Sei sulla pagina 1di 623

Praisefor

M.GaziYasargil:

FatherofModernNeurosurgery

“Therearemanymedicalheroesofthepast,butLarryRogershas writtenabiographyofamedicalheroofourowntime.FormerlyDr.M. GasiYasargilwasknownonlyinthehigherechelonsofneurosurgery. Thankstothissplendidbiography,aworkofbothstateoftheartscientific scholarshipandcelebration,thepublicatlargewillbeawareofYasargil’s extraordinarycareer,hisoriginsinruralTurkey,hismanyrevolutionary advancesinmicrosurgery,hisgenerositytootherstudentsofneurosurgery, hishumanityandbrillianceasateacher.Deeplyresearchedandthorough, cogently written, this biography is also a history of the field of neurosurgeryinmoderntimes.WeareindebtedtoDr.Yasargilforhis manylife-savinginnovations, andtoDr. Rogersforthis accomplished biography.”

RobertMorgan

AuthorofLionsoftheWest

“Thisisanoutstandingbookonthelifeofthemostrespectedand

honoredneurosurgeonofourtime.Fullandobjective,itdetailsProfessor

Yasargil’sjourney,bothinsunshineandshadow.”

ClarkWatts,M.D.

FormerEditorofthejournal,Neurosurgery

“Professor Yasargil taught a generation of neurosurgeons from

aroundtheworldhowtohandlevitalbloodvesselsandneuralstructures whileremainingcommittedtopreservingthefunctionalbraintissueof every patient—no exceptions and no excuses. But if you were not committedtohiswaronhispatients’pathology,youimmediatelybecame his enemy. Neither did he suffer fools, or polite, inane questions or commentswhileatwork!Youngmenwhomanagedtoplaybyhisrules wererewardedbeyondtheirwildestdreams,andsoweretheirpatients. Thisfinebooktellshisstory,noholdsbarred.”

VinkoV.Dolenc,M.D.

FormerChairman,DepartmentofNeurosurgery,

UniversityMedicalHospital

Ljubljana,Slovenia

“NeurosurgeonandwriterLarryRogershasundertakentheincredible taskofresearchingandwritingabiographyofthegreatestneurosurgeonin our lifetime. With uncompromising honesty he describes the historical settingintowhichGaziYaşargilwasbornandlived.Hevividlydescribes this neurosurgical iconoclast’s single-minded drive for excellence and unerringly captures his complex personality, which balances infinite surgicalpatiencewithanoccasionaluncontrollableoutburst.Yasargil’s lifelong spirit of generosity is tempered with intense intolerance for anything less than neurosurgical perfection. Through many years of observinghissurgicalartistryandstrivingtoemulatehim,Iamthrilled this book portrays the essence of this formidable neurosurgical giant. Readingitwillenablelegionstocometoknowhimthroughhisinspiring lifestory.”

RobertF.Spetzler,M.D.

Director,BarrowNeurologicalInstitute

J.N.HarberChairofNeurologicalSurgeryChair,

DivisionofNeurologicalSurgery

Director,NeurologicalResearch

“Generationsofneurosurgeonshavebeen,andwillcontinuetobe,

influencedbytheteachingsofProfessorYasargil.Thepassageoftimewill

continuetoimmortalizehisteachingsandtechnicalelegance.Hewilllive

ineternitythroughthepractitionersofmicrosurgeryandgenerationsof

patientswhobenefitfromit.”

Ketan.R.BulsaraM.D.

Director,NeuroendovascularandSkullBaseSurgery

YaleDepartmentofNeurosurgery

“A trainee of Gazi Yasagil’s in 1973, Larry Rogers, a former neurosurgeonhimselfandauthorofawell-receivednovelandamemoirof hisexperiencesasanArmydoctorintheVietnamconflict,hasproduceda

bookfromaseriesofinterviewsinthe1990sonthelifeandtimesofhis

teacher.ProfessorYasargilisoneofthemostrenownedneurosurgeonsof ourtime.Rogershascapturedtheessenceofthisambitious,driven,andat times, difficult man, who perhaps more than anyone else drove the developmentofmicrosurgicalneuroanatomyandmicroneurosurgeryaswe knowittoday.Thebookisverywellwrittenandeasytoread.Itwillbeof interest,notonlyasaworkofneurosurgicalhistory,buttoanyonedrawn tothelifestoryofamemorablehumanbeing.”

RobertL.Grubb,Jr.,M.D.

ProfessorEmeritusofNeurologicalSurgeryandRadiology

WashingtonUniversityinSt.Louis

“LarryRogershasgiventheworldthefirstbiographicalinsightinto

the man who delivered neurosurgery into the modern era. Professor Yasargil altered the approach to complex neurosurgical procedures by virtue of his creative mind and unsurpassed technical skills. More importantly, he was relentless in his crusading for their widespread adoptionacrosstheglobe.Rogers’biographyilluminatesthecomplexity ofthemanandsurgeon.”

RichardHodosh,M.D.

PastPresident,AmericanHeartAssociation

“Thislegendarysurgeon’smassiveeffortstotransformhisspecialty arealmostmatchedbytheauthor’sattempttopresentabalancedviewof his life. Every anecdote, observation, and detail exudes interest and humanity. The scope of the narrative goes well beyond its focus— neurosurgery—makingitnotonlyimportantfortheyouthofneurosurgery, even all of medicine, but this book also seems accessible to general readers.Itsucceedsingrandstyle.”

WilliamF.Pharr,M.D.

FormerDirector,Cardiovascular,Thoracic,andVascularSurgery

GeisingerMedicalCenter(Danville,PA)

“The operating microscope introduced by Professor Yasargil, has dramaticallyimprovedtheoutcomeswithcentralnervoussystemsurgery. Thisbookisavivid,dynamic,andaccurateaccountofthisunusualman’s lifeandtimes.Hehasclearlytransformedourspecialty.”

CharlesSternbergh,M.D.

Chattanooga,Tennessee

“Herodotus wrote his “Histories,”, the story of the Greco-Persian

wars,“inthehopeoftherebypreservingfromdecaytheremembranceof whatmenhavedone,andpreventingthegreatandwonderfulactions fromlosingtheirdeemedofglory.”Dr.Rogershaslikewisechronicledthe greatdeedsofProfessorM.GaziYasargil.ProfessorYasargilismuch more than a virtuoso neurosurgeon. His inquisitive mind, his love of culture,andhisphilosophyallcontributetotheexcellenceofhiswork.He wasagenerousteacherwhoprofoundlyinfluencedthecareersofalucky fewwhodirectlyworkedwithhimandchangedtheneurosurgicalpractice ofallwhoreadhisworks.Dr.RogershascapturedtheProfessornotonly asaterrificneurosurgeonbutasaveryspecialhumanbeing.”

AllanH.Friedman,M.D.

TheGuyL.OdomProfessorofNeurologicalSurgery

Neurosurgeon-in-Chief

DivisionofNeurosurgery/DepartmentofSurgery

DukeUniversityMedicalCenter

M.GaziYasargil

FatherofModernNeurosurgery

byLarryRogers,M.D.

©Copyright2015LarryRogers,M.D.

ISBN978-1-63393-113-8

Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,or

transmittedinanyformorbyanymeans–electronic,mechanical,photocopy,recording,orany

other–exceptforbriefquotationsinprintedreviews,withoutthepriorwrittenpermissionofthe

author.

Publishedby

author. Publishedby 21060thStreet VirginiaBeach,VA23451 212-574-7939

21060thStreet

VirginiaBeach,VA23451

212-574-7939

Inassociationwith

ParklandSS

CONTENTS

Acknowledgments

Preface

Epigraph

1.SurgeonoftheCentury

I.Beginnings

2.OutofPoliticalTurmoilandRevolution:theBirthofaSurgeon

3.Childhood:StoriesandPlay

4.HighSchoolandRumorsofWar

II.IntoWorldWarII

5.NaziGermany

6.MedicalSchoolatLast

7.EscapetoSwitzerland

8.SickBrains—BeginningsinPsychiatry

9.ResidenciesinMedicineandGeneralSurgery

III.EarlyAccomplishments

10.FromNeurosurgicalNeophytetoPioneerinNeuroradiology

11.VascularSurgeryandStereotaxis

12.ProblemstobeSolved:ATurningPoint

IV.TheBirthofMicroneurosurgery

13.Burlington

14.AnAmericanSafari

15.ReturntoZurich—ANewBeginning

V.TheNewEra

16.NewTechnologies

17.FrustrationandOpportunity

18.TensionsandConflictsLeadtoThinIce

20.TeachingMicroneurosurgery

21.Slovenia—ASpecialDisciple

22.TheTrialsofChairmanship:AnEndingLeadstoaBeginning

23.StormyRelationships:Disciples’Perspectives

24.AFreshLookatTemporalLobeTumorsandEpilepsy

25.DeathKnellforthe“BrainBypass”

26.LaterinZurich

VI.Retirement

27.LittleRock

28.LegacyoftheManandhisArt

SelectedBibliography

Notes

Photographs

Appendices A.BadBlood:TurksandArmenians

B.IntracranialAneurysmSurgery,1931-1955501

C.PercutaneousThrombosisofIntracranialAneurysms D.AdvancesinVascularSurgery:FromCarreltoJacobsen

E.LeonardMalis(1919-2005)

GlossaryofMedicalTerms

InterviewsandFinalAcknowledgments

Index

INMEMORYOF

AgnesandLarry

Whogavemelifeandtaughtmerightfromwrong

andtolovemyneighbor.

WilliamKempClark,MD

WhopresentedmeopportunityandinsistedlbeallIcouldbe.

LeonardI.Malis,MD

Aquiet,gentlegeniuswhoprovidedmetimely

encouragementforthisproject.

DEDICATEDTO

MywifeBetty,theloveofmylife,

Whohasmadeallthedifference.

PREFACE

Letusnowpraisefamousmen,andourFathersthatbegatus.”

Ecclesiastics44:1(KJB)

Asistruewithmanysurgicaldisciplines,theshortdevelopmental

history of neurological surgery is the story of the wisdom, talent and fortitudeofasmallnumberofpioneersurgeonswhosegiftstomedicine farsurpasstheirowntechnicalvirtuosity.Thesefewgiantsarethetrue fathers of our specialty, and since the time of Harvey Cushing, no individualhaspersonallydominatedtheevolutionofneurologicalsurgery ashasMahmudGaziYasargil. Beginning in the late 1960s, Professor Yasargil has directly influencedthecareerofeachpracticingneurosurgeon,andthroughthem thehealthandwellbeingofmillionsofsurgicalpatients.Thisfeatwould bearemarkableaccomplishmentforanyyoungphysicianemergingfrom thehallowedivytowersofEuropeorAmerica;thatitwasaccomplished

byanimpoverishedyoungTurkishmedicalstudentwhoarrivedinwar-

weary Germany during the final months of the Second World War is almostbeyondbelief.Thisisthatincrediblestory. Dr.LarryRogers,aretiredneurosurgeonandwell-publishedauthor, studied briefly with Yasargil in Zurich during 1973. Stunned by the conceptual and technical revolution Yasargil brought to operative neurosurgery on a daily basis, Rogers subsequently watched that revolutionsweepthroughacademicmedicalcentersandprivatesurgical clinics alike, ultimately to become the standard of world-wide neurosurgical practice. In less than a decade, a specialty previously

weddedtoincrementalchangesawitselffundamentallytransformedina quantumleappoweredbytheinsightandcourageofthissinglesurgeon. From Dr. Rogers’s unique perspective as a former student, a surgical

practitioner, and a personal acquaintance, he is uniquely qualified to documentthelife,times,andinfluenceofthisseminalfigure. Mahmud Gazi Yasargil is a multi-faceted, intriguing individual whosepersonalityhasevokedabroadspectrumofinteractionsduringhis dramatic rise and subsequent reign as the world’s most famous neurosurgeon.Thenatureandscopeofthoseinteractionsareintegraltoa clear understanding of both the man and his surgical genius. Their complexity contributes important texture, color, and contrast to this admirableportraitofthe“FatherofModernNeurosurgery.”

Thisisaninteresting,praise-worthybiographyofafamous,praise-

worthyman.

DukeSamsonMD

Professoremeritus

DepartmentofNeurologicalSurgery

UniversityofTexasSouthwesternMedicalSchool

Dallas,Texas

Thisisman’slawoftheblood:

Tomakewinefromthegrape

Tostrikefirefromthestone

Andhumanbeingsfromkisses

CanYücel(1926-1999)

(TranslationbyRuthChristie)

CHAPTERONE

Surgeonof

theCentury

IN1967GAZIYASARGILstunnedthemedicalworldbyusingan

operatingmicroscopetosewtwobloodvesselstogetherinsideaman’s head,arteriesone-millimeterindiameter,thusreroutingbloodfromhis scalptohisbrain,accomplishingtheworld’sfirst“brainbypass.” 1 The suturesheusedwerefinerthanahumaneyelash,impossibletoseeifheld atarm’slength.Theideaofthe“bypass”wastopreventstrokesinpeople believedtobeatrisk. Theoperationreekedoftechnicalelegance.Foragenerationofbrain surgeonsitwoulddefinetheultimateindelicateeye-handcoordination, andstoodasasymbolofhopeforpatientsanddoctorseverywhere. For years the operating microscope had been used effectively for operations of the eye and the ear, organs in which blood vessels are relativelysparse,andthereforetheriskofsurgicalhemorrhageisminimal. The brain, on the other hand, is one of man’s most vascular organs, makingthemanagementofbloodvesselsandbleedingamongthemost challengingaspectsofneurosurgery.Furthermore,brainsurgeonstypically musttraversesignificantdistancesthrough,beneath,andaroundimportant neuralstructuresinordertoreachtumorsandvascularpathologiesmany times the size of the eye or a compartment of the ear. Eye and ear surgeons,incontrast,focustheirmicroscopesonnarrowfieldsandmove thembackandforthverylittleastheywork.

To adapt microsurgery to neurosurgery involved designing a microscope that was freely moveable through three-dimensional space. Themicroscopesusedbyeyeandearsurgeonswereaboutasmobileasa giantslug.Andtheproblemofcontrollingbleedinginthebrainduring surgery required not only different methods and technologies, but masteringmicrosurgicalanatomy,evenadoptinganentirelynewmindset fornavigatingthroughthebrain. Yasargiltaughtagenerationthat“microtechniques”affordinfinitely moredelicate,moreaccurateoperations.Andhewasfortybeforehebegan toaddresstheissue.Bythenhewasalreadyanacknowledgedinternational expertinneuroradiologyandstereotacticneurosurgery. Reroutingbloodflowwasonlythebeginning.Intracranialaneurysms were prone to hemorrhage without warning and cause death within minutes,leavingsurgeryastheonlyhopeforsurvivorstoavoidaneven

moredeadlyhemorrhage.Buttheresultsof1960sbrainoperationswere

dismalindeed.Ofpatientsundergoingsurgery,atleastoneofeverythree diedwithinafewdays. 2 Ahandfulofcentersandbrainsurgeonswere betterthanothers,buteventhemostskilledsawoneofeveryeightoftheir patients die after aneurysm surgery, even those fully conscious before surgery,thoseanticipatedtohavetheverybestchanceforsurvival. 3 , 4 , 5

In1972Yasargilreportedoperatingon124aneurysmpatientswho

were awake prior to surgery without a single death. 6 Of seventy-four otherswhoweredrowsybeforesurgery,onlythreedied.Thisamountsto

anoverallmortalityof1.5percent,aneight-foldimprovementoverthe

besttreatmentavailableatthattime.Suchadeathratewouldbequite acceptableaftergallbladderoperations!Inaveryshorttimeotherswere committedtofollowhisexample. LikeHarveyCushingandWalterDandyintheearlydecadesofthe twentiethcentury,Yasargilhadinspiredaseachangeinbrainsurgery. Why did microsurgery make such a difference with intracranial

aneurysms?Acogentexampleofitsvalueisthatthemagnificationand improved lighting provided by the microscope revealed tiny arteries adjacenttoaneurysms,theimportanceofwhichsurgeonsevenawareof them had woefully underestimated. Preserving such vessels proved far moreimportantthananyonedreamed.Topreservethemingoodcondition couldbelife-saving!Furthermore,microsurgeryimprovedthetreatmentof braintumors,preservingcranialnervesandfunctionalbraintissue,thereby reducing the incidence of strokes and other neurological impairments followingsuchoperations. Monitoringhismagnifiedmovementsbeneaththemicroscopeinsured Yasargilgreatercontrolandprecision.Histalentwasprodigious,buthis

brandofmicrosurgerycouldalsobelearnedbyothers.Between1967and

1972neurosurgerywasalteredforever.

SoonbrainsurgeonsflockedtoYasargilinZurichtolearnhisbrand of microsurgery. Over the following decade those who committed themselves to learning his method saw their mortality rates with

aneurysmsfallbyasmuchas80percent.Talentvariesfromsurgeonto

surgeon,butmicrosurgeryhelpedanysurgeonwillingtocommittoits learningcurvetobemuchbetterthanhewasbefore. As the outcomes of aneurysm, brain tumor, and vascular malformation operations improved, similar results followed with microsurgeryforspinalpathologies,eventheubiquitousruptureddiscfor back and leg pain. Closed circuit television monitoring and video recordings from miniature cameras mounted on microscopes revolutionizedthemethodsofteachingyoungneurosurgeons.Stilllaterthe technologywasadaptedtosurgicalendoscopes,leadingtothe“minimally invasive”methodsofthetwenty-firstcentury. After a vote in 1999, an international panel of 170 neurosurgical

expertsnamedHarveyCushing(1869-1939)asthemanmostinfluentialin

theneurosurgicaladvancesofthefirsthalfofthetwentiethcentury. 7 Inthe

1920sand1930sCushingwasuniversallycelebratedaroundtheworldas

the“fatherofneurosurgery.” ThepanelalsonamedGaziYasargilwiththeidenticalhonorforthe period, 1950-1999. The internationally esteemed journal Neurosurgery published photographs of Yasargil and Cushing on the cover of its

December1999issueas“menofthecentury.”

WhowasthismanYasargil?Whatwashelike?Wheredidhecome from?Howdidhecometodowhathedid? GaziYasargilwasborninacavetoparentsheldcaptivebyarmed

outlawsintheaftermathofthe1923Turkishrevolution.Asachildhe

lived through a time of historic recovery in his homeland. He was fortunatetoachieveanexcellenteducationinTurkey’sbrandnewpublic school system. Then he found ways to benefit from the turmoil surroundinghim,tothrivebymakingchangeanadvantage.Atnineteen, hefoundhimselfscratchingoutamedicaleducationintheheartofNazi Germany during World War II. The bombs taking the lives of his classmatesandfriendswerecarriedbyBritishandAmericanairplanes. EventuallyhewouldescapetoSwitzerland,wherehecompletedmedical

schoolandresidency.Hewouldspend1966acrosstheAtlantic—inatiny

laboratory in Burlington, Vermont—toiling alone through twelve-hour daystounderstandanewanatomyandworkoutthetechniquesdestinedto transform brain surgery. As he reinvented himself, he elevated and reshapedtheart,essentiallyredefiningexcellence,affectingthelivesof millionsintheprocess. Hisisastoryworthtelling.

CHAPTERTWO

OutofPoliticalTurmoil

andRevolution—

theBirthofaSurgeon

ALTHOUGH EVIDENCE OF OPERATIONS through the human skulldatefromantiquity,neurosurgeryremainedstillinitsinfancyatthe

turn of the twentieth century. Origins of the specialty are very much European. French surgeons described their experiences with gunshot woundsofthebrainduringtheWarof1870, 1 andinRome,Francesco Duranteperformedwhatisbelievedtobethefirstbraintumorremovalin

1884. 2 In1894Chipaulthadproducedatwo-volumetextbook,Chirurgie

opèratoiredusystèmenerveux, 3 eightyearsafterVictorHorsleybeganto performbrainoperationsinLondon,approximatelywhenHarveyCushing wasfinishingmedicalschoolatHarvard. 4 Butsuccessful neurosurgical operationsinthenineteenthcenturywererareindeed!Althoughmorethan five hundred surgeons in the United States were reported to have

attemptedbrainoperationsbetween1886and1896,thenumberwould

shrinkoverthefollowingdecade. 5 SoonCushingwouldadvancetheartasnoonehadbeforehim,butat theturnofthecenturyitsEuropeanflavorremained.EvenforAmericans notrulytopqualitymedicaleducationwascompletewithoutexperiencein

Europe,atleastatriptoViennaorBerlin.In1900Cushingjourneyedto

Switzerland after Harvard and post-graduate surgical training at the MassachusettsGeneralHospitalandtheJohnsHopkinsHospital.Hespent

nearlyayearinBerne,dividinghistimebetweentheclinicofthefamous surgeon Theodor Kocher and the physiology laboratory of Hugo Kronecker.BeforereturningtoBaltimorehespentamonthinLiverpool withCharlesSherrington,thegreatneurophysiologicalpioneer.Cushing waslittleimpressedbySherringtonoranyoftheclinicalsurgeryhesawin Europe,butresearchinspiredbyachallengefromKochermadehimfront page news in America, resulting in an academic appointment at Johns Hopkins. 6 Hebecamethefirstsurgeonintheworldtolimithispracticeto operationsonthebrainandspinalcord.Withinadecadehislaboratory workandstoriedclinicaltriumphswoulddefinehimastheworld’sfirst

neurosurgicalgiant.Afterhisdeathin1939hewassucceededbydisciples

whowouldseetoitthathissurgicalmethodsandphilosophieswould dominatethedisciplineforgenerations. Notwithstanding Cushing’s influence and legacy, it should not be surprising that the man to dominate neurosurgery later in the century wouldbeaproductofEuropeanthoughtandexperience.Researchand medicalexcellencewereingrainedinnineteenthcenturyEuropeanculture. ItissurprisingthatthatmanwasbornandeducatedinTurkey,acountry

knownthroughoutthenineteenth-centuryandintothe1930sasthe“Sick

ManofEurope.”Howmanytimeshasanationbackwardinsciencebeen destinedtolaunchitsmedicaldisciplinetounsurpassedheights?Butwhen GaziYasargil’sinterestinmedicineandneurologymetthenewrealityof Turkishpubliceducation,newvistasopenedupforhim,formingattitudes andhabitsthatwouldmoldhislife. Theworld’seconomycareenedfromdevastatingpostwarinflationto

transientboominthe1920sonlytoimplodeintofreefallwiththeGreat

Depression.Europe,particularly,wasinturmoil.Germany,miredinwar

debt,facedpayingreparationsmandatedbytheTreatyofVersailles.Even

manyamongtheAlliessawhowimpracticalthatwouldbe.Itwouldset

thestagefortheriseofaNazination.HitlerwouldrallytheGermans

aroundaviciousbrandofanti-Semitism,leavingJewstofleeforasylum whereveritcouldbefound. Turkey,economicallyandpoliticallyweakerthanitsneighborstothe west, turned its emphasis inward, regrouping for better days. For five hundredyearsithadbeentheheartoftheIslamictheocracy,thevastand ruthlessOttomanEmpire.FinallyOttomanruleteeteredonitslastlegs.At lastTurkeybecamearepublic,thankstotherevolutionledbyMustapha Kemal,itswar-hero-turned-political-genius.TurksunderKemalvowedto avoid at any cost the unrest brewing in Europe. With the ink of its constitutionnotyetdryanditsnationalassemblyjustelected,itseconomy was reeling after years of Ottoman decline. Furthermore, the nation struggledbeneaththeweightofhavingbeenaloserinWorldWarI.It facedchangeshardlyimaginablethroughoutitshistory.PresidentKemal insuredthatmakingupgroundlosttohisEuropeanneighborsbecomea national preoccupation. His plans were reminiscent of a surgeon attempting to undertake a face-lift and a heart-transplant in the same patientunderthesameanesthetic. BlamingtheinfluenceofIslamforthecountry’seconomicstagnation andsocialbackwardness,KemalsetouttorebuildTurkeyasasecular state.TheIslamicinfluenceingovernmentandpoliticswaseliminated overnight.SecularlawreplacedtheKorantopreserveorderandsettle disputes.Religiouseducationwasbannedinschools.Thefez,thesignal headgearofOttomans,wassuddenlytaboo.Westernbusinesssuitscame intovogue,evenfedoras.Kemalgavewomentherighttovote,elevating themtoastatushardlyimaginedbytheirmothers.Heintroducedanew alphabet,evenanewlanguage,onepracticalinbothspokenandwritten forms. The new language was to encourage Turks to gain not only a national perspective, but to communicate efficiently with the West, to learnitsmethodsofindustryandcommerce. A national program of primary and secondary schools appeared.

Educationbecamethenumberonepriorityofthenewgovernment,thekey to Turks standing tall in the world again. Schooling would be free of charge, every Turkish child qualifying. A new kind of curriculum, includingclassicalstudiesandthebestofwesternthought,wasonthe drawing board. It required a new kind of teacher, one committed to teachingTurkstothinkforthemselves,tolookbeyondtheirimmediate environment and the traditions dictated by their Muslim past. Kemal allowed nothing to obstruct the path to learning. He threw maximum resourcesattheproblemandsawtoitthatnodetailwasoverlooked. ButtheTurksrequiredmorethannewfacesandnewhearts.They neededanewconceptofthemselves.Intheinterestofinstillinganew prideintheTurkishpeople,thegovernmentwentsofarastoreaddress certainaspectsofTurkishhistory,makingnewinterpretationsofevents andmovements,evenattheriskofblurringthelinebetweenmythand reality. Revisionist history soon echoed from classroom to classroom. 7 ChildrenlearnedthattheirancestorsfromthesteppesofCentralAsiaalso spreadthroughouttheworld,eventotheWesternHemisphere.Acasewas made that Turkish ancestors were somehow the fathers of American Indians.Neartheendofhislife,Atatürk,histhinkingperhapsbordering ondelusionalfromdissipationandillness,subscribedtothetheorythatthe Turksweretrulythemotherraceofallmankind. AsGazigrewup,hethrivedonprogramssetinplacetoenhance risingTurkishnationalism,buthewasalsoaffectedbytheunrestathome and immediately to the west; by the rumblings of dictators bent on dominatingnotonlytheirownpeoplebutthenationsaroundthem,alsoby theinconsistenciesandironiesoftheKemalistgovernmentasitvacillated betweendemocracyanddictatorship.PerhapsmostofallyoungGaziwas affected by the accelerated movement to Westernize in the interest of progress,toemulatethemethodsofmodernscienceandindustry.Atthe sametimehewasgroundedintheproudheritageoftheTurks,givento

understandthattheverylandonwhichhestoodwasthebirthplaceof recordedcivilizationtenthousandyearsearlier.Thiswasalandoncehome totheAssyrians,theHittites,and,centurieslater,theGreeks,stilllaterthe Romans. EarlyinlifeYasargilcametoseehimselfasanextensionofthat history. From childhood he understood that he was to make a great contributiontohispeople.ThroughoutfivecenturiesofOttomanruleall heroeshadcomefromthemilitary,yetthisgazi’sheroicswouldoccurnot onbattlefieldsbutinresearchlaboratoriesandoperatingtheaters. HitlerinvadedPolandwhenGaziwasfourteen.TheRussiansturned backtheGermansatStalingradandtheSeigeofLeningradwaslifted whenhewasseventeen.AteighteenhefoundhimselfintheheartofNazi Germany,workinginawar-tornhospitalwhileAlliedbombersrockedthe areaandAmerican,British,andRussiangroundtroopspreparedfortheir final advances. Then Yasargil made a harrowing run to safety in Switzerland,wherehewouldcelebratehistwentiethbirthdayonemonth afterthefirstatomicbombwasdroppedonJapan.InSwitzerlandhewould completehismedicaleducationandsetthestagetorevolutionizetheway brainsurgerywasperformedaroundtheworld. Young Yasargil heard countless family stories and legends. He celebratedhisOttomanandBalkanheritage,comingtothinkofhisfamily asextendingfivehundredyears,asitmovedfromcentralAnatoliato Constantinople(Istanbulofthetwentiethcentury).Bythetimeofthefall

ofConstantinopleandtheByzantineEmpirein1453,SultanMehmetII

hadalreadysucceededincrushingBalkanstatesbeneaththeOttomanheel. Yasargil took pride in Mehmet II having given “my great-great-great- grandfatheratribetoruleandanarmytocommand.”Hisancestorleftthe stark desert of Asia Minor for Banja Luka 8 totake overthearea and administeritforthesultan.InthelatenineteenthcenturySultanAbdül Hamit II ordered another of Yasargil’s “great grandfathers” back to

Anatolia.Yasargil,anavidstudentofhistoryeveninhisyouth,hada

feelingforthedifficultiesofgatheringupone’sfamilyandbelongingsto

leaveavirtualparadiseoftreesandthelushgrassyknollsandriversof

Bosnia.Hewouldreturntothearidlandandextremesoftemperatureof

Anatolia,whichmadeupthebulkofTurkey.

Gazi’sfather,Asum,wasanintenseyoungman,blondandlight-

skinned,withaprominentnoseandchiseledfacialfeatures.Hischaracter andtemperamentwerehonedbytheBalkanbloodinhisveins,thatof tribeswarringforcenturies,apeoplewithquicktempersandresentmentof injustice and outside control. With the exception of Asum’s father, a member of the Ottoman gendarmerie, the Yasargils at the turn of the twentiethcenturywerefarmersliketheirneighbors.Therehadneverbeen adoctorinthefamily.DoctorsinTurkeywereprimarilyGreek,orJewish orArmenian.Familytalescenteredonbrutalityanddeath,theresultof warandsocietalinstability.Asachildofthreeorfour,Asum’sfather, Gazi’sgrandfather,wassaidtohaveclimbedatreetoescapemarauding bandits. Helplessly he witnessed the slaughter of his nuclear family, leavinghimtoberaisedbyanuncle.Asum’schoicesforeducationand continuedlifeinthemiddleclasswerebasicallythree:militaryschool, policeacademylikehisfather,oraschoolfortrainingcivilservants.He chosethelast.Apostinthegovernmentassuredinstantrespectabilityand acceptance. For fifty years the dream of every Turkish male with a secondaryschooleducation wastohave ajobwhere hecouldwear a jacketandtie,dressdemandingrespect.GreeksandJewsintheirmidst wouldbelefttoconductbusinessandcommercewhiletheArmenians servedasartisansandcraftsmen. Times were changing: Asum’s generation reacted against the old- fashionedruleofthesultansevenmorethantheirfathershad.Whoknew what would happen? A huge makeover of society was coming. Asum Yasargil could feel it. Signs were in abundance, and change was on

everyone’slips.Hemustbeprepared.Buthehadalreadywitnessedthe greatcostexactedbychange.Whenhewasachild,theCommitteeof UnionandProgress(agroupofjuniormilitaryofficerstheworldpress described as “Young Turks”) revolted against Sultan Abdülhamit, and demanded a new constitution. A state of national euphoria followed. Muslimhojas,Orthodoxpriests,andJewishrabbisembracedeachother and went through the streets arm in arm. Jails were thrown open and politicalprisonersreleased.Youngwomenrippedofftheirveils.Crowds gatheredinpublicplacestohearpoliticalspeeches.Peopleranthroughthe streetsshouting“constitution”and“democracy,”hardlyunderstandingthe meaningofeitherterm. Aconstitutiondidcomeabout.TheYoungTurksdidweakenthe sultan.Butinimportantwaysnothingchanged.Turmoilcontinued.The war beginning in 1911 with the Italians at Tripoli continued, and ultimatelytroublebrokeoutintheBalkans.EncouragedbytheRussians, Serbia,Bulgaria,andGreece,forthefirstandlasttimeintheirhistory, united,anddeclaredwarontheTurks,theirOttomanoverlords.Asum Yasargilwastwenty,andstillastudent.Theactualfightingtookplacein theBalkans,buthefelttheshortages,thedevastationoffamilieslosing loved ones, and the universal fear associated with war. By mid-1913 hundreds of thousands of Islamic refugees had fled the Balkans into Anatolia,manystreamingintoIstanbul.

Asumwitnessedwarupcloseandpersonalin1914.Withthereserve

officer’scommissionawardedtohimasastudent,heenteredtheTurkish

armyinWorldWarIasatelegraphoperatorontheeasternfront.

HespenttheentirewarwiththeTurkishThirdArmy,fightingoff

RussianadvancesthroughthemountainsoftheCaucasus.PashaEnver,the

ministerofwar,proceedingagainsttheadviceofGeneralvonSanders,the

Germanliaisonofficer,personallyledanattemptedencirclingmovement

againsttheRussiansintheopeningmonthsofthewar.Itamountedtoa

dismalfailure.Abriefcounter-offensivefollowedinthespringof1916,

but the Turkish forces did well to achieve stalemate. Asum Yasargil learnedwhatitwastobepartofanexhaustedanddemoralizedarmy,a productofpoorleadershipandunrealisticstrategicgoals.Survivalseemed next to impossible, the Turkish forces literally “rotting with disease, exploitedbyunscrupulousofficersinleaguewithcorruptcontractors,and reducedtobedrockinarmsandammunition.” 9 Formonthsthetroopslived onhalf-rations,thenevenless.Theybracedthemselvesthroughthewinter forthebloodshedoftheoffensivethatwouldcomeinthespring.Butthe Russiansnevercame.Apoliticaleventwouldshaketheentireworldand have lasting consequences: the Russian Revolution. Nicholas II was overthrowninFebruary,andRussiawithdrewfromthewar. AttheendofWorldWarI,Asumwasamongthefirsttoleavetheir militaryposts.HehadacareertopursueinConstantinople.Evenmore important he had a girl on his mind. He married the sixteen-year-old daughterofaprominentlawyer,adevoutMuslim,awealthyman,one wellconnectedintheOttomangovernment.Hisfamilyhadbeenprimarily artistsandcraftsmensincecomingtoIstanbulfromcentralAnatoliainthe seventeenthcentury.Sahavet,possessedofadarkbeautyreminiscentof herItalianancestors,hadbeenabright,spiritedchild,oneherfatherhad missednoopportunitytoindulge.Fineclothes,jewelry,thebestschools— she had lived a life of privilege in a country struggling for economic survival.Withthemassesstrugglingmerelytoexist,herfamilyhada horse and coach and servants, including a private fisherman to take mackerelandspratfromtheBosphorus. Thoughdeeplyreligious,Sahavet’sfatherwasmoreliberalthanhis neighbors.Hesawtohisdaughter’seducationasthoughshewereason. Evenhisownwifehadreceivednoformalschooling,asdictatedbythe prevailinginterpretationoftheKoran.Sahavet’sfatherwasalsoanavid sportsman.Whenshewaseight,shecarriedthebrightbannerofhissoccer

clubatitsceremonialopening,wavingithighoverhead,hersturdy,pert legspumpingbeneathaskirtcutfarshorterthanmandatedbythedecorum oftheday.ForMuslimsherperformancewasscandalous.Itwasatime whenallwomenworeveilsandankle-lengthgarmentsinpublic.There wasnodiscoursewithmenoutsidethehome,andcustomdictatedthata womanneverwalkedabreastofamaninthestreet,evenherhusband, alwaystrailingatarespectfuldistance. Butherfatherignoredthecommentsthatfollowed.Heinsistedhis entirefamilyholdtheirheadshigh,andmeettheworldontheirownterms. Hewasaheadofhistime,trulyamanofthefuture,anexamplenotloston hisfierydaughter. In some respects the hardships Asum Yasargil endured in the Anatolianmountainsduringthewarprovedtrivialcomparedtowhathe and his young bride would be forced to tolerate in their first year of marriage.AsanallyoftheGermans,Turkeywasadefeatednation.The Alliesrecognizeditonlyasanationtobeoccupiedandcontrolled,ifnot overtlyexploited.Topreservehishopesforacivilservicecareer,Asum maintainedhisallegiancetothesultan,receivingofficialorderstoremain inConstantinople.Whatbetterchoicehadhe?TheOttomangovernment wasindisarray,andtheeconomyofthecapitalwasinshambles:there werenojobs,noindustry,notrade—thecountryitselfvergedonfolding up shop. There were swaggering Greeks in the streets to deal with, gloatingovertheirpartnershipwiththevictoriousAllies,alsothedismal sightofBritishwarshipssteamingintotheBosphorusfromtheSeaof Marmara. FollowingthesigningoftheTreatyofVersailles,theAllieswould occupyeverystrategicpointinTurkeyand,exceptforforcessufficientto maintainorder,allremainingremnantsoftheTurkishArmywouldbe disbandedandtheirgarrisonssurrendered.Technicallythesultanwasstill headoftheTurkishstate,buthewasessentiallyaprisonerinhisown

palace.Foreignerscontrolledthecountry.TheFrenchandtheItalianshad landedonthesoutherncoast,andtheBritishoccupiedConstantinopleand hadcontrolofficersscatteredthroughoutAnatolia.InParisdelegationshad beenarguingformonthshowTurkeyshouldbepartitioned.TheGreeks, theBritish,theArabs,theArmenians,theItalians,theFrench—allhad eyesonapieceofher.Thesultanwasreducedtoabundleofnerves.He hadnocardstoplayforhissubjects.Nodoubt,though,itwassavinghis ownskinthatwasuppermostinhismind. Constantinople’s economy, already ravaged by war, had been aggravatedbythemigrationofRussiannobilityescapingtheBolsheviks. Theyhadpouredintothecity,dumpingtheirgoldandfamilyheirlooms ontothelocaleconomy.Pricessoaredinthefaceofarapidlydwindling moneysupply.CountlessTurksbeggedinthestreets.TheYasargilsand Sahavet’sfamilyhadlittlechoicebuttoselltheirjewelry,theirfurniture, andwhatgoldtheyhadatwhateverpricestheirpossessionscouldfetch, finallybothoftheirvillas,oneinConstantinople,anotheronthebankof theBosphorus.Alltheirmaterialpossessionsgone,blackmarketprices continuedtosoarasprofiteerssetrecordsforshamelessness.Itseemed thatonlythievesandtheveryrichwouldsurvive.

Thewinterof1919wouldbeverycoldinConstantinople,andthe

youngcouplehadnocoal.Thenightswereparticularlydark,onlythemain streetsremainedlit.Tramsdidnotrun,andBosphorussteamerswererare. Policewerefewandfarbetweenandthoseencounteredcouldbeassumed tobecorrupt,hardlyworthyofanyone’strust.Goingoutinpublicafter dark was unthinkable without a weapon. Asum and his brothers were forcedtoshutthemselvesupintheirhomeswiththeiryoungfamilies, venturingontothestreetsforbriefperiodsatbest,hopingtofindaloafof breadforlessthanfivedollars(asmuchasonehundreddollarstoday). Onedayheandoneofhisbrothersusedtheverylastoftheirfundstoset themselvesupashamburgervendorsinthestreets.Therehadtobeaway

tofeedtheirfamilies.Butwhocouldpurchasefood?Noonehadmoney. Asumhadheardthatsomehadhiddentheirfezzesandtriedtogetjobs withtheoccupyingBritishforces.Itwasworthconsidering. Greekmerchantsandbusinessmenpuffedthemselvesupandstrutted inpublicplaces, forcingTurksto stepoutof theirway,jostling them againstwalls.TurkswereexpectedtosalutetheblueandwhiteGreek flagsflyingfromtheirplacesofbusiness,leavingTurkslittlechoicebutto slinkdownalleywaysinshame. ButMustaphaKemal,alegendamonghispeople,stoodindefiance of the sultan’s power, his mind set on freedom and dignity for his countrymen.Hehadestablishedpoliticallegitimacybyvoteofdelegates summonedtoconferencesfirstinErzurum,theninSivas,andwasinthe processoforganizingaforceofresistanceinthehinterlandsofAnatolia. Therevolutionwasunderway.TheAlliesmayhavedefeatedthesultan’s forces,butKemalwouldseethattheTurkishpeoplegottheindependence they deserved. He contended that the sultan no longer spoke for the Turkish people. He officially resigned his commission in the Ottoman army. The sultan had no troops with which to put down Kemal’s insurrection,butinhisroleascaliph,theleaderofallIslam,hedidhavea way of controlling the masses. He encouraged Muslims throughout Anatolia to rebel against Kemal’s makeshift nationalist movement, initiatingcivilwar.Withincidentsarisingdailyfromindependentbandsof terroristswhomeanttorob,buthadnoqualmsaboutmurdering,either,the occupyingAlliessensedtheirworstfear:theriseofanarchy.Nolongerat fullstrength,whatforeigntroopsremainedwereinnomoodformorewar, theAlliesinparticularhadnomeansofdealingwiththeinstability.They wereonlytoodelightedtosupplythesultan’sIslamicarmywitharms, fuelingtheunrestratherthanquellingit. Greece, judging that civil war in Turkey could only be to its

advantage,lookedtore-establishtheholdingsGreekshadenjoyedduring theirresidenceinAsiaMinorfromthefourthcenturyBCuntilRoman times. In a very real sense geographical Turkey remained a Greek

homeland.InMay1919GreektroopslandedatSmyrna.Reelingfrom

consecutiveskirmishesagainstthecaliphateforces,Kemalnowturnedhis heterogeneousnationalistarmy,theirarmssparseandunorthodox,tomeet theGreekoffensive.Theactitselfsolidifiedhimasthenationalleaderof theTurks.Kemalbecametheonlyhopeofhiscountrymen.Turkscounted onhimtoturnbacktheGreeksashehadtheBritishatGallipolifouryears earlier. Wearyoffightingastheywere,theTurks,AsumYasargilandhis brothersamongthem,weren’tabouttorolloverandplaydeadforanarmy ofGreeks.Theyjoinedthenationalistforcesstrugglingtowagewaron twofronts.TheirfoesweretheAllies-supportedsultan’sarmyplusthe invadingGreeksattheAegeancoast. AnactofdiplomacyralliedtheTurks.Afterextendeddeliberationsin

Paris,onJune10,1920theAlliespresentedtothesultan’sgovernmentthe

termstobeimposedonTurkey.ItwouldloseallitsArabpossessions, eightislandsintheAegeanwouldbecededtotheGreeks,theDardanelles andtheBosphorusstraitswouldbeplacedunderinternationalcontrol,and Turkey’sfinanceswouldbedirectedwhollybytheAllies.Theaudacity reflectedintheserequirementsunifiedTurksasnothingelsecould.The resultoftheParisconferencesignaledtheendoftheOttomanEmpire. Almostovernightthepopulationstillloyaltothesultanflockedto supportthenationalistcause,fullyunifyingtheTurksunderKemal.Inthe

summerof1922thelastofAsum’sbrothersjoinedKemal’sarmyasit

marchedagainsttheGreeks.Nowhehadfourbrothersinthefight.In

ConstantinopleAsumfoundhimselfwithfivestarvingfamiliestowatch

overandprotect.

UltimatelyKemaldrovetheGreeksfromthecountry,abolishedthe

sultanate, and sent Sultan Mehmed VI packing. In war, timing is everything,whetherthroughpatience,puregenius,orluck.Clearly,itwas acombinationoffactors. MustaphaKemalhadestablishedTurkeyasanindependentstate,one thatwasrecognizedthroughouttheworld.Finally,hewouldturndirectly

tothepeople.Inonemonthinthespringof1923hedeliveredthirty-four

majorspeeches,somelastinguptosevenhours,pouringouthisviewsand hisdreamsforthefuture.Crowdsformedtohearhisideasandquestion him.Hemetwiththemasindividuals,lookingthemintheeyeonebyone, shakingtheirhands,embracingthem.NeverbeforehadaTurkishleader reachedouttothepeoplethemselves,addressingthemdirectly.Suddenly MustaphaKemalwasthemostpopularTurkinthehistoryofhiscountry. Anewlawmandatednewnamesforallcitizens.Forthefirsttime both family and given names were required. The National Assembly changed one man’s name itself, renaming President Kemal as Atatürk (“fatheroftheTurks”).Fromthetimeofhisastonishingdefeatofthe BritishatGallipoliinWorldWarIhehadbeencalled,inboththestreets andpoliticalcircles,“thegazi”(“greatMuslimfighter”). 10 Thenamesof citieschanged:ConstantinoplebecameIstanbul,SmyrnabecameIzmir, andAngorawasrenamedAnkara,thenewnationalcapital.Forthefirst timeinsixteencenturiesConstantinoplewasnottheseatofgovernment,in itselfsymbolicofthedepthandbreadthofchange.

Withtheformationoftherepublicin1923cameademandforcivil

servants.Atthirty-three,AsumYasargilsiezedtheopportunityandwas dispatchedimmediatelytoapostinThrace,neartheBulgarianborder. Finally he had a job, and public responsibilities, plus a means of supportinghisfamily.Withinsixmonthshewasreassigned,backtoeast Turkey,aschiefmagistrateofthetownofLice,populationfivethousand.

InMarch1924,Atatürk,aspresident,addressedtheGrandNational

AssemblyinAnkara,presentinganagendaconsistingofthreepoints:a)

“to stabilize and safeguard the new republic,” b) “to create a national educationalsystem,”andc)“to“cleanseandelevatetheIslamicfaith,thus rescuingitfromitscenturies-oldstatusasmerepoliticalinstrument.” 11 (Italics added, emphasizing Atatürk’s manipulative language.) This amountedtoapreemptivestrikeagainstIslamasaforceingovernment. Thepointwasclarifiedwithinforty-eighthours,whentheofficeofthe caliphate was formally abolished. The caliph (also former sultan), Abdülmecit,andhisfamilywereloadedontotheOrientExpressinthe coldpre-dawn. ForanIslamicnationtheseactionswereradicalindeed.Immediately theyledtowidespreadresentmentamongtheilliteratemasses.Atatürk mighthavebeenabletotoleratetheoppositionpartythatsprangup,but when an armed Kurdish revolt broke out in the eastern provinces in Februarythefollowingyear,hemovedquicklyandruthlesslytoputit down.TheKurdswereatough,statelesspeoplelivingafeudalexistence in the Anatolian mountains for three thousand years, dominating the countryside in tribes, controlling perhaps a hundred small villages, a continuoussourceofheadachefortherulersofTurkey—past,present,and future. Thenewgovernmentputdowntherebellionwithavengeance.On May 10, Kurdish leaders were captured and sent for trial in nearby Diyarbakir.Withinseventeendaysforty-sevenofthemwouldhanginthe publicsquare.TwomonthsearliertheyoungYasargilfamilyhadbeen abductedatgunpointbyabandofKurdsinLice. Asum,theAtatürkgovernment’schiefmagistrateinLice,wasbound andgagged,thenorderedtoleadhiscaptorstohisfamily. Seeingherhusbandatthemercyofabandoffilthy,rifle-wielding thugs caused something inside Sahavet, then five months pregnant, to snap. 12 ShesteppedinfrontofAssumandthrewopenhercoat,thrusting herchestattheinsurgents,shouting,“Goahead.Shootme!Justshootme.

Idareyou.”Asumknewhiswifewasnotdespondent.Shewasangry, angrierthanhehadeverseenher.Shewasthebravestofthebrave,inno wayaversetorisk-taking.Thecouplewiththeirtwosmallchildren—a daughter,agethree,andaneighteen-month-oldson—werethenherdedas hostages into the mountains, some one hundred miles from the Iraqi border. Within a month of conception Sahavet had fallen from a horse, leadingtoconcernforthechildshecarried.Livinginacold,dampcave, withpoorsanitationandlittletoeat,onlymademattersworse. Atthesixthmonthofgestationsheceasedsensingmovementsinher womb,makingherallbutcertainthefetuswasdead.Fortunatelyitwas spring,andthebittercoldwaspassing,butthecaveremaineddarkand dank.Herlittlefamilyhadlivedwithoutachangeofclothesforthree months.Sahavet’sdailyprayerwasnotonlythatherbabysomehowbe bornalive,butthathebedestinedtobecomesomeonetrulyspecial,ason dedicatedtoservinghumanity,orperformingothergreatdeedsforher people.Sheyearnedforhimtobeaninstrumentforpeaceandtheendof suffering.AsachildGaziwouldhearthestoryofthefinalmonthsofhis mother’spregnancywithhimoverandover. InearlyJulytheeighteen-month-oldsonbecameill,complainingof tummypain.Herefusedtoeat,hisfacebecomingpaleandhiseyesdull andsunken,seeminglywithinhours.Onedayhewashealthyandstrong, withstrikingblueeyesandgoldenhair,andthenexthewastotallylistless. Hebegantovomit.Theuncontrollablediarrheaoftyphusfollowed. AsumandSahavetwerebesidethemselveswithfear.Theiryoungson wastheverycornerstoneoftheirfuture.Onenighthestruggledupright fromhispalletontheearthenfloorandwobbledtowardabottleofwater intheshadowsandbegantodrink.InstincttoldSahavetsheshouldstop him.Wouldn’tdrinkingwateronlymakethevomitinganddiarrheaworse? Therewasnodoctorpresenttoadviseherthatallowinghersontodrink

waspreciselywhatsheshoulddo. Within two days the child was dead, leaving the young family devastated.Sahavethadsustainedapsychologicalwoundthatwouldnever heal.Aterriblequestionrecurredoverandoverinhermind:whatifIhad onlygivenhimthewaterhecravedsodesperately?Shewastoloathe herselfforyears.

Dayslater,onJuly6,shegavebirthtoherthirdchild,anotherson,

severalweekspriortoterm.Shewasunawareofitthen,butitwasamatter

ofrecordthattheregionhadanappallinginfantmortalityof165deaths

per1,000livebirths.Hermother,amidwife,movedquicklywhenthe

infantseemedtolanguishinthebirthcanal,looseningwithherfingersthe umbilicalcord,whichhadgatheredasanoosearoundtheinfant’sneck. Thechildwasbornsilent,adeepblue,hisbirthweightnotevenfour pounds.Forafullminutehefailedtorespondtovigorousslappingofhis buttocks, even a liberal dousing with cold water. Finally, after being splashedwithhotwater,theinfantbegantocry, andbreathe.Buthis chancesofsurvival,eveninthebesthospitalsofthatday,werepoor. Withthetragedyofhiseighteen-month-oldson’sdeathstillheavyon hisheart,Asumsawhisnewsonascrucialtothesurvivalofeverything goodandjust.Hededicatedhimselftotheboy’ssurvival.Hewouldseeto itthathewouldgrowintosomeoneofimportance,agreatgeneralperhaps, likeKemal,eventhepresidentofTurkey.Heshouldhaveaspecialname. WhynotGazi? Seventy-threeyearslaterYasargilspeculatedthatthisnameresulted fromhisspendingthosefinalmonthsinhismother’swomb—struggling andfightingforhislife—withhisfamilyheldcaptivebyKurdishoutlaws. His plight was little different following his birth, as he struggled for survivalundercircumstancessimilartothoseclaimingthelifeofhisolder brother.Ofnecessityhehadbeenbornafighter.

