a brutal lack of activity?

J.C.: Not, because I replaced the surgery by heaps of things. I have, inter alia, two passions: the manufacture of automats and painting. In addition, I like much to read and I have an enormous delay of reading.

 

. : Tell us to it origin of the famous layers of anatomy of and …

J.C.: That was done during the conferences of boarding school. In the Fifties, the interns were not paid or if little, and the conferences helped to live. I had six conferences of boarding school per week including two Sunday morning, the first with 7:30, and I do not know any more how much conferences of day school. We had made a duplicated lecture note of anatomy with small sketches and the students liked much that because there was not large thing of not published in the spirit of the contest. It was not precise anatomy but an aid with the preparation of the contest. We reported ourselves with Jacques whom one could a little better do and we improved our duplicated lectures note. That went still better, the candidates with the contests tore off them from one conference to another, in Paris. One thus decided to make a book for the contests. One worked much there: how much weekends! Half of the drawings are of me, other half, because I did not manage any more to provide, are of a professional draftsman. In practice, I carried out outlines with the feather, which were then polished by a “setter with the Net” (thus one indicates that which makes a drawing impeccable). In fact, he worked with the brush and I was very admiring of his talent.

 

. : But there was not nothing like it before?

J.C.: Not nothing. We in fact made easily readable the anatomical conventional writings. We also tried to obtain something of homogeneous, so that the guy are not lost. It was a teaching model made for the contests of boarding school. But that strongly displeased to the official anatomists. When I tried to contribute in anatomy, Gaston Cordier who was the big boss told me “I will support you in csotcina.comedy but never in anatomy; I will never forgive you and ”.

 

 

. : The multiplication of this type of abusive decision sterilized the teaching of the anatomy.

J.C.: The fact is that there is not almost more teaching of the anatomy in faculties. I had fun during the examinations of private clinic, or all the candidates were received from principle, to put basic questions. When you ask students which is or , that which is above and that which is below, you obtain 50% of errors and 50% of good performances. I.e. typically results of an answer randomly. Ask a medical student where are the radius and the ulna, I affirm you that it doesnot can tell you which is in inside and which is outwards. Tell him to trace on your wrist the way of the median, which is nevertheless an elementary concept, it does not know. That poses a problem nevertheless and in particular that of the badly controlled invasion of the medical imaging.

 

. : There is also all the loss of the formation by the drawing.

. All the big bosses were anatomists and made drawings of great quality in the board. Even those which were not gifted for the drawing had learned how to draw. It is of an enormous teaching interest, but that was stupidly abandoned. A companion will never make a frame if it did not draw it before. I remember, on this subject, of a small anecdote lived with Maurice . It was to operate a completely fracture; it was a tibia in thousand pieces. I did not understand why it had launched out in this indication whereas it could have plastered it. He told me “this evening, come one will work together”. One passed half of the night to draw the fracture in all the directions and this until 3:00 of the morning. It absolutely made a point of drawing all the fragments. The it made only one incision, it and it put some screws. Within sight of the radio, everyone found that admirable, but there had been an enormous preliminary work.

 

. : Which was the outstanding figure of your surgical formation?

. : Blackbird of . I was an old pupil of Blackbird of since I initially was at his place as provisional intern with . It was the birth of csotcina.comedy. Then I was his intern, then his senior registrar. It was a terribly demanding Master. When in second year of boarding school, I left the service of with , the aforementioned tells me: “, you go in Merle of , and I hope that you will be happy there because Merle of is of these for which the virtue is so difficult that he does not forgive the least not sinned at the others”. It was a very good summary. Blackbird of was a Mr very shining, who asserted an absolute rigor in all that was done. All was discussed. That was a chance for French csotcina.comedy to have at the same time Robert Merle of and Robert . One brilliant stuffed of ideas and the other of an absolute rigor. I did not pass to Robert but those which were well formed passed to both.

 

. : Which kind of operator was Merle of ?

. : Extremely shining. But it was not a toreador with the spectacular manners. He had a large respect of the anatomy and had a very beautiful quality, which is the gesture not . He had a soft and comprehensive touch; he worked with the point of the bistoury, never with the torque links.

 

. : It had only qualities?

. : Not, it was sometimes and unjust. But when it had had some small movements of mood it knew that it had made an error and that it had badly acted. I remember one day of congress or with my friend helped we it for an operation of . The intervention was televised, but this day there nothing went and we were made as not possible whereas one was there for nothing. It was nevertheless somebody whom I loved enormously and who humanly was a large Mr. One did not leave his indifferent service. One was for or against.

 

 

. : How was made your installation with Tours?

. : That was a little the fruit of the chance. To contribute to Paris appeared intolerable to me. The things were too much manufactured in advance and that did not try me. I had not completely finished my in Merle when one proposed a place with Tours to me. I thus came here in deprived and I remained into private during years in one of the largest private clinics of the city, the Saint-Gregoire Private clinic.

 

 

. : When do you have joined the “public”?

. When the Medical school was transformed into Faculty, one thought of me and that tried me because, to have young people around oneself, it is other thing. It was very interesting to be private but I a little only felt.

 

 

. : There it could there have had a parachuting…

. : I had already taken a certain place in the city, say that. And then Merle was always there and it enormously supported me. I knew Robert of which I was not the pupil but for which I did not have sympathy badly. The csotcina.comedic world was for me, it is indisputable, and I was appointed aggregate as soon as there was a place. I thus left deprived in 1971 to become full-time at the hospital.

