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Sunday, November 10, 2013

My early childhood

Here is a revision of memories of my early childhood, with some illustrations. Should this be my first chapter, or should I open with the life-changing event, meeting Wendy, described in the previous post?


A Dusty Start

Dust. Red-brown dust, on the ground, in the sky, inside the house, outside the house, dust everywhere, on everything, in everything.

It’s my earliest memory, from when I was about three or four years old. Once when I had been put down for my day-sleep I got off my bed, padded across the linoleum leaving footprints in the dust, and climbed on top of the couch under my bedroom window, pulled aside the curtain and looked out over a bare paddock from which wisps of dust whirled slowly, lazily up into the cloudless blue air. Why, I wondered, did it fly up into the sky like this? The back yard of our house was dusty, I kicked it up with every step. Rorey, our red setter, rolled in it and shook himself as if shaking off water after a swim, though he carried a lot of it into his doggy-smelling kennel and my clothes got covered in it when I crawled in after him. Behind our car as my father drove over bumpy country roads, a brown smoke-screen of dust obscuring everything. It was always hot, dry, dusty. The rare and fleeting moments when it was cool, green, damp, and muddy seemed unnatural.  My fragmentary memories make my early life seem like the biblical myth of human beginnings.  I came from dust. My life as a toddler and small child was set in South Australia in the Dirty Thirties, years of drought and financial depression; my earliest memories date from the long summer of 1929-30.

South Australia is a scorched, brown country.   Inland, creeks and rivers are rare; many are just meandering traces, sandy creases on the flat landscape with occasional stagnant or sluggish pools of murky water or nothing but hot sand,  the memory of water marked by sparse lines of scruffy gum trees. When rain falls it is sometimes monsoon-like in ferocity, and can transform these arid remnants into raging flash floods.  In 1955, I was lucky to escape one when I misjudged the depth and force of water as I tried to ford a creek in the mid-north of South Australia.  I felt my little car being lifted, floating, tilting alarmingly with the water lapping against the door only inches from my elbow.  Then miraculously the car struck land again, righted itself, and using the battery to turn the engine, I managed to get out of harm’s way up on the bank, where, shocked and shaking, I dried out the distributor and got the car started and on its way again. That was one of several early near misses when my life could have ended before it had become interesting and worth-while.

One long river that never runs dry wanders westward across the south-east corner of the continent from the Snowy Mountains of New South Wales. It forms the border between New South Wales and Victoria before flowing on into South Australia. This is the River Murray. After a few hundred miles it ends its westward wanderings and turns south towards the sea. Rather nearer the end than the beginning of this part of its journey to the salt marsh shallows of Lake Alexandrina that separate it from the Southern Ocean, there are several little twists and turns. In the early days the settlers came to the river bank here to crutch their sheep - to castrate them and cut off their tails. So this place on the River Murray got its name – Tailem Bend.

Here, on September 22, 1926, I was born, the son of Raymond Jack Last and Vera Estelle Last, neĆ©  Judell. I’m told I was a sickly child weighing little more than three pounds, born prematurely and saved from an untimely death, my mother said, by the unseasonable heat which sustained me as though I were in an incubator. There is another story passed on to me by an attending nurse many years later, that I was one of twins, the other being stillborn. My mother died before I heard this story so I couldn’t ask her. My parents were estranged when I was born, my father absent from the scene, and when I asked him he denied it - but he was not there and the nurse was, so who is to say? If it is true it might explain some unresolved longings I have felt all my life, a curious sense of incompleteness.

Whatever the facts about this story, I carry a permanent reminder of my birthplace in Tailem Bend on the bank of the River Murray: My mother gave me my middle name, Murray, to commemorate the fact. This middle name proved useful in Edinburgh in 2003. When a committee was deliberating my nomination by the Usher Institute of Public Health for the degree MD Honoris Causa at the University of Edinburgh, someone on the committee remarked that the name ‘Murray’ indicated my connection to Scotland. Perhaps it’s as well that I wasn’t there to reveal how I got that name.
The only photo I have of me with both parents,
Booleroo, early 1927 when I was 5-6 months old

My father graduated from the University of Adelaide medical school in 1924 and, having completed his year of internship, was working at Tailem Bend as a locum tenens, a relieving doctor.  Soon after I was born, he settled in general practice in Booleroo Centre, a dusty little town in the wheat-growing district about 180 miles north of the city of Adelaide. My mother and I, joined a little over three years later by my younger brother Peter, lived on and off in Booleroo until the early 1930s when my parents' faltering marriage finally failed altogether, and my mother took us away from Booleroo Centre to return to her parents' home in Adelaide.

Memories of my early childhood at Booleroo Centre are like bubbles that form and burst, isolated from each other in time and place, not cohering or forming a pattern of sequentially unfolding events.  Many of my memories are dark and unhappy – tears, shouting, tense silences, parents who ignored me, or used me, I now realize, as a psychological weapon in their domestic conflict of mutual hatred.  That toxic atmosphere left my childhood scarred with wounds that took decades to heal. Perhaps some of those wounds never healed and the flaws I can identify in my character are there wholly or partly as a result. There are some happy memories from that time too of course, and puzzling ones, some that lingered for many years until I forgot them or solved the riddles of misunderstood words and phrases.

Here are some of those memory bubbles and some of the puzzles. 
 
Gumnuts at a stage show
My bedroom was decorated with prints from the Gumnut Babies, an original Australian creation, a colour comic-book series that came out in broadsheet format with stories beneath a series of comic strips. I don’t remember seeing that book any time after I was able to read. (I saw one like it in an antiquarian book shop in Sydney in the 1990s, selling for an astronomically high price).  My walls held several large coloured pictures of the Gumnut Babies, little elves with topknots and a stalk sticking up.  The Gumnut babies were unclad and their chubby bottoms gave them an erotic quality lost on small children but perhaps appealing to the parents who read these stories to their little ones. The sinister Bad Banksia Man lurked in a corner of one of the pictures on the wall.  I tried not to look at him or catch his evil eye.  The Gumnut babies were probably the inspiration for my imaginary playmates, Bee and Bay, who went everywhere with me.  I had to hold doors open for them to pass through, had to tell grown-ups not to trip over them.  Bee and Bay went away and never came back once I had a baby brother old enough to play with me.

We traveled in an open car with celluloid side curtains that were taken off on hot days so the air flowed through and ruffled my hair as well as bringing in dust that got in my eyes and up my nose. Driving from the house where we lived on the edge of the town to the main street of Booleroo Centre, to the bank, the post office, the hospital, I jumped up and down on the back seat, and was ordered by my father to sit down. Metal struts held the canvas roof in place, making convenient hand-holds for a little boy's fingers. I think it was a Chevrolet tourer, and that it was dark blue under the dust that I cleared away by tracing patterns with my fingers.
 
On the beach at Port Germain with my mother and Peter
We drove from Booleroo along the winding Gorge Road to the seaside at Port Germain. Porch a main. Why was it called a porch, where you went into a house? It wasn't a porch, it was a beach, a wide sandy beach where we sat in the shade of a big red white and blue striped umbrella or under the long jetty with little pools of water at the base of the wooden pylons supporting it, where the movement of the tides had gouged away the sand. These were times to paddle in the warm shallows, dig in the sand, and recover from the carsickness that marred those journeys from Booleroo to Port Germain. Why was the sand so white on top and black just below the surface?  My Uncle Lester told me rotting seaweed made it black.  I have a vivid olfactory memory of seaweed drying in the hot sun, an acrid antiseptic smell, rather like some of the smells from my father's consulting room, called the surgery.

Why so many memories of car travel? I suppose there must have been a lot of it, both locally in and near the town where my parents lived, and back and forth between there and Adelaide. I don’t remember any conversations, and have an impression that often my father and mother had nothing to say to each other even on the longest journeys.

On a night-time trip back to Booleroo from the Mahood's property, a sheep station at Melrose in the foothills of the Flinders Ranges, I heard the words bush and ranges and thought they had said bush rangers, evil, violent men who robbed coaches and presumably cars too, and I was terrified under a rug on the back seat of the car as it bumped along. How old was I then?  Four? Peter was in a basket on the front seat so I must have been very young. How did I know about bush rangers at that early age?  Someone must have mentioned them in conversation, and this fragment of partially heard and misunderstood information had stayed with me.

