About 25 years ago, a young physician told me how distressed she had been when attending the extremely difficult labour and delivery of a baby born to a teen-aged girl who had been subjected to radical genital mutilation. When she was a child, the girl's entire vulva had been excised and stitched together, leaving a scarred, deformed perineum with a small hole for menstrual fluid. Her husband had presumably battered his way through this to impregnate her.It seems unlikely that sexual intercourse could have been enjoyable for him and it was extremely painful for her. The scarred perineum had to be cut open to permit the passage of the baby. What distressed my young friend was that this 17 year old girl and her mother who accompanied her, were demanding that the girl's vulva must be stitched together again after childbirth.
The barbaric practice of radical genital mutilation, a rare and horribly perverted tribal custom, is a dark aspect of Canadian multiculturalism. An even darker aspect was brought into public view in the widely publicized trial of an Afghan man, his second wife and their oldest son, which has just ended with conviction of all three for the carefully planned murder of the man's first wife and three teen aged daughters who were said to have besmirched his honour by wearing provocative clothing, using makeup, and flirting. This was at least the third so-called honour killing to come to public notice in this part of Canada in recent years. Honour killings, in which girls and women are murdered because they have violated traditional patriarchal cultural values by asserting their autonomy, and radical female genital mutilation, are evil aspects of Canadian multiculturalism. These ancient tribal customs are not Islamic although many but not all the perpetrators and victims happen to be Muslims.
Arranged marriages in which parents select the marital partners for their marriageable children, are a feature of many traditional cultures. They generally seem to work at least as well as marriages based on love or mutual attraction. They are common and usually accepted willingly among South Asian migrants to Canada, even among Canadian born offspring who have been here long enough to have marriageable children of their own.
Arranged marriages aren't always cheerfully accepted by all parties. I have a vivid memory from my brief life as a family doctor in South Australia more than fifty years ago of a girl born and raised in Australia by Southern Italian parents. This girl came home from high school one day to find her parents entertaining a man more than twice her age who had recently arrived from Calabria as her prospective husband. I was called in when she tried to kill herself rather than accept him and give up her boy friend, a high school classmate.
Migrants tend to perpetuate the customs of their country of origin. Wendy and I did this benignly when we settled first in Scotland and then in Canada. For example we never ran out of Vegemite and Wendy’s pavlova desert was renowned for decades among our friends. We even carried one or two adopted Scottish customs such as fondness for haggis, as well as Australian and New Zealand customs, with us to Canada!
Despite the hideous dark side of multiculturalism I believe its benefits far outweigh its flaws. These benefits include widening of everyone's cultural horizons, encouragement and acceptance of cultural and ethnic differences, and creation of tolerance for these differences. These are values worth living for.
Monday, January 30, 2012
Sunday, January 29, 2012
Decisions, decisions, decisions
[This post got lost somewhere in the inscrutable nooks and crannies of cyberspace, reappeared today after I'd posted a summary of part of it, with photos]
In the period from late 1959 to late 1969 Wendy and I made three life-altering decisions and several lesser but significant decisions based on fundamental choices we made about the way we wanted to spend our lives. These decisions made it necessary to move from one continent to another, migrations which in those days we made comfortably by sea on passenger-carrying freighters. Of all the ways to travel, this, in my own and our family's experience, is far and away the best! I described our movements during that period in the memoirs that I began to write in the early 1990s and have revisited some highlights in recent posts on this blog.
We moved into the large, comfortable family doctor's home at 16 Henley Beach Road, Mile End, about 2 months after our marriage on St Valentine's Day, February 14, 1957. Rebecca and David were born while we lived there, and although it was in a grimy industrial area immediately west of the metropolitan area of the city of Adelaide, its sheltered back garden was a verdant oasis of bountiful fruit trees, grapevines, flower beds, overlooked by the north-facing glassed-in back veranda of the house. The veranda was sheltered from the summer sun by a trellis of grapevines and in winter with the sun lower in the sky, solar warmth flooded in to make it an ideal play area for Rebecca. As she grew into a toddler, the back lawn and the sand-pit, and playing with Helen, our Dachshund bitch, kept her amused. In front of the house, opening to the sidewalk, was the purpose-built consulting room suite called the 'surgery' with a waiting room, an office where I saw my patients, and a back room with a small laboratory and filing cabinets for my records. By this time my colleagues regarded me as a competent, capable family physician and I had increasing confidence in my ability to diagnose and treat a widening range of medical, minor surgical and obstetric conditions. My family had assured financial security and long-term stability.
As I have made clear in previous posts, my attraction away from the comfortable stability of family practice began earlier, during my time as a salaried assistant in the group practice. I began to classify and count the numbers of patients I was seeing with each of several commonly occurring conditions; I began to study the social and behavioural sciences that had been left out of my medical education. I had long been fascinated by epidemiology (though I didn't yet know it by this name) and when I read Jerry Morris's mind expanding article, Uses of Epidemiology in 1957, my intellectual and philosophical conversion was inevitable.
When I'd asked about a junior partnership in late 1955 I was rebuffed. I left the practice and became chief resident (in American terminology) at the Northfield Infectious Diseases hospital, where I saw many patients with viral encephalitis, hepatitis, some with the infectious rashes of measles, scarlet fever, etc, and soon after I started working there, a lethal epidemic of bulbar poliomyelitis that paralyzed swallowing and breathing muscles and killed many young adults in my own age group. Soon I had over 30 young adults in respirators ("iron lungs") and watched impotently as most of them died. It was the final polio epidemic in Adelaide. By the time the next late summer outbreak was due, we had Jonas Salk's polio vaccine.
