FOREWORD
DameMaryArcher
Agenius, a maverick, an inspirational doctor, a pioneering heart surgeon, a leading biomedical scientist, friend of prime ministers and royalty as well as of the poor and dispossessed, recipient of the Order of the Nile, Fellow of the Royal Society, member of the Order of Merit—and, above all, a great humanitarian. All these describe Magdi Yacoub. Throw in orchid breeder and fast-car aficionado and you have the description of a complex and unique man.
I have known Magdi for many years, first through my husband Jeffrey acting as auctioneer for the wildly successful gala evenings Magdi and his team organize to raise funds for his international charity Chain of Hope, and more recently through our common membership on the Board of Trustees of the Library of Alexandria. Yet reading this biography of Magdi told me much I didn’t know about this extraordinary man: how as a child in Egypt he set his heart on becoming a cardiac surgeon after the tragically early death of a young aunt from rheumatic heart disease; how he became a precocious medical student in Cairo; how he struck out for England and advanced medical training in the supportive company of his elder brother, Jimmy; and how he did his cardiac surgical training at the London Chest Hospital, the Brompton Hospital, and then the National Heart Hospital, where he worked under Russell Brock and Donald Ross, at the time the most influential heart surgeons in Britain.
There are many “firsts” in the story of Magdi’s long career as a surgeon. He performed one of the first “switch” operations to save babies born with their aortic and pulmonary arteries the wrong way round; Europe’s first heart-lung transplant in 1983; the world’s first
“domino” heart transplant operation in 1987; and the first “living lobe” transplant for a cystic fibrosis patient in the UK in l995.
En route, Harefield Hospital in Hillingdon was transformed from a small former sanatorium providing mainly respiratory medicine and thoracic surgery to a world-renowned center of cardiac surgery. Within months of his return from a formative year as an instructor–associate professor at the University of Chicago’s School of Medicine, Magdi had increased the number of open-heart operations at Harefield from one or two a week to fourteen or fifteen a week and established a lifetime habit of working outrageously long hours.
The pace was exhausting and the innovations in surgery not always successful at first. “He tends to go to places that others fear to tread,” remarked Magdi’s former PhD student Ismail El-Hamamsy. Pushing the frontiers of any major surgical procedure carries additional risk over and above the general risk that cardiac surgery poses to very sick or very young patients, and we also read of some bruising encounters Magdi had with the media and even with colleagues on occasions when early outcomes were poor. He was even privately described as a madman by Kenneth Clarke (then health minister) during the early years of Margaret Thatcher’s premiership. But it is only through the bravery of patients for whom surgery is their last hope, and the willingness of their surgeons to try something new to save them, that a risky and experimental procedure can turn into a highly technical but routine operation performed in major centers throughout the world.
A doctor can only treat the patient in front of him and even surgical innovation can only fix people one at a time. From his time in Chicago, Magdi recognized the importance of research in creating and underpinning medical and surgical advances. He started laboratory research at Harefield in the late 1970s, first targeting the transplant program and then expanding to other areas with the aim of identifying and resolving the fundamental biomedical issues that caused heart problems. Reading this biography introduced me to a Magdi I did not know, a clinical scientist with a prodigious output of over one thousand research papers to his credit, one of the most recent being a global perspective in Nature Reviews Cardiology of
the long-term effects of SARS-CoV-2 infection on the lungs. The Harefield Heart Science Centre, which Magdi founded, now bears his name.
When he reluctantly retired from the NHS in 2001 at the age of sixty-five (he had no choice), it was the end of an era at Harefield, but it was the start of a new chapter in Magdi’s life, which has had a profound impact on delivery of cardiac healthcare in several resource-poor areas of the world.
Every year, ten million children are born with a congenital heart defect, and 75 percent of them, mostly in developing countries, do not get the care they need to survive and thrive into adulthood. Magdi had always been troubled by inequities in healthcare delivery and he became more and more interested in how they might be redressed. With that in mind, he set up the charity Chain of Hope in the UK in 1995 and is the dynamo behind its ongoing expansion in Addis Ababa, Maputo, Aswan, Kingston in Jamaica, and most recently in Kigali in Rwanda. Meanwhile, the search for new treatments and techniques continues. Scientists at Harefield’s Magdi Yacoub Institute, and at other centers around the world, are now seeking to grow replacement valves and organs from stem cells and exploring the potential of gene editing to combat heart failure.