CHAPTERTHREE

Childhood:

StoriesandPlay

BEFORETHEYEARWASoutAsumYasargilbroughthisyoung familytoAnkara,formerlyAngora,thenewcapitaloftherepublic.Itwas hardlymorethanapairofnakedhillsarisingfromatreelessplane.Other civilservantscamebythehundreds.Althoughthecitydatedfromthethird century BC and had served as an important cultural, trading, and arts centerfortheRomans,andlatertheByzantines,ithaddeclinedduringthe nineteenthcenturyundertheOttomans.ComparedtoIstanbulandother westernized Turkish cities in 1925, it offered a spartan existence. Its populationwasbarelythirtythousand.TheentirepopulationofTurkey was hardly thirteen million, significantly depleted by war and disease. Ankara’s few paved roads were inadequate, and modern government buildingsandnationalmonumentscelebratingthenewerawereyettobe constructed. The land, teeming with vineyards and forests in centuries past, had been subject to neglect and erosion, turning the city from a virtualdustbowlinsummertoamuddymorassinwinter.Existinghouses wereprimitive,mostconstructedofmud-brick.Hotelroomswererare— businessmenslepttenandtwelvetoaroom—andthewivesofdeputies anddiplomatsrefusedtoaccompanytheirhusbandsontripsthere. 1 The treaty ending World War I dictated a compulsory population exchangebetweenTurkeyandGreece.OveronemillionGreekOrthodox Christians,manylivinginTurkeyforgenerations,weredeportedtoGreece

inexchangeforapproximately400,000Muslimswhohadbeenlivingin

Macedonia and Crete. The ethnic Ottoman Turks, Muslims, were not knowntohaveanyparticularmarketableskills.Losingthebusinessand commercialabilitiesoftheGreeksamountedtoaseriouseconomicand culturaldrain.Furthermore,manyArmenians,onceAnatolia’scraftsmen andshopkeepers,hadbeendeportedbytheYoungTurkgovernmentin

1916orfledafterWorldWarI,makingfurnitureandhouseholditemsin

thenewcapitalscarce. ButAtatürkwasdeterminedtobuildAnkaraintoacityappropriate forthecapitalofagreatnation.Itwouldstandasasourceofpridefor Turksandanobjectofwondertovisitors,especiallythosefromtheWest. Publicsquareswerelaidout,aswereresidentialareasfordeputiesofthe GrandNationalAssemblyandthegrowingcadreofcivilservants.Not onlyweregovernmentbuildingsunderconstruction,butfacilitiesforthe performingartsandmuseumstocelebratetheartandrelicsoftheTurkish past.Itwouldbeanidealplacetoraisechildren.BythetimeGaziwas eightyearsold,muchofthatinfrastructurewasinplace. Hisfather’snewjobcenteredonthelocaleconomyandadministering thenewsystemofeducation.Likeothersinthegovernment,Asumwas passionateaboutthepossibilitiesforthenewnation.Thedashingfigureof Atatürk, who on occasion could be seen moving through government buildingsandsurroundingstreets,supportedthatinspiration.ForTurksof

the1930stheskywasthelimit.Neverbeforehadthemiddleclasshad

suchastakeinitsfuture. ButthetonewithintheYasargilhomeremainedsomber.Itwasone ofYasargil’searliestmemories,particularlywithrespecttohismother.By thetimehewasfour,shehadgivenbirthtotwomorechildren,bothboys,

thenasixth,adaughter,in1936.Witheachnewchildcameanguished

memoriesoftheoneshehadlost.Shewouldneverbeabletoshakethat

recurringnightmare.Overandovershetoldherchildrenabouttheirlittle

brotherwhohaddiedinacavenearLice,storiesthatshapedGazi’smental imageoflittleEhran,howhehadlookedandsounded,hispreferences, includinghisfavoritefoodsandthemixtureofmischiefandtriumphonhis faceashewalkedthefirsttime.Thechildofthemythbecamearealityto Gaziduringhismother’spregnancies.Eventhoughtheyoccurredpriorto Gazi’sbirth,hecouldrecitethedetailsofthosetragicdayssurrounding Ehran’sdeath.Fromtimetotimeheandhisbrothersandsistersfound theirmotheralonewithherthoughts,atearworkingitswaydownher cheekasshestaredatafadingphotographofthedeceasedchild.Silently shecaressedthefewlocksofhishairshehadsaved,thenclutchedthemto herbreast.JustwhenSahavet’sgloomappearedtolift,italwaysreturned, each time seemingly worse than before. She was obsessed with the

realization that giving the child a little water to drink might have prolongedhislifeuntilmedicalassistancebecameavailable.Ifonlyshe hadknownwhattodo.Eachofhersurvivingchildrenunderstoodthat reality. It had seemed long ago ordained that Gazi and both his brothers would become serious students of biology, that two would become medicaldoctors,surgeons,thefirsteveroneithersideofthefamily. AtagenineSahavethadseenherworldturndarkandtumultuous. Withwarcamegreatfear,andunaccustomedpoverty.AndrewMango,in

hisbrilliant1999biographyofAtatürk,pointsoutthatthe“GreatWar”for

theTurksbeganin1911inNorthAfrica,andextendedthroughapairof

wars in the Balkans, then World War I, ending only with the final

resolutionoftheWarofIndependencein1923,whenSahavetwastwenty-

one.

Withherfather’sdeathwhenhewasforty-fourwentthelastofher dreams.Hehadbeenlivingproofthatwealthandprivilegewereatleast possible. The carefree days of her childhood suddenly turned to stale memories,alongwiththeanticipationofadvancedschoolingandalifeof

leisure and intellectual pursuits. She had even toyed with the idea of studying medicine herself. She had grown up thinking she would be differentfromhermotherandotherwomenofhergeneration.Sahavet’s lifehadturnedouttobemuchdifferentfromtheoneshehadimaginedfor herself. She was bent by grief and the ongoing responsibilities of motherhood.Atthirtyshewasmuchchanged,manifestingadeafening silenceabouther—reflectingequalpartsregret,guilt,grimdetermination, andhard-earneddignity. EveryonewhoknewherconsideredSahavetbrilliant.Hermemory wasvast,virtuallyphotographic.Currenteventsandhistorywereherforte. Shewasquicktoskewerpoliticianswhoseemedtoforgettheirprevious statementsanddeeds,hopingothersdidaswell.Herfriendsurgedherto standforelectiontotheNationalAssemblyherself.Otherwomenwere doingit.Whynother?ThefirstfemaledeputiestookofficewhenGazi wasalmostten.Nodoubtitwouldhavebeenanidealroleforher.She rememberednotonlythedetailsofvariouslaws,buttheprecisedatesof their enactment and the circumstances surrounding their coming into being, the sponsoring deputies, the published accounts of pertinent debates, all of it. As Gazi grew up his mother was a source of vast commentaryonpoliticsandcurrentevents. Andherflairformathematicswasequallygreat.Shewasabletostore andjugglelonglistsoffiguresinherhead,andsheperformedcomplex calculationswithstartlingspeedandprecision. But,consideringtheneedsofherfamily,therewasnotimeforherto haveapubliclife,evenasateacher.Withherhusband’sbrothersand sistersandtheirfamiliesnearby,plusherownfivechildren,herextended familyincludedalmosttwentychildren.Newclothingwasaconstantneed, andhersewingmachinewasalwaysinaction.Asaseamstresssheknew nopeer.Beautifulthings,intricateindesign,nevertwogarmentsalike, camefromherimagination:herdarkeyesdartingfromfiguretofabric,

thenherleanhandsgoingtowork,firstsketchingapattern,cuttingcloth, pinningpiecetopiece,thensizingtheresulttoachild’sbody.Withina fewdaystheprocesswascomplete,andshewasontothenextproject. Friendsbeggedhertomakedressesforspecialoccasions,andshewas loathtorefuse.Shewasperpetuallyworking,seatedatherprizedSinger machine.Andsuchtaskslastednearlyalifetime.Nephewsandnieces she’dclothedaschildren,shelateroutfittedforweddings,andthen,later, outfittedtheirchildren.Shewasquickandsurewithherhands.Itwasa traitshewouldpassontoatleasttwoofhersons. Aspre-schoolersyoungGaziandhissiblingsandcousinsthrivedon family stories. Death and destruction were common themes. Typically characterswerewarringTurksandgreatsultansactingintheinterestofthe OttomanEmpire,alsotheKurds,asavagepeoplebentonkilling,oftenfor

sport, even destroying healthy livestock. Countless hours he sat cross-

legged,raptathisgrandmother’sfeet,hisimaginationskippingandcart-

wheeling.Sahavet’smotherhadmarriedatthirteenandwaspregnantby seventeen.Aswasthecasewithmostwomenofhergeneration,Gazi’s grandmother could neither read nor write. Even being the wife of an esteemedlawyerhadnotqualifiedherforformaleducation.Therulesof Islamwereclearonthatscore:awoman’splacewastoprovideahomefor andfeedherhusbandandchildren,period.Yetherexperiencewasvast and her mind sound. The stories she told were fleshed out with vivid detailsandverve,eachwithalessonforhergrandchildren. Oneofhisgrandmother’sstorieswouldstaywithGazihisentirelife. Itconcernedamanandwomanuprootedanddevastatedbywar.Insearch ofasafeplacetolive,theyjourneyedtoPersia(present-dayIran),the timelessfantasylandforTurkishchildren.Whentheycametoavillage where there was no cemetery, they decided to stay. If there was no cemetery,perhapstherewasnodeath.Afteratimethewomanbecameill, losing her appetite, developing headaches. Her pasty appearance

frightenedtheneighbors—theyviewedherasacursewithintheirmidst. Whenherhusbandcamehomeonenight,hiswifewasgone.Shewas nowheretobefoundandinquiriesmetonlycoldstares.Intimeitbecame clearwhathadhappened.Theneighborshadkilledthewomanandeaten her.Theirkitchensweretheircemeteries! Withthehelpofhisgrandmother,Gazidrewanumberofmorals fromthestory,whichwouldalsostaywithhimforalifetime.Things weren’talwaysastheyseemed.Therewasnoreversingthenaturalorder ofthings.Withlifecamelimits,andapricetopay.Noonecouldhave everything.Otheraspectsofthetaleresonatedfromthewallsofhospitals wherehewouldworklater.Hospitalscouldbecemeteriestoo.Adoctor mustbeforevervigilanttoperformathisverybest.Toservethesickwas agreatprivilege,onenevertobetakenlightly.Itamountedtoastunning responsibility. Asthemanofthehouse,Gazi’sfathertookhisroleasteacherand spiritualleaderseriously.SuchwasdecreedbyIslamiclaw.Doubtless, AsumfacedacertainamountofambivalenceandconfusionsinceAtatürk heldtheoldMuslimwaysresponsibleforthenation’sbackwardnessand weakness. In so many ways Islam stood in the way of progress, and progresswascurrentlyTurkey’snumberonepriority.YetAsum’sfamily hadbeendevoutMuslimsforcenturies.Gazi’sgrandfatherwassaidto have committed the entire Koran to memory. Asum Yasargil had the responsibilitytocarryonfamilytraditionswithinhisownhome.Private worshipwasnotofficiallyforbiddenbythenewgovernment,butreligious ideaswerestrictlyseparatedfromsecularmattersandlaws.UnderAtatürk, religionbecamepurelyapersonalmatterforTurks.Thepresidentsawno roleforgovernmenttointerferewithanyone’sspirituallife. TheKoranwaskeptinaplaceofhonorwithintheYasargilhome, wrappedinlayersofimmaculatelycleanclothtoprotectitfromdust.Each dayAsumwouldwashhishandsbeforetakingdowntheKoran,thenbegin

toreadfromit.Nooneelsewaspermittedtotouchtheholybook. Yet Asum scrupulously avoided interpreting the scriptures and invitingopenreligiousdiscussion.Suchissueswerenotforexamination withinhishome.Itislikelyhehadtoomanyquestionsanddoubtshimself toallowhimingoodconsciencetofavoranyreligion.Hetaughtspeaking thetruthbyexample.ButAsumfeltcompelledtoreadaloudfromthe Koran, which he did regularly and with great reverence. Yet he specificallyavoidedvoicinghisownthoughtsaboutthenatureofGod, contendingthatsuchtalkamountedtowastingtime.“Wearenotcapable ofimaginingwhatGodis,”hesaidoverandover.“Thehumanminddoes nothavethecapacitytounderstandthenatureofGod,nordoesmodern language have the breadth and scope to describe him.” He responded curtlytothequestionsofhischildren,“Looktonature,”hetoldthem, revealinghimselfasadeist.“ThereyouwillseeGod,inthebeautyofthe animals,andtheworldaroundthem.”ButhisdailyreadingfromtheKoran wasAsum’ssignaltohischildrenthatspiritualvalueswereimportant.He seemedtohaveaneedforaspirituallifehimself.Butforhimreligionwas anintenselypersonalmatter,onethathewouldhavenopartinshapingfor hischildren.“Youcanbelievewhatyoulike,”heinstructedthem.“Or choosenottobelieve.Itisamatterforyourownmind.” Buthewasquicktorejecttheideathathisunwillingnesstodiscuss GodwasevidencehebelievedGoddidnotexist.Howeverscrupulouslyhe avoidedencouraginghischildreninaspecificspiritualdirection,hedid nottoleratetheexpressionofatheisticthoughtsorcriticizinganyreligion. AsumYasargilwasadamantonsuchpoints. Hetaughthischildrenfirmvaluesofpersonalintegrity.Hedidthis mainlythroughstoriesandpersonalactions.Hehadnohesitationabout discussingallaspectsofthemoralofagivenstory.Oneofhisfather’s storiesGaziwouldparticularlyrememberconcernedabeardedmanalone inaforest,lamentinghisadvancingageandthelimitedachievementsof

his life, particularly his inability to influence a wayward son. Without warningamassivestonenearbymoved,andahugemanappearedfromthe mouthofacave.Afterlisteningtothebeardedman’staleofwoe,thegiant offeredtotaketheman’ssontolivewithhimforawhile.Hethoughthe couldhelp.When,afteratime,thegianthadtomakeatrip,hecalledthe youngstertohimandannouncedhewouldbeawayforaweek.Hegave the youngster permission to use his entire home as he wished but commandedhimnottoenteracertainupstairsroom.Heemphasizedthat if the youngster entered the forbidden room, his life would be ruined forever.Ofcoursethegiantwasnotgonelongbeforethebeardedman’s sonenteredtheforbiddenroom.Hewasshockedbysalaciousartworkon thewallsandwasovercomebyalongingforthecarnalpleasuresthey portrayed.Vaguelyheunderstoodthatsuchpleasurescouldonlyresultin agonyandsuffering.Itwashisfirstexperiencewithyearningsoftheflesh. When the giant returned, it was too late. The youth’s mind had been corrupted.Hewasdoomed. Thecharactersandthesettingweredifferent,butitwasthestoryof

Genesis3,abouttemptation,andthetreeofknowledgeofgoodandevil.

AsumYasargilwascommittedtoreducingthetiesbetweenhimselfand

theIslamicfaithofhisancestorsnotonlyoutofhisownconvictionbutin

theinterestofAtaturk’ssecularizationofTurkishsociety.Yetitappears

thathisideasofmoralityhadbeenshapedfromtheoraltraditionleading

totheestablishmentofthethreemajorreligionsoftheworld,includingthe

HebrewandChristianfaiths.Thesymbolismofthisstorypointedclearly

totheboundariesformoralhumanbeings.Notonlydidhumanshave

limitationsinpersonaltalentandwhattheycouldaccomplishinlife,there

werealsolimitationsofconductwhicheveryonemustacknowledgeand

observe.Aboveallitwasastoryofself-discipline,amajorthemeofAsum

Yasargil’slessonstohissonsaboutconductingtheirlives.

Asumknewsomethingaboutcorruptionandthestruggletomaintain

one’sintegrity.WhenGaziwastwelve,hisfatherwastransferredtothe finance ministry. It was a significant promotion, one associated with increasedrankandpay.Oneofhisresponsibilitieswastoapproveand recordcertainofthegovernment’scapitalexpenditures.Itwouldbeduring thistimethatyoungGazibecameawareofthestressesandconflictshis fatherfaced. Asumwasneveronetoexhibitoutwardexpressionsofjoyorother emotions.Hewasveryconservative,evenwithdrawninsomeways.He possessedarichbaritonevoice,yetnotoncedidGazihearhimsing.Asum keptaviolinonhisbureau,andallthechildrenassumedhecouldplayit. Butnotoncehadanyofthemheardhimplay.Andnoneofthemcould imaginetheirfatherdancing. Thechildrenweredeterminedtocounterbalancetheirfather’slackof personal involvement through music and dancing. As a child, Gazi recognizedhisowngiftofrhythm,whichhegavenothoughtofhiding. Notonlydidheenjoydancing,helearnedtoplaymusicalinstruments, first the harmonica, then the accordion. He taught himself, simply by tinkeringwiththeinstruments,payingcloseattentiontotheirsoundsand how they worked in combination. Music gave him much pleasure, a phenomenonhesoughtforyearstounderstand. Gaziwascognizantofthetensiongatheringinhisfather’slife.It manifesteditselfinsubtlewaysatfirst,hisfather’sseemingtobecome distracted,clearlylessinterestedinhischildren’splayandtheireffortsto communicatewithhim.Hewaslesspatientwiththemthanhenormally hadbeen.Hebegantomisssleepandcomplainedofanachingstomach. Thediagnosisofapepticulcerfollowed.Finallythetensionsseemedto escalate precipitously, causing the children to pay close attention to whatevertheycouldmakeoftheirparents’unguardedconversations.One nighttheyoverheardtalkaboutaninvoicehisfatherhadbeenaskedto process for the delivery of an aircraft ostensibly purchased by the

government.Buttheirfatheradmittedhewascertainthattheagencylisted asshippingtheaircraftdidnotexist.Thepaperworkhehadbeenaskedto executeonlyservedtocoverupabribe.Tosignitwouldmakehiman accomplicetothecrime. Theincidentcreatedanatmosphereofanxietywithinthehomefor days.SeveralofAsum’sclosefriendsweresummonedforadvice.Oneof his oldest friends, whom he had known since childhood, was also a government employee. He was adamant about the futility of Asum’s refusingtosignthedocument.Resistingwasnotapracticaloption.“You cannotkeepthiscorruptionfromhappening,”hesaid.“Youcanonlyharm yourselfandyourfamily.Ifyoudonotsignit,youwillloseyourstatusin thegovernment.Someonewillreplaceyou.Youhavenochoice.Youhave afamilytoprotect.” Gazi had no doubt that his father hated his job. A government positionmightprovideadegreeofstatusandeconomicprotection,butthe costwasgreat.Overandoverhisfatherhadsaidthatamanstrippedofhis integritywasapoormanindeed.Asumcontinuallywarnedhischildrenof theperilsofgovernmentservice.Hewantedmoreforthemthanthat.He insistedtheynotbelikeotherwhite-collarpeople.Heurgedthemtolearn todosomethingtrulyuseful,ideallysomethingwiththeirhands.Donot, hisfathersaidoverandover,liveforwhatlifecangiveyou,butforwhat youcangivetotheliving. Gazisawtheagonyofhisfather’sexistence.Hewatchedhisfather throwhimselfevenmorefullyintohishobby,readingandstudying.He recognizedhisfather’sconsuminginterestinbooksasperhapsanescape intoaworldofwhatcouldhavebeen. AsumYasargilwasintenselyinterestedinthestudyofphilosophy, biology,andhistory.Morethanoncehetoldhischildrenofaneventinhis childhoodthatheconsideredtobeagreattragedy.Hehadbeenaskedbya teachertostandbeforetheclassanddescribewhathewantedtobewhen

hebecameanadult.Hisclassmatesbeforehimhadannouncedtheirdesires tobecomevaluedemployeesofareveredandpowerfulsultan,perhaps evengreatmilitaryleaders,generals.Asumrespondedinasimilarfashion. Allhislifehewouldruethatchoice.Why,ohwhydidn’thedecideto study biology, even medicine? He would have been so much happier. Longafterhisfather’sdeathGaziwouldquotehimonthistopic. Hisfathersurroundedhimselfwithfriendswithsimilarinterests.All ofthemstrovetolearn,tounderstand,toimprovethemselves.Asum’s homebecameagatheringplaceforintellectuals.Evenasachildoffive andsixGaziwasexposedtoadultideas.Hisfatherdevourednotonly Islamicphilosophers,butWesternwriters,too,includingCharlesDarwin, Goethe,BernardBaruch,Spinoza,LouisPasteur,AlbertEinstein,Andrew Carnegie,MadameCurie,HenryFord,andRobertKoch. Ashegrewolder,thescientificthoughtofDarwinandEinsteintook hold in Gazi’s mind, particularly Einstein’s “new world.” The idea of relativitystretchedGazi’sthinkingandkindledhisimagination.Howwas itpossiblethatifaphotonrequiredlightyearstotravelfromPointAto PointBthatatheoreticalclockcoupledtothephotonwouldnotregister thepassingofanytimeatall?Andhewasmesmerizedbyhisfather’s assurance that when light perceived today was emitted from galaxies billions of light years away, dinosaurs still walked the earth. Even calculating a “light year” produced a number that seemed to have no meaning when written down. Relativity was a vastly mind-expanding experience for a fourteen-year-old, however brilliant, preparing him to considerexactlywhoandwhathewas,demandingnotonlythathekeep abreastofscientificadvancesbutcarefullyexaminethethoughtofthe greatphilosophers. BythenGazihadrecognizedtheeffectofSpinozaonhisfather’s spirituallife.OfalltheWesternphilosophersthisdissidentDutchJewof the seventeenth century seemed to be Asum’s favorite, the one he

discussedmostopenlyandmostfrequently.ToGazi,Spinoza’sconceptof Godseemedtobeoneandthesamewithhisfather’s.LikeSpinoza,Asum viewedGodasnotcreatingnaturebutbeingnature.Spinozataughtthat manshouldstrivetoachieveonenesswithGod(nature),ideallyachieving a mystical sense of loving God and of his eternal place in the grand schemeofthings.Manshouldaimtolivejoyouslyinthepresent.Spinoza sawthemassesasbeingillequippedtoachievesuchanintellectualloveof God, but he understood that some form of religion was necessary for society. He abhorred the conception of religion as pure superstition, though,particularlythelife-denyingdogmathatproclaimedthepresent life to be mere preparation for a life to come. Gazi saw his father’s honoringtheideasandtraditionsofhisancestorsaspavingthewayforhis childrentohavespiritualliveswhichmayprovetobedifferentfromhis own.Whocouldknowthetruthabouttheunknowable?Yet,tonotsearch forsuchtruthwasnotinhisfather’scharacter. Asum’s intellectual pursuits amounted essentially to a patriotic hobby.Thenewgovernmentwascommittedtolearningthetechnology andmethodsofcommerceoftheWest,buttoachievethatrequiredanew language.Communicationwaskey.Asumhadaspecialinterestinthe derivations and sounds of words that made him quite useful to a governmentdecreeingthedevelopmentofanewlanguage.Alreadyanew alphabet had been adopted. The government actively recruited citizens able to formulate new words. Atatürk was adamant about creating a languageofpurelyTurkishwords.Hecampaignedbackandforthacross rural Anatolia, entering villages, town halls, classrooms, and cafes, extollingthevalueofanauthenticTurkishlanguage.ForcenturiesTurks hadbeenheldcaptivebyanorallanguageandaliteracyratewhichhad

neverexceeded20percent.TowritealetteraTurkmustseekoutaGreek

totranslatehismessageintoGreek,thusrequiringtheaddresseetofinda similar person to read him the letter. Improving education and

communicationwasanationalpriority. TheoldTurkishlanguage,thoughdistinctiveandresonantinsound andrhythm,wasoutofstepwiththerestoftheworld.Itswrittenformwas Arabic,ascriptbearinglittleresemblancetotheRomanlettersofmodern French,German,Spanish,andEnglish.Translationswerecumbersome, creatingseriousdisadvantagesforTurksseekingtotradewithWestern Europeandthosewithabenttolearnwesterntechnologiesandliterature. DuringtheglorydaysoftheOttomanEmpire,Turkshaddealtwiththe restoftheworldontheirownterms,principallywithweaponsandthe threatofwar.NowTurkstrulydependedontheirneighbors,particularly those of the West. Success in international affairs and commerce demandedanewlanguage. AsumYasargiltookupthecausewithenthusiasm.Itwassomething hecouldtrulybelievein.Cultivatinghisowninnateinterestinlanguages and modern words, their origins and nuances of meaning, he attended classesandseminarsintheevenings.Heoftentaughtclasseshimself. Yettherewasanirony.ForyearstheelderYasargilcollectednotes onanobscureeighth-centuryIslamicphilosopher,planningsomedayto writeabook.Asdedicatedashewastolinguistics,hisownwritingwasto remainobscuretohissurvivingfamilydecadeslater.AsumYasargilhad maintained his personal notebooks and early manuscript drafts in the curvinglinesandsymbolsofArabic,anancientformofshorthand.Hewas comfortablewithit.Itwasmoreefficientforhim.Noneofhischildren wasabletofollowuponhisscholarshipafterhisdeath.Aschildrenthey hadbeensweptupbythemovementtomodernize.Theyhadhadlittle interestinlearningArabic.Whatwouldbethepoint? VisitorsintheYasargilhomeincludedawiderangeofpunditsand

scholars.Atatürk’srelocatingthecapitalfromIstanbulin1923assureda

concentrationofeducatedTurksinAnkara,andagreatinfluxofforeigners

followed.WesterninterestinthechangestakingplaceinTurkeyamounted

tomorethanidlecuriosity.TheTurks’refusaltoaccepttheroleofa conquerednationfollowingWorldWarI,anddispatchinginvadingGreeks in the process, confirmed them to be a potent, independent people possessedofnosmallamountofaudacityandpanache.Itslocationalone gaveTurkeyhugestrategicimportancetotheWest,theDardanellesbeing Russia’s entrance to the Mediterranean by way of the Black Sea, the Bosphorus,andtheSeaofMarmara.AmericanandEuropeanpowerswere determinedtokeepTurkeyfromRussianinfluenceandcontrol.Theywere eagertosetuplisteningpostsandpointsofinfluencewithinthecountry. Whatbetterwaythantolendteachersandtechnicalexpertstoanation expressing such needs? It fit nicely into Atatürk’s plan to make his countrymenawareoftheattitudesandwaysoftheWest.TheTurkish government’sattemptstorecruitWesternacademicswereeasilysatisfied. The 1930s saw a steady stream of intellectuals leaving Germany, JewsfleeingthescourgeoftheThirdReich.CoupledwiththeRussians arriving after 1917, there was no shortage of lively discussion in the Yasargilhome.TheYasargilchildrengrewupwiththechildrenofthese new immigrants. They went to school together, and experienced the thought,fashions,behavior,andrelationshipsoftheadultworldaround them. Many an evening Gazi and his brothers and sisters were silent witnessesonthefringesofscientificandscholarlydiscourse,generally huddledinthecornersofthefamilylivingroom.Andtheirinterestdidnot gounnoticed.Theyknewtheymuststayalert.Questionscametheirway fromtimetotime.Theirfathermadecertaintheiryoungmindsdidnot wantforstimulation.Heinsuredthatnoopportunityforeducationwas wasted.Itwasanageofconversationanddebate—longbeforetelevision, evenradioinmostTurkishhomesatthattime. TheYasargilslivedinasmallhouse,setbackashortdistancefrom thestreet,withrailroadtracksbehindthebackyard.Hisfather’sinterestin

biologyandgardeningyieldedgroundsaboundingwithplantsandtrees. There were over two hundred species, thanks to his father’s relentless experimentation,thegraftingofoneplanttoanother.Asum’sspecialty wasroses,andhefrequentlywatcheddiligentlyintheshadowslateinthe daytoinsurethatpassers-bydidnotcuthispreciousroses. Asthetreesgrewandtheirbranchesfilledout,Sahavetcomplained thattheymayappeartobehidingtheirhome,perhapsdangerouslyso. 2 Possibly the neighbors, or even the government, might think they had somethingtohide.Turksinthosedayssawspiesandintrigueeverywhere. Asum’ssolutionwastocutallthelowerbranchesfromeverytree,an actionhetookpromptly.Hewouldmaintainthatpruningstyleforyears.It resultedinastrangelook.Sahavet’ssaddenedcommentwasonly,“Iwish Ihadcutoutmytongue.” Theneighborhooditselfprovidednoshortageofstimulationfora young boy. A cartographer’s studio was down the street—where Gazi watched with interest the making of maps—and a bakery around the corner.Bakerswithshavedlegsstoodknee-deepinamixtureofflourand milk, mixing it into dough, which they kneaded with their feet. He watchedtheslaughterofsheepatthebutcher’sshopnearby—ahugeman deftlystranglingananimalwithawiregarrote,bringingittoitsknees, thenintroducingablow-tubethroughsmallincisionsateachankleand systematically separating skin from underlying muscle with air under pressure.Thenitwasasimplematterofopeningtheneckandpeelingoff the animal’s skin. It was neat and controlled, an entirely bloodless procedure. A “sergeants’ school” was within a short distance, where non- commissionedofficersintheTurkishArmyweretrained.OneofAsum’s brotherswasaninstructoramongthem,aquartermastersergeant.Gazi sometimesaccompaniedhisuncleasheprocuredfoodwithahorsecart, loadingitwithfruit—plums,figs,grapes,andraisins.Hurriedlyyoung

Gazifilledhispocketsashewent.Itwastoestablishafoodpreference thatwouldlastalifetime.Decadeslaterhewouldjokethathehadsurvived on fruit. He even ate the seeds of watermelon, relishing their nut-like textureandtaste. Gazi got his first anatomy and physiology lessons from his grandmother,alongwiththebasicsofakindoffolkmedicine.Shewould griptheneckofachickenandspreaditslegs,thenslititsthroat,making certaineachcervicalarterywasfullysevered,thendunkthechickenin waterandremoveitsfeathers,finallysingeinginaflamewhatbristles remained.Thenshewouldgriptheesophagusfirmlyinonehand,asharp knifeintheother,andswiftlyremovetheentiredigestivesystemasaunit. Patientlyshewouldpointoutthesalientfeaturesofeachorganandher conceptofhowitfunctioned.Herlessonsfrequentlyendedwithalecture aboutwhyhensweren’tslaughteredandeaten—ithadtodowiththeir eggs, not only that they served as a delicacy but as a means of reproductionaswell.Itledtoquestionsfromcuriouschildren:ifeggs camefromchickenstoproducemorechickens,wheredidtheycomefrom themselves? Hisgrandmotherwasexpertattreatingvarioussuperficialinfections, covering some with a honey-based paste, lancing others with a sharp, flame-sterilized knife. A kitchen pharmacist, she knew which herbs workedbestforheadaches,andwhichforfeversandsorethroat.Since Selma, Gazi’s older sister, was sensitive to bee stings, developing a frightening episode of anaphylactic shock at age six, one of their grandmother’sfavoriteremedieshadtodowithinsectbites.Shetoldand retoldananecdotesheascribedtothemythofGilgamesh.Theherohad killedasnake,thenburnedit.Fromitsashesarosecloudsofchiggers, committedtoexactrevengefromhumansuntiltheendoftime.Forinsect bitesGazi’sgrandmotherfavoredtheapplicationoftheleavesofbean plants,andshewasconvincedthatplacingbedpostsincansofwaterat

bedtimewaspreventative. But,ingeneral,Gazi’sgrandmotherwasagainsttheremovalofleaves fromtreelimbsandthecuttingofflowers,particularlyonesshehadgrown herself.FindingherflowerscutusuallyledhertoaguiltyGazi,trembling behindabanister,holdinghisbreath.Withlittleceremonyshewouldroust himfromhishidingplace,twistinganearwithnoovertsignofmercy. Themostfrequentvisitorintheirhomewasthemedicaldoctorliving nextdoor,aneurologist,amemberofthefacultyatAnkara’smedical school.SükrüYusufSaribaşhadstudiedunderKarlBonhoefferinBerlin from 1918 through 1921 and became Turkey’s first professor of neurology. Like Gazi’s father, Saribaş was of Bosnian stock. Their familieshadcomefromthesamedistrict.Itseemednaturaltheyshould share many interests. Both were serious gardeners, experimenting endlessly,graftingplantstocreateexoticfruitsandvegetables.Saribaş wasabeekeepertoo.Forhoursintheeveningstheydiscussedbiology, especiallyevolution—thetheoriesofCharlesDarwin,Mendeliangenetics, the publications of Ernst Haeckel—in addition to a wide range of philosophicaltopics.Politicsandreligionwereneverdiscussed,onlyideas that could be examined and tested. Giving the supernatural conscious credencewastaboo. As a teenager, Gazi became interested in a book Saribaş was translatingfromGermanintoTurkish,TheOrganoftheSoulbyAugust Bier,aretiredGermansurgeon.Pagesweretakenbackandforthtothe Yasargilhome,whereGazi’sfather,acommittedstudentoftheGerman language,collaboratedwithSaribaşonsomeofthepassages.Saribaşhad translated into Turkish Bier’s revision of a German translation of Gilgamesh,aprojectforwhichBierallegedlyhadtakenupthestudyof Greekinhissixtiesinordertoaccomplish.SaribaşexplainedthatBierhad spottedinconsistencieswhilereadingapreviousGermantranslation.That kindofcommitmentdrewGazi’sattention.

It was Saribaş’s impression that Bier had retired to Vienna.

PreviouslyhehadbeenprofessorattheCharitéinBerlin.In1898hehad

performedtheworld’sfirstplannedspinalanestheticandsubsequentlyhad made important observations on the complication of post spinal tap headache.Tenyearslater,aftercomingtoBerlin,hepioneeredtheuseof

intravenousprocaineanalgesia.Evenaslateasthe1970sanesthesiologists

usedthe“Bierblock”forregionalanesthesia(bywhichalocalagentis injected intravenously peripheral to a tourniquet positioned to trap the anesthetic agent). Bier was co-author of Chirurgische Operationslehre (Operative Surgery). Earlier in his career he created controversy by dabbling in homeopathy, presumably the result of his interest in the philosophicaltheoriesofHippocratesandHeraclitus. At age seventy-one Bier retired in order to devote himself to philosophical pursuits in preparation for writing Organofthe Soul, in which he would reflect on his life as a surgeon, his patients, and the circumstanceshehadencountered—whatitallmeant.Gaziwasintrigued bythis,particularlyBier’sinterestinHeraclitus,anancientGreekborn circa 530 BC in Ephesus, near the west coast of what would become Turkey two thousand years later. As a teenager Gazi had considered Heraclitus’sideas,puttinghisownslantonsomeofthem,questioning others. One of the central issues in Heraclitean thought is that change is ubiquitousandconstant,that“everythingisceasingtobewhatitwasand isbecomingwhatitwillbe”asillustratedbythefamousanalogythatone isunabletostepintothesamerivertwicebecausethewaterflowingata given point has not been there previously. Gazi was fascinated by Heraclitus’sideathatchangeistiedtoreasonandisgenerallyapositive phenomenon, leading to the concept of the harmony of strife and the relationshipbetweenopposites(“formentogetalltheywishisnotthe betterthing—itisdiseasethatmakeshealthpleasant;evil,good;etc.” 3

Thiskindofthinkingcomplementednicelyhisfather’steachings. RecognizingAugustBier’sinterestinHeraclituswasaseminalevent forGazi,stimulatinghisinterestandimagination.Hebecamecommitted totravelingtomeetBier,andstudyingunderhim.Somehowhewouldgo toVienna. From his own perspective, at a young age, Gazi recognized psychologicalaspectsofmedicine.Atfourteenhebecameseriouslyill withpneumonia. 4 ForthreeweeksDr.Saribaşcamenightlytoapplyhot

poulticestohischest.ItgaveGazihisfirsttasteofthespecialdependence

apatienthasonhisdoctor.Later,atsixteen,hedevelopedanacutefacial

palsy.Saribaştreateditdailywithelectrotherapyforsixmonths.Gazi

experiencedahospitalforthefirsttime,andcouldbegintounderstandthe

importanceofaphysician’sencouragementandreassuranceintheabsence

ofcertaintyofagoodoutcome.

SaribaşbecameasecondfathertoGaziandhisbrothers,amanto

emulate.Theysawhimasquiet,serious—alwaysdressedformallyincoat

andtie,hisspeechpreciseyetmodestandunassuming—amanwithlittle

timeforsocializingorfrivoloustalk,onlyhisbooksandhisthoughts.

Saribaşreadconstantly.Yethewasgentleandpatient,eagertolistento

theboys,willingtoexplaincomplexconceptstothem,evenaftertwelve-

hour days spent seeing patients. The Yasargil children understood that Saribaşwasavailabletohispatientseveryminuteofeveryday.Helivedto helpthoseinneed. Gazinevertiredofstoriesofdealingwiththesick,themethodsand techniquesofmedicine,andthemysteriesofthenervoussystem.Ashe grewolderhewouldaccompanySaribaşonhisroundsatthehospital.He wasstruckbythevastnumbersofsickpeopleflockingtothehospital groundsfromfarawayplaces.Theretheycamped,andwaitedpatiently. Gaziwasmovedbyhowsadanddesperatetheyseemed. Gazi’sbrotherswereexcellentstudents,asambitiousandcompetitive

as he was. Erdem, two years younger than Gazi, was particularly industrious, eventually becoming a general surgeon of great skill. His interestintraumaledtoimportantresearch,andheeventuallyauthoreda respected book on shock. But Erdem’s heart was in an artistic hobby, constructing and repairing musical instruments, specifically violins. Professionalmusiciansbroughthimantiqueviolins,evenStradivariuses,to repairandrefurbish.Fromtheageoftwenty-fiveheturnedoutanew

violin annually, instruments presumably destined for increasing quality andvalueastheyaged.Withthetoneproducedbyviolinsallegedtonot reachmaximumqualityforonehundredyears,YasargilbelievedErdem’s

violinswouldnotachievetherecognitiontheydeservedbeforethemid-

twenty-firstcentury. Günay, the youngest boy, was quiet, more introverted than his brothers.LikeErdemhelaterstudiedmedicineinAnkara,butphysiology capturedhisinterestandwouldbecomehislife’swork.Hespenttheearly partofhiscareerinEnglandinthelaboratoriesofSirAlanLloydHodgkin

andAndrewFieldingHuxley(whosharedthe1963NobelPrizefortheir

workonnervecells),thenjourneyedtoWesternOntario,Canada,where he became expert in the construction of tiny recording and sampling devicesforstudyingspinalcordneurons.LaterhejoinedWalterRudoph

Hess(recipientofaNobelPrizein1949)inZurich.Thegreatphysiologist

hadretiredfromfullresearchresponsibilitiesbythenbutwasstillactive withinthedepartmentandwouldexertagreatinfluenceonGünay.He would spend the balance of his career in Zurich, designing delicate micropipettesandmicroelectrodesofvariousdimensions,instrumentsvital to neurophysiological research. He and an associate also developed a device for atraumatically trapping fish. Within three years they were makingneurophysiologicalobservationsonthespinalcordsoflivefish. TomrisGökönül,asister,wasbornwhenGaziwasten.Asayoung womanshealsostudiedbiologyandchemistry.Formanyyearsafterhe

had become established in Zurich, Gazi encouraged her to join him. Eventuallyshedid,butdidnotstaylong.ThelureofAnkaraandadesire tomarryandhaveafamilyweretoogreat. The Yasargil family lived adjacent to a large field which was bordered on one end by the new conservatory of music, opposite the “sergeants’ school.” The field was the site of trade with farmers, also militaryformationsandparades.WhenGaziwasthirteen,hewitnessedthe statefuneralforAtatürk,thelugubriousprocessionofsoldiersinplumed headgear to the mournful strains of Chopin’s “Funeral March” (third

movementofthePianoSonataNo.2inB-flatminor,Op.35).Thisfamous

piece,sofamiliarintheWest,wasnewtoTurkishearsyetnonetheless memorabletoyoungGazithatday,andformanyyearstocome. Colorfulbazaarswerestagedthereinthespringandsummer,which Yasargilwoulddescribemanyyearslaterasthe“SymphonyofAnkara.” 5 Theywereaseducationalastheywereentertaining.Farmerscameeach Thursday with fruits and vegetables in horse-drawn carts. Gazi was fascinatedbytheagrarianlifestyle,particularlythefarmers’livelysenseof celebration,theirfolksongs,expressivedances,andstyleofdress.He learnedtoimitatethem,dancingasanimmediateexpressionofjoyand freedom.Hewouldbecomeknownfarandwideasaveryseriousman,but evenwellintohisseventieshewaspronetodelightthegrandchildrenof friendsandcolleagueswithdancingafterdinner.Itwasanimportantpart ofhim. The public grounds also served as a football field, the ultimate playgroundforhimandhisfriends.YoungGaziwasfiercelycompetitive andquick,particularlywithhisfeet,“dancingfeet,”inhisownwords.It wasonlynaturalthatheshouldenjoysoccer.Hedescribedhimselfasan ablemidfielder.Hiseyeslitupwiththememory.“Mytalentwastobe abletoseethefieldandthepositionsofmyteammates.Icouldgetthem theballinpositionstoadvance,toscore.”

Regular cultural events were held in the center of the city, and attendancewasencouragedbythegovernment.AsachildGaziwatchedas Atatürkandhisentourageofambassadors,cabinetmembers,andother ministers gathered at the Ankara Exhibition House for an opera or a concert.Theywerecolorfulineveningclothesandgleamingjewels.After the dignitaries filed through the main entrance, Gazi and his friends troopedtothebackdoor,wheretheywereadmittedtothestudentsection inthebalcony. Hewasdrawntotheconservatory,wherehewasexposedtoallforms ofmusic.SomeofEurope’sgreatcontemporaryperformersandcomposers foundrefugetherefromthepersecutionofJewsinGermany,amongthem the great composer, conductor, violist/violinist, and musical theorist/teacher/writer, Paul Hindemith. Karl Ebert, the storied German actorandtheaterdirector,becameco-founderoftheconservatory,where hedrewacclaimforhisproductionsofoperasbyMozartandPuccini. 6 ItwasnotonlyMozartandBeethoventhatGazilearnedtolove.The music of all cultures was available in Ankara, including the oriental Turkishmusicfavoredbyhisgrandmother,localfolksongs,musicfrom IndiaandChina,andevenRussianandAmericanworks.Atatürkbelieved theyoungshouldbeexposedtoonlyWesternmusic,whichheconsidered the“musicofcivilization.”GazienjoyedallformsofAmericanmusic growingup,rangingfrompopularsongstocountry,soul,andblues.Byhis seventies, his musical interests included rock-and-roll and, particularly, Negro spirituals. From an early age he began to realize that music transcended all ethnic and political barriers. Its appeal to all humanity demonstratedthat.“Nodictatorhasbeenabletokeepthemusicofother culturesoutsidehisborders,”hesaidrepeatedly. Eveninhisyouthhewonderedabouttheeffectofmusiconthesick, consideringtheideasofanotherGreekphilosopherofthesixthcentury BC, Pythagoras, and his followers. Pythagoreans reasoned that the

physical characteristics of certain sounds and groups of sounds in combination—chords—madethemharmonioustothehumanear,while otherswerediscordant.Suchsoundswouldbringharmony,andtherefore joy,tothehumansoul.AncientGreekpriestsandphysicianshadfollowed thePythagoreans’slead,andusedmusictotreatnervousdisorders. 7 The ideathatmusiccouldbeasourceofhealingresonatedwithGazi.Laterhe wouldtesttheconcept,evenpublishanarticleonthesubject. 8 Heandhisbrotherswereplayful,yetseriousandambitious,intensely interested in geography, physics, chemistry, and art. They spent large chunksoftheirtimechallengingeachother’sminds,makinggamesof gatheringfactsandconceptsrangingfromidentifyingcharacteristicsofthe ninety-three chemical elements known at that time to recognizing and appreciatinggreatpaintingsandsculptures. TheYasargilchildrenpreferredtoplayathome,lookingtoeachother for stimulation and enjoyment, rarely leaving their immediate neighborhood.Theypossessedvastimaginationsandcuriositiesandfed offeachother’sideasandfantasies.Acommonthemeamongtheboyshad to do with exploring space, fantasies of flying out from this world to

discover new worlds, new civilizations. Plans to construct a spaceship

amountedtoanongoingproject

Erdemactuallyconstructedandlaunchedaseriesofhomemaderockets! Theywerefascinatedbytheprospectofstudyingtheinnerworkings ofanimals,frequentlyruminatingaboutcollectingbirdsorvertebratesfor anatomicaldissection.Yetitwaswithinsectsthattheyactuallyperformed experiments.WithProfessorSaribaşnextdoor,abeekeeper,itwasamore practical endeavor. Saribaş sensed their interest and one spring staked themtoafamilyoftwodozenbeestocareforandobserve.Butone weekendeverybeedied.Theboyshadharvestedtoomuchhoney,leaving the weakened bees to the ravages of marauding ants, which devoured them.Itwasalessoninsurvivalnoneofthemwouldforget.

onlytheywentfurtherthanmost.

Gazi was fascinated by the framed twenty-inch-by-twenty-inch pictorialsummaryofLouisPasteur’slifeandaccomplishmentshanging fromawallinhishome. 9 Eachofthesixteenframesbecamefixedinhis mindasachild,amongthemillustrationsofPasteur’sapplicationofgerm theorytomakemilksafetodrinkbyemployingheattokillbacteriaand moldswithinit,andhisconceptofimmunizationtofightchickencholera, anthrax, and rabies. Yasargil could describe these illustrations many decadeslater.Hecreditedthemashavingamajorinfluenceonhischoice ofbiologyandmedicineasacareer. EminGürol,anAnkaraattorney,rememberedGaziasachild.The Gürols lived hardly two hundred meters away, and he and Gazi were playmatesfromtheageoftwo,laterclassmatesthroughhighschoolatthe AtatürkLisesi.Gürol’smothertaughtthembothingrammarschool.“Gazi wasverysmartandhedidextremelywellinschool,”Gürolsaid.“Iwas constantlybeingcomparedtohim.‘Whycan’tyouworkashardasGazi?’ mymotherkeptsaying.‘Lookatwhatheisdoing.’ForalongtimeIwas veryjealousofhim.”GürolalsorememberedtheintricatecarvingsGazi wouldbringtoschool,oftenrealisticlikenessesofclassmates,fashioned frombarsofsoap. AnotherofGazi’schildhoodfriendswasCanYücel(pronouncedJon Yugel),thesonofHasanAliYücel,theministerofeducation.Yücelhad gottenhisjobafterAtatürkhadvisitedalocalschool. 10

Alwaystheteacherhe[Atatürk]examinedquantitiesofpupils intheschools.Hewouldstrideintoaclassroom,oftenpetrifying theteacherintosilencebyhispresence,andwanderaroundthe class,questioningthestudentsandscrutinizingtheirtextbooks. Inoneofthese,writtenbyayoungofficialoftheMinistryof Educationonhisstaff,HassanAli[Yücel],hedetectedsome Arabic words and summoned the writer to dinner for a discussiononthereformofthelanguage.Hefiredathisguesta

numberofquestionsonmathematicswhich,astheyoungman wascarefultoexplain,wasonlyincidentallyhissubject. “Whatisapoint?Whatisaline?”theGazi[Atatürk]asked him.Then,“Whatiszero?” HassanAli,withhiswitsabouthim,replied,“Itmaybestbe defined,Pasha,as‘myselfinyourpresence.’” “Butzero,”Kemalinsisted,“isimportant.” “SomustIbe,Pasha,ifIamhereinyourpresence.” Kemal filled Hassan Ali’s glass with raki, and said aloud beforetherestofthetable,“Youhavepassedyourexam.”He waslatertoberewardedbymanyyears’serviceasministerof education.

---

GaziwasafrequentvisitorintheYücelhome.Hewasparticularly impressedbytheextensivelibrarythere,translationsofclassicalliterature from around the world in over one hundred volumes—including the Greeks, the Romans, the French, the Russians, the Chinese, even Shakespeare.WiththeencouragementofIsmetInönü,Atatürk’ssuccessor, Yücelhadpublishedareplicaofeachbookinpaperbackforthemasses. Gazihadpurchasedmanyofthemhimselffortwentycentspervolume. But Yücel’s personal books were bound in grandeur—white, imitation leatherspinesandmarbledboards.Gazilovedtoholdtheminhishands, feeltheirweight. FromaperspectiveofsixdecadeslaterGaziviewedthosebooksas describingtheconflictsbetweenindividualityandsociety.Inasensethey wereasfrustratingastheywereenlightening.Eveninhisseventieshesaw himselfasignorantinsomanyways,nakedinasense.Hedescribedmen ingeneral(butTurksinparticular)as“birdswhosewingswerewithout feathers.” 11 Potentiallytheyhadthecapacitytoexploretheentireworld

witheaseandgrace,buttheirwingswerenotquitefunctional. 12 He met two very impressive young teachers from England in the Yücels’home.Laterhewouldunderstandthatbothwerealmostcertainly spies, negotiating with Yücel to create a free school in Ankara which wouldshowcasetheEnglishculture,givingtheBritishapoliticalfoothold inthenewrepublic,puttingtheminpositiontoshoreuptheTurkishstate in an effort to foil Russian expansion into the Balkans. After all, the OttomanEmpirewasnolongerTurkey’snaturalbarrier.

