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Why “Vic the fighter”

“No surrender, Vic!” I e-mailed him in 2004. “No way, I just started to fight” he replied. Victor Warren Fazio, born 1940 in Sidney, Head of the Department of Colorectal Surgery at the Cleveland Clinic Ohio since he was 35, Past President of the ASCRS (1995–1996) and Editor-in-Chief of Diseases of the Colon and Rectum (1997–2007), had entered the longer tunnel of his life, a serious illness. He fought outstandingly, as expected, still managing his journal and operating on patients for 11 years. He passed away on the 6th of July 2015, leaving his wife, a daughter and two sons, six nephews but also many friends and pupils, in the USA and worldwide.

Vic ran the Colorectal Department for 38 years, an enormous interval of time, favoring the growth of super-specializations, teaching and surgical databases. He had some exceptional co-workers. Let me just mention James Church and Ian Lavery, who recently wrote, on the ASCRS website, that he was able to “put strangers at ease and make them feel included” and he was “bold when boldness was called for and cautious when caution was needed” in the operating theatre. “Those who met him were instantly charmed by his personal charisma and magnetism”. True. He did not need to speak loudly or get angry to be obeyed.

The Fazio touch

“Set the bar for scientific excellence high and demand intellectual honesty at all levels; make difficult decisions and be able to say no even when it is awkward to do so; recognize new opportunities and act decisively to make the most of them. Call it the Fazio touch” Robert Madofff wrote when he became Vic’s successor [1]. Ten years before, when he became Editor-in-Chief, Vic promised “an internationalization of the Editorial Board” [2] and he kept his promise. The Associated Editors increased in number from 13, 2 of whom were from abroad, to 43, 13 of whom were from abroad. As an Editor he was cooperative, patient and educational. I remember when he sent me five letters (true paper letters, with air mail stamps, typed by Ms. Pat Oldenburg) suggesting the proper terminology to make my submission on psychosomatics in proctalgia more understandable to the readers.

Fazio at St Mark’s Hospital

He had sympathy for the younger Italian whom he met in his Clinic in 1979 and then in London, at St Mark’s, 2 years later, where he went to learn how to create an ileoanal pouch from the late Sir Alan Parks. At that time, in Cleveland, they used to make the Kock’s pouch, (complicated by frequent sliding of the antireflux valve) or the straight ileoanal (complicated by incontinence and diarrhoea). I remember when Vic came to London with his lovely wife, Carolyn, and I gave them a lift in my 500 FIAT, driven “Italian style”. The couple was terrified while the small car was cutting through heavy traffic, but fortunately relaxed in front of a plate of good spaghetti with Italian tomato sauce and parmesan cheese. So different from the meal he had offered me in Cleveland 2 years before, when, around 12 pm, after 4 h spent together in the outpatients clinic, when I was wondering where and when to eat, he suddenly put a hand in the pocket of his white coat, took out a banana, and asked me: “Do you want some lunch?”.

Large bowel diseases at the Cleveland Clinic Ohio

I had never seen so many patients with Crohn’s disease in my life. There were a lot of them at the Cleveland Clinic, scattered through different wards. There were not so many anorectal and pelvic floor patients, but the number dramatically increased in the nineties, crucial years for Vic, who between 1995 and 1997 became President of the ASCRS and Editor-in-Chief of DCR. If we look at some of his publications at that time, we realize that his team and expertize covered all fields of large bowel diseases: rectovaginal fistulae, paradoxical puborectalis, ulcerative colitis and familial polyposis, besides Crohn’s and cancer [3–6]. Ten years after his visit to St Mark’s Hospital, Vic and his co-workers had performed more than 1000 restorative proctocolectomies with ileoanal reservoir. Tracy Hull and Jeff Milsom expanded anorectal and laparoscopic surgery and allowed the Cleveland Clinic to be competitive with the other US “colorectal giants”, the Mayo Clinic, the Lehey Clinic (where Vic had previously trained in hepatobiliary surgery) and, of course, the University of Minnesota, plus the newborn, now outstanding, Cleveland Clinic Florida, founded by the late David Jagelman and developed by Steve Wexner.

The legacy of Vic Fazio

The legacy of Victor Fazio is represented by a large number of colorectal surgeons who learned from him. His style of teaching was much appreciated by his residents, as he was able to make even the most complex procedure easy, showing the proper anatomical planes to his pupils. If some of them showed too much satisfaction when dissecting and suturing, guided by his expert hands, he used to tell them: “Don’t admire yourself!”. Most of his trainees successfully treated patients worldwide, for instance the late Chilik Ziv, just to mention one of them, who became President of the Israel Society of Colon and Rectal Surgery and then of ECTA, the Eurasian Colorectal Technologies Association. Vic was Australian and, to confirm that he moved to a country whose development is based on foreign people, his successor was not an American, but a Turkish surgeon, Feza Remzi, who also is member of the Editorial Board of this journal.

Science, patients and ethics

Fazio published ten books and more than five hundred papers, but he was not only a scientist, he also had special empathy with his patients, as shown by the Compassionate Doctor Recognition awarded in 2010. “Follow-through the ethic” was one of his principles, so difficult to put in practice in a surgical community more and more influenced by companies pushing their innovations with strong commercial campaigns. But, bearing in mind that the industry’s financial support and technical equipment is essential for the progress of colorectal surgery, we have to conciliate ethics with pragmatism, always in the interest of our patients. I think that Vic Fazio fully accomplished this mission.

We are so grateful to you, “fighting Vic”!