Wendy had come back to Adelaide by then, and soon after we announced our engagement to marry, I was invited back into the group practice as a junior partner. I hesitated briefly before accepting this invitation. Seeing and treating epidemic infectious diseases had awakened my interest in epidemiology. Yet I loved the work and life of family doctoring and clearly it offered a far better start to married life. However, I did not like making money from other people's suffering and distress, and I became disenchanted by the greed, selfishness and lack of compassion of several of my partners. Wendy and I agonized and talked over and over about two alternative career pathways we could see ahead of me.
At the end of 1959 we made our choice in the first crucial joint decision of our married life. I resigned my partnership in the practice, and we left for the School of Public Health and Tropical Medicine at the University of Sydney, where I spent a year learning the basic foundations of public health sciences - epidemiology, biostatistics, environmental health, behavioural and social sciences (anthropology and sociology). Towards the end of 1960 I was awarded a modest traveling fellowship that paid my fare and a stipend for a single man without dependents for a year (1961-62) that I spent in the UK Medical Research Council Social Medicine Research Unit at the London Hospital Medical College, on Whitechapel Road in the East End of London. I'll expand on that last paragraph in another post.
In the period from late 1959 to late 1969 Wendy and I made three life-altering decisions and several lesser but significant decisions based on fundamental choices we made about the way we wanted to spend our lives. These decisions made it necessary to move from one continent to another, migrations which in those days we made comfortably by sea on passenger-carrying freighters. Of all the ways to travel, this, in my own and our family's experience, is far and away the best! I described our movements during that period in the memoirs that I began to write in the early 1990s and have revisited some highlights in recent posts on this blog.
We moved into the large, comfortable family doctor's home at 16 Henley Beach Road, Mile End, about 2 months after our marriage on St Valentine's Day, February 14, 1957. Rebecca and David were born while we lived there, and although it was in a grimy industrial area immediately west of the metropolitan area of the city of Adelaide, its sheltered back garden was a verdant oasis of bountiful fruit trees, grapevines, flower beds, overlooked by the north-facing glassed-in back veranda of the house. The veranda was sheltered from the summer sun by a trellis of grapevines and in winter with the sun lower in the sky, solar warmth flooded in to make it an ideal play area for Rebecca. As she grew into a toddler, the back lawn and the sand-pit, and playing with Helen, our Dachshund bitch, kept her amused. In front of the house, opening to the sidewalk, was the purpose-built consulting room suite called the 'surgery' with a waiting room, an office where I saw my patients, and a back room with a small laboratory and filing cabinets for my records. By this time my colleagues regarded me as a competent, capable family physician and I had increasing confidence in my ability to diagnose and treat a widening range of medical, minor surgical and obstetric conditions. My family had assured financial security and long-term stability.
As I have made clear in previous posts, my attraction away from the comfortable stability of family practice began earlier, during my time as a salaried assistant in the group practice. I began to classify and count the numbers of patients I was seeing with each of several commonly occurring conditions; I began to study the social and behavioural sciences that had been left out of my medical education. I had long been fascinated by epidemiology (though I didn't yet know it by this name) and when I read Jerry Morris's mind expanding article, Uses of Epidemiology in 1957, my intellectual and philosophical conversion was inevitable.
When I'd asked about a junior partnership in late 1955 I was rebuffed. I left the practice and became chief resident (in American terminology) at the Northfield Infectious Diseases hospital, where I saw many patients with viral encephalitis, hepatitis, some with the infectious rashes of measles, scarlet fever, etc, and soon after I started working there, a lethal epidemic of bulbar poliomyelitis that paralyzed swallowing and breathing muscles and killed many young adults in my own age group. Soon I had over 30 young adults in respirators ("iron lungs") and watched impotently as most of them died. It was the final polio epidemic in Adelaide. By the time the next late summer outbreak was due, we had Jonas Salk's polio vaccine.
Wendy had come back to Adelaide by then, and soon after we announced our engagement to marry, I was invited back into the group practice as a junior partner. I hesitated briefly before accepting this invitation. Seeing and treating epidemic infectious diseases had awakened my interest in epidemiology. Yet I loved the work and life of family doctoring and clearly it offered a far better start to married life. However, I did not like making money from other people's suffering and distress, and I became disenchanted by the greed, selfishness and lack of compassion of several of my partners. Wendy and I agonized and talked over and over about two alternative career pathways we could see ahead of me.
At the end of 1959 we made our choice in the first crucial joint decision of our married life. I resigned my partnership in the practice, and we left for the School of Public Health and Tropical Medicine at the University of Sydney, where I spent a year learning the basic foundations of public health sciences - epidemiology, biostatistics, environmental health, behavioural and social sciences (anthropology and sociology). Towards the end of 1960 I was awarded a modest traveling fellowship that paid my fare and a stipend for a single man without dependents for a year (1961-62) that I spent in the UK Medical Research Council Social Medicine Research Unit at the London Hospital Medical College, on Whitechapel Road in the East End of London. I'll expand on that last paragraph in another post.
