Another life-altering decision

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.