Chapter twelve
Some people are so open-minded their brains fall out.
(Used by Dr. William Deadman)
Anonymous
Bill’s next job was a two year contract with the Ontario Medical Association to develop a program for the treatment of erythroblastosis foetalis, a condition which developed in babies in the womb who had a different Rh blood factor than their mothers. These babies could die shortly after birth and the mothers could develop incompatibility reactions and become very sick. The only treatment in those days was an exchange transfusion for the newborns of a compatible Rh type. My dad travelled all over the province to set up facilities for these exchange transfusions in major hospitals in every region. During that time he commuted from Aldershot every day to Toronto, often having to stay over for evening meetings. He would have been 72 when they asked him to stay on for a third year to complete the project.
They had moved to Toronto in 1957 and had rented a duplex in Moore Park. I was working at the Banting Institute at that time. We visited them regularly and when Peter was born, Bill took him to the garden and had a great time. Two years later, we took Stephen and Richard to see them and he doted on them as well.
It was on the second floor of a building on Lower Jarvis St. and it was the perfect job for him. He was half-time so he planned to arrive at 10AM, work until noon, take a 2 hour lunch, usually with colleagues, then work until 4PM. It was great. He was working with H. Ward Smith, Jocelyn Rogers and Noble Sharpe. The Chief Coroner for Ontario, Dr. Beatty Cotnam was a regular visitor. He eagerly looked forward to his days there. He also enjoyed time with friends at their duplex in Toronto. And Bill and Helene continued their trips abroad.
Family Matters
Fran and I were married on August 2, 1958. Our first year was in Montreal and they travelled around the city and surrounding countryside at every opportunity. Hugh and Joan were getting married on October 4th, 1958 in Windsor and I was Hugh’s best man. It was a rush. We flew to Toronto and got a ride to Windsor with my parents who were also invited. We arrived on Friday evening just in time for the rehearsal. The wedding was in the Walkerville Anglican Church and the reception was at the Windsor Golf and Country Club. This was very much the old world, old money ambiance that they had always associated with Hugh. Everything was done properly and with style.
I recall: Jeannine Maclay1 invited us to her apartment for dinner and we had a very good time. We invited her back to our simple apartment a couple of times throughout the year.
My parents came to Montreal two weeks after Thanksgiving and took us out on the town. During that weekend, dad said that the daughter of a close friend in Hamilton had married about the same time as we had and was living in Montreal. They were Mary and Ed. Krucker. To our surprise, when we checked their address, we discovered that they were in the same building as we were, on the floor below. With my dad we went down and knocked on the door. We were greeted warmly if a little hesitantly at first and we exchanged visits throughout the year.
As I recall, Mary was not working at that time, but Ed, a man originally from Switzerland was the pastry chef at Ruby Foo’s Restaurant – probably the most prominent Chinese restaurant in Montreal at that time. We toured many restaurants that year and finally got to Ruby Foo’s as well.
Montreal Winter
The winter was harsh with huge amounts of snow that lasted from the last week of October until well after Easter. I usually drove the car to the Hospital but Fran had to take two buses to the downtown and it was really cold. Fran had her problems too. She had a long bus ride with two changes. It took over an hour to Place d’Armes. One very cold day she got the backs of her legs slightly frostbitten.
Spring
It seemed like the winter would never end. We had had continuous temperatures below freezing since November. Sally was feeling it and required a couple of more bouts in the shop to thaw out. In spite of stuffing cardboard in front of the radiator, the heater still could not get the frost off the inside of the windows. Finally in late March we had a day when the sun came out and the temperature crawled up to 40º. But it was only a respite. Fran’s parents came down for a few days from the Sault.
By the Victoria Day weekend we planned another trip to New England. By this time the snow was all gone in Montreal except for a small grubby pile in the Côte de Neige and Queen Mary Road Park. The grass was turning green and we were feeling much more optimistic about our year in Montreal. On Saturday we drove through the Eastern Townships to the New Hampshire border and down to Portland Maine. I remember a lobster dinner at Theodores Restaurant on the waterfront. We got back to our apartment in time for a late supper.
As the weather became warm, we were much more active socially. Mr. Geddes, the office manager at Fran’s law firm invited us to a barbeque and told us how much she would be missed. There were several parties with people from the Vets and again I realized that we were very much part of the group. They were all encouraging me to stay in psychiatry at McGill. We were almost beginning to regret our return to Toronto.
Plans for our return were by now well under way. I had saved a week of my vacation until the end so that we could have some time in Toronto to find an apartment and get moved in before I started my first residency year in pathology.
Back to T.O.
The trip back to Toronto was uneventful. We stayed with my parents for the week and were able to find a one bedroom apartment at 220 Eglinton Ave. E. that suited our needs. We then arranged for the moving company to move our stuff in and we spent a good part of July getting settled. I settled into a routine at the Banting Institute and Fran found another job with a law firm in Toronto that had close associations with the one she had been at before.
Fran was glad to be back with her friends. We visited regularly with Martha and Herb Rogers who had just moved to a new development in Etobicoke and were proud to show it off. Alice Briggs was completing her specialty training in allergies. Robin and Barbara were with us a lot. Robin was working with the Attorney General’s Department of Ontario.