Life-altering decision #1
The four photos above are the doctor's home at 16 Henley Beach Road, Mile End, immediately west of the metropolitan area of the city of Adelaide, where we lived for almost 3 years in 1957-1959; our 2 children Rebecca and David, in a little plastic paddle pool in the secluded, verdant oasis of fruit trees and garden, a secure child-friendly play area amidst a grimy industrial region; my mother Vera Last feeding her adored granddaughter Rebecca; and Rebecca showing her plastic blocks to her Great-Grandmother, my grandmother Millie Last.
By 1959 I was a confident family doctor, regarded as competent and capable by my partners in the group practice where I worked and by other colleagues with whom I worked and interacted in various ways. I was a prominent and eloquent advocate for general practice and community medicine, involved in the intellectual life of the rapidly emerging College of General Practitioners. I traveled interstate to meetings in Melbourne, Sydney and Brisbane, exchanging ideas with my colleagues across Australia. I was going through a philosophical transformation, keen to widen my intellectual horizons, to learn more about the contexts in which people got sick or remained healthy and to study underlying reasons why some were healthy and others were sick. I wanted to understand too what impact medical care, the distribution of doctors, hospitals and specialized services, were having on levels of health and sickness in the population. I needed to spend a while in full-time study and research, to try to find the answers to the questions that were increasingly preoccupying my waking hours.
Wendy and I had talked about my evolving ideas and aspirations since before we were married. We were happy in our home and the practice, getting involved a little bit in the local community, but increasingly aware that it would not be possible to achieve my professional goals if we remained in general practice. It shocked my colleagues when I announced my intention to leave just as I was getting so fully immersed in general practice, but Wendy and I felt that it was now or never. At the end of 1959 we made the first of our life-altering decisions. I resigned from the group practice to embark on a career in public health science, specifically in epidemiology.
Wednesday, January 25, 2012
Burns Day
On Burns Day in 1966, our Australian-born son David won the prize in his grade school class for reciting a Robbie Burns poem with the best Scottish accent in the class. Not bad, considering that when he'd arrived in Edinburgh a year earlier he had a Vermont Yankee accent overlaying the Australian that might have had a trace of London Cockney, or perhaps BBC English from living in London in his toddler year. He managed to cling to a faint trace of the Edinburgh burr for many years after we came to Ottawa - if I listen carefully I can sometimes still detect it. Rebecca's lovely soft Edinburgh vowels were buried deep in Ottawa Valley Canadian within a week or two, and Jonathan wasn't far behind in taking on the sounds of his surroundings. Accents are usually an indicator or our origins. My accent reveals my origin: despite living more than half my life outside Australia, I still speak as though I'd never left Adelaide. One reason I love Canada is that in this polyglot multicultural city I hear accents from all over the world, even last week in the line at the supermarket checkout, two youngsters discussing the contents of their trolley in pure Kiwi. I wanted to say "Don't let the prices rattle your dags" but I'm not sure if the phrase is still current, so I stayed silent.
And that prize-winning poem: Something about losing a "Toorie doon the stank," a marble down the drain. I wish I could remember more of it.
Rebecca, David and Jonathan just over our back hedge in Braidburn Park, spring 1968. By this time all three had lovely lilting Edinburgh Scots accents. Our home, 5 Greenbank Crescent, was the right-hand half of the middle house behind the kids.It was a splendid home, about 3000 sq feet, with a magnificent view south over the park to the Pentland Hills, as shown in the photo below, taken from our living-room window late on a summer evening, probably in 1967.
When I look at this photo and many others like it, of our home and its surroundings, and recall innumerable happy memories of those magnificent years, I wonder why we ever left Edinburgh. Well, I know why, and will relate the reasons in a future post on this blog.
And that prize-winning poem: Something about losing a "Toorie doon the stank," a marble down the drain. I wish I could remember more of it.
Monday, January 23, 2012
Thinking through the options
My memory of some events late in 1958 is hazy. I couldn't stop coughing as Wendy and I flew across the Tasman Sea from Melbourne to Christchurch. We stayed with Wendy's brother John and his wife Peggy Anne, then took the train north. Wendy told me I had been delirious and had a high fever during our first night with her parents at Picton. I couldn't get enough air into my lungs, I couldn't cough up any sputum. The local GP sent me to hospital in Blenheim. I was placed in an oxygen tent with a detergent mist that everyone hoped would loosen the mucus in my lungs. For 2-3 days it was a close run affair. The physician caring for me, and I, both though I might die. Slowly I began to recover after about 4 or 5 days in hospital. The influenza pandemic had receded 2 months before I fell ill, and my influenza antibody titre in Blenheim, repeated in Adelaide a few weeks later, did not indicate that I had belatedly been laid low by an influenza virus. X-rays showed diffuse patchy consolidation of both lungs. No pathogenic bacteria were ever recovered from sparse sputum I produced with difficulty. The experts believed I had a non-bacterial pneumonia, likely caused by a virus, but were unable to identify this precisely. Whatever it was, it nearly ended my life and while I slowly recovered over the next 2 months, I had time to pause and think deeply about my life to that point, and my future, our future, because clearly Wendy was an equal partner in all this. There was a test cricket match between Australia and the West Indies during my convalescence, not long before Christmas. I recall watching as though in slow motion, a ball that a batsman hit high in the air and deep, almost to the boundary not far from where I was sitting in hot sunshine; the nearest fieldsman ran to get under it and took a spectacular catch. As I watched this little drama on the cricket ground, my thoughts fell into place like that lazily descending cricket ball. I thought of the two I knew in my own age group who had died in the pandemic, and all the others I had seen. I recalled my experiences in the infectious disease hospital during Adelaide's last-ever poliomyelitis epidemic when for a few months I'd left the practice where at that time I had been a salaried assistant, not a partner, and had seriously considered specializing in infectious diseases. I had always been fascinated by the interaction between humans and infectious pathogens, and it was clear by the late 1950s that antibiotics were not the magic bullet we thought at first, but just another weapon, albeit a powerful one, that we could deploy to help us overcome some infections of some people. We needed a different strategy, different tactics, to keep entire populations free of diseases like tuberculosis and polio - with both of which I had rich clinical experience. I worked for about 9 months in a TB sanatorium near St Albans in Hertfordshire, and for 4-5 months in the infectious diseases hospital in Adelaide. I'd seen cases of rare and exotic diseases, including even cases of smallpox. Although many at that time thought modern medical science was rapidly "conquering" infectious pathogens, I thought otherwise, and events since then have proved me right. As the fieldsman took the catch, I concluded my train of thought: I wanted to study epidemiology. The challenging question that remained was to decide how, and when, and where, to go about doing this.