It is an inspiring story. As Magdi Yacoub: King of Hearts—a television documentary broadcast on the Discovery Channel—put it while following his last week as an NHS cardiac surgeon, “This man has touched more people’s hearts than anyone else, literally.” Both literally and metaphorically, this might serve as the epitaph of this remarkable man. But for me he is simply a big-hearted man, and we must be grateful that he landed on our shores.
Acknowledgments
Abiography of this kind cannot be written without the help of many people in many countries. We would like to offer our thanks to all those who made this endeavor possible.
First and foremost, we thank Professor Sir Magdi Yacoub for allowing us to write his authorized biography. “Prof,” as he is affectionately known to many people, gave us much of his time— seventeen interviews lasting more than twenty-five hours—which allowed us to tie him down in a manner that few have ever managed.
Later, while commuting endlessly between Harefield and Aswan, he checked that our use of medical terms and descriptions of cardiac surgery were correct. His stamina is quite remarkable. Indeed, we had not expected to have so much difficulty keeping up with an 87year-old determined to get on with his work!
Prof also triggered the interest of the American University in Cairo Press (AUCP) and garnered generous support from the Library of Alexandria. This book would not have been published without his involvement. We are very grateful.
We would like to thank his daughters, Lisa and Sophie, and his son, Andrew, for their help in bringing this project to fruition. Sophie and Lisa were both interviewed at length and Andrew responded by email. We also thank Haile, a young man from Ethiopia who suffered from rheumatic heart disease and who is now very much part of the Yacoub family. He too made a significant contribution to this book.
At a time when the Covid pandemic restricted access to libraries and archives as well as people, Lisa’s help was crucial. She opened the doors to many interviews on Zoom, provided us with medical and scientific papers and cuttings from newspapers and magazines, and gave us access to photographs and Prof’s personal memorabilia. Like her father, she was indefatigable, and this book could not have been written without her generous support.
No project of this nature is complete without differences of opinion over the nature of content and its emphasis, and this book was no exception. Happily, all such disagreements were resolved, compromises found, and difficulties overcome.
We would like to thank our literary agent, Barbara Levy, for her friendship, steadfast support, and guidance over a period of nearly three years, from the moment we agreed to take on this book in 2020 through to its publication in 2023. We are also grateful to the AUCP for working with us, and particularly Nadia Naqib, the senior acquisitions editor, for her patience, guidance, and good humor, as well as Miriam Fahmi and, at the outset, Michael Duckworth.
Two former colleagues at The Times in London, Martin Fletcher and Ed Gorman, played a significant role in the genesis of Prof’s biography. Martin, who joined the board of the charity Bridge of Hope, worked with the Yacoub family in producing the initial synopsis, which we developed. Ed, who is Fiona’s brother, conducted interviews with Prof in May 2020 and researched and wrote the first drafts of the chapters on Hollie Roffey and Diana, Princess of Wales. We are very grateful to both Martin and Ed for their involvement.
We also thank Jessica Herbich, our researcher, who gave us extensive help with editorial content; and Freddie Pearson, who read the chapters as we wrote them, and took photographs for us. We are also grateful for the work undertaken by Felicity Price, who provided legal advice, and Rachel Thorne over copyright.
A biography is only as good as the voices that help to tell the story. We owe a great debt to the many people who generously gave their time and allowed us to use their voices to tell the story of Prof’s life. They include many people who worked with him at Harefield Hospital and the Magdi Yacoub Institute at Harefield, and some who continue to do so: Peter Barlow, Helen Blair, Stan Brown, Mahmoud Barbir, Adrian Chester, Robert Craig, John Hunt, Asghar Khaghani, Najma Latif, Maria Rogers, Melanie Mendel, Victor Tsang, Jo Wray, and Gavin Wright.
A number of former patients and members of their families also agreed to be interviewed, some of whom talked about their
experiences openly for the first time: Liz Clark, Christopher Molloy, Patricia Molloy, Mary Poku, Eleonora Ruscio, and Maryanna Tavener.
We would like to thank those political figures who helped to shed light on the events that shaped Magdi Yacoub’s life, including Jeffrey Archer, Virginia Bottomley, Gordon Brown, and Ann Keen. Special mention must be made of Grey Gowrie—a politician, poet, patient, and influential figure at Harefield, who gave us a long interview on March 30, 2021. Sadly, he died later in the year, twenty years after his transplant.
Since the mid-1990s, Prof’s life has been deeply entwined with his charity, Chain of Hope. Those who worked for the organization and agreed to be interviewed include Noemi Cinzano, Claudia von Platen, and Emma Scanlan.