CHAPTERFOUR

HighSchooland

RumorsofWar

GAZI AND HIS CLASSMATES did not allow rumblings of the risingturmoilincentralEuropetodampentheirdreams.ThenewTurkey wasaliveandvibrant.Dailytheirteachersspokeoftherolesthatprepared youngTurkswouldplayintheworldofthefuture.Accomplishmentand influenceweretheirsforthetaking.Theirparentshadlivedwithalmost continuouswarformuchoftheirlives.Theyhadseenenoughbloodshed, enoughwastedresources,toomuchdisappointmentandheartache.Finally, unliketheirOttomanforebears,Gaziandhisfriendsnolongerdreamedof conquest,butincreasinglyofgoingtotheWesttoparticipateintheworld ofknowledgeandideasasameansofrealizingprosperityandfulfillment, bothforthemselvesandtheirfledglingnation. But there was no escaping the fact that the world was becoming polarized.SparksoffascismhadtakenflameinGermanyandItaly,and thewindsofyetanotherwarstirredthroughoutEurope.ButtheTurkish governmentwascommittedtoremainingneutral.Atatürkhadanationto build.WesternpowerscourtedtheTurks,ifnottoenlistthemasallies,at leasttokeepthemfromaligningwiththeirfoesastheydidinWorldWar I.ThedebateplayedoutinAnkara’sbrandnewartmuseums. TheYasargilchildrenwereregularsattheAnkaraExhibitionHouse afterschoolandonweekends.Itwasinwalkingdistanceoftheirhome. TheessenceofHitler’sNationalSocialism 1 wasportrayedinblackand

whitephotographsoftheworksofpioneeringNaziarchitects,amongthem WalterGropiusandAlbertSpeer.Theirbuildingsweremassiveformsin masonryandglass,emphasizingsteelframesandstrongsilhouette.They weredevoidoftheslightestexpressionofhumanindividuality,anyhintof joy.SuchexhibitsleftGazicold,confused,nottheintheleastimpressed. BycontrastanexhibitofthegreateighteenthcenturyEnglishpainters wasondisplayinapubliclibrarynearby.Gaziwasseeingtheworkof ThomasGainsboroughandJoshuaReynolds,alsoJosephM.W.Turnerof the following generation, whose abstract treatment of light, color, and spacehadinfluencedtheimpressionistsinFrance.Thesepaintings’beauty andscopestunnedhim,particularlytheirbreathtakinglandscapes.They reflectedagraceandmajestyhehadnotimagined.Hewasfascinatedby the lives of the English aristocracy. These paintings were uplifting, suggestingacelebrationofhumandifferences,whatsocietycouldactually be.

Gazi’soldersister,Selma,wasparticularlyimpressed.Itledhertoan interestinAnkara’snewBritishschool.Englishliteraturebecameherlife longpassion,resultinginherspendingmostofherlifeinBirmingham, England.Selma’schildhoodenthusiasmspurredGazi’scuriosity,leading himtoacceptaninvitationfromyoungteachershehadmetinHassan Yücel’s home to visit the British school. At sixteen he found himself attendinglecturesinEnglishthere,wherehewasservedmid-afternoontea andcrumpetsforthefirsttime.Hewasastonishedbytheidylliclifestyle oftheEnglish. NextdoortothelibrarystoodtheMuseumofAnatolianCivilizations, Ankara’sanswertothefamousMuseumoftheAncientOrientinIstanbul. HereGaziandhissiblingsbecamefamiliarwiththepermanentcollection of paintings, manuscripts, and relics left by peoples inhabiting their homelandthroughfivethousandyearsofrecordedhistory,includingthe ancient Egyptians, Sumerians, Babylonians, Hittites, and the Seljuks,

ethnicpredecessorsoftheTurks.Throughitsarteachcivilizationleftclear

ideasaboutwhoitspeoplewere,whattheythoughtandhowtheylived.

DecadeslaterGaziwouldhaveopportunitiesasaninvitedguesttovisit

virtually every inhabited part of the planet. By then visiting local art museumshadbecomealife-longhabit.Itwashiswayofgainingaquick, accuratelookatthelifeandhistoryofapeople,anoverwhelminginterest of his. He would astound his hosts with his knack for grasping local originsandpolitics,placingtheminawidercontext. Archaeological exhibits were especially revealing to the Yasargil children.Theycametoappreciatetheirbirthplaceastrulyacradleofmany civilizations,acountrypossessedofapermanencelikenootheronearth. AglimpseintoTurkey’spastgavethemprideinitsplaceinthemodern world.TurkeywasliterallyameetingplacebetweenEastandWest,and figurativelyacrossroadsfromthepasttothefuture.DailytheYasargil boysandtheirsisterswitnessedthelegaciesoftheirorientalancestors beinghonedunderthemodernizinginfluenceofEuropeannationalism. They could not escape a feeling of urgency about making personal contributionstotheirhomeland. AllaroundhimyoungGazisawevidenceofanewTurkishsociety arisingfromtheashesoftheOttomanEmpire,preciselywhereprevious civilizations had decayed and were replaced over thousands of years. LocalhistorydatedtotheBronze-AgeHattiankingdoms.ThePhrygians hadlivedintheregionduringthetenthcenturyBC,latertheLydiansand Persians,thentheGalatians,araceofCeltsinthethirdcenturyBC.This understanding led him to focus on the migrations and capabilities of groups influencing individuals and laying the foundations for new

societiesandcultures.Itledhimtostriveforalongviewoftwentieth-

centurysocieties,theiroriginsandhowtheyaffectedtheirfunctionand

theirfuture.Hewoulddevelopakeeninterestparticularlyinallaspectsof

societallife,includingart,religion,andsports,theiruseofleisuretime.It

inspired him to consider of how civilizations are built upon the accomplishmentsofthoseprecedingthem.Foralongtimeheconsidered devotinghimselftoarcheology.Herejectedthatideaultimately,butit becameaspringboardtoalifelongphilosophicalhobby. DuringYasargil’schildhood,Atatürkhadcopiedneithercommunism norcapitalism,takinginsteadworkableelementsfromeachsystemashe strovetocreateauniquelyTurkishsociety.Thisboldidea,rareindeedfor anationshapedbyitsMuslimpast,isanexperimentstillstrugglingto survive. AformativeexperiencecameasGaziapproachedhighschool.His literatureteacherwassystematicinpresentingstories,poems,andessays from around the world, day in and day out discussing such works according to a fixed plan. No writing style or major culture was overlooked.Buttwodaysaweekapart-timeteachermettheclass.Hewas wellknownlocallyasanauthorandliterarycritic.Hismerepresencewas inspiring.Hedidn’tconductclassesinaconventionalmanner,choosing insteadtogivewritingassignmentsthatwouldoccupythestudentsforthe bulkoftheclassperiod.Discussionfollowed.Itgavetheteachertimefor hisownwork,preparingarticlesformagazinesandnewspapers. One afternoon Gazi and his classmates labored to write an essay

assignedontheconquestofConstantinoplein1453,whichgavetheTurks

dominanceoverAsiaMinoraftercenturiesofByzantinerule.Itwasthe mostimportantdateinTurkey’shistory.Forthirtyminutestheystroveto make sensible, original comments about that crucial time. Eventually, towardtheendoftheclassperiod,theteachermovedaroundtheroomto monitoreachstudent’sprogress.HestoppedatGazi’sdeskandtookhis paper,browsingthroughthefirstpage,thenthesecond,finallyproceeding tothenextstudentandsoonthroughtheclass. Suddenlyhestoppedandspunonhisheel.“Youshouldbeashamed!” hecriedout.“Youarealmostinhighschool,yetyouwritesuchnonsense.

YoumakeonlytheTurkishcharactersboldandintelligent.Whataboutthe Greeks?TheByzantineshadbeeninpowerforathousandyears!You havedescribedthemasweak,morallyinferior.Iftheyweretrulythat,how couldTurksbeheroes?Whatvictorydoesoneachievebytriumphingover weaknessandincompetence?Whatchancehasacompetitortobetruly superiorifhisopponenthasnovalue?” TheideaintriguedGazi.Thelessonwasnotonlytodevelopconflict instories,buttohonorreality,celebrateit.Histeacher’slessonreflected thephilosophyofHeraclitus.Itwastrue.Theloserisasimportantasthe winnerinanycompetition.Withoutaloserthereisnowinner.Without choosingloftybattlestofight—worthy,difficultgoals—truevictorywas impossible.Onlybysettinghissightshighwouldhislifeachievereal significance. He was about to enter the final three years of gymnasium (high school).Ankara’spublicschoolsystemincludedfiveyearsofgrammar school plus six years of gymnasium at the Atatürk Lisesi; 2 the latter curriculumwasdividedintothree-yearsegments.Studentsfailingtomake satisfactory marks in the first segment would have to choose between enrollinginatradeschoolandgoingtoworkasalaborer. Gaziwasfifteenwhenheandhisclassmatesgatheredinthegardenof their recently constructed school as the principal described a new curriculum to be offered. Previous students had had a choice of emphasizing mathematics and physics in their final three years, or literatureandphilosophy.Gazihadplannedtoenrollinthemathematics andphysicssection.Hesuspectedhedidnotpossesstheanalyticaltalents of his brothers, certainly not his mother, but he was determined to overcomehisshortcomingswithhardwork.Hewouldprovetherewas nothinghecouldnotovercome. Thatmorningtheprincipaldescribedanentirelynewfieldofstudy,in additiontothepreviousoptions,a“classics”curriculum.Fortheveryfirst

timeTurkishstudentswouldhaveanopportunitytolearnLatinandGreek, basiccoursesinthebestoftheEuropeanschools.ForyearsGazihad consideredtheideaofgoingtotheWestonedaytomeetAugustBier,to study medicine. He enrolled in the classics section immediately, with hardlyasecondthought.KnowledgeofLatinhadtoimprovehischances foradmittancetoagreatEuropeanuniversity. Initiallythereweresixteenstudentsintheclassicssectionwhilemore thansixtysharedaclassroomineachoftheothersections.Studentsinthe literatureandphilosophygroupwererequiredtolearnaforeignlanguage —French,English,orGerman—butclassicsstudentsmustlearnallthree plusLatinandGreek.Itwasadauntingtask,easedonlywhentheteacher engagedtoteachGreekbecameillanddidnotjointheschool.TheGreek courseneverbecameareality. Onlythemostambitiousstudentscouldmaintainthepace.Withina fewweekstheclassicssectionshrunktoonlyninestudents.Buttheschool wascommittedtotheprogram:itwasfullyfunded,andtheteachersand books were in place. It was a huge opportunity for the students who remained.TheyattendedLatinlecturesandexercisesasagroup,butthe GermanandFrenchclassesincludedonlythreestudents.Gaziandone otherstudentmadeuphisEnglishclass.Histeacherswerespecial,all

gifted and enthusiastic, not only in languages but in biology, physics, chemistry,andpsychology.Onetaughtaformalclassinphilosophy. Someteacherswereparticularlyimportanttohim.Hispsychology teacher, a young woman, assigned him to write a paper on the great

Germanpsychologistandphysiologist,WilhelmWundt.Asasixteen-year-

oldporingoverWundt’sstudiesofthehumanbraininthelibraryduring

thesummerof1941,hebegantounderstandthedirectionhislifeshould

take.Laterhisteacherrecognizedhistalentandthepassioninhispaper

andurgedhimtoconsideracareerinneurophysiology.Yearslaterhe

wouldcreditherwitharoleindirectinghislifethatrivaledthatofDr.

Saribaş. 3 Even as a youth Gazi began to understand the human brain as a productofevolution,comparabletogene-controlledphysicalfeaturesin animalsandhowsocietiesevolved.HisFrenchteacher,afamousman locally,emphasizedhowmuchlanguageitselfwasadynamic,evolving process.Hepointedoutthatwhilethousandsoflanguageshadsurvivedto moderntimes,anevenagreaternumberhadbecomeextinct.Hewasquick to point out that languages were no less complex than genes. 4 These concepts became fixed in Gazi’s mind, to influence his thinking throughouthislife.Improvement—insociety,architecture,language,and countlessotheraspectsoflife—dependedonflexibilityandadaptation.As anadulthewouldobservehowevenvariousculturesreflectedadaptations of the human brain, how their people walked and talked, how they interactedwitheachotherandoutsiders.Makingsuchobservationsand comparisonsbecameaformofrecreationforhim.Later,asanadult,he would develop elaborate theories to explain how the organization and evolution of the brain paralleled the development of nations and civilizations.Evolution,firstconsideredasachildinhisfather’sliving room,becamealifelongintellectualpursuit.Hisownsystematicthought, hispersonalphilosophy,woulddevelopfromsuchroots.Thoughhewould rarelyputanyofitinwriting(forpublicationanyway)itwouldbeobvious inhiscandidconversations,andinanumberofthelectureshepresented overthefollowingsixtyyears.

---

InmostwaysGazi’sclassmateswereextremelyconservativeintheir habits and lifestyles—ambitious virtually to a fault, fully aware of the importanceofdiligentstudyandconsistentperformance,followingthe examplesoftheirparentsandteachersinobservingeverysocialruleand

convention.Yetamongthemwasonetrueiconoclast.Mejidsteadfastly refusedtowearatieandinsistedonallowinghishairtogrowlong.He remained staunchly different, in every way an individualist. He had a burningdesiretobeamusician. One day Mejid disappeared and did not return for a week. His classmates’curiositiesburnedonhisreturn.Theywerecertainhehadhad anexoticexperience.Eachofthemwasmorethanalittlejealousofhis willingnesstoactonhisown,withoutfearofconsequences. “Oh,itwasnothing,”Mejidinsisted.“Ijusthadbusinesstoattend to.”Fordayshestucktothestory. But the questioning intensified, and finally he confessed. He had bravedTurkey’scomplicatedrailroadnetworkandhadgonetoIstanbulto attendaconcertbyIrmaSachs,thefamouslyricsopranoofthatday.To financethetrip,hehadsoldacoat,ashirt,andapairofshoes. Gazi was as impressed as the others. Mejid had demonstrated initiative,determination,andsacrificetoachievehispurpose.Heandhis friendswouldneverhaveconsideredsomethinglikethatforfearoftheir parents’ and the school’s reprisals. None of them would ever forget Mejid’striptoIstanbul. Mejid was determined to study under the great Alfred Cortot, a formerstudentofChopin’swhobecameaParisianpianistandconductor. AtthattimeCortotwasreputedtobelivinginVienna.Mejidhadalmost convincedhisfriendsthathepossessedrealtalent,thathepracticednightly athome.Buttheywerenevercertain.Noonehadheardhimplay,andhe wasanythingbutreliableinmostrespects.Yet,theyhesitatedtobelieve otherwise. ButMejidremainedadamantabouthisintentiontogotoVienna. “How will you go?” Gazi demanded. “Where will you get the money?” “I’m saving my money. I will go. Make no mistake about that.”

Mejid’s character was suspect and his braggadocio tedious, but his assurancewasinspiring. Withtheseedofanideathusplanted,soonGaziandthreeothers determinedtojoinMejid,hisclosefriendCanYücelamongthem.They wouldallgotoVienna.Theymustgo.TheyallbelievedthattheWestwas thekeytothefuture.Itrepresentedprosperityandadvancement,Turkey’s destinedroleinscienceandtechnology.Theirteachershadconfirmedas much,eventheirgovernment.GoingtoEnglandorAmericawasoutofthe question.Itwasfartooexpensive.ButtrainfaretoViennawasmuchless. Itmightbepossible.Almostovernight,visitingAugustBierseemedonthe way to becoming reality. Already Gazi could imagine himself as a surgeon,operatingonabdominalorgansandbloodvessels,possiblyeven theheart. Thefiveofthemcommittedtoacommonfrugality.Theywouldsave everything and pool their resources: some would bring money, others food;theywouldeattogetherandworktogether,andspendonnothingnot directlyrelatedtotheirgoal.Theywouldtellnooneoftheirplan,butafter graduationallfivewouldgotoVienna. Gazivolunteeredtocontributefood.Atfirsthesmuggledoneortwo piecesofbreaddailyfromhome,thensomesoupandalittlecheese.Soon hewouldfilchahalf-loafofbreadforthecause,laterevenmore.To disguisehistheftshebegantoeatlessathome. Hisgrandmotherwassuspiciousimmediately.Gazihadavoracious appetite. But he kept his secret. For three years they pooled their money,

mostlyfromvacationearnings,sometimesnomorethan20-30lira($10-15

US)persummerforeachofthem.Theyhaddeterminedthatcontributions

tothecausewerenotrefundable,withoutexception.Therewasnoplace

forsomeonenotfullycommitted.

OnesummerGazispentweekdayscataloguingbooksandjournals

thathadbeendonatedforalibrary.Therewerethousandsofthem,sent from various places, many from foreign countries. Most were in poor condition:somedampandsoiled,otherswithpageschewedbyrats.He andhisconfrerestrieddesperatelytoputthemintoorder.Theywerepaid fortheirwork,butthelibrarywasnevertobecompleted. Weekends throughout the school year found him at the football stadium,sellingandcollectingtickets,cleaningupthestandsaftersoccer matches.Hekeptoneortwoliraperweekaspocketmoney,savingthe rest.

Otherfundscamefromgambling,shootingmarbles.Itshouldnotbe surprisingthatafledglingworldclassbrainsurgeonwouldbegoodwith hishandsasaboy.Competingonhishandsandkneesinthedirtwasan early passion. He was an outstanding player, able to make shots consistentlyatevenfourandsixfeet,stillmaintainingcrucialunderspin withhistrusty“shooter”ofhollowedsteel,controllingitwithinthering, prolonginghisturn.Capturingadozenmarblesinasingleturnwasnot unusual for him. One summer he cashed in the nearly one thousand marbleshehadwonformorethantenlira! Inthespringoftheirfinalyearofhighschoolthefivehadamassed

almost$600(US)betweenthem,enoughtomakethetrip.Buttherewere

unexpectedproblems.Twoofthemfailedthefinalexaminationatschool

andwouldhavetorepeattheyear.Theycouldnotgo.Mejidhadtwo

sharesofthemoneyinhispossession,GaziandCanYüceltherest.

ThenextweekMejidappearedinasquareinthecenterofthecityin

asmartnewsuit,carryinganexpensivebriefcase.GaziandCanwere

shocked.Immediatelytheysuspectedtheworst.“Whathaveyoudone?”

Gazidemanded.

“Oh,Ineededsomethings.SoIboughtthem.”

“Withwhat?Notoursavings,Ihope.”

“Sure.Whynot?”Mejidshowednottheslightestremorse.

“ButwhataboutVienna?Youcan’tbackoutnow.Whataboutour plans?” “Youcan’tbeserious.Withawargoingon?GoingtoViennais crazy!”Mejidwasemphatic,butheavoidedtheirgaze. “Whatareyoutalkingabout?”Gaziwasindisbelief.“TheAllies haveinvadedItaly,theGermanperimeteratLeningrad(presentdaySaint Petersburg) has been penetrated. The war is almost over.” It was a commonperceptionofAnkara’syouth.ReportsfromvariousEuropean frontsweregainingacertainmomentum,feedingyouthfuloptimism. “WearenotgoingtoViennaforpolitics.We’regoingtostudy,” Yücelinsisted.“Austriawillsoonbeliberated.Nowisanexcellenttimeto go.”

“No, no, no,” Mejid responded. “You’re fools. It’s way too dangerous.” ItwasthelasttimeGaziwouldeverseeMejid.Helaterwentto FranceandevenwroteGaziyearslater.Buttheletterwentunanswered. Gazihadnotimetowaste,certainlynotimeforfoolishnessanddeceit. TheTurkishgovernmentfundedascholarshipprogramtoencourage effortandstudiouspursuitsinhighschool,asmanyasthreecertificates goingannuallytothetopstudentineachclass.Threecertificateswould financeafullyearincollege.BythetimehegraduatedGazihadbeen awardedninecertificates. Therewouldbeaformalpresentationattheministryofeducation. Scholarshipwinnerswouldmeettheprimeminister.Theywouldcome fromalloverthecountrytospendafewdaysinAnkara.ForGaziitwould beanopportunitytomeetstudentsfromotherpartsofTurkey.Hedidn’t knowitatthetime,butitwouldprovetobeimportantforhimlater.He becamefriendlywithoneyoungsterinparticular.Aformershepherd-boy from the province of Isparta, Süleyman Demirel, would become the country’smostpowerfulpoliticianoverthesecondhalfofthetwentieth

century. For four decades he would be prominentin the Turkish

government,firstappointedprimeministerin1964,thenelectedpresident

in1993.Anotherscholarshipwinnerthatyearwouldbecomecommandant

oftheentireTurkishmilitary.

FollowinghiseighteenthbirthdayinJulyof1943,tensionsdeveloped

betweenGaziandhisfather.Therewerephilosophicaldifferences.His father discovered him reading Truth, a book by Emile Zola, the

controversialFrenchnovelist.In1898Zolahadpublishedanopenletterto

the French president, “J’Accuse,” in L’Aurore, a then-obscure daily newspaperinParis,defendingAlfredDreyfus,aJewishartillerycaptainin theFrencharmy.Dreyfuswasunjustlyconvictedoftreason,thenexiled andimprisonedinFrenchGuianaunderdeplorableconditions.Forhiscry againstprejudiceandinjusticeZolawastriedandconvictedofcriminal

libelin1899.Butthepublicoutcryhisremarksinspiredresultedinanew

trialforDreyfus,andultimatelyhisacquittalin1906,afterZola’sdeath.

The Dreyfus Affair had divided France, pitting a reactionary military againstmoreliberalelementsofsociety,likelyprejudicingGazi’sfather againstZolaandhisbooks.Thedebatehadragedacrossananti-Semitic Europe for forty years, and the effect was felt around the world. An AmericanfilmfocusingontheDreyfusAffairwontheAcademyAward forBestPicturewhenGaziwastwelve-years-old. But Truth, Zola’s final book, published posthumously in 1902, reflected the author’s views of the Dreyfus Affair. It described the aftermathofachild’sbeingsexuallyabusedthenmurderedbyapriest, whousedaJewishschoolteacherasscapegoat.Gaziwasattractedbythe humantragedyandthemoralissue,buthisfathercouldbeexpectedto opposethestory’s religiouselements.Atatürk hadrescuedTurks from

religioustyrannyinthe1920s,butthepotentialforMusliminfluencein

the government remained and had to be resisted. Enlightened Turks, particularlydefendersoftherepublic,hadnodesiretoseeTurksrevertto

theirbackward,wastefulways.TheelderYasargilwassensitivetohow religious argument, particularly from a zealot weighing in on the dichotomybetweenCatholicsandJews,mightinfluencehisson. “Don’twasteyourtimereadingthat,”hisfathersaid.“It’snonsense.” “Father,pleasedonotforbidme,”Gazirespondedfirmly,standing up, his arms tensing at his sides. “This is a compelling story. It is worthwhile.Itcontainsimportanttruths.” AsumYaşargil,seeinghissononthethresholdofmanhood,threwup hishandsandresolvedtoremainquiet.Hewouldnotbeluredintoa religiousdiscussion. ForthefirsttimeGazihadaddressedhisfatherasaman.Itinspireda fearsomefeeling.Hehadnowishtoopposehisfather,ortesthisauthority. Helovedhim.Hedidn’tknowitatthetime,butafteranotherweekhe wouldneverseehisfatheragain. He realized he had other issues to bring up, an announcement to make.Hehadputitoffforthreeyears,lookingfortherightmoment.Now wasthattime. “Father,”hesaid,stretchingtohisfullheight,hisshouldersthrust back,hishandstrembling,“NextweekIwillleaveforVienna.” AsumYaşargilstaredathim,shocked,hismustachetwitching,dark eyes narrowing. Gazi sought neither his father’s permission nor his blessing.Heonlyannouncedhisintention.Hisfatherknewtherewouldbe nochanginghisson’smind. Hismotherandgrandmotherwereaghast.Emotionsraged.Questions camefromallcornersoftheroom.“Butwhy?Howwillyousurvive?You can’t! The war!” Then, “You cannot leave your home at such an impressionableage.Yourcharacterandyourcapacitytodeterminethe bestcourseforyourfuturehavenotyetbeensufficientlyformed.Bygoing abroad now your life will never be complete. You will have missed somethingimportant.”

ButAsumYasargilsaidnothing. Thefollowingdayhisfather’sattitudehadchanged.“Youwillnotgo bytrain,”heannounced.“IwilldomybesttogetyoutoVienna,butyou mustnotgobytrain.”InYugoslaviaMarshallTitohadledaunitedfront ofCommunistsinarebellionagainsttheGermansandlocalfascistsand royalists(theUstashaandtheChetniks).Fightingwasgoingonthroughout theBalkans.Viennawasaweek’sjourneyfromAnkarabytrain,directly throughtheBalkans. FortwodaysandthreenightsGazifacedtheargumentsofhisfather’s friends, including Professor Saribaş and others. Many had had recent experienceswiththeNazis;somehadjustreturnedfromGermany.Hardly anyonefavoredGazi’sgoing.“Thisissenseless,stupid.Germanyisat war,”theysaid.“Sure,itislosingthewar,butthereisnothingofvaluein Austriaforyounow.Youwillbedisappointed.Don’tgo.Itisnotworth therisk.” ButProfessorSaribaşdidnotopposeGazidirectly.Whilehedidn’t standwithhimagainsthisfather,heseemedtoseealearningexperiencein theadventure.HerealizedthatGazi’smindwasmadeupandhewaswise enoughtosuggestacontingencyplan.“Youshouldtryit,”Saribaşsaidat last.Hespokesoftly,andhislookwassomber.“Butifitdoesn’tworkout, youmustnotbefoolish.Youmustreturnimmediately.” Gazi’sheartleaptasthetoneofthediscussionchanged.Hehadno ambition to do anything counter to the wishes of his family. He desperatelyyearnedfortheirblessing,buthehadtogotoVienna. “Therewillbetheproblemoffood,”oneofhisbrotherssaid.“You willgohungry.” “Not this boy,” chimed in his grandmother, finally laughing, providingamuch-neededchangeofatmosphere.“Hewillmissnomeals. Hewillfindaway.Somehow,Gaziwillfindfood.” His father remained skeptical about how he would live. Gazi

respondedbysayinghewouldwork,thathewouldmakehisownmoney. Fullyawarethathisfamilyhopedhewouldreturnwithinafewweeks,he wascertainhewouldnot.Inhispockethehadtheequivalentofthree hundredGermanmarks,hisshareofthemoneyheandhisfriendshad earnedandsaved.Hewouldmakeitlast.Hewouldovercomewhatever obstaclehewouldfindinhisway. A mathematics teacher had provided enthusiastic support. “Don’t worry,Gazi,”hehadsaid.“Go.Itisagoodidea.”Heprovidedhimalist ofcontactsinVienna. Asexcitementwelledwithinhim,hewasstunnedtofindthatCan Yücelwouldnotbeabletogowithhim.Theyhadalwaysbeenclose,with greatrespectandaffectionforeachother.Fortherestoftheirlivesthey wouldstayintouchastheybecameleadersindifferentprofessions.Can becameanesteemedpoetinTurkey,manysaythefinestofthetwentieth century. HasanYücelhadalongtalkwithGazi.Fortheeducationministerto sendhissonabroadtostudywouldamounttopoliticalsuicide.Itwould sendthewrongmessagetotheverypeoplehisprogramswereaimedat reaching.Cancouldnotbeattherootofthat.HasanYücel’spolitical resourceswouldassurehisson’seducation,butheadvisedGazitogo. YücelpointedoutitwasanopportunityGazicouldnotaffordtopassup. Heowedittohiscountrytobeallhecouldbe.EveryTurkmusttake advantageofwhattheWesthadtooffer.Fewerthanfifteenthousandorso of the fifteen million Turks had an opportunity to study in Western Europe,everyoneofthemchildrenoftheelite.Gazihadanopportunityto beamongtheveryfirstofthemiddleclasstogo.Perhapshewouldreturn oneday,afterhehadbecomeagreatdoctor,perhapsevenasurgeon. GaziwassadthatCanYücelwouldnotbeaccompanyinghim,butit wasclearthathewasthebeneficiaryofawindfall.Mejidpossessedthe shareofoneoftheboyswhodidn’tpassthefinalexaminations,which

likelycouldnotberecovered.Nevertheless,withGaziandCanholding threesharesbetweenthem,andonlyGazigoingtoVienna,hisfinancial problemsweresuddenlydiminished.Itwouldbenecessarytoforfeitthe three-yearscholarshiphehadwonforadvancededucationinTurkey,but hewoulddowhathemustdo.Suddenlythegoalwaswithinhisgrasp. By the weekend his father had had several discussions with his friendsinthegovernment.HehadreceivedwordfromtheofficeofSükrü Sarcoglu, the prime minister, that the German ambassador, Franz von Papen,plannedtoreturntoBerlinbyprivateplane.Itwouldgobywayof Vienna.PassageforGazimightbearranged.VonPapenhadbrieflyserved asChancelloroftheGermanDemocraticRepublicfollowingWorldWarI. Hehadalsomastermindedthedevelopmentofthemassivenetworkof Nazi spy rings and had been more responsible than any other single GermanforHitler’sadvancetopower. 5

Atatürkhaddiedin1938,buthissuccessorscontinuedtosupporthis

plan to keep the republic out of World War II. Economically and emotionallyTurkeyhadbeenravagedbywar.Itcravedpeaceinorderto develop the industrial base it desperately needed. It had long been committedtoneutralityButtheNazisstillsawtheTurksaspotentialallies at a time when they desperately needed help. Aiding an accomplished Turkishstudentwishingtostudyabroadcouldcertainlydothatcauseno harm.

CHAPTERFIVE

NaziGermany

ONOCTOBER13,1943GAZISTRAPPEDhimselfintoarearseat

ofasmall,single-engineaircraft.Heglancedthroughatiny,dingywindow at the swastika painted on the port-side wing, then stowed his valise beneaththeseatahead.Itcontainedtwochangesofclothes,twobooks (onebytheseventeenthcenturyGermanrationalistphilosopher,Gottfried Wilhelm Leibniz, the other by Walter Ruben on contemporary Indian philosophy),andatinofbiscuitsbakedfreshtheprecedingdaybyhis mother.Nineortenotherpassengerswerealreadyseated,almostasmany women as men. Gazi knew he could identify von Papen from his newspaperphotographs,buthedidn’tseemtobeaboardandeveryseat wastaken.Itwasthepilotwhocapturedhisattention.Hewasayoung man,abouttwenty-five,inadarkleatherjacketwiththecollarturnedupin backandacapwithearflaps.Rubber-rimmedgoggleswerepushedtothe topofhishead.Gazihadneverseensuchanoutfit. Finally, in a deafening roar the plane lurched forward, shuddered rightthenleftbeforegatheringspeedintothewindsweepingtherunway andtookoff.Gazigraduallyrelaxedhisgriponthearmrestsasthewing dipped sharply and the plane banked, bringing the elbow of the blue waterwayintofullview,wherethecalm,freshwateroftheGoldenHorn metthecurrentsoftheBosphorus.Astheaircraftleveledoff,theteeming streetsandcourtyardsofthecitydominatedhisview,punctuatedbythe countlessdomesandminaretsofancientmosques.Neverhadheimagined suchasight.Astheygainedaltitude,heconvincedhimselfhecouldmake

out the Bosphorus joining the Black Sea miles away, due north. The aircraftwasbuffetedbyawindcurrentasitcameleftagain,finallytaking on a course northwest for the Balkans, across Bulgaria, Romania, and HungaryforVienna.Acrosstheaislehecouldmakeoutthebrinyblueof theSeaofMarmara,nowslippingpastbeneathhim,tothesouth.Western Europelaydeadahead. In less than an hour the plane began to descend. There was no intercominthecabin,onlythedinoftheengine.Henoticedsurprised looksandconfusedgesturesamongthepassengersintheforwardseats.A womantworowsaheadturnedandsaidsomethingtothemaninfrontof him, but Gazi couldn’t make it out. He had a reading knowledge of German,buthisearstillstruggledwithvariouspronunciations.Heknew somethingwaswrong:theflightplanhadchanged.Viennawaseighthours fromIstanbul,atleast. His reckoning told him they had landed on the southern coast of Bulgaria.Twoarmedsoldiersapproachedtheaircraftandcommunicated somethingtothepilotthroughthecockpitwindow.Nooneleftthecabin. They just sat in silence. The Germans controlled every foot of land

betweentheMarmaraandVienna—allofAustria-Hungarysince1938,

RomaniaandBulgariasince1940.Hisanxietygrowing,Gaziscannedthe

passengersaheadofhim,mostofthemlikelyminorofficialsofHitler’s government,secretarialtypes.Hemanagedaglimpseofeachone’sface. VonPapenwasdefinitelynotaboard. After almost two hours, at noon, they were allowed to leave the aircraftandboardabusdrivenonthetarmac.Gazistudiedeachpassenger, everyoneofthemolderthanhim,mostshowinglittleconcern.Hehadno ideawhoanyofthemwere.Theyweretakentoahotelinthecenterofthe citywheretheypairedoff,Gaziassignedtoaroomwiththepilot.Hewent outwiththeothersintheafternoon,touringthedowntownstreetsofthe oldcity.Itwasclean,colorful,andtheinhabitantswereswarthy,sturdyin

appearance. He focused on the commercial negotiations taking place around him. The locals hawked tobacco products. Some of Gazi’s traveling companions purchased cigarettes in large quantities, several fillingasuitcasewiththem.Hewasawarethatothershadbroughtstoresof coffeefromIstanbul.Heunderstoodblackmarketprofiteering,buthehad noresourcestoriskonanything.Whatmoneyhehadmustlast. Intheeveningtheywenttothecinema.Therewasdiscussionamong them,butGazicouldmakelittlesenseofwhatheheard.Ifanyoneknew whytheflighthadbeeninterrupted,noonebotheredtoinformhim.Later, outsidethehotel,heoverheardtwomenspeakinginTurkish.Eagerlyhe introducedhimself.Theywerefishermen,recountingtheday’sactivities andthecostsofdoingbusiness.Theytoldhimhewasinthetownof Burgas. Thefollowingmorning,whichGazirememberedfifty-twoyearslater as a bright, beautiful Sunday (although October 14 was actually a Thursday),theyweretakenbacktothelandingstripwheretheyboarded theiraircraftandtookoffatshortlypastnineo’clock.Overthenextnine hourstheyflewoverdozensoftownsandvillages,atanaltitudeinthe rangeofthreethousandfeet.Hesawcountlesschurchesandwell-kept homes,colorfullydressedpeopleinthestreets,manicuredgardens,well tendedfields,andwindingstreams.Itwasbeautifulcountryside.Hewould notforgetit.Notoncedidheseeatankoramilitaryvehicle—nosoldiers, nosignsofdestruction,onlysturdyfarmpeopleintheirnaturalhabitat. Hishopessoared. TheyarrivedinViennaafterdark.Withoutdelaypassengerswere busedtothecenterofthecityandreleased,stillwithnoexplanationfor thestopoverinBulgariaforthcoming.OnlylaterwouldGaziarriveatan opinion about what had happened. He read in the newspapers that American bombers had made a heroic daylight attack on the vast

RomanianoilfieldsatPloesti.In1943thePloestirefineries,coupledwith

those in Hungary, produced approximately one-fourth of the German

army’sliquidfuels.Theproblemwiththistheoryisthatthe178B-24

“Liberators”ofthe 8 th and9 th US Air Forces dive-bombed Ploesti on Sunday,August1,overtwomonthsbeforeGazileftIstanbul. 1 , 2 , 3 (Dates and days of the week can be tricky to remember precisely over five decades.)Itwaspossibletheirsmallaircrafthadsustainedenginetroubles nopassengerrecognizedandthattheGermanssawnoreasontoexplain. Perhapsitwassomethingelse.Whateverthecauseforthedelay,itappears thatYasargilwasmistakenwhenheassumedthatfatehadkepthimfrom flyingintoabombingattack. The Turkish consulate was drab and run-down from the outside. Insideitwaslavish,withwell-appointedfurnishingsanddecorations.But therewasimmediateconfusion.Theliverieddoormanspokeinanold Austrian dialect that was difficult to understand. He was flushed and agitated,mutteringashortphrasewithincreasingagitation.Hewasupset thatGaziseemedtoignorehim.Gold?Wasthatwhathekeptrepeating? Washeaskingformoney?Why?Forwhat?Gazirealizedthatthedays andweeksaheadwouldbedifficultindeedforaTurknotunderstanding theGermanwordforGold! He insisted on seeing the chief consul. “Quite impossible,” the doorman snapped, his stubby hand still outstretched. Gazi was not experiencedindispensinggratuities,andhehadnointentionofpayinga bribe,certainlynotattheTurkishconsulate.Heproducedtheletterof introduction from his father, and finally was shown upstairs where a middle-agedmanquestionedhimhurriedly.Hewasred-faced,sweating. Hetooktheletterandscannedit,hisattitudechanginginstantly.“Oh,I see,” he exclaimed. “Herr Yasargil. You are the son of a minister. Welcome!Iwillsendyoutothehotel.”Gazididn’tconsidercorrecting himabouthisfather’simportanceinAnkara.Hewasweary,andunsettled. Heneededhelp.

“Youmustcomebacktomorrow,”themancontinued.“Pleaseexcuse metonight.Ihavenotime.Iamhostingareception.”Thered-facedman placedanarmaroundhimandpattedhimontheshoulder.“Don’tworry. Allarrangementswillbemade.Mychauffeurwilltakeyouhimself.” ThenightclerkattheGrandHotelassignedhimasuite,possibly protocol for guests from foreign governments. The sleeping room and adjoiningsittingroom,eachoutfittedwithfinecarpets,elegantfurniture, and flowing drapes, only enhanced his discomfort. The cost would be great.Butmainlyhewastired,andwearyofexplaininghimself.Mostof allhewashungry,veryhungry. Withoutpausingtochangeclothes,heinquiredaboutaplacetoeat, preferablyacoffeeshop.Hewaspromptlyshownintoadiningroomwith hugeCorinthianpilastersandwallsofredandgold.Tuxedoedmenand beautiful,bejewledwomeninglitteringgownsconversedattablesoffine linen,gleamingcrystal,andantiquesilverware. Hewasmetbyshockedexpressionsthatseemedtosay,“Whoisthis guy?”Hishairhadbeencutquiteshort,exposinghisscalp.Itwasthe German style of clipping prisoners’ heads. But he ignored the startled looks.Hewastoohungrytoworry. Hesighedasheattemptedtonegotiateamenuofferingprimarily French and Italian dishes. He recognized nothing familiar. Finally he presentedhisordertothewaiterbypointingtorandomlines.Hedidn’t carewhatheate,onlythatitwasservedsoonandthathewasleftalonein themeantime. Buthehardlytouchedwhathehadordered.Hesimplycouldn’teatit, oridentifywhatitwas.Hisfrustrationmounting,heescapedtohisroom whereheunwrappedwhatremainedofthebiscuitshismotherhadpacked forhimandbegantoeat.Hehadnotfeltsoaloneinhisentirelife.Panic wasnotfaraway,eventears.Heunderstoodtheexpensehewasincurring —thebillmightdemandmorethan hehad.Whatwouldhedo? How

wouldhesurvive?IfonlyhehadhestayedinAnkara! Thenextmorninghereturnedtotheconsulate.Whilewaitingtosee thechiefconsul,hemetastudent,alsoaTurk,ofapproximatelyhisage. The young man seemed to understand Gazi’s circumstances perfectly. “Youarenew,”hesaid.“Icanhelpyou.Forgetthisguyhere.Comewith me.Cheap.”Theofferseemedtoogoodtorefuse. Hisnewfriendledhimtoabureauwherehewasissuedcouponsfor food.Hehadonlytoregister.Couponswouldentitlehimtotheessentials —bread,butter,andcheese—atlocalrestaurants. As he waited, a girl approached. She was attractive, and quite friendly. Immediately his fortunes seemed to improve. The pretty girl laughedasshegreetedGaziandhisnewfriend.Shespokerapidly,and understandingherwasachallenge.Asheturnedtoreceivehiscoupons, his friend and the girl disappeared. But after a few minutes the boy returned.“Wherehaveyoubeen?”Gazidemanded.“Oh,totalktothegirl afewminutes,”heresponded,motioningtowardtheentrance.Shestood there,smiling.“Yougoaheadtoyourhotel,”heinstructed.“I’llmeetyou therelater.Iwillpickyouup.” ItwasMondaymorning,notyetteno’clock.Gazi’snewfrienddid not come that afternoon. Or all day Tuesday (assuming Yasargil’s

determiningthatOctober14wasaSunday).OnlyonWednesdaymorning

didhefinallyshowup.BythenGazi’sbillwaswellonthewaytoone

hundredeightymarks.

“Whydidyounotcome?”Gazihaddifficultyhidinghisanger.

“Oh,youknow,”theyoungsterreplied.“Thewoman.Shewastoo

goodtoleave.”Hesnickered.Surelyarichguy,onestayingatafancy

hotel,onewithconnectionsattheconsulate,wouldunderstand.

Gaziwasangryandconfusedandonthevergeofpanic.Inthreedays

hehadspentmoneythathadtakenyearstosave.Desperatelyhesought

spaceatthepensionwhichwashometoTurkishstudents,butnothingwas

available.Hespentthenightonahard,undersizedsofainhisfriend’s room. Three students shared the room, plus what girlfriends were available.ItwasmorethanGazicouldtolerate.Itwasbeyondanythinghe hadimagined.Didtheythinkhewasrich,andsostupidthattheycould stealhismoney?Hewishedhewassomeplaceelse,anywhere. Thenextmorningthelandladyfoundhimaloneatbreakfastintears. She sympathized with his circumstances and assigned him a sofa in a sittingroom.Withinafewdaysatinyroombecameavailable.Itcostfour marksaweek,butitwasworthit.Twosmallmealsadaywereincluded. Hewouldsurvive,atleastforawhile.Hewouldnothavetoreturnto Ankara,defeated.Notyetanyway. Otherfrustrationslayahead.HewasunabletolocateAugustBier. Thefewwhohadheardofhimweresurprisedtohearhemightbein Vienna, where Professor Saribaş had last contacted him. Gazi was disappointed,butnotfindingBierwasnoreasontoreturntoAnkara. 1943 Vienna was far from what he had expected. The grandiose, eclecticarchitectureoftheRingstrassewasimpressiveenough,theNeues Rathaus,theStatsopera, theBurgtheater,especially thevastnessof the Hofburg with its towering spires, turreted green domes, and intricate statuary,giantstonehorsesandancientGreekwarriors—ithadbeena favoriteresidenceoftheHabsburgsforsevenhundredyears.Hesawthe famousbuildingsfromtheoutsideonly,buthehadnodifficultyimagining fantasticfrescoesandexquisitefurnishingsinside.Hewascaughtupwith Vienna’sculturalandartshistory,especiallythemusic.Itwasthecityof Haydn,Mozart,Beethoven,Schubert,Brahms,andMahler. Thefamousoldroyalhospitalswererun-down,dilapidated,evento the point of being dangerous. The facilities in Ankara were far more modern.Gaziwasshockedbythesocialcontrasts.Slumswereabundant, evenwithinwalkingdistanceoftheRingstrasse,andvastsegmentsofthe population were malnourished and in rags, especially the hospitalized

poor.Hehadsacrificedsomuchtocome,andforwhat? HegravitatedtotheUniversität,whichwassecondonlytoPrague among the oldest German-speaking universities in Europe. Anton Bruckner,TheodorvonBillroth,SigmundFreud,KarlLandsteiner,names well known to Gazi, had been among its famous professors. At the chancellor’sofficehewasdirectedtocompletesomeformsaspartofthe registrationprocess.Hetookaseatinaroomresemblingarailwaydepot waiting area. Other prospective students were hunched in silence over smalldesks,fillingoutforms.Twosoldiersstoodattheperiphery,onein thebackoftheroom,theothernearthefront,bothincrispuniforms.A thirdwasseatedatadeskbehindawindowatthefrontoftheroom. Afterhehadcompletedthequestionnaire,Gazimovedtothewindow andslidthepaperacrossthenarrowcounter,alongwithhispassportasthe signindicated.Hestudiedthesoldiercarefullyashewaitedforapproval. Themanwasthin,withsharp,angularfeatures,ablackpatchcoveringhis lefteye.Hisfacetwistedintoadarklookashestudiedthefirstpage.“You arenotAryan,”hesnapped,glaringatGazi. “No.” He had checked neither block. He was neither Jewish nor Aryan. Agrincameoverthesoldier’sface,hisuncoveredeyeflashing.“You areaJew!” Gaziwasawareofoneoftheothersoldiersapproaching.“No,”he replied,strugglingtoremaincalm. “Whatareyou,then?”Theone-eyedman’sjawmusclesrippledashe stretchedbothhandsoverthequestionnaire. “IamaTurk,”Yasargilsaidwithpride,elicitingraisedeyebrowsand afaintgrinfromhistormentor. “YouareaJewdog!” “Iamnot.”Bloodrushedtohisface.Frightenedashewas,hewas evenmoresickenedbythenastyphrase.

Thesoldierlaughed,hiseyessuggestingthatwhatproofhedidnot yethavewasimminent.HesquintedatGaziafewseconds,thenbackat thepassport.Hemadeanextendedentryinhisnotebook.What?Hislocal address?Adescriptionofhim?Quicklythesoldierriffledthroughthe remainderofthequestionnaire,thentosseditontooneoftwostacksof papers.HereturnedhisattentiontoGazi.Hisgazewashollow,vapid. Slowlyhepushedthepassportbackacrossthecounter. Gazi,stomachchurning,turnedandwalkedaway,resistinganurgeto run.Hehadbeendismissed.Unregistered!Butitwasnoplacetoargue. Aryan?Jew?Caucasian?Whatwasthedifference?Angerboiledwithin him.Whatanimals!Buthowevercrudetheywere,theyweredeadserious. ThefollowingweekhemetaTurkishdoctorwhointercededwithan anatomyprofessorattheuniversitywhoallowedhimtoattendhisclasses and dissection demonstrations. But understanding the lectures was anythingbuteasy.Thenuancesofthelanguageescapedhim.Ordering from a menu or negotiating public transportation was one thing— understanding scientific concepts explained in a foreign language was quiteanother.Ifheweretoholdontohishopeofstudyingmedicine,his German must improve dramatically. The anatomy professor made a telephonecallforhim,andheaddedGermanclasses,plusdemonstrations andlecturesinthepathologydepartment.Hewasthrilledtobeworkingin thedepartmentofRokitanskyandVirchow,thenineteenth-centurygreats inpathology. In December, while spending an evening with two dozen or so Turkishstudents,hemetayoungengineerwhowaslivinginDresden.He wasvisitingfriends.Gazivaguelyrememberedhimfromhighschoolin Ankara.Themanwasonlyafewyearsolderthanhewas. WhenaskedwhathewasdoinginVienna,Gazitoldhimhecameto theuniversitytostudymedicinebutwasnotregistered.“I’mattending anatomylectures,though—watching,listening,tryingtounderstand.The

Germanisdifficult.I’malsostudyingpathology.”Heknewthewarwould endinafewmonths,andthepoliticalbarrierstohisadmissiontothe universitywouldfall.EventuallyhisGermanwouldimprove.Hesimply neededtohearthelanguage.Eventuallyhisearwouldadjust.Hewas confidenteverythingwouldturnoutwell. ButtheTurkfromDresdenwasn’tsosure.TheGermanspokenin Viennawasapleasantdialect,withclearmusicalqualities,butitwasfar from“highGerman,”stageGerman,thelanguageofscience.Hesuggested thatifGazireallywantedtoimprovehislanguageskills,heshouldgoto Germany.Ascitizensofadeclaredneutralinthewar,Turkswereentitled totravelinGermany.Foreignworkerswereneededforthewareffort.And his new friend knew exactly where he should go. He would write an elderlycoupleinNaumburg,westofDresden.Theywereformerteachers who spoke perfect Hannover German, the highest level of German pronunciation.AndtheyweresympathetictowardTurks!Theywouldbe delightedtoacceptGaziasahouseguest,atenant. Gazihadhadhisfilloflifeatthepension.Hehadbeenforcedto sharehistinyroomwithotherstudents.Howcouldhehaverefusedthem? No one knew the predicament of foreign students better than he did. Neither could he ignore the needs of his countrymen—not only other Turks,butGreeks,Armenians,andSlavsinpredicamentssimilartohis. Yethelongedforprivacy.Buttherewasnoescapingtherealityofwar. Along with Hamburg, Cologne, and other cities, Dresden had been bombed by the British the preceding winter, but the young engineer assuredhimtherehadbeennorecentattacks.Heclaimedtofeelperfectly safethere.InhisviewtheAllieshadfarmoreimportantmilitarytargets thanDresden.AndNaumburgwasevensafer.Itwasinaquiet,pastoral setting,ofabsolutelynostrategicimportance.ItwasanassessmentGazi acceptedwithoutquestion.Hewasonlyeighteen,andnotyetfullyaware ofthedangersurroundingalmosteveryoneinGermany.

Hewenttheverynextday,intheevening.Toheartheengineering studentdescribeit,Naumburgseemedbutashorttripaway,twoorthree hoursattheoutside.Inhishastetoleave,Gazihadn’tlookedatamap.But purchasingatickettoldhimthejourneywouldnotbetrivial.Ofthenearly onehundredmarkshehadremaining,almosthalfwouldgoforthetrain ticket. Fivehoursintothetrip,wellpastmidnight,thetrainpassedthrough Prague.Hewasshocked.Czechoslovakia?Hewantedtoseeamapinthe worstway.Suddenlyhebegantoworry.Wherewashegoing?Whathad hegottenhimselfinfor?AndhewasonatrainheadedforGermany!Two months ago his father’s fear had seemed trivial. Now it took on real meaning. Traveling in Germany was strictly controlled. Again Gazi was questioned by German police. Again they were gruff, arrogant, and seeminglyruthless.Afteralonglookathispassport,ashort,squatGerman snapped, “Why are you going to Naumburg?” The man stood ramrod straight,hiseyescold,impatient.Theotherpolicemanwastaller,heavier. ThetallpolicemanlookedGaziupanddown,hishandfidgetingwiththe holsterofhissidearm. Whatcouldhesay?Hisgoalwastostudymedicine.Buttherewasno universityinNaumburg.Inbroken,anxiousGermanhestammeredthathe wasgoingforonlyashortvisit.ReturningtoViennatostudymedicine washisultimategoal. Assoonashespokeherecognizedhisdanger.Hewasaforeigner, travelinginGermany,duringawartheGermanswerelosing.Howdidhe looktothem?Spiesweretalkedabouteverywhere.Onewasevenreported inthenewspaperhehadreadthatmorning.Theman,anEnglishman,had facedafiringsquad.Thepolicepatrollingthetrainswerechargedwith identifyingspies,andarrestingthem.ThemoreGazitriedtoexplainhis intentions,theworseitgot.Itwasnouse.HisGermanwaspoor,andhe

wasverynervous. Onepolicemanstayedwithhimwhiletheotherwenttothenextcar insearchofsomeonefluentinTurkish.Eventuallyhereturnedwitha short,thinmaninabusinesssuit,aGermanofficialwhohaddoneastint attheembassyinAnkara.Hehadagreedtohelpthepoliceunderstandthis strangeTurk. Thelittlemanwasquitefriendly.“Don’tworry,”hesaid,smiling, placingahandonGazi’sshoulder.“Tellmewhat’sgoingon.” AsthemanexplainedGazi’scircumstancestothepolicemen,Gazi gazed at the long flat buildings passing in the darkness outside the window.Smokepouredfromtallsmokestacks.ThetrainhadleftDresden almost an hour ago, and a fellow traveler had described the industrial complexhewouldsee.FirstwastheLeunaWerke,ahugechemicalplant where over twenty thousand workers were said to produce synthetic gasolinefortheLuftwaffeandthePanzerDivision.Theyworkeddayand night.FartherwestwastheKrumpaWerke,asimilaroperation.TheLeuna andKrumpaplantshadtobekeytargetsfortheAlliedbombers.Gazi could sense how dire his situation really was. These policemen were convincedhewasaspy! Buttheinterpretersavedhim.Infifteenminutesheconvincedthe policethatGaziwastooinnocenttobeaspy,waytoonaive.Plus,what kind of spy would enter the German heartland with barely sufficient knowledgeofthelanguage? Hetraveledwithcivilians,mostlybusinessmenitseemed.Noneof thepassengersappearedtobemilitaryorgovernmentofficials.Sofarhe hadseennothingtosuggestoutrighthostilities,certainlynoevidenceof physicaldestruction.Hehadchangedtrainsseveraltimes,withlongwaits at each station. It was the trains themselves that frightened him. Each presentedanewthreat,differentpolicemen,newdifficultiesexplaining himself.

