Life-altering decisions:1. Taking the road less traveled

Several times we have faced major signposts on the highway of our lives, when going one way or the other would make all the difference to our future lives. Deciding what was the right thing to do required long, deep thought, and it was very clear at the time how important the decision was. The first time this happened was over a lengthy period, perhaps 18 months, in 1958 and 1959. We had married in February 1957; Rebecca was born on New Year's Eve, the last day of that year, and already issues were lining up on each of two diverging paths, one compatible with a lifetime in an increasingly prosperous family practice, the other not. I had begun to discern, vaguely at first then with increasing clarity, that some time in the next few years I would have to make a major decision, whether to stay on that safe, familiar highway of general practice, or take "the road less traveled" into a different professional role. By the middle of 1958 we were established in the gracious old doctor's home at 16 Henley Beach Road, Mile End, on the western outskirts of the city of Adelaide, with my office or consulting rooms in a three-room extension in front of the house and a lovely garden with many fruit trees behind the house, in an oasis of calm amid a grimy industrial area. Rebecca was changing from a helpless baby into an active, communicating infant girl, and Wendy was pregnant again. I had become a capable family doctor; I was a junior attending physician in the outpatient department of the Adelaide Children's Hospital; and I was taking on new scholarly roles and some executive responsibilities in the newly born, rapidly growing College of General Practitioners. The senior partner in the 10-doctor group practice where I was the most junior partner was a prominent medical politician; he and I got along well, shared many values and views of life, and he had begun to mentor me as a potential follower in his footsteps. For that reason he encouraged my growing involvement in the affairs of the College of General Practitioners and began to encourage me to seek office also in the South Australian state branch of what was still in those days the British Medical Association. The other pathway that I could discern dimly at first then with increasing clarity as 1958 gave way to 1959, led towards a more scholarly career. I wasn't sure exactly what was along that road or where it would lead me and my dependent family but I knew it was more scholarly, more contemplative, and that it had something to do with public health sciences, mainly with epidemiology and medical sociology. In November 1958 when we flew to Christchurch, New Zealand, for me to meet and begin to get to know Wendy's family I was exhausted at the end of what had been a very nasty epidemic of influenza, the local manifestation of a global pandemic, in which two people in my own age group whom I knew quite well, a nurse in one of the hospitals where I delivered babies and an ambulance driver with whom I sometimes played golf, both died of overwhelming viral toxaemia. In New Zealand I fell critically ill. I had a viral pneumonia, was in an oxygen tent with a detergent mist intended to loosen tenacious mucus secretions that were choking the life out of me. For a few days I, and the attending physician, thought it was distinctly possible that I might die. I recovered slowly, and during my long convalescence I thought deeply about the future. I knew I did not want to spend the rest of my life getting rich from other people's misfortunes. At the monthly meeting with our accountant that came soon after the end of the influenza epidemic, I had been disgusted by the atmosphere of rejoicing that prevailed among my partners. As they clapped and cheered the numbers the accountant was reporting, I saw in my mind's eye the sad face of the mother of that young ambulance driver who had died. That very morning she had insisted on paying me for several fruitless visits I had made to see him, first at home then in hospital as he sank into irreversible coma and died. That was a moment of truth for me. After that I was increasingly at odds with some of my partners, particularly the two nearest my own age who were most blatantly practising medicine in order to get as rich as possible. My thoughts about a future career began to turn towards preventive medicine and public health. I began to reflect on aspects that I could study in detail while remaining in general practice and earning enough to support my family. When I tentatively floated this idea in a conversation with the most sympathetic of my partners, his extremely negative, even hostile reaction convinced me that such a desirable future was out of the question. I discussed other options with the professor of medicine at the Adelaide medical school. Sometimes openings appear for research associates in academic clinical departments but academic medicine was in its infancy in Adelaide in the late 1950s, and there was no scope for a move in that direction. After further reflection, I decided on a reckless gamble. I left the comfort and security of the group practice, took back the money I had invested to join the partnership, used it to live on for a year in Sydney while I studied for the DPH at the School of Public Health at the University of Sydney. That was the only place in Australia that offered any kind of academic study of public health sciences in those days. Despite the fact that the School of Public Health was not an intellectually very stimulating place in 1960, it was a mind-blowing year for me. I may have learnt more in that year than I did in all six years of the medical course that had ended 10 years earlier. At the end of 1960, I secured a traveling fellowship that paid a stipend intended for a single man without dependents, and embarked for London and a year in the MRC Social Medicine Research Unit. The reckless gamble was beginning to succeed and my new career in public health sciences was starting.