In Egypt, and particularly at the Aswan Heart Centre, we would like to thank Mahmoud Abdelhay, Wael AbdelAal, Ahmed Afifi, Ahmed ElGuindy, Hatem Hosny, Magdy Ishak, Heba Kassem, Samih Sawiris, Zeina Tawakol, Heba Aguib, and Yasmine Aguib.
In Greece, we thank Stergios Theodoropoulos, Marianthe Konstantatou, and Marianna Vardinoyannis; in Italy, Carlo de Gasperis; in Oman, Hamood Al Kindi; and in the United States, Robert Bonow, Robert Daye, Ismail El-Hamamsy, and Martine Rothblatt.
We would also like to thank Nilesh Samani and Amelia Komor of the British Heart Foundation; Archbishop Anba Angaelos; Maite Alphonso; the British-Egyptian Society, and the staff of the National Archive in Kew, West London.
Finally, we thank our three sons, Harold, Freddie, and Archie, for their love and forbearance as we worked on the manuscript of this book for more than two years—often at the expense of family life. We are more grateful than they will ever know.
INTRODUCTION
This is the story of a humble man who has accumulated knowledge in the way that many men and women try to accumulate wealth. He is a doctor who treasures the idea of community and believes in fighting for a fairer world.
In some ways, he is like you and me. He loves his family. He enjoys sharing a meal with friends. He often listens to music, particularly classical music. He grows roses and has an allotment. And he has a secret passion for fast cars—although his family question his unshakeable confidence in his driving skills.
In other ways, he is possibly not like you and me at all. He needs little rest, reads rapidly, and lives for his work; at the age of eightyseven, his thirst for learning—“the search for truth through science,” as he describes it—is undiminished. He has generated ideas that have inspired generations of doctors, galvanized research, and led to significant medical breakthroughs. He has also saved lives. Many lives. His patients have included rich and powerful men and women as well as some of the most wretched people on Earth. He is trying to make sure that his work continues long after he is gone; his focus is on the poor, not the wealthy.
His name is Professor Sir Magdi Yacoub. He is a member of the Order of Merit and a Fellow of the Royal Society. He was born and brought up in Egypt and made his name as a heart surgeon in Britain. His wife was German; their three children work in Ho Chi Minh City, Lisbon, and London. He is a man of the world who has worked in many countries, but always with Egypt in his heart.
This is his biography, the story of his life as he remembers it and of the people who worked with him and influenced him. It is a story that he hopes will inspire others to follow in his path.
1
PLYMOUTH, SOUTHWEST ENGLAND, 1983
As the hands on the clock in the operating room at Derriford Hospital in Plymouth edged past 4:00 a.m., Magdi Yacoub prepared to leave.
A tall, distinguished man who had come to Britain from Egypt in 1961, Yacoub was a cardiothoracic surgeon from Harefield Hospital in west London and a great champion of Britain’s National Health Service (NHS). As always, his movements were precise.
On many occasions, as he operated at Harefield, he played music —usually Bach or Mozart. On this occasion, he worked in silence, retrieving the heart of a woman who had suffered a brain hemorrhage and been certified as brain dead late the previous day. By consenting to be an organ donor when she was alive, she was, unknowingly, helping to save another person and making an important contribution to the future of heart transplants.
Three surgical teams worked urgently on the same donor that night. The liver and kidneys were also prepared for removal, but the heart was taken first. Once Yacoub had finished his task, the other organs were retrieved, but the three teams had to coordinate their actions.
“We usually worked together harmoniously,” said Yacoub, “but we had to be careful not to damage the liver or kidneys, and they had to be careful not to damage the heart.”
A transplant coordinator from Derriford Hospital watched over them, ensuring that the donor was treated appropriately and that no additional tissue was taken for research without consent.
Outside, on a grass helipad in the grounds of the vast concrete hospital, a twin-engine Dauphin helicopter waited to take Yacoub
back to Harefield, three hundred kilometers away, a journey of just over an hour by air.
The precise date has been forgotten by those involved, and no record of the event appears to be available in public files. Members of Yacoub’s team recall, however, that it was an autumn day in 1983, with fallen leaves strewn across the Plymouth landscape. Their flight from Harefield to Derriford Hospital, made in darkness, had been uneventful.