A party of grown-ups went bird-nesting, climbing up the trunks of ring-barked bare trees. Someone took my hand, pushed it into hollows too small for a grown-up’s hand, to feel for nestling budgerigars, rosellas, galahs, and sulphur-crested cockatoos. We had a galah and a sulphur-crested cockatoo in the yard at Booleroo as well as the red setter, Rorey. The birds had names too, but I have forgotten what they were.
Rorey with John, aged about 3, Booleroo 1929-30
The inside of Rorey's kennel smelt doggy and was as big as Dawdie Mahood’s doll's house. We   went often to the Mahood’s spacious homestead near Melrose. It was from there that one cool day when the grass was green so it must have been late winter or early spring, August or September, we went on a snake-killing drive, which I watched in fear with grown-ups from a safe distance while a group of young men and teen-aged boys thrashed at the long grass, driving snakes out to be killed. My father killed a snake in the driveway of our house, blasted its head off with a loud explosion from his shotgun, a great black snake, extremely venomous, its body writhing and twisting it seemed for hours after it was dead and harmless. The little son of the local Methodist minister, a child about my age at the time of his death a year or so earlier, had died from snakebite. The whole district hated and feared snakes. That little boy’s toy train set, a memorial icon of sorts, was high on a shelf in one of the rooms in their house, but although I could look at it I wasn’t allowed to play with it.

Yabbying was a seasonal country pastime. We caught yabbies, freshwater crayfish or shrimps, in a little stream somewhere in that part of the world where streams are rare.  Probably that too was near Melrose, on the Mahood's palatial property. Something nipped my fingers as I trailed them in the cool creek water and they stung for hours but I didn’t complain. I felt brave keeping my suffering to myself.

Once I awoke at night and the back veranda of the house was alive with big blue crabs, rustling skittering things that crawled across the cement floor of the laundry from a large wet hessian bag, then were gathered unceremoniously and with great hilarity by raucous grown-ups, and dumped into a boiling copper cauldron in the laundry. These crabs came from Port Germain or Port Pirie, the smelting and mining town that also was within driving distance of Booleroo Centre. I came out of my bedroom in my pyjamas to look at the crabs, blinking in the glare of the back veranda lights. Was it that night somebody gave me a glass of beer to sip? It was a frothy bitter drink that put me off beer until I was well into my twenties. The crabs were blue, but their shells were red or pink next day when I saw what remained of a mighty feast attended by who knows how many friends and neighbours. How had that happened? Later I saw the same thing with crayfish. Ah! crayfish!  That's a whole series of other memories from later in childhood, and feasts at Auntie Katie Saunders’ home at Henley Beach, when I was old enough to know, or to work out for myself, that cooking induced chemical changes which made the shells change colour from blue or purple to red.

Under my bedroom window was a piece of furniture that remained with us for many years, a set of three wooden crates nailed together, with a hinged lid, the whole covered with bluish paisley patterned linen. This was the box-couch. Later in childhood it was the repository for small boys’ treasures, my Meccano and Dinkey Toys, Peter’s train set, lead soldiers, toy animals, comics. Dividing the compartments between Peter and me led to quarrels, when Peter complained that I had more than my fair share. Peter often complained that I had more than my fair share, but I don’t think it was so. Anyway, I was older, had been there longer and logic dictated that I was bound to have collected more things in my three and a bit extra years.  At Booleroo when I was a toddler, the box-couch was high enough so that when I climbed on top of it I could look out the window, over wheat paddocks towards distant blue hills..
A young golfer: John with his father, c 1929

There were golf games at Booleroo and at Melrose with Gar Mahood, and garballs - golfballs - that he made disappear behind his ear or mine, then plucked them out of my nose. A photo shows that I first held a golf-club in those days, learnt how to hold it when young enough so that I have always had an easy, fluent swing that made me better at golf than any other sports. In the late 1950s Gar Mahood , retired by then to a seafront flat at Henley Beach, was my patient during his terminal illness, and was bewitched by my likeness to his friend, my father.

My father made a huge kite of brown paper. Huge to me anyway as I knelt at one end of it while my father, the only time I remember that he played with me, tinkered with the struts and anchored the paper at the other end, fully six feet away in my memory, perhaps not quite so big in reality, but large enough so that with the string stretched taut it required all an adult’s strength to hold it in check when the kite was flown in a strong wind in the paddock behind our house. We sent messages up the string, pieces of paper cut out and slipped over the string and carried up by the wind. Then the string broke and the kite flew far away out of sight. I tramped with others across a field of stubble in search of it, and we found it, torn and broken, far away beyond a dam at the other end of the paddock. This must have been in winter; it was a drizzly bleak day, there was muddy water in the dam and nobody wanted to get wet. This was perhaps when I was four or five years old.
Towing the Express Wagon

There was a four-wheeled trolley, the Express Wagon, made of wood with metal wheels, and the words "Express Wagon" painted in yellow on its shiny red sides. Those words, "Express Wagon" painted on the side of the little trolley, barely big enough for me to sit in and be pulled along, have even now for me after more than 80 years, the emotional resonance that "Rosebud" had for Citizen Kane in Orson Wells’s famous movie. There is a photo of me sitting on a tricycle pulling the Express Wagon in the yard of our house in Booleroo, when I was about 3½ or 4 years old.

I was learning words voraciously then, and wondered about the connection between Express Wagon on my little red trolley and State Express on red tins that had held cigarettes and had the hypnotic tang of tobacco, sometimes also layers of fine silver foil and tissue paper when opened while I inhaled the aroma as somebody taught me to do - preparing for the future time when like everybody else I would be smoking cigarettes instead of merely inhaling the aroma of tobacco. Express and red are permanently linked by these associations, and the word ‘express’ was one of the first words I recognized, before I learnt to read. The Express Wagon, or one like it, remained part of childhood for years, through the later years at Brighton where it was certainly a different one, but still called the Express Wagon.

Those were hard times, the years of the Great Depression. Years of drought too, with storms of red dust filling the air, the nostrils, making Rorey rust-coloured. My mother tried to seal the house against the dust, but it got in anyway, covering the cream carpet in the living-room, a carpet that followed us to later homes at Brighton and Glenelg. On windy days, the dried leaves of date palm trees rustled. Twigs and dead branches, sometimes bigger than I was, tumbled down from the gum trees at the entrance to the driveway from the road in front of the house.

Men came to the door begging meals, were willing to do any sort of odd job for a crust of bread - chop wood, clean the car, shift heavy loads. Their faces were weather-beaten, lined and dirty, their eyes angry, or, I now realize, sad, defeated. Some carried their belongings in a roll slung over one shoulder, the traditional Australian swagman's style. They smelled stale and sweaty, a different kind of body odour from that of a maid who took me one day when she was off duty to visit her girl friend, and was joined by two men – young men, I suppose, as the two girls were also, but seeming old to me like the swagmen, and wicked, talking of and doing something I didn’t understand but that seemed a bad thing to do, though I didn’t see clearly what it was. 

There is an association in my mind between swagmen and my father's massive (to my small person) X-ray machine, with sparks that shot out of it. Swagmen and that sparking X-ray machine are linked memories. Perhaps there was once a swagman patient whom I accompanied into the surgery for an X-ray. I remember chanting "Nux Vomica" - the name of a drug in prescriptions my father dispensed, and I remember handling shiny surgical instruments that had mysterious uses. I have two or three of those instruments today, including a pair of small curved surgical scissors, never discarded despite multiple moves around the world, that I’ve used for many years to trim my finger-nails. 

