Chapter Sixteen

I started my Junior Internship at the Toronto Western Hospital on Dominion Day, July 1^st, 1957. I had heard all the stories about the long hours and impossible workloads but it is hard to imagine until you are actually in it. Then you find that – like most other things – you get into a rhythm and it just becomes life. We covered the wards or clinics during the day and then were on duty every second night. We seldom got any sleep while on duty so we craved sleep. You were too busy and too tired most of the time to complain. It reminded me of my days in the navy on board ship where they had a dozen terms for sleep or bed but never had enough of either.

There was an apocryphal story, possibly true, that the professor of surgery at another teaching hospital was doing ulnar nerve relocation around the olecranon process in the elbow. As usual, when the chief scrubs in he is accompanied by several assistants including the senior and junior interns. The junior was at the end of the row and was responsible for trimming the sutures after the surgeon had tied them. He had been up all night and was dozing off as the chief did a very careful dissection to free up the ulnar nerve. Finally he held up the ulnar nerve on two probes and proudly said “there”. The junior snapped awake and reached around with his scissors – snip!

The consequences for the patient would have been catastrophic. A fairly routine procedure with minimal sequellae had suddenly been turned into a debilitating partial paralysis of the arm that would take many months to heal and sometimes never healed completely. The consequences for the unfortunate junior were also very serious. If he had aspirations for a career in surgery, they would be dashed. Even his subsequent medical career would be in some jeopardy.

More recently the issue of internes’ long duty hours with little sleep has been partially addressed and has improved somewhat. But the essential problems of internships in my day remain. Having interns and residents at your beck and call is one of the perks of a teaching appointment at university centres. Often the staff men would only visit the hospital to do rounds once a day or to perform surgeries that were booked. The rest of the time they would be in their private offices and only available by telephone – if you could get them.

There were never enough interns or residents to do all the work of a busy general hospital. And the long hours and pressures were inexorable, resulting in poor judgement and inevitable errors often with serious consequences. It was seen as a kind of “hell week” initiation or baptism of fire but it lasted all year. It was more like the new-boy year at TCS. Those of us who survived it were proud of this as if it was a great accomplishment, but it is no way to run a railroad – or a health care system.

First Rotation – Surgery

There were four 3 month rotations in the junior year. My first was surgery. We covered the public wards in the old building on Bathurst Street. We scrubbed in on surgeries with our staff man. I often worked with Harry Joynt which I thought was a good name for a surgeon – almost as good as my father’s name in pathology. We also covered the Emergency Department and Special Clinics that dealt with venereal diseases.

July was a blur. Sometimes when Fran and I went out I was so tired that I probably wasn’t much company. The rotation was 28 hours on and 20 hours off for a whole month. I remember one night when it wasn’t too busy I decided to catch a nap on one of the stretchers at the end of the hall. I had just nicely nodded off to sleep when the charge nurse called me to tell me that a patient had come in. It was 3:00 AM. Somewhat groggily I saw the patient, a young guy about my age, who explained that he couldn’t sleep and wanted a sleeping pill. I exploded: “…because you can’t sleep, I can’t sleep either!” He was genuinely startled and I apologised. After I explained my situation, he was more sympathetic. He assumed, as did everyone else, that we were on 8 hour days like all the rest of the working world.

There was a very large Italian and Portuguese population in the area around the hospital and they felt a strong loyalty to ‘their’ hospital. An Italian group had been hunting north of Barrie and when one was injured, they insisted that he be taken to the Western in Toronto – their hospital. We got a call that an ambulance was coming in with the victim of a hunting accident. We had all the backup surgeons and the blood bank at the ready. Eventually the ambulance pulled up to the door and a stretcher was wheeled in accompanied by a vociferous Italian family, all trying to explain what had happened. Eventually I got the patient separated from the rest of them and he told me that he had been climbing a fence and fell, spraining his ankle. But his shotgun had gone off and they all assumed that he had been shot. No one thought to ask him how he was.

I was on the surgical ward in August and September as well – not quite as much pressure but still 28 on, 20 off. On weekends, it was only, 24 on, 24 off which seemed a bit better. The interns’ residence was in a smaller building connected to the north end of the old hospital. We grabbed sleep when we could. A classmate of mine, Doug Johnston was building a Heathkit radio and trying to find time to finish it. My roommate was from Saskatchewan. At that time the University of Saskatchewan did not have a full medical program so many of them came to U. of T. to finish their training. I remember once his brother called him from Regina at 3 in the morning. He explained that it was midnight there and he had tried earlier but couldn’t get him. My roommate replied: “Oh, that’s OK; I had to get up to answer the phone anyway.”