A pioneer in heart surgery who had undertaken some of the first transplants in Britain, Yacoub was accompanied by two colleagues: Helen Blair, one of the transplant coordinators at Harefield, and Peter Barlow, a cardiac perfusionist. When they arrived at Derriford Hospital that evening, they prepared everything they would need in the operating theater: the surgical instruments, fluids, and the cool box with ice ready for the donor heart. A scrub nurse from one of the other transplant teams assisted them.
Barlow, a good-humored man with strong, friendly features, was an experienced medical technician. Nicknamed “Pete the Pump,” his role during transplants was to operate a heart-lung machine, which takes over the essential functions of the body during surgery and keeps the patient alive. It is a delicate task. His job that night was to keep the donor heart “fresh” for transplant. His small, portable heart-lung machine had been developed at Harefield and was believed to be unique at that time. It was, he said, a simple piece of equipment: “Just a few boxes with a disposable oxygenator, a pump, and a lot of crushed ice.”
When it is connected to a patient receiving a transplant, deoxygenated blood is—in the simplest terms—drained from the body and pumped through an oxygenator in the heart-lung machine and back into the patient’s system. The machine performs the work of both the heart, pumping blood round the body, and the lungs, supplying oxygen to red blood cells. The procedure is known as putting the patient “on bypass.”
When the heart-lung machine is connected to a donor, blood is drained from the right side of the heart, then oxygenated and cooled in the machine before coursing its way back through the body and
reducing the donor’s temperature. Once the temperature of the cadaver has fallen to 15°C, the heart-lung machine is turned off and the cardiac surgeon removes the organ. Time is all-important. From that moment, Yacoub had just four hours to start the transplant operation before the donor’s heart was no longer viable for use. This is called ischemic time.
“The heart is more sensitive than the other organs,” said Yacoub. “You can cool the liver and keep it for twelve hours before transplant. With the heart, we have to move quickly and get the transplant done.”
The burden of the night’s work now fell on Blair, an industrious woman who had worked with Yacoub since 1976. She has an infectious smile and a direct manner, and talks quickly. As the coordinator from Harefield, she had already dealt with UK Transplant —the authority overseeing organ transplantation—and the donor hospital to establish the blood group and tissue type, and to select a suitable patient to receive the donated organ. At Derriford, she started to pull together a tentative schedule that would bring together the people and equipment necessary to undertake the transplant at Harefield. In those days, organs were retrieved only at the end of the day, after the patient had been officially declared brain dead, which meant that transplants involving the heart usually took place at night, often in the early hours.
Blair’s checklist was long. Using a landline, she told staff at Harefield about potential timings. Her calls had to be completed before the team left Derriford. Another three years would pass before she was issued one of the first mobile phones.
She called an anesthetist, the theater nursing staff, a perfusionist, and an electrocardiogram technician. She also alerted the x-ray, blood transfusion, and immunology departments, and the tissue-typing laboratory.
Several minutes passed.
Porters at Harefield were told to expect a helicopter. The hospital has a small concrete landing pad in an adjacent field; a capital H is painted in red on the base. A conical orange windsock flies from a pole nearby.
But then, quite suddenly, the night took on a forbidding aspect. As Yacoub left the operating theater at Derriford and looked out of a window, he became concerned. Fog was engulfing Plymouth. He headed for the helicopter, carrying the retrieved organs in an icebox. Barlow had the portable heart-lung machine and other surgical kit. Blair talked to the helicopter pilots.
The clock ticked.
“Four hours is not long,” said Blair. “By the time we left Plymouth, everybody at Harefield would know what they had to do. The theater team would know what time to send for the patient and the estimated time the donor organs would arrive.”
At 4:31 a.m., with the fog thickening, Yacoub, Barlow, and Blair boarded the Dauphin. All of them felt anxious. “It was really quite scary,” said Blair.
The pilot knew there were electric cables close by, but he could not see them. Even as he strapped himself into the cockpit, visibility deteriorated further. He attempted take-off three times, but was forced to abort. At 4:45 a.m., with the blades still turning, he canceled the flight.
Yacoub felt a deep sense of dismay. “I was worried about the sick patient at Harefield whose chest was about to be opened,” he said. “I had a heart in my hand. What on earth could I do now?”
The only option available, it seemed, was to travel by road, a journey of 360 kilometers, which usually takes four and a half hours. Now Yacoub had only three hours and fifteen minutes before the organ would become unusable.