Speed reading
Two email correspondents challenged my claims for the benefits of speed reading. I didn't say speed reading is perfect; nothing in life is. Speed reading enhances comprehension and retention, but when I became the editor of a large reference textbook, I found I missed typos and transposed words and phrases, when I tried to read galley proofs at top speed. I was forced to slow down, and over time my visual field may have contracted so I could no longer consistently take in a paragraph or a paperback page at a glance. Reading the books about Lizbeth Salander's dragon tattoo, playing with fire and kicking a hornet's nest restored much but probably not all my proficiency. Speed reading is not the way to read poetry (nor is the sepulchral tone some poets use to read their own work). I read Auden, Wilfred Owen, other favourites, as I would sip a fine wine or single malt whisky. I can't imagine gulping down The Love Song of J Alfred Prufrock or The Waste Land as a thirsty man gulps cool water.
Saturday, January 21, 2012
Transforming times
In recent posts on this blog I have restated in different words some of the events I described in my memoirs, written more than 20 years ago, that led to my career change at the end of 1959. I'll continue the narrative here. At the recent workshop on memoir-writing, our mentor Jon Peirce discussed 'defining moments' but I have to describe a prolonged period of decision-making. Wendy and I agonized over this for most of the first three years of our lives together. It can truly be called a defining period, but not a defining moment. Some experiences during the period were important parts of my intellectual development, and because of the way these shaped my perception of life and the culture and society in which I lived, they became factors in the ultimate decision that Wendy and I faced and made together.
I began to study several scholarly disciplines that had obvious relevance in my medical practice but had been entirely absent from the medical curriculum, notably social and behavioural sciences. I devoured some of the standard works in these domains, Sigmund Freud, Karl Jung, Melanie Klein, Margaret Mead, Max Weber, Talcott Parsons, and others. I began to explore epidemiology and environmental health, mainly in current medical and public health journals that I began to read. I began to classify and count the patients I was seeing in my office and in their homes. I read an electrifying article by J N Morris, "The Uses of Epidemiology" in the British Medical Journal, then I bought and read closely the short book with the same name, Uses of Epidemiology, by J N Morris, and resolved that somehow I must find a way to work with and learn from him. These exciting concepts that Jerry Morris explained so clearly, and a few other seminal papers on epidemiology opened my eyes and my mind to a whole new way to think about sickness and health.
I took a speed-reading course. This had a dramatic impact: I found, as others before me had found, that as my reading speed increased from about 400-450 words per minute to 2000 words or more per minute, my comprehension and retention of what I was reading, increased too. This seems counter-intuitive until it is explained: when reading slowly, the mind is easily distracted, whereas when reading at maximum speed, the brain is totally occupied by absorbing the information on the printed page. By the time I had completed the speed reading course my eyes had become conditioned to taking in a paragraph at a glance, and when reading a small paperback book, I could often take in a whole page at a glance - and retain the content of that page more completely, more efficiently, than when reading slowly. Of all the intellectual advances I made in the 3 years from 1957 to 1959, this was far and away the most important.
A cultural change was quite important too. I had enough Italian-speaking patients who did not speak English, to motivate me to learn enough of their language to communicate with them. Italian is a lovely language and I picked it up rapidly and easily. If you can pronounce an Italian word, you can spell it, and if you see it written down, you can pronounce it, because unlike English and French, Italian spelling and pronunciation are consistently and reliably related. I got far enough in Italian to be able to read Dante with the aid of a dictionary, and to understand the libretto of some of my favourite operas. "Che gelida manina" is so much more musical, more poetic, than "Your little hand is frozen!"
I became active in the newly established College of General Practitioners, was appointed to committees, spoke at meetings, traveled interstate and networked with like-minded GPs in Melbourne, Sydney and Brisbane. I discussed these new activities with the professor of medicine in Adelaide, and he encouraged me to continue, to find linkages between community-based family practice and academic research. He encouraged me to think about taking a year of full-time study at the School of Public Health at the University of Sydney, then return to Adelaide where, he hoped, there might by then be scope for a university-based academic general practice.