My other big issue was plans for next year. Father had just assumed that I would take up pathology but I was not at all sure. General practice did not turn my crank. Internal medicine and obstetrics seemed like general practice on a specialist level. I really enjoyed surgery but I was put off by the arrogance of some of the surgeons that I had worked with. Pathology and laboratory medicine seemed very technical and scientific but did not involve working with patients. I even remember reflecting at one point – what happens if you work your tail off to get through medical school and then find that you don’t like it?

Finally I decided on a senior medical internship. I applied at the veterans’ hospitals in Toronto, Montreal and Vancouver. Queen Mary Veterans’ Hospital in Montreal was the first to reply and I accepted it. Fran and I were also planning to get married next summer so a year away from both families in a city whose culture had always appealed to me seemed like a good idea.

Second Rotation – Obstetrics & Gynecology

The next rotation was Obstetrics and Gynaecology. It was a bit easier because there were five interns on the service and only two were on duty each night. As a result we actually had weekends sometimes. With our large Italian and Portuguese populations, we often had trouble communicating with patients and we called on the local interpreters a lot. I had two experiences that reminded me how important communication is. One woman who was expecting in four months was gaining weight far faster than we thought was good for her. I tried explaining this to her in the few words of Italian that I had learned. I even gave her a diet plan that our dieticians had worked out with Italian dishes on it but she continued to gain weight. Finally I called in the interpreter who spent a while talking to her. She then explained to me that the woman thought that she was to eat the special diet in addition to her regular meals. My first encounter with the concept of eating for two.

The other goof was more serious. One night I delivered a baby girl and then phoned the father to announce the happy news. His English was about as good as my Italian, so when I didn’t seem to be getting through, I said “bambino”. He was ecstatic and rushed off to tell his friends. When he came to collect his wife and baby a few days later, he was furious. He said that the doctor who phoned him had distinctly told him that he had a boy and now they were trying to palm off this girl on him. I should have said ‘bambina’.

Third Rotation – Medicine

The next rotation was in Medicine. I returned from a short New Year’s break to take up duties on the public medical wards that were one floor above the surgical ones. It was set up very much like the old English hospitals that father used to talk about. The ward was open with about 30 beds on each side, with a nursing station in the middle on one side and an entrance to the communal washroom on the other. There were a few single rooms that were reserved for people too sick to be on the open ward. The official rate was $3 a day but in the days before universal health insurance, few of these patients could afford to pay even that. Private and semi-private patients would have rooms in the new tower at considerably higher cost. Interns covered the public wards during the day but on call duties included patients in the tower.

That spring mother had her holiday in Mexico. She always loved to travel and was thoroughly fed up with dad’s idea of a vacation where he had a big conference in some distant city and she got to see the sights alone while he was in meetings. She had finally persuaded father that he was now retired and they could take some trips together. Cousin Harry had been living in Mexico for some years and had been constantly asking them to come and visit. She had booked an elaborate trip for both of them and then dad announced that he couldn’t go, too late to cancel the plans. She got a friend to go with her instead. Much to father’s chagrin, they had a wonderful time. Dad never tried that trick again.

Just after they got back from the trip, Aunt Christine died. She had been slowly declining with dementia and was becoming a problem for the nursing home in Grimsby. She had been transferred to St. Peter’s Hospital in Hamilton but not long after this had fallen and broken her hip. There was a gradual decline until April when she died. Again my experience with funerals came in handy. With both Eric and Christine the visitations were at Two Acres and they were buried in Beeton. I got an afternoon off to attend the funeral.

Fourth Rotation – This and That

I spent a month on a minor specialties service and then a month at the Oakville Trafalgar Memorial Hospital. I was the only intern there and I was able to do almost everything and I got to know some of the local physicians. I also got to play golf with one of the doctors who was a member at the Cedar Springs Golf Club. This really took me back because our scoutmaster, Bob Todd used to take us there in the winter to ski some 15 years before. Betsy took more of a beating because I was in to Toronto to see Fran and also running home to see my parents from time to time.

My last month was in the blood bank and daytime coverage for the private patients in the tower. This was the days before the Canadian Red Cross ran the whole blood service and many hospitals had their own blood banks. It was great for interns and other members of the destitute classes (like interns) because they paid you for donating blood and the Red Cross didn’t. It was also the launching of Sputnik by the Russians. Everyone was out at night to see if they could see it. The others around me claimed to see it but I could not discern it. Shades of Phoebe Cooper and the ghost in the old chapel at TCS.

