As we moved further into the 1960s it became clearer
to Wendy and me that our contented and very happy lives in Edinburgh could not
and would not continue indefinitely. With much help from a mortgage finance company we had ‘bought’ a lovely home ideally
located next to an attractive park, conveniently close to the Usher Institute,
to the rest of the University of Edinburgh and to the heart of the city of Edinburgh.
But it was a constant struggle and an increasing concern that we could barely
afford the city taxes, mortgage payments, rising inflation and costs of living
at the standard we wanted to maintain. Rebecca had begun attending an excellent
merchant company school, George Watson’s Ladies’ College, where she was getting
a first class education. The fees were modest in comparison to private schools
in England or Australia but were far from negligible. David needed to transfer very
soon to a boys’ school of comparable standard and cost, and in due course, so
would Jonathan. We were far more concerned that Jonathan’s chances of survival into adult life quite
literally depended on obtaining extremely advanced pediatric cardiac surgery
that would be very costly, far beyond our financial means if we were to select
one of the two centres in the world where the operative outcomes were the most
favourable. I had become very
well known and respected in my professional field and was beginning to get
invitations to join the staff of other medical schools, almost all of them in
the USA, none, unfortunately, in Australia or New Zealand. Even the other
medical schools in the UK were offering higher salaries and better fringe
benefits than I was getting at the University of Edinburgh. If we moved to one
of the US medical schools from which I received an invitation in 1968,
Pittsburgh for instance, my salary would be double or more what I was getting
in Edinburgh.
In 1968, I was invited to two meetings in Australia. The first and more important was at the Australian National University, a
conference on linkages between community-based primary care and academia. I had
corresponded by then with Dick Scotton, an economist in Melbourne, who had
followed my lead in studying medical manpower in Australia. It was rumoured
that he and I were being considered as potential directors of a research centre
for medical care and medical education at the Australian National University. Several senior people at ANU went out of their
way to have conversations with me that amounted to interviews.
But there were obstacles to the plan. The main obstacle was budget constraints that
eventually ruled out the idea of the research centre (it did not materialize
until 1988 when the National Centre for Epidemiology and Population Health was
established at ANU; NCEPH has done some of what we visualized at the 1968
Canberra conference but did not become a reality until 20 years later. Some of the research I had suggested in 1968 did not begin until almost 30 years later). Doubts about the viability of the rumoured national centre didn’t
stop me having the time of my life on that return visit to Australia in 1968. The AMA/BMA congress in Sydney went well too, and as at the Canberra conference, I met
many interesting people, notably Brian Barrett-Boyes, the Auckland based cardiac surgeon. I realized that Canberra, previously a boring little
country village, was becoming a beautiful city. It was obvious that in a few
years it would be a worth-while place to live. Wendy and I had several return
visits to Canberra in later years, on several occasions staying there for a few
weeks when I was a visiting professor. Each time it seemed to us that Canberra had
become better than ever before as a place to live.
The other important event on that 1968 visit to Australia
was helping my mother to wind up her independent life in a small town-house and
move into an old folks’ home where she would spend the rest of her life. It was
a trying experience and Wendy rose to it nobly, doing more than I to help
dissect my mother’s important possessions (not necessarily the most valuable)
from all that was expendable. A great deal was expendable, and an interesting
insight into differing values between us and our sister-in-law Jenny was that
Jenny consigned many things to a bonfire, packs of cards for instance, that we
would have donated to a worthy cause. My mother had several precious heirlooms,
and gave some of these to me; but a sad reflection on our financial status at
that time is that I was obliged to sell them, for without the cash they
yielded, we would not have been able to afford meals and overnight accommodation
on our way home to Edinburgh, our financial resources were so stretched. Too late I realized that my mother’s contribution to our air
fares to and from Australia was as much a curse as a blessing. There was
nothing to spare for incidental expenses. My air fare and expenses were paid by
my hosts at the two meetings at which I was invited to speak. We would have been better off if the family
had stayed in Edinburgh while I traveled to attend these meetings on my own.
