Marco has been seated three times, but is now the only pediatric lung surgeon in the Netherlands

The lights are turned off in the corridor of the pediatric surgery department at the Sophia Children’s Hospital in Rotterdam. Only the aquarium near the counter is lit. It’s quiet. “It’s time for an afternoon nap,” says Marco Schnatter. He has a soft voice with a slight Amsterdam accent, and a friendly face with round glasses.

He’s a guy kids feel instantly at ease with. Marco is not only a pediatric surgeon, but also the Director of the Pediatric Breast Center, part of the Erasmus MC Sofia Children’s Hospital. Babies, toddlers, elementary school children, and teens come from all over the country with diseases of the heart, lungs, respiratory tract, or esophagus.

“All specialties work together here as one close-knit team. From surgeons and nurses to physiotherapists. This is unique in the Netherlands and Europe.”

Control for life

About twenty times a year, patients with a rare lung disorder come here. Sometimes Marco recognizes them even before they are born. “We help parents who hear on a twenty-week ultrasound that something is wrong with their baby’s lungs.”

He sees some children grow up. “We follow children who come in with a serious abnormality for years. When the children turn 18, they are transferred into adult care. Some remain in the hospital for a check-up for life.” The center is the only one in Europe and possibly the world over that provides such care throughout life.

Remember every patient

He can remember almost all of the patients who were on the operating table with Marco. Recently, a very sick patient was born who could not get enough air even with the help of a ventilator.

“We hooked him up to a pediatric heart-lung machine (ECMO), which temporarily takes over the function of the heart and lungs. We use a heart-lung machine often in children, but that is almost never the case with a congenital lung defect in children. It is required. Now, this is exceptional. .”

“I remember everything about this child: the operation, the pathologist’s findings, the follow-up process. The whole file is in my head. But many children are in my memory. Disorders are often very rare, as you remember them.”

Three high back

It wasn’t clear that Marco would become a highly specialized surgeon. His father had his own printing company, and his mother was a seamstress. He grew up on the “third floor from back” in Amsterdam. In Staatsliedenbuurt, a working-class neighborhood in his youth. They were small houses and there were a lot of problems in the area.”

In the early 1980s, squatters took control of the neighborhood. Heroin addicts lived next to the traffickers. There was a lot of unemployment and poverty. So Marco’s parents moved to South Amsterdam.

But there were also social problems in the Schnater household. His parents divorced when he was fifteen years old. Marco and his sister went with his mother. He found the divorce difficult. So things didn’t go well at school. Failed three times in the fourth year of pre-university education. “I found a lot of things interesting, but the school wasn’t.”

Work in a vegetable seller

He would rather play guitar in the school band than in class. He missed a lot. “However, my mother encouraged me to keep learning and to make something out of life.”

This penny did not depreciate until he was eighteen. “I’ve had all kinds of side jobs. I’ve delivered mail, worked a long time as a greengrocer and for various construction companies. After that countless number of jobs, I thought: Is this it?”

Accidental medicine

So he saved up, went to live on his own and got a diploma of pre-university education at the age of twenty. A dean advised him to apply for medical studies. He entered. “But I had a fun group at vwo, all languages, history and economics. No physics and chemistry.”

What followed was “the most difficult year of his studies”. During the day he worked at a greengrocer’s, in the evenings he had lessons and on weekends he did his homework. After a year, he passed the exams he needed for medical training. “I found studying relatively easy, compared to the previous year.”

“Working on children is really different.”

Marco finally chose surgery, cutting, and working with his hands. In addition to his studies, he did research for his doctoral degree in a rare form of liver cancer in children. And yes, he also specialized in vascular surgery. “I doubted for a long time which direction I wanted to go. A pediatric surgeon was at the top of my list, but in the end I chose the chest, the chest. All the vital organs are right there. Very interesting.”

The fact that he went in this direction is also related to the hospital he was working at at the time. Seven vascular surgeons have already worked there. His predecessor trained him internally as a lung surgeon. For years he worked on adults. And sometimes children. It became more and more.

“Working on children is really different. The techniques are different and the instruments are of course smaller. The children’s help is wonderful. They are always honest and pure, what you see is what you get. Little children one day are so sick they can walk down the hall again the next. And I think it’s a sport To communicate so that the child understands me and vice versa.

