The Magarey unit
In 1968, I moved on to the third of the three general surgical units, the Magarey Clinic on Ward 5A, as Senior Surgical Registrar. The three Honorary Senior Surgeons on that unit were Bob Magarey as Head, John O’Brien as his second in charge and Don Beard.
Bob Magarey had a long and distinguished career in medicine and medical politics. For five years during World War II he served his country in active theatres of war, including the Middle East where he was involved in the Syrian campaign and later with the Seventh Division in the bloody conflict with the Japanese on the Kokoda Trail.
Bob was unwittingly my mentor, both during my medical student days and also throughout my surgical career.
I happened to be attached to his surgical outpatient clinic in my fifth year and considered myself indeed fortunate as he was justifiably known as the ‘Prince of Tutors’. He was well organised and loved teaching – I still remember what he passed on. He would have been 42 in that year, 1956, and was a Clinical Assistant at the Royal Adelaide Hospital.
Being a Clinical Assistant in those days was a dog’s body job as they had no operating rights and were required to put their outpatients requiring surgery on the operating lists of whomsoever was their designated head of unit. The Senior Honorary Surgeons did not deign to stoop so low as to attend outpatients and actually talk to patients. The Senior Surgeons who had sole operating rights were Alan Lendon, Sydney Krantz, Alistair McEachern, Alan Hobbs, and James Estcourt Hughes.
Around that time, Bob had a melanoma on his back diagnosed and operated upon. He elected to have block dissections of both axillae and both groins – formidable procedures for a potentially lethal condition. Fortunately, he had no recurrence. I remember melanoma was his favourite teaching topic at the time and what he taught stuck.
In our sixth year, he was elected President of the Medical Students’ Society. For some reason unknown to me, I was elected to organise the annual Medical Students’ Dinner at the Myer Apollo Dining room, time I could ill afford, and I was answerable to the President for the organisation, so I developed quite a rapport with Bob. Thanks to his sound advice the dinner went off very well!
Bob’s contribution to the medical profession was amazing and he showed great leadership and wisdom in all the many offices he held. He led The QEH Medical Staff in its transition from being Honorary to salary-based in 1971. He always did his homework thoroughly and we were all the benefactors of his skilful negotiations with the government bureaucrats of the day.
Bob was considerate to his patients, both public and private. He was of that era of surgeons that were more or less self-taught. They assisted their seniors with a particular procedure and then went off and did the procedure on their own patients without supervision. There were no training appointments in teaching hospitals available to them during their learning years.
Bob Magarey served his profession with great distinction; Chairman of the QEH Staff Society, President of the AMA of SA, Federal President of the AMA, Australasian Surgical College Councillor and Chairman of the Court of Examiners to name a few of his positions. His knighthood announced in 1979 was richly deserved and humbly accepted.
Bob was easy to work with. He treated me with extreme kindness and accepted my judgement and I became very fond of him. One might say he was almost a father figure – and Trevor Pickering felt the same. I was asked to assist him with his private operating and, dare I say, was able to show him some new tricks. On one occasion I was retracting one lobe of the thyroid so he could identify the recurrent laryngeal nerve before doing a thyroidectomy. He said he had never seen the lobe retracted like that and that he would instruct his future assistants to do likewise. Well, I had learned to be grateful for accolades, as they came all too rarely.
Bob was not so kind to all his registrars. One senior registrar that preceded me by a few years got on his wrong side and Bob made his life hell to the extent that he resigned and, by coincidence, joined my brother-in-law John Fisher in his Warrnambool surgical practice. There it became apparent that he was having a nervous breakdown and shortly after he ceased practising surgery altogether.
Bob’s claim to surgical innovation became known infamously as the ‘window’ operation. He required his registrar to do a choledochoduodenostomy on all his gall bladders, young or old. I conformed to his wishes against my better judgement, particularly in the young. I believe the complication rate documented in the paper he published on this subject in the British Medical Journal was underestimated and the side effects required us to perform a number of reversals over the years. Bob had invited Bill Proudman to be a co-author of his paper but Bill, in his wisdom, declined.