Close by the house at Booleroo was a wheat paddock. One day three of us squatted in the middle in a place where we had flattened a shelter amid the tall wheat sheaves, away from inquisitive adult eyes, and shared secrets. The others were two girls a few years older than I, one called Nancy, the other her friend or perhaps her sister. The secret we shared was as old as children's curiosity. They were very firm with me. I had to take down my pants and show them what I had between my legs; they in turn would show me what was between their legs. This we all three did very solemnly and so far as I recall, no touching of each other's parts. My pants were attached to my shirt by buttons that held me together, and at that time I was too young to manage buttons so Nancy did it for me. Nancy and I were playmates. She occasionally took me to school with her when I was about four years old.  I sat on a seat in the back of her classroom; but the seat had no back-rest, and when I leant back, the seat tipped me onto my head on the floor, a frightening and painful experience that made me cry; Nancy had to take me home, sobbing, and she was crying too. Years later when I was a medical student, Nancy was the staff nurse in charge of one of the wards at the Royal Adelaide Hospital; we knew each other politely as grown-ups by then, not having met since I was about 4 or 5 and she about 8 or 9. I never reminded her, nor she me, that we had seen each other's private parts long ago. She had become a fine handsome woman, a dedicated nurse.

Some varieties of carbonated soft drinks came then in bottles that were sealed with a rubber ring and a clear glass marble stopper; one broke the seal by pushing the marble down a little, then the contents could be poured into a glass, frothing excitingly. I coveted these shiny marbles. In my innocent curiosity, I formed the notion that all bottles contained marbles, and I could collect as many as my heart desired by breaking enough bottles. There were crates of bottles in a shed behind the house, medicine bottles that my father used for the potions that he dispensed for his patients. One day when I was about 5 years old I had an orgy of bottle-breaking, discovering to my disappointment that none of these bottles contained marbles after all. But I kept on trying to find one that did until a whole crate of bottles lay scattered around the yard in shards of glass. I got a terrible beating for this misguided attempt to accumulate a collection of marbles. My father didn’t listen to my explanation, instead commanded me to find a suitable stick to be flogged with. I found a thick, heavy one; and he gave me a thrashing such as I have never had again, all the while misunderstanding my motives for breaking the bottles.  Perhaps he believed that it was an episode in the smouldering warfare with my mother. Towards the end of his life I asked him one day if he remembered giving me that beating, or the time I ‘helped’ him make a kite. Sad to say, he remembered neither of these events that loom large in memories of my early childhood.

His anger at me for breaking his medicine bottles seemed to persist for a long time, erupting periodically when I did other clever things. I discovered that I could use the length of a picture book held in my hand to extend my reach far enough to turn off the light switch and plunge his den into darkness. He cuffed my ears for that, and perhaps swore at me. My mother seized me and ran out of the room, crying, clutching me to her breast. There must have been many other episodes of tension, for that entire period of my life is shrouded in feelings of anger, rage, tears, unhappiness. Some memories of that period date back to before I was toilet-trained.  One day at the hospital I soiled myself, walked bandy-legged, uncomfortable, smelling of shit and feeling horribly embarrassed into a room beside the operating theatre where my father shouted angrily at me from where he was slouched on a sofa, sharing a cigarette with a woman not my mother. Perhaps I had caught them in flagrante. But all those unhappy memories are blurred, jumbled and mostly incoherent.

I have no recollections of the final breakup of my parents' marriage. For a while we lived at my maternal grandparents' home, a gracious old place, 16 Northgate Street, Unley Park. We had been there earlier to stay when I was only three, before Peter was born. That was in the Unley Park Private Hospital, where I was taken t
John and Peter with Grandmother Rebecca Judell
16 Northgate Street, Unley Park, probably late 1930
o visit my mother. I remember walking along Unley Road, just around the corner from Northgate Street, with two women, one my Auntie Elsa, on the way to see my mother in hospital, though I don’t remember whether that was when she was there with toxemia of pregnancy and high blood pressure, or after Peter was born. I was sent away about then to stay with the Statton family who had moved from Booleroo to Clarendon in the hills south of Adelaide. At that time I was not yet reliably continent, or had become incontinent because of emotional stress, and I suffered acute embarrassment when I wet the bed. 

The large garden of the Northgate Street house was overgrown with weeds. A horse-trough of stagnant water contained many wrigglers – mosquito larvae – and close by was a small pond with tadpoles. There was a tennis court, but I think perhaps not in use at that time though it had been earlier when my parents were courting. My grandfather Leopold Judell died in 1927, and my grandmother Rebecca died in 1931 when I was about 4 ½ years old. I remember her as a tiny lady clad in black who once gave me a very hot peppermint that I spat out as soon as I could. There were frequent large family gatherings at the Northgate Street house, though I seldom knew who was who. They all seemed very old to me, like Auntie Rae, my grandmother’s sister, who wore a black ribbon around her neck to disguise her wrinkles, and I seemed to be in their company much of the time, except for rare occasions when I mingled with pre-adolescent cousins like Betsy and Ross Ragless, and Barbie Saunders and her sister Peggy, who was already sick and soon died of Hodgkin's disease. 

At Northgate Street the grown-ups sometimes read aloud to me: Peter Pan, and a childhood abbreviation of Robinson Crusoe both of which I still have today, illustrated with colour plates that prompted my cousin Betsy Ragless to dress, or undress, as one of the pirates with her pink bloomers puffed out to resemble the buccaneer's pantaloons in one of the pictures in the book. I hadn't started school then, but knew the alphabet and puzzled out the meaning of words under the plates in Peter Pan. This was before I was five years old.  I had begun to read for myself before I was six, and another pair of books from that period, the two volumes of poems by A. A. Milne, When we were very young and Now we are six were a precious part of my childhood, still safely stored in the bookshelves reserved for my most valuable books.  Who read them to me?  I don’t remember my mother ever reading aloud to me, but Auntie Olive or Auntie Doris did, and soon I was puzzling and sweating my way through the verses on my own. I was forever asking questions that often the grown-ups didn’t or couldn’t answer. Except for Uncle Lester, who was not often there but when he was, always bent down to my level and patiently replied to my eager inquiries – why did the dust rise in the air, how did a magnet, a motor-car work. He more than anyone else recognized my hunger for knowledge and understanding. I am forever in his debt. I wanted to find out so many things!  That was the time of greatest curiosity in my life, as it is in every small boy’s. How much we would know, if only all those questions could be answered and the answers stored in small children’s busy brains!

I had quite a lot to do with several cousins then, most of all with the cousin closest to me in age, Janet McRae, who was just three months older than I (her birthday was the same day as then little Princess, now Queen Elizabeth). Janet and I went together to a kindergarten in a church hall at the end of Northgate Street, run by two sisters, the Misses Fleming, perhaps spinsters because their boy friends had been killed in the Great War of 1914-1918. Several others who attended that kindergarten, and I, went on to St Peter's College and the Adelaide Medical School, so our lives were intertwined from early childhood. The most fun was playing in a sand tray, or cutting out paper shapes with scissors that had rounded ends so we couldn't stab ourselves or each other, or making plasticine models (a pastime that I got quite good at later, copying another cousin, Alan Saunders, whose models seemed to us to be magnificent and probably were very good).

The interlude at Northgate Street was early in the Great Depression, a time of desperate hardship and an ominous time with rumblings of coming political troubles. The conversations of the grown-ups in this partly Jewish household were full of foreboding, and some of their fears and dread unspoken thoughts communicated themselves to me. From a very early age I had a haunted sense of bad times coming, a feeling that has remained with me all my life, and sadly has proved true on several occasions as the world entered successive downward spirals of tension, confrontation, hostility and warfare. The household, like all others with sons old enough to fight in the Great War, was still in mourning in the early 1930s for "Lidie", Elias Judell, the favorite son who had not come back. He had been killed at Gallipoli in 1915. On the other hand, the youngest son, Ceddie (Cedric) had come back, bringing with him a wife, Dorise, a foreigner in ways, values, religion, disrupting the cohesion of this otherwise close-knit family. None of these nuances were comprehensible to me then (some still aren't) but they coloured the atmosphere of the Northgate Street house.

I don’t remember our final departure from the Judell family home and the sale of it and most of its contents at sacrifice prices in the depths of the depression early in the 1930s, after my grandmother Rebecca died. The house sold then for £1300. It changed hands again in 1991 for over three quarters of a million dollars - a reflection of inflation as well as of rising land values as Adelaide turned from a small city into a regional metropolis.