I was starting my Senior Internship at Queen Mary Veterans Hospital on July 1^st and Fran and I were getting married in the Sault on the 2^nd of August. As a wedding present, my father had given me a newer Vauxhall, a 1955 model, to replace my old 1950 one. I had driven the old one into the ground – it needed an engine re-bore, valve grind and some other things. It had over 70,000 miles on it by then and I had put almost half of the miles on it myself. A week before I was due to go to Montreal, we exchanged cars and I parked the new Vauxhall in the Western hospital lot. My father kept the old one as a spare and a few years later, when we were back in Toronto, dad and I drove it back to Hamilton Motor Products where father had bought it in 1950. By then it had 75,000 miles on the odometer and they said that they would put it in the front window as an advertisement. Both Fran and I shed a tear for Betsy’s last ride.

The Trip to Montreal

I had planned to finish my internship early on Monday, 30^th of June and leave for Montreal by early afternoon. I had obtained a room at the Queen Mary Veterans Hospital interns’ residence starting that night. However I was on the Blood Transfusion Service which was busy that day and I did not want to leave on an eight or nine hour drive to Montreal in the late afternoon. I planned to get away early the next morning and phoned the hospital in Montreal to tell them that if I could get away by 6:00, I planned to arrive about 3:00 in the afternoon.

It was quite a trip. My Vauxhall was heavily packed with all of my worldly belongings and some of Fran’s that I had agreed to take. I had to take all my heavy medical books out of the trunk and place them in the passenger seat footwall because the back springs were right down on the bumper stops. Finally there was just enough room for me to get into the driver’s seat but every other cranny was packed with stuff. It was closer to 7:00 am when I drove the car out of the lot and made my way through city streets to Kingston Road and eventually to the new highway #401 at Highland Creek. Highway 401¹ had only a few sections completed at that time. There was the Toronto bit that ran from Highway 27 near Malton to Bowmanville. The Kingston by-pass was only about 8 miles long and didn’t help much. The old Highway 2A ran from Gananoque to Brockville but only one side was finished. The rest of the way, I followed the old Highway 2 which ran through every town and hamlet right into Montreal.

I had lunch in Kingston and phoned the hospital to say that I would not make it by 3 o’clock. Progress was slow on the 2 lane highway because with the heavy load, it was impossible to pass anything, even farm wagons. When I got to Cardinal, I took a break to look at the canal that I had traversed 3 summers before with the HMCS Wallaceburg on the way back to Halifax. Between Ingleside and Long Sault I ran into a colossal traffic jam. People were stopping along the side of the road, climbing the bank beside the road and standing on top. I asked someone what the fuss was about and he looked at me as if I was from another planet. “Don’t you know? They are flooding the seaway in about half an hour.” I was a witness to an earth-shaking event and I didn’t even know it.

Settling in at Queen Mary Vets

I did not have a detailed map of Montreal, but finally found the hospital on Queen Mary Road. It was about 6:00 o’clock and I had been on the road for 11 hours, a distance of 356 miles on my odometer. But my car had held up even though I probably had sacrificed several of its nine lives. Over the next week I got familiar with the hospital routine and settled into my ward work. I was also hunting for an apartment and then getting it ready for our wedding in the Sault on August 2^nd. The subsequent honeymoon to Lac St. Jean and Quebec City was over too soon and I was back on the chronic chest ward with a group of other interns who were about in the same position as I was. But the McGill atmosphere was subtly different from the atmosphere in the hospitals in Toronto and the presence of the French culture and the francophone co-workers reminded me of my summer in Europe only two years ago. Again I had the feeling of a change in my life that I have felt several times before.

Senior Internship, Medical Rotation

Queen Mary Veterans Hospital only had senior interns. The medical year was divided into three rotations of four months each. My first, in medicine, was on a ward with many veterans who had fought with the Van Doos² in the First and Second World Wars. Somehow in my Ontario-centric view of the world, I had only heard of French Canadians who had refused to join up or refused overseas service.³ I had not realized what an important contribution the famous Quebec regiments had made until I was working with them as patients.

The other big event of this year was the landslide victory of the Diefenbaker Conservative government. It was the first time in many years that the government was not dominated by the Liberals with their strong power base in Quebec. The staff internist on the ward knew all the patients, and when talking to Francophones he would refer to the prime minister as Messeur Diefenboulonger.

