Renewed Uncertainty and an Enticing Invitation

My encounter with the aggressive bureaucrats from the Commonwealth Department of Health had a very unsettling effect.  Based on a handshake agreement I had been appointed as a ‘lecturer’ in the School of Public Health and Tropical Medicine at the University of Sydney, but my salary was paid by the Commonwealth of Australia Department of Health and my contract identified me as a Commonwealth civil servant, not as a staff member of the University of Sydney. When I had mentioned ‘academic freedom’ in that unpleasant encounter, one of the bureaucrats had uttered an obscenity laden rebuttal of the notion. As far as he was concerned, there was no such thing – I certainly had no academic freedom as he saw it. For several weeks I felt badly shaken and very insecure, although I carried on as best I could, trying to put the incident behind me. I immersed myself in my interesting projects on weekdays and in family life at weekends.  

Then, out of the blue it seemed at the time though the chain of causation soon became clear, I had a letter from Kerr White, MD, Chairman of the newly established department of epidemiology and community medicine at the University of Vermont. The letter was an invitation to me to join the team he was building. I had never met Kerr White but had heard a lot about him. He had been my predecessor as visiting fellow at the MRC Social Medicine Research Unit, and while I was working there a year after he had been there, he had published a paper on the ‘Ecology of medical care’ that had been much discussed. Kerr’s paper was the other side of the coin, so to say, of my ‘Iceberg’ article. He and several colleagues had calculated where and how a hypothetical 1000 people in America got their medical care. Kerr was originally Canadian, a McGill medical graduate trained in internal medicine and – much like me – had been attracted to epidemiology.  In early 1963, Kerr had returned to the UK from the USA on a brief head-hunting expedition, seeking  to recruit an experienced family physician trained in epidemiology, able to apply epidemiological methods in health care research. My friends at the SMRU had given him my name. At that time, experienced family doctors with training in epidemiology were very rare, I was one of a very small select group, and the demand in universities far exceeded the supply. Kerr White offered to pay my fare and my family’s fare from Adelaide to Burlington, Vermont, and offered me a key position on his research team, where I would lead several research projects for which he had secured funds.

This invitation led to much soul-searching discussion between Wendy and me, and thence to a decision and subsequent events that changed the course of our lives once again. We realized immediately how life-changing this decision would be, and the enormity of what we faced gave us considerable pause. We had just made a down payment on our first home, begun to put down roots for the first time in our married life. If I accepted Kerr White’s invitation, we would have to uproot and resettle as immigrants in the USA – this was not an exchange fellowship but a long-term perhaps permanent move away from Australia to a new life in a new country.  We would be in a similar situation to some of the immigrant patients whose lives and health problems had interested me so much when I had been in general practice. Wendy and I thought about and talked about Kerr White’s invitation for several weeks before deciding what to do.  This most certainly would truly be a life-altering decision. We could see that it would ultimately involve a decision about giving up our nationality and citizenship and becoming American. We loved our homelands enough to face this prospect with many misgivings.  Having delayed as long as I decently could, I wrote back to Kerr White, accepting his invitation.  I described this in my memoirs, composed about 20 years ago, and what follows is edited from these memoirs:

Wendy and I knew that the decision to emigrate from Australia would be life-changing, even though at the time I was uncertain whether we would be leaving for an interlude of a few years or for life. We hoped it would be just for a few years. For many weeks we weighed the pros and cons. We were in the situation, not for the first or the last time, in Robert Frost’s poem:

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth;  

Then took the other, as just as fair,

And having perhaps the better claim,

Because it was grassy and wanted wear;

Though as for that the passing there

Had worn them really about the same,  

And both that morning equally lay

In leaves no step had trodden black.

Oh, I kept the first for another day!

Yet knowing how way leads on to way,

I doubted if I should ever come back.  

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and

I — I took the one less traveled by,

And that has made all the difference.  

