Efthimios Avgerinos, MD, FACS, FEBVS Professor of Surgery at the University of Pittsburgh in the USA and a distinguished vascular surgeon internationally traveled a long way in America and – fortunately for us – returned to Greece. The dedication, perseverance, hard work, and empathy that characterize him are a compass for all of us.

By Mia Kollia

Did you feel any gift or inclination for medical science as a child or a teenager?

I wouldn't say that I felt at least any gift or inclination beyond being a pretty good (but not excellent) student in school. But, I am convinced that school toppers are not the norm for successful people.
I had to attempt three panhellenic exams to succeed in medical school. But I persevered, learned from my mistakes, tried again, and always had a positive thought and attitude. In my life, recognizing and enjoying the fruits of my effort and hard work, I understood that anything is possible.
The continuous effort concerns our professional and personal life, family, and relationships. I will sum it all up in one word with many interpretations: empathy.

What does it take to make one's dream come true?

Perseverance, patience, hard work, and a positive attitude. You must fail to succeed; you must be disappointed to be happy! Dreams come true when you believe in yourself and see yourself as a protagonist, not a spectator of your life's work.

What were the most significant challenges, how did you overcome them, and what did they teach you?

In my academic life, after entering university (which was highly arduous), my most significant difficulty was adjusting to the reality of American Medicine. I was thirty-six years old and had just finished my surgical training in Greece in 2011, with short educational breaks in Europe. My challenge as a newly qualified Vascular Surgeon was to respond to the needs of the largest Vascular Surgery Department in the USA (University of Pittsburgh Medical Center - UPMC). Complex electronic files, constant calls to the emergency room, many complex surgeries, new techniques, and endless challenges of professional survival in a chaotic, for a foreigner, system. The difficulty was even more significant since I had left behind my beloved wife and two newborns (2 years later, they followed me to live together in the US). It took constant effort and many nights to fill a significant gap between two worlds; it took humility and a positive attitude to win over people, my older and younger partners. How could I have imagined that a few years later, I would receive the most important award for me, the recognition from my students "Teacher of the Year Award" among the entire educational staff of the Vascular Surgery Clinic of UPMC.
A recent difficulty I faced was leaving behind the greatness of American labor and medicine. At the height of my professional career and reputation in the USA (Professor of Vascular Surgery), I wanted to return to the Greek reality, a Greek reality that had twice disheartened me by closing the door of my return (claiming a university position).
The reasons for wanting to return were many and obvious for someone who has grown up in beautiful, with all its flaws, bright blue Greece, its lifestyle, and its people. Our Greece had and has much more to offer in all sectors, regardless of economic and political crises that come and go. If you want something badly, there are always solutions, as long as you have realistic expectations and adapt quickly to the place and the time.

How do you handle the medical error?

A medical error exists for those who practice advanced combat surgery and is always challenging to manage for anyone who practices it humanely. When I was younger, I looked elsewhere for responsibilities; today, I recognize it and take my responsibility with honesty and humility, but with a lot of stress and loss of sleep. Fortunately, it does not happen often; good preparation, constant scientific information, and respect for medical indications for any medical intervention are allies. The correct and comprehensive information about the patient is critical. The most significant complication – a medical error that happened to me several years ago that almost took the life of one of my patients, led to a deep friendship between us. I was by his side throughout his recovery journey, honest and humane. The Doctor is not a god nor a semi-god - he is human, and in its best version, it limits its mistakes or at least their severity.

How much and how do you cope with the constant updating that your job requires?

When you choose medicine as a profession, and the selection criteria are the pleasure of scientific research and the best offer to fellow human beings, constant information is a given but also pleasant. I have the privilege of holding academic positions in Greece (EKPA) and the USA (University of Pittsburgh) with intense research activity; I participate in the production of new medical knowledge and enjoy the integration of new technologies (pharmaceutical and interventional) in the treatments of my patients. People who know me will tell you that I am "always working" - and yet I do not consider myself to be constantly working - it is my pleasure, my hobby, to keep up to date with anything new in the sphere of my medical influence.

Managing groups and people. What does one need, and how does one accomplish it?

Managing people and keeping everyone happy is hard work. I don't believe in totalitarian rule over people and enforcing respect. The simplicity and friendly approach with my partners, the generous sharing of positive emotions, and the financial benefits in recognition of their effort remain the basis of successful people management. Respect and team cohesion is a natural consequences. I hold this as a rule, but there are always exceptions - fortunately, few. "good" people and partners generally surround me: maybe it's the natural choice in the ecosystem I've created.
 
What is life like else in the US, and why did you return to Greece?

I lived in the USA for ten years, the land of opportunity, meritocracy, and the realization of dreams. I lived the American dream, from being a young immigrant scientist in training to becoming a Professor of Surgery at one of the most recognized hospital centers in the country. Excellent working conditions, high financial earnings utterly dependent on the productivity and quality of my work, high-level education at all levels, rewarding excellence and human culture in everyday life.
But this is one side of the coin; human relationships are more challenging to deepen, fleeting and rarer; the friendly call has a start and end time, and there is no spontaneity. The Mediterranean temperament, the lifestyle, the loud laughter, the intense, strong emotion, and the nice hustle and bustle of your life are missing, as are the strong bonds with family, the climate, the sun, and the sea.  
Values and priorities are different at every age. Approaching 50, I now appreciate and seek the value of human relationships and personal life more than the value of continuous professional development and financial rewards. Although my return to Greece has not limited my working time, I have found more excellent inner balance. It is priceless to have a life outside your work, hobbies, and friendships with people with shared experiences and cultures. And if you are also a parent like my wife and me, raising Greek children is invaluable.

Who are the beacons in your life?

My parents! My father is an example of a family man, a self-made man, a hard worker, and always a dad playing with us, advising us (even though not always correct), and helping us.
My mother always cared for our well-being; she looked for quality, and the joy of life, an authentic Greek mother. As much as we often give a negative connotation to this term, I still enjoy the Greek mother traits.
My Professor and teacher in Vascular Surgery, Christos Liapis, with whom I still maintain a close collaboration today. The man who put Greece on the world map of Vascular Surgery, a pioneer, visionary, leading personality, tireless clinician, and researcher, taught me the art of Surgery and instilled a passion for scientific research and extroversion. Now I understand that the way to the top is not handed freely to you; you claim it and earn it.

Efthimios Avgerinos, MD, FACS, FEBVS is a Professor of Surgery at the University of Pittsburgh in the USA; he is a Visiting Professor of Vascular Surgery at the University of Athens and Director of the Vascular and Endovascular Surgery Clinic of the Athens Medical Center.