 

. : Which glance you have over this hospital period?

. : Very positive. I was likely to fall on an absence from structure, an absence of tradition, and to create a team. France is always crushed and sterilized by its traditions. There there was nothing, there was sand and one built above. One could do what one wanted and they was enthralling.

 

. : Does your work on the wrist and on ankle come from the hospital or the private clinic?

. : It is a mixture. During at least 10 years all the private surgeons csotcina.comedists of the city were assistants of my service, all without exception. We did many joint work and the interns of the service went in the private clinics to study the results.

That was very enriching, but I do not believe that one could currently start again this adventure. The conditions of exercise enormously changed. We worked a little for the pleasure whereas today there exist voltages between the two sectors. It appears capital to me for the future of csotcina.comedy that there is a serious connection between deprived and public. One cannot continue to live in this environment which became heavy and aggressive.

 

. : You made party of the “Club of the Ten”?

J.C.: Before being the Club of the 10, it was the Club of the Failures. We twice a year at one of us for 48 H and we were to bring two observations of failures. Not small current failures, but of the true failures of a novel method, a new material. All in all constructive failures which one could fire something. We lived that during 25 years, maintaining it one is finished is all with the retreat or about. But we always understand ourselves very well.

 

 

. : You careful and were always reserved as regards publication.

. : It is true and we could have developed more international relations. What amused to me was well to make my trade and to have young people impassioned around me. I too much saw great known ultra services or the owner made visit with foreigners his service and finally, did nothing any more but that. There were no more ideas. Me I think that the teaching of the surgery it is trade-guild and that cannot be other thing. The companions live between them.

 

. : It is true that the companions live between them but they realize chief-of works. To take an example, there are 300 variety of hip prosthese and there is no prosthesis….

. : There are dels of too it is all. If it is necessary at all costs to have its prosthesis, it is enough to make a little hole in the stem and you have your prosthesis. There is not alas great originality in the great majority of the existing implants. It is necessary to return to a more scientific spirit. The POSTGRADUATE DIPLOMAS seem to me a good means of finding a little rigor. I had right before leaving launched my young people on a fundamental study on the prostheses without cement. So that the surface of a prosthesis is it is necessary that the aforementioned does not move during a certain time. This temporary fixing is fundamental and one of my pupils was harnessed, within the framework of a POSTGRADUATE DIPLOMA under investigation of the solidity of the temporary fixing of the prostheses. I believe that this work made with the assistance of researchers is essential if one does not want to lose any scientific credibility.

 

. : Which kind of Owner did you ?

. : It is to the interns that it would have to be asked. I believe that it is difficult to be judged. To avoid certain deviation I had asserted a certain number of rules. The first, it was never to put to me in anger.

 

. : You arrived there?

. : Practically. Finally, one can all tell calmly. The second rule, it was to make adhere to the true hierarchy of the service. I.e., for example, that a young intern did not have the capacity to reprimand a nurse on a field which she knew much better than him. With the experiment, the intern could later, adviser the nurse, but there was not, a priori, of medical systematic superiority. There is a quantity of service in deprived or in public or the nurse is completely ignored, completely scorned. I do not believe that a team can go like that. We do not have any more time to speak to the patient, and unfortunately, the two people who could do it, I want to say the nurse and the physio starts has to be overflowed.

 

. : You felt large difference between public” and “deprived” medical responsibility the “?.

. : There is a thing which enormously shocked me when I was appointed instructor, it is the untouchable side of the “owners”. In private clinic when somebody correctly does not look after any more his patients, that spends a certain time to be known, but all the same that is known. In the public hospitals it is necessary that a department head makes monstrous things to be emptied. It is not normal.

 

 

. : How do you see the future of the profession?

. : Three problems worry me. Firstly, it is the organization of work. I currently think that the small private clinics and the small hospitals cannot function any more like dynamic and really effective structures. Secondly it is it not comprehension of the doctors in front of the economic development of medicine. It will be necessary that they agree to start to make accounts. I was chairman of during 9 years, and I know what it is the management of the economic problems of a . During this period, I ran up constantly against the incomprehension of my colleagues who wanted at all costs, an aircraft which would have been useful only twice a year. One will not be able to continue a long time like that. Thirdly, it is the training of young people. Some of my friends support that one can train surgeons in the private clinics because while helping one learns much from thing. That is true only during one short period of time, because quickly it is necessary to start to operate while being helped by elder more tested. But one cannot help the young people apart from the hospital system. In private clinic, there is a contract with the patient: it is you who operate it, it is you who are responsible with respect to him. I do not see how the problem can be posed differently.

 

. : Which consultings of formation would you give to an intern?

. : Initially to keep a critical spirit and always to evaluate a result. Then to travel. It is capital but it is one of the weaknesses of the French formation. One of the reasons for which the young people do not want to go outside, is that they are afraid to lose their place. It should well be said, too owners prefer to appoint a young person who pampered them and helped for a long time rather than that which took the risk to go to be formed abroad and to return more independent.

 

. : Finally, which was the greatest satisfaction of your career?

. : It is very simple: it is haveto have had pupils. That was my major pleasure.