At the same time as this, the senior partner in the group practice I had joined, was a prominent medical politician, president of what was then the Australian branch of the British Medical Association. He began to take me under his wing as a potential next generation medical politician who could succeed him and move up in the hierarchy of medical politics. However, medical politics didn't interest me. The official medical association, soon to become the Australian Medical Association, existed to serve the interests of members of the medical profession. I was then and have always been more concerned about serving the interests of the general public. The senior partner in the practice was a gentleman through and through, a thoroughly decent man, had become a good personal friend with whom I shared many values and beliefs but I differed from him in priorities. I had absolutely no interest in serving in an organization concerned primarily if not exclusively with advancing the interests of the medical profession.
Rejecting the notion of rising through the hierarchy of the medical association was one thing. Turning away from a prosperous group practice that offered a lifetime of security and stability was something else altogether. Wendy and I agonized over this for many months, finally deciding late in 1959 that we would leap recklessly into the unknown and unknowable, leave the comfort, stability and security of general practice for a very uncertain and surely a far less prosperous life on the lowest rung of the academic ladder. I'll say more about the factors that led to our final decision in another post.
Those first three years of our married life were formative years in our marriage too. We had two children close together - Rebecca was born ten months after we married, and David followed fifteen months later. Wendy and I were both over 30 years old, accustomed to autonomy and independence and beginning to get set in our ways when we married. We had to get used to each other too, get adjusted to life as a married couple and as parents. How we managed to achieve that is another entirely separate story.
I began to study several scholarly disciplines that had obvious relevance in my medical practice but had been entirely absent from the medical curriculum, notably social and behavioural sciences. I devoured some of the standard works in these domains, Sigmund Freud, Karl Jung, Melanie Klein, Margaret Mead, Max Weber, Talcott Parsons, and others. I began to explore epidemiology and environmental health, mainly in current medical and public health journals that I began to read. I began to classify and count the patients I was seeing in my office and in their homes. I read an electrifying article by J N Morris, "The Uses of Epidemiology" in the British Medical Journal, then I bought and read closely the short book with the same name, Uses of Epidemiology, by J N Morris, and resolved that somehow I must find a way to work with and learn from him. These exciting concepts that Jerry Morris explained so clearly, and a few other seminal papers on epidemiology opened my eyes and my mind to a whole new way to think about sickness and health.
I took a speed-reading course. This had a dramatic impact: I found, as others before me had found, that as my reading speed increased from about 400-450 words per minute to 2000 words or more per minute, my comprehension and retention of what I was reading, increased too. This seems counter-intuitive until it is explained: when reading slowly, the mind is easily distracted, whereas when reading at maximum speed, the brain is totally occupied by absorbing the information on the printed page. By the time I had completed the speed reading course my eyes had become conditioned to taking in a paragraph at a glance, and when reading a small paperback book, I could often take in a whole page at a glance - and retain the content of that page more completely, more efficiently, than when reading slowly. Of all the intellectual advances I made in the 3 years from 1957 to 1959, this was far and away the most important.
A cultural change was quite important too. I had enough Italian-speaking patients who did not speak English, to motivate me to learn enough of their language to communicate with them. Italian is a lovely language and I picked it up rapidly and easily. If you can pronounce an Italian word, you can spell it, and if you see it written down, you can pronounce it, because unlike English and French, Italian spelling and pronunciation are consistently and reliably related. I got far enough in Italian to be able to read Dante with the aid of a dictionary, and to understand the libretto of some of my favourite operas. "Che gelida manina" is so much more musical, more poetic, than "Your little hand is frozen!"
I became active in the newly established College of General Practitioners, was appointed to committees, spoke at meetings, traveled interstate and networked with like-minded GPs in Melbourne, Sydney and Brisbane. I discussed these new activities with the professor of medicine in Adelaide, and he encouraged me to continue, to find linkages between community-based family practice and academic research. He encouraged me to think about taking a year of full-time study at the School of Public Health at the University of Sydney, then return to Adelaide where, he hoped, there might by then be scope for a university-based academic general practice.
At the same time as this, the senior partner in the group practice I had joined, was a prominent medical politician, president of what was then the Australian branch of the British Medical Association. He began to take me under his wing as a potential next generation medical politician who could succeed him and move up in the hierarchy of medical politics. However, medical politics didn't interest me. The official medical association, soon to become the Australian Medical Association, existed to serve the interests of members of the medical profession. I was then and have always been more concerned about serving the interests of the general public. The senior partner in the practice was a gentleman through and through, a thoroughly decent man, had become a good personal friend with whom I shared many values and beliefs but I differed from him in priorities. I had absolutely no interest in serving in an organization concerned primarily if not exclusively with advancing the interests of the medical profession.
Rejecting the notion of rising through the hierarchy of the medical association was one thing. Turning away from a prosperous group practice that offered a lifetime of security and stability was something else altogether. Wendy and I agonized over this for many months, finally deciding late in 1959 that we would leap recklessly into the unknown and unknowable, leave the comfort, stability and security of general practice for a very uncertain and surely a far less prosperous life on the lowest rung of the academic ladder. I'll say more about the factors that led to our final decision in another post.
Those first three years of our married life were formative years in our marriage too. We had two children close together - Rebecca was born ten months after we married, and David followed fifteen months later. Wendy and I were both over 30 years old, accustomed to autonomy and independence and beginning to get set in our ways when we married. We had to get used to each other too, get adjusted to life as a married couple and as parents. How we managed to achieve that is another entirely separate story.
Friday, January 20, 2012
Why do some people get sick and others not?