In the event, salvation was at hand. Two police cars from the Devon and Cornwall Constabulary were standing by in the hospital car park in case of emergencies. They were Rover SD1s with V8 engines and an official top speed of 212 kph; the police cars were probably capable of going even faster. The team from Harefield had often worked closely with the police but, even by their standards, the police drivers who found themselves at Derriford that night were about to embark on a remarkable journey. Yacoub was ushered into the back of the first car with the cool box. Barlow and Blair traveled in the second.
“The drivers were highly trained; they were really moving,” said Barlow.
“I think they loved these medical missions,” said Blair.
“We had an understanding,” said Yacoub. “We were all in public service.”
In one car, the speeds at which they were traveling took a toll on one officer. He opened the window and was sick. The driver, a sergeant, shouted, “Are you OK, son? Are you OK?” as he drove on into the night.
“Yes, Sarge,” the officer replied repeatedly, looking increasingly green and uncomfortable.
Barlow cannot be sure how long the journey took, but he reckons it was about 120 minutes. With blue lights flashing in the darkness, they must have driven at more than 210 kph on some of the better roads.
Yacoub retrieved many hearts on many journeys before dedicated teams from Harefield took over from him and organ donation became an established business in Britain, but he never forgot the Plymouth run.
“I was frightened; I couldn’t open my mouth,” he said. “I just remember driving through fog in country lanes and winding roads, and then doing the operation when I arrived back at Harefield.”
By the time he got there, Yacoub felt a deep sense of relief. They were in time; the donated heart would not be wasted. In the operating theater, a man in his forties had been prepared for surgery and the surgical team was ready. The patient’s chest had been opened.
“When you are in that mood, you get all this energy from adrenaline and endorphins. Your body is mobilized, and you feel almost indestructible,” said Yacoub. “But then I became very calm. I played Bach while I scrubbed to prepare for the long surgery ahead.”
The operation carried out by Magdi Yacoub that morning lasted about five hours. It was another significant step in the pioneering heart transplant program at Harefield Hospital, which paved the way for many medical advances.
2
EARLY YEARS
From the beginning, Magdi Habib Yacoub was an “outsider”; it was a trait that would shape his life as a man and mold his work as a surgeon and scientist. He was born in Belbeis, the site of an ancient fortress in the kingdom of Egypt, on November 16, 1935. The small town was built on the banks of a tributary of the Nile in the north, far from the metropolitan lights of Cairo and Alexandria. His family were Coptic Christians, a minority in a predominantly Muslim country.
Magdi’s father, Habib, was a general surgeon employed by the government, who later worked in public health. He was a thoughtful man. Magdi’s mother, Madeleine, was the daughter of a judge. A strict parent who organized their family life, she was determined that her children should succeed. She played the piano, a limited repertoire that included the “Moonlight” Sonata, and painted with oils on canvas.
Magdi was the third of four children. He had an elder sister, Mohga, and an elder brother, Gamal, known affectionately as “Jimmy.” A third son, Sami, was born four years after Magdi. The Yacoubs were a handsome, middle-class family; they were also educated and ambitious.
Habib would talk to his children about values and say, “I don’t want to leave you money—I don’t have much money anyway—but I want to give you a good education and knowledge. That will never fail you. And I will die a happy man because you will be able to look after yourselves.”
He worked for the Ministry of Health and, every few years throughout the 1930s and 1940s, was posted to different towns in
various parts of the country. This peripatetic existence had a profound impact on his second son. Yacoub later described his childhood as “the gypsy period of my life.” He recalled, “Whenever the ministry wanted a surgeon, the whole family moved. It would happen every few years.”
While his parents always created a stable, loving home for their children, the many moves brought upheaval and disruption. At the age of three, Magdi was sent to a private American-run school, but didn’t like the experience. It would be a recurring problem. He then attended a series of government schools, but found it difficult to settle. “The schools were quite good in those days, but it was traumatic,” he said. “I would eventually make friends and then I would have to change schools again as my father changed jobs.
“I was very frightened as a child. Everybody looked at me. I would think, ‘My God, they hate me!’ But actually they didn’t; they just didn’t know me.”
In Belbeis, Magdi made a hesitant start at his first government school. He stood out as the biggest child in the infant class and was moved forward a couple of years, where he seemed to turn in on himself. He was a quiet child and always sat at the back of the class. He appeared to pay no attention to his teachers, and refused to participate in lessons.
“The teachers commented, ‘That kid is mentally defective. He doesn’t ask questions, he doesn’t talk. We’ll have to take him to a psychiatrist or a psychologist,’” he recalled. “They asked, ‘Why don’t you talk?’ I answered, ‘I’ve got nothing to say!’”