The stressful events of that time, a time of bereavement and mourning, and of financial crisis for the entire family, like other painful experiences of early childhood, are at least partly suppressed. There were tears, hushed voices, whispers. Something bad was happening.
                                                                                                                       
Then, rather suddenly it seems to me now (or maybe I had been sent away again to stay with friends, the Stattons perhaps), my mother had left there and taken my brother Peter and me to live near the sea at Brighton, a seaside village some distance in those days from the suburban fringes of the small city of Adelaide. It was the beginning of a new and happier life.


[Reflecting on this account in 1997, ten years after I first wrote it, I was struck by something else, the absence of any memory of real affection – cuddles, kisses, loving words – from either of my parents.  Like many children of divorced parents, my childhood was haunted by guilty feelings – a syndrome now recognized and understood, but not comprehended in the early 1930s. It must have been my fault that my mother and father had parted. What was it I had done?  A show of genuine affection from either or both of them would have dispelled those feelings. I realize now that they had other preoccupations, in their minds I merely existed, wasn’t bonded to them in the way that other children, like my school friends, were bonded to their parents.  I didn’t know my father well until near the end of his life, and this was never something he could or would talk about, but it became clear to me as I got to know him that he lacked the ability to feel affection for anyone close to him. My professional life took me away from my mother before I had learnt enough about psychology or psychiatry to have any insight into the dynamics of parent-child bonding, and she died before I ever had a chance to discover, had I sought to do so, why she never cuddled and rarely kissed me. Perhaps this is why the bonds of affection to her were weak enough for me to set off for a life on the other side of the world without feeling that I was severing a precious link.  In many ways then, as ever since, I felt closer to other blood relations – especially to my Uncle Lester and a few cousins – than to my mother.  After much introspection and with the wisdom of long hindsight, I believe now that those early affectionless years permanently shaped my personality, made me withdrawn, shy and reluctant to form close friendships].   


Saturday, November 2, 2013

How Wendy met John

I've posted on this blog already some of what appears here. The following might become the opening chapter in my memoirs -


The most important event in my life – an utterly random event – took place about 9 a.m. on Sunday September 25, 1955. I was off duty in the group medical practice where I was the most junior doctor. I was looking forward to playing golf with three friends at a modest golf links on the southern outskirts of Adelaide, South Australia.

It was a lovely spring morning, sun shining, flowers blooming, almond blossom bursting forth, paddocks painted yellow with sour-sobs or purple with Salvation Jane, song-birds nesting, magpies yodeling, kookaburras laughing crazily.
Almond blossom and sour sobs, September 1955
Southern outskirts of Adelaide

In the small hours of the previous night I’d delivered a baby in a cottage hospital on the far fringes of our practice catchment area. I went back first thing Sunday morning to make sure mother and baby were both OK.  Because of my detour to that cottage hospital I was approaching my golf links on a road I’d never used before to get there, running about an hour late.

Soon after I set off on that unaccustomed road, I picked up two hitch hikers. In those days not long after the end of the war and of petrol rationing, we picked up hitch hikers.  I had hitch hiked in England a year or two before and I was fond of the custom.

These two introduced themselves: Louise Zuhrer from Zurich, Switzerland and Jan Wendelken from Christchurch, New Zealand. They were nurses who had just completed a year at Princess Margaret Rose Children’s Hospital in Perth, Western Australia. They intended to explore as much as they could of Australia in 6 weeks before returning to their homelands.

Jan, the fair-haired New Zealand girl with glasses, had smiled at me as she got into my car, a smile like no other I had ever seen, a smile that bathed me in its warmth and sincerity. She began to talk about her hitch hiking experiences, both recently in Australia, and on her travels in Europe and the UK. Her happy chatter communicated to me that she was a special person, that fate had been unusually kind to me by bringing us together that morning.

“This is cosy! Much better than the cab of a lorry, we can hear each other talk, have a real conversation,” Jan said. She went on: “My room-mate Pearl and I hitched all over Europe; most of our lifts were in lorries or trucks, and they were always too noisy to hear each other.”

“Where are you heading today?” I asked. Jan replied, “Mount Gambier; the Blue Lake. This week it’s supposed to have its annual colour change and we want to see it.”

“You’re on the wrong road,” I said. “I’ll take you as far as a corner about ten minutes along from here, you can cut across to the road you need from there.”

But in the 10 minutes we took to reach that corner I was so captivated by Jan that instead of dropping them I offered to drive them myself. I said: “My friends will have given up waiting for me an hour ago, and gone ahead without me. They’re used to my golf being pre-empted by medical emergencies. If you like I’ll show you the country south of here, take you back to Adelaide, then you can set off for Mount Gambier tomorrow.”

I spent the day showing them the lovely dairy farming and wine growing country between Adelaide and the south coast.  It was the most magical day of my life. Everything sparkled in the sunshine, and so did our conversation as we told each other who we were, what we had done with our lives to that point, what we hoped for in the future.

Jan had more to say about her hitch hiking adventures. “Hitching in Europe with my friend Pearl, we mostly got lifts with lorry drivers, almost all decent chaps. We had to run for it to get away from a pair of amorous Italians outside Milan but there’s safety in numbers; we often joined forces with other hitch hikers. Also Pearl and I aren’t exactly beautiful and we did our best to look dowdy and unattractive.” I held my tongue, although I didn’t agree that Jan was unattractive.

“Once when I was working in Edinburgh and had gone south to see friends in London my purse was stolen so I had no money, no return train ticket, had to hitch back on my lonesome. A truck driver took too much interest in my legs, tried to fondle my knees. We were on a by-pass around Durham. I said, ‘That’s Durham Cathedral isn’t it? I’ve always wanted to see that cathedral. So I’ll hop out here.’ Before he could grab me, I opened the door and jumped out.”

We began to talk about our future plans. Jan said: “When I get home to Christchurch I’m taking a 6-month course in plastic surgery nursing.  I’ll learn how to dress severe burns and care for skin graft patients. That sort of surgical nursing is the kind of experience I need before I go to work in a Maori community.”

I said: “I’m the youngest doctor in a 10-man suburban group practice, building up a practice of my own. I’m hoping to be offered a partnership in a year or two. I’m loving it; it’s excellent experience and I especially love house calls, seeing people in their everyday habitat. It’s a great way to get to know and understand people. There are fascinating contrasts between many of the ‘New Australians’ and ‘old Australians’ whose ancestors came here from the UK or Ireland several generations ago. I wish I had time to do research on this.”

By mid-day it was quite hot. I shed my heavy winter pullover and rolled up my sleeves when we stopped at Yankalilla to buy pies and lemonade for our lunch.  Louise took a photo of Jan and me as we sat, earnestly talking on the side of a hill above the beach. We were talking by then about our hospital experiences in the UK.


“In coronation year I worked in the private wing of the Royal Northern Hospital on Holloway Road,” Jan said. “I was just up the road!” I said, “At the Highgate Wing of the Wittington Hospital, said to date from when Dick Wittington was Lord Mayor of London – it looked it too!”

“Money talks,” Jan said. “The private wing of the Royal Northern had luxurious rooms with phones and TVs, lovely new bed linen, patients got a menu and 3-course meals. Many weren’t even sick enough to be in hospital.” She mentioned a famous film star with gonorrhea to whom she had given Penicillin injections. “If he wasn’t loaded with money as well as gonococci, he’d have got long-acting Penicillin once daily as an out-patient. The rest of the Royal Northern is pretty squalid, like your wards at the Wittington.” She was talking of conditions in 1953: Britain was nearly bankrupt paying off war debts, divisions were opening between the wealthy few and under-privileged masses who despite the Welfare State, struggled to scrape by.

Meeting as we did was a gift of blind chance, a fluke, a miracle. I was approaching my golf club on a road I'd never used before to get there and running an hour late.  Jan and Louise were on the wrong road and over an hour later than their intended start that day too, because the landlady of the Bed & Breakfast where they'd stayed the previous night was sick and Jan had insisted on tidying the place, washing their sheets and towels, getting fresh milk and bread before they set off. Jan went up a long way in my opinion when Louise told me this.  When I knew Jan better I soon got used to the spontaneous acts of kindness to strangers that were an integral part of her personality.  