Residency in Pathology
When we got back to Toronto we stayed with my parents until we could move into our new apartment. I reported for duty at the Banting Institute on Dominion Day, 1959 – a Wednesday as I recall. There were about 6 assistant residents, half assigned to the Department of Pathology and half to the Toronto General Hospital.
We met Professor Hamilton and our immediate supervisor, Professor John Barrie and had a tour. First year residents were assigned to the autopsy service and our whole year centred on doing the autopsies from the Toronto General Hospital each of us in rotation, taking specimens in formalin, preparing and studying microscopic slides and presenting our findings to the group at the weekly rounds. We covered weekends also on rotation so this was not onerous. Dr. Barrie supervised us closely in the first few weeks until he was satisfied that we knew what we were doing.
John Barrie was an interesting man. Born in China of missionary parents, he went back to England for most of his education and came to Canada after extensive experience in Europe. He was an interesting raconteur with a subtle wit and a keen mind. He also was very much the old school in pathology. We were trained to rely on our powers of observation, deduction and intuition, using histology and chemical analysis to support or disprove our theoretical formulations, not as a fishing expedition in the hopes of getting lucky.
Weekly rounds were a bit of a trial for some of us. After we had prepared our specimens and our microscopic slides we presented the case to Dr. Barrie and other supervisors together with the research fellows and sometimes the attending physician of the deceased patient. I can remember one presentation on which I had laboured for a couple of weeks. The path chemistry and the histology was complex and I spent some time in the library trying to understand it. When I was finished, Barrie’s voice came out of the darkness: “Deadman, you clearly do not understand the difference between haemochromatosis and haemosiderosis. Present it again next week.” With that the lights came on and Dr. Barrie walked out. My colleagues were polite enough not to snigger – each of them probably thinking: ‘There but for the grace of God go I.’
My first weekend on duty was punctuated by a call at home from the Deaner.2 He said an autopsy had been ordered that could not wait for Monday and we were doing it first thing Sunday morning. He would meet me there at 8 o’clock. This was early rising for me on a Sunday so I left Fran in bed and proceeded to the Banting, letting myself in through the back door with the key provided. I had arrived before the deaner so I proceeded down the stairs to the sub-basement, flipping on lights as I went. The morgue was at the far end of a long hall and you could smell the formalin long before you got there. I could imagine Dr. Frankenstein’s lab or all the creepy horror films I had ever seen. I unlocked the morgue door and reached in to flip on the light. The whole floor moved and slid sideways. Within a few seconds there was not a cockroach to be seen.
Cockroaches
As I was struggling to recover my composure the deaner arrived behind me, giving me another start. “Oh!” he said “cockroaches. They are the bane of my existence. They are into everything. Every so often we get the fumigators in and they all run through the tunnel to the hospital. Then the people over there call in the fumigators and they all run back again. So we just live with it.” Dr. Barrie was more philosophical. He said that they were clean, did not carry infection and had been part of human experience since the time of the pyramids and before. And they are interesting critters too. He went on at some length to reassure me that I should not worry about them. When I told Fran, she was worried that I would bring them home so I was very careful to remove my lab coat and shake it out before I went home.
When the tape recorder that we used for dictating stopped working one day, the deaner opened the bottom and shook half a dozen cockroaches out of it and it resumed working. We would find them in the drawers of our desks. We were sitting around having coffee one morning when Dr. Hamilton’s secretary, Miss Boyd told her cockroach story. She was an older woman, very refined and stylishly dressed – unlike most of us who had shunned our shirts, ties and suit jackets for more practical garb in this environment. She said:
“My niece was getting married and I walked over to Eaton’s College Street store to buy a pair of long white gloves and other things for the wedding. It was all going fine until I reached into my purse for the money and two cockroaches jumped out. I was so mortified, I left without the gloves; I almost left without my purse.”
The rest of the year continued with a fairly standard routine. Each autopsy required a gross examination with the taking of samples for microscopic examination. When the histology slides were back, we examined them and completed the report that we had earlier dictated on the funny little tape recorder in the autopsy room. Then there was the presentation at weekly rounds. Gradually I became more efficient and the autopsies that took 3 or 4 hours in the beginning were now taking about 2 hours.
Brain Slicing
Dr. Robert Pos was the newly appointed chief psychiatrist at the Toronto General. He was a Scot with a sharp wit and an encyclopedic knowledge of the brain. Starting in January, Robbie would come over on Friday afternoons and we would slice brains that had been in formalin for a couple of weeks to fix them and firm them up. Robbie was a good teacher and we learned a lot. One thing which he always pointed out was how damage or pathology to one part of the brain seemed to affect other areas in consistent patterns.
We became familiar with the various fibre tracks and bundles that connected all parts of the brain. One brain had been taken from a patient who had had lobotomy several years before death.3 Not only was the prefrontal area atrophied, but significant other areas in the parietal and occipital lobes were atrophied as well. The extent of this damage was really astounding and yet in the early 1960s, lobotomies were being done at a rapid rate in most of the old mental hospitals. This information stood me in good stead in later years when the research began to indicate what a bad and destructive procedure this really was.