One final recollection about Bob. He was a big man with huge hands. Accordingly, he felt he had to make big incisions and his patients had long scars. When someone pointed this out to him he retorted: “Wounds heal from side to side, not end to end!”
The second in charge on the fifth floor was John O’Brien with whom I also got on very well. John was the last of the ‘apprentice’ surgeons – those who learnt their surgery by assisting established surgeons with their private operations before doing it themselves without supervision. They had never had an opportunity to broaden their experience through working in the public hospital system as registrars and then senior registrars.
John had been a clinical assistant surgeon at the RAH when I was a student, although never on any unit to which I was assigned. John’s forte was his brilliant mind. He was an excellent speaker and had a very quick wit. He served TQEH well and was devoted to its service.
He was a beautiful pianist and liked everything to be just so. Occasionally, he took on a procedure for which he was not well-equipped. On one occasion, on a Monday morning after a particularly heavy take the night before, I had the temerity to put a semi-urgent case on the end of his Monday afternoon operating list. It was my job to organise the running of the unit as efficiently as possible and I thought nothing of it. To my surprise, John lost the plot and tore a strip off me as he had not been consulted. I accepted his reprimand in my usual humble way. (Langue et joue. Ed.)
John, like Lou Opit, was almost too smart to be a surgeon – perhaps a physician’s life may have suited him better. He did not have a very big private practice, probably because he chose to live at Stirling which did not lend itself to night calls. John and Faye, his wife, were very hospitable to Sadie and me and invited us to family functions where we saw first hand his model train set-up which occupied a double garage. What I liked best about John was his brutal honesty at all times about all things (even my shortcomings). I also enjoyed his slightly ‘mystic’ demeanour.
Decades later, when we had both retired and he had lost his dear wife Faye, I gave him a copy of a book I had written and I was touched to receive the following letter which is included here for three reasons. Firstly it demonstrates John’s mastery of prose, secondly I was very encouraged to find that someone whom I respected and admired would give the book an accolade! Finally, it presents a pen picture of the man himself and alludes to his upbringing better than any third party description. The letter was written in August, 2015, when he was 90 years of age.
After coming inside on Wednesday afternoon with the gift book tucked under my arm I read the title and was surprised to see it included reference to part of the title of one of my favourite poems by one of my favourite poets. Even after seventy years I can remember slabs of it e.g. ‘The youth who daily further from the East must travel still is nature’s priest, and by the vision splendid is on his way attended …. at length the man perceives it die away, and fade into the light of common day.’ I can’t find my book of Wordsworth to verify how accurate that is.
I liked the poem while not fully understanding (or agreeing with its message).
In retrospect some of the allegory is a bit over the top – ‘trailing clouds of glory do we come from God who is our home’.
I think my boyhood interpretation was rather that it described the decline and eventual loss of the ‘magic’ of childhood.
Your book is amazing – light weight in avoirdupois sense although certainly not in content! The amount of reading you must have done judging by the quotes and bibliography is incredible. Most of your conclusions I share but stop short of accepting a divine or omnipotent controller of the cosmos, I suppose being what you would call an agnostic. I thought it a bit unkind to refer to an agnostic as lazy which implies that with some mental effort and research they should be able to reach a definite, if mutable, opinion. I approve your willingness to accept that sometime in the future your views could change.
I have read the whole book and I found some of the extracts most interesting. I did not know about Cooneyites and my knowledge of religious history was way behind yours. I liked John Pfitzner’s poems by the way.
My father left the Roman Catholic church when a medical student in Melbourne, much to the dismay of his parents and two sisters. Like many who leave orthodox religion he became extremely open-minded and insisted that I not be baptised until I was old enough to decide what religion I would adopt. He took me to a wide variety of events – flying in Tiger Moths, attending the observatory, symphony concerts, and even the pouring of a huge casting at an engineering works that required two gantry ladles, and much more. He spent much time at night, not telling me fairy stories, but opening my mind to the wonders of space and time. Regrettably his premature death when I was 12 stopped this. He married my mother in an Anglican church (her religion) and sent me to a Methodist kindergarten, and later to an Anglican boarding school. Here I decided to be confirmed – not because of any belief but because all the other boys were doing it! When they found out I was not baptised I had to go through that first! I am ashamed to say that my main memory of confirmation was the injunction not to wear hair oil because the bishop had to put his hands on my head. With time I drifted into the school choir and was pleased to become its leader because I could wear a special necklace!