All her friends knew how her smile lit up her surroundings.  The tributes I received after she died included this: “Her smile was so infectious! It was like a belly laugh that came from somewhere deep inside her, a sense of joy that shone from behind her eyes. Everyone she knew basked in the warmth of her personality and sense of (often wicked) fun.” I was instantly enchanted by her smile when she got into my little car.  When she described some of her hitch hiking experiences as we drove on, her irrepressible good humour and adventurous spirit attracted me further. Later that day as we sat on a hillside eating our lunch, she was near tears as she spoke of the injustices and inequities she had observed in her nursing career. She was talking of this when Louise took the photo that hung above the head of our bed throughout our marriage. She clearly had the same values and beliefs as I, about what was wrong and what was right in the world. I decided then that she was the maid for me.  

When I began reading her diaries after she died, I was hoping to find remarks that revealed her similar instant attraction to me. I didn’t find anything that suggests such powerful emotions as I felt, but she did confess to fondness for me in some of her letters.

In her diary for Sunday September 25, 1955, she wrote:
“A glorious day. Got breakfast in bed for sick landlady. Took bus to Darlington. Left camera on bus! Picked up by John Last in little Austin, drove south on coast road, lunch at Yankalilla overlooking sea. Drove to Cape Jervis, looked over narrow sea to Kangaroo Island. On to Victor Harbor. A beautiful drive, rolling hills, native bush, silver and blue sea, kookaburras, rosellas, and good company. Back to Adelaide through forested ranges, past large reservoir. Out to John Last’s home, 238 Melbourne Street, North Adelaide. A very nice person & mother who is most hospitable."

On that magical spring day we drove eventually to Victor Harbor, where a little island is connected to the mainland by a causeway along which an antique horse-drawn tram trundles bumpily back and forth during the tourist season. Not that day though, it was too early in the year for the tourist season. So we walked across the causeway and around the island, gazing at huge ocean breakers all the way from Antarctica, dodging the spray as they beat against the rocks on the exposed southern side of the island. 

On the way back to Adelaide the two girls were singing as we drove along, and I joined in with my hopelessly out of tune voice. By then I knew I definitely wanted to see much more of Jan.  Before we parted at the end of the day we exchanged addresses, promising to write to each other.  My first letter to her, timed to welcome her home, revealed the emotional impact on me of meeting her:  “I have thought of you often in the last few weeks… That was one of the happiest days I can remember… you and Louise (especially you) were two of the most delightful and charming girls I have ever met.  I am deeply thankful for the odd way of chance, or fate, that took me along that rather out of the way route to the golf links just at the moment you were waiting for some kind stranger to pass by.  I wish you didn’t live so far away though!  I’d dearly love to see more of you, get to know you a whole lot better than was possible in a day.”

Jan wrote her first letter to me on the ship that took her from Sydney to Wellington, a long letter with vivid descriptions of her travels with Louise to Alice Springs and Darwin, across to Mount Isa, Townsville and Cairns, then south to Brisbane and Sydney where she parted from Louise.  It was her second and third letters that contained her reactions to what I’d written: “How very sweet of you to have a welcome home letter waiting for me... “  But she showed more caution and restraint in her letters than I did in mine, saying “I mistrust swiftly moving events … and any sentimental or romantic thoughts, however sweet to hear, mustn’t spoil our relationship at present.” She gave me renewed hope in her third letter, paradoxically complained  that she’d waited a long time to hear again from me:  “For three weeks I have been eagerly scanning the letter rack and I had convinced myself that our correspondence had died a natural death….  It makes me so happy to hear from you.”  (The reason for the gap in our correspondence – the only gap – was an epidemic of respiratory infections that had all of us in the Western Clinic running off our feet from dawn until late at night).

I didn’t even try to suppress the attraction I felt, attraction that grew stronger as her letters eloquently displayed her command of language, her wit and intellect, her empathy for others, and most important, her interest in me, and as our letters continued, her affection for me.  Soon we were writing to each other twice a week, sometimes more often.

Some members of the Wendelken family were nicknamed Wendy; during our exchange of letters, which soon evolved into something like a 19th century epistolary courtship, Jan became Wendy. She was Wendy ever afterwards to me and to my family and our friends, Janet or Jan only to her family and childhood friends in New Zealand.

We wrote 125 increasingly affectionate letters to each other between November 1955 and May 1956. Most ran to 8, 10, even 12 pages of closely written hand-writing. We never ran out of things to say to each other! When Wendy finished her plastic surgery nursing course she flew to Melbourne and I drove over to collect her and bring her back to Adelaide. From June 1956 until our marriage on February 14 1957 we had a more conventional courtship. Our happy marriage lasted for almost 55 years until Wendy’s death on November 15, 2010.


Wendy was my inspiration, my moral compass, my reason for living. Under her gentle influence, my life, our lives as a couple then as a family, were always happy although they changed profoundly through that long period. At the end of 1959 after much thought, not yet 3 years since we married and with two tiny tots in tow, I left the financial security of general practice for a precarious new career in public health science and epidemiological research.  That new career took us to Sydney, then to London, briefly back to Sydney then across the Pacific, through the Panama Canal and up the eastern seaboard of the USA to Burlington, Vermont. A year later we flew on to Edinburgh, Scotland, and in 1969 flew back across the Atlantic to Ottawa, which Wendy and I thought of at the time as likely to be a brief stop en route back to Australia or New Zealand where we wanted ultimately to come to rest and settle down.

But in Ottawa I got drawn into the upper levels of public health policy, not only in Canada but also in the United States, then in South and South-East Asia and ultimately throughout the world, much of this under the auspices of the World Health Organization.  Our early travels were leisurely sea voyages on freighters that carried a handful of passengers – by far the best, most civilized and rewarding form of long-distance journeying – but as the pace of my life accelerated, that relaxed way to move about the world gave way to the rising urgency of air travel. Soon I lost count of the number of flights I made between Ottawa and Toronto, Ottawa and Washington, Ottawa and New York, Los Angeles, Chicago, and across the Atlantic to London, Geneva, Paris, Stockholm. From 1985 onward we had opportunities almost every year for the next 20 to make really long-haul flights “home” to New Zealand and Australia, sometimes there and back across the Pacific, sometimes around the world.

After modest beginnings in Edinburgh in the late 1960s I got involved in 1977 in writing and editing on a grand scale, when I was appointed as editor in chief of the most widely used reference textbook of public health and preventive medicine in the world. In 1980 I was appointed editor in chief of the Dictionary of Epidemiology – work that brought the most fame and gave me the greatest pleasure. This went through four editions between 1983 and 2001, was translated into at least 15 languages and made my name known to epidemiologists all over the world. At international meetings I felt like the Eiffel Tower because so many people wanted to be photographed standing next to me. From the late 1970s onward I became active in the governance of national and international associations of specialists in my domain, mixing and mingling with the most eminent public health specialists in the world, sometimes with cabinet ministers who trod the corridors of power.

A few weeks before our final examinations and my graduation from medical school in 1949, we had two lectures on medical ethics and our legal obligations. These consisted of admonitions to keep secret what we learnt in our encounters with patients, not to get sexually involved with them, to teach our craft to our colleagues’ sons, and how to fill in official forms like birth and death certificates. Like most of my classmates I didn’t take these lectures very seriously. However I was confronted by my first ethical problem almost before the ink was dry on my medical license to practice, as I will relate later in these memoirs. Under Wendy’s benign influence my sense of values, my concern for equity, fairness, and human rights were consolidated and reinforced, became a prominent feature in the fabric of my medical persona. Over the years I wrote and spoke publicly with increasing confidence on ethical problems in public health and epidemiology, and took international leadership in developing guidelines and codes of conduct on ethical aspects of epidemiological and public health practice and research. The seeds of this important part of my professional activities were sewn in the talk that Wendy and I had over lunch on the day we met, and this led in time to my highest honour, sadly too late for Wendy to share the glory. In 2012, two years after she died, I was appointed an Officer in the Order of Canada.