Decision Time Again
By the end of August, the professor was setting up appointments to discuss with us what areas of pathology we were interested in as the courses were now more specialized each succeeding year. As I prepared to meet with him I was in turmoil. I had no idea what I wanted to do, but I was pretty sure it wasn’t pathology. I must have been a sad sack at home because I noticed that Fran seemed on edge and was after me about the smallest things. I finally started to talk to her about it.
After listening to my tirade and all my worries for what must have been some time, Fran said: “John, you have been fussing about this as long as I have known you. The only time I saw you really happy was when you were in psychiatry last spring.” I had to acknowledge that she was right and we began to talk about it. I had enjoyed the work, the camaraderie on the psychiatric unit and it seemed to me that this was a new and growing field. But the down side was that it was seen as unscientific, even unprofessional ‘snake oil’ stuff by many physicians.
The Toronto Psychiatric Hospital was the seat of the Department of Psychiatry. It was just behind the Banting Institute on Surrey Place. I phoned and got an appointment with the professor, Dr. Aldwyn Stokes for the next week. He greeted me warmly and provided me with all the information about the program. He also acknowledged my training in Montreal. That night Fran and I discussed this and the decision was made.
I approached the interview with John Hamilton with trepidation. He was a close friend of my father. He was dedicated to pathology and was very pleased that Bill Deadman’s son had decided to go into his field. I felt like some kind of traitor to the cause. But I couldn’t back out now, the die was cast. Dr. Hamilton greeted my warmly and asked me what sub-specialty area I was interested in. I can’t remember my exact, somewhat stumbling reply but the message was that I wanted to switch to psychiatry.
Dr. Hamilton didn’t bat an eye. He said, “John, I wish you had come to me sooner. Last month, we had a resident in psychiatry who wanted to switch to pathology. We could have made a straight switch. As it is, you will have to finish the year here and switch next year. He added in the course of our discussion that loyalty or family tradition was not an issue for him. The issue was that a student was in the right field that he could do well at. He didn’t want students in the program who were not dedicated to pathology. I felt a great sense of relief and more confidence in my decision.
But I still had to face my father. I phoned mother and discussed it with her. She was upset but said that she understood and it that is what I wanted she would support me. But she added: “You have to tell him”. It was arranged that I would go over for supper that night and have a private talk with dad. After supper, we retired to the sunroom and dad seemed thrilled that I was in pathology and began talking about my future career. I can’t remember exactly what I said next but it probably came out as: “…Dad, I’m thinking of going into psychiatry.”
It took a moment for this to register, but when it did, he was flustered and obviously upset. He went on about how unscientific the field was and how unhappy I would be in psychiatry. I told him about my experience in Montreal. I also said that I could understand his concern about the scientific part. I said that when he went into pathology, the whole field was opening up. The scientific advances in the late 19th century had made it a very fascinating field. I mentioned Semmelweis, Morgagni and Ball. But I added that I had overheard two clinical fellows at the Banting who had just acquired a new electron microscope, arguing about whether there were two or three layers in the sub-lamellar membrane of the glomerulus. To me this sounded like medieval arguments about how many angels could dance on the head of a pin.
I then added that my experience in Montreal had convinced me that psychiatry was opening up in the way pathology had been after the First World War. I added that the field was changing rapidly and was now becoming more scientific. After a brief sputtering minute or two, dad finally said: “John, you must talk to Claude McLenahan. He will put you straight on this psychiatry business.” Before I could stop him, he was on the phone dialing a number. I only heard one side of the conversation but I could imagine the rest.
…after a pause… “Hello…Oh is Claude there?” …pause… “Hello, Claude … Oh I’m fine … and Helene is too … Say, my son John is thinking about going into psychiatry. … Would you talk to him? … Are you there tonight? … I’ll send him right over.” He hung up the phone and I knew I had my marching orders.
Dr. Claude McLenahan was a classmate of my father. He was the superintendent of the O.H. Penetanguishine during the Second World War. When I was going to Camp Kitchikewana back in 1942 and ’43 I had stayed with them and had come to know the whole family. I remember Mrs McLenahan as a plump pleasant blonde woman who must have been a real beauty in her prime. Her daughters carried on the genetic tradition. There was an older boy whom I never met and a girl Mary who was the one to pick me up after camp.
After his retirement after the war, the family moved to Burlington and bought a big house on Indian Point which was just south of Two Acres. I drove over to the house in Burlington and was greeted by Mrs. McLenahan who said “John, Claude is in the study. Just go down the hall, he’s expecting you.” I went into the study and Claude greeted my warmly. He said: “John, I understand you are thinking about psychiatry.” I said: “Yes, I am.” He said: “You lucky dog, I wish I were 30 years younger.”
That did it. He offered me a drink and we chatted about his experiences in the old mental hospital system. He was impressed by the strides that had been taken in psychiatry since the war and since his retirement. I left feeling buoyed up in my decision. I never did find out about the subsequent conversation with my father but the next time I met with dad, he seemed consoled about my choice. I will never forget his comment to me on that occasion:
“John, I don’t care what you do in life, just don’t be a hack.”