Towards the end of 1957, not long before Rebecca was born, I re-established contact with a man who had been a classmate of mine at Brighton Public School, had gone on from there to the Adelaide Technical High School and then to the University of Adelaide where he studied engineering. We got to know each other well during his first year at Adelaide Tech and my first year at St Peter's College, traveling together on the train from Brighton to Adelaide, always engaged in earnest conversation. We never ran out of things to talk about. His name was Robert (Bob) Culver. We re-established contact because his mother was one of my patients, and I was delighted to renew our friendship. His wife Cassie (Cassandra) was a bright person too and got along very well with Wendy. Bob had become an academic engineer, was doing research in a field called rheology, the study of ways fluid flows through confined spaces - important in such diverse applications as water storage and conservation, and blood flow through arteries and veins. Bob was studying basic, seemingly simple questions about fluid flow that nobody previously had addressed or apparently thought about. I told him I was interested in basic questions too. The College of General Practitioners was born about that time, I had attended its meetings, and at one of these I had posed the question at the head of this post - "Why do some people get sick and others not?" It generated some discussion; someone wrote it down, and about 30 years later it turned up as the title of a book that for a while was quite famous. Bob and I kicked this question around too and concluded that interaction between personality, social environment, and disease agents like micro organisms and poor diets accounted for a good deal of illness, but the seemingly simple question held many complexities. It surely does, and in the years since, a great many person-years of diligent research by battalions of epidemiologists, immunologists, behavioral and social scientists, have clarified some of the confusions that previously perplexed us. Those conversations with Bob Culver in our garden at 16 Henley Beach Road, Mile End, taught me a great deal about ways research workers must think, what constitutes original research, and what a wonderful exciting life it can be in academia. So Bob Culver and all I learned from him about ways to think and frame questions, also played a part in shaping my my career.
Bob and Cassie Culver lived in the Adelaide Hills. Their home and all their possessions were destroyed in one of the disastrous bush fires that ravaged South Australia, some time in the early 1960s if my memory is accurate. I wonder if they are still alive. It would be splendid to re-establish contact with them again after all these years.
Bob and Cassie Culver lived in the Adelaide Hills. Their home and all their possessions were destroyed in one of the disastrous bush fires that ravaged South Australia, some time in the early 1960s if my memory is accurate. I wonder if they are still alive. It would be splendid to re-establish contact with them again after all these years.
Thursday, January 19, 2012
Slings and arrows of outrageous fortune
The young ambulance driver I mentioned in my last post who died of the overwhelming toxaemia influenza can cause, was one of two siblings I had known since school days. Let me call him Bob Monkhouse - not his real name. He and his sister Jessie (not her real name either) had gone to expensive private schools. Jessie's plans, or her mother's plans for her, included a 'finishing school' in Switzerland, something almost unheard of in late 1940s Adelaide. Bob Monkhouse had gone to Geelong Grammar School, reputedly the best boys' school in Australia and surely the costliest, was destined for the diplomatic service after he finished his degree in law. Their mother threw the most lavish parties in Adelaide. They could afford all the frills: Mr Monkhouse, a meek-looking man, was the Adelaide head office manager of one of Australia's biggest banks and his wife came from an old established land-owning family. I was surprised when I got back from England in 1954 to find Bob Monkhouse playing golf at my grotty little club. I'd have expected him to play at the Royal Adelaide Golf Club, with its pristine fairways, manicured greens and challenging bunkers. As for Jessie, instead of a finishing school in Switzerland, she was a shop assistant in a department store. I discovered what had happened when I became their family doctor. Meek and mild Mr Monkhouse had run away from his family and his bank, with a very large amount of the bank's money and one of its young female clerks. His wife had sold their gracious home, her jewelry, their cars, and much else, to pay in part for her husband's misdeeds. Her name and accounts of her children's glamourous parties no longer appeared in the social pages of the Adelaide Advertiser. Bob and Jessie took their lumps rather well, all things considered, Bob especially so. He was a modest, caring young man, committed to doing good. He had been obliged to abandon his law degree and get a job to help support his mother. It was his choice to work as an ambulance driver. He felt he was doing something worth while and although I didn't know him well, he didn't seem to me to regret the diplomatic career his mother had sought for him.
In about the second week of the influenza pandemic of 1958, Jessie phoned early one morning, asked me to come to see Bob who, she said, was very ill. They lived nearby and fortunately I called first thing. He was indeed very ill, high fever, semiconscious, very breathless and a nasty colour. There were no anti-viral drugs in those days. I was concerned enough about him to go back to see him mid-morning. I found him much worse, indeed critically ill. I sent him to the Royal Adelaide Hospital, where he was placed in what passed in those days for intensive care. I went back to see how he was doing early that afternoon, got there just in time to be present at his death. When I had first seen him about breakfast time that day, he had said a strange thing: "I forgive you all," he said, "even Dad." Thinking about it a few days later when I had time to pause briefly in the midst of that hectic pandemic, I concluded that he must have had a premonition of his impending death, one of very few similar experiences in my life as a family doctor. His death was the end of the family. Without his moral fibre to sustain her, Jessie followed her mother's lead into alcohol dependence. I saw her by chance on one of my return visits to Adelaide about 20-25 years later, and wouldn't have recognized her if she hadn't made herself known to me. She told me her mother had died and her father had surrendered to police a few years earlier and was in prison. She was still a shop assistant, by then in charge of a whole department
Bob Monkhouse's rapidly fatal illness, and the very similar death of a midwifery nurse in the hospital where I did most of my obstetrics and whom I had also known since her childhood, were two events I recalled during my convalescence from a life-threatening bout of virus pneumonia that laid me low a couple of months after the Asian influenza pandemic had subsided. The deaths of these two fine young people made me reflect on how much more worth while it would be to spend my own life trying to find ways to prevent such deaths. So it's true to say that these deaths played a role in shaping my career.
