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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.

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