First Rotation: General Hospital Psychiatry
On the first day at St. Mike’s I met the chief, Dr. Arthur Doyle and Dr. David Lewis, our staff man. My compatriot was Dr. Leo Levinskas also in the diploma course on his first rotation. It was a busy ward of some 30 beds. The main treatment seemed to be ECT (Electro-convulsive Therapy.) Dr. Doyle specialized in depression and that was the best treatment for depression at the time. The treatments were given at lunch time on Mondays, Wednesdays and Fridays and most patients received 6, 8, or even 12 treatments.
Besides our ward work, we were asked to do consultations throughout the hospital for our staff man. We also had a day a week in the out-patient clinic. St. Mikes was in the inner city so we got to see some pretty sorry examples of humanity from time to time and some terrible social and living situations. My colleagues had a lot of trouble with this at first but somehow my experience with my Indian classmates in the one-room country school had prepared me for this and more. Despite their outward appearance I realized that they were people with problems just like everyone else. And their mental illness only made it harder to cope with their lot in life.
More on the Crime Lab
Bill had settled in to his job and was now assigned more duties. When a steamer trunk from Toronto arrived unexpectedly in St. John’s Newfoundland, it had developed a strong peculiar odour. When opened, there was the body of a woman who had been dead for at least 10 days. They contacted the Crime Lab for help and Bill was despatched to deal with it. The victim had several blows to the head that was the cause of death. This became a criminal issue and a murder investigation. Bill spent almost a week there with the autopsy and follow up. The husband was the suspect and he was finally found in the U.S.
Bill always regarded this as his best case and he was pleased to tell anyone who asked. He said that, by comparison, it far exceeded the Evelyn Dick case, even though that was the case that made his reputation. When he returned, the husband had been charged and at the trial, he gave his usual exemplary evidence.
Back at the lab, Bill was praised by others and his reputation secured. There are pictures of the party they had with all the staff and a cabinet with rifles and other evidence on the wall behind.
New Arrival
Fran and I had had much discussion about having a family. I had always wanted children but not until I had completed my medical training. Fran had wanted 4 or 5 – two of each and a spare just in case. While we were in Montreal, the Cold War was at its height. A hydrogen bomb had been exploded on Bikini Atoll in 1954. The U.S. was building the Distant Early Warning (DEW) line of radar stations across Canada’s Arctic. The Soviets were making nuclear threats and testing atomic and hydrogen bombs in Siberia. We both read Neville Shute’s book On the Beach, a novel that described an Australian family’s coping with nuclear annihilation.
By this time, Fran was convinced she didn’t want children at all because we would be leaving them a terrible world – or possibly no world at all. When she missed a period then, we were in a panic because neither of us wanted children at that time. Her periods returned to normal the next month and we both heaved a sigh of relief.
In February 1960, Fran missed a period. She had had some irregularities before so at first we were not sure but by March when she missed another, we realized she was pregnant. She went to the family doctor, Dr. Porter who was able to confirm this, and based on her dates, gave and expectant date of October 5th. At that time there was no universal health care in Canada and we had a plan through the OMA called Physicians Services Incorporated and we had just taken out a Blue Cross plan that covered hospital only. There was a waiting period of 8 months for obstetrics but that would click in on September 1st so we felt it was alright.
Fatherhood
As the summer wore on, Fran became more and more pregnant. By this time we had moved to a 4-plex in Leaside. Dr. Porter, our family doctor was managing the pregnancy but over the summer he was in Muskoka and did medical work there. He assured us that he would be back well before Fran was expecting at the beginning of October.
August was hot. Fran had always hated the heat but this was worse. She complained of not having a comfortable night’s sleep. She gave up her job at the law firm in early August and we spent the time getting ready for our new arrival. We had bought a crib and highchair and a lot of that other stuff you need at such times. I had raided the barn over at Two Acres and found some furniture for the larger apartment and the baby’s room. I found an old dresser from my childhood that would do just fine. I also found a rather dilapidated sideboard. We managed to get it over to Toronto and I set to work scraping years of accumulated chicken manure off it, fixing the broken door on the front and then refinishing it. I did all this work in the baby’s room which became quite a mess.
On August 31st before dawn Fran woke up with cramps. We were both pretty inexperienced with this so I timed the contractions and they stopped after a while. Then they started again and I decided we should go to the hospital. We arrived at about 7:30 and Fran was taken up to the delivery area at the Wellesley Hospital. I remember phoning Dr. Doyle at St. Mikes to explain that I would not be in that morning. He was most upset because it was an ECT day and I was needed. David Lewis got on the phone then and he was more understanding.
As it turned out Dr. Porter was still in Muskoka so Fran was delivered by the intern with some supervision from the resident. Peter was born at about 12:30 so the labour was not too long for a primipara.4 Today, I would have been allowed into the delivery room. In those days babies were carefully protected by the nurses from all alien forces – like mothers and especially fathers. I reflected that the intern who delivered Peter probably had no more experience than I did. But in this case I was only a father. I had to sit out in the waiting room with all the other expectant fathers. Oh well, c’est la vie.
Finally I was ushered in to Fran’s room. The baby looked awfully small and fragile. And it made a lot of noise for its size. Fran was very tired so presently the baby went back to the nursery and she went to sleep. I went home for a bit and then went over to the parents’ place for supper. I must have lost track of the time because I suddenly realized I would have to get a move on to get back to the hospital before visiting hours were over. I rushed in to Fran’s room to find her crying and very upset. I seem to blow those prime moments in my life.
