In memoriam: Professor Domenico Pagano

I disagree with what you say, but I will defend to the death your right to say it. Professor Domenico Pagano (Figure 1) died on the 10th of October 2022 after a brave fight with a terrible disease. He was 60 years old, and it was far too early. Domenico was a true leader and an inspiration to those clinicians whose first priority is to their patients. While displaying a strong sense of humour and occasionally mischief (particularly if he became bored), Domenico’s commitment was not only to his own patients but to all patients, especially through his work on clinical practice guidelines and in rooting out biased scientific practice. Corruption and self-interest were anathema to him, and he was fearless in calling them out, often making enemies in the process. ‘Never whisper in the presence of wrong’ was one of his favourite quotes and a driving principle of his professional career. As opposed to many in our profession, Domenico would unwaveringly support opinions different from his own if they were based on evidence, not eminence and self-interest or self-promotion; the one at the beginning of this piece was another of his frequent citations. Prof. Domenico Pagano. Domenico was born in Pompei, Italy, where he received a classical education of which he was rightly proud. He studied Medicine in Naples and trained in Bologna, before moving to the UK where he spent the remainder of his clinical career, becoming a valued colleague in the broader clinical team. It was always time consuming to walk together along the main hospital corridor at the Queen Elizabeth Hospital Birmingham, because of the number of people who wished to exchange a greeting and a few words with him. Domenico showed equal respect to all, regardless of their seniority or status, valuing excellence and integrity, and detesting hypocrisy and mendacity. His funeral was attended by more than 200 mourners, some of whom had taken time from their hospital duties to pay their respects, but also including a past patient who heard about his death by chance when serving a colleague of Domenico’s at his local restaurant. Indeed, Domenico was the kind of surgeon that all of us would choose to operate on family members and friends; he had a superb safety record built on doing well-established procedures to a very high standard and never putting surgical ego and technique before patients’ best interest. That said, Domenico was certainly no saint, and his wake included the affectionate sharing of anecdotes from his career and life, none of which can be repeated here! Domenico’s research focused on the identification of hibernating myocardium using positron emission tomography scans, working closely with his fellow Italian Paolo Camici, a British Heart Foundation Professor of Cardiology. He successfully conducted several medium scale clinical trials and published over 150 research papers during his career. It was in the subject of health policy and guidelines where he particularly made his mark, advancing the clinical quality agenda in his own hospital, and addressing a number of very controversial topics. These included studying the increased risk-facing patients who were admitted to hospital at the weekend and duality of interest in guidelines especially those developed by clinical societies including the European Association of Cardiothoracic Surgery (EACTS) where he became Secretary General in 2016. At EACTS, Domenico advanced an agenda of modernization and set the foundation to strengthen the financial solidity of the Society. While change is often painful, unexpected challenges such as the coronavirus pandemic demonstrate how the normal processes and income of an organization can be severely disrupted and highlight the need to ensure a firm foundation of professional societies. Domenico worked tirelessly for EACTS, only stepping down when forced to do so by poor health. He had many true friends, but also recognized that leadership positions such as those with EACTS bring status which truly belongs to the position rather than the holder. Domenico loved family, wine, good food, and Juventus FC in football. He was appalled when his team lost and by the departure of the UK from the European Union. While his life was spent abroad, his heart remained firmly in his beloved Italy. He became a single parent to his cherished daughters Marie-Claire and Beatrice (Bibi) with the tragic death of their mother while they were still young. A loving and caring parent, Domenico did all in his power to support them through challenging times and was fiercely proud of them, considering them both his greatest achievement in life. He is survived by his daughters, by his sister Anna, and his father Carlo. In the hardest moment, in professional life and at EACTS, Domenico, who was the absolute driving force of the group, would often hearten us all by saying ‘Let’s do this one more thing; one more challenge and then we will all rest. We will all go fishing’. It is unclear to us if Domenico knew anything about fishing and (as he would have liked this to be said), there are no objective data to prove his fishing ability—it is very likely that our fishing expedition would have been quite benign to the fish. Nevertheless, we like to think that he is resting now, looking at the beautiful Italian sea that he loved and knowing that we all will be missing him deeply. Ciao, Domenico! All authors declare no funding for this contribution. No new data were generated or analysed in support of this research.

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