The Victoria Hospital ‘big brain’ surgeon at the time figured out what would make a hospital most attractive to surgeons thereby attracting the best surgeons there. It wasn’t part of the teaching hospital system though surgeons would bring residents with them for certain procedures. I was attachéd to the amazing orthopaedic surgeon who loved doing hip replacements there. I was also attached to the Plastic Surgeon who would do his noses and breasts there. It was mainly ‘elective’ surgery. Both these amazing surgeons were glad for an ‘extra pair of hands’. I’d take care of their patients with the nurses who were compassionate and caring.
To make the whole operation run smoothly the surgeon administrator had installed a proto computer system in the wall of each OR which was a checklist of what needed to be done before the surgery could occur, lab, consent, etc. The surgeon efficiently put in the minimum requirements and then dictated a minimum set of notes post surgery. It was almost a paper free environment decades before such an idea would occur.
The government would take over the hospital. My father would almost die there. I’d be driving by on my way home from the university wondering if my father had checked in for his prostate biopsy. As I was working a week on and two weeks off on call in Morris Hospital as a family physician at the time I thought his admission was the next day. A wee small voice told me to turn off and check. It was actually a much stronger premonition, those fay experiences Celts take for granted but don’t discuss in public circles with those who are blind or insane. I just knew I had to check. Christians call it a ‘nudge’. I walked onto the ward. My mom was at the foot of the bed crying. Dad had had his ‘surgery’ and now was in coma. It was actually anaphylactic shock
I opened his lines, called for help and took over resuscitating him. He perked up and began breathing again. He’d been kind of gurgling with little respiration. Not technically dead as he had a heart beat. The nurse called the house officer. The house officer had been my intern the year before so accepted me giving orders . Together we got the meds into Dad , cardiology was called, and the surgeon, well past his shelf life, came by, embarrassed and apologetic.
He’d tried a ‘new medication’ on my dad. He was at that age where doctors try to ‘look with it » by trying the ‘latest and greatest’ without really understanding this. My dad was allergic to the medication. Dad also had a heart condition so that had complicated things too. It was a mistake, not an honest mistake per se, but a clinical error that could occur. If I hadn’t arrived he’d have died though so it was a mystical moment.
I did nothing more as Dad recovered well. His urologist was indeed one of the greats in his and Dad’s day but was falling off. We all worry older about this, going out gracefully. My father and mother were more upset later that I’d made a ‘kerfuffel’ and raised my voice at the staff. They wanted to remind me of how many awards their doctor had received in his day. Dad had no idea what had happened when he was absent. Mom was just upset that I’d hurried everyone.
They had real difficulty with the idea that if I hadn’t arrived and intervened Dad would be dead. I was forever a bad 15 year old to my parents and never ever got beyond that. Except in their conversations with others. Between us I was a teen ager but when they spoke of me to others I was a great man, a genius, a saint. Parents are weird. I was just thankful to God that I’d been called and heard and responded. I would have lots of uncanny experiences like that in the trenches of medicine.
They can all be explained away by those who lack the ‘sense’, the blind have always been able to tell the sighted what they don’t know. I was just thankful for the gift and wondered why it didn’t stay but only appeared on occasion. Like the night I gave 100 mg of morphine to a patient in the ICU and woke from sleep an hour later to realize I’d made a mistake. I had seen in my sleep forgetting to put in the decimal to make the 100 , 10. I dashed back to the ward and asked the nurse.
« Did you give the patients the morphine. »
« Yes I gave them 10 mg as you ordered.’
« I forgot the decimal point.’
« I didn’t see that. I just gave the 10 mg because that’s normal and what they needed. I’d never give a 100 without double checking. »
I loved and still love the interconnected feed back loops and checks within the system. My ‘unconscious’ or ‘my guardian angel’ or the ‘patients guardian angel’ and the nurse all prevented the patients death that day.