In about the second week of the influenza pandemic of 1958, Jessie phoned early one morning, asked me to come to see Bob who, she said, was very ill. They lived nearby and fortunately I called first thing. He was indeed very ill, high fever, semiconscious, very breathless and a nasty colour. There were no anti-viral drugs in those days. I was concerned enough about him to go back to see him mid-morning. I found him much worse, indeed critically ill. I sent him to the Royal Adelaide Hospital, where he was placed in what passed in those days for intensive care. I went back to see how he was doing early that afternoon, got there just in time to be present at his death. When I had first seen him about breakfast time that day, he had said a strange thing: "I forgive you all," he said, "even Dad." Thinking about it a few days later when I had time to pause briefly in the midst of that hectic pandemic, I concluded that he must have had a premonition of his impending death, one of very few similar experiences in my life as a family doctor. His death was the end of the family. Without his moral fibre to sustain her, Jessie followed her mother's lead into alcohol dependence. I saw her by chance on one of my return visits to Adelaide about 20-25 years later, and wouldn't have recognized her if she hadn't made herself known to me. She told me her mother had died and her father had surrendered to police a few years earlier and was in prison. She was still a shop assistant, by then in charge of a whole department
Bob Monkhouse's rapidly fatal illness, and the very similar death of a midwifery nurse in the hospital where I did most of my obstetrics and whom I had also known since her childhood, were two events I recalled during my convalescence from a life-threatening bout of virus pneumonia that laid me low a couple of months after the Asian influenza pandemic had subsided. The deaths of these two fine young people made me reflect on how much more worth while it would be to spend my own life trying to find ways to prevent such deaths. So it's true to say that these deaths played a role in shaping my career.
Wednesday, January 18, 2012
Defining moments, defining events, defining situations
At the recent workshop on memoir-writing, our mentor Jon Peirce discussed defining moments. That is not the best way to classify several of the important turns my life has taken, although it does describe the most important event of all. I told the story publicly for the first time in a CBC Radio classical music request program on our 40th wedding anniversary, February 14, 1997. On the first sunny spring Sunday of 1955, I was off duty in the group medical practice in Adelaide where I was working at the time and on my way to play golf, when I stopped to pick up two young women hitch hikers. They were on the wrong road to reach their intended destination but I said I would take them to a junction where they could make their way to the road they needed. A few minutes conversation with one of these hitch hikers so impressed me with her spirit of social justice and her sense of fun, and her smile so entranced me, that I decided to abandon my plan to play golf that day, and said I would drive them myself: two defining moments a few minutes apart that changed the course of my life.
In 1958, the Asian Influenza pandemic led to life-changing decisions following a moment of truth. I shared those decisions with one of those hitch hikers to whom by then I was married, and at that time we had an infant daughter. My partners and I in our group practice worked almost around the clock during that pandemic. Those who died included a young ambulance driver whom I knew socially. He was the sole support of his family, and about a month after he died, his mother came to see me and insisted on paying me for the fruitless visits I had made when her son was dying. That evening we had the monthly meeting at which our accountant presented the financial figures: we had never before made so much money in a single month. As my partners cheered, clapped and slapped each other on the back, I sat silently, seeing in my mind's eye the sad face of that woman as she thrust banknotes into my unwilling hands. It was a moment of truth, a moment in which I realized that I did not want to spend my life getting rich from the sickness, suffering and death of other people. That was one of several episodes that led to the decision Wendy and I made a little over a year later, to leave general practice and begin a new career in public health sciences. In a future post I will talk about other events that influenced this decision.
In 1958, the Asian Influenza pandemic led to life-changing decisions following a moment of truth. I shared those decisions with one of those hitch hikers to whom by then I was married, and at that time we had an infant daughter. My partners and I in our group practice worked almost around the clock during that pandemic. Those who died included a young ambulance driver whom I knew socially. He was the sole support of his family, and about a month after he died, his mother came to see me and insisted on paying me for the fruitless visits I had made when her son was dying. That evening we had the monthly meeting at which our accountant presented the financial figures: we had never before made so much money in a single month. As my partners cheered, clapped and slapped each other on the back, I sat silently, seeing in my mind's eye the sad face of that woman as she thrust banknotes into my unwilling hands. It was a moment of truth, a moment in which I realized that I did not want to spend my life getting rich from the sickness, suffering and death of other people. That was one of several episodes that led to the decision Wendy and I made a little over a year later, to leave general practice and begin a new career in public health sciences. In a future post I will talk about other events that influenced this decision.