We had to part from Boomer in 1968. He was a beautiful
dog but thought he was a person and expressed his affection for all of us by
jumping up on us and vigorous tail wagging. When we had to leave him on his
own, he ate the furniture, and in the car he ate the seats. He loved and sought
to protect delicate little Jonathan most of all but his exuberantly
wagging tail was strong enough to knock Jonathan off his feet. Either Boomer or Jonathan had
to go, so reluctantly we gave Boomer to a biochemist at the children’s hospital.
I saw Boomer again on my way back to Ottawa from Indonesia in 1972. He had
grown into a beautiful, sedate adult Labrador, no doubt benefiting from more rigorous and patient training than we had ever provided.
By the middle of1968, Wendy and I had reluctantly concluded that we could
not survive in our lovely home in Edinburgh on my senior lecturer’s salary,
even though it was at the top of the scale. I had been forced to sell my life
insurance policies to make the payments on our mortgage. We would be forced to
sell our home and settle for something more modest, might have to abandon the
notion of sending the children to the fee-paying merchant company schools that
provide an outstanding education in Scottish cities. Also looming ahead was the
absolute necessity of costly life-saving cardiac surgery for Jonathan. The
writing was on the wall: our financial future in Scotland was bleak. But these gloomy thoughts were subliminal
during what was on the whole a cheerful visit to Adelaide. It was wonderful for
the children to meet their cousins in Adelaide and subsequently on the way
home, their cousins, aunts, uncles and grandmother in New Zealand. It was wonderful for me
to have some leisurely visits with much loved relatives, my Uncle Lester in
particular, and my favourite cousins. Jenny, good-hearted and hospitable soul
that she is, mounted a splendid family party; and I got around a great deal to
visit many old friends including medical school classmates as well as almost
all my relatives.
Adelaide and Ottawa Last families at Peter and Jenny Last's home in Adelaide, 1968
On the way home to Edinburgh, I stopped off in
Seattle, where my friend John Lee, formerly Jerry Morris’s colleague in London, was my
host; in Vancouver, where I visited Don Anderson; in Chicago, Case-Western
Reserve in Cleveland, Washington DC, and Boston, where Vic Sidel whom I had met
in Edinburgh and with whom in later years I often interacted, looked after me.
Everywhere I was able to talk about my research on medical education and health
care. It was a very good experience in every way, meeting old friends, making
new ones, and getting a new look at many parts of North America, to which my
thoughts had begun to stray again. It would solve our financial problems to
move back to this hemisphere, where academic salaries were at least double the
level of the UK. I dropped a few hints that I might respond to the right
invitation, should one be forthcoming. Yet I was ambivalent; this was the
summer of the Robert Kennedy and Martin Luther King assassinations, of the
Democratic National Convention in Chicago (I could smell the tear gas on the
curtains when I stayed at the Conrad Hilton Hotel in Chicago two weeks after
that convention). The violence, the corrupt political system, the shallow narcissism of American life, seemed worse than ever.
International experiences continued in 1969 when I
went back to the USA to a conference on hospital discharge abstract systems and
the statistical analysis of data they contained, not a sexy subject, but one
that brought together a stimulating group of people, some already known to me,
others I was meeting for the first time. The former included Donald Acheson,
later chief medical officer of England and Wales, Kerr White, and my friend
Mike Heasman from the Edinburgh Research and Intelligence Unit. The latter
included Sid Shindell, later president of ATPM who was instrumental in the ATPM
involvement with the Maxcy-Rosenau textbook of which I was to become
editor-in-chief. Dave Sackett who had just gone to McMaster University in
Hamilton, Ontario, and Howard Newcombe who had developed the Canadian Record
Linkage System, were also there; so was Osler Peterson whom I had met
briefly when he visited with Jerry Morris, and Paul Densen, whom I had met
while I was in Burlington. Osler Peterson and Paul Densen were doing health
services research at Harvard, and they invited me to consider a position as
director of the liaison group that would link the medical school and school of
public health. I flew to Boston, looked the place over, was interviewed by the
dean of the Harvard School of Public Health, was offered the position – and
provisionally accepted it.
That was before the conference at Airlie House, in the
Maryland countryside about an hour’s drive from Dulles Airport. I remember
Airlie House fondly because of the fireflies that flickered in the hot summer
darkness as we strolled on the paths around the place. That conference was a thinly disguised head-hunting expedition: as many as a dozen of the promising up-and-coming experts of whom I was one, had been invited so we could be looked over by research directors, deans, department heads seeking recruits with specific skills. I was being assessed as a potential recruit to a cross appointment between Harvard Medical School and the Harvard School of Public Health and had already been to Boston and Cambridge, had already provisionally accepted the invitation.