There were many veterans who had been gassed in the First World War and were in advanced states of emphysema. They were all heavy smokers and the ward was wracked with coughing fits and anguished gasps for breath. I also noted that volunteers, dressed as Red Cross nursing sisters were handing out free cigarettes. I had spoken to several of my patients about quitting smoking but was greeted with derision. One older man explained to me that smoking was about all he had to live for. We were doing rounds with our staff man when I proposed that we should stop patients smoking on the ward or at least stop the volunteers from handing out free smokes. He replied: “That’s a great idea, Deadman. I will appoint you as a committee of one to implement that.” I’m afraid the idea died right there. I knew when I was beaten.

This was decision time – we all had to decide what we were going to do next year. Father had already spoken to his good friend John Hamilton, the professor of Pathology at U. of T. and I knew I would be accepted there but I really wasn’t sure if that was what I wanted. I spoke to several people at McGill about a career in chemistry or neurology or other more scientific pursuits but nothing resonated with me. I even began to hark back to my happy days in the Arts programs and wondered if I had made a mistake going into medicine. Finally I applied and was accepted in pathology at Toronto.

Senior Internship, Rotation on Neurology

This rotation went from November to the end of February. There were two staff men who were senior faculty at McGill. I became involved in the ongoing discussions of neuro-humoral transmitters – work that was just beginning to open up in the period after the war and was now advancing rapidly. I had learned something of dopamine and epinephrine but now was learning about serotonin and some of the others. This stimulated an interest in brain function as the wave of the future in medicine.

I took a particular interest in the medical problems of service men and ex-service men, probably because of my summers in the UNTD. We had several assessments of service men for medical fitness for service and I learned that one had to be careful in the wording of reports because they could easily be misinterpreted. A big part of this was giving medical evidence at pension review hearings.

Veterans’ pensions were determined by the severity of the illness, injury or disability and the degree to which it was caused or aggravated by war service. Obviously it was in the interest of the Department of Veterans Affairs to show that the veteran was not disabled or that his war service had not caused the problem. And it was in the interest of the pensioner to have his pension increased by showing that it was disabling and entirely related to war service. Immediately after the war, the pensions were handed out in a fairly generous way but by 1958, the Pension Board was much stricter in interpreting the rules. Similarly the veterans fought tenaciously to show that the original pension was not adequate and needed to be increased. Some interesting battles developed and very often the attending physician or the interne was somehow caught in the crossfire.

Many disabled veterans, seen as heroes after the war, were now seen as ‘down-and-outs’ with no job or prospect of getting one. Their life seemed focused around the Legion Hall and many got into booze. Soon the Veterans Hospitals and the pensions became their only refuge when times were tough. If things were going badly for them, they could always get admitted to the hospital with clean sheets on the beds, nice nurses and 3 squares a day. Who could ask for more? If they came into the Emergency Department with a complaint and were turned away or offered out-patient treatment, this was an affront to their dignity that could not be tolerated. Covering the Emergency therefore was often a challenge for inexperienced interns with only love and compassion in their hearts.

One evening when I was covering emergency, an ambulance brought in a veteran who was paralyzed from the neck down. I examined him and determined that his reflexes were normal, there were no lateralizing signs and his claim of anaesthesia in all limbs did not follow the expected neurological pattern. I had the temerity to say to him that I did not believe he was paralyzed at all. He became extremely angry, jumped off the stretcher and chased me and the emergency attendant into a glass-walled inner office. He then picked up a large office typewriter from the desk and threw it through the glass partition narrowly missing us. He then stormed out, saying that we would be reported to his member of parliament and would lose our jobs. My only consolation was that at least my diagnosis was correct.

We had clinical case conferences every week in which we all took turns presenting a case history with the medical workup. One intern got so involved in all the lab work that had been ordered that he circulated a list of just about every test that one could think of. Some members at the back got a bit fed up with this rather obsessive and largely unnecessary ordering of tests and said: “You didn’t order the serum jam or serum rhubarb!” This provoked much laughter and quite a discussion.