Friday, January 13, 2012
More on Wendy's diaries
My intermittent reading of Wendy's daily diary record of her life and times has reached 1991, and my respect and admiration for her intelligence, empathy, crap-detecting capacity, ability to define the caliber and character of friends, continue to grow. Her diaries routinely record banalities like weather, household chores etc, but interspersed with this are uninhibited and perceptive remarks about many of those with whom she had daily or occasional contact. Although she tolerated fools when in their company, she let herself go in the privacy of her diary, completely confident by then that no one but she would read it. She trusted me when I told her truthfully that I never looked at her diary even though she kept it in plain sight on her desk. She berated herself for what she perceived as her own shortcomings, and in this she was her own harshest critic, finding fault with herself when I and others close to her had nothing but praise and admiration for her. She referred to me as "his nibs" when she wanted to ventilate about my misdeeds and sundry inadequacies - which she usually discussed with me face to face as well; and I'm happy to report that as the years passed and we drew closer to each other, critical comments about me became infrequent as (I like to think) I became a better person under her guidance. She was unsparing also in her remarks about her friends and other family members, recording her criticisms frankly. Her irrepressible humour shines through all. Often as I read, it's as though she is there beside me talking, which is a good enough reason for spinning out this pleasure as long as I can, continuing as I have so far, to take her diaries in small doses. She kept up her diaries when we traveled as we began to do more often from the early 80s onward, and when we got home from travels to South Asia, China, Central Europe, Scandinavia etc, she usually typed up a more detailed report that she sent to her mother and sister in New Zealand. I hope I find copies of these among the boxes of her papers that I have yet to read!
Wendy at her desk, 34 Waverley Street, Ottawa, with a floppy hat to keep the sun out of her eyes as she writes. Her diary for 1984 is on the front left-hand corner of her desk.
Monday, January 9, 2012
New city sights
Ottawa has a rather boring skyline. I see it when I look north from my apartment and always think it looks better at night when only the city lights, not the profiles of the humdrum city buildings, are visible. Wendy never tired of the changing effects of light and shade as the sun moved across the sky, and I'm chuffed when I remember what pleasure she got from gazing at the city buildings although I never completely shared in that pleasure. Today as I made my monthly pilgrimage northward on Colonel By Drive and across the Ottawa River to the SAQ store where I replenished my favourite strengthening medicine, I caught glimpses of the skyline from other perspectives and saw up close some new buildings and one still under construction on the University of Ottawa campus, that are exciting architectural additions to Canada's national capital. I can see from my apartment windows the top few floors of the new high-rise tower on the campus. As I came closer to it I was very pleased to see how handsome this tower looks. When it's completed it will be an ornament to the city and its skyline, which is fitting. Canada's national university in Canada's national capital is the proper place for innovative and architecturally elegant buildings like this. Another newcomer is the new Convention Centre which has no impact on the skyline but has a striking profile that overlooks the Rideau Canal. Only a handful of other public buildings in Ottawa, the National Gallery, the Museum of Civilization, two or three office buildings, and the Chateau Laurier (which must be getting on towards 100 years old) are worth a second glance. It's unfortunate that the splendid setting of this city, at the confluence of three rivers and with potentially great natural beauty, has not inspired a greater number of aesthetically thrilling and architecturally exciting buildings. I hope the few new ones on the U of O campus and elsewhere will inspire other architects and planners to do better.
Sunday, January 8, 2012
Defining moments
Yesterday I took part in a workshop on memoir writing. There were about a dozen of us with a leader who set several exercises that obliged us to think and reflect critically on what we were doing, how we were doing it, and encouraged us in various ways. For instance one way to construct a memoir would be around a setting like a family home. We focused on defining moments or events that shaped the subsequent course of our lives. I had no trouble with this, was pleased when the workshop took this direction because this is how I have structured the memoirs that I first began to write about 20 years ago. In the opening chapters about my early childhood the setting into which I was born and spent my early formative years, I have described how I believe that setting and the events of that time contributed to my emotional makeup. In later chapters it's easy to identify defining moments that shaped the course of my life from that time on. However, on further reflection, I think only one could truly be called a 'moment' - the others were decision nodes, times when I faced a fork in the road of life and had to choose whether to go one way or the other. Several of these were like Robert Frost's famous poem about two roads that diverged, and taking the road less traveled by, "... and that has made all the difference." This has assuredly been my experience. There was one precisely defined moment when I stopped to pick up a pair of hitchhikers, and a little over two years later was married to one of them who shared with me in all the subsequent defining moments, or rather in all the decision nodes.On a few occasions, a moment of truth led inexorably to a decision node, but after Wendy came into my life the decision was always a shared one, and came at the end of a build up of circumstances and events which forewarned us of a decision that we would soon have to make. So yesterday's memoir-writing workshop was reassuring about the structure of the memoirs I've been assembling; and yesterday as I was reading a few excerpts aloud to the dozen or so memoir writers in attendance, I spotted ways in which I must revise them to make them more readable and interesting. There is no doubt that it was an extremely well spent day.
Tuesday, January 3, 2012
Seasonal gifts
Because David and Desre were traveling back to Toronto from Johannesburg on Christmas Day, our seasonal gathering was delayed until the New Year weekend, which included Rebecca's birthday on New Year's Eve. That evening I took the family, i.e. Rebecca (minus Richard who stayed home with a bad back), David and Desre, Jonathan, and my grandchild Chris, now 25, to a delicious dinner at the Green Papaya, Ottawa's best Thai restaurant. On New Year's Day we gathered at R&R's home for the annual seasonal gift exchange. As usual I gave everyone books, and in return I got several books and other things I had asked for. The most exciting and unexpected gift I got was a painting, from Chris, an under-water view of a swan, its long neck and its beak reaching for succulent weed on the bottom of a pond. Here it is on the living room wall, next to the Indonesian woodland sprite on top of the piano. It's acrylic paint on canvas, and I will explore ways to frame it, although it looks good on the wall as it is, unframed.
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