After the conference ended, almost as an
afterthought, I flew on to Ottawa, where I had never been before, because I had
received a hand-written invitation to consider a position there also. Although I had
provisionally accepted the position at Harvard, I had misgivings about
taking the family back to the USA for what this time would surely be a long
stay. Did we really want our children to become American? I had very serious
doubts, did not believe we would adjust easily to it.
I arrived in Ottawa about 5.30 pm on a summer evening,
having eaten already. I was staying at the old colonial Bytown Inn on the
corner of Albert and O’Connor Street, demolished not long after I stayed there. In the long
daylight of a summer evening I walked along by the Rideau Canal with the
University of Ottawa on the other side of the Canal, turning to head back to
the hotel as dusk was falling on a velvety hot night. I walked back to my hotel
through quiet tree-lined streets in the Glebe, perhaps along First Avenue where I live now. It all looked so peaceful: parents sat on their front
steps while their children played on the street. What a contrast this was to
the menacing atmosphere of Boston with its riots and threats of further
assassinations! I had an epiphany, a revelation of the sort that Joseph Smith
is said to have experienced when he arrived in the Great Basin of Salt Lake,
that “This is the place!” Ottawa would be a better place than Boston to raise
our children. I went back to Edinburgh with much to decide, a time of
swithering, to use that lovely Scottish word. I felt in my bones that our children’s future in Edinburgh was uncertain. But how was
I to decide between Harvard and Ottawa? That was really difficult!
On one hand was the prestige of a great and famous
institution and the real challenge, which I recognized and which attracted me,
of trying to build a bridge between the medical school and the School of Public
Health. This task had frustrated and defeated the excellent man who had just
left and whom I would replace. There were many uncertainties, notably the fact
that the position was not tenured and the salary was soft money. And there was
the fact that we would have to declare our intent to become American citizens,
with all that this entailed.
On the other hand, Ottawa had an insignificant and
second-rate medical school (third-rate might be more accurate). But it offered
abundant opportunities: to become a department chairman and build my own team,
to create something where previously there had been nothing. It was in Canada,
with values we shared, a prime minister, Pierre Trudeau, whom Wendy and I
admired. Yet Canada seemed hard to identify with. It would be colder than Vermont, and winters
would be longer. I would have to learn some French. Could I succeed in building
a department? What would happen if I failed? What were the risks? Could we
after all stay in Edinburgh, and try again for the promotion to reader next
year? Above all, could we face the thought of yet another intercontinental
migration to yet another entirely new country?
There were other options besides Harvard or Ottawa. Senior academic appointments were mine
for the asking in two medical schools south of the border, in England. There were possible openings in the offing in
Australia in another year or two, although it was far from clear whether I would be able to secure one
of them. All these places, Nottingham, Newcastle, Harvard, the nebulous positions
in Australia, would have been, relatively speaking, familiar territory. Ottawa,
indeed Canada, was unfamiliar, a country whose culture and traditions we didn’t
know. Yet Canada beckoned, seemed to have more to offer than these other
possibilities, if we could tear
ourselves away from Edinburgh which all of us had come to love.
After long deliberation, and with heavy hearts, we
decided to move to Ottawa. We began to pack, to sell off, to strip down, preparing for
another great leap across a wide ocean. We had been victims of inflation -- everything was costing more, food, public transport, newspapers. We were beneficiaries of inflation when we sold our lovely home for slightly more than double the amount we paid for it less than five years earlier, and thus had a larger amount available as down payment when we bought a home in Ottawa a few months later. Even so, parting from our lovely home, watching people take away items of furniture we'd decided to sell rather than take to Canada, was emotionally traumatic. I have a lump in my throat as memories
come back, most of all the final day at 5 Greenbank Crescent, when I had to
drag David away from his bedroom window, both of us crying as we looked for the
last time at the glorious view along the Braidburn Park from his bedroom
window. For both of us it was a wrenching traumatic experience that we hope
never to repeat.