There was another reason she was crying and I was not there to help her with it. Peter had a large lipoma in his hand between the index finger and the next one. It made his hand look as if it had two thumbs and three fingers. We talked to the doctor who was a bit too offhand about it, especially for anxious parents. However we were referred to the surgeon who explained that this was not uncommon and could be repaired when the baby was about a year old. At that time he had the surgery at the Hospital for Sick Children by Dr. Bob Salter, probably the leading paediatric surgeon in Toronto at that time.
Fran and Peter were in the hospital for 5 days. I was frantically trying to finish Peter’s nursery and get the place cleaned up and presentable before they came home. Also, since Peter was born in August, before our health coverage clicked in, I had to come up with the money for the hospitalization. The doctor’s bill was OK because of professional courtesy. In those days before universal health care, doctors did not bill other doctors or their families. But it was a frantic 5 days.
I made it – barely. Fran may not have been too impressed with my housekeeping but everything was ready for the new baby. Over the next few months we dealt with one problem after another. But by Christmas time, we had parents and friends in for holiday celebrations. I have pictures of Peter with his grandparents and crawling around the floor with various Christmas wrappings and toys.
My last few months at St. Mikes proceeded apace. I remember some fascinating clinical experiences, such as the patient who was convinced that Dr. Wilder Penfield was directly controlling her brain by mental telepathy from Montreal. She was so convinced and convincing that I almost began believing it myself. Another was David Lewis’s preoccupation with Lilliputian hallucinations. He had several schizophrenic patients who saw little men. I mean little people about six inches tall. He had written papers about it.
When one of his patients was admitted to the ward, he came under my care. I remember one morning when I asked my patient how he was, he replied “terrible!” Apparently his father and several of his friends had appeared to him in miniature form and taunted him from across the room. He became angry and shouted at them. They then came and beat him up as he lay in his bed. He said “They really beat the shit out of me. My chest is still sore.”
I examined him but could find no signs of injury. I then was aware that hallucinations can seem very real to patients but there is no substance to them but I thought I should examine him anyway. However since he had not improved after a few days, we decided to use ECT. I sent him down for an electrocardiogram as part of the workup for ECT. The report came back “recent myocardial infarction”. I phoned the cardiologist and asked him “How long ago is recent?” He replied “about four or five days”. I observed that that was when he had hallucinated that his father and friends had beaten him and he had a sore chest. It was really a heart attack. So hallucinations are not always completely off the wall.
Second Rotation: Mental Hospital Psychiatry
This rotation was at the Ontario Hospital, Toronto – the famous ‘999 Queen St. West’. It was the original Provincial Asylum opened in 1850. The new wings were added on the back in 1878. An admitting hospital was added along Queen Street in 1954. It at least partially concealed the old asylum behind, but the famous dome was clearly visible as you came down Ossington Avenue. It was fashioned on the dome of the Hôpital Salpétrière in Paris, the hospital where Phillipe Pinel struck the chains off the lunatics in the 1790s.
Officially all interns and residents started rotations on the first of July and January. But at government institutions, were closed on stat holidays and I reported on July 2nd. The next day I was issued a white lab coat and assigned to one of the Male Units under Dr. Josep Grodzinsky. Dr. Howie Trupp was the senior and there was one other first year externe assigned. We had about 250 patients in total on about four wards. The hospital was divided exactly down the middle with male patients on the west side and female patients on the east side. Overcrowding was terrible. They even had a ward in the base of the dome which had to be accessed by a precarious curving staircase.
The admitting ward for our unit was in the new building on Queen Street. There were about 50 patients in a ward that today would hold about 30. Back in the old building there were two wards so tightly packed that the dormitory had 27 inch beds down both sides, two beds together separated by a small bedside table, and an additional row of beds down the centre of the room so that you almost had to walk sideways between the beds. The day room was a long room about 12’ wide with a 10’ ceiling with two rows of chairs facing each other along the walls. This arrangement discouraged conversation or social interaction. It was too far to talk to people across the room and you had to twist around to talk to the person next to you. The nursing station was almost like a guard tower at the far end. The movie One Flew Over the Cuckoo’s Nest was filmed at the Washington State Hospital and when I saw it I felt like I was back on that ward at 999 yet again.
Another ward for very chronic debilitated patients was behind the main ward in the so-called new wings from 1878. It was even worse. The smell of urine, feces, unwashed bodies and paraldehyde was nauseating. Patients wandered aimlessly around in various states of dress or undress. Some hung around the locked doors, hoping to get out when a staff person opened a door. Sometimes they succeeded and ran down the hall but soon seemed to be unsure what to do next and were corralled and herded back to their ward.
Externs were on duty about once a week. It was a harrowing experience. You had to make rounds about every hour or so and you could be called to a ward by a paging system of flashing numbers on panels in most hallways. Entering the ward was a challenge. You had to open the door slowly with a large skeleton key on a huge heavy ring watching closely for patients hanging around the door who might jump out at you. By comparison, the cockroaches at the Banting were downright friendly.