HehadleftViennaat8pmandarrivedinNaumburgthefollowing

dayatmid-morning.Itwasanold,cathedralcityonthenorthwesternedge

oftheThüringenbasin,justwestofwheretheRiverUnstrutjoinsthe

Saale,fiftykilometerssouthwestofLeipzig.TheSaaleflowsnorthfrom

thehighlandsnearNuremberginBavariathroughoutthelengthofthe

provinceofThüringenandwellbeyondtowhereitemptiesintotheElbe

westofBerlinandPottsdam.Naumberg’swartimepopulationwashardly

thirty thousand—retired people mostly, upper middle class Germans. Therewasnoindustry,onlybeautiful,gentlyrollingcountryside,woods andfieldssaidtobeinhabitedbyrarespeciesofbirds. Notonlydidtheretiredcoupleprovetobelearnedandcultured,they werewarm,friendly.Immediatelytheyrecognizedhimforwhathewas— anearnestforeignerwiththehighestintentions,adeterminedyoungster, desperatelyfightingoffhomesickness.Hisfeelingsshowedinhiseyes, andinthesoundofhisvoice.Almostovernighttheyacceptedhimasa son,andhebegantoviewthemasadoptedparents.Hewouldpayasmall amountofmoneyforhisroom,andtheywouldberesponsibleforwashing his clothes. They showed no concern that he had little money—more importantwasthefactthathehadfamilyinAnkara,andthereforeaccess tocoffeeandcigarettes,itemsmorevaluableinGermanythangold.

“Butwhatareyourplans?”themanwantedtoknow.“Yourlong-

termgoals?”LearningGermanhadtobeameanstoanend. GaziexplainedthatheintendedtostudymedicineinViennaafterthe war.Therewasagreattraditionthere—thefamousuniversitywherethe greatsofnineteenthcenturymedicinehadworkedandtaught.Heyearned tobepartofthat. Buttheyhadabetteridea.WhynotgotoJena,onlythirtykilometers away? A great university was there. It boasted major contributions in scienceandphilosophyandincludedoneoftheoldestmedicalschoolsin

Europe,datingfrom1558astheUniversityofJena.Itwasrenamedthe

FriedrichSchillerUniversityin1934.Hegelhadbeenanundergraduateat

Jena,andbothSchillerandGoethehadtaughtthere.Gaziwasfamiliar withSchillerandGoethefromhighschool,andthevastliteraturetheyhad created. Ernst von Haeckel, the evolutionist who succeeded Charles Darwin,hadbeendeadfortwentyyearsbuthadworkedinthebiology departmentinJena.ThementionofhisnamepiquedGazi’sinterest.He hadheardhisfatherandProfessorSaribaşdiscussHaeckelwellintothe night.Gazihadcomeawaythinkingthat“Haeckelism”wasasimportant as“Darwinism.”Bothhadbeenonhismindforweeks,fromthemoment hewasturnedawayfromtheuniversityinViennabypolice.Hewasstruck bythecruelironyofHitler’susingtheconceptofevolutiontojustifyhis heartlessideaofestablishingapureraceofAryans.Therecouldbeno validexcuseforthevenomreservedforJews. TheideaofgoingtoJenawasimmediatelyattractive.Itwasalso possiblethathisattempttoregisterattheuniversitywouldnotmeetthe scrutinyithadinVienna.Becauseofthewartherewerefewerforeigners in Germany, and therefore possibly less reason for officials to be so exclusive. Furthermore, Gazi’s hosts were aware of the wartime labor shortagesfacedbyalmosteveryhospitalinGermany.Wouldthataffect thenumberofmedicalschoolapplicants?Itmaybeanidealtimefora foreignertoseekadmission.Didn’tuniversityhospitalsusestudentsto helptakecareofpatients? Hewentinafewdays.Bytrainitwasonlyathirty-minutetrip. Physically the Friedrich Schiller University was an imposing sight, especially its huge brown administrative building, constructed in the classicalGermanstyle,withgreatcolumnsandfinelykeptgrounds.After reviewinghisbackgroundandhisperformanceattheAtatürkLisesiin Ankara,thesecretaryatthemedicalschoolwasencouraging.Gaziwould beacceptedasastudent,butonlyifheagreedtoworkfirstasanurses’aid at the hospital. There were manpower shortages. Strong young men,

particularly,wereneeded,whatevertheirskills.Everyable-bodiedGerman malewasfightingatthefront.ManyhospitalsinGermanywerestaffedby thewar-wounded,astheyrecuperatedfromtheirinjuries.Inreturnforsix monthsasanurse’sassistant,theuniversitywouldofferhimsixmonthsas afull-timestudent,mealsincluded.ThiswasmusictoGazi’sears,buthe stillwantedtoresumehisstudiesimmediatelyandhehadnoideahowhe wouldbringthatabout. He went directly to the office of the medical school admissions director, seeking to enroll immediately for classes to review his basic science knowledge—in physics, chemistry, and mathematics. He suggestedworkingsimultaneouslyinthehospital,atnight,oratalater date.

Sheturneddownhisideabutofferedacompromise.Gaziwouldwork

threemonths,thenstudythreemonths.Hebroughtupthepossibilityof

workingatthehospitalinNaumburg.Hereallylikedthecouplethereand

missedbeingpartofafamily.Theadmissionsofficeragreedtoallowhim

toworkinNaumburg.Thehospitaltherewasalsoinneed.Hewould

receivenowages,buthismealswouldbeprovided.Afterthreemonthshe

wouldcometoJenaforthreemonths,intimeforthespringterm,which

wouldbegininApril.InJulyhewouldreturntoNaumburg,thenbackto

JenainlateSeptemberforthefallterm.Butsheemphasizedthathemust

bringdocumentationofsatisfactoryworkatthehospital.

WhenhereturnedtoNaumburg,hislandlordswereasexcitedashe

was.Theywerepersonalfriendsofthechiefsurgeonatthelocalhospital,

andtheoldgentlemanandthedoctorweremembersofthesamehunting

club.

ForthefirsttimesinceleavingAnkara,Gazicouldrelaxalittle,begin

tofeelalmostcomfortable.Atlasthewaslivinginarealhomeagainand

hisimmediatefuturewasassured.Hehadhisownroom.Itwassmallbutit

washis.Andthecoupleseemedtocareabouthim.Hewasfinallyableto

writehomewithgoodnews:hewasenrolledattheuniversityinJenaand

soonwouldbestudyingmedicine.Laterhewouldhearfromhisbrothers

howsadhisletterhadmadetheirfather.TheGermanheartlandwouldnot

benearlyassafeasVienna.BritishandAmericanbomberswereonthe

way.

Thehospitalhadtwohundredbeds.Itwasorganizedprimarilyinto surgery and internal medicine, but there was also an obstetrics and gynecology department. Two surgeons did mainly small operations:

inguinalherniasandgallbladders—occasionallyastomachresectionfora bleedingulcer—butbeyondsettinganoccasionalfracture,traumacases wererare.Therewerenobigoperations,vascularsurgeryorneurosurgery. Therewerethreeoperatingtheatersadjoiningasinglex-rayroomonthe secondfloor. Immediately Gazi found the nurses both friendly and helpful. He watchedthedoctorscarefully,howtheyrelatedtopatients,conductedtheir examinations and made their rounds, but the nurses were his primary teachers. Nursing care of the 1940s was still more custodial than therapeutic. The image of the nurse as an angelic source of medical wisdomandefficiencyhadnotyetburstintothepublicconsciousness.The prevalenceofpeacetimehospitalshadnotincreasedastheywouldwiththe comingofparenteralantibiotics,newsurgicalwonders,andprogressin healthcaretechnology.Hospitalswereanythingbutpopular.Fordecades the knowledgeable population sought to live down the memories of hospitalsaslargelydeathcampsduringWorldWarI.Medicalcarewas stilldeliveredprimarilyinprivatehomes. Nursing was in transition, particularly in Germany. Gradually scientific principles were being applied to both practice and training. Formerlynurses’allegiancehadbeentothechurch.Manyhadbeennuns. Now their primary responsibility was to the hospital, to the patients themselves.Atrueprofessionwasforming,withacommitmenttoservice,

tocaringforthesick.ThefiftyorsixtynursesemployedbytheNaumburg hospital were devoted to the alleviation of human suffering, and they functioned as highly intelligent, rigorously trained professionals. Their actions followed an orderly protocol, featuring backbreaking work. An eighteen-year-olddedicatedtoalifeofservicewouldfindtherewouldbe littleglamour. NursestaughtGazihowtocleanpatients’rooms—scrubbingwalls andfloors—andmaketheirbeds.Hebecameversedonthehumanneeds ofhispatientsandhowtoprovidethem.Thiswouldgivehimaspecial incentivewhenhefinallyenteredtheclassroomandthelaboratory. Hewasoutofbedbeforefiveeachmorninginordertobeatthe hospitalbeforesixtobeginbathingpatients.Hedistributedsoapanda basinofwatertoanyoneabletomanageabathalone;theothershewashed himself. Most days he worked with a partner, quickly learning the techniquesofturningpatientsfortheirbaths,standingthemupandhelping themintowheelchairsandbedsidechairs.Afterthebathscamebreakfast. Heloadedtraysoffoodontoacart,thendistributedthemfromroomto room,assistingpatientstoeatwhennecessary.Assoonasthatwasdone, hecollecteddishesandsoiledtowelsandwashcloths,andreturnedthemto thekitchenandthehospitallaundry. At eight o’clock beds were made, rooms swept, and trash cans emptied.Hewouldbeatdustfrommattressesonwindowsillswithwhat lookedlikeahockeystick,andsweepthecorridorsclearofdebris,then mop, finally cleaning the chairs and tables. This was done between transportingpatientstothex-raydepartmentortheoperatingtheaterto meetthemorningsurgicalschedule.Heorientednewadmissionstotheir roomsandassistedtheminfillingoutforms.Therewasalsotheworkof taking and recording the morning vital signs—blood pressures, temperatures,pulse,andrespiratoryrates.Theywererecordedtwicedaily. Byeleveno’clockitwastimetoservelunch,thencoffeeatmid-afternoon.

Onlyattenatnightdidhefindhimselfbackwithhisadoptedparents, embarrassedbyhowtiredhewas,howdesperatehewasforsleep.His workatthehospitalleftlittletimeforthefamilylifeheyearnedfor,but hisfatiguewasnotunpleasant.Hewasdoingsomethingimportant.Hewas needed,andhewaslearning. His thirst for learning and his indefatigable nature soon became legendarythroughoutthehospital.Withinafewweekshehadmastered thedetailsofcustodialcareandbeganlookingfornewassignments,new challenges.Hewasreadyforhisfirstexperienceintheoperatingtheater. Thewarwouldsupplyhimachancesoonenough. Oil is the lifeblood of any army of tanks. The German Panzer

Divisionrequiredhugeamountsofit.Withthefailureofthe1942Russian

campaigntoprocurenewsourcesofoil,plusincreasingAlliedpressureon

theRomaniansupplyinthefallof1943,Germanyincreasinglyreliedon

syntheticgasoline.Hidingthesitesofsyntheticgasolineproductionfrom theAlliedhighcommandprovedtobeimpossible.

Priorto1943neithertheBritishnortheAmericanshadsufficient

numbersofbomberscapableofdeliveringheavypayloadsintotheheartof Germany.BritishattacksonGermanoil-producingcentersbeganinearly

1941.Withinayeartheywereextendedtotheindustrialcitiesandrailway

centers,particularlyintheRuhr,Hamburg,Bremen,Hanover,Frankfurt, andStuttgartwheretheyhadprovedtobelargelyineffective.Finally,in

1943,sufficientnumbersofheavybombersandlong-rangeescortfighter

planes (Thunderbolts, Lightnings, and Mustangs) rolled off Allied assembly lines to allow effective daytime forays into Germany. Simultaneously,newradartechnologyfacilitatedaccuratenightbombing. Byearly1944theAllieshadachievedairsuperiorityoverGermany. 4 GazihadalreadywitnessedthevastLeunaandKrumpaplantseastof Naumburg, and months earlier he had assumed that his flight out of IstanbulhadbeendelayedbyanairstrikeagainstRomanianoilfieldsthe

Germanshadcontrolledsincethebeginningofthewar.TheGermanhigh commandhadtoknowthattheLeunaandKrumpaplantswouldbeprime

targetsfortheAmericansandtheRAFas1944woreon.Inhabitantsof

Naumburgheardthedeadlydroneofbombersforthefirsttimeonthe

eveningofMay12.Alliedbombsdestroyedkeyelementsoftheoperation,

knockingoutgasolineproductionaltogetherforawhile,butwithinten days a force of several thousand additional workers put it back in operation. 5 InJena,Gaziheardabouttheattack.Hehadbeenattending classeshardlymorethanamonth.FollowinghisreturntoNaumburg,the Leunaplantwashitagainwithinaweek,Americanbombersthatcame

duringthenightofJuly7,thedeadlysoundofaircraftfollowedwithin

minutesbytherumblingvibrationsofbombsexploding.Likeeveryone else Gazi was alarmed, but he understood that such attacks were inevitable. Homes shook, tableware rattled. Anyone within seventy

kilometersunderstoodwhatwashappening.TheJuly7attackwentonfor

hours. Destroyingthevastindustrialsite,evenwithastrikeofhundredsof aircraft,washardlypossible,butdisruptinggasolineproductionforcrucial periodswasareasonablegoal.Asuccessfulattackcoulddisruptoperations for weeks. The Allies proved to be extremely efficient at keeping the Leunaplantdisabled.Theirinstinctaboutwhentobombseemeduncanny, almosttooperfect.Whenoperationsresumedfollowingsuccessfulrepairs

onJuly19,theAlliedbomberscameagaintheverynextday,thenagain

onJuly28andJuly29whenoperationswereupandrunningagain. 6 The Germans knew a spy had to be signaling the resumption of production.Gaziwouldreadthestoryinanewspapertwentyyearslater.A youngEnglishstudent,fromOxford,hadparachutedintotheareaatnight, armedonlywitharadiotransmitter.Hemadeconnectionswiththelocals andfoundworkattheLeunacomplex,hidinghisradiointhebasementof theprivatehomewherehelived.RepeatedlyhecontactedLondonassoon

astheplantwasoperationalagain.IftheAlliedattackshadbeenmore irregular,thespymighthavesurvivedindefinitely,makinghisinformation infinitelymorevaluable,buttheGermansferretedhimoutwithinweeks. Hefledtothecountrysidebutcouldnotescape.Hewasexecutedlatein thesummer. With each bombing of the fuel sites, injuries poured into the Naumburghospital,afacilitywithlittlecapacitytotreatmasscasualties andmajortrauma.Withinthirtyminutesofthesoundsandvibrationsof bombing,theybegantocome.Gaziandtheothernurseslearnedtotime theirarrivalprecisely.Thehospitalwasoverwhelmed,dozensofcasualties swarming the grounds, the gardens, the front steps of the hospital, groaning, bleeding, crying out in pain—countless chest and abdominal wounds, grotesque extremity injuries, hemorrhaging from the face and scalp. The chief surgeon was an older man, retired from his civilian practice.Hewasassistedonlybyayounggynecologistandtheheadnurse. Thenursewasaremarkablewoman—capable,tough-minded,efficient—a criticalplayerintheoperatingtheater.Sheknewexactlywhatthesurgeons neededandshesawthattheygotit.Sheevendidsurgeryherselfwhenthe surgeonswereoverwhelmed,performingamputations,ligatingbleeding vessels, suturing lacerations. Gazi stayed glued to her side. He was appalledbythehideoussights,butneverthelessintrigued,evenstimulated. Hewouldneverforgethisfirstexperienceintheoperatingtheater.A young man had a devastating lower extremity wound. His knee was mangledandbloodyfromshrapnel,boneexposed,hislegflailingfromhis lowerthigh.Hewaswideawake,screaminginagonyastheheadnurse completedtheamputation.Gaziheldtheman’slegandfoot,stillinalong heavybootandgrimy,bloodypants,asthenurseligatedthearteriesand veins,thensawedthroughthefemur.Whenhefeltthefullweightofthe devitalized extremity in his hands, though, he stood dumbfounded,

tremblingasheclutchedit,paralyzedinterror,pleadingwiththenursefor guidance.Hecouldnotspeak. “Go!Putitthere,idiot,”theheadnursescreamed,herfaceastudyin professionaldetachment,pointingatthegarbagepailnearby. Itwastoomuchforhimtocomprehend.Heonlystaredatthelifeless leg.Theactofsurgeryhadn’taffectedhim,buttheideaofdiscardingas garbagethepartofthatman’ssoulresidinginhislegshookGazitohis verydepths.Hestaggeredbackwardafewsteps,theoperatingtheater beginningtospin,andcrumpledintoaheap. Foralmostadayandanighthecouldn’teat,andsleepcameonlyin spurts.Butthefollowingmorninghewasbackintheoperatingtheater, lookingforwork,readytohelp.Whatchoicehadhe?Thiswastobehis life’swork. Hisdeterminationdidn’tgounnoticed.Thatday,hebecameafull timeoperatingtheaterassistant,anorderly,cleaningtherooms,sterilizing instruments, running errands, doing whatever was needed, moving and workingalwaysatafreneticpace. Emergencyoperationsfascinatedhim—dealingwithwarwoundsand criticalpatients,theurgencyofitall,theskillandpersonaldetachmentit demanded.Surgeonsandtheirassistantsworkedfeverishlytosaveone man’slife,knowingthatothersawaitedinthecorridor,manydestinedto dieifcarewasdelayed,othersdyingregardlessofwhatdoctorsdid.It dominated his attention. Surgeons did what they could and somehow adjusted to what they couldn’t, always working against the odds. Casualties in shock from blood loss were destined to die, without exception.TransfusionswerenotpossibleinwartimeGermany. Not all the casualties from the synthetic gasoline plants were Germans—somewereRussian,French,Tartar,evenafewfromAnatolia, thevastAsianpartofTurkey.Theyhadbeenprisonersofwar,thelowliest oftheworkersattheLeunaandKrumpaplants.Withaplacetosleepand

foodtoeattheycouldprovideaservicefortheThirdReichasunskilled laborers.InstinctivelyGaziunderstoodthatinjuredGermanswerefirstto receivemedicalcare,buthewasnevercertainaboutit.Hehadnoidea whomadedecisionsabouttransportingthewounded. ThehospitalinNaumburgwasanexcellentvantagepointforthe philosopher in him, a place for contemplation. He began to examine warfareasasocialextensionofnature.Hesawperpetualwarineventhe most serene of biological systems, countless predators devouring each otherupanddownthefoodchaintoprovideabalanceofnature:mice controllingtheinsectpopulation,thenbeingeatenbysnakesandferalcats, whichinturnweredevouredbybirdsofprey.Allanimallifemustfightto survive. He viewed the war as continuous strife to prevent a ruthless politicalpowerfromdevouringthedefenseless,especiallyJews.Merelyto survivewastowininwar.Inspring,thegrasswasalwaysgreenandthe flowersbloomed.Whenthebomberscame,thebirdsvanished,butthe nextdaytheywouldbeflittingfromtreetotree,singingtotheirhearts’ content. Inashorttimeactivitiesatthehospitalwouldbecalmagain—mostly inguinal hernia surgery in the operating theater, or an occasional appendectomy.OnlythreetimesinhissixmonthsinNaumburgwasthere aninfluxofmassbombingcasualties. One morning the chief surgeon operated on a personal friend, a seventy-five-year-old, a member of the local hunting club, a man also knowntoGazi’slandlord.Thehuntingclubwasexclusive,drawingits membersfromtheeliteandsociallyconnected.Theoldgentlemanhada urinaryobstructionfromanenlargedprostategland,andwasundergoing surgery to remove hypertrophic prostatic tissue. It was the first spinal anestheticGazihadeverwitnessed.Initiallytheoperationwentwellbutin timetheprostatebegantobleed,slowlyatfirstbutlatertheflowbecame alarming.Theoldsurgeonsaidnothing,simplytoiledawaysteadilyinthe

risingseaofblood,makingrelentlessprogress,constantlyirrigatingthe fieldwithcoldsaline,butneverquitestoppingthebleeding.Gaziwatched theperspirationbeginningtobreakoutonthesurgeon’sforehead.Hehad never seen him sweat before. The old man had lost too much blood. Repeatedly the surgeon inquired about his friend’s blood pressure and pulserate.Eventuallythebloodpressureslippedalittle,andhisheartrate crept upward. No seventy-five-year-old heart could last long without sufficientbloodpressuretoperfuseitscoronaryarteries. Gazihadwitnesseddeathsfrombloodloss.Youngmeninshockfrom shrapnel wounds had no chance to survive. Ten and fifteen pint transfusionswerenotpossible.Suchvolumesofbloodsimplywerenot

available.LandsteinerhaddiscoveredtheABObloodgroupsin1901,and

sodiumcitratewasavailabletopreventclotting.Intheory,transfusions werepossible—butonlyinsophisticatedcenterspossessingthemeansof typingbloodandstoringitundersterileconditions.IfGermanmedical officershadorganizedplansforbloodtransfusions,theydidnotinclude hospitalsliketheoneinNaumburg.Butherewasamanwhowasonthe vergeofdeathfrombloodloss.Aoneortwopinttransfusionmightsave hislife.Onelookatthesurgeontoldhimtheywerethinkingthesame thing. Lyingbesidethemanintheoperatingtheater,connectedvein-to-vein tohimviaashort,sterilecatheter,unawareofhisownbloodtype,Gazi gainedhisfirstexperiencewithbloodtransfusions.Andhewasthedonor! Thebloodwasneithertyped,cross-matched,norotherwiseexaminedfor incompatibilities.NeitherwasGazi’sbloodfortifiedwithananti-clotting agent.Itwasjusttransferredintotheoldman.Thecircumstanceswere desperate.Gaziwasyoungandrobust,andthemanwasindirestraits.It just might work. The transfused blood wasn’t even measured, Gazi donatedjustenough,thesurgeonclosingofftheconnectionwhensatisfied thatacertainvolumehadbeentransferred.Onlylaterdidhediscoverthat

hisbloodtypewas“O.”Hewasa“universaldonor,”hisbloodacceptable toalmostanyone. Theoldmansurvived.FromthatdayforwardGaziknewhehadone veryspecialfriendinNaumburg.Andthateveninghedidn’teatsoupand potatoeswiththeothernursesandstaff.Hewasgivensteak! Thatsummerafewpatientswithchronicwoundsweretransferred from one of the hospitals in Cologne. The British had dispatched one

thousandbombersortiestoCologneinMay,1942,thenonlyintermittently

fortwoyears.ButnowtheAllieswerebombingCologneagain,inearnest andwithgoodeffect.ChronicpatientsfromColognewereevacuatedtothe countryside,someevenasfarasNaumburg,threehundredkilometerseast. Most had open wounds, amputated extremities, many with stumps smoldering with infections and osteomyelitis. Each posed a risk of infecting the staff. There were no antibiotics, only the purple-staining potassiumpermanganateandRivanol. 7 Onemorning,atnineo’clock,Gaziandayoungfemalenursebathed oneofthenewarrivals,washinganddébridinghiswounds.Itseemeda hopelesscause.Hewasagrownman,almostsixfeetinheight,yethe weighedhardlyahundredpounds.Hisdarkeyesandcheeksweresunken, coveredbytranslucentskinstretchedacrosshisforehead.Evenhishair seemedlifeless—itwassparse,wispy,hardlycoveringhisscalp.Gazi’s associatewasparticularlycarefulbecauseshehadcutherthumbpeeling potatoesinthekitchenthedaybefore.Togethertheyhumoredtheman, seekingtobringhimout,tolethimfeeltheirwarmth.Intheprocessthey pokedfunateachother,laughingandjoking.Withinanhourthegirl becameill,chillsatfirst,thenahighfever.Withintwohoursshewasina deepcoma.Andtherewasnothingtheycoulddo. ShortlypastnoonGazicarriedherbodytothemorgue,downthe narrowstepstothecellar,alone,tearsstreamingdownhisface.Aching withgriefhelaidherbodyonthecoldtablewhereanautopsywouldbe

performed. Her body was pale and swollen hideously in death, her beautifulfacehardlyrecognizable.“Comeback,”hewailed,listeningto hiscryreverberateoffthewalls.“Comeback.Thiscan’tbe!”Dailyhehad readofthedeathsofhundreds,eventhousands.Hehadalreadywitnessed death many times himself, bombing casualties with little chance of survival.Butthiswasdifferent.Itwaspersonal,upclose,someonehehad knownandcaredabout.Hehadheardherspeakofherfamily,herparents in Weissenfels, her two brothers at the front. He had witnessed her uniqueness,hervitality.Hewasashamedthathehadnotdiedinherplace. Thestairwelltothecellarheknewonlytoowell.Inadditiontothe groundfloorthereweretwoupperlevels,andabasementforatotalof fourlevels.Withonlyasingleelevatorandatleastonehundredfifty patients,quicktransportationtothecellarwasproblematiceachtimethe air raid alarm sounded. Generally they could count on thirty minutes’ warningbeforeanattack.Therewerealwaysfiveorsixpatientswhocould notwalk.Beingtheonlymanonthenursingstaff,hewasexpectedto carry them to safety. The only other man who wasn’t a doctor in the hospital drove the ambulance. Gazi had been through the drill several times—racingbreathlesslyupanddownthestairsnon-stop,eachtimewith apatientdrapedoverhisshoulder.Itgavehimaheroicfeeling.Then, sometimesevenbeforethelastpatientwassafelyinthecellar,the“all clear”signalsounded,indicatingthattheslower,moredifficultworkof carryingthembackupthestairscouldbegin. Generally, he enjoyed his time in Naumburg. Looking back on it many decades later, he saw that experience as his most rewarding in medicine.Hesensedthepurehumanityofitall,notyetencumberedbythe heavyresponsibilityofbeingthesurgeonincharge.Helearnedmuchfrom thenurses,andhisGermanimprovedrapidly.Hebegantolearnalittle aboutmedicine,verypracticalthingsaboutdealingwiththesick:howto give intramuscular injections and start intravenous infusions, how to

catheterizethebladderandthreaddownstomachtubes.Hewitnessedlive operations,andsawtheproblemssurgeonsfaced,alsothenursesandthe anesthetists. He saw the difficulties of inhalation anesthesia: mask inductions,etherorchloroform.IntravenousPentothalwasatechniqueof thefuture,aswereendotrachealintubations.Anesthesiawasadministered exclusivelybynurses. HishospitalworkinNaumburgwasfarmoreimportanttohimthan aspaymentforhisfirstsemesterofmedicalschool.Thereheinterfaced withtherealworldofmedicinefortheveryfirsttime.Heperformedno surgery himself, but he assisted dedicated, experienced people. He witnessed, first hand, surgical discipline and classical techniques. He becamefamiliarwith thebasicsurgicalinstruments,theimportance of sterile technique in the pre-antibiotic era, the problems achieving hemostasis,theimportanceofgentlyhandlingtissues,andthevalueof precisewoundclosure.Hegainedanunderstandingofthetrustpatients placed in surgeons and some ideas about how best to discharge the responsibility that came with it. Even more important he came to understandthevulnerabilitiesofthesickandinjuredinaveryspecialway, plustheproblemsfacingnursesandtheirassistantsfromaperspective mostdoctorsneverwouldhave.Hecametoseemedicineasadiscipline groundednotonlyinsciencebutinintegrityandhumanisticphilosophy, ideashehadbeenexposedtoasachild.Itsuitedhispersonalityandhis character.Theexperiencewouldservehimwellinthefuture.Hisappetite for learning the details of medicine was truly whetted. Hundreds of questions formed in his mind that would demand answers later. The anatomy,physiology,andbiochemistryhehadyettolearnwouldmeanfar moretohimeventuallythanifhehadenteredmedicalschoolthenormal way,directlyfromanacademicenvironment.Hewouldbepreparedto takemaximumadvantageofwhatevercametohimlaterinclassroomsand laboratories.

TheNaumburgexperiencewasimportantinotherways.Thevillage wasarrangedaroundtheLateRomanesqueandEarlyGothicCathedralof SaintsPeterandPaul,oneofEurope’sfinestcathedrals.Constructionof the Dom was begun in 1213, with many alterations occurring in later

periods,upthroughthe19thcentury.Itwastheregion’sfocalpoint,a

storehouseofartistictreasuresrangingfrompurebeautytotheintensely practical,fromtheancienttothemodern,fromthespiritualtothetravails and sufferings of humanity. He was drawn particularly to a life-sized statueinlimestone,thebeautifulUta,wifeofEkkhard,founderofthe village.InastrangewayGazifellinlovewithher,herfinefigure,its perfectproportions.Sevenhundredyearsold,itwasforhimasymbolof theupliftingbeautyofman’scapacitytocreate. Butnoteveryculturalexcursionprovedfruitful.Somewerefraught withdanger.FriederichNietzsche,thenineteenth-centuryphilosopher,had spenthischildhoodinNaumburg.GaziknewaboutNietzsche:he’dgrown up in a strict Lutheran home only later to question the value of any religion. It brought to mind Atatürk’s secularization of Turkey, even thoughGazihadbeentaughttoatleastrespectIslam,andthereligionsof others.NietzschehadbeeninfluencedbyDarwin,andwentontoattack virtuallyeverysocialfoundationofmoderncivilization.Hehadviewed equality and democracy as against the flow of natural selection and survival.Hesawpower,notjustice,asthemeanstoanation’sdestiny. Nietzsche’sphilosophyhadjustifiedBismarck,andnowHitler.Gazisaw the terrible evidence all around him. Nietzsche’s thought could not be ignored.Gaziwasdrawntoconsiderit. ThesmallhousewhereNietzschehadgrownup,plustheschoolhouse hewassaidtohaveattended,werenearby.Gazitriedtovisitthemandthe museum that he assumed housed the philosopher’s artifacts. It was a beautifulcampussetinawoodedarea,withfinelyconstructedbuildings.It suggestedtoGazihowacollegemightlookinEngland,orahighschool,a

schoolbuiltforthesonsanddaughtersofwealthyfamilies,intellectuals. He saw a number of young men, all in uniforms and seemingly well motivated,eager.Therewerenoyoungwomen.Hegotaglimpseofwhat wasthere,butwasdeniedentrance. The caretakers were openly hostile. “Why are you here?” they demanded. “What do you want?” They were incredulous that a young Turk,astudent,mighthaveaninterestinapurelyGermanlandmark. “Nietzschelivedhere,”Gazireplied.“Iwouldliketovisit.”What couldbesopeculiaraboutsuchaninterest? “He is not here! Nothing is here.” Their response was curt, intimidating. He would later find that the elaborate campus did not house a Nietzsche museum at all. It was a school for training SS officers, the HeinrichHimmler–trainedeliteunitthatprotectedHitlerdaytoday,and whoperformedhisbiddingagainstciviliansandprisonersofwar. Later, visiting the Naumburg couple on a break from Jena at

Christmasin1944,heaccompaniedfriendstoachoralperformanceinthe

Dom’swestchoir.Abrassensembleplayed,withoneofhismusician

friendsparticipating.Gaziclimbedthecenturiesoldtowerandwasstruck

bytheviewoftheancienttownandtheSaaleflowingthroughthevalley

beyond,inspiringhimtoquestiontherelationshipoftimeandspace,of

solitudeandpeace,yetmarredbytheterribletragedyofwar.

CHAPTERSIX

MedicalSchoolatLast

INAPRILGAZIRETURNEDtoJena,thistimetobeginhisstudies

attheuniversity.HistrainpassedtimelesscastlesalongtheSaaleasit

ascendedthroughtheeasternedgeoftheThüringerWald,strikinglyscenic

initscontrastsofforestedhillsanddeepvalleys.JustnorthofJena,the

valley narrowed abruptly, steep limestone cliffs jutting from the river

basin,borderingadenselywoodedplateau.Hugeelongatedimages,wire-

tetheredhelium-filledballoons,twentyandthirtyfeetlong,hoveredover theriver.Theyseemedlikegiantfish.Flyingfish.Itwasastartlingsight. InfourmonthsGazihadlearnedtoavoidcallingattentiontohimself byaskingquestionsaboutanythingthatmaypertaintothemilitary,butthe balloonsseemedinnocuousenough.Hewastoldtheywerefordefense, thattheyappearedonlywhenmilitaryintelligencewarnedthatairattacks were imminent. He knew not to ask for details, but how could giant balloonspossiblydefendthecity?Howdidtheywork?Didtheysetup electromagneticfieldstodeflectorconfuseAlliedradardevices?Henever heardtheissuediscussedinpublic. AfterthewarhewouldcomeacrossinformationthatRooseveltand Churchillsawtoitthatcertainpotentialtargetsweremadeofflimitsto Alliedbombersduringthewar.Amongthemwerethequaintuniversity town of Heidelberg and the priceless architectural and art treasures in Vienna.Asthelargestsupplieroftop-qualityopticsintheworld,theCarl ZeissCompany 1 inJenawasalsoonthelist.Duringthewaritproduced surveillancecameras,binoculars,andbomb-sightsfortheGermans,but

lateritwouldproduceindustrialandpersonalopticsfortheentireworld.

Possibly the inflatable fish were simply markers to alert Allied flight crews. IfprotectingtheZeissCompanyhadanythingtodowithYasargil’s

safetyin1944,hewouldreturnthefavorlater,manytimesover.Asthe

drivingforcebehindtheadventofmicroscopicneurosurgerytwenty-five years later, he would inspire Zeiss Company engineers to produce operatingmicroscopesadaptedtotheneedsofneurosurgeons.Later,as microsurgical techniques caught on around the world, Yasargil would make millions for Zeiss as neurosurgeons flocked to purchase their microscopes! Amoreplausibleexplanationofthe“inflatablefish”isthattheywere anadaptationofthe“barrageballoons”famouslyemployedbytheBritish earlierinthewar.Suchballoonsweretetheredbywinch-controlledsteel cablesatanaltitudeofapproximatelytwothousandfeetasobstructionsto dive-bombers and other low-flying aircraft. As physical and mental

hazardstoGermanpilots,suchcablesledtheLuftwaffetoinstallwire-

cuttingdevicesontheleadingedgeofthewingsofNaziaircraft.More

likelythannot,theGermansweresimplygivingtheAlliesatasteoftheir

ownmedicine.

---

HisfirstdayintheareaGazisearchedforaplacetolive.Jenawas

nothinglikeNaumburg.Hejudgedacityofonehundredthousandtobe

tootemptingatargetfortheAlliedbomberstoignore,andhehadno

intentionofplacingmuchfaithininflatablefish.Hetookatramoutfrom

thecityandgotoffattheLobedastop.Itwaslessthantenkilometersfrom

theuniversity,thirtyminutesbytram.Heestimateditwouldtakeanhour

onfoot.

Jena-Lobedawasanewdevelopment.Allconstructionwasmodern, differentfromthehomesandbuildingsinJena.Gazilikedwhathesaw. Forhoursthatmorninghewentdoortodooraskingifanyonehadaroom forrent,attractingbemusedlooksashewent.Finallyhefoundawoman withspacetorent,FrauSchnaufert,wifeofaZeissCompanyengineer. Like the couple in Naumburg, the Schnauferts had no children. ImmediatelytheyrecognizedGazi’svulnerability,hissingle-mindedness, insomewayshisnaivité,andaboveallhiscompellingneedforfriendship andfamily.LiketheNaumburgcouple,theytookhiminandtreatedhim asason.WithinaweekHerrSchnaufertfoundhimanoldmicroscopeat theZeissplantforhisworkinhistology.Gazihadalaboratoryinhisown bedroom. MostofhisfellowstudentswereGermansoldiersconvalescingfrom woundsinflictedatthefront—eyeinjuries,chestwounds,abdominaland extremity wounds. There were perhaps two hundred such part-time students.Withfewexceptions,onlythewomenstudentswerehealthy. Young men with war wounds received priority. People with medical trainingwereurgentlyneeded,particularlydoctors’assistants,nurses,and nursingassistants.Thosewhoqualified,bypassingperiodicexaminations andnotbeingphysicallyfitforthefrontlines,wereassignedtoafield hospital. Gazi was the only healthy man in his class. Some of his classmatesweretoosicktostudy,particularlyinwinterbecauseofthe drafty,unheatedclassroomsandlaboratories. AlthoughmanyoftheGermanstudentsavoidedhimsocially,Gazi didmakesomefriends.OneinparticularwasahighlydecoratedU-boat commanderwhohadbeencapturedbytheEnglish.Duringcaptivityhe wasallowedtostudyatOxford,andtheexperienceseemedtoleavehim psychologically different from the other Germans. Eventually he was returnedtoGermanyinexchangeforacapturedEnglishspy.Hekeptone sideofhisfacehiddenbeneathaclothveil.Shrapnelhaddestroyedhis

entirecheek,exposinghismaxillarysinus,theinsideofhismouth,his teeth,andhistongue.Onlytheclothmaintainedtheillusionofanintact face.Reconstructionofhismid-facewouldchallengeeventhemostskilled plastic surgeon today, but reconstructive surgery was unheard of in wartimeGermany.Thismanwashardlytwenty-sevenyearsold,buthe was a man of substance and integrity. He carried himself with great dignity.HehadestablishedabrilliantcareerintheKriegsmarine,andhad beenawardedaRitterkreuz(Knight’sCross),hiscountry’shighestmedal forvalor.HewasaherotoallGermans.Butthewarwasoverforhim;he wasadefeatedman,nowmarkedwithahideousdeformity.Butayoung womanwasdevotedtohim.Theyhadjustmarried.Gaziwasdrawntothe submarinecommanderandadmiredhim.Hesawhimasagentle,caring person, with a liberal outlook. Gazi had the impression that the commanderwasembarrassedbytheNazis.Hisfacialwoundmadehim especiallysensitivetocoldsoGazisawtoitthathespentabsolutelyno timemorethannecessaryindraftylecturehallsandlabs.Hesharedhis classnotesandalsoperformedhisfriend’sanatomicaldissections. OneeveningGaziaccompaniedthecommandertothehomeofa chemistryprofessor.Hehadvisitedthefamiliesofsomeofthenursesin NaumburgandhadfrequentdiscussionswiththeSchnauferts,butnever beforehadhesocializedwithamemberofthefaculty.Thatnighthewas primarily a listener, and many details of what was said escaped him becausehisconversationalGermanstillhadlimitations.Antibioticswere discussed. Alexander Fleming had discovered penicillin fifteen years earlier,andHowardFloreyandhisgroupatOxfordhadbeguntoisolateit in reasonably pure quantities immediately before the war. Gazi’s host predicted the Allies would gain access to it very soon, but not the Germans. Neither the professor nor Gazi’s friend doubted that the war was drawing to a close. The U-boat commander was informed that the

Americans were nearing the construction of a very special bomb, one capable of destroying entire cities. It was a mind-boggling idea, one soakedinirony.TheprojectrequiredresourcesthatonlyAmericahad, including Jewish physicists who had escaped the Nazis. Germany had exhausteditsresources.Ithadbeenreducedtotrainingbattlecasualtiesto becomecombatmedics.TherumorthattheNaziswereamassingamighty summeroffensiveseemedlaughable. GazihadavoidedconversationswithGermansaboutweaponsbefore, buthehadbecomesocomfortablethateveningthatheposedaquestion aboutrumorshehadheardaboutGermanrocketsandfirebombs.Atthat pointhishostandhisfriendbrokeoffthediscussionaltogether.Allied spieswerepresumedtobeeverywhere.Everyforeignerwassuspect. Gazibecameclosetohisanatomyteacher,ProfessorvonVolkmann, great-grandsonofthegreatnineteenth-centuryanatomistknowntoevery modern medical student for his work on the microscopic anatomy of compactbone.Volkmannwasanengagingman,talkative,eagerlywilling tospendtimewithaseriousstudent.ButhewasalsoacommittedNazi, fanaticalinhisviews.Allhissonshadbeenmedicalstudentswhenthey were conscripted into the army and sent to the front. Gazi was with Volkmannthedayhewasinformedthatallthreehadbeenkilled.From thatdayforwardGazibecamemoreorlessasontoVolkmann. ButVolkmann’sviewswerefarfrompalatabletohim.Hissons’ deaths hardened him further, his political views becoming even more inflexible,trulydisgusting—hewasazealotofthefirstorder,onebenton revenge.Hemarchedintotheclassroomeachmorninginabrownuniform, greeting the class with a stiff-armed Nazi salute and a shouted “Heil, Hitler!”Hebeganeachlecturewithaten-minuteresuméofthewarnews, outliningeachpublicizedorrumoredGermanadvance,praisingthevaliant Nazisoldiers,predictingvictory,longlife,andworlddominanceforthe ThirdReich.

Volkmann’sspeecheshardlyfellonsympatheticears.Hisstudents knewtruthsaboutwartheirprofessorcouldnotfathom—theterror,the suffering,theutterfutilityofitall.TheysecretlyprayedVolkmannwould cutshorthispoliticalharangueandgetonwithhislecture.Butnoonehad thecouragetocomplain. Gazi saw Volkmann’s remarks as crude, heartless, even stupid, particularlyhisviewsaboutJews.Hecouldn’tstomachhisprofessor’s blatantanti-Semitism.Manyofhisfather’sfriendswereJewswhohad

escapedtheravagesofHitlerinthe1930s.Toamantheyweregentle,

talentedpeople,wishingnoharmtoanyone.Persecutionofanyminority worried him. He himself was an Asian, currently living in a nation obsessedwithglorifyingtheAryanrace. ProfessorHarmes,hiszoologyprofessor,wasstrikinglydifferent.He was short and stout, with a heavy belly protruding over his belt. He possessedgreatvigorandhadasternface,seldomgracedbyasmile:a stereotypicalGermanvisage.Asmallbrowndachshundaccompaniedhim everywhere he went—it lay at its master’s feet as Harmes addressed studentsinthelecturehall.NotoncedidHarmesspeakofpolitics.Hewas the consummate academician, always striving to be above the war, ignoringitasmuchaspossible.Harmes’sworldviewwasawelcome relief from Volkmann’s. In a short time he recognized Gazi’s intense interestinanatomyandevolution,plushisgreatenergy.Harmesgavehim special access to the zoology institute, and the important exhibits of comparativeanatomycollectedbyHaeckelandGoetheondisplaythere. Evolution had been a prominent theme of Gazi’s thought as a teenager,datingtowhenheheardDarwin’stheoriesdebatedinhishome. ErnstHaeckel,acontemporaryofDarwin’sandanenthusiasticproponent ofhiswork,madeevolutionpopularinGermanyearlyinthetwentieth century. His study of animal and marine life in Jena led to his recapitulation theory (“ontogeny recapitulates phylogeny”). It remained

controversial for decades after his death in 1919. The idea that an organism’sbiologicaldevelopment(ontogeny)parallelsandsummarizes its species’ entire evolutionary development (phylogeny) stimulated Yasargil’simagination.CarefullyhepouredoverHaeckel’sdrawingsand paintingsoforganismsandembryosondisplayattheinstitute.Heonly wishedhisfathercouldbepresent. AnotherthemeofYasargil’slifewhichmaturedashegrewolderwas his appreciation of the details of human anatomy and their variations. Goethe’s animal skeletons were on display at the institute. They were accompanied by volumes of detailed notes and drawings, primarily concernedwiththeevolutionofthespine,inparticularhowtheskulland facialbonesevolvedfromthecephalicvertebraeofloweranimals.Gazi wasinstructedbyGoethe’scapacitytovisualizefunctioninanatomical details.HewasfascinatedtoothatGoethewasasmuchascientistashe wasaliteraryfigure,painter,andstatesman.Hehadspenthisentireadult lifeinWeimar,justwestofJena. WeimarwashomenotonlytoGoethebuttoSchillertoo,theBachs oftheearlyeighteenthcentury,andFranzLisztonehundredfortyyears later.GazivisitedthecityonaSundayafternoon.Hereveledinthesense oftheGermanromanticismthatwaskindledthere,amovementwhich ultimately came to Turkey by way of the English. Romanticism had dominatedhislifeasayoungsterinAnkara. ThoughtsofthewarwerefarbehindhimashefirstwenttoGoethe’s home.Heimaginedhimselfpayingapersonalvisittoagreatman,oneofa differenttime.Upawindingstaircasehesawpaintingsandsculptures, thenamodestlibrary,whichwasdevoidofbooksatthattimebutdid containasmallcollectionofminerals.AdjacenttothelibraryGoethe’s workroomwasstrikinglyaustere,withbarefloorboards,plainbluewalls, andsimplewoodenfurniture.Asmalldeskhadbeenplacedinfrontofthe

onlywindow,presumablyitslocation150yearsearlier.Itlookedontoa

well-tended garden. In the distance, at the rear of the garden, stood a separatesmallbuildingwhere,Gaziwastold,Goethehadcomposedhis famous botanical work, Metamorphose der Pflanzen (“An Attempt to ExplaintheMetamorphosisofPlants”).Theroomadjoiningthestudy,a bedroom,wasequallydour,withonlytwosimpletablesandasmallbed, coveredbyafadingquilt.Atinyruglayonbarefloorboardsinthecenter oftheroom.InviewofGoethe’sobviouswealthandfameneartheendof his life, Gazi was impressed by the lack of personal comfort he had allowedhimselfasheworked.Itwasalessonforhim.Dayslaterhebegan toreadGoethe’sfamoustragicplay,Faust. Franz Liszt’s home was hardly three hundred meters away. Gazi memorized the streets, the gardens, and the homes as he went, his imaginationstirringwildlywithinhim.Thatdayhealsovisitedthehome ofSchiller,soakingupimpressionsfromtheartifactsandhisrecollections ofthemythsoftheman.InWeimar,Schillerhadcomposedhisfamous poem,“AndieFreude”(“OdetoJoy”),whichBeethovenwouldlatersetto musicasthechoralmovementofhismightyNinthSymphony. NodoubtGazi’sexposuretothetimesandworksofHaeckel,Goethe, andSchillerplayedaroleinnourishinghisinterestnotonlyinclinical medicineandresearch,butalsoinliteratureandart. Whateverhispoliticalfaults,Volkmannwasanexcellentanatomist, andGazirecognizedthathisprofessor’sdevotiontohimamountedtoa greatopportunity.Hewascommittedtolearninggrossanatomy,attimes tothedetrimentofhisstudiesinphysiologyandchemistry.Virtuallythe onlyfullyable-bodiedstudentintheclass,hebecameVolkmann’sfull time student-assistant. Among his duties was to prepare an anatomical specimen each day to illustrate the professor’s lectures. He did the dissectionshimself,normallyworkinglateintotheevenings.Volkmann frequentlycamearoundtothedissectionroomtolookoverhisshoulder, offering advice and pointing out pearls of anatomy. Gazi ended up

dissectingnotonefullcadaverthatspringandfall,butthree!Inonlyafew monthshebecameanexpertinhumananatomy,notsomuchofthebrain and spinal cord—which required special preparation and were not emphasizedinVolkmann’scourse—butthemuscles,joints,extremities, chest,andabdomen.Hegainedapreciseknowledgeofeachstructure—the originandinsertionofeachmuscleandwhichnervesuppliedit,alsothe shape,size,andweightofeachbone,everyarteryandveinthroughoutthe body,pluseachknownvariationofeverystructure. ButGazicouldn’tresistofferingadissentingpoliticalview.“Surely the Germans will lose this war,” he said once. The comment troubled Volkmann. “You must be very careful,” he replied with a stern look. “Don’tgivethisviewtoanyoneelse.Itisnotsafeforyou.” On the afternoon of July 20, 1944, a few weeks after Gazi had returnedtoNaumburgforhissecondthreemonthsasanursingassistant,a bomb exploded in a staff conference held by Hitler, killing four and injuring two dozen. Assassination attempts had been rumored for two years,andfinallyonecameveryclosetosucceeding.Hitlerescapedwith onlyminorinjuries,buthisvengeancewasquickandsevere.Notonly wereconspiratorstorturedandexecutedwithintwoweeks,theirrelatives andfriendswereroundedupandsenttoconcentrationcamps,wheremany died.

