Sobrinho Simões

Two minutes. Maybe three. It doesn’t much longer to realise it. He arrived, smiled and his fresh words did the rest. Sobrinho Simões is of an admirable simplicity. A giant. In terms of brain power. Ruthless, in terms of sincerity. In his gestures or in the way he talks, there is none of the unapproachable scholar. Quite the contrary. It’s fascinating the closeness he builds. Despite being the president and founder of the respected Institute of Molecular Pathology of the University of Oporto (Ipatimup). Despite being the most remarkable face of the Institute of Research and Innovation in Health (i3S). Despite leaving his mark, with great prestige, at the School of Medicine of the University of Oporto. From feelings to cancer. If it’s complex, he’ll simplify it. And it’s if he’s performing magic. As it’s impossible to embark on a conversation with him without losing the notion of time. Time. That old tormentor that dares to stalk the best pathologist in the world.

Have you lost a lot of friends recently?
I have lost lots of friends. Dr Mário Soares, Miguel Veiga, professor Serrão, who had been my boss. And two doctors of mine died; Professor Trigo Cabral, who operated on my knee, and who has always been my orthopaedist, and Carlos Resende, who was a dermatologist and who came to work with me when I was very young; he came as instructor for my subject. So, I’ve had five people die on me, from very different worlds. Resende was younger than me, he was my mentor, his death is an anachronism, metachronous deaths despite everything are less painful. I don’t cope well with losing friends, I don’t know why, but I don’t.

How can you tell if you’re sad? Do people notice?
No. I’m a workaholic. If I get depressed or start to feel depressed I work more. My solution is forging ahead regardless. That’s why I’m working a lot more this year than I have in previous years.

But, as you’re such a rational person, can’t you see yourself and realise that this could be doing you harm, or that it will do you harm?
I’m certain it’s doing me harm. If you like, you could say it’s a way of fooling retirement and metaphorically, it’s a way of fooling death. It’s people that don’t notice it (he laughs).

Do you think about your death?
Of course I think about it; as if I wouldn’t! But we go around acting as if it’s all okay and then we die, don’t we? Death, in this respect, commands respect for its inexorability. If you’re not dumb you know that it’s very rare not to die and that it won’t happen to you. I’m in funny phase, in terms of increasing my work load, which is just stupid, rationally speaking, because, if I’m going to retire, in the end, as of next year, I am going to have less to do, and I’m going to feel this break more and should be making an effort to slow down and I am not. I’m accelerating, clearly.

Do you ever get mad?
Often, on my goodness do I! I’m insufferably crabby. I over react, I’m rude, I yell, for example, but I’m not prejudiced, I tell people what I have to say. Often I think I’m losing my mind, because I get irritated and I get hot-headed, but afterwards I soon shake it off.

And are you man enough to eat humble pie?
Yes, yes, that’s no trouble. But I far too old to have these little anger attacks. People like me, who are workaholics, are inclined to have such scenes of irritation, of elation. And beware; this isn’t good. My wife always has a go at me about this, with regard to my grandchildren. It’s a bad example to get angry, yelling... Yelling? Come on guys, we’re all grownups here (he laughs). I feel really bad, but that’s just the way it is. It’s also too late to change. 
«I’ve already been voted the worst dressed professor in the school of medicine and they gave me a voucher to go shopping»

Do you feel that your students like you and your classes?
Indirectly, from surveys and such, I am often considered a guy who thinks it’s fun to teach…I often get given ridiculous prizes. I’ve already been voted the worst dressed professor in the school of medicine and they gave me a voucher to go shopping (he laughs). I have no reason to complain about the rewards I have enjoyed as a teacher with regard to how my students have rated me. We’ve been doing anonymous surveys with students for years; I’ve always felt they should be done. Somewhere around 20 years ago we got a survey that was really positive, saying that we were serious, that we were doing our job, that the classes were well structured, but there was one complaint: « professor Sobrinho Simões, who everybody says knows so much, gives some really weak classes» (he laughs) and I did a slide. My great aspiration is that people understand and, therefore, I don’t do very complex slides. I believe that I have played some role in a demystification that there was in Portugal concerning what cancer was. What people were saying about cancer and how they were saying it, exactly because I can explain things in simple terms.

And in this case, in the fight against cancer…
Which people find frightening, because of the psychological side, not for the reality. In spite of everything, we die less from cancer than we do from strokes, which is staggering. Look, cancer is on the increase in Portugal, as it is on the increase in the world, but we are dying less from cancer. Already we treat more, we diagnose earlier, we are more efficient. We are as good as the other countries of Western Europe. Mortality has already gone down. Note that we are now going from 50,000 new cases a year to 60,000 and mortality has remained at around 25,000 or lower. If you look, if this were 25,000 of 60,000, this already means that we already control much more than half, which is really good.