I wasn’t at Victoria Hospital when they began to use it for the old people. The government administration were just seeing beds as beds and filling them without further consideration. Victoria Hospital the greatest surgical hospital started to be used as a homeless people place and geriatric ward. The staff and whole hospital weren’t purposed for that. Thanks to the ‘new’ administration Mom almost died because she is a slow eater. To make the government factory run smoothly her tray would be removed before she ate. If her tray was left she’d eventually get around to eating it. But she nearly starved and didn’t get better without fluids or sustenance because no one in an acute surgical hospital was trained to treat 80 year olds. Then an orderly yanked her arm trying to hurry because the factory had a schedule and mom’s arm was broken. Everyone was angry with Victoria and I knew. It wasn’t Victoria Hospital it was happening everywhere. Gross mismanagement.
I’d do two years of residency in Community Medicine and study policy and public health. I could see the gross stupidity and watch all the idiots self congratulating themselves because they’d give themselves these goals without concern for the overall gestalt. Mom became a ‘bed blocker’ because there was a housing crisis and the housing minister was tougher than the health minister who caved and gave hospital beds up to housing. It was a classic mess. Insane really with politicians cock crowing and everyone so far removed from wards but always congratulating themselves and holding parties and ceremonies.
Mom was finally moved to the geriatric hospital, where the nurses and staff were used to old people. She thrived with excellent care but the writing was on the wall and a year later she died. The broken arm had meant she couldn’t get out of bed. A minor injury but in the elderly major. Of course the geriatric nurses would never risk such a thing because they knew so much about mobility but an acute surgical hospital which normally catered to the young and healthy didn’t deal in osteoporosis. The administration didn’t have a clue what an acute surgical hospital and what a geriatric hospital were. They had their pretty graphs and numbers with beds and kept them filled with all the wrong people in the wrong way and congratulated themselves. They kept giving themselves raises and perks. Soon the administration was the highest paid and most pampered positions in the health care system. They would never discuss it with real doctors but would find a yes doctor who wanted easy money and he’d agree with whatever they said to get the check. Often these administrative doctors were the real bottom feeders, lowest of the low, hiding some past and just glad to not have to actually see patients any more. They worked together as ‘nests’ self congratulating and awarding each other for anything but morbidity and mortality, the ‘m & m’ of real medicine and surgery.
I have on several times occasions across the ‘accident prone patient’ . The first time was very unsettling. Everyone of the best staff had made a mistake with this patient. People who never made mistakes. One after another. Things just went wrong with them. Realizing that there was something uncanny with them I doubled checks and double checked everything and was so glad to see them leave. I saw my first ‘accident prone patient’ at Victoria and watched the older staff all register the phenomena while the younger staff didn’t understand why everything was going wrong.
I loved Victoria Hospital when I was there because everyone was happy, nurses, doctors and patients and the whole place ran smoothly and efficiently. There were none of the beds in the hallways and the years of delay to get a scan. It was all ‘sane’. I loved the hospital in my day. But it would change. This was the golden age of medicine and surgery. This was still when the Canadian health care system was world reknowned, when Canadian doctors were admired the world over. We had the best of the British system and the best of the American system.