NewsofHitler’srageandinsecurityspreadthroughoutGermanythat summerandearlyfall.Securitychecksweredoubledandtripledasevery foreigner,particularly,wassuspectedofbeingagravethreattotheReich. TheGestapomadeseventhousandarrestsandalmostfivethousanddeaths followed. 2 WhenhereturnedtoJenainOctober,Gazimetconstantreminders fromFrauSchnauferttobecautious.Shewasdesperateforhissafety. Oneeveningaharshknockingcameatthefrontdoor.Policewere outside. Frau Schnaufert was frantic. She was certain the Nazis had

discovered they were harboring a foreigner. Gazi was very frightened. BeforeSchnaufertopenedthedoor,heinstructedGazitostayquiet,tosay nothingtoanyone,tostayoutofwhateverhappenedasmuchaspossible. The police were gruff and rude, but they ignored Gazi, taking only Schnaufertwiththem. Schnaufertreturnedthenextday,late,atdusk,andwouldgiveonly sketchydetailsaboutwhathadhappenedtohim.ThelessGaziknewthe betterforhim.Schnauferthadbeenquestionedaboutcontactshemayhave hadwithpeopleinawoodedareanearby,betweenWeimarandJena.The Nazishadflushedoutaheadquartersforpoliticaldissidents,theJewish underground.Acommunistleaderhadescapedfromprisonandhadmade contactwiththem.Amassivemanhuntwasunderway.Latertheywould capturetheirquarryandputhimtodeath.InawayGaziwasrelieved.He felthehadbeeninnotruepersonaldanger,butitneverthelesswasa soberingexperience. TheSchnaufertscontinuedtoworryforhissafety.Dailytheywarned him.“Becarefulwhatyousay.Donotstateyouropinions.Ifyouthinkthe Germanswilllosethewar,keepittoyourself.”Theyfearedhewouldbe calledinanydayforquestioningbythepolice. Eventuallyhewas.Onlythistimethepolicewerefriendly,strikingly differentfromthoseattheSchnauferts’oronthetraintoNaumburgor whiletryingtoregisterattheuniversityinVienna.“Telluswhatyouare doing.”theyasked,smiling,seekingtoputhimatease.“Iamstudying anatomy, doing dissections daily. It is a good experience. I like my professors.Iwantverymuchtostayhereafterthewar.” Thencamethequestion,“Whodoyouthinkwillwinthewar?”Other thanhisuniformandtallblackboots,themanseemedinnocuous,almost fatherly.Certainlysuchamanwouldn’tsendanineteen-year-oldstudent toaconcentrationcamp.Gazismiledandrepliedsoftly,“Iamsureyou won’t.”Theofficeronlylookedathimsadlyandshookhishead.Laterhe

contactedHerrSchnaufertandwarnedhimtocounselGazinottovoicehis views. Afewweekslaterthestudentswereinvitedtoalargegatheringinthe garden at the university. They all came, the Germans plus some two hundredforeigners—studentsfromEgyptandtheArabcountries,some GreeksandTurks.Awoodendaishadbeenconstructed,andNaziflags waved in the breeze as martial music—horns, trombones, trumpets— rippedthroughthenightair.TallyounguniformedGermansandbeautiful blondegirlsstoodontheplatform.Thechancelloroftheschoolwasthe primaryspeaker.Hewasasmallman,withathinpatchofveryblackhair slickedagainsthishead.Hisnosewasmisshapen,largeandbulbous.It wasnotaGermannose.ThechancellorseemedtobeofFrenchorItalian descent.Hehadformerlybeenaprofessorofgeneticsbeforehebecamea committedNazi.AhighofficialfromWeimaraccompaniedhimonthe makeshiftplatform,alsoashortman,verythick,wearingastiffbrown uniform,trimmedinblack.Theentirefacultywasseatedbehindthem. Thechancellorgaveacharismaticspeech.Herantedandravedwith warnews.Thehomelandwasbeinginvaded,buttheFührer’sarmywould prevail.Hitlerwouldruletheworld,notwithstandingtheforcesaligned againsthim,includingthespiesanddissidentsamongthem.TheRussian army was now in Poland, preparing for the final onslaught. German defenseswerebeingdesignedandconstructed,buttheAsians(Russians) werecoming.PreparationsmustbemadetoprotectGermanhomes,to savethechildrenandthewomenfromrapeandpillageby“theAsiatic hordes!” Gazi resented the European stereotype of Turks as warriors, as membersofbarbaroustribes,rapingandwreakingdestructionwherever theywent.Turksstruggledtolivedowncertainaspectsoftheirheritage, descendentsofthevaststeppesofCentralAsiaalongwithAttilaandthe Huns,GenghisKhanandtheMongols,TamerlaneandtheGoldenHorde,

andmorerecentlytheOttomanarmies. Forthefirsttimehefeltnotonlyanti-Nazi,hewassuddenlyand intenselyanti-European.Butwhatcouldhedo?Stealtheirflags?Fight them?Hehadbeeneagertoattendtherally,curiousaboutwhatwould takeplace.Seatedinthefrontrowofstudents,hewasstunnedwhenthe plea was voiced for all foreigners to join in the war effort—German citizenshipwouldfollow,freestudyattheuniversity,aguaranteedplacein theneworder.Allwereencouragedtoenlistinthearmy,evenintheSS,to fightofftheAsianbarbarians. Somethingsnappedinsidehim.HiseyesnarrowedonVolkmannin thefrontrowofhisteachers.HewasresplendentinhisNaziuniform. SuddenlyGaziwasonhisfeet,onehandstretchedhighoverhishead. “Professor,”hescreamed.“Whataboutme?IamnotEuropean.Iaman Asian!Whatwillyoudowithpeoplelikeme?” Hisvoicewaslikearifleshotinthecrowd.Firstafewcriesrangout, thenangryshouts,finallyadeafeningroarwentuparoundhimandfurious looksfocuseddownonhimfromthedais.Heyearnedforaholetocrawl into.

LaterthatnightaworriedProfessorHarmessummonedhimtohis home.Hestruggledtoputasidehisanger.“Areyoucrazy?Haveyoulost yourmind?Youhavenopowerhere,nofreedomtospeakyourmind. Thesepeoplewillhaveyoushot!Cometoyoursenses,forGod’ssake!” Harmesbroughthimbacktoreality.ForthenextfewweeksGazi stuckstrictlytohisdutiesattheanatomyinstitute,hardlyspeakingto anyoneasHarmesdidwhathecouldtoquellthesentimentagainsthim. Eventuallythematterblewover.Theorganizersoftherallyultimately realizedtheirerror,theirinsensitivity.SomeSyrianandEgyptianstudents hadalsocomplained.Insomewaystherallyhadbeenafiascoforthelocal Germans.Foreignstudentshadmeantthemnoharm.Theywereonlythere to study. To them Germany was only for their enlightenment, nothing

more.HowcouldanyoneexpectthemtotakeuptheGermanpolitical cause?

JenadidnotescapeAlliedbombingduringthesummerof1944.The

airraidscamemorefrequently.Nooneignoredthelowwailofthesiren, thealarmtotakecover.Nooneremainedconfidenttheinflatedfishwould savehim.ForthefirsttimeAlliedbomberscameatnight.OnceGazifled withotherstothehugeundergroundbunkerconstructedinthecenterof thecity.Itprovedtobeaterribleexperience.Thousandsgathered,creating intensely crowded, cramped conditions. Ventilation was adequate, but therewasnolight.Therewasnowaytoread,topassthetime,andthe“all clear”wasnotsoundedfortwohoursafterthebombershadpassed.For thefirsttimeinhislifeGaziexperiencedrealclaustrophobia.Hehadtoo muchenergytositquietlyandstareintodarknessforhours.Henever returned to the bunker when the air raid alarm sounded in the future, choosinginsteadtogooutintothecountrysideorlieagainstaninterior wallonthegroundflooroftheanatomyinstitute. Asstudents,theydideverythingtheycouldtoputthewarbehind them. This was especially difficult for the soldiers among them, who understoodtheywouldbereturningtothefront.Beyondtheairraidsand Volkmann’s daily political tirades, Jena and its environs remained essentiallypeaceful.Studentsrarelydiscussedthewar,onlytheirstudies, the problems of anatomy and physiology. They were bound by the commongoaltolearn,inordertoamounttosomething. Gaziwasbefriendedbyaninfantryman.Erichhadbeeninjuredinthe Russiancampaign,achestwound.Aquietandcompassionateyoungman, heandGazistudiedtogetherandswappedstoriesfromtheirchildhoods. RarelywouldErichspeakofthewar,andonlythentomentionthecruelty hehadwitnessed,theterrorhehadfelt.Followinganexaminationone afternoon,heinvitedGaziandseveralotherstocelebratetogetherover dinnerataquaintlittlerestaurantintheheartofthecity.

Gazithoughtaboutgoingbutdecidedagainstit.Afterthenastinesshe hadencounteredattheuniversityrally,hewasmorewarythaneverof groupactivities.Whatgoodcouldcomefromitanyway,apartywithhis friends?Drinkingandtellingjokesseemedamindlesswasteoftime.He hadnotimeforsuchactivities.Hepreferredbeingalone.Itwashisnature. Hehadvastamountsofenergy,butonbalancehewasaseriousyoung man. For him, socializing was best accomplished in quiet, one-on-one conversation. InsteadofgoingoutwithErichandhisfriends,hewentbacktothe anatomyinstituteforafewhours,thenwanderedaimlesslythroughthe universitygroundsalongtheSaale.Hedidn’tseeasoul,and,finally,he startedhome.FrauSchnauferthadafearofhiswalkinghomeafterdark, but it was a clear night and he looked forward to the stroll. He felt perfectlysafe. TheAlliedbomberscamearoundeleveno’clock.Gaziwasbarely outsidethecity,andwentdownonhishandsandkneeswiththefirst explosion,thenwatchedasthebombsrockedJena,shakingthegroundand lightingupthenightsky.Trembling,hewasawareofhisheartthudding insidehischest.Thedestruction,thepowerofitall,lefthimhelpless.The balloons—thoseswollen,flyingfish!Wherewerethey?Puttingthemup nowwouldhavebeenuseless.Whocouldseetheminthedarkfromfive thousandfeet? When he returned to Jena the following day, he found that the restaurantwherehisfriendshadgatheredhadbeenreducedtorubble.Only asinglewallandareardoorframeremainedstanding.Erichandtheothers weredead.Everyoneofthem.Theanatomyinstitutewherehehadbeen thenightbeforewasseverelydamaged,alsothechurchnearby. Thetopflooroftheanatomyinstitutewasinchaos—brokenglass, fallenplaster,andoverturnedfurniturethroughout.TheGoetheskeletal

collection,theuniversity’ssignalheirloom,wasinshambles,150-year-old

bones strewn from shattered exhibition cases. A crowd milled about outside,murmuringinshockedtones.Thebuildinghadnottakenadirect hit,buttheblasthadblownouteverysinglewindow.Debrislitteredevery room,anddustfromplasterandinsulationcoveredeverything.Thelibrary downstairswasalsodestroyed,booksthrownthroughwindowsontothe lawnandstreet. Gaziandthecuratorwenttoworkthatverymorning,beginninginthe library. Systematically they removed debris, swept floors, and washed down walls. Eventually they collected and repaired the books and reassembledthebookshelves.ThentheytackledtheGoethecollection. Whathadseemedanimpossibletaskattheoutsetgraduallytookshape, andwithinfiveweekstheyhadrestoredtheanatomicalcollectionand madethelibraryfunctionalagain.ForhiseffortsGaziwasawardedthe HamburgPrize:fivehundredmarkscash,plusfreemedicaleducationfor aslongasheliked!Thethree-monthstintsinNaumburgwerenolonger necessary.Forthefirsttimeinhislifehefeltrich.

December1944wasbitterlycold,withdailytemperaturesranging

from the teens (or below) to the low forties. On the same latitude as southern Canada, Germans saw hardly eight hours’ daylight in winter. Therewerenoresourcestorepairthebrokenwindowsoftheanatomy institute. Dissecting on stone tables in the huge hall—it was nearly a hundredfeetlong,housingtwodozendissectionstations—Gaziworea heavyjacketbeneathhislabcoatandwoolglovesandrubbergaloshes over his shoes. Such conditions prevented students with physical infirmities—virtuallytheentireclass—workinglongerthananhourortwo atastretch.Gaziperformedtheirlaboratoryexercisesforthem,dissecting morethantenarmsandlegs,andtheentirespinetwice.Hehadbeeninthe laboratory seven days a week and most nights since October. The experiencewasaGodsendforhim,andhethrivedonthework.Hewas happy.Itwasanopportunitytohonehisdissectionskillsandmasterthe

nuancesandvariationsofgrossanatomy. InJanuary,ProfessorHarmeshadbadnews.Afterheannouncedthe beginningofthepracticallaboratoryexercises,heinformedGazihewould notbeabletoparticipate.Onlyfiftymicroscopeswereavailable,certainly notenoughtogoaround.Woundedsoldierswouldhavepriority.Gazi realizedhewouldnotreceivecreditfortheanatomycourseifhedidn’t completethemicroscopic work.Harmespromised todoeverything he couldtoprovideamicroscopeforhimthefollowingsemester,butthatwas thebestsolutionhecouldoffer.GazihadHerrSchnaufert’smicroscope foruseathome.Itcouldnotbetakentothemedicalschool.Evenifhe obtainedpermissiontouseitinthelaboratory,Harmeswouldberequired toassignittooneofthesoldiers.Missingthe“practicals”wouldpose consequencesforhimlater.

---

FornearlysixyearstheTurkishpresident,IsmetInönü,hadtroddena finelinetokeeptherepublicneutral.TheFriendshipandNon-Aggression

TreatyAtatürkhadsignedwiththeRussiansin1925remainedvalid,but

InönücouldhardlyaffordtobreaktieswithBerlin.Turkshadreliedon tradewiththeGermansfromtheearlydaysoftherepublic,andtheAnkara press contributed to mounting pressure for Turkey to join forces with

Hitler.In1942Turkeyhadriskedthecredibilityofits“neutrality”by

agreeing to send forty-five thousand tons of chrome to the Krupps armamentfactoriesinGermany. NooneinAnkaracouldimaginetheSovietsasallies.Turkshad

alwayssuspectedthemotivesofRussians.ButinNovember1943,when

RooseveltsuggestedtoChurchillinTehranthat“alargelandmass”such astheUSSR“deservedaccesstowarmwaterports,”Turkeyrealizedit must finally side with the Allies. If they did not make a tangible

contributiontothewarsoon,theywouldleavethemselvesvulnerableto RussiandesignsontheBosphorusandtheDardanelleswhentheAllies parceledoutthespoilsofvictory. 3 Turkeycouldnotcedethatpowerto Russia.

ByApril1944,theThirdReich’sfalteringwarmachineleftTurkey

nooptionbuttostopitsshipmentsofchrometoGermany.Butevensix weekslaterTurkey’sintentionswerenotentirelyclear.InJunetheAllies complained of Inönü’s allowing German warships passage through the Straits,leavingthepresidentlittlealternativebuttodischargehisforeign minister. For months Numan MenemencioÄŸlu had been perceived as pro-German. 4 Butsacrificinghimwasnotenough.Turkeymustclarifyits positionbeyondalldoubt.Thefightingwasvirtuallyover,andGermany wasadefeatednation.IfTurkeyweretobeamongthefoundingmembers oftheUnitedNations,itmustjointheAllies.Inönü’sgovernmentdeclared

waronGermanyonFebruary21,1945.

A few weeks earlier, Gazi received a four-line telegram from the TurkishconsulateinHamburgannouncingTurkey’sintentiontoenterthe war. It advised all Turkish nationals, including nearly three hundred students,toleaveGermanyatonce.Hewasshockedashere-examinedthe envelope. It had been delivered by German post. How careless! The GermansdidnotyetknowthatTurkeywouldnolongerbeneutral. Gazi faced two choices. He could either try to go north by train throughHamburgtoKielandtheNorthSeaforashiptoTurkey,orhe couldtakehischancesthroughsouthernGermanytoSwitzerland.Taking the direct route (through Vienna and on down through the Balkans, reversingtheroutehehadtakenbyairfifteenmonthsearlier)wasnotan option.NowtheRussiansoccupiedRomaniaandHungary.Leavingby shipwouldcarrygreatrisk.HewouldhavetosailaroundDenmark,then downthroughtheEnglishChannel.Thefightinghadbeenintensethere onlymonthsearlier.Buthehadtogoquickly.Soonhewouldnolongerbe

protectedbyTurkey’sneutralstatus. Not only was there no guarantee Switzerland would accept him, living there would be expensive. Since Turkey had maintained good relations with Berlin throughout the war, the Turkish lira consistently exchangedoneforonewiththeGermanmark.Thesamewasnottruein Switzerland,wheretheSwissfranksoldformorethanfourTurkishlira, thedollarfivetimesthat,andtheBritishpoundgoingforevenmore. GoingtoSwitzerlandseemedoutofthequestion.Gazihadnoknowledge ofhisfamily’sfinancesinAnkara,butheknewhecouldn’taskthemfor help.

Yet,hishearttoldhimtogotoSwitzerland.Heremainedcommitted

tostudyingintheWest.Somehowhewouldmakeit.Hehadto.

CHAPTERSEVEN

Escapeto

Switzerland

INFEBRUARY1945GEORGEPATTON’SThirdArmygearedup

tobeattheRussianstoBerlin.SoonroaringuptheSalle,Pattonwould reachJenaaheadofschedule.Butitwouldprovetobeahollowgain. Roosevelt, Churchill and Stalin had determined at Yalta to allow the SovietstotakeBerlin. GaziYasargilfacedrealperil.WiththeRussiansandtheAmericans convergingontheWeimar-Leipzig-JenatriangleandtheGermanmilitary intheareastrugglingtoreorganizeintopositionsfromwhichtomounta defense, travel in eastern Germany was chaotic at best. To escape the cominghostilities,thousandsofimpoverishedandhomelessGermanstook tothehighways,manyonfoot.Gazi,nolongerprotectedbyTurkey’s

neutralstatus,had240milestocoverforthesafetyofSwitzerland,and

preciouslittletimeforthejourney.

HisU-boatcommanderfriendaccompaniedhimtotherailwaystation

infullmilitaryuniform,theRitterkreuzathisthroat,itsdiamondgleaming

inthesun.Hiswifecamewithhim.Gazi’sleavingonaciviliantrain

wouldhavebeenalongshotattheverybest.Fewseatswereavailable,

andthosethatwerewenttothewell-connected,oftentothehighestbidder.

WiththeAlliescoming,localfamiliesfledtheareaanywaytheycould.

TohaveaccesstoatrooptrainwasahugeadvantageforGazi.Inavery

realsensehecouldowehislifetohisfriend,thesubmarine-commander

hero.

Afterspeakingwiththerankingofficeratthedepot,thecommander securedhimaseatonamilitarytrainboundforNuremberg,whereGazi wastoboardatraintothearmy’strainingfacilityatWeingarten,atthe Swissborder. Wearing a pair of wooden shoes, he stowed the old suitcase the Schnaufertshadgivenhimaboveaseatintheleadcar.Hesharedthe compartmentwithfourGermanofficersinpresseduniformsandfreshly

polished boots. He couldn’t help noticing the rugged, stern-faced men outsidewhoweresupervisingtheboardingofenlistedmenintothecarsto therear.Theiruniformsshowednodesignationofrankornationality.Gazi subsequently discovered that they were Russians, members of the infamousghostunit,the“RussianLiberationArmy,”whoseideological “commander,”GeneralAndreiVlasov,hadsurrenderedtotheGermansat Leningrad when his troops faced certain slaughter. Vlasov’s Army consistedofmorethanfivehundredthousandRussiandefectors,manyof whomoptedtoserveinvariouscapacitiesfortheGermanwareffortafter

1942. 1 , 2 WithRussiansassignedtoguardtrooptrains,generallyoneper

car,noGermansoldierwouldbetemptedtoescapehisduty. Onlyafewminutesoutofthestation,atruculentGerman,therank insigniaofmajoronhiscollar,engagedGaziinconversation.Soonthe officerburstoutlaughing.“ThisguyAtatürk,yourleader,yourformer president,”hislipssnarlinginderisionashespoke,“madeaverystupid statement, one I’ve never understood until this very moment.” Gazi trembledastheGermancontinued.“Heinstructedyourcountrymentosay, ‘IamaTurk,thereforeIamproud.’”WhatcouldGazisay?Howcouldan arrogantNazinotunderstandthepsychologyofinstillingnationalismin theheartsofcitizensofafledglingrepublic?SomanyoftheGerman soldiersGazihadmetwereimbuedwithmorepridethansense.“ButnowI understandperfectly,”theofficerwenton,hisstainedteethbaredinironic

laughter.“IamaGermangoingtothefronttofight.But,youareaTurk,

goingtoSwitzerlandtostudy!YoupeoplearedifferentfromusGermans.”

Theothersjoinedthesnarlingmaninlaughter.Itechoedoffthewallsfor

longseconds.

AtNurembergthetrainwentwest,andGaziwasplacedonasouth-

boundtrain.BecauseofpaperworkinitiatedbytheU-boatcommanderin Jena,anofficerinNurembergpromptlysecuredhispassage,buthewasno longertotravelfirstclass.Hewasthrustamongsoldiers,enlistedmen,ina boxcarnormallyusedtotransportfreightandlivestock.Thefloorand wallswereroughandgrimy,andtheplacehadadank,barnyardsmell, unmistakablyofcattle,sweat,andhumanfilth.Remnantsofhaywere strewnonthefloor.Unshavensoldiers,theiruniformsrumpledanddirty, manyhungry,huddledonthefloor,somesleeping.Thesergeantincharge hadorderstoseethathegottoWeingartenunmolested,butGazihad seriousquestionsaboutthestateofdisciplineamongthesemen. Afterafewmilesoneofthesleepingsoldiersawakenedandgapedat him in anger. “Who are you? What are you doing here?” The soldier pickedupGazi’smakeshiftluggageandslammeditintoawall.Theflimsy latchbrokeandhispreciousanatomybookstumbledtothefloor.The Germansroaredinlaughter.“Books?Howdoyoufightwithbooks?” “Leave the boy alone,” snapped the sergeant. “He is to go to Weingarten.Ihaveorders!”ButGaziwasveryafraid.Possiblynoharm wouldcometohim,buttheywereapetulantlot,possessedoflittlesense ofreasonorhumanity.Andhewouldbewiththemforhours.Hurriedlyhe gathereduphisbooksanddesperatelytriedtorepairthesuitcase. Slowlythetrainwounditswaysouthward,stoppingeverytwentyor thirtyminutes.Thefirstfifteenmilestookovertwohours.Bymidnight

theyarrivedatNeu-Ulm(foundedin1811),thesmalltownacrossthe

DanubefromtheimperialcityofUlm.Toproceedfarthersouthwould

requirechangingtrainsonceagain,andpassengerstoWeingartenwould

needtodisembarkfromadifferentstation,theHauptbahnhoff(maintrain station)intheoldcity. Itwasverycold,andonlythemoonlitthenarrow,winding,deserted streets.WithoneofthesoldiersGazistruckoutfromthe“new”train station(asitwascalledbythelocals)insearchofUlm’smainstation,both leavingtheirgearunguardedbesidethetracks.Everyonefacedthesame plight. Even the thieves among them were oriented primarily toward findingsafety,tostayalive.Theirshabbybaggageofcheapclothingand, inGazi’scase,books,wasperfectlysafe. Nearlyeverybuildingwasinruin,destroyedbybombs.Onlytheold

cathedral,theMinster(constructionbeginningin1392)seemedintact.It

wasthelargestGothicchurchinGermany.Themajesticsteeple,rising morethanfivehundredfeetintotheicynight,hadbeenthetallestchurch

spireinEuropeatthetimeitsconstructionwascompletedinthe1880s.It

wasvisiblefrommilesaround,hoveringoverthemlikeagiantghost,a lastingsymbolofthevisionandstrivingofman.AlthoughYasargilwas notawareofitatthetime,anotherhistoriclandmarklaywithinafew hundred yards of the main station, a four-story building at 20 Bahnhofstrasse, where a tributary of the river Blau flowed beside the street,changingdirectionbeforeitreachedthecathedral,pouringintothe Danube. 3 ThebuildingrecentlyhadbeenlaidtowastebyAlliedbombs. Sixty-fouryearsearlierithadbeenthebirthplaceofthemostimportant mathematician-physicist to grace the planet for three hundred years, arguablythegreatestscientistofanytime,AlbertEinstein.Alsounknown toYasargilthen,hispathwouldultimatelyparallelEinstein’stoZurich, whereEinstein’stheories ofrelativityhad beenworkedoutthirty-nine yearspreviouslyandintroducedtotheworld. Yasargil and the German soldier found the main station’s ancient terminalinshambles,itsroofcavedin.Refugeeshuddledaroundasmall fire near the tracks. One greeted Gazi in Turkish. Others, grimy and

disheveled,smiledwhenheresponded.Therewereperhapstwodozenof them,studentsmainly,mostlyTurksbutafewGreeksamongthem,men andwomen.Warminimizedethnicdifferences.TurksandGreeksmight notspeakinthestreetbackinTurkey,butbeinghereamongtheGermans theywerealmostfriends. TheGermanstoodinthebackgroundwhileGaziandhiscountrymen comparedcircumstances.Theothershadcomefromdifferentdirections. Ulmwasthefinalmeetingpointbeforeembarkingfortheirdestination south.GaziandtheGermansoldierexchangedstrainedgrinsasoneofthe refugeesdirectedthemtotwoluggagecartsnearthefallenterminal.One was worthless, its rear axle broken, but the other seemed serviceable enough.Atleastitswoodenwheelsremainedintactandstoodinapparent alignment.TogetherGaziandtheGermannavigatedthewindingtwo-mile routebacktothe“new”stationfortheirbelongings.Arrivingagainatthe “main”stationwithhisluggageoveranhourlater,Gaziwasexhausted andsweatingdespitethecold.Hisshirtclungtohisbackandchest.Hehad madethetrekthreetimes. Asachildhisgrandmotherhadwarnedhimoftheriskofcatchinga cold,evenpneumonia,ifhecooledofftooquickly.Butwhatcouldhedo? Thefirewassmall,andthegroupofrefugeeslarge.Hehadnochangeof clothes. Grimly he opened a textbook, and began tearing out pages, selectingthemcarefully,onebyoneslippingthembeneathhisshirtand downhispants,lininghistorsoandlimbs.Hewasveryafraid. Butbymorninghewasfine—stillcoldbutdryagainwithnosignof illness.Finallyheremovedthecrinkledpagesandsmoothedthemoutflat, thenreplacedthem,onebyone,inthebook. Aftertwoandahalfdays(normaltraveltimewaslessthansixhours), he arrived at the military camp in Weingarten. The German army’s training facility consisted of barracks for three thousand troops. Approximately 150 foreign students would be interned there until the

Swissgovernmentagreedtoprocesstheircredentials.Withtwentyothers Gaziwasassignedtoalong,narrowroomonthesecondfloorofoneofthe buildings,the“Rommelroom,”asherememberedit.Theywereprovided threemealsdailyandwerepermittedtoleavethecampinthemorningsfor exercise.EachmorningtheGermansmarchedintothehillstodigtrenches in anticipation of an assault by the French, whose cannon fire echoed continuallyinthedistance.Curfewwasfiveo’clock,almostanhourpast nightfall. TheancientcityofRavensburgwaswithinwalkingdistance.Gazi andhiscomradeschosetoexploreitimmediately.Hardlytenmilesfrom theborder,itwasacleanandbeautifulhometothirtythousand,apopular destinationfortouristsbeforethewar.Thetownhall,agothicstructure datingfromthefourteenthcentury,stoodinthecenterofthecity,and fartherdowntheMarienplatzwastheoldKornhauswheregrainhadbeen

tradedforoverahundredyearspriorto1700.Diagonallyacrossthestreet

was a huge baroque church, which was said to have once housed a Carmelitemonastery. Gazi found it incredible that townspeople, mostly older Germans, retired people, lunched in restaurants as though the war did not exist. Therewerenosignsofdestructionanywhere.Heandhisfriendswere welcomedtojointhelocalsataquaintestablishmentonasidestreet.A smallensembleofstringinstrumentsprovidedmusicinthebackground. OntheseconddaythreeofficialscamefromSwitzerlandandmet withdelegateselectedbythegrouptodiscusstheprocessofimmigration. The students would be accepted as a group, but each was required to provide valid identification and proof of financial independence. Since theyweretobeprocessedinalphabeticalorder,Gaziwouldhaveperhaps aweektowait. Mostdayshebidedhistimebetweenmealswithhisbooks,leisurely reading,orgettingtoknowtheothers.Someofthegroupwereolder:

several university professors, even a few medical doctors, and businessmenofapparentacumen.Eachcarriedhislife’ssavingswithhim. Oneortwobarteredwiththelocalfarmersforaturkeysomedays,orfresh eggs. Communal dinners were frequent, prepared by the expert cooks amongthem.Onenighttheyinvitedthecamp’scommandant,ageneral, andotherGermanofficerstooneoftheirparties.Totheirsurprisethe Germansaccepted!Afeastwasafeast!AndtheGermansseemedtoenjoy gettingtoknowthem.Manyofthesoldiersexpressedenvyofanybody goingtoSwitzerland. GazibefriendedaTurkishmedicaldoctorwhohadbeenpracticingin Mainz,ageneralsurgeon.Theywalkedtogetherinthecountrysideone entiremorning,surveyingfarmlandandlivestock,thedoctoralwaysonthe lookoutforafreshfoodbargain.Theyhadcouponsformilitaryrationsbut meat and cheese were rarely served. The doctor ended up trading his wintercoatforagoose!Springwascoming,butitwasstillverycold.Yet thedoctordidnotseehispurchaseasasacrifice.Thefarmerthrewina loafofbreadasanactofcharity.Gazifounditastrangeexistence,notso badinsomeways,butherealizedthatthelifeofabeggarwasnowayto live.

Intheafternoontheymetanotherfarmer,ayoungman,whomthey greeted in German. But the man, in his mid-twenties, responded in Turkish.Gaziandthedoctorwereoverjoyedtomeetafellowcountryman, and enthusiastic embraces and kisses on cheeks followed. The young farmeridentifiedhimselfasArmenian.ArmeniansandTurkshadbeenat oddsforgenerations(AppendixA),buteachwaswillingtooverlookfeuds going on since well before their birth. Furthermore, in contrast to the GreekrefugeeshehadmetatthetrainstationinUlm,thismanwasalone. HeandYasargilbothwerealone.Ineachtheysawsomethingextremely important:someonefromhome. ArmeniansandGreekssharedasimilarculturewithTurks.Theyhad

beenraisedwiththesamemythsandhadsimilartastesinfoodandmusic. Therewasmuchtotalkabout.Thefarmer’sfamilyhadfledTurkeyin 1920. His father had recognized that there was little hope for an independentArmenianstateastheAllieshadpromisedafterWorldWarI. Hesensedthatonlymoretroublewouldfollow.Thefarmer,virtuallya

toddlerbefore1920,hadnopersonalknowledgeofthestrifeineastern

Anatolia,onlythevenomouscommentsofhisparents.Thesamewastrue forGazi.Buttheyrecognizedthattheyhadmoreincommonthannot.The farmer’s family had moved to France, settling in Marseilles where his fatherhadoperatedanautomobilerepairshopbeforebeingcapturedbythe

Germansin1943asamemberoftheResistance.Theyoungmanhadleft

his family, seeking his own way in the world, drifting north, finally settlingonafarmoutsideofRavensburg.Theownerofthefarmandhis entirefamilywereaway,leavinghistophand,theyoungman,incharge. HeinvitedGaziandthedoctortostayforlunch. Wellintotheafternoontheycomparedtheirchildhoodexperiences anddreamsforthefuture.ItwasawonderfultimeforGazi.Whenthey parted,hetookdowntheyoungman’sfamilyaddressinMarseilles,fully intendingtovisithimwhenthewarwasover. Theyreturnedtothecamplate,wellbeyondcurfew,andtherewas alsotheproblemofthegoose.Therewasnowaytheycouldhideit.But the doctor convinced the guard to let them in. As elaborate as his colleague’sargumentswere,Gazisuspecteditwasabribethatfinallydid thetrick. Another member of the group was a biochemist from Istanbul, a woman.Afteraweekshetookill—whetheritwasafeignedillnessornot wasneverclear.Inanycase,shewasallowedtocheckintoahotelin Ravensburgtoavoidthecrampedconditionsinthemilitarybarracks.The lastthingtheGermanswantedtohaveontheirhandswasanepidemic. Thegeneralsurgeonwentwithher,toministertoher.YearslaterYasargil

wouldquestionTurkishstudentscomingtoZurichaboutthebiochemisthe hadmetinRavensburg.ShehadreturnedtoIstanbulwheresheresumed her career as a vital member of the medical school faculty, working primarilywithfirst-yearstudents. Manyofthegroupwereengineers,fromtheFrankfurt-Mainzarea mostly,someofthemquitewealthy,carryingwiththemlargeamountsof cash.Therewasanightlypokergame,fiftyorsixtycrowdedarounda tableinaroomdensewithcigarettesmoke.Gazihadneverwitnesseda pokergamebefore, andhisattention wasraptas hewatched.A huge amountofmoneywaspiledinthecenterofthetable.EventheGermans participated.Afewmilitarypolicemenwereplayers,andanofficerortwo observedwithinterest,perhapstryingtofigurethepermutationsofthe gameandtheoddsofwinningthehugepots,whichattimes,accordingto Gazi’scalculations,approachedonehundredthousandmarks.Buthehad nointerestinchancingthelossofanyofhissavings.Hisnestegghad beenincreasedbyagiftofonehundredmarksfromtheSchnaufertswhen heleftJena,butheknewhemayhavetomakeitlastaverylongtime.The gamewentsofast,andtheplayerswereadept.Hemarveledathisfellow countrymen, many who were students like himself. Were they really playingwithblackmarketearningsfromthesaleofTurkishcoffeeand cigarettes?Theyseemedtoplayasthoughtheirmoneyhadnorealvalue. One of the Turks, particularly, was a businessman of the highest order.Chiefofthegroup’sdelegates,hewasglib,amasterofdebate. Whentheypreparedtocrosstheborder,headamantlyrefusedtoallowthe Germanofficialstoopenhisluggage.Relentlesslyhetwistedlogic,not abouttoyieldtothem.Othersinthegroupbecameuneasyforhissafety, andtheeffecthishagglingmighthaveontheirown.Theirprocessingwas heldupfornearlyanhour. FinallytheGermanofficialstiredofthedialogueandlettheman pass.OntheSwissside,customsagentsopenedhisbagsanddiscovered

thecompleteantiaircraftweaponhehaddisassembledandpackedamong hispersonalgear!

InearlyApril,safelyacrosstheborder,the150checkedintoahotel

inZurich,fiveandsixtoaroom.Theyweretogototheconsulatethe followingdaytobeginunravelingtheredtapestandingbetweenthemand visas.Againtheprocessingwouldbeinalphabeticalorder.Itwouldbe daysbeforeGazi’sturncame. Determinedtomakegooduseofhistime,heimmediatelywenttothe admissionsofficeattheUniversityofZurich.Heexplainedhehadstudied twosemestersinJenaandwishedtoapplyforadmissionasasecondyear medicalstudent.Atfirstthesecretarysaidnothing,onlyshuffledthrough thefileoftranscriptsGazihadgivenhim.Finallyhiseyebrowswentupas hefinishedgoingthroughthepapers.“Yousayyouactuallystudiedin Jena?Butawarisgoingonthere.Howcouldyouhavelearnedanything?” Gazihadnoresponse.Hestooduptoleave.Howcouldheproveanything hisdocumentshadn’t?Butthesecretarycouldnotignorethefactthatthis wasaveryseriousyoungman.HewentbacktoGazi’spapersandbegan togothroughthemasecondtime,sendingGazi’shopessoaring.Both Volkmann and Harmes had written letters of recommendation, and evidenceoftheHamburgPrizewasthere.Finallythesecretarylookedup again.“WhatwasyourLatinlevel?”heasked.“Doyouhaveabackground inLatinandGreek?”Gazipointedoutthathehadreceivedcreditforthree yearsofLatinattheAtatürkLisesiandexplainedwhyhehadnotstudied Greek.Hewouldnotresorttoemphasizingthathehadrankedfirstinhis classeverysingleyearinAnkara.Thatshouldhavebeenapparentfromhis documents. “Iamsorry,myfriend,”thesecretarysaidfinally,closingGazi’sfile asecondtimeandhandingitbacktohim.“Youarenotqualified.You needtwomoresemestersinLatinbeforewecanconsideryourapplication. Even then, though, you will have to start over, begin as a first year

student.” Gazi’s disappointment was devastating, but he knew he had no groundsonwhichtopresstheissue.“Allright,”hesaidsimply,andturned toleave.Arguingfromapositionofweaknesswasn’tinhim. Afterlookingatamap,hebookedhimselfonatraintoBasel,fifty milesaway.Hedidn’tknowthefirstthingabouttheplacethen,acityof over one hundred thousand, but he would find that it served as headquarters for four international pharmaceutical giants—Hoffman La Roche, Sandos, Geigy, and Ciba—and made up one of the oldest intellectual communities in Europe, a gathering of humanists. The

universityhadbeenfoundedin1459,beforethetimeofErasmus.Ithad

recentlyassembledafacultydedicatedtothesciencestocomplementits famedschoolsforthearts,divinity,law,andmedicine.Therewerealso excellentartmuseumsinBasel. Inthemorninghepresentedhimselfattheofficeofthedeanofthe medical school, a man named Schonbein, a professor of forensic pathology.Schonbein’ssecretarywaspleasantbutgrim.“Heisnothere,” sheinformedhim.“Hiswifediedtwodaysago,andheisattendingthe funeral.Youcannotseehimtoday.” Gazigroaned.Whatcouldhedo?Hecouldn’taffordasecondtrain tickettoreturnanotherday.Hecouldn’tresistaskingifthedeanwould returnintheafternoon. “Hewillbehere,buthe’scancelledallhisappointments.Youwill notbeabletoseehim.”Shegavehimanincredulouslook.Surelythis youngTurkcouldunderstandherboss’sgrief. “Willyouallowmetowaitforhim?”Gazihadnowishtointrudeon thedean’sgrief,buthewasdesperate.Finallythesecretarythrewupher hands.Shewouldlethimmakeafoolofhimselfifhewished.She’ddone allshecoulddo. Atmid-afternoonSchonbeinarrived.Hewasdressedinblackand

woreadolefulexpression.Gazispoketohimfromthedoorwayofhis office;therewasnowaythesecretarywouldintroducehim.“Sir,Iama Turkishstudent.IhavebeeninGermany.” Schonbeincockedaneyetowardhim,seemingtoshowahintof interest. “You’ve been living in Germany? Where?” Possibly the dean realizeditmightbegoodforhimtotalktoastranger,someoneunawareof hisgrief.Itmightprovidehimarespitefromhisthoughts.Possiblyhewas simplytoogentleapersontoberude. WhenGaziinformedhimhehadspentsixmonthsattheSchiller UniversityinJena,Schonbein’sinterestseemedtogrow.Hewantedto knowabouttheplace,whathadgoneonthereduringthewar,whatGazi hadwitnessed,whathehadlearned.HerecognizedthatGaziwasavery earnestyoungman,withnoorientationatalltowardtheNazis,positiveor negative, no political feelings whatsoever. Finally he asked to see his papers. “Allyoursciencecreditslookgood,”hesaidafterafewminutes.“I don’tseewhyyouwouldn’tbeabletocompetewiththemedicalstudents here,ifyoucanpasstheentranceexamination.Itisnextmonth.Butyou aremissingthelaboratoryworkinzoology.Thatisimportant.” Gazi explained about the microscope shortage in Jena, that only Germanstudentshadaccesstothem. Foralongtimethemansaidnothing.Gazi’shopesroseasitbecame clearthedeanwastakinghisrequestquiteseriously!Thecurrentsemester endedwithinafewweeks.Possiblyhewouldbeadmittedforthenext term.“Okay,”Schonbeinsaidfinally.“Iwillhelpyou.I’lltry,anyway.” Hepickedupthetelephone. The dean spoke with Professor Portmann, Adolph Portmann, a professorofanatomy. 4 “I have a Turkish student in my office who is interestedinstudyinghere.HewasinJenaforasemesterbutmissedhis laboratoryworkinzoology.Couldyoutakehiminyourlaboratorythis

summer, perhaps work something out?” There was a long pause as Portmannresponded. Thedeansmiledashehungup.“YouneedtotalktoPortmann.Ifyou arepreparedtotakeanexaminationinphysics,chemistry,andzoology nextmonthandcanarrangetomakeupthelaboratoryexerciseswithhim thissummer,wewillacceptyouintothesecondyearclass.” Gaziwasonhisfeetimmediately,hisheartpounding.“Iamready.I knowIcanpass.IwilldowhateverProfessorPortmannrequires.” “Butyoumustseehim.Heexpectsyoutoday,immediately.Go.” Apleasantsurpriseawaitedhim.WhenhemetProfessorPortmannin themedicalschoolcafeteriaanhourlater,hefoundthatvonVolkmann, hisanatomyprofessorinJena,wasPortmann’sbestfriendofyearsago. PortmannwasfullofquestionsabouthowVolkmannwas,hishealth,his professionalactivities,theconditionshehadfacedinJenaduringthewar. GazihadnotknownVolkmannonapersonallevel,buthewasableto relatethetragedyofhisthreesons’deathsduringthewar.Portmannwas visibly moved by the news. He had known Volkmann’s sons as

youngsters. Slowly Portmann explained his relationship to Volkmann. Volkmann had studied in Basel and had stayed on the faculty after

receivinghisdegree.Hisdarkside,thefactthathewasanavowedanti-

Semite,hadupsettheentirefacultyandendedupresultinginhisleaving Basel.AsHitlerrosetopowerinthethirties,Volkmann’senthusiasmover theviewsoftheNationalSocialistPartybecameanobsession.Hemadeno efforttokeephisideastohimself,andhisfriendswereunabletopersuade him that his beliefs were wrong-headed, immoral. Volkmann sincerely believedthatJewswereascourgeonsociety.Hehadbeenvocalabout howstupidhethoughttheBritishhadbeenwhentheyrejectedtheoverture

ofRudolphHess(DeputyFühreroftheGermanReich)tothemin1941to

formacoalitionwiththeGermansandtheRussianstoforcetheJewsfrom

Europe.VolkmannhadfoundnosympathizersinBaselandeventuallyleft,

joiningtheNazisinGermany.Portmannwasextremelyinterestedinwhat hadhappenedtohisoldfriend. Fornearlytwohourstheytalkedovertea.Therewereotherthingsto discuss. Portmann’s research interests centered on evolution. He had written extensively, having published over twenty books. That he was enthusiastic about the work of Darwin and Haeckel made Gazi very comfortable.Hehadheardtheirideasdiscussedsincechildhood.Portmann seemed eager to give him a chance. “If you pass the basic science examinationsinMay,Iwillgiveyouasummerjob.”Itwasset. Yet,backattheemigrationoffice,nothingwascertain.Fortunately, anoldfriendwouldcometohisrescue.GaziheardthatHasanAliYücel, Can’sfather,theTurkishministerofeducation,wasinZurichonofficial business.Hewenttohimathishotelandexplainedhiscircumstances.The MinisterwasonlytoodelightedtoironoutthedetailswiththeSwiss emigrationofficials,andpromisedtocarryGazi’sbestwishesandwordof hisgoodfortunebacktohisfatherinAnkara.Gazibegantofeelhewas livingacharmedlife.

CHAPTEREIGHT

SickBrains:

BeginningsinPsychiatry

GAZI PASSED THE EXAMINATIONS with flying colors and beganworkingforPortmanninJune,barelyamonthaftertheGermans surrendered to the Allies at Rheims. The laboratory was located in a fifteenth-centurystructureonthebanksoftheRhine,theoldestuniversity buildinginEurope.Itwasbeingconvertedintoafacilitydedicatedto zoology. Space was limited, but cutting edge research was being conductedthere. SinceHoffmanLaRochehadchargedPortmantostudytheeffectof pituitaryglandsecretionsondrugsinproduction,Gazi’sfirstassignment was to perform partial hypophysectomies in frogs. As a defense mechanismagainstpredators,frogshavetheabilitytochangetheirskin color.AsateenagerGazihadheardhisfatherandvisitorsinhishome discusssuchadaptations.Otherlowerformsoflifealsopossessedthistrait tosomeextent,specificallyfishandotherreptiles.Thechangeisbrought aboutbythestimulationofblackandyellowpigmentcellsinthefrog’s skin,asmediatedthroughthesecretionofintermedin,ahormoneproduced bythecellsofthepituitary’sparsintermedia.Inman,similartoother higher forms of life, with no need for such an adaptation, the pars

intermediaisrudimentaryinsize,consistingofapproximately2percentof

themassofthepituitarygland.Butinfrogstheparsintermediaismuch

largerbycomparison.Portmann’sprojectwastoexaminetheeffectof

various injected agents on the frog’s skin color in the absence of intermedinsecretion. In the frog the pituitary gland is pea-sized, the pars intermedia a crescent-shaped strip approximately one millimeter in thickness. Gazi recognizeditbyitscharacteristictextureandtheorientationofitsfibers. Thedistinctioncouldbemadeonlyunderthelowpowerobjectiveofa standardlightmicroscope,eventhennotasimpletasksincethecolorof adjacent tissue is identical to the pars anterior and pars posterior. Operating under a light microscope was nothing like the microneurosurgery he would pioneer twenty years later, but perhaps it plantedasubliminalidea,onetobeexploredlater.Gazithrewhimselfinto identifyingthisdelicateareaandmakingtheprecisedestructivelesions Portmannproposed.Withinafewweekshewasexpertatit.

Duringthesummerof1945Gaziexaminedtheanatomicalcollections

and exhibits in the laboratory and read Portmann’s publications on evolution.Notonlydidthissatisfytosomeextenthiscuriosity,itprovided intellectualmeatforletterstohisfather. Portmannwasagentleman,wellinformedonmanysubjects,and somethingofacontroversiallocalfigure.Hewasadeterminedecologist. WiththezoologicalinstituteontheRhine,heworriedabouttheplightof theriver’saquaticlife.Heunderstoodthatwiththegreatpharmaceutical companiesupstream—HoffmanLaRoche,Sandos,Geigy,andCiba—fish couldnotsurvivetheriver’sdailycontamination.Hewroteseveralarticles forlocalnewspapersandspokeperiodicallyontheradio,creatingtension betweenhimselfandthepharmaceuticalgiants,theveryhandsthatfed him.

Hiseveningsfree,Gazijoinedaphilosophyclub,wherehemadea numberofyoungfriends,onewhowouldbecomeprofessorofphilosophy at the University of Basel, and later at the “technical high school” in Zurich. He ultimately wrote a book on “presence,” which would gain

Gazi’sinterestlater.Thephilosopher’swifewasanotedwritertoo,apoet. The philosophical concepts presented at the weekly meetings provokedmuchthought,leadingtospiriteddiscussions.Fewinthegroup wereorientedtowardbiologyandmedicine,andmostweresurprisedto findamedicalstudentamongthem,particularlyonewithGazi’sdepthof interest in philosophy. Another member was the daughter of Professor GeorgioftheDepartmentofNeurologyandPsychiatryatthemedical school.Sinceherboyfriendwasamedicalstudent,itwasonlynaturalthey shouldgravitatetoGazi.Overcoffeeoneeveningthegirldescribedher father’shypothesisofthepathogenesisofpsychiatricdisease.Georgiwas convincedthatmentaldiseasehadaphysicalbasis,thatitdidnotresult frompsychologicalderangementsatall.ItwasaconceptGazicouldnot getoutofhishead.Withintheyearitwouldinfluencehiscareerpath. ThemedicalschoolcurriculumattheUniversityofBaselwasintwo parts:threeyearsofbasicscienceandthreeyearsofclinicalwork.Even the clinical courses were didactic, sometimes two hundred or more studentsinthelecturehall,manystanding,listeningtolecturesoninternal medicine,pathology,andtheotherspecialties.Fivesubjectswerecovered eachmorning,othersintheafternoon.Casedetailswerepresented,with patientsonhandinwheelchairs,alongwiththeirx-raysandlaboratory data.

Hisentrancetothemedicalschoolwithadvancedstandingplaced himatadisadvantageinmakingconnectionswithfacultymembersto guidehisresearch.Dissertationsonresearchprojectswererequiredfor graduation. Since arrangements typically were made with various professorsnolaterthanthefirst-yearfinalexaminations,thefactthathe enteredtheclassasasecond-yearstudentpresentedaseriousproblem. LargelybecauseofhisoperatingtheaterexperiencesinNaumburg,he wasdeterminedtobecomeasurgeon.Notonlywereallfacultymembers insurgeryalreadyengagedbystudentstosupervisetheirresearchprojects,

soweretheinternalmedicineprofessors. ButonevisittotheofficeofProfessorGeorgi,fatherofhisfriend fromthephilosophyclub,providedasolution.Gaziwasfascinatedby Georgi’sideasaboutthepathogenesisofpsychiatricdiseaseandchoseone forhisstudentresearchproject. Georgiproposedthatdeliriumtremens,theacutepsychosisalcoholics experienceafterabstainingfromalcoholforafewdays,wasmediated throughtheliver.HesuggestedthatGaziexaminethechartsofalcoholic patientstreatedinBaselovertheprecedingfiftyyearsforevidenceofliver disease.Hehopedtodocumentatrendinserumbilirubinandurobilinogen

levels,primemarkersofliverfunctioninthe1940s,whichwouldconfirm

the presence of underlying liver disease and perhaps lead to an understandingofthebasisforDTs. ButGazifoundthatdataonclinicalbilirubinandurobilinogenlevels weresparse,especiallyinchartsdatingbackbeyondafewyears.Itwas certainly not a reliable method of following day-to-day liver function. Furthermore,mostalcoholicpatientshospitalizedwereintheendstagesof theirdisease.Manydied,butautopsieswerenotperformedsystematically. Undeterredbytheabsenceofsolidbiologicaldata,hehadlittlechoicebut to plod ahead with his doctoral paper, but he had serious reservations aboutthelackofthedata’ssignificance. In an effort to learn all he could about mental illness, he began spendingweekendsatthepsychiatrichospitalinMüsingen,nearBern, fiftymilessouth.Attheveryleasthewoulddevelopamoremainstream perspectiveofpsychiatry.