From there I graduated to lesson reader and chapel server but still scarcely religiously involved.
At University I passed through a panentheism phase to become an agnostic.
I include this personal boring history so that you can appreciate the possible biases in any of my comments on your book.
Quotes that stand out for me include David Hume on miracles, and on ’evil’ – (surely wise long before his time), Einstein at the end of the book, Hawking on the time conundrum, and some wonderful one-liners – such as the definition of happiness!
I think you were very brave to have written the book but certainly do not mean you shouldn’t have written it. I think it most important that we humans retain our innate curiosity and a sense of humility and wonder.
John’s wife Faye describes his sense of humour: “When John had a full head of steam he would have the family in stitches with his jokes and mimicry.”
Certainly, when John and Lou Opit got together there was always much laughter as they shared a similar irreverent bent.
There was a tremendous sense of camaraderie at TQEH, everyone having the welfare of the hospital at heart, with palpable loyalty extending from the professors to the theatre orderlies down to the cleaners. It was a great place to work.
Bill Proudman writes about the TQEH Review Society in his history of the early days of the hospital:
TQEH Review Society was formed in 1966 by Lindsay Barratt, Martin Thomas and Stan Judge. The Reverend Stan Judge was a Northern Irelander and the parish priest of the Anglican church on the Port Road which still has a lychgate at its entrance. The Society presented its first show at the Arts Centre in Angus Street and, over the 19 subsequent years, missed putting on a show just once, in 1968. The last show was presented in 1984. However, in 1991, the cast and crew got together once again to present a special Anniversary production called Silver Stitches.
Needless to say, John O’Brien was always a star comedian in these shows as he and Alan Kerr Grant shared a comedy skit.
The third honorary on the unit was Donald Beard. I got on well with Don who came to TQEH with an impressive war record, having served initially in the Occupation Forces in Japan and then in the Korean War (including the battle of Kapyong) and, finally, in the Vietnam War. He was tall, like Bob Magarey, (around six foot six inches), and was a similar surgeon – macroscopic rather than microscopic. I’m sure he would have been an excellent surgeon in a war zone.
Don got on well with Bob Magarey and John O’Brien but, surprisingly, John O’Brien did not always support Bob Magarey and was very critical at times. Bob felt this antipathy towards him and said to me on one occasion, “I don’t know what John’s got against me”. I liked and respected them both but, as a result, the atmosphere on the unit was not quite what it could have been. Perhaps John felt he could have run the unit better, but I don’t think he would have, as Bob was an excellent organiser. Both were destined to serve as very competent Chairmen of the Medical Staff Society.
Don was a colourful, larger than life figure, one who tended to make spontaneous decisions. On one occasion, he was picked up by a police patrol whilst speeding down the Port Road. He told the police motor cyclist that he was hurrying to an emergency at TQEH, whereas he was in fact due to attend a routine 2.00pm operating list. The obliging officer, not entirely believing Don, said he would accompany him, and set off ahead with siren blaring. He accompanied Don up to the operating theatre, where the quick witted sister-in-charge, Barbara Osborne-White, immediately recognised the problem and told the officer that indeed he was wanted urgently. A GP friend of mine, Lenny Valente, was in a similar situation on one occasion and told the officer he was hurrying to an urgent delivery. When the officer offered to accompany him he had to confess and finished up confessing to a magistrate in court!
Don was a cricket tragic. He had in his younger days opened the bowling for Sturt District side. I opened the batting playing against him in a QEH Resident’s team versus QEH Honoraries. At that stage he was well past his prime but still bowled a respectable line, length and speed.
Don Beard became very friendly with Don Bradman during his time as medical officer for SACA (SA Cricket Association) which required him to be on hand for all the test matches.
When Donald Beard eventually retired, ex-test cricketer and journalist Ashleigh Mallett offered to write Don’s life story and this offer was duly accepted.
One of Mallett’s favourite anecdotes in the book is of the day Bradman batted his last innings in the Beard’s backyard where the curator of the SA Cricket Association, Les Burdett, had laid a full-length pitch.