I remember I was quite discouraged and was again asking if I had made a mistake to go into psychiatry. In retrospect I was probably clinically depressed. I remember talking to Dr. Grodzinski about it and he reassured me that things would get better. He also told me that the World Congress of Psychiatry was having its second international meeting in Montreal in the early spring and many staff people from the OH Toronto were going. When these people returned from the meeting they were very enthused and this helped all of us to feel better.
Third Rotation: Forensic Psychiatry
In July I started my rotation at the newly created Forensic Psychiatry Clinic of the Toronto Psychiatric Hospital. TPH had an in-patient service with a few beds under the direction of Dr. Kenneth Gray who was both a physician and a lawyer. In 1956 the sexual assault and murder of three young children in Toronto by a 17 year old man, Peter Woodcock raised the issue of sexual violence and murder by persons with presumed mental illness. The clinic was set up in 1956 as a result of this.5
Dr. R. Edward Turner was the director with Johan (Hans) Mohr as research director. It was a very interesting place to work and all the externes wanted to go there. I went to the clinic on Queens Park Circle on my first day and was introduced to the whole group. I was particularly interested in the research program led by Johan (Hans) Mohr. They were studying sexual deviations, now known as paraphilias. When their book came out in 1964 I purchased a copy which I still have.
Fourth Rotation: Child Psychiatry
On January 2nd, 1962 I started at the Children’s clinic on Grosvenor St. just a few blocks east of the forensic clinic. It was winter and my father had loaned me his big Pontiac to use in bad weather. There was limited parking there but I usually found a spot. It was also a very good rotation. They had a strong psychology group and we received a series of lectures on Learning Theory and related subjects. This started with Pavlov’s dogs, on to operant conditioning and animal studies on how rats learn to run mazes. We learned about Thorndike, Hull, Skinner, Olds and Mowrer.
Joseph Wolpe had pioneered new psychotherapy techniques that he called ‘reciprocal inhibition’. Harry Harlow was famous for his work on surrogate mothers. He used rhesus monkeys that were still nursing and found that they would attach to a terry cloth model of a monkey with a nipple of a nursing bottle exposed. John Bowlby, working with orphans who had no attachment to a consistent care-giver, found that they developed psychological problems and were never able to relate to consistent adults in their lives. Conrad Lorenz and Nicolaas Tinbergen had studied instinctual behaviour and created a new field called ‘Ethology’ Jean Piaget studied and began to explain the cognitive behaviour of young children. The whole field of psychology was opening before us.
At the Child and Adolescent Service I worked with children too. The parents worked with a social worker. Often we would meet together to discuss a child’s development. I remember one child who played on the floor but paid no attention to me. We call this ‘parallel play’ and Piaget had described this in very young children. I wondered if he was mentally retarded (the term we used then) but when I spoke to the mother, she said that he had taken his (mechanical) alarm clock completely apart and put it together again – and it worked. This was my introduction to Autism. I remember another occasion when I was reassuring a mother that her child would be well treated in the clinic when from the next room came explosive out bursts of swear words, “shit, fuck”and other offensive words. The mother was not impressed but this was my introduction to coprolalia, part of the Tourette syndrome.
This was a rich and rewarding experience for all of us. I was sorry when it ended in June. But I was then to take on a seniour externe position at the Toronto Psychiatric Hospital. That fall we had the diploma exams and we studied for them. I remember that my examiner was Dr. Griff McKerracher who had made his name in Saskatchewan. I apparently did well and this helped me in my new position.
Seniour Externe at T.P.H.
The pay was very poor for people in training. I remember as a junior interne in 1957-8 I received $45 a month. At the Queen Mary Veterans’ Hospital this was increased to $200 a month so we could not have survived without Fran’s earnings at the law firm that were about $265 a month. As an assistant resident in pathology I received $250 a month so when Fran became pregnant and stopped work we had to dig into bonds that my uncle Eric had left me in his will.
I started the year with high hopes. I was supervising a couple of juniour externes and working with my roster of patients, most of them on the third floor which was a research floor. The Chairman of the Department and director of HPH had a pet project there so he was on the ward frequently. The assistant director was Dr. Mary Jackson and she worked with women. The men’s ward was directed by Dr. Alex Boncalo who gave us a course on phenomenology, a field that seems to be neglected nowadays. The director of the women’s ward was very interested in hysteria, that erstwhile diagnosis that had survived from the 19th century and Dr. Charcot at the Salpetriere Hospital in Paris. I seemed to spend my time there dealing with threatened or attempted suicide and there were some really scary incidents.
There were Grand Rounds in the auditorium every Wednesday and all the externes and others were expected to attend. I got to know just about everybody in psychiatry. I remember a classmate Dr. Alan Davidson gave a Grand Rounds, complete with audio-visual effects on the topic of brainwashing that came out of the Korean War. Also we had Professor William Sargent, whose brother was Malcolm Sargent, the famous conductor. His topic dealt with the revolution in psychiatric thinking around the world and it inspired us to think about all the changes that were happening at that time. I remembered my father’s concerns about psychiatry being unscientific and this reassured me. But this canard is still raised today by physicians and others.