With1,200beds,theMüsingenfacilitywasthelargesthospitalfor

mentaldiseasesintheworld(withinafewyearsthemassivefacilitywould be completely renovated and modernized) and its chief of staff, Max Müller,wastheleadingpsychiatristinEurope.Hismulti-volumetextbook covered every facet of psychiatry and was accepted as the bible for

European psychiatrists. Müller’s orientation toward mental disease was considerablydifferentfromGeorgi’s,particularlywithrespecttophysical symptoms.ToMüller,aFreudian,likevirtuallyeveryotherpsychiatristof

the1940sand1950s,psychosomaticillnesswasexactlythat,rootedpurely

inpsychologicalderangementsemanatingfrominternalconflicts. GazifoundMüllertobeexceptional.Followinghisinitialvisitto

Müsingenin1947hereturnedateveryopportunityfornearlyayear,allof

hisvacationtimeandvirtuallyeveryfreeweekend.Müller,unlikemanyof theSwiss,seemedtowelcomeforeigners,evenGermans,professionals andstudentsalike.Gaziadmiredhimforthat. OtherprofessorsinBaselinfluencedhimtoo.Hehadachievedan extensive background in gross anatomy in Jena, but he had learned virtuallynoneuroanatomythere.InBasel,ProfessorsEugenLudwigand WolfHeideggerwereworldauthoritiesinneuroanatomy.Heideggerhad publishedasensationalatlas,andLudwighadproducedoneofthevery besttextbooksavailableanywhereontheanatomyofthebrain. Ludwig recognized the extent of Gazi’s knowledge of general anatomyandhisthirsttolearnneuroanatomy.Ludwigwasanintense, formalman,yetfullydevotedtohisstudents,afacthewoulddemonstrate ononeoccasioninparticular.Hewasunusuallyquietasheenteredthe classroomthatmorning,thenbegantopacebackandforthasheaddressed theclass.Itwasnotnormalbehaviorforhim. “Thismorningmyfamilyfacesagreattragedy,”hebeganfinally,his voicefarfromsteady.“Mydaughtertookherownlifelastnight.”He pausedafewmomentsashushedmurmurssweptthroughtheclassroom. When he continued, his voice trembled with emotion. “For a while I considerednotcomingtolecturetoday,butaftersomethoughtIrealized thatyoutooaremychildren.Andyouremain.Youareimportanttome.I cannotletyoudown.” Gazi was surprised, and impressed. His professor saw his

responsibilitiestohisstudentsasmorethanajob.Hewastrulycommitted tothem,andthatmorningLudwigneededtheclassmorethanitneeded him. Gazi would ponder that relationship for years, and suspected his classmateswouldtoo. UnderstandingthatGazihadaspecialinterestinneurology,possibly evenneurosurgery,LudwigintroducedhimtoJosefKlingerforspecial guidanceinthelaboratory.Klingerwasanexperimentalanatomistwhose particularinterestwasinthebrain’swhitematter,specificallytheoptic radiations. He was currently photographing dissections to be used as illustrations in his and Ludwig’s book, Atlas Cerebri Humani, which ultimatelywaspublishedinfourlanguages. Twenty years earlier Klinger had worked with Eduard Pernkopf, chairman of the famous Institute of Anatomy in Vienna. Pernkopf’s multivolumeatlasofhumananatomywasafavoriteofmedicalstudents aroundtheworld.PernkopfhadcommissionedKlingerandR.Ehmanto constructathree-dimensionalmodelofthecentralelementsofthebrain (the striatum, diencephalon, limbic lobe, and mesencephalon). They photographedcoronalsectionsofthehippocampus,amygdala,andother centralnuclei,thenprojectedtheimagesonascreen,fromwhichthey madedetailedtracings.Thentheyreproducedthesamestructuresfrom different spatial perspectives, trans-axial and sagittal. Finally they transferred the tracings onto copper plates, including the most minute detail,evenarenderingofthemicroscopicanatomy.Fromtheplatesthey constructedtwentyinterchangeablethree-dimensionalpartswhichcould beexaminedindividuallyorassembledintothewhole. Twomodelswereconstructed,onetobekeptinVienna,theotherto accompanyKlingertotheInstituteofAnatomyinBasel.Yasargilspent countlesshourswithKlinger’smodel—analyzing,studying,committingto memorytheanatomicalrelationshipsitdepicted. Hewassoimpressedbyhowthemodelhelpedhimmasterthedetails

ofcomplexneuroanatomythatlaterhebuiltmodelsforhimself,including oneofthehumanbrainstem.BasedonKlinger’stechniqueheenlarged photographshehadmadeofthirteenaxialsectionsfromaneuroanatomy textbook,thenmountedthemonplywood,coloredthem,andassembled themonawoodenbase.Heillustratedtheprimaryfibertractswithcolored wiresandbrainstemnucleiwithachild’smodelingclayinvariouscolors. Adecadelaterheconstructedamodeloftheentirebrain’sarteries,veins, andvenoussinusesfromwiresofvariouscolorsandshapes.Thiswas accomplished during his leisure hours, on weekends mainly, but the processwasneitherdiversionnorrecreation. 1 Klingerwasanimposingfigurephysically,witharam-rodstraight posture,thinninghair,andatinydarkmustache.Hedressedmeticulously. Butitwasthemonocleheworeinthelaboratorythatsethimapartfrom otherprofessors.Throughhismonoclehesquintedatvariousspecimens anddissectionswithconsideredceremony,evenflamboyance.Klinger’s individualitywasnotlostonanystudent.Yethewasfamouslyaccessible toeachofthem.IntemperamentKlingerwastheantithesisofLudwig;he wasalight-heartedsoul,fulloffunandhumor. GaziwasdrawntoKlingerimmediatelyandacceptedhimasaquasi rolemodel.HewassurprisedthatKlingerdidnotpossessadoctorate. Klinger only joked about it, explaining that when he was a graduate student he had spent too much time in celebration. He described his distractionsas“music,wine,andwomen.” 2 Klinger had developed a unique technique of fixing brain tissue, preparingitforstudy.Aformalin-fixedcadaverbrainwasfrozenintoa statefromwhichwhitemattertractscouldbepeeledawaylayerbylayer with thin, wooden spatulas of various sizes. 3 In the course of such dissectionthestudentwasaffordedauniqueunderstandingofeachtract’s three-dimensionalorganizationandcomplexity,aperspectivethatwould serveGaziwellyearslater.

Under Klinger’s supervision Gazi dissected the thalamus, the hypothalamus,theparathalamicnuclei,andthesubcorticalnucleiofthe temporallobe,studyingtheirfiberconnectionsandspeculatinghoweach elementrelatedtotheothers.Hepreservedhisfavoriteneuroanatomical dissectionsinformalinandaconcentratedsugarsolutionandkeptthemin hisofficeforyears,leadingtointensefrustrationwhenthepreparations wereinadvertentlydiscardedwhenthedepartmentwasbeingremodeled

whilehewasintheUnitedStatesin1966.

Thecomplexanatomyofthecentralpartofthebrainwouldremaina lifelong interest. In the 1940s its functional significance was largely theoreticalifspectulative,certainlyoflittlepracticalsurgicalimportance. Ultimately,however,thisareaofthebrainwouldbecomethebasisforthe stereotacticprocedureshewouldpioneertotreatthemovementdisorders of parkinsonism, also the microsurgical epilepsy operation he would develop.

---

WhenGazipointedoutthatthecaseshehadcollectedinBaselwere inadequate to determine a relationship between alcoholism, acute psychosis,andliverpathology,Georgisuggestedheconsidervisitingthe psychiatrichospitalatMüsingen.HewasshockedthatGazihadalready beentheremanytimes,andwaswellacquaintedwithProfessorMüller’s ideasandmethods.LaterMüllerwasenthusiasticaboutGazi’sexpanding hisBaselinvestigationsinMüsingen. HefoundthatthemedicalrecordsatMüsingenweremoredetailed thaninBasel,andthelaboratorywasmoresophisticated.Heattackedthe projectwithrenewedvigor.Ultimatelyhediscoveredthatalcoholicswere farmorelikelytodiefrompneumoniathanliverdisease.Manydiedin prison.Theywerearrestedasdrunks,publicnuisances.Assuch,thecare

they received was inconsistent at best. Malnourished, with impaired immunesystems,theywereplacedincellsandessentiallyignored.The prisons were cold and drafty, resulting in respiratory illnesses, compoundedinsomecasesbymenaspiratingtheirownvomitus,typically hasteningtheirdeaths. Recognizingthedrainalcoholismforcedontheeconomy,theSwiss governmentconsidereditaserioussocialproblem,oneurgentlyinneedof asolution.Itdevelopedaprogramtoinstitutionalizealcoholics,manyat Müsingen,andprovidethemwithpsychotherapyandwhatevermedical treatmentmightbeneeded.Recognizingthegovernment’sinterest,Gazi preparedareportonalcoholisminSwitzerland,aproblemaffecting,atthat time,anestimatedsixtythousandpersonsofapopulationoffivemillion. Althoughnoearth-shakingrevelationsresulted,hisworkeloquentlystated theproblemandsummarizedcurrentthinkingabouttreatingthedisease. This,hismedicalschooldissertation,becamehisfirstpublishedwork. 4 After his doctoral paper was approved and he passed his examinations,hewenttoworkatthepsychiatrichospitalinMüsingenon

March15,1950.Hedidnotallowhimselftopanicorbecomedisheartened

when no postgraduate position in surgery or internal medicine was available.Eventhoughhestillharboredvisionsofasurgicalcareer,atthat momentpsychiatryremainedanimportantinterest.Hewasdeterminedto findanswerstothequestionsarisingfromhisstudentresearch.Working forGeorgifromadistance(hemetwithhimfacetofacehardlyfivetimes overfourteenmonths)andwiththeapprovalofMüller,heexpandedthe scopeofhisresearchtoincludetheliverfunctionofpsychoticpatients. Themostreliablemarkerofliverdiseaseatthattimeseemedtobethe presenceofcertainaminoaciddegradationproductsinurine.Hehadno interestatallinpsychologyorpsychoanalysis—innowaycouldhesee himselfemploying“talkingtherapy”—butheremainedcuriousaboutthe possibilityofametabolicbasisformentalconditions.

InMüsingenhecollecteddatafromsomefortypatientstreatedwith drugs in an attempt to induce vomiting when they drank alcoholic

beverages.Inresponse,40percentofthegroupstoppeddrinkingforgood,

40percentdrankless,withtheremaindernotalteringtheirdrinkinghabits

atall.Heconcludedthatwhilehemaybehelpingatleastsomepatients,

hisoverallresultswerefarfromsatisfying.Andhecouldnotmakesense

oftheurinarymetabolitedatahehadcollected.Hewasconvincedthatthe

answertoalcoholismlayelsewhere.

---

Yasargil’sentryintotheworldofpsychiatrymayhavebeenmerelya matterofconvenience,afall-backpositionwhenopportunitiesinsurgery werenotavailable.Butinactualfacthisinterestinpsychiatrystemmed fromsomeverynegativeexperiencesinhisyouth,whenhewasagesix andseven. Thepublicareanearhishomewasagatheringplaceforhimandhis youngfriends.FarmerscameonThursdaystoselltheirproduce,followed by colorful folk dances, games, and athletic contests on weekends. Militaryformationsandparadestookplaceatthemilitaryschoolnearby. Across the grounds stood the music conservatory and “the sergeant’s” school.Sometwohundredmetersbeyond,highonahill,stoodaprison.It was visible all around the neighborhood, an imposing site for any youngster.Hewasconstantlyremindedbyhisparents,aunts,uncles,and grandparentsthatitwasadangerousplace,wheretheworstelementsof societywereincarcerated,thievesandmurderersamongthem. Publicexecutionstookplaceperiodically.AsachildGazihadno wish to attend a hanging, but peer pressure assured his presence. Witnessing an execution was a means of a pre-adolescent proving his progress toward manhood, a rite of passage few boys could ignore,

howevermuchtheirparentsdisapproved. YoungGazistaredinterrorasthecondemnedoftenbalkedatthe nooseorattemptedtofightofftheexecutioner.Buttheyalldied,eachone horribly.Formanyyearsafterwardheimaginedthetorturedlivestheyhad lived,andparticularlyhowtheyhadsufferedattheend. Heruminatedaboutwhatmadecriminalsliveoutsidethelaw.Surely theircrimesdidn’toccursimplybecausetheywerepredisposedtocause harm. Or were they? Criminals seemed no different from anyone else physically,buthespeculatedthattheirbrainsweresomehowsick.Hehad beeninformedthatexecutionwasasmuchameansofprotectingsocietyas aformofpunishment,butheworriedthattakingaman’slifewasnotthe answer.Hewasconvincedthatsuchmenneededhelp.Butitseemedthat fewotherssharedhisview,particularlywithrespecttothosewhohad committedespeciallyheinouscrimes.Someofhisfriendsseemedtorelish theexecutions,asthoughtheyconstitutedaformofpublicredemption,a purification of society. Even as a child Gazi rejected such ideas. He became preoccupied with misgivings about executions, even the incarceration of such human beings. How many of those labeled as criminalswereinnocent?Didtheiractionsagainstsocietyindicateonly thattheyhadamentaldisorderandshouldbetreatedwithcompassion? TheSwissjusticesystemwasmorepalatabletohimthanwhathe’d witnessedinTurkey.Atleastsocialdeviantsweregiventhebenefitofthe doubt.Noonewasimprisonedfollowingarrestafteracrimeuntilthe perpetrator had undergone psychiatric examination. That was true regardless of the crime, whether petty theft or murder. Nobody was consideredacriminalafterarrestuntilhewasproventobesane.Asastate institutionitwasoneoftheprimaryfunctionsofthehospitalinMüsingen. SoonaftergoingtoworkthereGazifoundhimselfquestioningscoresof menwhowereaccusedofcrimes.Nearlytwohundredofthehospital’s

Hisresponsibilitywastosolicitdemographicinformationandrecord

thegeneralcircumstancesoftheaccusedatthetimeofarrest.Next,a

junior resident initiated a formal psychiatric evaluation. Finally, the responsibility fell to the chief resident to decide whether the accused wouldbeadmittedfortreatmentorsurrenderedtotheauthoritiesfortrial. Thechiefresidentwasthesonofawell-knownlocaljudge.Gazi couldn’thelpseeinghimasmorejudgethanphysician.Thechiefresident wentabouthisworkquickly,withoutshowingtheslightestsignofdoubt. Heseemedtohavedividedallmankindintotwocategories—criminalsand non-criminals—and saw himself as fully capable of distinguishing one from the other. Often he did it with a mere glance, or after a single question.Thechiefresidentwasnotabouttoadmitthatneitherhenor

anyoneelsehadthecapacitytomakesuchdeterminations.Inhismid-

thirties,hehadbeenonthestaffforhardlytenyears,possessingnotatall thekindofexperienceappropriateforsuchanawesometask.Thelaw required his judgment, and society depended on his not releasing a dangerouscriminal.Furthermore,ifhecouldn’tdothejob,whocould? On one level Gazi knew the chief resident could not possibly be qualified for his task. Some blatant cases could easily be diagnosed— obvious schizophrenics and other psychotics—but most were more complex.Instinctivelyhefeltthatsomementalillnessesdefiedprecise classification.Butperhapstherewasaway,amethodnotyetidentified. Thepossibilityspurredhimonward.

---

As he gained experience he would be charged with treating the mentallyill.Hisprotocolforpsychotics—schizophrenicsandtheseverely depressed, mainly—included electroshock therapy and the induction of insulinshock.EachmorningMüllerpresentedhimalistofpatientswith

instructionsabouthowmuchinsulintoinject,orthestrengthandduration oftheelectroshockhewastoadminister.MüllergavetheorderandGazi executed it, then observed the effects that followed. For insulin shock patients,forexample,comawouldbeinducedforvaryingperiodsoftime eachmorning.Differentdosesofinsulinwereadministeredintravenously, inducing varying degrees of hypoglycemia, then again at appropriate intervals—fiveminutesoneday,tenminutesthenext,andsoon,upto thirty minutes. Each patient was resuscitated by administering sugar infusionsintravenously.Allthiswasdoneinathree-roomtreatmentsuite —onelargeroomwithtwosmalleronesadjoining.Hemanagedtwentyor thirtypatientssimultaneously,eachinadifferentstageoftheprotocol. Fiveorsixnursesassistedhim.Gazicollectedurinespecimensandinthe afternoonanalyzedtheminthelaboratoryforthepresenceofaminoacid byproducts. Atfirsttheurinaryaminoacidmetabolitecontentseemedtopredict thelevelofpsychosis,butthecorrelationdidnotstanduplong.Testing controlsubjectsconfirmedthereality. He also examined psychopaths, most of them hardened criminals, menunfittoliveinsocietybutnotappropriateforincarcerationbythe criminaljusticesystem.Typicallytheyweresullen,refusingtointeract with the staff at all. Gazi found their urine even more abnormal than patientswithacutepsychosis.Psychopathsweresimilartopsychoticsin thattheyrefusedtoeat,atleastinthebeginning.Herecognizedthatthe urinarybreak-downproductsmeasurednotspecificallyliverfunction,but advancedlevelsofmalnutrition,reflectingsignificantproteindegradation. Alcoholics,psychotics,andpsychopathsalldiedstarvation-relateddeaths. It was obvious that other tests, more specific for liver function, were needed.Therehadtobeawaytodistinguishbetweenthesethreegroups. Systematically he began to analyze blood sugar levels in parallel with serum electrolytes, white blood cell counts, red cell counts, and

hemoglobinlevels,virtuallytheextentofthelaboratorytestsavailable.

Aftermonthsoftesting,thelaboratorydatayieldednothingtosupport

Georgi’shypothesis.DayinanddayoutGazicollectedbloodandurine

specimens from patients undergoing electroshock therapy and insulin- inducedcoma,buthecoulddrawnomeaningfulconclusionsfromthe results.Furthermore,theirbaselinevalueswerenodifferentfromthoseof thehardenedcriminalsexamined,thepsychopathicgroup. GeorgiessentiallyignoredGazi’sfindings.Heclungtotheideathat livermalfunctionwasaspecificcauseofpsychoticstatesandalcoholic delirium.Negativedatadidnotdissuadehimintheleast.Subsequently Georgiextendedhistheorytothepathophysiologyofmultiplesclerosis, receiving a huge grant from the Swiss government to pursue it. Gazi agreedthatitwasaninterestingconcept,butGeorgihadnointentionof includinghiminhismultiplesclerosisproject. Hewroteatotalofthreescientificpapersfromhisexperiencesin Müsingen,twoafterfinishingmedicalschool. 5 , 6 Themainbodyofhis work remained unpublished since he was unable to see the project to

conclusion.Hemadeasmallbookofhisfindings,someonehundredtype-

writtenpages,andshowedittouniversityphysiologistsandbiochemistsin Bern,butnothingcameofhisdata. But his misadventures in Müsingen would not be in vain. One incidentwouldservehimwellyearslater.Müller’sinsulincomaprotocol hadGaziadministeringsugarinfusionsIVatpreciseintervalsafterthe onsetofcoma,resuscitatingallpatientswithinvaryingperiodsoftime.He haddesignedathree-waystopcockforthepurpose.Hehadwitnessedno deathsfrominsulinshock,butheknewitcouldhappenifresuscitations werenottimely. Occasionallyacatheterizedveinbecameinfiltrated,requiringthathe establishanothermeansofaccesstothebloodstreamimmediately.Starting anIVquicklycouldbequitedifficultwithpatientsinshock,whowere

typically vasoconstricted and sweating profusely. Puncturing a vein beneathslipperyskincouldbenexttoimpossible.Insomecasestheonly veinavailablewasintheneck,thejugular.Sometimeseventhejugular could not be accessed immediately. Occasionally the only palpable pulsationintheneckwasthatofthecarotidartery.Onceortwicehe punctureditindesperation.Anditworked!Insulinshockwasquickly reversed after the sugar solution was infused into the artery. He rememberedthelandmarkstothecarotidandhowtothreadaneedleinto it.Thisskillwouldcomeinhandywhenhebeganperformingcarotid arteriographyyearslater,inZurich. Additionally, what he saw in Müsingen made him more compassionate. Working with schizophrenic patients gave him serious pause about the mysteries of brain malfunction. Mental disease could happentoanyone.Oneofhispatientswasaclassicalscholar,aformer professorinHeidelberg,amaninhisfifties.Hecouldreciteverbatimlong passagesfromGreekmythology.Gaziwasfascinatedbyhisknowledge andsoughttolearnfromhim.Theyhadlongdiscussions.Attimesthe professorperceivedhimselfinsidethemythhedescribed,nolongeran observerbutaparticipant—aking,awarrior,sometimesevenananimal.It frightenedGazi,seeingthislearnedgentlemanreducedtohallucinations. When lucid, the professor’s knowledge seemed unlimited. The transformationcouldbeshocking. Other patients were ensnared by the deep gloom of psychotic depression,unabletoevenverbalizetheirdarkthoughts.Then,suddenly, afterelectroshocktherapy,theywerebrightandinteresting,fullysocial again.Gazicametounderstandthattheyhadbeenthoughtful,productive peopleinside,yetheldcaptivebytheirillnesses.Onesuchpatientwasa beautiful actress, celebrated throughout Europe. Another, a talented art student,haddoneabeautifulportraitofGeorgi.Itwasstartlinglyrealistic, skillfullyandaccuratelyconstructed.But,ashisillnessprogressed,the

youngman’spaintingsdeteriorated,losingallsemblanceofrealism.They weregrosslydistorted,evenhideous,takingonthecharacteristicsofpoor Picasso imitations. The course of the artist’s disease could be traced throughhispaintings,givingGazimuchtocontemplateabouttheyoung man’sbrainfunction. He saw how devastating psychiatric illness could be. For years psychoticpatients,throughnofaultoftheirown,struggledtoadjustin society, bouncing from hospitalization to hospitalization, from experimental treatment to experimental treatment. Finally, the physical effectsoftheirdiseasebecamesogreatthattheirbodiescouldnolonger compensate.Theyessentiallyburnedout,andstoppedeating—paralyzing theirimmunesystems—anddied. He saw himself in many of his patients. He was comfortable assuming that psychiatric disease was not rooted in psychological disturbancesduringchildhooddevelopment,orinthestressesoflife.The mentallyillwerelikehimselfinmanyways.Theirtroubleshadtohavea biochemical basis, inherited or otherwise. That assumption fueled his enthusiasm,andhewasfrustratedthathehadyettoproduceevidence supportinganyofGeorgi’stheories. Histendencytoidentifywithhispatientsledtoabizarreexperience

in1948.OneofGeorgi’sassistantssuggestedthatGazivolunteerfora

protocoldesignedtostudytheeffectsofmescaline.Itwouldlethimsee

forhimselfhowmanipulatingbiochemistryaffectedthebrain.Georgi’s

daughterandherboyfriendhadparticipatedinsimilarexperimentsand

assuredhimtheywereperfectlysafe.

Ratherthaninjectingmescaline,theygavehimalowdoseofLSD.

Forafewhourstherewasnonoticeableeffect.Atthreehourshestillfelt

wellandhadexperiencednohallucinations,buthebegantohavevague

illusions,parallellinesbecomingdistortedandwavy.Thentheirspatial

relationshipchanged,thelinesnolongerparallel,becomingalternately

convergentanddivergent.Suddenlyhishandsseemedlarger,histhumbs

swollenandgrotesque,andheperceivedhislegsasmuchlonger,outof

proportionwithhistrunkandupperextremities.Buthisabilitytoreason

wasneverlost.Thedrugonlyaffectedhisperception.Heunderstoodthat

his hands and legs were actually quite normal. But it was unnerving nevertheless. Laterintheafternoonheexperiencedastrangeeuphoria,asensation ofbecomingunifiedwithhisenvironment.Thechairandthetableinthe roomwerenolongerinanimateobjects.Theybecamepartofhim.He lookedoutthewindowatthetreesonthegroundsandbegantofeelhewas partofatree.Hewasthetree!Whenagardenerbegantoprunealimb,he criedoutinalarm,“Stophim.Heiscuttingoffmyarm!” Hisfriends,finallyunderstandingthatsomethingwaswrong,became more attentive, questioning him constantly, evaluating his every movement. Thateveninghewenttodinnerwiththem,includingGeorgeSpringer (son of the German publisher) and Schroeder (who would later teach internalmedicineinStuttgart),plussomepeopleGazididnotknow,one ofwhomhadbeenaLuftwaffepilotduringthewar.Gazididnotfeelwell, andconsiderednotgoing.Hehadbeguntohavedifficultyjudginghis movementsinspace,wheretoplacehisfeet,howtoseathimselfina chair,howtoachievethenecessarymovementsinpropersequence.He sensedthatthespeedofhismovementswasaffected.Heunderstoodthat hiswalkingandhandmovementswereactuallyatnormalspeed,buthe perceivedthemtobemuchfaster.Hethoughthisproprioceptivefunction hadbecomederanged.Hesaidnothing,andthosearoundhimseemedto noticenothingunusual.Theyessentiallyignoredhim.

Thefighterpilotwasdescribingthetacticsofwarfare,aerialdog-

fighting, emphasizing how important it was to never allow an enemy aircrafttogetbeneathone’sown.“Ifhe’sunderyou,you’readeadman,”

hesaid.Thenheseemedtosayitoverandover.SuddenlyGazicouldsee theentiresceneintheceilingoftherestaurant.Hewasinafighterplane, andsensedanenemyplaneanglingbeneathhim.Theclatterofthewaiter moving glasses and plates was loud, horrifying, like the firing of antiaircraftweapons.Asterrifiedashewas,though,hesaidnothing.He understooditwasonlyhisimagination. By eleven o’clock he developed a severe headache and excused himselffromthegroup.Bythenhewasmuchcalmer,andstillincontrol ofhisthoughts.Hewasverygladtogethomethatnight.Hehadgainedan insightintotheeffectsofmentalillnesshewouldnotforget.Hebecame even more convinced that psychoses were the result of biochemical derangementswithinthebrain,similartokidneydiseaseandheartdisease. Mentaldisordersmayhavesocialimplications,buttheywerenottheresult ofsocialinteractions.Hewascertainofthat. Georgi’sstaffurgedhimtotrytheexperimentagain.Hehadbeen givenaverylowdoseofthedrug,andhadneverlostasenseofrealty.But hehadhadenough.Althoughhehadnotlostthecapacitytothink,hedid notlikehavinghisperceptionsaltered.Thisexperiencewouldinfluence histhinkingaboutusingalcoholfortherestofhislife,evensocially.He hadneverbeenintoxicatedwithalcohol,andheknewthenheneverwould be.Hewastooproudtoallowhimselftobecomeaggressive,ashehad seenothersbecomewhendrunk,ortoperformstupid,ridiculousacts. Itwasanexperiencehewouldconsiderforyears.Itinspiredallsorts of thinking about brain function: the “mind,” the delicate balance of sensoryperceptions,memory,andwillinhomeostasis,howthoughtswere stored,thenconvertedintowillfulactsbypersonswhenwelladjusted,but disintegratingintountrustworthyideation,evenchaos,whenthatperson’s brainfunctionwentawry.Howdidithappen?Whatwasthemechanism? Howwasitmediated?Hecouldnotescapethememoryoflosinghisown sense of perception of time and space, leaving him to feel outside of

himself,asamereobjectintheenvironment.Buthehadneverlostthe capacityforrationalthought.Wasthereaninternalhierarchyofhuman thought, with perception and rational thought on different levels of a spectrum?Howdiditwork?Hestruggledtoreasonitoutinphilosophical terms—anewconceptofconsciousnesswaspossible,ofbeingitself. HetookcarefulnotesonhisLSDexperience,planningtopreparea reportashisunderstandingimproved.ButnewsstoriesfromtheUnited

Statesintheearly1960sdissuadedhim.YoungpeopleinCaliforniawere

experimentingwithmind-alteringagentspurelyforrecreation.Itwasclear

that drug abuse had serious social implications, even invited national vulnerabilities.Itwasaprojecthewouldnevercomplete. SomeoftheworkhedidinMüsingenlefthimcold,particularlya series of electronarcosis experiments Müller had him perform. Awake patientsweregivenlowdoseelectricalstimulationinanefforttoinduce sleep.Gaziwasconvinceditdidn’twork.Brainfunctionwassometimes impairedtotheextentthatsubjectsseemedtorefusetocooperate,even speak.Theyassumedafugue-likestate,buttheydidnotsleep.Afterward theydidnotdescribeawakeningfromsleep.WhenGaziannouncedhis skepticism,Müllerchallengedhimtosubjecthimselftotheexperiment.

Perhapshewouldchangehismindthen.ButGaziwasthroughwithself-

experimentation. Herefusedothersuggestions.Müllerencouragedhimtosubmitto psychoanalysis,arequirementofeveryoneinthedepartment.Müllerwas undergoingpsychoanalysishimself.WhenGazidismissedtheidea,Müller insisted.“No,youcannotrefuse.Thisissomethingyoumustdo.” But Gazi was adamant. “No, sir. I am sorry,” then, “I am psychoanalyzingmyself, like Freud.” Freud was said to have analyzed thousandsbuttohaveneversubmittedtopsychoanalysishimself.Neither wouldGaziYasargil. ButMüllerdidnotaccepttheargument.Neitherdidothersonthe

staff.“Gazi’snotFreud,”oneofhisyoungcolleaguesquipped. ButoneofMüller’sseniorassociates,Dr.Weiss,cametohisrescue. “Who knows, Professor? Perhaps Gazi will make a contribution to psychiatry.PerhapshewillbethenextSigmundFreud.” The group laughed, but Yasargil’s refusal did not sit well with Müller. Hisworkinpsychiatryremainedunfinished.Hewishedtopursuethe projectshehadstarted,butitwasnottobe.ProfessorMüllerunderstood thatGazihadnointerestinconventionalpsychiatry,buthehopedhecould convince him to stay in Müsingen, to do research, to work out the biochemistryofpsychiatricdisease.ButGazireasonedthatbecomingtruly proficient in any scientific discipline would require vast additional training,requiringsixyearsminimum.Thathecouldnotafford.Hemade asmallamountofmoneydoingphysicalexaminationsforSwissinsurance

companies,roughly$100(US)permonth,butsincebeginningmedical

school he had received no salary. He received free room, board, and laundryinMüsingen,buttherewasnoregularremunerationforhiswork. Furthermore,afterfourteenmonthshecametotheconclusionhehad reachedadeadend,thathistalentslayelsewhere.Psychiatrywasripefor revolution,andmuch-neededevolution.Untilsomeoneelevatedittoa scientificdiscipline,hewasn’tconvinceditcouldadvancemuchinhis lifetime.Hedidnotfeelhehadthetimetowaste.Healsoquestionedhis capacityforrealscience.Hesawhimselfashardworkinganddetermined, butweakinmathematics,certainlyatthelevelnecessaryfortheoretical physics,thegoldstandardforscientists.Hedidnothavethemathematical talent his brothers had inherited from their mother. Instinctively they graspednumberstheoryandwereabletoperformcomplexcalculationsin theirheads,evendescribeactsofnatureinmathematicalterms.Neither couldheenvisionhimselfasthesaviorofpsychiatry,certainlynotasa mainstreampsychiatrist.Hewasrepulsedbypsychoanalyticalmethods.

Asanurses’aidehehadbeenquitecomfortablewithbothmedical andsurgicalpatientsinNaumburg.Heyearnedtoworkinthatkindof settingagain.Hewasespeciallymovedbyhisoperatingtheaterexperience inNaumburg.Ithadledhimtothinkofhimselfasafuturesurgeon.Atthe FriedrichSchillerUniversityhehaddistinguishedhimselfparticularlyin anatomy,theverysubstrateofsurgery. HisfirstthoughtwastoreturntoJena.Hehadlikedthecityandits surroundingsandwasdrawntotheGermanpeople.ButafterthewarJena hadbecomepartofEastGermany,underRussiancontrol.Goingtherewas notanoption.

Finally,in1951,apositioninclinicalmedicineopenedatthehospital

inInterlaken.Hewasinvitedtospendayearininternalmedicineanda secondyearingeneralsurgery.Therewouldbenosalary,buthehad learnedtogetbyonverylittle. While in Müsingen he had met a very special young lady, Dorly Arnold.Shewasbeautiful,intelligent,andlongedtohaveafamily.She waseverythingGaziimaginedhecouldeverdesireinawoman.Shewas employedatthehospitalasasocialworker.Timeforromancewaslimited, butbothunderstoodthattheyweremeantforeachother.Yet,marriage, children,andfamilyseemedsoveryfaraway.Therewassomuchtodo, andlearn,butsolittletime.AndGazi’sfinancialresourceswerenil.He

wouldnothaveasalariedpositionbefore1956.

Plus, there was another problem. He received a letter from the governmentinAnkarainforminghimofanobligationtoperformmilitary service in Turkey. Ordinarily the tour on active duty lasted only six months,butforTurkishexpatriatesmarriedtoforeigners,therequirement increasedsixfold.Itwasamajorstumblingblocktomarriage. Dorlytookupworkatanotherpsychiatricinstitutionasheprepared to leave for Interlaken. But the separation didn’t suit either of them. Eventuallyshewouldjoinhimthere.

CHAPTERNINE

ResidenciesinInternal

MedicineandGeneral

Surgery

BACKINTHESPRINGof1944,withthebombingoftheLeunaand

Krumpasyntheticfuelplants,Gazihadfaceddangerhecouldnotignore. HeconsideredreturningtoVienna.GoingtoSwitzerlandhadbeenanother option. Not only was there no war there, or German police, Swiss medicinewassteepedintradition.Hefacedanarduousprocess,including the necessity of working at intervals for food and shelter. Earning a medicaldegreewasalwaysthegoal,butheevencontactedseveralSwiss hospitalsaboutemploymentasanurse,nettinghimanofferofworkasa nurse-assistantinthedepartmentofinternalmedicineatthehospitalat Interlaken.LateranavenuetotheUniversityofBaselhadopenedup. Within seven years he had a medical degree and verified psychiatric researchexperienceinMüsingen.Whenthenextopportunitycamefrom Interlakenhissituationwasmuchdifferent:hewasDoctorYasargil,age twenty-five, preparing for residency training in internal medicine. He

arrivedonMay16,1951.

Interlaken lay in a valley in the Bernese Alps in west-central Switzerland,tenmilessouthofMüsingen.Asthenamesuggestsitwas locatedbetweentwospectacularlakes,theBrienzersee(LakeBrienz)to the east, and the Thunersee (Lake Thun) to the west. The towering

Jungfrau(13,638feet)anditssisterpeaks,theEigerandMönch,were

withineasyhikingdistanceandcouldbeseenfromanumberoflocations. Romanticsofthelatenineteenthcenturyhaddiscoveredthemajestyofthe area.ThereGoethewasinspiredtowritehisfamouspoem,Gesandder GeisterüberdenWassern(“SongoftheSpiritsovertheWaters”),and RousseauspreadthewordofitsgreatbeautytoParisiansociety.Lord Byron was said to have conceived Manfried in nearby Wendgernalp. Byron was followed to the area by Percy and Mary Shelley, William Thackeray, John Ruskin, and Mark Twain, also the great English landscapist, J. M. W. Turner, and Johannes Brahams. When Queen Victoriaherselfcameforavisit,thefloodgatesfortourismwereflung openforever. 1 YasargilfoundthepeopleofInterlakenanditsenvirons,thecanonof BernerOberland,specificallytheJungfrauregion,trulyspecial.Theywere ofanoldstock—natural,practicalpeople,asstoicastheywereindustrious andhonorable.Theylivedinneat,colorfulhomes,solidlybuiltagainstthe ruggedwinters.Quaintchaletsdottedthecountrysidelikethegingerbread homesofthetalesbytheBrothersGrimm.Theirspeechwasunique.The dialectofBernerOberlanderspossessedamusicalqualityreminiscentof theoldSwiss-German,asdifficultforoutsiderstounderstandasitwas pleasingtotheear. Professor Walter Baumgartner was the chairman of the medical department.Hewasahematologist,trainedinBernbyProfessorsHaddorn andSchuepbach.InspiredbyhisexperienceinMüsingen,Yasargilwas oriented not only to learn clinical medicine but to perform research. Baumgartnerhadawell-equippedlabandwideinterests.Itwasaperfect arrangement. Baumgartner was interested in studying hemoglobin, the oxygen- bindingproteinofredbloodcells.Gazi’sfirstassignmentwastodevisea methodofseparatingiron-containinghemoglobinfromplasma,andextract itinapureform,essentiallyemptyingthecellsoftheircontents,leaving

only transparent membranous sacks. Considering what he knew about osmotic pressure gradients and the permeability of the erythrocyte’s membranetowater,Gazisurmiseditshouldn’tbedifficulttoaccomplish. He had only to manipulate the salt content of the liquid in which he suspended erythrocytes. He threw himself into the project with enthusiasm,andsystematicallyworkedoutamethod. Hecollectedsyringesofhisownbloodandseparatederythrocytes fromplasmainatabletopcentrifuge.Heusedhisownbloodbecausehe would need to draw it again and again to confirm his work. He resuspended the cells in saline of decreasing concentrations, first

physiologicalsaline,0.90molar,then0.85molar,0.80,0.75,andsoon.

Cellssuspendedin0.30molarsalineswelledandtheirmembranesburst.

Remnants of the lysed cells were recovered after another spin in the centrifuge, and the ghost-like cells he had anticipated were confirmed beneaththemicroscope.Thesupernatantcontainedpurehemoglobin.It wasanexcitingday. ItconfirmedforBaumgartnerthatGaziwasspecial,extremelybright and industrious, and he began to look for ways to tap into his new resident’sstrengths,possiblyevenhavehimhelpwithapaperhewas preparingforpublication.Whenheaskedhimtowriteoutthedetailsof howhehadextractedhemoglobinfromwholeblood,though,herealized thatthatGazi’sEnglishwasweak.Hehadnotusedthelanguagesincehe waseighteen. Baumgartnerexplainedthatitwasnosmallshortcoming.Themajor medical accomplishments of the nineteenth century may have been

describedinGerman,butthatwasnotthecasein1951.Advancesofthe

futurewouldbepublishedinEnglish.“Ifyouwishtobeinformed,you mustlearnEnglish,”Baumgartnertoldhim.“Thereisnootherway.” Gazi immediately purchased a primer and began to review the principlesofgrammarandtheconversationalphraseshehadlearnedatthe

AtatürkLisesi.Hemadelistsofnounsandadjectivesthatwererelevantto

scienceandmedicine,andalsobegantinkeringwithverbs,analyzingtheir

conjugation and usage. Then he began making his laboratory notes in English, and experimenting with the sounds and rhythms of simple sentences. Hisinitialworkontheclinicalwardswassimilartowhathehaddone inGermanyasanurse’sassistant,makingpatients’beds,cleaningtheir rooms,performinginjections,etc.Onefloorofthehospitalwasdedicated tointernalmedicine.Itconsistedofoversixtybeds.Asimilarnumber wereallocatedtosurgery,onanotherfloor,plusapproximatelytwenty

bedsdedicatedtoobstetricsandgynecology.Therewasalsoasmallear-

nose-and-throatservice. Forthefirsttimehewouldbegintoputintopracticetheclinical principleshehadlearnedinBasel.Hewasresponsibleforhisownpatients inthehospital,someofthemquitesick.UnderBaumgartner’sguidancehe wouldstrivetomeettheireveryneed.Withinafewmonthshebecame skilledintakingtheirhistoriesandmakingaccurateobservationsfrom physical examination, succinctly recording his findings in the hospital charts,makingsenseoftheinformation,trustinghimselftodeterminewhat wasrealandgermanetoillnessfromthecountlessvariationsofnormal. Baumgartnerpushedhimintheartofdifferentialdiagnosis,continually quizzing him and forcing him to support his conclusions. Laboratory diagnosis was also a responsibility, along with the daily mixing of intravenousfluids.Gaziessentiallylivedwithhispatients,recognizingthat for some reason the most meaningful clinical events tended to occur duringtheweehoursofthemorning,wheneverybodyelsewassleeping. Baumgartnerwasasticklerforamassingeveryconceivablefactabout apatientasquicklyaspossible,establishingapresumptivediagnosisearly, thendevisingandexecutingatherapeuticplanofaction,finallyrevising thatplancontinuallyasnewfactsbecameapparent,neverrelaxingthe

vigiltomakefreshobservations.Tohiswayofthinking,asystematic diagnosistrumpedintuitioneverytime,andleftmuchlessroomforerror and delaying accurate treatment. In addition to discipline, he taught responsibility, continually pointing out the slippery slope of excusing one’sactionsorinactions,evenifacknowledgedonlytooneself. Baumgartnerwasavariedandcomplexman,notonlyanexcellent clinician, teacher, father, and husband, but also an avid sportsman, regularlysailinghisownboatononelakeortheotherduringthesummers, alsotakingonthemostchallengingskislopesinwinter.Inaddition,he wasacitizen-soldier,havingrisentotherankofcolonelintheSwissArmy Reserve. Before their mid-forties Swiss men were required by law to maintainamilitarystatus,spendingamonthannuallyatdrillingexercises. IntimesofcrisistheSwissgovernmentcouldmobilizeanarmyofsome two hundred thousand within twenty-four hours. Self-defense was a national priority. Baumgartner was assigned to the Alpine troops, consistingofhighlytrainedmilitaryunitsoperatingonskis,wearingwhite uniformswhichservedascamouflageagainstthesnow. Oneday,afterYasargilhadbeeninInterlakenonlyafewmonths, Baumgartnertookhissons,ageseightandten,sailingontheBrienzersee, leavingYasargilinchargeofallthepatientsinthehospital.Earlyinthe afternoonawomaninherearlythirtiescametotheclinicinrespiratory distress.Headmittedhertothehospitalandstartedheronmaskoxygen andpenicillinforapresumedlungcondition,butwithinanhourshewasin obviouscardiacdistress,indangerofdying.UnabletoreachBaumgartner athomeorbythetwo-wayradioonhisboat,heracedtothelakeshoreon abicyclehehadhastilyborrowedfromanurse.Hestoodonthebank, waving frantically at the tiny boat some two hundred meters in the distance.FinallyhecaughtBaumgartner’sattentionandbeckonedhimto shore. Quicklyheexplainedwhathadhappened.Hehadtriedeverythinghe

knewtodo,butnothinghadhelpedthewoman.Hedidn’tknowwhattodo next.Hewasn’tevencertainofthediagnosis.Herauscultatoryfindings were consistent with pneumonia, and there was no history of serious illnessinthepast.Shewastooyoungtohaveheartdisease.Baumgartner listenedforafewmomentsandaskednoquestions.Finallyhetookthe bicycle,leavingYasargiltowalkbacktothehospitalwithhissons. Fortyminuteslater,whenhefinallyarrivedatthehospital,Yasargil foundBaumgartnerinaverydarkmood.Hehadrarelyseenhischiefin suchastate.TheyoungwomanhaddiedandBaumgartnerwascertainthat Yasargilhadoverlookedanatrialseptaldefectinherheart.Shehadn’t beenoldenoughtohaveatheroscleroticheartdisease,butshehaddieda clearlycardiacdeath.BaumgartnerwascertainshehadhadanASD.There wasnootherexplanationforwhathadhappenedtoher.Ordinarilyvery calm,Baumgartnerstruggledtosuppresshisrage.“What’sthematterwith you?Can’tIbegoneforafewhours?Youshouldhavebeenabletohear themurmur.Ithadtobeloud.Ican’tbelieveyoucouldn’tmakesucha simplediagnosis.Haveyoulearnednothinghere?Howwereyouableto passyourexaminationsinBasel?” Yasargil felt terrible. Baumgartner had trusted his clinical assessmentsandjudgmentperhapsmorethanheshouldhave.Nowhehad lethisprofessordown.Hehadbeenthecauseofawoman’sdeath.Hewas tooupsettospeak.Hecouldonlyshakehisheadandlookatthefloor. Perhapshehadembarkedonthewrongcareer. BaumgartnercontinuedtoberateYasargilastheybegantheautopsy lateintheafternoon.IngreatdetailhelistedtheclinicalfeaturesYasargil hadfailedtorecognizeearlier—theheavy,boggylungs,filledwithedema fluidfromheartfailure,notinflammation.“Youmustlearntothinkin pathological terms when you examine patients,” he lectured, his voice tense. “You’ll never be able to distinguish pulmonary edema from pneumoniaifyoudon’tfirstthinkofthepossibility!”Baumgartnerwas

determined to make the post mortem a teaching experience his young residentwouldneverforget. Buttheheartitselfwasnotobviouslyenlarged.Gazinoticeditevenif Baumgartnerhadchosentoignoreit.DeftlyBaumgartnertransectedthe ascending arch of the aorta, then the pulmonary vessels, finally the superiorandinferiorvenacavae,releasingtheheartfromthemediastinum toholdinhishand.Carefullyherinsedresidualbloodfromitschambers withcoldwater,andthen,withgreatceremony,heincisedtherightatrium

of the heart and folded the leaves backward, exposing the interatrial septum. But there was no opening! No defect at all. The structure was perfectly intact! Without a word Baumgartner opened the septum, and inspectedthemitralvalve.Itwasperfectlynormal.Whythiswomanhad diedacardiacdeathwasstillnotapparent. Beginningtoreddenslightlybehindhisears,Baumgartnerremained silentforseveralminutes,graduallyproducingaruefulexpression.Forone ofthefewtimesinhislifeGaziknewnottoopenhismouth.Hewas relievedhehadnotmadeadiagnosticblunder,buthealsoappreciatedhis professor’spredicament.

“Well

thereshouldbeadefect,anyway,”Baumgartnermumbled,

finallygrinning.“Itwasaclassiccaseinallrespects.”

Fouryearslater,in1955,whileYasargilwasaresidentinZurich,he

receivedwordthatBaumgartnerhadmetwithtragedy.Hehadtakenhis

entirefamilyskiinginthemountainswithoneofhisfriends,Dr.Stucki,

theotolaryngologistYasargilrememberedfromthehospital.Baumgartner

andhissons,allexperiencedskiersandexcellentathletes,werewellahead

oftherestofthegroup—therewereatleasttwentyofthem—whenan

avalanchesweptdownthemountain,envelopingthethreeofthem.Fora

fewminutesthosewitnessingthetragedyfromaboveexpectedthemto

appearasthegreatbankofsnowfinallybrokeupandbegantosettle.But

therewasnosignofanyofthem.Ittookhourstorecovertheirbodies. Baumgartnerhadbeenabrilliantman,notyetfiftyyearsold.Hehad beenscheduledtosucceedthechiefofmedicineinBern,whoseretirement was imminent. He had been wealthy and had a beautiful family. A thousandpeoplecametothefuneral,Yasargilamongthem.Thepriest presidingwasBaumgartner’sdearfriend.Hecouldn’thelpaccusingGod, admitting he was wrong to challenge providence. But it was a circumstancethosepresentcouldneitherunderstandnoraccept.Itwasa veryunusualservice, oneYasargilwould notforget.Baumgartner had beenamajorrolemodelforhim,amanwhohadmoldedhisthinkingin importantways. After a year with Baumgartner, he went to the general surgery service,underProfessorWalterBandi,anativeofMüsingenwhowas trainedinBernintheTheodorKochertradition.LikeBaumgartner,Bandi took an immediate interest in Yasargil. They discussed their common interestsinneurologyandneurosurgeryalmostdaily.Bandihadsoughtto becomeaneurosurgeonhimself,butthathadnotbeenpossible.Hehad aspiredtostudyunderHerbertOlivecronaattheKarolinskaInstitutein

Stockholm,theprimaryneurosurgicalcenterinEuropeinthe1930s,but

there was no money to go to Sweden. Instead, he became a general surgeon.Hewasamanofgreatintegrityandtechnicalsurgicalskills.He did not fail to notice Yasargil’s drive and the fledgling talent he demonstratedwithhishands.Bandiinstilledinhimthevalueofaseptic techniqueandhemostasis,insistingonprecise,bloodlessdissections,also theimportanceofvigilanceatthebedsideandhowcrucialaccurate,timely postoperativecarewastotherecoveryofsurgicalpatients. AfterYasargilhadmasteredthefundamentalsofopeningandclosing theabdomen,Bandiallowedhimtoperformsuchdutiesalone,laterto performentireoperationsalone,simpleappendectomiesatfirst,eventually severaldozenherniarepairsinthegroin.BeforeYasargil’stwelve-month

rotation was completed, Bandi had assisted him in removing a gall bladder,then,finally,athyroidectomy.IneighteenmonthsGazihadgone fromcleaningpatients’roomsandchangingbedlinenstoperformingone ofthemostdemandinggeneralsurgicalproceduresofthatday. One surgical case stood out among his Interlaken memories. It provided a thumbnail sketch of Bandi’s character and attitudes Gazi wishedtoemulateashedealtwithpatientsinahospitalenvironment. Bandi operated on a man with thrombocytopenia. He had generalized purpura (patches of purplish hemorrhage into skin and mucous membranes) and an enlarged liver and spleen. The patient was poor, earning his living repairing shoes, and had been referred from Baumgartner’shematologyservice.BothBandiandBaumgartnerhada specialinterestinclottingdisorders,especiallyhemophilia.Baumgartner wasexpertwiththevariousclottingfactorsknownatthattimeandwas eagertoexpandhisknowledge.HehadaskedBanditoobtainablood sample directly from this patient’s splenic artery and vein before he performedthesplenectomytheyexpectedtobetherapeutic. After exposing the vessels of the spleen, Bandi punctured the enlargedsplenicarterytodrawabloodsample.Butthepressureinthe vesselwashighandthelackofplateletsimpairedclottingatthepuncture site.Massivehemorrhagefollowed.Thepatient’sthickabdominalwall maderetractiondifficult,andthevesselwastenuous,defyingstandard techniquesformaintaininghemostasis.Notonlywastheworkingspace restricted,overheadlightingwaslessthanideal,andthewound’ssteep wallsmadevisionatitsbottompoor.Itwasadangerousmoment. Amomentwhichseemedtogoonforhoursandhours.Theman’s bellyfilledwithswirlingbloodwhichthreatenedtooverwhelmthesuction system.Thelimitedexposurethreatenedtomakecontrollingthebleeding impossible.Multipletransfusionswereneededtokeepthepatientalive. But ultimately Bandi, fighting off panic, coolly occluded the

abdominalaortawiththeheelofhislefthand,thensystematicallywent aboutthebusinessofmorefullyexposingandisolatingthedelicatesplenic vessels,intermittentlyreleasinghisgripontheaortainordertoallow circulationtothespinalcord.Finallyhesucceeded.Controllingthevessels entering the spleen between his thumb and index finger, he applied transfixionsutureswithhisoppositehandasYasargilsuctionedawaywhat bleedingremainedwhileretractingseveralloopsofbowelandtheenlarged liver.Finallythesuturesheld.Ultimatelytheoperationwascompletedand theman’slifewaspreserved.Drenchedinsweat,bothsurgeonsachedwith fatigue.Massivetransfusionshadbeenrequiredtoreplacethelostblood. Theyhadusedeveryounceofbloodstoredinthehospital’sbloodbank. Thefollowingdaythepresidentofthehospitalcommission,astern man with definite socialist leanings, showed up in Bandi’s office. He severelycriticizedthesurgeonforexhaustingthehospital’sbloodsupply. “Whydidyounotallowthismantodie?”hedemanded.Bandigathered himselfandtookseveraldeepbreaths,strugglingtoovercomehisanger. Hisonlyresponsewasacalm,“Sir,justwhodoyouthinkyouare?” ItwasascenarioGazilivedandrelivedinhismind,determinedthat hetoowouldalwayschoosethatperspective. WhileworkingwithBandi,Yasargilwasemployedasanighttime operating room assistant, a position which allowed him to pay for his room.Mealswerefreeinthehospitalcafeteria.Healsohadanafternoon offeveryweek.Oneafternoonawealthytouristfellwhilehikingthetrails inthemountainssouthofInterlakenandbrokehiship.Yasargilwentwith thenursesandotherattendantsupthemountaintobringthegentleman downtothehospital.Hewasstruckbythecoolmountainairandthe breath-taking views. He determined that he would return at his first opportunity. Later,havingnomoneyforthetrain,heagainborrowedabicycle(no gears, no handbrakes) and struck out. After a brief discussion with

grinninglift-attendantsatthefootofthemountain,heascendedinacabled chair-lift, clutching the bike across his lap by a front wheel and the handlebar. The attendants hadn’t seen someone take a bicycle up the mountainbefore,buttheyagreedthatdescentwasatleastpossible.They promisedhimthatanexcellentroadexisted.Convincedthatthetripdown wouldbeasimplematter,Gazipurchasedaone-wayticket. Ashenearedthepeak,though,thewindpickedupandbegantowhip throughhislightclothing.WhathadbeenawarmOctoberafternoonin Interlakenhadturnedintosomethingelseataltitude.Therewereeven patchesofsnow.Finallyatthepeak,hebegantomakehiswaydownthe shortdistancetoatinyvillage,wherehehadbeentoldhewouldfindthe road.Thepathwasallbutunseenandnotatallcontinuous.Inoneplacehe hadtodescendstonesteps,thebikesuspendedacrosshisshoulders. Ashemadehisway,heranintoamiddle-agedcouple,anAmerican Armycolonelandhiswife.Theyhadhikeduponeoftheshorttrailsfrom thevillageandwereontheirwayback.TheirGermanwasquitegood.The colonelwasalawyer,aJew,whoseelderlyparentsstilllivedinBasel.He hadservedontheNurembergCourtafterthewar.Gazi’snewfriends couldn’t help kidding him about his bicycle. They couldn’t have been moresurprisedifhe’dbeeninabathingsuit,carryingdivinggear. Withbroadsmilesthecouplewishedhimgoodluckasheleftthemat thevillage.Itconsistedmainlyofanoldmountainhotelandseveralsmall houses. The Americans would take the cable car to the foot of the mountainandthetrainbacktotheirhotel.Gazifoundtheroadandstarted downtoInterlaken. Theviewwasspectacularandthetravelswift,marredonlybyaherd ofsomefiftyorsixtycattlecrossingtheroad,requiringhimtowalkthe bikeamongthem.Hedescendedthousandsoffeetinthirtyminutesand wasbackatthehospitalwithintwohours.Thestafflookedupathimfrom thesuppertable,theireyeswideathiswind-swepthairanddisheveled

clothing. “Where have you been?” Rarely was he gone for an entire afternoon. “Imadealittletrip.I’vebeenupinthemountains.” “Howdidyougo?”Atrainridewouldn’texplainhisrumpledlook, andtheyknewhewasalwaysshortofmoney.Therewassomethingabout himthatannouncedhewaswithholdingimportantfacts. “Itookabicycle.Borrowedit.” Looksofdisbeliefmethimfromaroundthetable.“Abikeinthe mountains?That’snotpossible!” “No.Itwasdifficultinspots,butImadeit.”Buoyedbytheirlooksof astonishment,hecouldn’tresistgrinning. Thechiefresident,askepticalyoungmanfromBasel,possessedofa sharptongue,wasn’tabouttoacceptthestory.“Comeon,Gazi.Don’t expectustobelievesuchnonsense.Whathaveyoureallybeendoing? Where’veyoubeen?”Theyknewhehadagirlfriend. Atmidnighthewasawakened.Awomanfromthehotelnearbywas tohaveemergencyabdominalsurgery.Shewasalreadyanesthetizedwhen hereachedthehallwayoutsidetheoperatingtheater.Bandiandthechief residentweretalkingtoherhusband,checkingthehistoryonemoretime, explainingthesurgerytheywereabouttoperform. “Oh, Gazi,” the man exclaimed when he saw him. It was the Americanofficerhehadmetintheafternoon.“I’msogladtoseeyou.My wifegotverysickafterdinner.” EyebrowswentupallaroundasthecolonelexplainedthatYasargil reallyhadbeenatthemountaintopwithabicycle. Thewomanhadperforatedaduodenalulcer.Ricefromherdinner wasspreadthroughoutherperitonealcavity.Forweeksafterwardthestaff calledGazi“thatcrazyTurkbiker.”Mountainbikeswouldnotbecome popular in the area for another two decades. Nearly fifty years later Yasargilwouldinsistthathehadstartedthetrend!