I’ve had a few « accident prone patients’. They are rare in good settings but their potential for doom increases in messy settings. They really are uncanny and while the chronically negative by the law of attraction can be the worst it doesn’t seem to be solely this but rather a phenomena that can happen to anyone. Once I identified an ‘accident prone patient’ I’d off set their negative spirit or predestination simply by increasing vigilance talking with older nurses who know about the ‘accident prone patient’ and getting everyone on board to make sure the ‘halo’ effect counteracted whatever weirdness they were bringing to the hospital. Smart old clinicians consult psychiatry on these. They’re identified by good staff missing things they never would. They seem ‘jinxed’. Administrators don’t know about them because they’re living in lulu board room world and don’t actually work in the real world. Experienced clinicians would reflect, ‘that’s odd, no blood work wasn’t taken’, ‘that’s odd the BP wasn’t taken’. Just a lot of ‘missed things’. Of course the lawyers loved these people and made a fortune off of their blame and shame and gain game but it had no scientific validity. No one but the clinicians would say. ‘That’s odd, harry , frank and Susan never do that....why would they miss that...etc ». I was ‘interested’ and when I got a whiff of sulphur I’d act on it and up the vigilance. I’d later learn from Freud about thanatos and Eros. Our society doesn’t speak about ‘death wish’ today because the legal game is so unscientific and not interested in anything but ‘blame’. As a scientist I wasn’t interested in blame but rather in keeping my patient alive and getting them better so I was interested in why this ‘phenomena’ occured. It was obvious to the experienced. But try to discuss the ‘accident prone patient’ for their sake and someone will scream’ don’t blame the victim’. And blaming the victim was another problem which would occur along side this so it was even more interesting. My colleagues and I would be ‘interested’ in addressing the phenomena but eventually administrators and lawyers would move in with the accountants and politicians and the gag orders and the lie lie lie deny deny deny and what’s the cheapest solution. So one day we’d have euthanasia as medicine. Odd really especially as these folk would insist that they were ‘loving and caring’ as if everyone else wasn’t.
Once you’re in a clinical setting all sorts of new things that never appear in the books show up. It’s real. The older staff pass on tips to the new apprentics. Secrets are shared. Things that journalists never know are discussed. The things judges never hear are discussed. Late night with coffee and peanut butter the truth is told.
The hospital is a whole little world, like a ship at sea. It’s all tribes and societies. The text books are important but they’re just the tip of the ice berg. When you begin to live in the hospitals you see a whole other world. That’s where the gestalt becomes critical.
At Victoria I had this incredible experience of assisting operations every morning for 3 hours then having the afternoon to read and do surgical medicine. I talked with the patients and changed dressing and mobilized patients. In the afternoon I was doing after care. Sometimes I’d do pre care too. I’d accompany the orthopaedic surgeon to the Winnipeg General for his clinic there as well as to attend surgical rounds. I’d also spend a lot of time attending pathological rounds where the pathologist would tell us what had really been going on with the patient. They commonly found several conditions shutting down and we only knew of one. Wear and tear happened systemically. I loved surgical pathology rounds. The pathologist invariably shared things he’d learn that were like a classic ‘who dunnit’. We’d be thinking the butler and the pathologist would show us it was the chambermaid. Really fun rounds. Lots of surprise and laughter and learning for all. Pathologists are a quirky lot and well reflected on television shows which have capitalized on their personalities.
Victoria Hospital was a wonderful time in my life. It confirmed my desire to be a surgeon. 2 months with the most wonderful surgeons and staff. The Plastic Surgeon was a Harley Street Surgeon, Britains best who fell in love with Winnipeg girl who was vacationing in London. In a fabulous love story this genius followed her back from the capital of the world to the outer reaches and lived happily ever after. He was in charge of the Burn Unit at the hospital and his amazing skill saved countless lives. He’d be called into American hospitals for special cases because his expertise in certain areas was world reknowned. He developed techniques for particularly rare burn unit problems like rotating good tissue around a vessel to place it where the burn had removed all flesh. Things he did then were totally original but today are common and taken for granted. He rapidly became the head of plastics and revolutionized the department.
« I’d the cosmetics here to balance the work on burns. This pays me for a month of work there. Hollywood keeps offering me ultra rich positions to come down and work with the movie stars but there’s nothing like helping a child or anyone really whose face has been lost and I get the priviledge to restore it. In England I’d do that. My speciality was restoring a smile. I had a niche. England was great cosmetic surgery and a burn patient got the best care but here I not only get to operate but I get to develop a department to ensure the burn patients get the best outcomes. Winnipeg has been very good to me. «
He’d then mention the doctors like the Victoria surgeon who were visionary attracted the best of the best to Winniepeg. Winnipeg had this heart in medicine and surgery that would be crushed in time. Peopl who really cared would be bypassed for others. I liked the Osler type greats, humans with big hearts and big brains. Lots of my teachers were like that.