While the change of classes was uncomfortable, the move had one significant benefit for Magdi, who, even at the age of four, was remarkably self-aware; he was put in the same class as his brother Jimmy, who was eighteen months older. The Yacoub boys were loyal to one another and great friends.
Magdi was bigger than Jimmy. In family photographs, he looks more serious—possibly more aware of the camera—than his elder brother, who nearly always wears a playful smile.
According to Magdi, he took the academic lead throughout their education. “Jimmy struggled, while I got good marks and won
prizes. But we were close. He never resented me. He always said, ‘I’m proud of my brother.’”
They were nearly always found together: at school, at home, at play. Eventually, they would enter medical school at the same time and later travel to Britain. “It was remarkable,” Magdi recalled. Jimmy was his rock.
Each day, the two boys would join the rest of the family for lunch, usually at about 3:00 p.m., when they returned home from school. The meal was a semiformal occasion, with the children well dressed and watchful of their behavior. Habib would tell them about his work at the hospital, the difficulties he had faced with patients, and what was on his mind. Magdi would tell them about his day at school or what he had seen on his frequent walks. He had a camera and was fascinated by nature.
Within a few months of joining his brother’s class, the little boy who sat in the back row and never said anything was top of the form. Everyone was astounded. Some suggested that he was cheating, but his academic record speaks for itself. Then, at the age of five, a family tragedy gave Magdi an inner momentum that would help him to overcome the uncertainties triggered by constant change and established in him an unusual, but overwhelming, sense of purpose.
In 1940, his father’s younger sister, Eugenie, died from heart disease. A university student, she was just twenty-two. Her mitral valve, which controls the flow of blood from the left atrial chamber of the heart to the left ventricle, had been damaged by rheumatic heart disease. The condition was caused by rheumatic fever, which was endemic in Egypt. At the time, no effective treatment was available.
Frustrated by his inability to treat her, Habib became depressed. For a while, he found it difficult to work at the hospital, and a pall hung over the family. Though he was so young, Yacoub retains strong memories of Eugenie’s death and the purpose it gave him. He resolved to become a heart surgeon and to find a cure for the disease that had killed her. He told his father of his plans, but Habib dismissed the idea. “My dad told me, ‘You can’t do it because you’re
so disorganized. You will not make it to be a heart surgeon. You’ve got the wrong temperament.’”
The boy had always admired his father. He watched him leave for work nearly every day, driving a small Chevrolet. But now he was going to prove Habib wrong. “From that moment on, I was even more determined,” Yacoub remembered.
Further afield, in Britain and the United States, advances were being made that would one day help him fulfill his ambitions. Technology was emerging in America that would lead to the first heart-lung machine, which takes over the functions of those organs during surgery, and there were advances on both sides of the Atlantic in the development of cardiac surgery.
Other changes were also taking place that would have a great impact on the Yacoub family, none more than the start of the Second World War. Yacoub remembered his father sitting in front of his little radio in despair, listening to the news and declaring that the conflict would involve the whole world.
Egypt, which had been controlled by the British since 1882, declared martial law in 1939 and broke off diplomatic relations with Germany and Italy. Britain then used the country as a base for its operations in the Mediterranean and confronted the Axis powers in North Africa. As the fighting ebbed and flowed during the course of three years, Habib was posted to the town of Fayoum, a hundred kilometers southwest of Cairo. When the German army—the Afrika Korps—approached the Egyptian capital in the autumn of 1942, Magdi was just seven. Then a second tragedy, seared on his memory, reinforced his ambitions to become a doctor. The Luftwaffe bombed a factory near his home, injuring many people.
“It was a huge factory,” recalled Yacoub. “They were producing massive amounts of cotton. Some of it was made for industry, most of it was packed to be shipped for export, but this huge factory was well lit. When the Germans came to El Alamein—they were almost occupying Egypt—their bombers mistook the building for an arms factory run by the British.”
Nearly eighty years later, he could still describe the different sounds of German and British aircraft engines. “The Germans used
to fly over our home,” he remembered. “We recognized their aircraft and would shout, ‘Let’s hide!’
“So they bombed the factory, and there were several hundred people there. I remember, I was a child. All of these people injured.”
He remembered his father’s involvement with pride. “He was helping a lot. I thought, ‘I’m going to be a doctor like my dad.’ He was on the front line and didn’t come home for days, and when he did, he was utterly exhausted.”