We were so short staffed that I became the interim director of the women’s ward for a while but I found that attending team meetings, covering duties elsewhere and trying to keep up with my studies was exhausting. In the spring they hired Dr. Phillip Melville to take over the research unit and to assist me on the women’s ward. Phil was an experienced clinician who had much experience in community psychiatry that had become a current buzz-word. I got to know him very well over the next few years. He took on some very difficult tasks such as becoming Medical Director of the newly formed psychiatric hospital in Timmins at South Porcupine. I remember visiting him there when I was a consultant with the Ministry.
Junior Staff man, at the Day Care Centre
When I ended my training in the Diploma Course, I was hoping that I could get a teaching appointment with the Department but that was not to be. I first went to the Day Care Centre in the old church on College Street in 1963. It was a good year. I saw lots of patients who were in various groups and learned about group therapy. I also reviewed a book: Strategies of Psychotherapy by Jay Haley. This introduced me to the so-called ‘Palo Alto Group’ at Stanford University. They had developed what they call Communication Theory and were very productive. However they fell into bad odor when Don Jackson and Gregory Bateson came up with the concept of the schizophrenogenic mother. This outraged mothers and those working in schizophrenia, and the Palo Alto group has faded from sight. It is simply not discussed these days.
I also worked closely with my supervisor in psychoanalysis, and learned a lot about psychotherapy. This was not taught at Toronto. The Chairman, Aldwyn Stokes had studied under Aubrey Lewis at the Maudsley Hospital in London and their orientation was very organic. But most other psychiatric centres in North America were oriented to psychoanalysis so this left a gap in our training. I continued my supervision when I went to the Queen Street Clinic the next year.
I was studying for my Certificate in Psychiatry that fall. I had checked with the Royal College because I had a fifth year (in pathology) so I might have written them the year before. But they decided that this year did not count. As I remember, the written exam was at Sunnybrook Hospital in September. I passed that so I moved on to the orals, held at TPH in November. There was a panel of several eminent psychiatrists, several of which I had met before. I was asked a question about tertiary syphilis that I knew quite well but they were looking for another point and when I drew a blank, they coaxed me until finally I got it.
The results would be announced at 6 o’clock so I looked for a place to wait until then. But I was so worried about my problem that I couldn’t think of anything else. Finally when I returned to TPH, they took us in one at a time to give us the results. The suspense was awful. Finally when it was my turn, I went in to be congratulated with hand-shakes all around. I couldn’t wait to get home to tell Fran about it. All she said was “I knew you would pass”.
I remember that my classmate Ian Hector who was one of the brains in the class had decided after completing the Diploma Course that he and his young family would study in the UK. He had a year at the Maudsley and then another year at Queens Square (neurology) and had returned home, prepared to write the exams at the same time as I was. But he was so confident that he only applied to write the fellowship instead of the certificate exams that I was doing. Amazingly I passed and he didn’t. So I was a qualified psychiatrist for a whole year ahead of the class brain. But Ian and I were on good terms throughout our whole careers.
I remember one other incident that fall. The assassination of President Kennedy took place in November and this was big news for all of us. We viewed the scenes several times on our little black and white television in the basement at home. They played it over and over again until it was burned into our memories. Peter was just old enough to understand but the twins were too young but later they seemed to know about it.
I was back at the Day Hospital and told everyone there of my success in the exams. After another round of congratulations, we all settled down to work again. Dr. Bruce Quarington was the leading psychologist and he was working on the use of computers and data analysis in psychiatry. Since the data in psychiatry is soft, it required big computers to handle and work with the data. They had been doing it by hand with a calculator and it took many hours to solve one problem. On the computer, these things only took a few minutes. I was to work with this more when I went to Whitby a few years later.
During that year, I made friends with Hugh McLeod who was a psychologist at TPH. His father was the recently retired Moderator of the United Church of Canada. We had many discussions over religion and Hugh’s comment was “I’m not sure if I am agnostic or simply a doubter but I think religion is irrelevant anyway”. I remembered my thoughts about religion after leaving TCS. Hugh and I set up a car-pool but because I didn’t have wheels, he did most of the driving. We remained good friends for many years after that.
Towards the end of the year I asked the chairman for another appointment. This was granted but I was told it would be the last one. In July 1964 I started at the Mental Health Clinic in the OH Toronto on Queen Street West.
Junior Staffman, at the Mental Health Clinic
In July, 1964 I started my year at the Queen Street Mental Health Clinic. Donald McCullogh was the director and Farrell Toombs was a teaching therapist. Farrell was very much into Rogerian therapy6 where you simply reflect back to the patient what they have just said. He also had a great library and I remember I borrowed a book and didn’t return it when the year was over. A year or so later while Fran and I were attending a Toronto Symphony concert, Farrell came up to us and reminded me of the missing book. At the next concert I gave it back to him.
I was still getting psychotherapy supervision and my tutor asked me to pick a patient that we could discuss. I worked with that patient the whole year and practiced much of what I had learned with him. He improved considerably and I continued to work with him for a while after the year was over.