These marvelous surgeons would chat with me like friends telling me stories and sharing the history of surgery, talking about Richardson’s and other families in Winnipeg who had funded the hospital and expansions.
« Winnipeg is a generous city. I’ve know other places where the people are rich but they’ve not cared for hospital or arts. They’re into their own gluttony or hedonism or places around the world but here there are these incredible people that really care about community. I worked in a few hospitals in my training and lived in a couple of different cities but stayed here because of the Winnipeg community. People care here. ’
The Neurosurgeon who was called in to consult on the Teddy Kennedy case was from Winnipeg. His personality was as close to Spock as any man I’ve ever met. To watch him operate though was to watch hands perform ballet. He was a yogi in his calmness too and connected to some ancient source of wisdom. Very few of words. All across the world people would apply to assist him. HE was that good and that famous. One or two would be chosen and they’d be his ‘disciples’ truly blessed and privileged. I was invited by him to be on his team for a month. I ‘d just asked and been accepted.
« You’re the fellow who taught my wife dancing. She told me about you. You can start Monday. I don’t know you’ll see much but I’ll make sure you learn. My colleagues speak well of you. That will be all. » He was militaristic, abrupt. Years later I’d learn that someone like him I worked with would defend me, put in a good word for me, or suggest that others pay attention.
So for a month or two I looked over shoulders and waited. There were 5 to 8 of us in the room. Theoretically if a plague struck everyone before me down I’d take up the scalpel and scissors and finish the extraordinarily impossible surgery at the base of the brain. What was the joy of that experience was the chief resident a brilliant man who loved to teach and said. « He likes you, he doesnt really show much emotion but we know he likes you. He likes us all really. We wouldn’t be here if he didn’t like us. He respects competence, conscientious and care. You are conscientious and care so he likes you but he hopes I’ll make you competent. Few become neurosurgeons but those who go through a neurosurgery rotation become a whole lot better doctors. »
The great man’s wife was gorgeous and brilliant and hilarious. I loved teaching her dancing. She learned everything so well and was naturally flamboyant. She could have been a movie star. A regular Marilyn Monroe. Now to see them together was a delight. HE was so serious and quiet and reserved while she was the life of the party. Compliments. They loved each other deeply each in their own way. The tenderness and mutual respect was so apparent..
I ‘d love to be a student of Dr. Ross, another great surgeon. He was a general surgeon who specialized in GI. My favourite all round surgeon and just a wonderful guy. It helped that my friend to be Frank was his surgical assistant. Frank, a Checkoslovakian whose father ,a doctor, had escaped from the Communists. Frank completed school in Canada and had done his family medicine. He’d continue to do family medicine but several days a week he worked as a surgical assistant. He became Dr. Ross’s principal surgical assistant. I became number 3. That went on for months. I’d even come back and assist Dr. Ross when I was a family doctor, referring cases to him and being invited to assist, sometimes with Frank or without by then.
« It’s the way you handle tissue, » Dr. Ross said. « If you are gentle with the tissue, the healing will go well. » he told us. He’d teach as he was operating. Pointing out things. Always talking about what we were seeing.
When we asked him why he’d become a GI surgeon rather than cardiologist or Neurosurgeon, the more lofty surgeries, he replied.