At Christmas time, I got some time off so we were able to travel to Toronto and spend a few days with my parents who had just moved from Two Acres to Moore Park in the fall. In January, I then faced another choice. My final 4 month rotation was to be at the chronic care hospital for veterans at Ste. Anne de Bellevue. This was a huge 3000 bed hospital at the very west end of the island of Montreal. There were about 7 interns assigned to this area and I did the math – we would have about 400 patients each. When I asked a colleague who had been there on the first rotation, he replied that he did rounds in the morning and played golf in the afternoon. Since I did not play golf and anyway, I would be going there in winter time, this was not very reassuring. I happened to sit down for lunch with a psychiatric resident from South Africa, Dr. Leon Sloman, who told me that there was a vacancy in psychiatry. I met the chief of service, Dr. Claude Dancy and it was soon arranged. On the first of March, I started on the psychiatric ward.

An Introduction to Psychiatry

I didn’t realize it until sometime later but I had come into psychiatry at a very exciting time. When I graduated in Medicine from the University of Toronto in 1957, Chlorpromazine had been in use for three years. The research of the late ’30’s, ’40’s and ’50’s in psychology, neuro­physi­ology and neurochemistry had suddenly given psychiatry a much more scientific look. Paul MacLean’s concept of the Limbic System was in every discussion. We began to hear the term Neuro-humeral transmitters and talked about acetylcholine, norepinephrine, dopamine and serotonin. We didn’t yet know what they did exactly, but it was all pretty heady stuff for young psychiatrists just starting on their careers.

Some of the best teachers were at McGill at that time. And they all came around to the various units in the McGill network that covered the whole city. Heinz Lehmann and Robert Cleghorn were at the Verdun Protestant Hospital (later the Douglas Hospital). Nate Epstein was at the Jewish General and talked about family therapy. Alan Mann was at the Montreal General. He was my supervisor at the ‘Vets’ for a while but then I had Dr. C.C. Smith. The only one who didn’t come to the hospital was the Chairman, Cameron himself. My only recollection of him was attending lectures at the Allan Memorial Institute when he was on the podium and I was at the back of the lecture theatre.

Senior Internship, Rotation on Psychiatry

The psychiatric unit was a busy place. I was assigned to work with Dr. Alan Mann, from the Montreal General who had about 16 patients on the ward. There was active training for residents, social workers, psychologists and nurses. We had sessions with staff psychiatrists from other hospitals in the network every Wednesday afternoon. A clinical fellow, Dr. Gerald Sarwer-Foner was conducting a clinical trial on a new anti-depressant drug, G22355.

While I was on the rotation, the clinical trial was completed and Dr. Heinz Lehmann came to the unit to announce the results from about 5 centres in the Montreal network. Geigy issued the drug as Tofranil, the first of the so-called tricyclic antidepressants. Dr. Lehmann⁴ also described all the other drugs, tranquilizers, antidepressants, anxiolytics and anti-convulsants that were coming on the market in the next few years. We had lectures on a lot of other interesting stuff. The McGill program had a heavy psychoanalytic orientation and I got some training in the approach and some books to read. For someone who had never paid much attention to psychiatry it was very exciting.

The senior resident, Dr. MacKay was known on the unit as Jock. I assumed he was Scottish until I met him. He was ‘pure laine’ Quebeçois from Laval whose English was still somewhat rudimentary. His name actually was Jacques and he was a descendant of one of General Wolfe’s soldiers who married into a family in Quebec City after the conquest in 1759. The children were raised by the mother who spoke only French and within a generation English was not spoken at home. I subsequently met a number of francophone people with similar backgrounds.

One of my patients was a man who had many strange paranoid notions including the idea that I was not helping him; I was secretly poisoning him. I sought help from a colleague and we both went into the room to talk to him. He screamed at me: “now you’re ganging up on me!” When he started to come after me, we both beat a hasty exit. Suddenly his bed came shooting out of the room and it made quite an impression on the opposite plaster wall. I hadn’t thought of psychiatry as a dangerous profession before.

As the winter turned into spring, I realized that I had made many good friends and had developed a whole new viewpoint on my budding career. I was now making plans to start my training in pathology. We had really enjoyed our time in Montreal but were looking forward to being closer to family and old haunts. The people were great and at least one asked me if I had considered staying on to complete the program in psychiatry at McGill.

Fran had had a more difficult time than I had. She really missed her family and friends in Toronto and also was upset at my indecision about my future career. She had had problems dealing with my father who had never warmed to the idea of our marriage and whom she saw as quite interfering. She also saw her mother-in-law as more aloof, even faintly disapproving. In fact, mother was skating a fine line between father who was actively guiding his son’s career to follow in his footsteps, and a son who wanted to do things his way and didn’t want to do it father’s way. It was not an easy situation for any of us.