All this and more followed from that chance meeting in September 1955, and from Wendy’s inspiring influence. Over the course of a long life I’ve traveled and worked in many countries, met many interesting people, had many interesting experiences, learnt some useful lessons that others might find helpful. Some of this is described in my memoirs, along with reflections on the meaning of it all.

Monday, October 14, 2013

Wendy's birthday

Wendy's birthday. She'd have been 88 today if she were still alive. My mind is full of memories of all the wonderful times we had, all over the world.  We were very fortunate to have 55 years together. I continue to be thankful on her behalf that I behaved in a gentleman-like manner, as Jane Austen might have put it, and let her go first.

Friday, October 11, 2013

Malala

Occasionally a single person captures the whole world's imagination. Nelson Mandela comes to mind, a man whose wisdom, compassion, tolerance transcended the brutality and evil racism of the regime that he and his followers replaced. Something similar is happening to Malala Yousafzai, the Pakistani teenager who was shot by the Taleban in the Swat Valley because she not only refused to stop going to school but spoke up boldly and eloquently in favour of equal rights to education for girls.  She is 16 now, seemingly fully recovered from the gunshot wound that miraculously did little or no damage to her brain - although it severed her facial nerve and destroyed hearing in one ear. She is articulate, obviously very intelligent, modestly chuffed that she is a candidate for this year's Nobel Peace Prize, in interviews momentarily a bubbly teenager fond of the current teen pop star's "music" - but deadly serious about the cause of equality of educational opportunity for girls and boys. She is also burning with ambition, considering whether medicine or politics offer the best platform for her to advance the causes she believes in. Later this week we will know whether she wins the Nobel Peace Prize. I'll hold this post until the award is announced.

Well, Malala was awarded the European Union's Human Rights Prize, but the Nobel Peace Prize went to a group overseeing removal of chemical weapons from Syria. She would have been credible Nobel Peace prize award winner but perhaps she has been recognized  and feted enough for the time being. If or when she fulfills the promise she shows as a young teen ager there will be time and opportunity later for further recognition and no doubt awards.

What I take away from my observation of her recent performances and speeches is much renewed hope for the future. I'm reminded of David Suzuki's daughter, who spoke most eloquently and movingly to the United Nations when she was 11 or 12 years old. She showed great promise, and it was fulfilled when she was a young woman. Now she is married to a handsome First nations man from Haida Gwaii and devoting the next phase of her life to breeding. Malala may follow a similar trajectory, although she demonstrates  a steely resolve that suggests she may put her public life ahead of private and cultural pressures to marry and have many babies. Time will tell, and it's unlikely that I will be here to observe the ultimate outcome. But my bet, if I had one, would be on Malala giving higher priority to public life and fulfillment than withdrawal, temporary or long term, into marriage and family life.  

Thursday, October 3, 2013

Farewell Harald Ziemer

Today an email from Dodie Ziemer brought the sad news that her husband Harald Ziemer had died suddenly and quietly while sleeping beside her,  Dodie and Harald arrived in Adelaide as immigrants from Germany in Christmas week 1955.  I met them when I was on call for the entire Western Clinic on Christmas Day.  I think it was only their second or third day in Australia.  They were recently married and their migration to Australia was in some ways rather like an adventurous prolonged honeymoon. 

We soon became good friends.  Years later Harald told me once when we were visiting them that Wendy's and my home - our first small rented cottage when we'd been married ourselves only for a few weeks - was the first Australian home into which they had been invited.  

They did well in Australia. Harald was registrar of the Lutheran boy's college in Melbourne for many years. Their four children have all done well too, and all have produced admirable members of the next generation. They have begun to establish a dynasty in Australia, successful migrants who are contributing to Australia's success. 
Harald Ziemer, Wendy, Dodie Ziemer, Melbourne, August 2005
Harald's family, Dodie, their four children, all their grandchildren, can look with pride and love upon their accomplishments and contributions. As for me, I am aware of another gap in my life as another good and true friend departs. I will miss Harald, and keep his memory alive in my thoughts.

Monday, September 30, 2013

Maddaddam



I've admired Margaret Atwood's writing for many years. Whether she is writing poetry, literary fiction, literary essays and criticism, social commentary and criticism, plays, or the Massey Lectures, she is always worth while.  I think I've read almost everything she's written in the past few decades, except a few reviews that have appeared in vehicles I don't routinely read. Of her recent works, the two I've most admired and enjoyed are Penelopiad, a retelling of Homer's Odyssey from Penelope's perspective, and Payback, her Massey lectures, which I listened to at least twice from beginning to end, read from cover to cover, and dipped into a few times in search of quotable remarks. As a social critic she is in a class of her own.

She wrote a brilliant dystopic novel, The Handmaid's Tale, about a society afflicted with the deadly blight of religious fascism. Unaccountably this didn't win the Booker Prize, although a later less brilliant novel, The Blind Assassin, did - perhaps because the judges wanted to atone for their earlier oversight.

She has outdone her earlier dystopia in the trilogy that culminates in Maddaddam. These books are set in a world infested with the unintended consequences of meddling with genes and DNA.  Like The Handmaid's Tale, it's the world we live in now, just tweaked a little bit, to demonstrate how close we are to an apocalypse. Oryx and Crake, the first book in the trilogy, was published 10 years ago. It describes the misadventures of Snowman who believes he may be the last human, after everyone else has been killed by a lethal pandemic, the result of another genetic experiment that went horribly wrong. The second book, The Year of the Flood, is set in the same time period. The principal character is Toby, a resourceful woman who survives not only the plague (the waterless flood) that kills almost everyone, but horrific torture by the painballers in a brothel. She escapes, finds refuge in a spa, a derelict rejuvenation clinic, AnooYoo, keeping a lookout for her lover Zeb, keeping at bay with her antique rifle the predatory pigoons (genetically engineered pigs from which organs can be harvested for transplant to humans). Maddaddam is the story of the human and other survivors, a frenetic adventure story, brilliantly told. Predictably it ends sadly.

At a superficial level, disregarding the allegorical elements, all three books are rattling good adventure yarns - Boys' Own Paper stories with f-words. Especially in Maddaddam, there is also a lot of laugh-out-loud humour, courtesy of the gentle, naive Crakers, green eyed genetically engineered handsome but simple folk who have interesting social and biological characteristics, such as males flashing their large penises and peeing in a circle, and both sexes displaying colour changes in their genitals when in rut. Their attempts to understand Toby's stories, their breathtaking simple-mindedness, provide much of the humour. It must be nearly 10 years since I read Oryx and Crake, and 4 or 5 years since I read Year of the Flood. I'd have liked to dip into both to refresh my memory but both books disappeared long ago into the black hole of Rebecca's book shelves. Anyway it isn't necessary because Maddaddam opens with a synopsis of both, considerately provided by Margaret Atwood at the beginning of this final book in the trilogy. The synopsis is considerably more convoluted and complex than my simple summary above, which omits a lot of important detail.

Collectively the three novels in this trilogy are very impressive, portraying a dystopia as chilling as George Orwell's 1984, but much richer, more complex, its imaginative sweep exceeding all other dystopias I can recall. 

As I look over Margaret Atwood's extremely impressive output I'm gratified to see how the judges of prestigious literary awards have recognized her talent. I think she is well and truly worthy of the most prestigious of all literary awards. I hope the Nobel committee has her works in front of them next time they are deliberating.

Monday, September 23, 2013

September song

If I must have an ear worm I couldn't ask for a better one than Kurt Weil's September Song. With  a lovely melody and amorous sentiments including regret, its theme is the relentless inevitability of passing time. This tune ran through my mind for several hours yesterday as I reflected on the significance of yet another birthday. The sun came out intermittently after the previous day's drenching rain, and the first autumn colours have appeared. I can see scarlet leaves and gold ones in the trees below my windows

Before lunch, David drove me to an up-market store that specializes in top quality recliners. I squandered more of my children's inheritance on a splendid Norwegian-made recliner where I can sit or  lie and read or watch TV. It will be an incentive to move from the comfortable chair in front of my desktop iMac to the greater comfort of the recliner where I'll be able to stretch out, put my swollen feet up and read, listen to music, or even if all else fails, watch TV or a DVD.