Our choice surely made all the difference in our lives. The roads before us led in two entirely different directions. One road was slow and unexciting, secure if I conformed to the conventions. The other was hazardous, vague, unknowable - but adventurous. Wendy loved adventure if anything more even than I did. We had mixed and confusing images of the United States, of American academia, and of Kerr White, who had invited me to join his team. Complex and lengthy procedures involving much paperwork were required to get the necessary documents to enter the USA as immigrants and a work permit for me. I wrote the examination that would confer eligibility to write state certifying examinations to get a licence that would enable me to practice medicine in the state of my choice. I passed this easily despite encountering incomprehensible questions on new realms of biochemistry and pharmacology that had materialized since I last thought about these subjects. Meanwhile, I had disturbing thoughts about my reckless improvidence and the culturally disruptive act we were committing. Yet as I dipped into books and magazine articles that provided glimpses of many and varied aspects of American customs and culture, I began to feel a little bit of its magnetic appeal. Not much, just a touch.

I had some insight into the psycho-social aspects of migration, having begun to study the process as a family doctor and as a graduate student (my dissertation for the DPH dealt with some health implications of cultural differences between migrants and Australian-born citizens). I understood a little of what was involved in uprooting ourselves from Australia where four out of five of us had been born and where I had been raised. My own roots were shallow in some ways, quite deep in others, especially when it came to family ties. I felt no pull from Australian traditions and customs.  Indeed I wondered if there were any, though once removed from the land  of my birth and upbringing I began to perceive with nostalgic force some Australian traditions and customs, most of which I miss much more now than when we set off for America.

As we prepared to leave Australia perhaps for ever, we cut some ties. Helen, my dachshund bitch, was among the first of these. She was aging and ailing with some canine gynecological disorder that made her a low-slung nymphomaniac, perpetually in season. One morning we awoke to barking and other doggy noises, and saw on the terraces of our hillside garden in Cremorne a parade of dogs of every description, each waiting his turn to mount and impregnate her. The honour, we decided, went to an elderly and rheumaticky bitser from along the road, who snuck into the house itself when our backs were turned. The pups were born looking deformed and went into a bucket of water. Helen soon after that accompanied me on her last walk. With heavy heart I took her to see a friend at the University of Sydney who gave her a lethal injection. Milan Kundera's Unbearable Lightness of Being hadn’t been written then, but he captured in his poignant account of the last moments of “Karenin” something of what I felt as I walked Helen into the School of Public Health to meet her humane dispatcher.  Soon after that we held what would nowadays be called a garage sale, disposing at sacrifice prices of some family treasures, my golf clubs, sundry household impedimenta (we had a Royal Doulton chamberpot that we sold for pennies, perhaps worth a fortune as an antique; other antiques we didn’t recognize no doubt went too). I gave many books to our neighbour and baby-sitter Richard Sweet and was happy to see most of them, old friends, safe on his shelves when I stayed with him and his wife Patsy years later at their home on the edge of Sydney Harbour in Kirribilli. Other items went into store to be sent for later or disposed of when our future became clearer. It was the first of several times we thinned out possessions, each time inadvertently parting from treasures we later missed, things we had thought were of no account that could have been meaningful, useful or both.

Our drive across Australia from Sydney back to Adelaide for the Christmas of 1963 gave me an opportunity to immerse myself for what I knew might be the last time in familiar sights and sounds, the clear blue sky,  warbling magpies, bleating sheep, the dust and heat of the inland.

We went through sleepy little country towns and stayed briefly on a farm near Bordertown, South Australia with our friends Jan and Allan Fry.

 We had a slightly melancholy sixth birthday party for Rebecca in the east parklands on the edge of the city where there was a jungle gym shaped like an elephant, and a small tribe of little children wearing paper hats sat around a picnic table eating cakes and drinking lemonade. 

Then we said farewell to my mother and other family, flew back to Sydney and after a night at a hotel beside the Harbour at Neutral Bay, we went aboard the Port Alfred, a well-appointed passenger carrying refrigerator ship on which I had free passage as the ship’s surgeon, with Wendy and the children traveling at peppercorn rates as passengers. That voyage was interesting enough to be the subject of another post on this blog.