We also had regular sessions with Stan Freeman. He encouraged us to explore society around us from various perspectives. We invited people from the CBC and from other places that really gave us a rich experience. Later, when I was at Whitby, Stan was working on a newly developed project that would send pictures over telephone towers around the province so that we could interview patients in remote locations. But telephone towers had a narrow bandwidth so it meant that the screen was only refreshed every 20 to 30 seconds. This made it very difficult to see the patient’s change of expression during the interview.
Another thing happened that was much closer to home. I had returned from lunch when the secretary called and said that my wife had called very upset because Stephen had fallen down the stairs and the bottle he was carrying had broken and a ragged shard had driven into his left eye. Fran was a Sunnybrook emergency and I jumped in the car and got there as fast as I could. Fran met me at the door and said that fortunately the shard had gone in beside the eyeball but had not ruptured it. He was going to be alright. But the long scar beside his left eye is still noticeable today.
Final Days.
Bill and Helene had decided that he should retire soon and so they planned to buy a small place in the country for their final days. They found a nice property in a small village just south of Guelph, bought it and prepared to move in. the house was run down and over the next few months they spent a lot of money on repairs, including a new septic tank that was leaking. They began moving furniture and other things there and seemed to be getting established. Fran and I visited as did many of their friends.
In the summer of 1964, the family had noticed that Bill was losing weight and seemed unwell. I talked to him about it and he passed it off as if it was not significant. I asked him if he might have cancer. Apparently he had told Helene that he was too old to get cancer. Both he and I knew this was untrue but he didn’t want her worrying. In February, Bill’s work seemed laboured and difficult. One day in April, 1965, he went to the Crime Lab and a staff member found him sitting on the bottom step, unable to climb the stairs. They called an ambulance and he was taken to the Toronto General Hospital.
I was working at the clinic at the Queen Street Hospital then so my mother and I came to visit him every day. He was examined carefully and the attending physician said that they could not find the cause of his illness but would keep working on it. Bill had developed ‘blind boils’ all over his body and his weight loss was more extreme. I became convinced that he had stomach cancer because in my clinical career, I had seen other patients with the same clinical course. We had the blind boils sent away for pathology.
Before the results came back, I sat with him one day and he was straining to urinate. He struggled but nothing came. He then said that he must be in renal shutdown and that would be close to the end. I held his hand and we sat there sharing our memories and then I head the stridorous breathing that continued for several minutes and then stopped. I called the resident who confirmed that he was gone. As they prepared him to be taken to the morgue, I told them that I must go home and get his wife to be with us. I phoned her to say that Bill was gone and she was ready when I got there.
We discussed this with the doctors and they offered condolences and discussed the next steps. In a kindly way, the doctor said: “I don’t think an autopsy is necessary”. Helene broke in: “Of course there will be an autopsy. You said that you didn’t know the exact cause of death so we must have it. Besides, he has probably done more than 100,000 autopsies in his long career so it is appropriate”.
An autopsy was done and it showed that he had cancer in the portal veins of the liver with secondaries throughout his whole body. The portal circulation was blocked at the lower esophagus and this contributed to his inability to swallow.
Over the next few days, we made arrangements for the funeral. There would be 3 days of visitations at the Blatchford and Wry Funeral home in downtown Hamilton. Then the Funeral would be held at St. Luke’s Church in Burlington with interment in the Greenwood Cemetery, just south of Two Acres.
The family took turns being at the funeral home during the visitations and I even pressed my friend Peter Kappele to help. Mother got a room at a downtown hotel because we could not commute from Toronto. Mother and I were busy contacting people to let them know and we both wrote thank-you notes to all the condolence letters that flowed in. I arranged for pall-bearers from the family and we appointed several of Bill’s closest doctor friends as honourary pall-bearers. During the funeral, the church was packed and fortunately it was a nice day because many had to stand or sit outside. Rev. Heathcote gave the eulogy and I think he outdid himself.
Over the next few months, we continued to get letters and phone calls from people and this helped both of us with mourning. We visited the cemetery regularly and had a headstone and other matters dealt with. Gradually life seemed to return to normal but both Fran and I had missed his happy times.
1 We talked about Mme McLay in earlier chapters.
2 In English tradition, the senior morgue attendant was the Deaner. He was responsible for the proper functioning of the morgue in all respects.
3 Prefrontal lobotomies, or leucotomies were a treatment used in the 1940’and ‘50s to cure serious mental illnesses such as schizophrenia and obsessive-compulsive disorder. It was a very crude procedure in which a burr hole was made in the forehead and a thin knife was inserted to cut off the prefrontal area of the brain. There were so many done in the mental hospitals in the ‘40s that often the cut was wider than expected, leaving the patient incapacitated for the rest of his-her life.
Dr. Pos was demonstrating how damaging these were to the whole brain, not just the damaged areas. In the 1950s, there was much research done that showed that, not only were they damaging, they were also quite ineffective and by 1959, they were abandoned across Canada.
4 Primipara: first pregnancy, first live birth.
5 At Woodcock’s trial in 1957 he was found ‘not guilty by reason of insanity’ and confined to the Oak Ridge Division of the O.H. Penetanguishine on a Lieutenant Governor’s Warrant (LGW).
6 Karl Rogers used what he called ‘client-centered therapy. The therapist is a blank slate and remains silent or reflects the patients’ thoughts, encouraging them to say more.