It was during a Test series between Australia and India, and the Bradmans and fast bowler Jeff Thomson and his wife were among guests for lunch at the Beard house.
Matthew and Alistair, the Doc’s two boys, must then have been teenagers. After lunch, the boys announced they were going outside to have a hit and invited Bradman, then about 70, to join them. And to everyone’s amazement he said, ‘Yeah I would.’ And Thommo said, ‘Well, if Bradman’s batting, I’m bowling.’
And Thommo said it was just the most amazing thing he’s ever seen. For 20 minutes Bradman belted hell out of every ball. Didn’t miss a ball. No box, no gloves, just the boys’ bat and quite lively bowling. Thommo reckons he was bowling leg breaks but his leg breaks are about Dennis Lillee’s pace, so they’re quick. He was the quickest bowler who ever lived.
Thommo said, ‘I’ve seen a lot of old footage of Bradman and I thought the editors had knocked out all the bad shots but it was just – every ball, he smashed it. It was unbelievable’.
It must have been an incredible thing to see; a bloke that age in horn-rimmed glasses and no gloves.
Don and his delightful wife Margaret were regular skiers in the Victorian ski fields. Their regular companions were George David and his wife. George was a GP anaesthetist and was Don’s regular anaesthetist in his private practice. On one occasion when they were returning from such a holiday, poor Margaret developed an acute abdomen. Don loved any sort of drama, so he examined his wife and pronounced that she needed urgent surgery and there was no better surgeon available than himself capable of performing the necessary operation. The group pulled in to the next Victorian country town and Don persuaded them to make their operating theatre available to himself as surgeon and George as his elected anaesthetist. I have no knowledge of what the diagnosis turned out to be but it was successful and, in due course a few days later, the caravan continued on their way.
Don was selected to be Surgeon-to-the-Queen on her visit in 1963 but, fortunately for her, there was no reason to operate.
He marched religiously every year on the Anzac Day, even when he was well into his 90s, and was awarded an AM for his services to the Army.
I enjoyed my year on the Magarey Unit. The work was enjoyable and I enjoyed the company of my peers and seniors. And there were moments of humour.
As mentioned previously, every third night was a ‘take’ night. The resident staff would sleep in the hospital so that we were readily accessible for emergencies. It was customary for the Senior Registrar to organise an evening operating list to deal with the acute surgical cases that had accumulated during the day. Daylight hours were taken up with normal operating lists and the operating theatre put aside for emergencies had to be shared between all the surgical specialties.
On this particular evening, if I remember correctly, I had accumulated a list of three cases: an appendix, a bowel obstruction and a fractured hip. Just as I was about to scrub up to start the list, I was rung by the casualty RMO with a surgical problem. “Have you done a rectal examination?” I enquired. I did not receive a satisfactory answer, so I said to the anaesthetist, “Hold off for a minute while I go down to casualty and sort this out.”
With that, I went to the change room and put on my white coat and hurried downstairs to the casualty department. As I hurried through the packed waiting room of the casualty department, I called out for a ‘Mr. Malenkowitz’, the name of the patient I thought I had been given.
A man promptly jumped up from his seat and I told him to follow me into a cubicle. “Would you drop your strides and jump up on the couch please,” I instructed him. The man complied, clearly impressed by my brusque manner and theatre garb. “Turn on your left side,” I next instructed and, again, he obeyed. although he looked at me quizzically over his right shoulder as I put on a glove in preparation for a rectal exam.
“Just relax and it won’t worry you,” I assured him as he visibly squirmed under the exam.
“Hmm, nothing to find here,” I commented. “What brought you into the casualty department?”
“Oh,” he said, ‘I was just waiting to pick up my son who was having his stitches removed.” All part of the service, I hope he thought.
The big event in 1968 for Sadie and me was the arrival of our third daughter Celia. I was quite happy that the third born turned out to be another daughter – the main thing was that they were all healthy and happy and, besides, I had enjoyed having three sisters in earlier years.