DuringhissecondyearinInterlaken,hebegantoseriouslyconsider what was next. To that point the great themes of his life outside of medicinehadcenteredonintellectualpursuits—philosophy,history,art. Theworkingsofthemindwereofgreatinteresttohim.Oneofhisearly memorieswasthedesiretobecomeaneurologist.ProfessorSaribaş,his nextdoorneighborinAnkara,hadbeenhischildhoodhero,alongwith AugustusBier,thesurgeon-turned-philosopherhehadnevermet.Laterhe had met surgeons and witnessed their work, first the old man in Naumburg,nowBandi.Gazihadprovedhimselfasananatomist,andhe hadideastoexplorethere,butthelifeofanacademiclikeKlingerdidnot provide the challenge he sought. His experience with Baumgartner in internal medicine had been fine, even stimulating and instructive, but somehowinternalmedicinewasn’tquitewhathehadinmindforacareer, forthatmatternoteventhelifeofaneurologist.Hewantedtodomore thansimplydiagnosedisease.Inimportantwaysneurologistshadnomore powertointerveneintheinterestoftheirpatientsthanpsychiatristsdid.If heweretobeadoctorwhodealtdirectlywithpatients,hehadtohave somethingfirmtoofferthem,somethingtrulypositive.AsaTurk,bornof theAtatürkrevolution,itwashisdutytomakeapositivecontribution,to dosomethingforhumanity.Hisfatherbackhomewouldexpectnothing less.

Hefelthemighthavearealtalentforworkingwithhishands.The thyroidectomyandtheherniorrhaphieshadprovedthat.Possiblyhewould becomeabrainsurgeon.Whatgreaterchallengecouldtherebe?Itwould allow him to be a neurologist but far more. It might give him an opportunitytopursuehisintellectualinterestsatthesametime.Eventhe busiestphysiciansandsurgeonsseemedtofindtimeforotherpursuits. AugustBierhad.Asmuchashelikedtheoutdoors,hewasnosportsman likeBaumgartner,orahunterlikethesurgeoninNaumburg. HewroteProfessorHugoKrayenbühlinZurich,inquiringaboutthe

possibility of his coming to study neurosurgery. Bandi knew of the programthere.Ithadbeeninplaceforseveralyears.Nolongerwasit necessary to go to Stockholm to become a neurosurgeon. Zurich was whereBaumgartnerandBandisenttheirownpatientswithneurosurgical problems.Krayenbühlhadwrittenthemlengthylettersback,explaining whathehaddonefortheirpatients,theproblemshehadencounteredand howhe’dsolvedthem.Krayenbühlwasarefinedgentleman,possiblyeven anintellectual,onewhocaredintenselyforhispatients.AndZurichwas hardlyanhourawaybytrain. Byreturnmailhewasinvitedtocomeforaninterview. GazifoundKrayenbühlpleasantandrelaxed.Hehadbeeninsurgery thatmorning,andhadreservedanhourintheafternoontotalktohim.It wasclearthatKrayenbühllikedhim,thathewasimpressedwiththework hehaddoneinBaselandInterlaken.Krayenbühlwasalsoimpressedby his background in psychiatry. He had once considered a career in psychiatryhimself.Hisfatherhadbeenapsychiatrist,andhismotherhad ownedaprivatepsychiatricclinicinnorthernSwitzerlandwhenKrayenbül was growing up, after his father’s death. He told Yasargil about performinganautopsysoonaftercompletingmedicalschoolatCharitéin Berlin.Thepatienthadbeenonthepsychiatricserviceforyearsandwas wellknowntothestudents.Buttheautopsyrevealedabraintumor,ahuge olfactory groove meningioma, fully benign by histological study. The man’smentalproblemshadhadnopsychiatricbasisatall.Anoperation couldhavecuredhim!TheexperiencehadledKrayenbühltochoosea careerinneurosurgery. But Krayenbühl had no position to offer him at that time. He explainedthatpossiblyonewouldbecomeavailablethefollowingyear,or thenext. GaziknewBandiwouldbetakingonanewresidentinafewweeks, that he had no place to go. He explained to Krayenbühl that he was

interestedinresearch,thathewasagoodworker,thathewouldstayevery nightinthehospitalifnecessary.“Icanlivewithoutsleep,”hesaid.Itwas thewayhehadbeenlivingfornearlytwoyears,aloneinhisroomwithhis booksfarintothenightwhenallwasquietonthewards. Krayenbühllookedathimforalongtimeacrosshisdesk;thenhe rubbed his forehead wearily. “Well, all right,” he said finally. “If you wouldliketocome,wewillmakeaplaceforyou.Somehow.Butbelieve me,youwillhavetowork.”

---

OnhisfirstfreeafternoonafterreturningtoInterlaken,Yasargilwent toBaseltoseehisoldneuroanatomyteacher,ProfessorKlinger.Hetold himofhismeetingwithKrayenbühl,andofhisplanstogotoZurich.“I am going to be a neurosurgeon,” he explained. “I must learn neuroanatomy.” Klingereyedhimsharply,lightreflectingfromhismonocle.Gazihad alreadytakenhiscourse,excelling,infactpossiblyperformingbetterthan anystudenthehadeverhad.Hecouldn’tfathomwhattheyoungmanwas talkingabout. “Ihaveaconfessiontomake,Professor,”Gazicontinued.“Before, whenIwashere,Ilearnedanatomyjusttopasstheexaminations.NowI wanttoreallylearnit.Imustknowitcompletely,betterthananyoneelse intheworld.” Klinger’seyebrowswentup,andhelookedaway,outthewindow. Gazisensedhewaslaughinginside. HespentsixweekswithKlingerandhisassistantbeforegoingback to Zurich. Then he returned for a three month period after he started workingforKrayenbühl.Hourafterhourhedissectedtheopticradiations, theauditorytracts,thenthelimbicsystem,thinking,wondering,tryingto

imagine how a surgeon might navigate the region while preserving importantfunctionaltissue. Klinger’s primary investigative interest was the hippocampus, the curvingstructureadjacenttothetemporalhornofthelateralventricle.His eyeslitupwhenhespokeofit.“Nowhereelseinlifedoesthereexistsuch morphology,”hesaid,hisvoicetremblingalmostreverently.“Itislikea flower, opening beautifully in every direction.” Together they traced hippocampal connections with the anterior temporal cortex and other limbicstructures.Klingerwasconvincedtheareawouldbefoundtobeof crucialimportanceoneday,probablyinYasargil’slifetime. Klinger’senthusiasmwasinfectious.Throughoutthefollowingtwo yearsGaziwouldreturntoKlinger’slaboratoryonweekends,sometimes stayingforaslongasaweekwhenhecouldwranglethetimefromhis dutiesinZurich.

CHAPTERTEN

FromNeurosurgical

NewcomertoPioneerin

Neuroradiology

ON JANUARY 4, 1953 YASARGIL showed up for work at the KantonsspitalZurich(ZurichStateHospital).Twomonthsearlier,whenhe wasthereforaninterview,ProfessorKrayenbühlhadspentsometime describingtheexistingresidentstaffandhowhemightfitintoit.Several timesheheardtheword,“Shularzt,”oronethatsoundedlikeitanyway. He’dneverheardthetermbeforeanddidn’tknowitsprecisedefinition. Hebroketheworddownandthoughtaboutit.Schooldoctor?Really? PerhapshehadmisunderstoodKrayenbühl’spronunciation.Hecouldn’t getitoutofhishead.Exactlywhatdidaschooldoctordo?Hehadnoidea. Butsinceitwouldbehisposition,oneKrayenbühlcreatedespeciallyfor him,whateveraShularzt’sresponsibilitieswere,hewouldembracethem andmasterthem.IfbeingaShularztwasasteppingstonetobecominga neurosurgeon, so be it. He would become the best Shularzt he could possiblybe. AfterreturningtoInterlakenhehadbouncedthewordoffhisfriends. Noneofthemhadabetterdefinitionforitandadictionaryrevealedno otherwordwithasimilarpronunciation.Heconcludedthathewasto beginhisworkinZurichasadoctorataschoolofsomesort,possibly workingwithchildrenwithneurologicalproblems.Hehadhadnoformal traininginpediatricsbutwasdeterminedthatnoassignmenttriphimup.

Hewouldbeprepared.HehadalreadyreadandrereadWalterDandy’s

classicmonographonbrainsurgeryinProfessorBandi’slibrary(Lewis’s

PracticeofSurgery,Vol.XII.1944,reprintedin1969asTheBrainby

HoeberDivisionofHarperandRow).

Hepurchasedthebestpediatricstextbookhecouldfind,aseven-

hundred-page volume by Professor Fanconi, chief of staff at the KinderspitalZürich(ZurichChildren’sHospital).Intheweeksbeforehe returned to Zurich it was with him continuously. Carefully he went throughitthenbackandforth,masteringthephysiology,biochemistry, andendocrinologyofchildhooddiseases.Itwasnewmaterialforhim,but he assumed it would hold him in good stead later, whatever duties Krayenbühlhadinmindforhim. Forweekshecarriedthedog-earedcopyofFanconi’stextbookwith himashewentabouthisdutiesattheKantonsspital,continuingtostudyit, occasionallyreferringtoitonroundsandindiscussionswiththeresident staff.

EventuallyitbecameclearthatKrayenbühlhadnotenvisionedhim workinginanypediatriccapacity.Hehadsimplymisunderstoodtheterm hehadheardinNovember.Krayenbühlcouldn’tresistkiddinghimabout itlater.WhatotherneurosurgicalchiefinEuropehadaresidentwitha profoundinterestinpediatrics?ThisyoungTurkfromInterlakenwould become an unusual neurosurgeon indeed! Krayenbühl even telephoned Fanconiandtoldhimaboutit!Yasargilwentalongwiththejoke,buthe sensedthatKrayenbuhlwasimpressedwithhisinitiative.Hewasofftoa goodstart.Eventuallythehugepediatricsbookwouldfinditsplaceona shelfinhisroomwhereitcouldfinallybegintocollectdust.Buthenever didaskKrayenbühlwhataSchularztwas! As Yasargil began his residency, the new one-thousand-bed Kantonsspital building was not yet two years old. The neurosurgical service claimed seventy beds (expanded from thirty-five in 1951),

includingtenintheICU;plustwoORs(operating“theaters”inEuropean parlance);fourroomsforEEGstudies;atwo-roomresearchlab;anda library. In addition, there were eight rooms for administrative use and storage.Fiftytoeightyneurosurgicalpatientswereadmittedweekly. Yasargilrentedasmallroomataboardinghousenearby,buthewas almostneverthere.Hisluggagewouldnotbefullyunpackedforthree months.Hewasatthehospitaldayandnight—watching,listening,asking questions, absorbing the details of his new environment. He was determinedtohonorthecommitmenthehadmadetoKrayenbühltothe letter.Everypatientadmittedwouldbehistoppriority.Hewouldmove mountainsifnecessarytosolvetheirproblems.Eventherarestdiseaseor conditionwouldnotremainunfamiliartohimovernight.Theseweregoals hewouldmaintainforyears.Everyminuteofeverydayhewasnotonthe wardsorintheoperatingtheaterhewouldspendreadingormakingnotes inpreparationforroundsoraconferenceortheclinicalreportshewould onedaywriteformedicaljournals.

---

KrayenbühlopenedtheneurosurgeryclinicattheKantonsspitalin 1937. He had learned neurosurgery under Hugh Cairns at the London Hospital,whereCairnshadestablishedthefirstacademicneurosurgical

departmentinEnglandin1927.Hehadspent1926andmuchof1927at

thePeterBentBrighamHospitalinBostonwithHarveyCushing,whohad takentheworldbystormoverthepreviousfifteenyearswithhissurgical resultswithbraintumorsandgasserianganglionoperations,plushiswork on the physiology of and surgical approaches to the pituitary gland. Cushing had been a stern and disciplined surgeon, emphasizing to his students the importance of gentle handling of tissues and meticulous controlofbleeding.KrayenbühlviewedCairnsasanextensionofCushing,

andsoughttoemulatehis(andCushing’s)methods. Krayenbühlhadpurchasedhisownsurgicalinstruments,operating table,andx-raymachine.Onlysixbedswereassignedtoneurosurgeryin theoldhospital,andheperformedonlytwentyoperationsthatfirstyear, includingspinalcases.Buteachyearhispracticegrew.Heworkedalone intheearlyyears,havingageneralsurgeonassisthimwhennecessaryon caseshecouldn’thandlealone.Herecruitedastaffofnurses,andtaught

themwhattheyneededtoknow.Mostofthemwerestillonhandin1953,

makingupthebackboneofthedepartment.Krayenbühl’sheadnursenot onlyassistedhiminsurgery,butadministeredanesthesiaandmadex-rays, androutinelypreparedsmearsoftissuespecimenforhistologicalstudy. His nurses were devoted to him and never complained about the long hoursthatpatientcarerequired.ItwasthefirstthingYasargilnoticed abouthischief.Krayenbühlsawtoitthatnooneworkedlongerandharder thanhedid.

GerhardWebercameclose,though.HehadcometoZurichin1943

andwouldstaytwenty-nineyears.Inadditiontohissurgicalschedule,he performed complete neurological examinations on every patient on the neurosurgicalservicetwicedaily. Krayenbühlhadcontinuedthechartingsystemhehadlearnedfrom Cairns. It was precise and systematic. The admitting resident recorded eachpatient’shistoryinlonghand,includingthedetailsofhisneurological examinationandtheresultsoflaboratoryinvestigationsandx-rays.These reportswerethentypedbysecretariesandfiledinthehospitalcharts.On thedaypriortosurgerytheadmittingresidentwasexpectedtoconcisely update the record, typing the details himself, using the hunt-and-peck systemifnecessary.Hewastostatehisowndiagnosisandexactlywhat kindofoperationhefavoredandbywhatapproach.Ifhedisagreedwith thescheduledoperation,hemustsaysoinwriting.Andnosuchchart entrywastobelongerthanahalf-page.

Krayenbühlexpectedhisresidentstocommiteveryimportantthought towriting,andnorelevantdetailwastobeomitted.Andtheresidents expectedtobeheldtotheirwrittenopinions.ItwasthewayKrayenbühl had learned himself. Not only did Krayenbühl judge a resident’s knowledgebywhathewrote,butwhohewas,hischaracter.Hereadeach noteandmadecommentsandcorrections,alwaysinwriting. After surgery Krayenbühl, since he was generally the primary surgeon,dictatedthedetailsoftheoperationhimself,explainingwhyhe hadoperated,whatpathologyhehadencountered,andwhatactionshehad taken. If the preoperative diagnosis had been incorrect, indicating he should not have recommended an operation or should have taken a differentsurgicalapproach,hestateditinnouncertainterms.Hemadeno excusesforhisownmistakes.Instantlysuchcommentsbecamepartofthe permanent record. Every resident made it his business to read Krayenbühl’soperativenotebeforetheinkwasdrybecausehewouldface piercingquestionsontheoperationatlateafternoonrounds. Such a method would prove to be troublesome in the 1970s as

lawyerssearchedthrougheverychart,butinthe1950sitwascrucialto

learning.Textbooksonmodernbrainsurgerywerevirtuallynonexistent. Residentslearnedfromreadingthepatients’charts,whichservedastheir textbooks. Krayenbühl, like Cairnes before him, expected unequivocal truthineverychartentry—nodefensivelanguageorattemptstocolor facts.Withoutunadornedtruththelessonslearnedwouldbeflawed,and liveswouldbeplacedatrisk. Whenapatientwasdischargedfromthehospital,thechiefresident wastosummarizethepertinentclinicaldetailsofherclinicalcourseintoa finalreport,acopyofwhichwasultimatelysenttothereferringdoctor. Like most other important chart notes, these summaries were to be succinct, systematic, and always typed neatly. They amounted to a Krayenbühltrademark.YasargilrememberedthereportsBaumgartnerand

Bandihadreceived.

---

Attheturnofthetwentiethcenturydoctorsconfrontedwithpatients withneurologicaldisordersandophthalmologicalevidenceofincreased intracranialpressurehadonlythefindingsofneurologicalexaminationto determinewhichpartofthebrainwasinjuredordiseased.Brainanatomy hadbeenworkedoutindetailbythen,buttherewasnowaytolookinside the skull to actually see the size, shape, and precise location of the offendingpathology.Whentheonlytherapeuticoptionwassurgery,and withonlyhisneurologicalfindingstoguidehim,thesurgeonmoreoften thannotencounteredonlyswollenbrainatsurgery.Thenhisonlyoption wastodecompressthebrainbyleavinganopeningintheskullbeneaththe temporalmuscle,atemporizingmeasure. Radiographictechniquesremainedrudimentaryatmid-century.Only

withthedawningofthedigitalageinthe1970s—producingcomputed

tomographic(CT)scansandmagneticresonanceimaging(MRI)—would neurosurgeons be able to actually visualize brain substance without openingtheskull.X-rayswereoflimitedvaluesincetheyrevealedonly thedetailsofbonearchitecture.Theydidrevealcalcificationswithinthe duramater(coveringofthebrain)sometimes,andrarely,withinblood

vesselsandvascularelementsofunusualtumors.By1920braintumors

andotherintracranialmasseswerebeginningtobelocalizedbyinjecting airintothebrain’sventricularsystem. 1 , 2 Air,beinglessdensethanbone, appeareddarkerthanboneonskullx-rays,evenblack.Oncethenormal pattern of ventricular air was determined, deformities and shifts of air shadowsonx-raycouldleadindirectlytothepresenceofanytumorthat altered them even slightly. But air in the subarachnoid space typically causedexcruciatingheadaches,plusnauseaandvomiting.Itwasabrutal

formofinvestigation,anditcarriedacertainamountofdanger. Arteriograms,enablingthedetectionoftumorsandotherlesionsby studyingthedisplacementordeformityofintracranialbloodvesselson plain x-rays, were still performed as they had been when they were describedin1927. 3 Patients’neckscontinuedtobeopenedintheoperating theatertoinjectthecarotidartery withameasured amountofdye, or contrastmedia,whichwouldappearwhiteonx-rays(incontrasttobone’s varying shades of gray). Bleeding could occur in the course of such operations, and not infrequently patients had to be returned to the operatingtheateraftersurgerytocontrolbleeding.Anarteriogramwas clearlyanoperationinitself,sometimesnotatallaneasyonetoperform withsafety. Krayenbühl’sdiagnosesweremadeonthebasisofthehistoryhehad takenfromthepatientandhisphysicalexamination,buthewasamasterat gleaningatleastsomeinformationfromplainskullx-rays.Evidenceof long standing elevated intracranial pressure from brain tumors was typically apparent in bone thinning or erosion, particularly in bone

surroundingthepituitarygland.Midlinestructures,particularlythepineal

gland,alsocontainedsufficientcalciumtobevisibleinpatientsmiddle-

agedandolder.Krayenbühlhadasharpeyeforsuchdetails.Acalcified pinealshiftedtotheleftevenafewmillimeterstypicallyindicatedthe presenceofamasslesionontherightside.Sometimesjustknowingthat saved a patient from the agony and risk of an air study. Further confirmationwaspossiblewithanarteriogramlimitedtoonesideofthe brain. Krayenbühl was even adept at seeing calcified objects in three dimensions,in“stereo,”bysimultaneouslystudyingpairedx-raysmadeat slightlydifferentangles.Bycrossinghiseyes,justso,hecouldperceive threedimensions.

---

OncewatchingKrayenbühlstrugglewithacarotidarterythrougha

six-inchneckincision,Yasargilknewtheremustabetterwaytoperform

anarteriogram.Krayenbuhl’smethodinvolvedexposingthevesselinthe

operatingtheaterandinsertingalarge-boreneedle,then,aftercoveringthe

openwoundwithasteriletowel,thepatientwaswheeledtothex-ray

departmentfortheinjectionofcontrastmediawhichwouldshowuponx-

rayasdye.Afterx-rayswereprocessedandjudgedtobeadequatefor interpretation,thepatientwasreturnedtotheoperatingtheaterforwound closure. It was a long and arduous process, particularly for the poor patient. YasargilrecognizedthatKrayenbühl’ssystemtrustedtraditionand wasseeminglycutinstone,buthecouldn’tresistpresentingacasefor flexibility.Hedescribedhisexperienceswithpsychiatricpatientsininsulin shock experiments in Müsingen, pointing out how he had sometimes simplyplacedaneedlethroughtheskinintothecarotidarterywhena cervicalveinwasnotavailable.Whynotpuncturethecarotidarteryforan arteriogramthesameway?Heknewhecoulddoit.Itwouldbesomuch easierthanopeningthenecksurgically.Therewouldbenowoundtoheal, onlyatinypuncturesite.Afterremovingtheneedle,bleedingfromthe arterycouldbecontrolledbysimplyapplyingpressuretothefrontofthe patient’sneckfortenminutesorso.Apercutaneousarteriogramcould evenbedoneinthex-raydepartment! KrayenbühlwasskepticalbutdecidedtoletYasargilhaveatry.Why not?HewasprobablyintriguedbyYasargil’saudacity,andhadthegood sensenottosuppressinitiativeandingenuity. AndYasargilwassuccessfulonhisveryfirstattempt,afterafashion anyway.Withhisfingertipsheidentifiedthecarotidarterythroughthe skin,thenstabilizeditwithhislefthand,finallypiercingitwithaneedle,

allowingthepointtopassthroughthefrontandbackwallsofthevessel. Afterremovingthestylet,veryslowlyhewithdrewtheneedleashehad doneinMüsingenuntilalongstreamofbloodescapedthroughitshub, indicatingthatthetipoftheneedlewasunobstructedinsidethelumenof theartery.Atthatpointitwasasimplematterofredirectingtheneedle forward, quickly threading it a centimeter or so into the vessel, then replacingthestylet. That’swhathethoughthehaddone,whathewastryingtodo.In actual fact the needle tip had slipped past the carotid artery and had puncturedthevertebralartery,muchdeeperintheneck. Hewasshockedwhenhesawthex-rays.Heexaminedthemfirstin the dark room before the developing chemicals had dried. The middle cerebralandanteriorcerebralarterieswerenotapparentasexpected.He sawthebasilararteryinstead,asitlayagainstthebrainstem,alongwith theposteriorcerebralandsuperiorcerebellararteries. Hehadinjectedthevertebralartery!Hehadneverseenavertebral arteriogrambefore. Immediatelyhetookthex-raytoKrayenbühl.“Look,”heexclaimed. “Thevertebralartery!” Krayenbühlstaredatthefilmindisbelief.Itwastrue.Thevesselsof theposteriorcranialfossawereclearlyopacified. “Howdidyoudoit?” Yasargilexplainedwhatmusthavehappened.Hehadbeencertainhe could puncture the carotid artery, and assumed the vertebral artery, partiallyencasedinboneatadeeperlevel,wasnotaccessible.Thefact thathehadslippedaneedleintoitexcitedhim.Withpracticeheknewhe couldrepeatitwheneverhewished.Itwouldbenecessaryonlytodisplace the carotid artery outward and advance the needle tip deeper, until it contactedbone,thenadvanceitalongthebone’sedgetoaspacethrough whichitcouldpiercethevertebralarteryafewmillimetersdeeper.

“Howisthepatient?”Krayenbühlwassuddenlyalarmed.Hiseyes narrowed,andhisforeheadfurrowed.Thevertebralarterysuppliedblood directly to the brainstem, the small element of the brain that made consciousness,breathing,andbloodpressurecontrolpossible. “She’s fine,” Yasargil responded, and took Krayenbühl to her bedside. Krayenbühl spoke with the woman at length, then examined her cranialnervesandcheckedherextremitymovements.Andherrespiratory rate,pulse,andbloodpressurewereperfectlynormal.Shesmiledupat him.

ThelookonKrayenbühl’sfacewasexhilarating.Yasargiltookadeep

breath.Hadhejustperformedtheworld’sfirstpercutaneousarteriogram?

---

Afterafewpatientshebecameadeptatplacinganarterialneedlein

eitherthecarotidorthevertebralartery.Puncturingthevertebralartery

with consistency was easier than he had expected it to be. Overnight,

arteriographywithoutasurgicalincisionbecamecommonplaceinthex-

ray department. Percutaneous arteriography was safe and it minimized patients’discomfort.Therewerenocomplications.Threeorfourcouldbe done in an hour, possibly more. Krayenbühl began requesting percutaneous arteriograms for patients he wouldn’t ordinarily have consideredfortheopenprocedure.Withtheinformationtheyprovided, fewer surprises would occur during brain operations, therefore making them safer. Yasargil’s primary responsibility in the neurosurgical department became performing cerebral arteriography daily. It was not brainsurgery,butitwasimportant.Itenabledhimtomakeatangible contributionwithinKrayenbühl’sdepartmentimmediately. From the beginning, a minimum of three or four patients were

scheduledforarteriographyeachday.Yasargilrecordedthedetailsofhis findings in a series of notebooks, cataloguing precisely the path and variationsofeachintracranialvessel,alsohowtheirsubtledisplacements revealedvariousmasslesions,includingtumors,abscesses,andclotsfrom intracranialbleeding.Byperiodicallyreferringtohisvoluminousnotes— keepingaseriesofhypothesesfocusedinhismemory—hebegantomake senseofanatomicaltrends.

---

ItislikelythatYasargil’sinitiativewithpercutaneousarteriography affordedhimaccesstoKrayenbühlthathiscolleaguesdidnothave.Not onlywashewillingtoworkhardandlong,hewasthoughtfulandquick, even willing to take chances when appropriate. Almost certainly

Krayenbühlrecognizedthesecharacteristicsearlyon,andwasdetermined

tomakegooduseofthem.

Inanycase,KrayenbühlandYasargilbegantoporeovertheday’sx-

rays and arteriograms together in the evenings. For Krayenbühl, anticipatingwhatwouldhappenduringsurgerythefollowingmorningwas uppermostinhismind.Yasargil’sabilitytoassimilateinformationquickly andprocessitinspecialwaysmadehimaperfectsoundingboardforhis boss.Hecouldbecountedontoneverhesitatetostateafreshopinion, supplying Krayenbühl, an intimidating personality to many, with a differentpointofview. ForYasargilthoseeveningsessionsnotonlyamountedtoatutorial on the current benefits and limitations of neuroradiology, they also provided a perspective from which he could learn to plan operations. Radiologistsinthex-raydepartmentwerestillgeneralistsandhadlimited knowledge in the details of brain anatomy. Neurosurgeons at the Kantonsspitalwereontheirowntoprocesstheirownx-raysandmake

theirowninterpretationsofthefindings.Yasargilimmersedhimselfinto thebusinessofmakingintracranialanatomycomealiveonx-rayfilm. It was also an opportunity to take the measure of Krayenbühl, indisputablyoneofthebrightlightsofEuropeanneurosurgeryatthetime. FromKrayenbühlhelearnedthecostofsuccessatthatlevel.Krayenbühl’s tirelessdedicationwasimpressive.Itwasclearthathehadalifeoutside the hospital, but it was always secondary to his professional responsibilities. He was content to sit in his office until midnight and beyond,thinking,discussing,exploringideaswithhisyoungprotégé.In Krayenbühl, Yasargil also found a mentor of considerable depth in literature,history,andart.Hewasreputedtopossessoneofthegreatest collectionsofChineseartinEurope. Forhourseacheveningtheyexaminedthearteriogramsofpatientsto beoperateduponthefollowingday.Siximagesweremadeinsequenceas dyecoursedthroughthebrain’svascularsystem,firstwiththex-raytube positionedatthesideofthepatient’shead,thenfromabovetheforehead. Withineightsecondsafterinjectiontheearlyandlatearterialphaseswere documented,thenthecapillaryphaseandvenousphases.Thegoalwasto determinethesize,shape,andlocationofeachpathologyaspreciselyas possible,alongwithitsvascularcomponents,whichallowedKrayenbühl todevisesafer,moreefficientsurgicalapproachestothem. They spent even more time studying arteriograms revealing no pathology,givingthemtheopportunitytoworkoutpreciselythevariations of normal. Only a fraction of the patients from the outpatient clinic harboredsurgicallesions.Itwasimportanttodeterminewhichoneswould benefit from surgery. The era of exploratory craniotomies based on patients’historiesandneurologicalexaminationswasrapidlypassing. Over time, by comparing preoperative studies with Krayenbühl’s surgical findings, they came to recognize more and more subtle arteriographicabnormalities.Theybegantounderstandthateventhemost

subtlefindingswereoftensignificant.Sometimes,noticingthatonlyatiny wispofavesselwasdeformed,oroutofplace,waskeytoestablishinga difficultdiagnosis. Soontheywereperformingstereoarteriography.X-raysweremade beforeandafterrotatingapatient’sheadfourorfivedegrees,injectinga bolusofcontrastmaterialeachtime.Yasargillearnedtoassesssuchpaired x-rayssimultaneouslybyadjustingthemforwardorbackwardoneither sideofadoublemirrorinadevicedesignedto“stereo”plainskullx-rays. Byconcentratingontinyperipheralvesselsoverlyingthebrain’scortexas they coursed over gyri and dipping into sulci and fissures, they could actually“see”thebrain’ssurface.EventuallyYasargillearnedto“stereo” x-raysasKrayenbühldid,simplybycrossinghiseyes.Stereoarteriography enabledthemtovisualizearteriesandveinsasa“skeleton”ofthebrain.Of courseitwasanindirectview—tinyvesselsonthesurfaceofthebrain outlining its substance—but the method was accurate and useful. It revealedfarmorethanthewidevoidcircumscribedbytheinnertablesof theskullonplainx-rays. Thetechniquegavethemaspecialperspectiveofbraintopographyin theregionoflesionstobeoperatedon,enhancingtheirperceptionsand allowingthemtorefinespecificsurgicalstrategiesandtacticsbeforehand. Although stereoarteriography was not to be adopted by every neurosurgicalcenteroverthecomingdecades—noteveryexaminercould

perfecttheknackof“3D”visualization(withorwithoutthemirrordevice)

—inZurichitremainedanimportantdiagnostictool.Evenfortyyearslater Yasargilcontendedthatitpossessedadvantagesnotaffordedbymodern methodsofvisualizingthebraininthreedimensions.Inhisopinioneven MRI did not provide comparable views of the relationships between certainbrainlesionsandcorticalsurfaces. Deepveinsalsowereanalyzedsystematically.X-raysdocumenting theearlyandlatevenousphasesofcerebralcirculationwereexamined

stereoscopicallyfirst,identifyingthepositionsoflandmarkstructuressuch astheseptalvein,theinternalcerebralveins,thebasalveinsofRosenthal, and the transverse venous sinus system. Equally important were the smallerveins,includingthosedraininganeoplasmoraninfarct.Thenthe capillaryphasewasstudied,searchingforablushoftumorvascularityora veinoutofsequencewithothers.Finally,theyanalyzedtheearlyandlate arterial phases of cerebral circulation for displacements or other abnormalities. They determined that tips to a tumor’s histology often lay in its patternofvascularity,themoredestructivelesionsdisplacingvesselsto theperipheryofobviousmasses.Theabsenceofbloodvesselsdeepwithin such lesions typically correlated with necrosis, cyst-formation, or hemorrhagewithintumorstheyencounteredatsurgery. The high circulation rates associated with aggressive tumors were signaled by veins appearing out of sequence, earlier than expected. Diligently they searched for “early veins,” which characterized certain tumorsandareasofbrain“softening,”theresultoftissuedeathfromthe lossofbloodsupply.Infarcts,orstrokes,weredistinguishedfromtumors bythefactthatvesseldisplacements,characteristicoftumors,werenot present. Undoubtedly others made similar observations in neurosurgical centersaroundtheworld.Ultimately,overtimeandthroughcasereports anddiscussionsatneurosurgical(andlaterneuroradiological)conferences, suchconceptswereconfirmed.

---

In truth, Yasargil had not performed the world’s first vertebral arteriogram.Similarprocedureshadbeendoneasearlyas1940. 4 , 5 , 6 , 7 Andalthoughhethoughtpercutaneouscarotidarteriographywashisidea,

thatwasnotthecaseeither.Theyhadbeenperformedasearlyas1936. 8 , 9 ButtheseprocedureswereverynewinZurich,andhe,byincreasingthe numberandqualityofthearteriogramsperformedonlyafewmonthsafter arrival,waskeytorapidprogress. Comparedtocarotidarteriography,vertebralstudieswererequired infrequently.Mostpublicationsaboutthemdescribedthefindingsofonly a few patients. With Krayenbühl’s clinic serving a rapidly increasing numberofpatients,Yasargilavailedhimselfoftheopportunitytoamass onehundredvertebralarteriogramsineighty-onepatientsinlessthana year.Thenhesummarizedthefindingsanddescribedhistechniqueina paperthathesubmittedforpublication.Itwasacceptedimmediately.He hadpublishedinhisfirstyearasaneurosurgicalresident! 10

---

He continued to assist Krayenbühl and Weber in the operating theater,andperformedcraniotomieshimselfforbraintrauma,mainlyat night.Hegotanopportunitytoperformabraintumoroperationfromtime totime,withKrayenbühlassisting.Progressivelyhisexperienceincluded spinalprocedures.Eventhen,though,hisprimaryroleinthedepartment wasasitsneuroradiologist. Asheincreasinglyimmersedhimselfintoneuroradiologicalprojects, hebegantofeelthepressoftime.Hissolutionwastogiveupsleepingon TuesdayandThursdaynights,permittinghimselfonlyabriefnapanhour orsobeforedawnwhenpossible.Thosenightshespentcollatingand organizinghisnotesandx-rayfilms,searchingforepiphaniesforfuture publications.Inthequietofthosehourshewroteandrewroteanumberof manuscripts. Trouble came only when he was called to the operating theaterforanemergencyonaWednesdaynight,whichrequiredhimtoget byonoccasionalnapsfromTuesdaymorninguntilFridaynight,astretch

of more than one hundred hours! Some might consider making an exception for Thursday if he’d had to operate into the wee hours on Wednesday.NotYasargil;ifhehadaplanhewouldsticktoit.Itwasa schedulehewouldkeep,atleastinpart,foryears. Legendaryamountsofenergytypicallyexhausteventhegreatestof humanstaminaovertime,leadingtoinevitablestress.Soonhefellinto experimentingwithcigarettes,Turkishtobacco,ofcourse.Veryquickly the habit claimed him. When Krayenbühl got wind of it, though, he stoppeditinnouncertainterms.Therewerenohints,lectures,orthreats, onlyasingleconfrontation.Withthecommandtostopsmoking,Yasargil nevertouchedanothercigarette.HetrustedKrayenbühl’sadviceashehad hisfather’s.InaveryrealwayKrayenbühlhadbecomeasecondfatherto him.

---

Krayenbühl’s primary interest lay in the traditional neurosurgical pathologies of the day—tumors and abscesses that demanded surgical treatment.Ofthetreatmentsavailableforvasculardiseaseintheearly 1950s,virtuallynone wereeffective.The followingchapterdeals with someoftheill-advisedattemptsKrayenbühlinsistedupon,whichdidnot catchYasargil’sfancy.Butitwasbloodvessellesionsthatrapidlybecame hisfocus.Therehadtobeawaytodealwiththem. IntimeYasargil’sexperiencewithneurovascularx-raysswelledfrom hundredstothousandsofstudies.Hebecameexpertwiththevarioussizes, shapes,andlocationsofintracranialaneurysms,blister-likeoutpouchings fromarterialwallsatsitesofbranching.Aneurysms,withdefectivewalls bydefinition,werepronetorupturewithoutwarning,causingparalysis, dementia,and/ordeath.Healsodevelopedagreatinterestintheclumps andtanglesofabnormalvesselsill-fatedpatientshadharboredsincebirth,

arteriovenous malformations. Within an AVM blood flow bypassed normalcapillarybeds,notonlyrenderingthecirculationinefficientand resultinginperiodicischemicepisodes,butsettingthestageforconvulsive seizuresanddevastatinghemorrhages. YasargilandKrayenbühlwerefrustratedthattheveinsdrainingthe eye were not detectable by either carotid or vertebral arteriography, presumably because such veins were in continuity with the prominent periorbitalvenoussystems(cavernoussinusandpterygoidplexus).This problem prohibited precise arteriographic study of patients with exophthalmos(bulgingoftheeye),atypicalfindingamongpatientswith tumorsintheorbit(eyesocket).Eventhoughorbitalneoplasmswerenot alwaysthecauseofexophthalmus,surgicalexplorationwasnecessaryto rule out the possibility of their presence. Open surgery, under general anesthesia,amountedtoahugestep,particularlyinchildren,whomadeup thegroupofpatientsmostoftenafflicted.Therehadtobeawaytomake suchproceduresunnecessary. Yasargilsetouttofindawaytostudythevenoussystemoftheorbit withoutinvolvingthearterialsystem.Hediscoveredthatcompressingthe veindrainingthemid-portionofthefaceoftencausedaveinimmediately beneaththeeyetodilatesufficientlyforaneedletobeinsertedintoit. Injectingthatveinwithradiographicdyemadeimagingtheveinsdraining theorbitpossible.Incaseswherepercutaneousaccesswasnotpossible, theveincouldbeexposedsurgically. 11 Anorbitalvenogramhadbeen performedonceinMexicotoidentifyanorbitalvenousmalformation, 12 butithadnotyetbeenreportedelsewhere.PriortoCTandMRIitbecame theroutineprocedureforevaluatingthepossibilityoforbitalmassesin Zurich. Notonlydidorbitalvenographysavescoresofchildrenfromsurgical explorations,itallowedthepreciseplanningoforbitaloperationswhere tumors were actually present. Yasargil published their experience with

overonehundredcasesinaSwiss-Germanjournalin1957. 13 Nineyears

laterKrayenbühldiscussedtheirexpandedseries(261cases,allstudied

radiographicallybyYasargil)ontheoccasionofhisbeingthehonored guestoftheCongressofNeurologicalSurgeonsin1966atSanJuan. 14

---

In 1955 Krayenbühl sent Yasargil to Vienna to observe a new technique being developed there, echoencephalography. By bouncing ultrasonicbeamsoffdensemidlinestructuresinsidethehead,mostoften the falx cerebri, the tough fibrous structure between the cerebral hemispheres, one could determine if a pathological shift was present. Echoencephalographywasfarmoresensitivetothepresenceofcalcium thanaplainx-ray,andthereforeapplicabletomanymorepatients.Itcould beperformedquickly,non-invasively,andatthebedside.Yasargilbrought the technique back to Zurich and presented it to the department’s electroencephalographers,RudolphHessJr.andothers,whobecameadept atperformingit.Itwasespeciallyvaluableincasesofintracranialtrauma, strokes,andinstancesofunconsciousnessofunknowncause.

---

In 1958 Yasargil and Krayenbühl published a monograph on the arteriographic diagnosis of intracranial aneurysms and arteriovenous malformations. 15 SinceKrayenbühl’sphilosophywithAVMswasquite conservative, another fifteen years would pass before serious attempts wouldbemadetosurgicallyresecttheminZurich.Forthispublication Krayenbühl insisted that many of the illustrations appear in full color. Although he and Yasargil were proud of their operating theater photography, printing color photographs was expensive, increasing the book’s price, and therefore limiting its circulation. Few neurosurgeons

readit.Thefollowingyeartheycontributedlargesectionstoabookon anterior communicating artery aneurysms, which was published in France. 16

Asthearteriogramspiledupinthelater1950s,Yasargilrealizedthat

cadaver dissections were crucial if cerebral vascular anatomy and its variations were to be fully understood, particularly with respect to the venoussystem.Noatlaswasavailable,oramonographdescribingthe detailsofanatomicalvariants.Slowly,workingaloneonweekendsinthe pathologydepartment,hesystematicallyinjectedthecerebralvesselsof fixedcadaverspecimens,andstudiedtheirrelationships,keepingextensive drawings and notes of his work. In early 1963 he reviewed his vast arteriographicdatainthelightofthesefindings.Bythen,seventhousand arteriogramsandthearteriesandveinsoftwohundredinjectedcadavers wereavailable,afulltenyears’work,clearlyenoughmaterialforamajor textbook.Overthenextyearandahalfhedevotedeverysparemomentto itspreparation.

---

YasargilandDorlyArnoldmarriedin1956,andthreechildrensoon

followed.Athometheoldestofthemscrambledamongstacksofhisnotes and x-rays, screeching for her daddy’s attention. Ultimately all his materialsweretransferredtothebasement,whereatablewassetupthat waslargeenoughtostorehismaterialswithoutfearoftheirbeingsoiledor rearranged.Thechildrenunderstoodtheywerenottodisturbanythingon thattable. YearslaterYasargilwashesitanttodescribearecollectionofhis daughter standing at the foot of the basement stairs after dinner one evening,pouting.Almostintears,shestuckouthertongueathim,and said,“Youdon’tcareaboutme.Youonlycareaboutyourx-rays.”His

childrenoftenfoundhimthenextmorningastheyhadlefthimthenight

before,hunchedoverthemakeshifttablescratchingoutpageafterpage.

---

Performingarteriographyonhundredsofpatientsinhisearlyyearsin

Zurich,helearnedlessonsthatwouldaffecthissurgicalphilosophylater,

particularly with respect to the timing of operations. For instance, he recognizedthatperformingarteriographyonunconsciouspatientsrarely resultedinagoodoutcome.Possiblyafewsuchpatientscouldbesaved, especiallythosepresentingwithepiduralbleedingfollowingheadtrauma, butthevastmajoritydied,particularlythosewithacutestrokes,whether fromspontaneoushemorrhageorvascularocclusion.Earlydiagnosisand treatmentdidnotchangetheoutcomesofsuchstrokes.Hewasconvinced that,withtheexceptionofheadtrauma,emergencyarteriographyrarely servedunconsciouspatientswell,andcouldactuallyhastentheirdemise. Observinghowfullyconsciouspatientsreactedduringarteriography confirmeditwasstillfarfromabenignprocedure.Underlocalanesthesia, evenunderthebestofcircumstancespatientswereuncomfortable.Itwas necessaryforthemtoliestillonahardx-raytable,andmanybecameeven moreupsetwhentheirprocedureswereprolongedifadditionalx-rayswere required.Semiconsciouspatientswereevenmorerestlessandirritable,and theirbloodpressuresandpulseratescommonlyreflectedthestressthey

faced.Yasargilgenerallyresistedperformingarteriogramsonnon-head-

injuredpatientswhowerenotfullyconscious.Bywaitingadayortwo, mostrecoveredsufficientconsciousnessforarteriographytobecarriedout withoutcausingharm. He relied on such experiences to determine the optimum time to operate on patients with aneurysms. He concluded that if no life- threateninghematomawerepresent,unconsciousaneurysmpatientsshould

betreatedsupportivelyuntiltheyimproved.Later,inthe1970sand1980s,

controversywouldrageallaroundhimovertheissueofoperatingwithina

fewhoursofsubarachnoidhemorrhageinordertomaximizesurvival,but

tohimitremainedamatterofconscienceandcommonsense.Humanlife

wastooprecioustokeeplearningthesamelessonoverandover:that

patientswhowerenotsettledphysiologicallywereunlikelytodowellwith

theaddedstressofananestheticandanoperation.Hecouldnotescapethe

memoryofhisfather’stalefromchildhood.Hewasdeterminedthathis

hospitalwouldnotbecomeacemetery.Hemustrecognizehislimits.

---

Yasargildiscoveredthatofapproximatelyonethousandconsecutive

patients undergoing arteriography after stroke, one hundred had totally blockedmiddlecerebralarteries.Hebecamequiteinterestedinthisgroup, specifically their survival rates and whether or not they recovered

neurologicalfunction.Hewasabletostudytwentysurvivorswithfollow-

uparteriograms.Threearteriographicpatternsemerged:A)spontaneous resolutionoftheblockage,B)persistentblockageofthevesselwithout collateralvesselsbypassingtheocclusion,andC)persistentblockagewith collateralcirculation.HenotedthatpatientsingroupsAandCwerefar morelikelytorecoverneurologicalfunctionthanthoseingroupB. Thesiteofthepersistingblockageofflowseemedtobeparticularly importanttothedevelopmentofcollateralcirculation,and,asaresult,the resolutionofneurologicaldeficits.Yasargilnoticedthatonlywhenthe blockageoccurrednearthecenterofthehorizontalsegmentoftheMCA

(thesocalledM1branch),wherelenticulostriatearteriesnormallyarose,

was there no development of significant collateral circulation. Vessels blockedneartheoriginofthemiddlecerebralartery,beforetheoriginof lenticulostriatearteries,developedretrogradeflowinthelenticulostriates

bywayofcollateralcirculationfromanumberofsources,andblockages beyond the origin of the lenticulostriates developed collateral channels fromleptomeningealvesselsonthesurfaceofthebrain.Hefocusedonthe implications of these findings for months, publishing the results independently of the book he was writing. 17 He would discuss these findings before a number of groups of neurosurgeons and radiologists

throughouttheUnitedStatesin1966.

This subset of patients spurred his interest in studying collateral circulation developing in any stroke patient, even those whose strokes weredeterminedtoberelatedtocarotidarterypathologyintheneck.At thetime,suchstrokesweregenerallyfelttobetheresultof“vasospasm,” thespontaneousnarrowingofpertinentcerebralarteries.Atheoryofthe dayproposedthatsuchspasticnarrowingresultedfromthesecretionofa mysterious substance or “humor” from the extracranial carotid artery bifurcation.ForyearsKrayenbühlinsistedthatstrokepatientsbeexplored surgically and their carotid bifurcations be ligated, sometimes even excised.ButYasargil’sarteriographicfindingsinthesetwentypatientsdid notsupportthatpractice. Thisworriedhim,particularlysincehewasrequiredtooperateon strokevictimsfromtimetotime.Hebelievedthatbothcarotidligationand bifurcationexcisionhadnegativeeffectsoncollateralcirculation.Such procedures reduced the chances for survival. Furthermore, he was reasonablycertainthatvasospasmdidnotoccurinstrokepatients.Many wereconvinceditdid,buttherewaslittleevidenceforitinthethousands ofarteriogramshehadperformedstoke.Heunderstoodthatadisputewith Krayenbühlloomedonthehorizon.