Back in T.O. 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. I was one assigned to TGH which entitled me to a room in the internes’ residence on University Avenue. Most residents were married or living off campus by then so the residence was not used much – mainly for people on night duty. I think that I slept there twice. I gathered up a lab coat, bed sheets and towels and put them in the room. I think they were still there at the end of the year.

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. After presenting the gross pathology, the room was darkened for slide presentation. The projector was a microscope with a carbon arc light source that was so bright that even with a water cell to damp the intense heat, it could burn through your precious slide in a matter of seconds if the slide was not kept constantly in motion.

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.⁵ 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.

Stories about cockroaches were legion at the Banting. One day John Barrie proposed having a cockroach race. I naively asked “what’s a cockroach race?” he described how a large circle is drawn on the floor with chalk, everyone selects their cockroach and they are all placed under a cup in the centre. Then the cup is lifted and the person whose cockroach crosses the chalk line first, wins. I asked: “How can you tell them apart?” John Barrie replied with a twinkle in his eye: “By the expressions on their little faces.” The other residents were all laughing. He had got me.

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.”

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, she 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. One current view was that you went into psychiatry if you couldn’t make it anywhere else. Psychiatrists were often seen as having emotional problems giving rise to a common perception that they were as crazy as their patients – it went on and on.

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 19^th 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. Evelyn had been in the Canadian Women’s Army Corps (CWACs) at that time and came to visit us at Two Acres several times. The next youngest daughter, Ellen was about my age and was at home. The youngest daughter was also at home and all I could remember about her was that she liked to chew up aspirin tablets. Not your usual doctor’s family but very nice people nonetheless.

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 had visited there several times and often met Ellen and the others at high school dances and in the town. Our paths no longer crossed when I went off to university. 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. He told me that he had often complained about the terrible conditions in the hospitals but steps were now being taken to clean that up. 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.”

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. We often had staff physicians from the General Hospital come over to see our work and discuss patients we had seen. Gradually I became more efficient and the autopsies that took 3 or 4 hours in the beginning were now taking about 2 hours.

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. 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.

Move to Psychiatry

By February, we were aware that Fran was pregnant with an expected delivery date at the end of September or early October. In my last few months at the Banting, I was finishing up all my reports and preparing to leave in an orderly fashion. I can remember at one point in early June I seemed to have a backlog and John Barrie asked me about this. I was able to reassure him that I would have all cases presented and done by the end of June.

Fran and I only had a one year lease on the apartment at 220 Eglinton Avenue. It had always been our intention to get a bigger place as Fran was expecting. We found a 2 bedroom apartment in a 4-plex on Millwood Road near Bayview and in June we made all preparations to move in. By this time, Fran was definitely showing and was buying maternity clothes. My first rotation in psychiatry was to be with Dr. Arthur Doyle at St. Michaels Hospital starting as usual on Dominion Day. It was hectic in the last couple of weeks but we made it. My days of uncertainty seemed to be behind me. It seemed that the whole world was finally opening up. It was yet another time when I sensed that my life had entered a new phase.

Notes:

1 Ontario had started a four lane divided highway to extend the Queen Elizabeth Way from Toronto to Montreal. It was to be called 2A, but when construction was halted in 1940 because of the Second World War, only two bits had been started, one from Kingston Road to just beyond Oshawa and another bit through the Thousand Islands with only one side paved. Construction did not start again until about 1950 when the 400 series highways were being built. The first, Highway 400 ran from Toronto to Barrie. The second, Highway 401 started with a bypass north of Toronto but ultimately was to be the trans-Ontario highway from Windsor to the Quebec border near Montreal. It incorporated the old Highway 2A bits but was not completed until about 1968, after Expo ’67 was over.

2 The Royal 22^nd Regiment of Quebec City was popularly referred to as the ‘Vingt Deux’ – or Van Doo’s. It had illustrious service in both world wars.

3 Reluctantly the Liberal government had been forced to bring in conscription in 1943. But as a sop to their power base in Quebec, overseas service in the war remained voluntary. Many Francophone conscripts from Quebec refused overseas service and were assigned to the home guard. We had many of them guarding important installations such as the Adam Beck Hydro station at Queenston and old veterans like my father sneeringly called them zombies.

4 Heinz Lehmann is generally credited with introducing chlorpromazine to Canada. Originally developed in Europe for use in anaesthesia and obstetrics, it was found to have a very calming effect on people with acute psychosis without being overly sedating – hence the term, tranquillizer.

5 In English tradition, the senior morgue attendant was the Deaner. He was responsible for the proper functioning of the morgue in all respects.