He also operated on children who were on the waiting list at Sofia Children’s Hospital. “When they finally offered me a job there, I didn’t hesitate for long. I went into training for 1.5 years to get my partial degree in pediatric surgery. Going back into training didn’t feel like a step back, I knew what I was doing. Being part of the Teb Center team Children’s chest is a party.

Antwerp, Brussels, London

Since then he has become the only surgeon in the Netherlands specializing in pulmonary and pediatric diseases. He accompanies surgeons in Antwerp and Brussels in surgical procedures, and for Corona he travels twice a month to the specialist Children’s Hospital Great Ormond Street in London to develop his expertise under the care of a heart and lung surgeon.

“In Rotterdam, there are about two dozen rare lung diseases a year. These operations are not enough to remain eligible. In London, patients come from all over the world for treatment. I can still learn a lot there.”

Marco wants to help children with a rare lung disease who now have to go to London for specialized surgery in the Netherlands. He even wants other babies from Europe to come to the specialized team of the Pediatric Breast Center at Sofia Children’s Hospital, because they don’t have the resources or expertise in their own country.

Exceptional formula

There’s just one problem with his plans: The combination of pediatric surgery and lung surgery is no ordinary combination. As few surgeons know about this group, there are only a few distinguished specialists worldwide, such as Marco and his colleague in London, who can perform the specialized operations.

“This is the fragility of the system. I sometimes try to support the London doctor and myself, but we need more ‘competent specialists’. Ultimately our goal is to hand the baton to younger surgeons who also aspire to this group.”

Marco prefers to groom one into a kind of master-apprentice system, just as the great painters used to do. “But it’s hard to find the right person. You can major in surgery with partial degrees. I have partial degrees in lung surgery and pediatric surgery.”

There are about 35 pediatric surgeons in the Netherlands and none of them have lungs as a common specialty. “I’m looking for someone who can question me critically, who is supportive and ultimately complements me and takes over. That would be great.”

To date, this person has not been found. Meanwhile, Marco continues to work on another dream: a national registry system for children with a congenital lung defect. “In the Netherlands, it is not kept track of how many congenital lung defects are found annually and which doctor treats the children. For example, there are children who have problems with the esophagus or diaphragm, but who do not have lung problems.”

work or not?

Before Marco retires, he also wants an answer to a very important question: “Should we or should we not immediately operate on children with a congenital lung defect?”

Seems like a simple question, right? “But we can’t work together. There are two camps: one doctor who is always on duty, and the other only if the child has complaints. It just depends on which hospital you come to as a patient. I belong to the latter group. Of course we closely monitor children who do not have No complaints so far, but they can have it. They benefit from having an operation at a young age, and for others the operation is not necessary.”

European cooperation

He and his doctoral students are working hard on the best treatment for these children. A European collaboration with his team is now being established. Many doctors will follow the 166 children for years. Half are turned on and the other not.

This may sound unethical, but according to Marco, it is not. “Half of the doctors are already working right away, and the other isn’t. So there’s nothing crazy about that. The study was set up in Europe, because with twenty babies a year in Rotterdam alone, it’s going to be a while before we get the results.”

“If you work hard, you get things done”

conducting operations, conducting meetings, supervising examinations, observing other surgeons, and writing plans for the Pediatric Breast Center; Just like in high school and during his studies, Marco is busy with different things at the same time. “I worked and learned, that’s how I did it during my studies. Now I do it as well as a specialist. In my twenties I already had to put my own affairs in order. I learned that if you work hard, things get done. That was the case and it still applies today.” .

However, Marco can easily give up his work when he gets home. “It’s not that difficult. Three years ago, our eldest son left home and my wife and I bought an idyllic farm on the edge of Betwe. The farm is small and the land is big.”

together in the woods

The alarm rings at 05:15 every morning. Then Marco or his wife – it just depends on who’s awake – feeds the horses. Then he took the car to the hospital.

Evenings and weekends he does odd jobs on the floor. He maintains fruit trees, takes care of horses—”my wife is more fanatical about that”—or goes for a ride. “The farm is on the edge of a forest. I haven’t driven this winter, but when the weather gets nicer it will itch again and my wife and I will no doubt go into the woods.”

Marco’s life is busy and intense, but he can manage his work and free time fairly efficiently. “I have to. I want to keep going for a while. My work isn’t done yet.”

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