The family came here for lunch and for once I remembered to get out my camera. David also took a few photos with his iPhone, which seems able to do everything except boil eggs and darn socks.




Monday, September 9, 2013

An untimely interruption

Wendy and I discovered during our year in London in 1961-62 that we woke each morning an hour or two before our children. If we wanted quality time to ourselves without interruptions or distractions, those early morning hours were our best bet, better than evenings when one or both children often had demands that kept us hopping until it was our own bed time.. This hour or two of freedom from kiddies was especially welcome at weekends when I didn't have to get up and away to start my day at the Social Medicine Research Unit.

Early on a summer Sunday morning Wendy and I were frolicking on our king-size bed, happily expressing our mutual affection. It was hot so we had discarded our bed clothes, nightgown and pyjamas. The technical name for our enjoyable activity is foreplay and it was absorbing our undivided attention. We may have been whispering or murmuring sweet nothings to each other but our bedroom was quiet until suddenly the silence was broken by the outraged loud voice of Rebecca, demanding to know, "What's Mummy doing to Daddy?"

There behind us were our two toddlers, hand in hand as they often were, gazing with wide open eyes at their embarrassed parents. Hastily we pulled a sheet over us and swept under a pillow the devices we used in those pre-Pill years to minimize the risk of further additions to our little family. Wendy donned a robe to render herself respectable and escorted our two little spoil-sports back to their own bedroom.

Years later I asked both Rebecca and David if they remembered that morning. David was too young to have started laying down memories and Rebecca was on the cusp, does have some fragmentary memories of that wonderful year, but has no recollection of that embarrassing morning, embarrassing to us anyway. Probably it's just as well that she doesn't remember it. That episode could have left scars on her psyche - or given her ideas long before she was able to put them into practice. Rebecca's question that Sunday morning doesn't qualify as a cute saying but it's one early childhood remark we never forgot.

Sunday, September 1, 2013

Another new year

For more than 40 years the Labour Day long weekend has been the watershed event in my calendar, marking the start of a new academic year. In the early 1970s I fell into the habit of using this weekend to review the events of the past year and draw up a list of priorities for the new academic year that began on the first Tuesday after the Monday Labour Day holiday. The highest priorities were my academic responsibilities - teaching commitments, curriculum review and revision, marshalling other members of the teaching team into a coherent group in which each knew what everyone else was doing. The second tier priorities were the research domain, which included my role as principal investigator, team member in multi centre studies, peer reviewer of research proposals, author of articles reporting results of research. As the years passed my role as author and editor of books evolved from a third tier of priorities to take first place, consuming the largest proportion of my waking hours, pushing other intellectual activities lower down in my personal scheme of things. 

The shift in priorities began on Bastille Day 1977 in New York City, that steamy hot day of a massive power outage, when I accepted the role as editor in chief of the massive American reference textbook of public health and preventive medicine, and set about transforming it from what it had been to what it is now. I am pleased and proud that this huge book is now known as Maxcy-Rosenau-Last, after its first and second editors - and me. But my role and involvement ended when the 15th edition was published in 2007. 


John Last and some of the books he's edited or written; the 11th edition
of the big public health textbook is by his right arm
I'm more proud and pleased about my role as compiler and editor of the Dictionary of Epidemiology that took over my life from the early 1980s until 2001 when I handed it over to Miquel Porta in Barcelona (I've stayed on as an associate editor of the 5th and 6th editions). Last time I counted this dictionary had been translated into 15 languages; it's used by epidemiologists all over the world, and at meetings of the IEA  (International Epidemiological Association) as I've said before, I feel a bit like the Eiffel Tower because so many of them  want to be photographed standing next to me. The 6th edition is to be published in 2014 and I expect that my role will come to an end.
John Last with the two dictionaries, at APHA meeting,
Boston 2006


So this Labour Day weekend, like last year's, finds me with a much abbreviated list of priorities. At the beginning of this calendar year I set myself the modest task of licking my memoirs into shape by the end of the year. As readers of this blog know, I've been posting abridged excerpts of my memoirs. I'll probably continue to do this, but my blog is a convenient place to ventilate about whatever happens to be on my mind at a time when I feel like sharing thoughts with the amorphous assortment of blog readers - including those inscrutable Latvians who haven't told me why they hit on my blog.

Monday, August 26, 2013

Values and beliefs

A theme that has run through numerous posts on my blog has been aspects of my beliefs and values. For many years I've thought a great deal about these important but intangible matters. The first time I can recall thinking consciously about my own values and being aware of a significant change was when I was doing research for the UK Royal Commission on Medical Education in the late 1960s. Some of the questions in the surveys of medical students and established general practitioners and consultants probed these intangible but important personal attributes, and prompted me to think introspectively about my own beliefs. I've been sweating over a chapter in my memoirs on values and beliefs, trying to find the right way to express my thoughts. This post isn't the place to display a preview of this troublesome chapter but I'll mention a few examples.

When I was a teen ager and a medical student, like many of my classmates I was typical male chauvinist. Until my year, the cohort or graduating class of 1949, there had never been more than one or two women in a class which in those days in Adelaide averaged 30 to 40. There were 60 graduating students in my year, and 15 of them, 25%, were women.  We called them "girls" and resented their presence among us. 

The responses to the RCME survey questions revealed many ways in which women faced greater obstacles than men to pursuing their chosen career. They had to overcome much discouragement by their parents and school teachers, and bias against them by selection committees. To get into medical school they had to be determined, highly motivated, and usually academically superior to their male contemporaries. It's not surprising that women got the largest share of gold medals, prizes and distinctions, and were more likely than the men to graduate with honours. But the surveys of students and graduates from 25 of the 26 medical schools in the UK in 1966 showed that despite their academic superiority, discrimination against women persisted after graduation: women graduates were often passed over for the best internship and residency positions. In addition to the hard facts revealed in survey responses, many women wrote comments that revealed the obstacles and discrimination they faced. My sense of justice and fairness was outraged and easily trumped what remained of my male chauvinism. Almost literally overnight I converted and became a feminist, eager to help correct this uneven playing field and make life more equitable for women doctors. That's a long story I've told more fully in my memoirs, and it illustrates how values can change under the influence of evidence.

Changes in attitudes and values regarding crime and punishment may have responded to other stimuli. As best I recall, my belief in the death penalty for murder and harsh punishment for crimes like rape and sexual assault faded slowly rather than being overturned suddenly, until the last vestiges were dispelled by unequivocal evidence that several alleged murderers had been wrongly convicted.  My tolerance for people of equivocal gender identity was a more slowly developing change. How did this value change come about? I suppose it was influenced by opinion leaders in the media and by evidence that was presented in scientific articles - and personal friendships with gay and lesbian colleagues.  Nowadays I believe that tolerance of gender ambiguities is one of the indicators of a mature civilization, and rejection of the death penalty and other harsh punishments is another. In the USA, intolerance of LGBTQ people is widely prevalent in the right-wing states where gun ownership is part of religious beliefs (along with the obscene distortion of the teaching of Jesus about the virtue of poverty and the evil of wealth: the religious right wing has a strong belief in the 'virtues' of wealth and greed as well as gun ownership). It's easy to get angry about these weird aspects of the American way of life. I won't dwell on this further, just finish by saying that my kids seem grateful that Wendy and I decided to settle in Canada rather than the USA, and resolutely resisted all seductive invitations to move south of the 49th Parallel. I'm still wrestling with the words and phrases needed to express these thoughts tactfully in my memoirs. Professionally my lines of communication almost all flow north-south rather than east-west, I probably still have more American than Canadian friends, I've been president of two American national associations and vice-president of a third one, I've been awarded the highest distinction, the gold medal, of the American Public Health Association, and I've been described as an 'honorary American'; I hope what I've written here doesn't hurt the feelings of my American friends. I am pretty sure most of them share my values anyway: that's why they are my friends.