As the years passed, Magdi grew in confidence. His peers started to recognize his attributes: maturity and physical strength coupled with gentleness. At one school, they elected him captain of the football team. “The boys used to say, ‘If anything bad happens, we’ll get Magdi to punish them,’” he recalled.
He was a good swimmer too. At different times during his childhood, Habib and Madeleine took the family to Ras al-Bar, which means “head of land,” at the point where the Nile meets the Mediterranean. “We stayed in sash houses right on the beach; that was like dreamland. So swimming and the sea were part of my story, and the Mediterranean was just magic.”
Magdi’s teachers started to recognize his academic talent and to believe that he could go far. “A teacher of mathematics used to come and say, ‘I know you. You’re going to get all the answers, so may I ask you to keep quiet?’ That inspired me. ‘I’ll say nothing, sir!’”
In 1948, when Magdi was thirteen, his family moved to Aswan, a city on the eastern bank of the Nile more than eight hundred kilometers south of Cairo. There, the family would live for nearly two years.
Aswan had long been recognized for its strategic importance as the southern gateway to Africa, but also for its archaeological sites. Today, it is a center for tourism and has a population of more than 1.5 million. In the middle of the twentieth century, there were considerably fewer people.
Magdi was inspired by Aswan. He went to a small school, where he was popular with the teachers, but it was the landscape and the people that made a lasting impression.
“In those days it was much quieter than now,” he said. “You have the Nile and green on either side and you have the desert behind. The colors are just amazing, because the desert is not a scorching yellow; it’s a pastel yellow, and the green is a very light green—quite subtle colors—and the Nile is huge and blue.”
He was also struck by the multiethnic nature of Aswan: Egyptians, Nubians, and people from the desert. “I was in awe at the variety of people. It just fascinated me. And against that background, the relics of ancient Egypt, the temples signifying love, dedication, and art, and the remains of massive statues. In the Temple of Kom Ombo, near Aswan, there were even depictions of the first surgical instruments in hieroglyphics.”
“As a child,” he said, “it was all so inspirational to see reminders of an ancient civilization, and to be by the beauty of the Nile. We were there only for two years, less, and I said, ‘One day, I’m going to come back.’”
It was a pledge that Yacoub would eventually fulfill, establishing a heart center to tackle the complex diseases that plague the poor and creating hundreds of jobs in Upper Egypt. As a boy, however, Magdi concentrated on his studies and on gaining a place at medical school. He read widely, particularly on medicine and science, and witnessed a surgeon at work for the first time. It was not a happy experience.
He was invited by his maternal uncle, who had trained with Magdi’s father, to join him in the operating theater. “I went and scrubbed,” he said, “and during the operation, after seeing a lot of blood, I fainted and fell to the floor.” It caused some surprise, and a swift jibe from his uncle. “And you want to be a heart surgeon!” he exclaimed.
Years later, Yacoub explained: “I can’t stand the sight of blood. How can this be, you ask, when you have spent a lifetime immersed in blood? In the operating theater I am completely absorbed, but I also feel I am completely in control. If something ruptures, it is not a problem. I am going to control it. But outside the theater, in the street, if I see an accident, I’m not in control.”
Undeterred by his vulnerability to the sight of blood, Magdi set out to win a scholarship to Cairo University, then known as the King Fuad I University. He had already decided that he did not want to have to rely on his father to pay the fees for the next seven years. He was recognized as a precocious academic talent and sat the exam at the age of fifteen, still just a boy. One of the scholarship papers involved writing an essay about the future of science. Magdi wrote about radioactivity, drawing on his extensive reading and the achievements of the New Zealander Ernest Rutherford, widely regarded as the father of nuclear physics, and the French physicist Marie Curie. The examiners awarded him a distinction and the scholarship.
Of the thousands of students who applied for places in 1951, Magdi was ranked in the top ten. Jimmy also won a place at the medical school that year. Thus, ten years after the death of Eugenie, his young aunt, the outsider from Belbeis who had made up his mind to be a heart surgeon at the age of five was on his way.
3
GROWING AMBITIONS
In an elegant apartment in the Cairo suburb of Mohandiseen once occupied by Madeleine Yacoub, a black and white photograph that captures a glittering moment in the summer of 1957 still hangs on a wall. Taken at Cairo University, as the King Fuad campus was now known, the photograph shows her son Magdi receiving an academic prize presented by the country’s president, Gamal Abd al-Nasser, who had led the Egyptian Revolution that deposed the monarchy five years earlier.
