The unexpected death of Dr. José Antonio Mosquera Pestaña has shocked all of the people who knew him and had the privilege of his friendship. Many people have accompanied his family these weeks in his deep pain. The press disseminated his image and his human and professional virtues through articles written with admiration, gratitude and affection who, for years, shared their daily work with this exceptional doctor.
Born in Camponaraya (El Bierzo, León), Dr. Mosquera had a long professional life at the National Institute of Silicosis (INS), a monographic hospital, with a care, training, research and preventive function, dedicated to patients with lung conditions linked to to the inhalation of coal dust in the mines. The main objective was later extended to other pneumoconioses and opened up to other processes of the respiratory system. Dr. José García-Cossío, who was the first director and head of the medical department, took care to provide it with an excellent medical and technical staff that had been in charge, since 1970, of clinical, basic and engineering services, and that contributed the best knowledge to the development of the center. From the beginning, he was in this task.
Dr. Mosquera was always very studious. He went to the General Hospital of Asturias (HGA) in the 1960s, attracted by the teaching program for the training of medical specialists that that pioneering center had incorporated. He was a serious and pleasant person. When he wasn’t talking about medicine, in informal conversation, he exuded a fine Galician humor. He was not interested in social events, because all his sentimental illusion was placed on Cristina, his girlfriend in Santiago de Compostela, then his wife and mother of his two children, and now his widow.
He possessed orderly intelligence, a prodigious memory, and a strong will. He was compassionate and kind to his patients, who saw him as a competent and responsible doctor, close and interested in their problems. It continued like this for the rest of his life, as those who were close to him for a long time in the INS have recounted.
In the archeology of those clinical histories, written by hand, he championed a model of progressive clinical course during the patient’s hospitalization. It was distinguished by the enumeration of the problems in order of importance. What the patient referred to was noted down first; then clinical examination. The diagnostic possibilities were reasoned and studies were requested to rule out invalid hypotheses and support the true diagnosis with evidence.
The treatment was decided based on the evidence, after having started with the non-specific, but necessary, symptoms. As a climax, the information given to the patient and family was recorded. The clinical course not only updated the evolution of the patient in the hospital; it also reflected the functioning of the hospital (promptness in the studies and the responses of consultations). It allowed the doctor on duty, if he did not know the patient, to act in the event of any incident, with the same knowledge of the person in charge, and to treat the information uniformly, outside of normal hours.
Dr. Mosquera had a passion for medicine and teaching. In addition to organizing multiple teaching activities for INS and external doctors, nurses, students and others, he was personally involved in two scenarios: the joint visit of complex cases and the clinical sessions. The doctors from the Pneumology service had assigned the patients, but the most complicated cases were seen together. At the head of the bed, the history was reviewed, the examination (which he did himself) was updated, and in a separate room the studies were examined and the diagnoses and treatment were discussed. To the point of view of the patient, to his malaise (“illness”), the medical vision of the disease (“disease”) and other perspectives (“sickness”) were added, the exposure to dust in the workplace, in the the case of active miners, or the degree of silicosis and the regulations that regulated this situation when it was already acquired. The periodic sessions with cases scheduled in the assembly hall, to which other HUCA services attended and participated according to the pathologies (oncology, thoracic surgery, infectious diseases…), are remembered as among the best in the health complex.
Dr. Mosquera went through life without knowing six of the seven capital vices, but he did know one, that of anger, understood as the irritation produced by being faced with an obstacle that prevents us from doing good or avoiding evil. He was very angry at injustice, which for him was changing his assistance model. He would not tolerate a manager criticizing him for making medicine out of him, and likewise he would staunchly defend his team members if criticism was directed at them.
For the doctor, the workshop is the service. Quality is based on your empirical knowledge. Patient care must be excellent and its quality model is inspired by the search for perfection. Skill is acquired by imitation and develops with experience. Dialogue and cooperation are genuine features of each service. Dr. Mosquera believed and practiced this language and it was difficult for him to tolerate the dominant counterpoint of politicians: numerical objectives; individual performance, based on repeating the same task as many times as possible; displacement of craftsmanship by technology; Change of the concept of quality to base it on the fulfillment of objectives.
Dr. Mosquera added to his extensive training in pulmonology and internal medicine a remarkable knowledge of infectious diseases and histopathology, with which he would tackle his lung cancer research with determination. In the infectious part, Dr. Amalio Telenti, from the HGA, a teacher and friend of his, influenced him, who advised him to do a stay at the Mayo Clinic in Rochester, Minnesota (USA). The other influence was that of Dr. Andrés Ribas, head of Pathology at the HGA, specializing in tumor cytology in the US, with whom he studied many cases under the microscope.
Dr. Mosquera had a passion for research and guided her to discover the basic altered mechanisms that lead to the manifestation of variants of the disease. In his maturity, he set out to measure the influence of the microbial environment on the respiratory system of patients with lung cancer. He formed a research team with three tasks in parallel: to study under the microscope a type of bacterial flora that was easy to identify, with appropriate stains, inside and outside the tumor cells; follow the clinical evolution of cancer patients, and leave statistical studies to those INS colleagues with the best mathematical knowledge.
Any study of a certain size requires a large number of samples to reach significance. His forced retirement interrupted his continuity in hospital and research, since he could no longer have study material. But the repeated observations made up to then suggested that the presence of bacteria accompanying the tumor was more frequent in unfavorable cases (recurrence and metastatic spread) than in cases with response to cancer treatment, and the probability of significance pointed towards this. He still followed the research team studying tumors in animals, with the collaboration of expert veterinarians in animal clinics, but it was not the same.
One cannot help wondering how the investigation of a person of his talents and qualities would have progressed with greater ease. What rickety institutions we have that give so little value to someone who spent his entire life serving public medicine in the hospital, taught so much and researched with so much passion! With hardly any means, he faced one of the most serious and frequent cancers.
We are now in the age of molecular medicine. The image-based methodology has moved on to genomic sequencing of the microbiome. But the physical laws that govern nature are the same. A more powerful methodology makes it easier to obtain new data in less time, but it is useless without ideas and numbers. The interaction between tumor and infection or, in this case, alteration of the respiratory microbiome in lung cancer will be addressed by other researchers who will replicate or find greater complexity in the interaction mechanisms. How much is left to give freedom to science, create meeting spaces, favor talent affinities and spend a little more so that young and mature researchers work motivated by their scientific curiosity and research passion!
After the basic studies come the applications and, in medicine, the new treatments. Science progresses with hypotheses, which are born one day out of curiosity when the researcher wonders why some or other things happen and through the scientific-experimental method tries to unmask the unknowns. It takes a lot of effort to design work, collect samples, analyze them, study results and, in the end, obtain evidence. But the investigative passion is not easily quenched by difficulties. Failures don’t…