« I saw how relieved my patients were when they were unable to defecate. Young people know about diarrhea but the older you get the more you know of constipation. Their whole bodies would rebel. Then I’d relieve the obstruction and give them the opportunity to relieve themselves again. It’s quite miraculous really. They were also the most grateful. I done heart surgery, respiratory surgery, all the rotations, but it was the GI patients who were simply the most relieved. They were the ones that sent me cards of thanks sometimes for years and decades later. I thought about that and decided that being an ‘asshole’ surgeon was what I needed to do. It gave the patient and me the most relief and satisfaction. It’s been a good choice. »
We laughed. Surgeons were known for profanity but always well chosen and timed. He’d rarely swear. There wasn’t any hysterics in the operating room either. It was always meditative. I felt like I was in a physical symphony environment. The surgeons would tell jokes or whatever they needed to do to relieve the tension but their hands were always a dance. I loved watching the impossibly fine movements
Dr. Ross was a deeply spiritual and humble man. He took me round each week to talk kindly with his ‘fistula’ patient. « He’s my fistula patient. Everyone whose done enough surgery has one. He deosn’t heal like other or like he ‘should’. Fistulas form just looking at him. All I can do is do my best. I study fistulas always in the literature. I keep up. It’s beyond the present limits of our craft. We’re trying everything we can. I figure fistulas are there to teach me humility. He’s been in the hospital a year. Every doctor has their one case, some more, that they just can’t help. We need to keep working on that one but never forget all those others whose lives we share. This fellow is my nemesis. He’s what keeps me grounded. I would do anything to heal his fistulas and may one day. That’s why I liked Crohn’s and Ulcerative Colitis. When. I was young like you I liked the appendicitis and gun shot wounds. We could do surgery and cure them and congratulate ourselves. If things went well great, if not the patient died. It was always neat. But Crohn’s and ulcerative colitis they just carry on. A lot of what we do as doctors isn’t cure. We provide relief. We comfort. This guys fistula happened after I removed the Bowel that Crohn’s and destroyed but the crohn’s affected the new tissue just as soon as we took out the old. And a fistula occurred.
A smart doctor would avoid the colitis patients. He’d cherry pick the best cases. I’ve just never been so smart. It’s the tough cases that are the most challenging though. If we left it to lawyers and insurance folk or gambling men all these people would be left to die. None of them are a good bet. »
Dr. Ross would talk to Frank and I eye to eye in the surgery before cases while we drank coffee. I heard more wisdom in the surgical lounge often than I heard in church.
I loved the ear nose and throat and opthalmologic surgeons. They showed me what they were operating on through these incredibly huge magnifying lenses they wore on their heads like Navy Seal night vision glasses. They had such control of their fine motor functions that they could literatlly split hair sized tissue structures. My tremor alone would have destroyed that whole surgical space. What would be a ‘familial tremor’ would become more apparent in the coming year.I’d have it investigated and be cleared but it would get under my skin. I certainly never thought of microscopic surgery. The tremor went away when I was doing activities but it was there and I worried it would grow. No one could say for sure.
When I began my surgical internship thanks to my experience at Victoria Hospital and the surgeons I’d assisted I was going to be a general surgeon like Dr. Ross. I thought there was a need in Africa for an all round surgeon. I imagined cutting off gangrenous appendages and saving lives by removing the bad bits of appendicitis’s. I liked he very idea of cutting out ‘bad bits’. I was already in 4th year assisting at surgeries I knew I could do. I was being given the knife and taught where and how to cut. I was closing up the wounds with the assistant.
I will never forget the first time I was offered the scalpel.
« I think you’re ready to make the first cut Dr. Hay’. And there I was pressing down with the scalpel against the resistance of flesh and fearing I’d put the knife right through the abdomen and into the aorta. I hardly made scratch.
The surgeon laughed. « You’ll have to eat more Wheatie’s if you expect to be a surgeon one day.
Despite everyone wearing surgical masks we knew everyone was smiling and chuckling.
« Don’t be bothered. I don’t think you could see my first cut either. Better to be gentle than brash. Harry there hardly broke the skin when I asked him first to cut. »
It’s an apprenticeship. We’d all been there. It was an apprenticeship. Soon I’d learn just the right pressure. The gentle pressure. The amount of pressure that would send a scalpel an millimeter through the skin. It was easier once the empidermis had been passed. The outer layer is like a hide. I’d always be good at minor surgery. I was in awe when the tissue parted and inside cavities appeared.
I began learning these « gifts of the guild » at Victoria Hospital. It was in the doing things. Feeling the needle moving through flesh sensing it entering the vein by the slightest of touches. I’d learn to put in butterfly needles in babies’ skulls and a few years later save a dozen or so with just those needles when I was faced with a meningitis epidemic on an Aboriginal reservation. A minor skill that I did over and over again for a week and all the kids lived with only one having minor mental impairment that would resolve.