During my period as Senior Registrar we had shared in a program known as the Visiting Nimmo Professors. This Professorship was named in honour of Rowland Harold Nimmo who died in 1956 and bequeathed funds to the Royal Adelaide Hospital to support visits by famous medical identities for one month each year. Part of the arrangement stipulated that the Nimmo Professor would spend a week of this month at TQEH, living in a flat provided on site on the ground floor of the Connor Building.
I recall that in my third year as Senior Registrar I was called upon to host Professor Pat Forrest, later Sir Patrick Forrest, who held the Chair in Clinical Surgery in Edinburgh, during his week at TQEH. He had followed a long line of famous surgeons in this chair – James Syme, Lord Joseph Lister, and Sir Harold Stiles. Professor Forrest’s special interest was breast surgery and he inaugurated breast screening in UK. My job was to accompany him each day and facilitate his teaching program. I found him a charming Edinburgh Scot and he reminded me very much of that other charming Edinburgh Scot with whom I had worked earlier, Professor Norrie Robson (in 1974 he was also knighted). One incident sticks in my mind during that visit. He was giving sixth year medical students a tutorial on the breast and one of them asked him a question.
“I do not know the answer to that,” he said honestly, “But let me show you how to go about questions to which you don’t know the answer. It happens to me quite often. You have a library here?” he asked me.
Fortunately at TQEH we had an excellent library with all the latest journals and it was across the corridor from the tutorial room. I introduced him to the librarian and he demonstrated to the students how to track down a question.
Another famous visiting surgeon who spent a week with us was Professor Lloyd Nyhus, Head of the Department of Surgery at the University of Illinois, and another was Henry Harkins, Professor of Surgery at the John Hopkins Hospital in Baltimore. Henry was famous for his inguinal hernia repair and we arranged for him to demonstrate his technique to us on a real patient. I assisted him and was unimpressed. He flew out of town the next day. The poor patient developed the most enormous haematoma I have ever seen, followed later by a recurrence of his hernia.
This incident caused us to reflect on the wisdom of fly in, fly out surgery and two other similar cases come to mind, one very successful and one disastrous, the latter resulting in a total ban on the practice at TQEH. We eventually decided that asking surgeons to operate outside their comfort zone in foreign surroundings with scrub sisters whom they had just met for the first time, possibly with jet lag, was too much to ask and too dangerous for patients.
The most successful fly, fly out operation at TQEH would have to be on a patient of Bill Proudman and I quote from Bill’s recollection:
On one occasion I had to ask for International help. Many years before liver resections and transplants were being performed in Adelaide, I was sent a patient who was the owner of a well-established winery, with a primary cell tumour of the liver. The hepatoma was about six to seven centimetres in diameter, confined to the left lobe and with no evidence of any secondaries as shown by angiograph of his liver. It had been noticed by the patient himself. I had done no hepatic surgery, although one or two had been done in Sydney at that time. I thought this patient could afford the best, so I rang Professor GB Ong at the Queen Elizabeth Hospital in Sha Tin, Hong Kong. I had recently met him in Adelaide at the Surgical Congress of the RACS. He had been a guest speaker on the topic and had even operated on his own brother in Hong Kong! I eventually got through to him by telephone and his conversation was matter-of- fact. I told him of the patient and asked if he was interested. He said: ‘I can’t come Wednesday of this week as I have to go to court as an expert witness. On Thursday I have a meeting but I could see the patient on Friday, operate on Saturday morning and go back home on Sunday.’ I asked if he had any other requests and he said he wanted a first class air ticket to Adelaide and a bedroom in a five star hotel. I then told him I could arrange to provide the anaesthetist and my Senior and Junior Registrars would be his assistants.
I had trouble arranging his air ticket but with his Hong Kong connections he had no trouble organising it himself. I duly met GB Ong at the airport and took him to TQEH to see the patient and to introduce him to the theatre staff who would be scrubbed up with him and provide him with any particular tools he would need.
On Saturday morning we did the operation. I had invited a number of surgeons to come as onlookers and quite a few did. He was amazing to watch and, despite some trouble with the hepatic veins of the liver, he had the left lobe excised in 55 minutes from the start. He closed the wound himself.