Saturday, August 24, 2013

Reconciling aspirations and reality

Our last year in Edinburgh, 1969, was a time for coming to terms with reality. I had quite a high profile by the beginning of that year. I had been principal investigator for almost all the research I'd done for the Royal Commission on Medical Education, had published many original articles that had been widely praised and discussed and I had taken several initiatives that led to other publications. I'd presented results of my work at important national meetings in the UK and at international meetings and seminars in Australia and the USA. I was getting attractive invitations from universities and research groups in USA, Canada and elsewhere in UK, but not from Australia. I'd been passed over when I applied for the foundation chair of community medicine at Monash University in Melbourne, which had gone to a well connected professor of medicine who had no experience and no track record of community-based research in epidemiology. I'd been informed in quite unmistakable language that I would not be promoted from top-of-the-scale senior lecturer to reader (= associate professor) at the University of Edinburgh. Early that summer I'd been invited to present a paper at a think-tank at Airlie House, near Dulles Airport, just outside Washington DC. This proved to be at least in part a pretext to enable  several senior people at Harvard Medical School and Harvard School of Public Health to consider me for a challenging cross-appointment that would link the medical school to the school of public health. After the Airlie House meeting I flew to Boston, met the deans of Harvard Medical School and the School of Public Health, was offered and provisionally accepted the cross appointment. But I had many misgivings. Accepting this position meant migrating back to the USA, where we would have to find a place to live perhaps 2 hours commute away, and this time, unlike my previous post at the University of Vermont, we would have to concede and assume that the USA would be our permanent home, would have to become American citizens with all that this entailed. 

I had received another invitation, to become a professor of epidemiology and community medicine at the University of Ottawa. Almost as an afterthought I flew from Boston to Ottawa, where I'd been booked into the rather down-at-heel but picturesque old colonial Bytown Inn. I arrived in late afternoon of a hot summer evening. I'd already eaten, so I strolled up to Parliament Hill, then over to the Rideau Canal and south beside the Canal to somewhere near where I live now, on the corner of Queen Elizabeth Drive and First Avenue, where as dusk began to fall, mums and dads sat quietly chatting on their front verandas while their kids played street hockey. I had an epiphany. This would be a better place to raise our children than some far distant outer suburb of Boston. These didn't look like the kind of people who would keep a loaded handgun in their homes!  Canada hadn't gotten involved in the ruinous Vietnam War. Canada had a parliamentary democracy, not the corrupt pseudo democracy of the USA where political decisions usually depended on which special interest group bought the most favours from elected office-holders.     

Harvard is one of the most prestigious universities in the world and it was a rare distinction to be invited to join the staff. But there were drawbacks. The position was funded by 'soft money' - I would have to raise money to pay my own salary as well as the salaries of the team of researchers I would be expected to recruit. I was fairly confident that I could do this. I was full of ideas, unanswered questions about determinants of the quality of medical care both in hospital-based and community-oriented practice. (Even now, almost half a century later, some of these questions haven't been answered by studies using validated evidence). More troubling was the harsh reality of academic politics that had defeated previous efforts to build a secure bridge between the medical school and the school of public health. 

Ottawa University medical school was young, established in 1945 and undistinguished, to put it mildly. To call it mediocre was to flatter it. Turning this inside out, it had nowhere else to go but up. It had tremendous possibilities, a small medical school in a large city with two large hospitals meant rich resources for teaching, for staff-student interaction, in both languages too. I had the track record the medical school was seeking, clinical experience and impressive training and experience in epidemiology. I was ideally qualified to lead the department of epidemiology and community medicine with its combination of research focus and family practice. But we loved life in Edinburgh, so didn't want to think about leaving this lovely old city.

Wendy and I agonized over the decision for as long as we dared. Both Harvard and Ottawa  wanted my decision within a relatively brief time, 2 or 3 weeks as near as I can recall after many years. It was the most difficult decision we've yet faced and while we were deliberating over it we thought of little else, talked about little else.  

Thursday, August 15, 2013

Preaching to the choir





On Tuesday morning August 13 I took the train to Kingston, where David met me. We drove to his home for a light lunch, then David drove Charles, John and me to Waterloo, where I gave my annual rabble-rousing talk to the new class of MPH students. This annual event is always one of the highlights of my academic year. The MPH Class is a roughly 50-50 mix of youthful health sciences graduates and mid career public health workers - nurses, physicians mostly, many who have worked for MSF, Oxfam, IFPA, etc, in developing countries and the world's trouble spots. As in previous years it was refreshing to find them very responsive, able to engage in vigorous interactive dialogue, so that rather than having to talk at a sea of faces (about 80 altogether) I engaged with them all in a splendid discussion of changing values and health-related behaviour.

The previous evening I joined David and his three young adult kids, and Peter's partner Sylvie Spraakman for dinner at an excellent restaurant where a helpful table server took the photo at the head of this post. From L to R, Peter, Charles (formerly Christina) John, Sylvie, me, David.

While I was rabble-rousing with the MPH class, David met with several of his colleagues, with whom he is spending his sabbatical year. Then we had a quick lunch and set off on the drive back to Kingston  using the toll road north of Toronto to avoid the traffic congestion crossing the city, which would almost certainly have delayed us long enough to miss my train back to Ottawa from Kingston. It was all a very pleasant interlude.

Tuesday, August 6, 2013

Hiroshima

The news that an entire Japanese city had been obliterated by a single bomb on August 6, 1945 reached us in Adelaide quite soon after the event, and was soon followed by the news that a second atom bomb had been dropped on the city of Nagasaki with equally widespread death and destruction. Members of my medical student class had studied physics recently enough to comprehend the nature of these immensely powerful bombs. I remember our discussion one August day in 1945 in the students' hut where we had lunch and some of us played cards (I'd played cards too for a while but stopped when they began playing for money). We understood without being told that atom bombs had changed our world forever. John Hersey's account of the devastation in Hiroshima occupied an entire issue of the New Yorker a year later on August 31, 1946 (I still have my copy) and Albert Einstein's eloquent words about a "New Manner of Thinking" had considerable impact too. Today is the 68th anniversary of that world-changing event. It's a sad comment on our information-overloaded times that the anniversary passed without notice this year; and I saw no little paper boats carrying candles in the pond beside the Canal a couple hundred meters south of my condo, where they have been a mute tribute to memory of the dead in previous years. Technology has changed the world almost beyond recognition during my lifetime. Atom bombs and other nuclear weapons are the most ominous technological change - in the Epilogue to the First Edition of Public Health and Human Ecology (1986) I dreaded their possible imminent use; 10 years later in the Epilogue to the Second Edition  I wrote more hopefully that the danger of a nuclear holocaust had receded. But it hasn't altogether vanished, and never will unless a cadre of wise statesman and women who love humanity more than illusory "victory" in a nuclear war agree to destroy stockpiles of nuclear weapons all over the world. There seems absolutely no chance that anything of this sort will happen in my lifetime.

Monday, August 5, 2013

J K Rowling's ear




Karen Trollope Kumar told me about Harry Potter and the Philosopher's Stone which she'd heard about from her English relatives, before it was published on this side of the pond, so I bought and read it before the publishing juggernaut began to roll. It was great fun to read, laugh out loud funny in places, and, I thought, spot-on accurate in capturing the way English school children were talking in the 1980s and early 1990s. Rowling's ear for demotic speech is the most impressive feature of The Casual Vacancy, an excellent novel about small town politics infested with a large cast of unlikable characters. Most of the school children are especially unpleasant, but Rowling has captured the way they talk, including the way they use obscenities, with consummate skill. She's done it again in The Cuckoo's Calling, a pseudonymously written whodunnit with a tough guy private detective, Cormoran Strike, who lost a leg in Afghanistan and is saved from bankruptcy by a wealthy childhood acquaintance who pays him well to find evidence that a sister's recent suicide was murder. Like J K Rowling's other books, the strength of this one rests on the smart, pungent dialogue, liberally seasoned with the meaningless obscenities that punctuate almost every conversation in pubs and public transport in London. Perhaps Cormoran Strike will reappear in more books still incubating in J K Rowling's fertile brain. I hope so: he has considerable potential, and so does his temporary office help Robin Ellacott, who will become a permanent fixture I hope.