But are we controlling too much? You’ve even said that there are cancers that should be left in peace.
Yes, but that is another matter. You need to be very careful because I am very much in favour of prevention and of early diagnosis by screening. But it’s not the same thing to screen a person of 40, 50 or 60 years, or to start to screen the elderly of 80 or 90.

Isn’t it worth it?
It is, but you have to be sensible about this. In the majority of cases when, in an elderly person, of more than 80 years or 85, we find small tumours; it’s not even worth calling them micro cancers, because they’re not going to cause any trouble. However, it’s indecent to remove the prostate of an 85-year-old man because he has two or three micro tumours and he was going to die of natural causes before having any problems with them. Anyone who says this says the same about the thyroid gland. There are many tiny nodules on the thyroid gland that there is no point in removing, for goodness sake!

Do you think that you have helped society to understand that cancer is bad but that it can end up being a race you can win?
Yes, cancer is controllable, and for this reason I think I have, but this in my small world and because we have very good people. I have people working with me that are already much better at me in diagnosing many kinds of cancer. In every cancer I diagnose I say that it won’t be cancer before another ten cases. The benign to malign ratio for the thyroid gland is ten to one, therefore I don’t just diagnose cancer; in ten people I diagnose one cancer that needs to be treated and nine people I reassure, because I tell they don’t have cancer. Diagnosing cancer, in spite of everything, is an exception with regard to the non cancer diagnoses we make. Does that make sense? And for me it’s very good. I never liked being a doctor because I feel really bad for the patients. I have people in my family who are oncologists and at a given time they have to tell people that that they have a disease that could potentially kill them. This disgraced me. I never liked seeing sick people and I really like to give good news. 

Would you like to leave your mark?
For me teaching is by far my most rewarding activity. I find much more reward in teaching, with medicine students, with interns and pathologists, than I do in research alone, or diagnostics.

Because it has a greater yield?
Much greater and is very important from the point of view of future effects.

Because it leaves a work?
Because it leaves people.

Which is something you like?
It’s the think I most like doing. There the sadness of confirming malign cancers is reduced. I do diagnostics and train people in diagnostics. This is the funniest thing there is in terms of anyone who likes to leave a memory, because it is the memory of people. I find it very funny to write papers. I really like to be quoted, these mundane vanities (he laughs). But the papers die, they have a life span. The people you teach remain.

This thing about memories means that you like taking pictures?
No, no I don’t. I like to memorise.

But then you can’t memorise everything...
No… And, then, I find it really funny that when I’m sent photos I reconstruct that memory. But I don’t take photographs. I don’t have any gadgets; if I did, I’d lose them. It’s bad enough with my glasses and my tablet. Photography is predatory, but at the same time it fixes the memory. I use this a lot today when I want to write things about my grandfather from Arouca or about my grandmother from Bombarral and I go and look for photographs in my mother’s albums. And from the photographs I remember situations. I think it’s really nice, but my life doesn’t allow me such things.

Looking back at your life, and as someone who has won so many awards, who got such high marks and who is so used to success, what do you feel you deserve to have failed in?
In many things. Firstly in anger management. It is unacceptable for a guy of my age, an adult, to lose his head when he is faced with a setback. I don’t like to be defeated and I don’t like to do stupid things. I cope really badly with my failures. The first thing I would give myself a bad mark in would be my inability to be sensible and polite when faced with a major setback. The other one I have is that I am highly efficient in day-to-day matters, I do so many things, I ruin peoples’ lives, I am very selfish, people around me work themselves to death, it’s frightening. Because I am then a steamroller, this is another bad aspect I have. Another which my family often accuses me of is that I do so many things. For my generation, I helped a lot more in the home than my colleagues. I laid the table and cleared the table and filled the dishwasher, etc. I would have my children once a week and I never left them with my parents or my parents-in-law. I would give them their dinner, bathe them. I would often switch their pyjamas by mistake, poor things. My daughter would cry a lot because she didn’t have the things she wanted because I didn’t know what dress she wanted to take, but I did all of this with little emotional involvement. Meaning that I remember very little of my children when they were little, I barely remember the houses I lived in. It doesn’t make any sense, I’m ashamed of this. People like me, who do many things and have many small successes and who knows what, do so at the expense of very great efficiency, total accountability – I didn’t annoy people, I didn’t shirk my responsibilities –, but there is no emotional involvement. I would be changing the children’s nappies, while thinking about other things. I only find my children fun from the moment in which I start interacting with them as adults. Then I always loved – because my wife didn’t want to go abroad with me, because I work a lot – the fact that they started to come with me. And I had trips all over the world with my children, but it’s when they were already counterparts. I don’t find little children at all fun. This is something negative (he laughs). If I were to have an emotional connection this would probably take away my ability to do more and do it quicker. It’s a limitation and I always feel this with my children.
«I’ve been very lucky in as much as having a positive repercussion nationally»