Afterwards, in the tea room, I again discussed his fee and he said he left this to the local physician. I knew the patient was fairly wealthy and at the time the Australian dollar was worth more than the US dollar, so I settled for $US5,000. The patient had also provided a fund to take the people involved in his operation out to dinner. The next day GB Ong saw the patient and flew back to Hong Kong. He put his fee in a sinking fund he had established in his hospital for further research.
Postoperatively, the patient did well, except for a bad attack of the DT’s in which he imagined he was shooting down enemy aircraft at El Alamein. He had been in the RAAF. He lived a further twelve or so years, during which he had his gall bladder removed by me some three years after his liver operation.
The author was among the privileged who witnessed this master surgeon at work – no fuss, no wasted movements and all done inside an hour or so. It was an historic occasion not to be missed.
The second, less successful fly-in, fly-out operation, will be described later.
Entering my third and last year as a Senior Registrar I was starting to feel restless with thoughts extending to my next career move and I arrived at the conclusion that it would probably be private practice.
We had a lively group of students that year. Our students on the ward alternated between fourth years and sixth years. As senior registrar part of my job was to give weekly tutorials to students and lectures to nurses – but the sixth years wanted extra tutorials which I was quite happy to do without pay as I enjoyed the challenge. As a result I got to know that particular group quite well, led by one Trevor Pozza who later entered general practice (and became a scratch golfer!)
It was normal practice for the unit to have a small farewell gatherine for departing students. At the end of this group’s term, they invited the whole unit to a party at a sort of fraternity they lived in near the hospital on Trimmer Parade, Seaton. Fraternities are common in North America where the students organise their own accommodation as a group, in a large private residence, where they all contribute to the expenses. I had occasion, in Canada a year or so later, whilst teaching anatomy, to be invited to several of these fraternities. I believe they were developed to accommodate students when the number of students was too great to be absorbed by university colleges.
On the appointed evening, the whole unit found their way to the address – the three honoraries, two registrars and house surgeons. Refreshments were provided, including alcohol. It became clear to me there had been a conspiracy amongst these students to get their Honoraries drunk. I restrained myself but it was difficult as the drinks had been laced. I witnessed my three Honoraries becoming unsteady on their feet and their speech slurred. These were the days before there was awareness about the dangers of driving whilst affected by alcohol and, one by one, the three Honoraries were helped into the drivers’ seats of their Jaguars and sent on their way. I left later, thinking I had avoided the trap and settled myself into our trusty Austin Lancer. However, when I found myself driving under the railway over-bridge on the Port Road at Port Adelaide and then onto number 5 wharf next to the Port River, I realised I was in trouble. It was by then 2.30 am and so I tried to gather my wits and slowly drove up Grand Junction Road to Vale Park and home.
My wife, Sadie, bless her, had called the police to see if I had been involved in an accident, so the patrol cars were on the lookout for my vehicle. She had also contacted all the public hospitals!
As 1968 progressed into the second half of the year, and knowing my wish to launch into the private sphere, my good friend Trevor Pickering made approaches to Bill Proudman to see if he would be prepared to allow me to share a room in his private practice building at 94 Ward St, North Adelaide. The building had been purchased by Bill in joint partnership with John Watson, who had been a Physician Senior Registrar with him at TQEH in 1959. Bill and John shared one consulting room and there were a number sharing the second. These included Trevor, Colin Paull and a physician, Bob Burston. Adding another to share this second consulting room would make things fairly squeezy.
Nevertheless Bill, in his usual generous manner, had no hesitation in offering me the use of the room for a couple of half days each week, free of charge, so my only expenses would be secretarial costs, which I would share with Trevor and Colin. How generous of all concerned – but that was the tradition of all the staff at TQEH, helping each other.
The other event that helped me decide to enter private practice was the sudden availability of a half-time paid appointment in charge of the casualty service of TQEH. I had previously been in charge of the Croydon Hospital Casualty Department in UK, so that was a big plus in my CV when I applied for the post. Fortunately, they had no means of checking my credentials in that job. Unfortunately, my boss there had committed suicide.
Bob Magarey, my boss at the time at TQEH, was most supportive and offered to employ me as an operating assistant in his private practice. And so, towards the end of 1968, I handed in my notice after three happy years at TQEH and launched into the private sphere.
READ Chapter 14