---

Forelevenyears,until1964,Yasargilwouldspendfullyhalfhistime

with neuroradiological pursuits. His mind grappled with surgical difficulties as he operated regularly as a staff neurosurgeon, but his research and original contributions came from his work in the x-ray department.Throughhispublicationsandpresentationsatneurosurgical meetingshebecameknownthroughoutEuropeandbeyond.Patientlyhe bidedhistime,realizingthathisbestdaysasasurgeonlayaheadofhim. HealsorecognizedthatonedayhewouldbemorethanKrayenbühl’s assistant.Inthemeantime,though,hehadestablishedforhimselfquitea reputationasaneuroradiologist. By 1964 he had published ten papers on arteriography, plus over thirtyonotheraspectsofneuroradiology.Buthismajorworkwasthebook basedoncadaverdissectionsandliterallythousandsofarteriogramson livehumans.TheGermanlanguageeditionofCerebralAngiographywas

publishedin1965,ItalianandEnglisheditionsfollowingin1967and1968

respectively.AlthoughitwasnotwidelydistributedintheUnitedStates,

thebookwasamajorsuccessinEurope.

CHAPTERELEVEN

VascularSurgery

andStereotaxis

RESECTING THE COMMON CAROTID bifurcation to treat a strokepatientwouldseemabsurdtovascularsurgeonsevenasearlyas

1958.Somesurgeonsintheearly1950s,though,Krayenbühlamongthem,

speculatedthatstrokesresultedfromanunknownsubstancebeingreleased into the bloodstream from within the carotid bifurcation that caused narrowingandblockageofsmallerarteriesfartherupstream.Yasargil,on

Krayenbühl’sdirection,performedtheoperationforthefirsttimein1953.

He had been a neurosurgical resident for hardly months. The patient, unconsciousandparalyzedbeforesurgery,diedwithinweeks.Removing (orsimplyligating)thecarotidbifurcationoftenhadlittleornoeffecton patientsawakeafterstroke,andtheunconsciousuniformlydied,withor withoutsuchsurgery.Oftheotheravailabletreatmentoptions,Krayenbühl sanctionedonlyblockingthesympatheticnervefibersarisingfromthe carotid bifurcation by injecting the stellate ganglion with a local anesthetic. Yasargil viewed it as useless as removing the carotid bifurcation.Theonlyotheravailabletreatment,anticoagulation,seemed moredangerousthaneffective. Thefollowingyear,withKrayenbühloutoftown,Yasargiltooka similar patient to surgery determined to try something different. Arteriography had revealed only a narrow stream of flow beyond an obstructionattheoriginoftheinternalcarotidartery.Insteadofligatingor

removingthecarotidbifurcation,heplacedtemporaryligaturesaboveand belowthefirmplaquehecouldfeelthroughthewallofthebifurcation. Thenheopenedthevessel,removedtheplaquealongwithanattached

thrombus,thenclosedthearterialwallwith4-0silksutures—materialhe

judgedtobetoocoarseforthetask,butitwasthefinestsutureavailable. Hewasconfidenthehadimprovedbloodflowtothepatient’sbrainsince there were bounding pulsations in the artery beyond the site of the previousblockage. Pleased,helookedforwardtoKrayenbühl’sreturn.Ifnothingelse,he hadprovedtohimselfthatabloodvesselcouldbeopenedandclosedand stillcarryblood!Therewasnoleakageatthesutureline. ButKrayenbühlwasfuriouswhenhefoundoutaboutit.“Youdid what?”heroared.“Howisthepatient?Ishealive?” “Yes,sir,”Yasargilresponded.Themanwasdefinitelynoworse,and possibly would get better over time. Yasargil hoped to confirm the improvedbloodflowbyarteriographyafterafewdays. “Ican’tbelieveyoudidthisbehindmyback,”Krayenbühlwenton, pacing back and forth, his eyes blazing. “Can’t I be absent from the departmentforonedaywithoutyoudoingsomethingcrazy?Whatyou’ve doneisverydangerous.Youhavechangedthehemodyamicsofthispoor man’sentirecerebralcirculation.Hewilldieforcertain.Youwillsee.” Butthepatientdidnotdie.Hishemiplegiafailedtoimprove,buthe survived.Yasargildidnotrequestpermissiontoperformapostoperative arteriogram.HeknewhehadpushedKrayenbühldangerouslycloseto curtailinghissurgicalopportunities,ifnoteliminatingthemaltogether. Thechiefruledtheneurosurgicaldepartmentwithanironhand.However ridiculoushethoughtKrayenbühl’sconceptoftheetiologyofocclusive strokewas,heknewhecouldn’triskhisangeragain. Itislikelythathehadperformedoneoftheworld’sveryfirstcarotid thromboendarterectomies. Michael DeBakey reportedly performed the

operationin1953,buthispublicationwouldnotappearforanotherfive

years. 1 Krayenbühl was never known to acknowledge his mistake, essentially conceding the development of carotid endarterectomy to DeBakey’sgroupinHouston,amongothers.Bytheendofthecenturythat operationwaswidelyconsideredthebestsurgicalmanagementforcarotid strokes.Somesuchstrokeswerepresumedtoresultfromemboliarising fromthrombiattachedtocarotidbifurcationplaques,andothersfrompoor flowintheadjacentinternalcarotidartery.Inbothcases,newstrokes couldbepreventedwithatimelycarotidendarterectomy,andinsome casestheresultingenhancementofcollateralflowimprovedrecoveryfrom theinitialstroke. Yetoverthefollowingforty-fiveyearsYasargilmadenoclaimof havingperformedthefirstcarotidendarterectomyorhavingbeenapioneer ofcarotidarterysurgeryinanyway.Hedidadmit,though,tohavingbeen

saddenedbynotbeingabletofollowhisinstinctsin1954.

WithinafewmonthsofYasargil’sthromboendarterectomy,Eastcott, Pickering,andRobreportedresectingathromboticplaquefromapatient’s carotid bifurcation. 2 They were unable to restore flow in the internal carotidarterybutuseditsstumptowidentheoutflowtrackoftheexternal carotid artery. Their report was destined to stir the interest and imaginations of vascular surgeons everywhere, prompting wholesale attemptsatcarotidarterysurgery. Charles Rob came to Zurich the following spring to discuss the operationheandhiscolleagueshadperformedinLondon.Yasargilwas thrilledtohearhimemphasizethattheiroperationsucceededbecauseit hadincreasedthecollateralcirculationaroundtheinternalcarotidartery blockage,aphenomenonwhichwasinstinctiveforhim.Yasargilglanced atKrayenbühlfollowingthecomment,butKrayenbühl’sfocusremained straightahead.Hehadtoseethattheoperationstheyhadbeendoingin Zurich—eliminating the carotid bifurcation—were precisely what they

shouldnothavebeendoing.Thoseoperationsreducedthelikelihoodof natural collaterals forming. The external carotid artery, arising at the bifurcation,mustbepreservedwheneverpossible.Robandhisassociates hadgoneoutoftheirwaytopreserveit.ToYasargil’srelief,thenextday Krayenbühlannouncedthatthebifurcationwouldnolongerbeligatedor resectedattheKantonsspital. Suddenly Yasargil had other avenues to explore. His interest in vascularsurgerywouldleadhiminanentirelydifferentdirection,one whichwouldfurtherconfirmhispenchantforindependentthinking.

---

He accompanied Krayenbühl to the 1956 World Neurosurgical CongressinBrusselsandwasfascinatedbyapresentationofstereotactic surgery.TraugottRiechertoftheUniversityofFreiburg,thenaleader among European stereotactic neurosurgical centers, described his technique.Hedemonstratedaspecialapparatus,acalibratedframesecured toapatient’shead,whichwasdesignedtoguideanelectrodetoprecise targets within the brain. Then he presented a series of patients. Heat lesionshadbeengeneratedtowithinfractionsofamillimeteroftargetsin theglobuspallidusandvariousthalamicnucleiinthebrainsofpatients withParkinson’sdisease.Bydestroyingtinyneuralelementsinsuchareas, resttremorsandmuscularrigidityweredramaticallyreduced,ifnottotally relieved. Krayenbühlhaddoneseveralcraniotomiesonparkinsonismpatients inordertoperformchemopallidectomiesasdescribedbyIrvingCooperin NewYork. 3 , 4 Hehadpassedalongneedlefreehandthroughthefrontal lobeintothebasalgangliaregion,ultimatelydestroyinggroupsofneurons byinjectingsmallquantitiesofalcohol,supposedlyintheglobuspallidus. Theresultswerevariable.Sometimestremorswerediminishedinstantly,

orapatient’srigiditywasreducedtosomeextent.Othertimesnochange at all resulted. One patient remained lethargic for days after surgery; another developed a speech deficit; and several experienced alarming intellectualchanges.ItleftCooperdiscouraged. But Riechert’s technique offered hope. Lesions were made with mathematicalprecisionthroughaburrholeunderlocalanesthesia.Andthe resultswerefarsuperiortoKrayenbühl’sattemptsatmakingfree-hand lesionsthroughanopenskull.ThatnightYasargilcouldnotsleep.Buthis insomniawasnotinducedbythoughtsoftreatingparkinsonismandother movement disorders. It was vascular disease that kept him awake, specificallyaneurysms.Hewasexcitedaboutthepossibilityofemploying Reichert’stechniquetotreataneurysmsanentirelynewway. Afterperformingarteriogramsdailyforthreeyears,hewasobsessed with the treatment of aneurysms and vascular malformations. Direct surgery,throughanopencraniotomy,wasuncertain,withfewsurvivors abletoreturntonormallives.Heenvisionedabetterway.Whycouldn’t Riechert’sstereotacticmethodbeadaptedtoobliteratinganeurysms?After stereotacticallyplacingthetipofaneedleagainstthewallofananeurysm, irondustorsomeotherthrombosis-producingsubstancecouldbeinjected insideit,potentiallyeliminatingtheaneurysmfromthebrain’scirculation withoutperformingacraniotomy.Mortalityratesshouldbelow,andbrain swellingorbleedingwouldbeunlikely.Ifsuccessful,aneurysmsurgery wouldberescuedfromthedarkages.Consequently,hewasconvincedhe hadtolearnthestereotacticmethod.Itwastoogreatanopportunitytopass up.

OntheflightbacktoZurich,heagonizedoverhowheshouldword hisrequesttoKrayenbühl.Hemustnotberefused.Butpossiblyheshould consider his idea a little longer, sleep on it another night or two. Krayenbühlwasnotoriouslyquicktorejectanyideanotexaminedfrom everyconceivableangle.AskingtospendamonthortwoinFreiburg

couldsendKrayenbühlintoatirade.Yasargilknewhisabsencefromthe departmentwouldcreatehardshipsforthestaff.Thecaseloadrequired everyoneworkingeveryday. Finally he decided to throw caution to the wind, thinking that Krayenbühlmaybehavingsimilarthoughtshimself.Itmaybetheperfect timetobringupthesubject.Hismouthwasdryashebegantospeak. Krayenbühl listened with half-closed eyes. “Please, let me go,” YasargilsaidwhenKrayenbühlseemedtodozeoff.“Icandoitduringmy vacation.IpromiseIwillmakeitwork.Iwilllearneveryaspectofthe Freiburgoperation.”ForalongtimeKrayenbühlsaidnothing,butfinally he relented. It is likely Krayenbühl discounted treating aneurysms stereotacticallywithoutanotherthought.Hewasthinkingabouttreating movement disorders, problems that were far from solved by the open methodhehadbeenusing.Reichert’sdemonstrationwasimpressive. In November 1957, Yasargil journeyed to Freiburg. He had been thereonlytwoweekswhenhetelephonedKrayenbühl.“Tomorrowtwo operations are scheduled. You must come and see for yourself. Their techniqueisverygood.Itissomethingwecandoourselves.” He and Krayenbühl watched as Riechert made a burr hole in a patient’s head under local anesthesia. Once the dura was opened, Riechert’sassistants,FritzMundingerandRolfHassler,tookover,making

the necessary mathematical calculations, then adjusting the stereotactic frameandloadingthelesion-generatingelectrode.Theyworkedwithslide

rules,overthegraph-ruledpagesofawornstereotacticatlas.Afterdouble-

checkingandtriple-checkingtheircalculations,theypassedtheelectrode towardatargetaprecisedepthinthepatient’sthalamus,thenchecked their calculations once again. Finally they stimulated the area with a limitedburstofcurrent,closelywatchingthepatient’sface,arm,andleg ontheoppositesideofhisbody.Involuntarymovementsofanykindcould indicatethattheelectrodewasdangerouslyclosetotheinternalcapsule,

wherepyramidaltractfiberswerebunchedtightly.Makingalesionatsuch a site could result in permanent paralysis if it weren’t precise and circumscribed.Repeatedlytheyquestionedthepatient,askingwhathefelt, howthestimulationaffectedhim,carefullynotinghisresponses.Then, whentheywerecertaintheelectrodewaspreciselyplaced,theydelivereda coagulating current, destroying a finite population of brain cells. Mundingerplacedastethoscopeagainsttheoppositesideofthepatient’s headandlistenedforthepoppingsoundconfirmingthereleaseofgasasa smallamountofbrainwasvaporized.Immediatelythepatient’stremor lessened, and he was able to move his arm and leg more freely, less encumberedbyrigidity.Itwasamagicalmoment. EvenKrayenbühlhaddifficultyhidinghisexcitement.Hequestioned Riechertextensively,thenMundingerandHassler,andfinallyreviewed theircalculationsandtheiratlas,makingmentalnotesoftheirprotocol. Krayenbühlwasnomantojumptoconclusions,buthewasimpressed. “Okay,”hesaidlatertoYasargil.“Iagree.Wecandothis.” YasargilstayedinFreiburgforanadditionalfourweeks.Krayenbühl expectedhimtolearneverythingaboutthemethod,exactlywhatcouldgo wrong and how it could be prevented. The technical details would be Yasargil’stotalresponsibility. Oneproblemwasthevariabilityofthesizeofthelesiongenerated. Somepatientsrequiredthegenerationofmorethanonelesiontoachieve thedesiredeffect.Therewasalsotheproblemofexcessivelycharring braintissue,evencreatingaboilingeffectifthecurrentwasnotincreased in measured increments. It was better to make several lesions than to increasethecurrentprecipitously.Sometimesabitofbraintissueoreven clottedbloodwasapparentonthetipoftheelectrodeasitwaswithdrawn. Ifthecoagulatingcurrentcouldincitebleeding,allsortsofneurological disasters were possible—permanent weakness or clumsiness of the extremities,dramaticpersonalitychanges,perhapsevendeath.Riechert

wasdeadsetagainstmakinglesionsonbothsidesofthethalamusonthe samedayinthesamepatient.Hehadseensuchbilaterallesionsresultin comaandpermanentintellectualloss.Unrecognizedbleedingcouldbethe sourceofsuchproblems.Stereotacticsurgeryremainedverymuchinits infancy,butitsdangerswereclear. Within a few weeks Yasargil had collected all the necessary instrumentstostartupstereotacticneurosurgeryinZurich.Hepurchased themfromtheFisherCompanyfortwothousandmarksandhadthem securelypackedinalargemetalcase. Hewasanxiousasheprocessedthroughthecustomscheckpointat thetrainstationinBasel.He’dknownhemighthavedifficultygettingthe instrumentsintoSwitzerlandbutwasdeterminedtomakeit,somehow. Nowhewasn’tsosure.Acustomsofficiallookedattheboxsuspiciously. “Whatisthis?”hegrowled. “Surgicalinstruments,”Yasargilreplied,musteringalltheimportance hecouldsummon,daringeventomimicKrayenbühl.Hehadbeentold medicalinstrumentswereonthecontrabandlist,butwhy?Itdidn’tmake sense. Theagentwasshockedbytheweightoftheseventy-poundcaseashe hoisteditontotheinspectiontable.Ashestruggledtocontrolit,helosthis balanceanddroppedit.Crashingtothefloor,itlandedononecorner, springingthelatchmechanism,throwingthelidwideopen. Alarmed, Yasargil sprang forward to inspect the instruments for damage.Eachoneremainedsecurelylockedintoplacebymetalclamps. Onlythecaseitselfwasdamaged,asinglecornerbent. Buttherewasnowayhecouldallowtheopportunitytopass. “Mein Gott!” he roared, his hands flying in the air. “Look what you’ve done! These are very expensive instruments. The university is countingonthem.” Heunlatchedthedelicate-lookinginstrumentcarrierandhelditupto

thelight,inspectingitsshinysurfacewhereitwouldbeconnectedtothe aimingbow,feignedanxietyonhisface.Thenhetookoutacoupleof electrodesandsighteddowntheirlengths,thenexaminedtheirgleaming tips,mockworryonhisface. “I need these instruments to perform brain surgery in Zurich tomorrowmorning,”hebeganinhismostauthoritativetone.“Nowthatis notpossible,andyouareresponsible,”hescreamed,andaskedtheagent for identification. He made a show of squinting at the agent’s clip-on nametag,fumblinginhispocketforapentojotdownhisidentification number. “We must make a list of everything that is damaged. These are precise instruments, extremely expensive, not available anywhere in Switzerland.” The agent’s face turned red and he began to sweat. He stared at Yasargil for a few seconds, then at his colleague across the aisle. Eyebrowswentupamongtheothersintheprocessingline.Suddenlythe agent snapped the box shut and motioned for Yasargil to pick it up. Hurriedly he stamped a paper and handed it to him. “Go,” he said brusquely.“Leave!” Relieved,Yasargilgathereduptheinstrumentsandhisotherbagand practicallyracedfromthecustomscheckpoint. Buthehadnointentionofoperatingimmediately.Therewereaspects oftheRiecherttechniqueheremaineduncomfortablewith,especiallyifhe wasgoingtoberesponsiblefortheresultsofRiechert’ssurgery. Thenextdayhediscussedtheproblemsofcontrollingthecoagulating currentwithhisyoungerbrother,Günay,nowanelectrophysiologistin Zurich,andsubsequentlywithGünay’schief,OscarWyss.Workingwith cats, Walter Rudolph Hess, head of the Physiology Institute, had

introducedthetechniqueofselectivestimulationofnervoustissuein1932.

Itledtohisworkingoutthefunctionalorganizationofthehypothalamus,

howitcoordinatedtheactivitiesofothervitalorgans.Thediscoveryhad

nettedHesstheNobelPrizeforPhysiologyin1949.Wysshadcontinued

Hess’sworkandrefinedhistechniquesfurther.Heandhisassistant,R.W. Hunsperger,hadbeenmakinghigh-frequencylesionsincatsformorethan adecade.OverthenextfewweeksWyssandHunspergeradaptedtheir coagulating system for Yasargil’s use in humans. Employing a much higher frequency current generated much less heat, resulting in more focusedareasoftissuedestruction.Itwasthereforelesslikelytoaffect surrounding nerve cells. In a series of cat experiments the electrode consistentlywaswithdrawnperfectlyclean,notatraceofclotorother debrisonitstip.Andautopsiesrevealedlesionsofconsistentsize,withno evidenceofbleeding.Yasargildecidedthehighfrequencygeneratorwas safeforhumanstereotacticsurgery,buthehadreservations. Hestilldidn’tquitetrusttheanatomyandlocalizationtechniqueshe hadlearnedinFreiburg.Hehadotherquestionsthatneededanswers.He setaboutanextensivereviewofthethalamusandbasalgangliaregionof brainspreparedbythefreezingtechniquehehadlearnedfromKlingerin Basel, this time working with a specific goal in mind. He constructed detailedclaymodels,firstofthethalamus,thenofthethalamopallidum. Theinternallayeroftheglobuspalliduswasanunusualstructure—thin, curving, quite complex in three dimensions. He decided the globus palliduswouldbesaferthanthethalamusforhisinitiallesions,butstill therewererisks.Theglobuspallidussurroundedtheinternalcapsule,the whitemattertractcarryingmotorfibersfromthemotorstripinthecortex. Inadvertently coagulating the internal capsule would be disastrous. Permanentparalysiscouldfollowwithinseconds.Anddirectlyvisualizing these structures at surgery would not be possible. Only by fully understanding the precise relationships between the target area and externalskulllandmarksplusthetopographyofthelateralventriclecould he produce lesions accurately and safely. Mapping out the pallidal

structures was dependent on electrical stimulation. He was very tense performing his first several operations in humans but the results were good,infactdramatic. Hehadgreatconfidenceinthehigh-frequencylesiongeneratorWyss hadconstructedforhim.Itwasmuchdifferentfromotherunitsemployed instereotacticcentersatthattime.Yasargilwaseagertodemonstrateitfor Hassler and Mundinger. When he did, they showed interest but had reservations.Theyparticularlyquestionedthetemperaturesgeneratedat the tip of the electrode. Professor Wyss subsequently made precise temperaturemeasurementsaslesionsweregeneratedandalsopresented the detailed physics of the lesion generator to the group in Freiburg. FinallyHasslerandMundingerwereconvinced.Theydecidedtoadoptthe techniquethemselves.Later,WyssandHunspergerpublishedadescription of their high-frequency lesion generator. 5 Soon they were available commercially.Quicklyhigh-frequencylesions,generatedfirstinZurich, becamethestandardaroundtheworld. InashorttimeYasargilbecamemorecomfortableconsideringthe thalamus as a target, specifically the ventralis oralis posterior (VOP) nucleus(theposteriorbasalpartoftheventrallateralnucleus).Itwasmore compactanditsrelationshipwiththelateralventricleseemedmorecertain.

Hebegantoperformthalamotomiesinthespringof1958,withresultsso

goodthatMundingerbegantopreferthalamiclesionshimself,ratherthan thepallidotomieshehadpreviouslyfavored.

InNovember1958,YasargilwenttoParistovisitJeanTalairach,one

ofEurope’sstereotacticgiants.HewasanassociateofMarcelDavid,a close friend of Krayenbühl’s, and chairman of the department of neurosurgeryatl’HôpitalSainteAnne.Talairach,thenforty-eight,ahighly decorated member of the Résistance after the German occupation of

Francein1940,dominatedthedepartmentwithhisenergyandideas.He,

workingwithDavidandPierreTournoux,hadjustpublishedanatlasof

stereotactic surgery that was rapidly gaining worldwide attention. Talairach’sframeapparatuswasslightlydifferentfromtheoneYasargil and the Freiburg group used, and his views on the potential of the techniquemoreexpansive.Hewasbeginningtousethemethodtotreat epilepsy patients, even taking biopsies of deep-seated tumors and performing pituitary ablative procedures. Yasargil stayed six weeks, watching,questioning,thinking,planning.

---

After1958,hisexperiencegrewsteadily,andsoonneurosurgeons

streamed to Zurich to observe his methods. Krayenbühl saw to it that Yasargilgotfullcreditforhisaccomplishmentsasastereotacticsurgeon, buthestilldidnotpermithimtoperformmoremainstreamintracranial operations,specificallyforbenigntumorsandvascularlesions.Yasargil continuedtospendmuchofhistimedoingspinalsurgeryandperforming craniotomiesforbraintrauma.Thesecaseswereinadditiontohisnormal dutiesinthex-raydepartment,performingpercutaneousarteriography.By

1965hehadperformedeighthundredstereotacticprocedures,mostlyon

parkinsonismpatients.Hisresultswerebestwithunilateraltremors,but patientswithmuscularrigidityimprovedtoo. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Patientswhoweresymptomaticonbothsidesofthebodyremained unsettling for stereotactic surgeons everywhere. They understood that bilateral operations were likely to produce impaired consciousness or distressfulpsychologicalchanges,andnoonerecommendedthatpractice. ButYasargilwasn’tsosureitcouldn’tbedonesafely.Hereasonedthatif hecouldcontrolthesizeandsiteofhislesionsprecisely,hecouldavoid the complications others feared. Over time he learned that staging the bilateralcases,operatingontheoppositesideaftergivingtheinitiallesion time to heal (generally several months) yielded consistently safe and

effectiveresults. 14 Thisboldideawascontroversialatfirst,butYasargil’sresultssoon quietednegativeopinions.Neurologicaldeficitshadoccurredastheresult oftheexcessiveswellingassociatedwithadjacentlesions.Allowingone lesiontohealbeforecreatingthesecondsolvedtheproblem.Hespent considerabletimewitheachpatientbeforehand,pointingouttherisksof thetechniqueandthefactthatitwasnew. He varied the size and location of lesions in a few parkinsonism patientsinanefforttoaffecttheirdyskinesia,theircharacteristicallyblank facialexpressionsandhighlymechanicalextremityandbodymovements. But it was not successful. Their dyskinesia remained. He also experimentedwithlesionsintheposteriornucleiofthethalamusinseven patientswithchronicpain.Afewseemedpossiblyimprovedaftersurgery, buthewasnevertrulyconvincedhehadhelpedanyofthem.Twoofthe sevenseemedworseaftersurgerysohegaveuptryingtotreatpain.He also stopped treating torticollis when a handful of patients showed no improvement. 15 Possibly thinking of his days in Basel, with Professor Klinger,hetreatedonepatient,achildwithtemporallobeepilepsywho hadseizures,bymakingalesionintheamygdala.Buttherewasnoclear improvement.Hemadeasinglelesion,fourmillimetersindiameter.Years later the experience he was to have with the success of microsurgical parahippocampoamygdalectomysuggestedthatthestereotacticlesionhe hadmadewassimplynotlargeenough. He was called on to treat a young girl afflicted with episodes of frighteninglyaggressivebehaviorfollowingencephalitis.Oneminuteshe wouldbesittingquietly,conversingwithherfamily,andthenextminute shewouldattackthemviciously—fighting,scratching,snarling,spitting, seethinginanger.ShewastheonlydaughterofaveryprominentZurich citizen.Thechild’sprimarydoctorhadcometoKrayenbühl,hopingthat somekindofsurgicalprocedurecouldhelpher.Heexplainedthather

parentsweredesperate,preparedtoacceptalmostanyrisk. Ultimately most of the neuroscientists at the university were summonedforopinions.Foryears,rageresponseshadbeenunderstoodto bemediatedbythehypothalamusinlaboratoryanimals. 16 Someofthe mostimportantexperimentalworkcharacterizingthisphenomenonhad beendoneinZurich.RudolphHesshimselfhadproducedrageresponses incatsbystimulatingtheirhypothalami. 17 Krayenbühl brought up the idea of making bilateral stereotactic lesions in the periforniceal areas of the hypothalamus. Yasargil was summoned. Onthemorningofthesurgerytheoperatingtheaterwasfilledwith medical doctors and physiologists. The chairman of the department of endocrinologywaspresent,alsothechairmanofinternalmedicine.Noone hadanyideawhatwouldhappen,andeveryoneofthemfearedtheworst. Bilateral hypothalamic lesions of this type had never been attempted beforeinahuman.Amongthepossibleimmediateresponseswerearacing

heartrateversusprofoundslowing;temperatureelevationsto106or107

degrees(Fahrenheit)versusseverebodycooling;suddenlysoaringblood pressures versus profound shock; even death. Electrolyte and water balance problems were certain to follow, but hopefully they could be managed. Hesshimselfwaspresent,bythenwellintohiseighties.Thegreat neurophysiologiststoodinthebackground,directingexactlywherethe lesionsbeplaced.Oneprofessorrepeatedlytookthegirl’sbloodpressure, andthechairmanofmedicineheldherwrist,continuouslymonitoringher pulserate.VerycarefullyYasargilmadeonelesion,thentheother. Andnothinghappened.Hervitalsignsremainedstableandshedid notdie—neitherdidsheexperienceendocrineorwaterbalanceproblems. But her disease remained unchanged. Subsequently Krayenbühl did a craniotomyandperformedbilateralfrontalleukotomies.Thiscontrolled

herrageresponses,butherpersonalitywasaltered.Sherarelyshowedany

emotionatallfortherestofherlife.

---

ForsevenyearsYasargilperformedstereotacticsurgery,mainlyfor parkinsonism, but to devise an operation for aneurysms remained his ultimategoal.Inthecourseofperformingthousandsofarteriogramshe becameextremelyinterestedinthetreatmentofthesedeadly,berry-shaped lesions projecting from the walls of intracranial arteries. He had read everything he could find on the subject, and was fully aware of the problemsothershadfaced(AppendixB). Thoughextremelyconcernedforhispatientsandtheseriousrisks aneurysmsposedforthem,Krayenbühlhadnowishtomakemattersworse byattemptingoperationsclearlybeyondhisability.Aschairmanofthe departmenthedeterminedwhichsurgeonoperatedonwhichpatient.As themostexperiencedsurgeonhereservedallaneurysmcasesforhimself. Treatinganeurysmsamountedtoanawesomeresponsibility.Fullyaware oftheshortcomingsofattackingtheselesionsdirectly,hefeltthatsuch patientshadthebestchanceforsurvivalwithcarotidarteryligationinthe neck, the method he had employed for years. But often it was not successful,andthelong-termeffectoftyingoffanyarterytothebrainwas worrisome. As reports of successful intracranial aneurysm clip-ligations continued to pile up from Stockholm (Herbert Olivecrona), Cologne (WilhelmTönis),andelsewhere,Yasargilbecamemoreandmorerestless. Performingpercutaneousarteriogramsonalltheaneurysmalhemorrhage patientsadmittedtothehospital,hewasfrustratedthatabettertreatment wasnotavailable.HenevermissedanopportunitytoremindKrayenbühl whatwasbeingdoneelsewhere.FinallyKrayenbühlcouldnolongerresist

attempting to clip an aneurysm directly. And the initial results were encouraging,leavinghimexhilaratedfordaysaftersurgery.Buttherewere negativeeffects,too. Krayenbühlwasanelegantsurgicaltechnician,withbeautifulhands —smooth,unblemishedskin,andlong,carefullymanicuredfingers.His movementsweredelicateandprecise,alwayshandlingthebrainwithgreat care, seeming to reflect a profound reverence for his patients and his responsibilities.Itwashispracticetoreflectahugefrontalscalpflap,then removealargediscofskullinordertogainaccesstotheareabeneathboth frontal lobes. His craniotomies were performed deliberately in the old Cushingtradition,alwaysstrivingtolimitbloodlossandminimizetrauma toextracranialmuscles. But the nature of aneurysm surgery placed the surgeon under unimaginablepressure.Despitehistalentandcourage,Krayenbühlwas neitherpsychologicallynoremotionallyequippedtodealwiththatkindof stress.Ananeurysmoperationcouldturn,withinseconds,fromadelicate, precise dissection into chaos as the surgeon faced massive bleeding, knowingthatdeathcouldnotbefaraway.Methodsofcontrollingbleeding were much different in the brain, compared to abdominal and chest operations,whereextremedelicacywasnotalwaysrequired.Andeven more frustrating, sometimes patients did not wake up from operations whichseemedtobeexecutedperfectly. DisastrousmomentsandtragicoutcomesleftKrayenbühldepressed fordaysatastretch.Theycastapallovertheentiredepartment.Aneurysm operations became dreaded. The number of successes paled against an

overallsurgicalmortalityhoveringnear30percentineventhebesthands

everywhere. Even worse, patients surviving aneurysm operations were frequently never the same again—mentally, neurologically, or emotionally.Returningtoanindependentlifewasmoretheexceptionthan therule.

Yasargil sensed there was a better way, a safer, more precise technique,onethatsomehowinvolvedlessmanipulationofsurrounding tissues,amethodthatstackedtheoddsmoreinthepatient’sfavor. From the time of Riechert’s presentation in Brussels in 1956 he wrestledwiththeideaoftreatinganeurysmsstereotactically.Onenight,as hestruggledtogettosleep,thesolutionbecamecleartohim.Immediately hehoppedoutofbedandbegantopaceintheshadowsofhisbedroom. Sleepwasnolongerpossible.Hereasonedthatamagneticprobecouldbe introducedinsidetheskullandplacedbystereotacticmethodsprecisely againstthewalloftheaneurysm.Suchamagnetshouldbeabletotrapiron particles injected into the cervical internal carotid artery via a small catheter.Concentratingenoughironparticleswithintheaneurysmshould inducethrombosis,excludingitfromthecirculationandcuringthepatient. Nolongerwouldanopenbrainoperationbenecessary,orhavingamajor arterytiedoff. Thenextdayheapproachedacardiologistworkingintheinternal medicinedepartment’slaboratoryandconvincedhimtoprovideaccessto dogsaftercardiacexperimentswerecompleted.Overaperiodofseveral weekshewentaboutthetaskoftryingtotraptinyiron-particlesinjected intoadog’sfemoralarterywithalargemagnetplacedmid-wayinthehind leg,overshavedskininitially,thendirectlyadjacenttoanexposedvessel. Unfortunately,themagneticfieldwasnotsufficientlystrongtocounteract theforceofbloodflowontheironparticles.Theypassedthroughquickly, collectingintheanimal’sfoot,whichwassoonischemicandcold.The experimentwasdiscouraging,butheremainedconvincedtheideacould work.Heonlyneededamoreefficientmagnet. Ifheseriouslyconsideredapplyingtheideatohumans,heneededan altogetherdifferentkindofmagnet,onefarmorepowerfulthantheone he’dbeenusing.Theidealmagnetwouldbesmallenoughtobeintroduced stereotactically to be focused on precise spots along the course of an

intracranialvessel. Hewenttothenearby“TechnicalHighSchool” 18 toseekanexpert onmagnets.Hewastoldthatthemagnetherequiredwasnotavailablein Zurich.Theengineerswereconfidenttheycouldconstructasmallmagnet, perhapsthesizeofahumanthumb,butYasargilinsistedthatitstipbeno largerthanafewmillimetersacross,andthatitalsomustbequitestrong. Ironparticlesmustnotescapetheaneurysmintobranchesofthemiddle cerebralartery,wheretheycouldcauseastroke. TheTechnicalHighSchoolexpertswerefamiliarwiththeconceptof a “cold” (superconducting) magnet. Cold magnets could be extremely small.Bycoolingthetipofsuchaninstrumentwithheliumandnitrogen, itspowerfulmagneticfieldwouldnotgeneratesufficientheattoimpede theflowofelectrons.AlthoughnocoldmagnetwasavailableinZurich,it wasrumoredthattheUnitedStatesArmyhadproducedoneorwasatleast experimentingwiththeconcept.TechnicalHighSchoolexpertssuggested thatheusehisAmericancontactstoinquireaboutit. William Sweet, professor and chairman of the department of neurosurgeryattheHarvardMedicalSchool,wasaregularvisitor.Heand Krayenbühlwereclosefriends.SweetwasaguestinKrayenbühl’shome foramontheverysummer.Yasargilknewhimpersonally.Hispresencein theoperatingtheaterandthex-raydepartment,eventhelaboratories,was legendary.Sweetwascalledthe“notebookman,”orthe“Americanspy.” Hewasneverwithoutanotebook,constantlymakingnotesaboutwhathe saw:operations,arteriograms,evennotesonpatients’historiesandclinical findings.Hewroteeverythingdown. YasargildescribedhisideatoSweetandtoldhimabouttheproblems hehadexperiencedinthelaboratory.Sweetjotteddownafewpagesof notes,madesomedrawings,andpromisedYasargilhewouldcontacthim withinafewweeksofhisreturntoBoston. Sweet would interest one of his residents, Hugh Rosomoff, in

Yasargil’sidea.InashortperiodoftimeRosomofffoundtheappropriate ironparticles,ironpowderusedinBoston’scommercialbakeries.Bythe mid-1960s Rosomoff had used a magnet to trap iron particles inside artificialaneurysmsconstructedindogs.Hismodeldidactuallyinduce thrombosis,andhepublishedhisfindings. 19 Yasargil saw the idea also as a solution to the problem of arteriovenousmalformations.PeripherallylocatedAVMscouldbetotally excisedsolongaselementsofthetemporallobeorapoleofthefrontal lobeweresacrificed.HehadperformednoAVMsurgeryhimself,buthe hadseenKrayenbühlresectseveral.Theoperationsweretypicallylong andtedious,butsomeofthepatientshaddoneextremelywell. ButmanyAVMsoccurredinlocationswheresurroundingbrainmust be preserved at all costs. Removing coils of pulsating arteries and arterializedveinswhilepreservingadjacentbraintissueanditsvascular supplycouldbeextremelydifficult,ifnotimpossible.Toooftenbleeding obscuredthesurgeon’svision,andadjacentbrainwasultimatelydamaged. Suchpatientswereleftdevastatedaftersurgery.ButYasargilenvisioned AVMs as potentially curable by thrombosis induced by injecting iron particlesonceanelectromagneticfieldwasestablishedatthesiteofthe lesion. Arelatedideainvolvedinjectingapolymerizingsubstancedirectly intoananeurysmoranAVMfromaneedleintroducedthroughasmall burrholeandplacedadjacenttothelesionbystereotacticmethods.He reasonedthatifacraniotomywasnotperformed,apatient’sintracranial pressurewouldnotbelowered,leavingthepressureimmediatelyoutside theaneurysmorAVMessentiallythesameasitsinternalpressure.With littleornopressuregradient,verylittlebleedingshouldoccurwhenthe vascularwallwaspiercedbyaneedle.Theconceptcarriedacertainrisk, butitjustmightwork. InthelaboratoryYasargilinjectedafewdogs’femoralarterieswith

surgical cement, but with little success. The glue was swept too far upstreaminthecirculationbeforeitbecamesolid.Immediatelyhewent backtotheTechnicalHighSchool,thistimeseekingapolymerizingagent thatwasmorefast-acting.Againhewastoldthatnosuchsubstancewas available in Europe. Once again, he was advised, “ask your American friends.” RobertW.Rand,chairmanoftheneurosurgicaldepartmentatUCLA, was another frequent visitor in Krayenbuhl’s department. Yasargil described his ideas to Rand and demonstrated in the laboratory the problemshefaced.RandtooktheideabacktoLosAngelesandpresented it to his resident, John F. Alksne. Like Rosomoff, Alksne went immediatelytowork,andpublishedanumberofscientificpapersonthe subject, including the elimination of intracranial aneurysms in a small seriesofpatients(AppendixC). Yasargil had gained a certain satisfaction in seeing his idea of stereotacticthrombosisofaneurysmsmeetwithexperimentalsuccess.As impressed as he was by the work done in the United States, he was saddenedthathehadnotbeenabletoworkoutthetechniquehimself.By

1966,though,hewasontoevenmoreimportantwork,aprojectthateven

he himself did not realize would not only stall the development of stereotactic aneurysm surgery during his lifetime, but would also revolutionize the way vascular neurosurgery, even neurosurgery in general,wouldbeperformed.Itwouldcertainlystuntthedevelopmentof treatinganeurysmsstereotactically.

CHAPTERTWELVE

ProblemsToBeSolved:

ATurningPoint

IN1959YASARGIL,AFTERtwoyearsaschiefresident,pausedto

takestockofhimself,whathehadlearnedovertheprecedingsixyearsand whathisoptionswereforthefuture.IntheSwissmodelforpost-graduate training in the surgical specialties, as elsewhere in Europe and Great Britain,aresidentremainedessentiallyanapprenticeuntilajobopenedup elsewhereinthecountry,whichcouldbefouryearsorfortyyears.He’d hadnointentionofspendingtherestofhislifeinZurich.Theconceptofa neurosurgeon’sbecoming“fully trained”wasa blurredonein Europe. Krayenbühlhimselfwasagoodexample.Hisformaltraining,priorto workingwithCairnsinLondon,hadbeeninpathology,internalmedicine, and psychiatry. Although it was Yasargil’s impression that the Cairns mentorshiplastedonlythreemonths,EricZanderindicatesitwasactually nearertothreeyears. 1 CairnshadspentonlyayearwithCushing, 2 andfew ofCushing’sresidentsstayedlongerthantwo. 3 Under Krayenbühl, Yasargil had mastered the techniques of neurosurgeryasperformedbyCushing,Cairns,WalterDandy,andthe

othertopneurosurgeonsofthe1940sand1950s.Havingperformedalarge

numberofcraniotomiesforsubduralandepiduralhematomasandassorted intracerebral hemorrhages, Yasargil was comfortable managing neurosurgical trauma, especially given that surgical trauma cases often began with an arteriogram. In addition, he had operated on over one

hundredbraintumors,glioblastomasmainly, 4 andhadtreatedovernine hundredlumbardiscs,plusanumberofmorecomplexdegenerativeand traumaticspinalconditions. He clearly had established himself as one of Europe’s leading neuroradiologists and stereotactic surgeons. Furthermore, he was acknowledgedbythosewhoknewhimbestasananatomistofthefirst order.Alongthewayhehadgainedasuperbunderstandingofhuman physiology as it related to operative and postoperative care. He had a practical knowledge of neuroanesthesia and operating under local anesthesia.Hewasabletointubatepatientshimselfandsupervisetheir physiologicalcareduringandaftersurgery.Itseemedtohimthathewasat leastaspreparedtostartadepartmentelsewhereasKrayenbühlhadbeen

whenheintroducedneurosurgerytoSwitzerlandin1937.

But he had performed virtually no intracranial vascular surgery. Arteriovenousmalformationswereonlyrarelyconsideredforsurgeryin Zurich before 1973, but Yasargil hadn’t operated on any aneurysms. Krayenbühlreservedthosedifficultlesionsexclusivelyforhimself,along withacousticneurinomasandotherbenigntumors.Yasargilhadoperated ononlyasinglemeningioma,notasarewardoravoteofconfidencefrom Krayenbühl, but as the result of a mistaken preoperative diagnosis. A sixteen-year-old farm boy’s apparent glioblastoma turned out to be a parasagittalmeningioma.HardlyaweeklaterKrayenbühlassignedhim anothercasethoughttobeaglioblastomaonthebasisofpreoperative pneumoencephalography. It proved to be an occipital arteriovenous malformation! Removing it amounted to the sum total of his personal experiencewithintracranialvascularlesions.Operatingonmeningiomas andAVMspresentedchallengesthatglioblastomasdidnot.Hesimplyhad notbeenaffordedtheopportunitytooperateonmanyofthem. WhenhecametoZurich,aplantoreturntoTurkeyatsomepointwas uppermostinhismind.TakingEuropeanneurosurgerybacktoAnkara

wouldfulfillhischildhooddreamofmakingamajorcontributioninhis

homeland.HestillexchangedletterswithProfessorSaribaş,thenext-door neighbor who continued to run the neurology department in Ankara. Yasargillookedforwardtothedaytheywouldworktogether. But the news from Turkey was unsettling. 5 Adnan Mendares had

beenelectedprimeministerin1950,endingtwenty-sevenyearsofsingle-

partyrule.Heembarkedonthecountry’sfirstexperimentindemocracy andliberaleconomicsinthedecadethatfollowed.Becauseofitsstrategic location and the threat of spreading communism, Turkey had received militaryassistancefromtheUnitedStatesbywayoftheTrumanDoctrine andeconomicaidthroughtheMarshallPlan.Itwasacceptedasapartner

inNATOin1952.The1950ssawrealprogressinTurkey.Newroadsand

schools were constructed and waterways were dammed, extending electricityintoruralhomesandthebusinessesofAnatolia.Avigorous programoflandredistributionwasaccomplished.Butadivisivedispute over Cyprus followed in 1955, and rioting broke out in the streets of Istanbul. The masses were whipped into a frenzy of nationalism, with venomoussentimentsagainstthenon-Muslimbusinessesthatfueledthe neweconomy.TensofthousandsofGreeksleftTurkey,nevertoreturn. Economicconditionsworsened.Inflationraged.Thepoliticalscene became increasingly polarized, and religious tensions swelled out of control.Atatürk’sboldattemptatwesternizationthreedecadesearlierhad reachedastandstill.Settlingtheirpoliticaldifferencesthroughdiscussion andhammeringoutworkablelawsdidnotsuittheinclinationsofTurksof the late 1950s. In order to maintain some semblance of public order, Mendares reverted to the repressive tactics of his predecessors. Westernizationandsecularizationwerestillworthygoals,buttherehadto beameansofmaintainingpeaceatthemoment.Ifviolentminoritiesand religiousgroupswerenotheldincheck,thenationwouldbetornapartand Atatürk’s legacy would come to nothing. Muzzling the press, even

arrestinganumberofjournalistsfor“insulting”thegovernment,ledtoa militaryjunta.Abloodycoupd’étatfollowed.Fifteencivilleaderswere

sentencedtodeathin1960,Mendaresamongthem.Itwasclearlynotime

foraforeignnationaltoreturntohishomeland. Furthermore, Professor Saribaş took sick and died. It happened almost overnight. He had developed a gastrointestinal tumor and was hospitalized with a bowel obstruction, a condition destined to be complicatedbyperitonitis,andfinallygeneralizedsepsis.Hewasdead withindays.Yasargil’shopestoreturntoTurkeyseemeddashedforever. Butallwasnotlost.WithanimportantfriendinTurkey,Yasargilhad highhopesthepoliticalclimatewouldchange.SüleymanDemirel,whom hemetasaboyatagatheringhonoringnationalscholarshipwinners,had risen through the public educational system and become a famous engineer.Yasargilfollowedhiscareerthroughlettersfromhisfamilyin Ankara. On his way to personal prosperity and political prominence, Demirelwasamajorplayerintheconstructionofthevastcampusof Ankara’sMiddleEastTechnicalUniversity.InMendares’sgovernmenthe

servedasheadofthenationaldam-constructionproject.By1964hewould

beheadoftheJusticeParty,andthefollowingyear,followingthedeathof GeneralRagipGümüşpala,hebecameTurkey’syoungestprimeminister. Under Demeril’s administration the Keban Dam and the spectacular Bosphorus Bridge, linking Europe and Asia, were constructed. The economy began to grow steadily and rapidly, leading Demeril to be dubbed“SüleymantheBuilder.” Even more importantly, there was a legal problem blocking Yasargil’s returning to Turkey in 1961. Government officials were required by a law pushed through parliament after the coup to systematicallycheckthestatusofTurkishstudentsandprofessionalsliving abroad. Yasargil was almost thirty-five years old. He had not set foot insideTurkeysincethreemonthsafterhiseighteenthbirthday.Plus,the

military obligation that had delayed his marriage in 1951 remained unsatisfied. He was notified through the embassy in Zurich that his passporthadbeencancelled. LosinghisTurkishcitizenshipwasastingingblow.Inhishearthe wasaTurkandwouldalwaysbeaTurk.ButfallinginlovewithaSwiss woman,livinginSwitzerlandforfourteenyears,thelasteightofwhichhe spentfocusingeverythoughtonwork,hadputhiminalegalholefrom whichtherewasnoescape.HehadallowedhimselftoignoreTurkishlaw.

HadheputhisrelationshipwithDorlyonholdin1952,afterhisyearas

surgicalresidentunderProfessorBandiinInterlaken,andpostponedgoing to Zurich for six months, he could have satisfied his active duty requirementintheTurkisharmyandavoidedlegalproblemsaltogether.

Evenafter1960,unmarriedTurkishdoctorslivingabroadweregranted

reserve status as officers simply by serving six months’ active duty. Yasargildidnotqualify.HehadgambledthatnooneinAnkarawouldpay attentiontohiswhereaboutsandwhathewasdoing,andhehadlost.

An1877OttomanlawprohibitedTurksmarriedtoforeignersfrom

beingcommissionedasofficersinthemilitary.TheonlywayYasargil couldregainhisTurkishcitizenshipwouldbetoreportimmediatelyfor threeyearsactivedutyasanenlistedman.Thegovernmentwasinflexible onthatpoint,unwillingtoconsideranyexceptions. Feeling outcast from Turkey was a gut-wrenching experience. He agonized over his few options with Krayenbühl for days. Joining the militaryinTurkeyforsixmonthswouldhavebeenworthconsidering,but leavingneurosurgeryforthreeyearsatthispointwasoutofthequestion.It woulddestroyhiscareer.Krayenbühlsawitasacolossalwasteoftimeat thiscrucialstageofanyneurosurgeon’slife. Unofficially Yasargil was informed he could circumvent the law simplybytemporarilydivorcinghiswife,butforhimthatwasnooption. Krayenbühlagreedthatsuchastepcouldresultinserioussocialproblems

forhiminZurich.Swisssocietywasveryconservative,anddivorcewas uncommon.Yasargilwasanemployeeofthestate.HeandDorlywere parents of three, including a toddler and a new baby. He had little alternativebuttoapplyforaSwisspassport.

Theexperiencewouldhaunthimforyears.By1975hehadbeen

arguablythemostprominentneurosurgeonintheworldforseveralyears. InTurkeyhewasparticularlyrevered,afavoriteson,anationalhero,a manwhohadbroughtgreatcredittoallTurksandtheirwayoflife.But

thefacthehadforfeitedhiscitizenshipin1961,andhadnotlivedamong

his fellow Turks in their time of national trial, fed controversy in the

media.Aslateas1991,whenhewasconsideringareturntohishomeland,

hewouldfindthematterdiscussedopenlyinnewspapersandontelevision inAnkara. TherewerevirtuallynoopportunitiesforaEuropeanneurosurgeonin privatepractice.Onlybybeingassociatedwithamajorinstitutionanda largehospitalcouldonehopetosurviveasaneurosurgeoninSwitzerland orGermany.A Krayenbühl-trainedmanheld theneurosurgicalpostin Geneva,andaStockholm-trainedmaninBern.NootherSwissfacility couldsupportaneurosurgicaldepartment. Krayenbühl convinced Yasargil to stay in Zurich, appointing him “PrivatDocent,”givinghimadditionalacademicandclinicalstatuseven thoughhewouldinfactremainchiefresidentforanotherfiveyears.“You stayherefornow,”hereasoned,pleadingforpatience.“Youropportunity toreturntoTurkeywillcomelater.”Yasargilwascomfortablewiththe routineattheKantonsspital.Hefelthisworkingconditionswereperfect. Plus,Zurichwashometohisfamily.DorlyandthechildrenwereSwiss. Theywerehappywiththestatusquo.Itwasnotimetostrikeoutonhis own.

---

By1959Krayenbühlhaddevelopedanincreasinginterestinthesurgical

treatmentofepilepsyandbeganpushingtheKantonsspital’sneurologists to refer him patients who were disabled by seizure disorders not respondingtomedicaltreatment. For a decade epilepsy operations performed at the Montreal Neurological Institute were planned on the basis of EEG (electroencephalographic)spikeandsharpwavesthatseemedlimitedto thetemporallobe.WilderPenfieldreportedthatremovingsegmentsofthe temporallobefromsuchpatientsresultedinseizurecontrolinone-halfof sixty-eightpatients. 6 PersistingEEGabnormalitiesinthosecontinuingto haveseizuresledtointraoperativeelectrocorticography(ECG)revealing persisting seizure foci in de