Yacoub, then aged twenty-one, is being honored as one of the university’s leading medical students. The room in which the graduation ceremony is held is packed. The two men appear to be on the point of shaking hands, with the president about to hand over a citation. Both men are smiling. Nasser congratulates Magdi Yacoub, who finished ninth among the expanded intake of 1951, and the young student thanks the president. It is only a brief exchange.
A generation apart, Nasser, as Egypt’s leader, was changing the world. Later, Yacoub would do the same, but in a different field and in a very different manner. Both men harbored visions of social justice. Nasser’s powerful slogans advocating equality, justice, and the rights of the poor appealed to the medical student’s idealism, but his brand of socialism sat uncomfortably with Yacoub’s pursuit of excellence.
Asked later why he had left Nasser’s Egypt, Yacoub replied, “We were conscious that in Egypt there were those who had dignity and those who were denied dignity; but Nasser tried to achieve open access to education for all. However, as a result, standards dropped and Nasser’s ‘solution’ undermined excellence.
“The medical education in Cairo was brilliant. There were only about sixty people in each batch of students. But Nasser said that everybody had the right to a university education and suddenly opened the floodgates. We were sixty and we became 1,000, so people were hanging from the roof trying to listen to lectures. Quality and excellence disappeared.”
By and large, Yacoub avoided politics. He was determined to concentrate on his medical studies and remain apolitical. Even during the Suez Crisis in 1956, when Britain, working with France and Israel, invaded Egypt after Nasser had nationalized the Suez Canal, Yacoub kept his distance. He was recruited by the civil defense organization and sent to the canal as part of a medical team, but avoided protests and demonstrations.
“I didn’t want to mix with activists,” he recalled. “My focus was medicine and humanity. I have never veered from that position.”
This single-minded pursuit of excellence would mark Yacoub’s career as a surgeon and scientist, whether in the operating theater or laboratory, in state-of-the-art medical facilities in the West or in small, humble hospitals and clinics in the developing world. As he pushed at the boundaries of knowledge and developed new surgical techniques, the outcomes would hinge on the quality of his work. In Yacoub’s mind, there was no room for compromise.
“I consider myself very lucky,” he said. “I experienced the ‘golden days’ of the medical school in Cairo.”
And there he thrived, both as a student of medicine and as a teenager growing into manhood. Driven by intense curiosity, Yacoub and his fellow students developed great affection for the men who taught them.
“We were very excited to be in medical school and we were very fond and respectful of our professors, who were both kind to us and renowned in their own professions.”
One professor who influenced Yacoub during his first year was a colorful Russian physiologist, Gleb Vassilievich von Anrep, who had been born in the Institute of Experimental Medicine in St. Petersburg in 1891 and had fought with the White Russians after the Bolshevik Revolution.
Anrep was a brilliant scientist; he lectured at the University of Cambridge, was acclaimed for research into the conditioned reflexes that determine how the heart rate is regulated—“the Anrep effect”— and was elected a Fellow of the Royal Society in 1928. He also took out British citizenship. In 1930, however, he moved to Cairo, where he met and married an Italian widow. When she died, having been bitten by a dog, he married her sister.
Anrep was renowned among his students for working long hours through the day and night—a routine familiar to anyone who has worked with Yacoub—and for the rigor of his academic discussions and passion for research. After the Egyptian Revolution of 1952, Anrep was banned from the university and died three years later. By then, he had made a lasting impression on his youngest students.
“We were rather naive individuals at that time, and he taught us a lot of things that are fundamental to medicine,” recalled Yacoub. “He did a lot of experimental work in the Department of Physiology. I came to understand that physiology is dynamic and explains how the living body functions. He stressed to us the value of experimentation in understanding physiology. We had terrific respect for him.”
Another lecturer who made a considerable impact on Yacoub was Professor Ali Hassan, a biochemist, whose wife, Zeinab Kamel, later looked after Egyptian doctors training in London. After teaching the students about how the body functions, Hassan would visit villagers outside Cairo and study their diets. He was looking for deficiencies that affected their health, explaining to his students why such research needed to be continued over a long period of time.
“He impressed us,” said Yacoub. “I became aware that medicine is as much about communities as it is about science and books. That was engraved on my mind.”
He also developed close relations with the professors of surgery and bacteriology.
“The good thing about them all was that they knew each one of us, and, in the beginning at least, we had a one-to-one relationship with these incredible figures.”