But didn’t you try to be different with your children, turn to them and say «I’m proud of you!»?
No, I always implied it, gave an indication. But I didn’t say it outright. And they always accused me of this, but this has a lot to do with our culture, both from my father’s side, and from my mother’s side. In my family we don’t praise easily, we never have. People don’t need to say they are proud because they know they are, and so you don’t say it. What’s more, in my day and in my schooling, people weren’t as vocal as they are today.

It is too much today?
Very much so. Portugal has really high marks. We don’t have any tradition for reward/punishment assessment. This is a society that is unable to independently assess and reward. Entirely unable. Partly because we are all cousins and in-laws, we are a high-context society, we are small-scale. We don’t believe in the value of assessment and we don’t have the courage to distinguish. We give really high marks to everyone. People are always the poor thing when they screw up, they’re always the victim.

You are an asset to the nation. Are you able to see that you’re one of Portugal’s finest?
No, I believe that I’ve been very lucky in as much as having a positive repercussion nationally, perhaps because of it being cancer and because health sciences are seen as important. Perhaps because of having really good communications skills. People feel that I am useful and this is very rewarding. Everyone teases me a lot about the story of the world’s most influential pathologist, but because I do many courses all over Latin America, Eastern Europe... These are the people that vote for me. I’m delighted by this. It’s not vanity, I truly like it. Just thinking – maybe I’m being presumptuous – that I’m useful.
«If I had to name the thing that I lack most, I would say it is time»
We’re increasingly concerned about being healthy, but even so we always end up dying. But the notion out there is that we’re not being efficient…
No, because we’re primitive. It’s true that only three out of ten smokers get lung cancer; then more than one and a half of them get bladder cancer or something else. More than half of smokers don’t end up dying of cancer caused by tobacco. And people always think they’ll be among the ones that don’t. And we have something else that is terrible: the culture of unaccountability. We are a society has not developed, as we do not have reward/punishment assessment. If I hit my wife I am able to say it’s just my genes. It isn’t. It’s because I’m a savage, a brat and a beast. But if I were to say «ah, but my father hit his wife too, this isn’t genetic, it’s cultural», that’s worse still. In Portugal we have little literacy; we have a rhetorical culture, unlike the Anglo-Saxons, who are very good at what is essential. We have a culture of the accessory, of the detail. We don’t reply to what is asked of us, we always reply at an angle.

Is this what you’re doing now?
No. I don’t have time to think. I take advantage of the times I talk to journalists to think; I’ve always been like that. I’ve learned some things with you today that I’ve never thought about before.

Do you know the biblical verse about time, it begins with the line «there is a time for everything, and a season for every activity under the heavens»?
I know it, but I don’t have time for anything. If I had to name the thing that I lack most, I would say it is time. Maybe it’s because I think my time is coming to an end. I’m not stupid about this. I think I have little time left. Part of my acceleration has certainly to do with this. I’ve always lacked time; now I’m even more lacking in time because I know that I have little time.

And what are you running away from?
I don’t know, maybe escaping death.

Was dying from cancer something terrible?
It was. I am terrified of cancer. I’m also easily frightened, I’m afraid of everything. I’m afraid of gas, I’m afraid of the dark, I’m afraid of the unknown and I’m very afraid of everything. Whenever I go for a routine check up I’m afraid that they’ll find something, and they always do, at my age you always do. I know that a person getting or not getting cancer, in addition to having to do with certain behavioural factors, is mainly down to luck. That’s why I am against that stupid thing «I beat cancer». You didn’t beat anything, you were lucky. You did good, you went to a good doctor, you found the cancer early, but, for the love of God, beat cancer? As if anyone who dies of cancer doesn’t have the willpower. It’s just stupid. And I’m afraid. Cancer scares me a lot, not least because I’m pessimistic. In our family, we haven’t had that many cancers, we have more heart disease, diabetes and strokes, and I am more afraid of this. I am petrified of getting dementia and not understand, and ruining my children’s and my family’s life.