I’d follow these surgeons who were teaching my hands to feel to ST. Bonfice Hospital and Winnipeg General. That’s where the emergencies occured. That’s where the chaos reigned. That’s where there were residents and interns before me. That’s where as many as a dozen would be in the room. Sometimes we’d even sit looking at the surgery from arena seating. The more I knew about the surgery the more I admired the surgeons and what was being done. They really were the greatest athletes I would ever know. Their bodies were their instruments. Their hands and eyes Olympic standard.
My first year was a Surgical Internship. I was accepted into Surgery. I’ve written elsewhere how unusual the interview was. All questions about what I’d done with my hands, like my hands were being interviewed, my fixing bicycles and cars and working on macrame all more important to the surgeons than my academic straight A’s.
I’d also get accepted into OBGyne and Pediatrics. I was approached by Surgery, OBGyne, and Pediatrics but not by Internatl medicine. I might have been able to get a position in the latter but everyone knew I wanted to ‘cut’. I also continued to not have enough respect for the detail needed for internal medicine. I’d learn this respect later in residency. Psychiatry and Community Medicine were medical specialities. Psychopharmacology was all about detail. Neurology was detail. Everything was detail but I only grasped the importance of the decimal and zeros when I was a year or two older. I wanted to cut and I loved fixing dislocations and putting on casts and doing sticking needles everywhere. I loved the ‘doing’. And I’d have that other unusual capacity of thinking in an emergency. I excelled there and in ICU. I could function under stress. It was something that was necessary for surgery and I had that. It would be a while before I’d get that skill which came with reflection, the essence of internal medicine considerations. . Then I was really interested in the practical and pragmatics..
The women really liked my care of women. I had great female teachers. They celebrated my egalitarianism and were impressed that I championed them individually. I was loved by the children . I’d organize students to do visits to the pediatric surgical wards. We’d do our various entertainments. A number of us had funny song and dances. Thèse things were noticed. Like my spending Friday night in the Emergency when I learned I could assist and gain valuable time learning there. I thought everyone would be jumping at this but less than 10 of us in the class took advantage of it. I loved helping with the children. Little people. Big problems. The trouble with that was that I feared I’d kill parents. I couldn’t stand seeing parents who harmed children. I knew it would not be a good fit. Despite being asked repeatedly to join Pediatrics I stuck with my surgical plan and thought maybe I’d do pediatric surgery one day. The gynaecologists liked me too. I’d met them delivering babies. I’d delivery a dozen or more in my fourth year.
I remember St. Boniface Hospital and the deliveries. They just came. No holding up those trains. I’d be delivering a baby with a nurse simply because the OBGyn was doing a C section and the resident was doing a difficult delivery’s and the nurse and I were left with the easy one. Often the family physician didn’t get in in time. The nurse would call me to gown up and we’d be off to the races. I loved obstetrics. I loved the OBGyn’s too especially this beautiful EAst Indian doctor who told me she’d delivered thousands in her home country before she came here. I liked people who shared numbers not as a brag but as a means of sharing experience. I’d delivery a hundred babies before I stopped doing that and one day George my family physician my best friend would say he’d delivered a thousand or two. Without the ‘numbers’ you didn’t know.
My brother ran a marathon. I never ran a marathon. I know what it’s like to run a half marathon. There’s a whole lot more beyond that. Only people who’ve only run a mile know it all. Experience is humbling. .
I wanted to cut and the cutting crowd wanted me. I was happy about that.
For the next year I’d focus solely on the physical. It was a great year. I loved the learning. I always loved the learning and still love the learning. I especially loved hands on learning. Surgery was the very best hands on. All the surgeons I knew could have been great musicians but only the greatest musicians, like Ravi Shankar, Yehudi Menuhin could have been great surgeons. I was happy to have played in the band.
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