Establishing a career: 1966
We had been away from Adelaide for four long years and things had changed. Whilst we were undoubtedly pleased to return to familiar faces and surroundings, there was much to do re-establishing ourselves – accommodation, for starters. It made sense to rent initially and we settled into a comfortable place on the Patawalonga at Glenelg. It was owned by a local chemist who went off on a world tour.
Anne, our eldest, aged two, had not had a good trip on the ship, being troubled with constant earache and eating poorly with weight loss. I lost no time in getting her to a specialist who had a good reputation when I was a student, although nearly ten years had elapsed since that time.
Eric Sims was his name and I was somewhat aghast when he promptly took a scalpel blade and incised her ear drum in his surgery. No warning, no anaesthetic, no time wasted. Well, he was a paediatrician of the old school. Needless to say, our daughter was affronted and at the age of two years and three months announced that, ‘Dottor Sims is not my dottor, Dottor May (the local GP and a classmate of mine) is my dottor.’ Well, the treatment worked and Anne recovered fully and her health was restored.
Whilst at Glenelg, we looked around for more permanent accommodation and made an offer on a nice property at Eden Hills. I paid a $500 deposit and then went shopping to the banks, chasing the balance. Somehow I misjudged my appeal, believing myself to have guaranteed employment and anticipating no trouble in being granted a mortgage. Not so; I was not able to raise the balance and was forced to withdraw my deposit. The land agent refused to pay up and so I engaged the help of a school friend cum lawyer, John Mangan, who chastened me for being so naive and foolish. A simple letter from him had my deposit in the return post.
I had approached my father to act as guarantor for me and he politely but firmly refused. Finance was tight in 1966.
We lowered our sights and eventually settled on a small spec-built house in a Brimblecombe development at Vale Park. My father-in-law, Eric Marr, bless him, persuaded one of his widow clients at Eudunda to invest $15,000 at 5% in his son-in-law. He was too polite to ask me to repay the capital when interest rates went up to 10% after three or four years and it was only when my conscience pricked me and I offered to repay the loan that he agreed it would be a good idea.
How fortunate we were. An FRCS (England) was a gateway to good jobs. A senior registrar job in a modern, recently-opened teaching hospital was exciting and exhilarating. Like all young men who suddenly feel they are at the top of their game, I couldn’t wait to get up each morning and get to work. It had been a huge risk going to England, considering that I was an average student with no money but it had luckily paid off. I would never have obtained a surgical qualification and such a wealth of experience had I not taken a chance – and I would never have attained such a good senior registrar job in the UK as the one offered at TQEH, so I fully appreciated my good fortune. The pay was enough that Sadie did not have to work.
TQEH had three general surgical units and two orthopaedic units in 1966. A senior registrar appointment was for three years, spending one year on each general surgical unit. The first surgical unit to which I was allocated was situated in Ward 4A and headed by Noel Bonnin, who specialised in Urology. His two subordinates were Bill Proudman and Colin Paull. Those three surgeons were all honorary and therefore unpaid by the hospital. This system of honorary consultants had been in existence since the hospitals were created in South Australia and persisted until 1970, when the Dunstan Labour Government changed the system so that the visiting staff were paid.
The Bonnin Unit was a good unit to start on. Noel Bonnin was a proud man from an established Adelaide Huguenot family. He was a good surgeon and Adelaide’s leading urologist. He was made head of unit by virtue of his seniority in the surgical pecking order in Adelaide and chose to leave the Royal Adelaide Hospital to join the fledgling TQEH when it opened. Although the unit was nominally a general surgical unit dealing with all types of surgery, an arrangement was made whereby the second in charge of the unit, Bill Proudman, handled all the non-urological work. The third surgeon, Colin Paull, with whom I was later to join in a private partnership, was also very experienced and highly proficient. He was a general surgeon with colorectal interests.
Bill and Colin accepted that I came to the unit as an experienced, competent surgeon and I was given a free reign to run the day to day organisation of the unit. I was fulltime in the hospital, whereas the other three spent about half their time there as they had busy private practices to run. I was trusted to run the ward, perform all the emergency surgery, arrange each of their weekly operating lists from the waiting list and ensure everything ran smoothly. I had a junior registrar who was a surgeon-in-training without a higher degree and two first year graduates as live-in house surgeons whom I was expected to train. In addition, we had some eight to ten medical students, alternating between fourth year and sixth year, who came on the twice-weekly ward rounds and to whom I gave regular tutorials. Every third night was a ‘take’ night in which each of the three units admitted emergency cases for a 24 hour period. These nights could become very hectic but I had already had nearly four years coping with such an arrangement in UK where in fact we admitted every second night rather than every third.
At that stage of the hospital evolution, the two orthopaedic units were just evolving and did not have their own registrars and so, as senior registrars, we did all the emergency orthopaedic work after hours and handed the cases over to the orthopods the next morning. Smith Peterson pins were still being done in Adelaide at that time, rather than replacing the head of femur with an Austin Moore prosthesis, a procedure at which I had become very adept in Shoreham. As a result, I was invited to assist the two orthopaedic consultants with their private operations in Adelaide’s private hospitals, usually Calvary. For this I was paid a generous assistant’s fee. I subsequently became Rod White’s regular assistant at Calvary for his private list every Friday morning. Rod was the senior orthopaedic surgeon at TQEH and approached me later to leave general surgery and join the orthopaedic fraternity. I gave this serious consideration but eventually determined that general surgery was more exciting and challenging for me, particularly abdominal surgery.
It was a most enjoyable year, slightly marred by one incident that sticks in my mind. I had done twelve months urology before leaving the UK and felt fairly confident in this area. We had done Millen’s type prostatectomies at Shoreham and very early on at TQEH, Noel gave me his BMA Journal article on his particular variation which involved doing a YV-plasty at the trigone of the bladder, supposedly to accelerate healing of the area. I had no problem with his modification and readily adapted.
The annoying incident involved a patient who arrived in Casualty one ‘take’ night with a ruptured membranous urethra, an unusual injury. I happily took the patient to theatre, stitched up the rupture with plain catgut and inserted a catheter. I was happy with the final result.
The next morning on the ward round Noel became very upset with what I had done: ‘You should have rung me straight away and I would have come in,’ he blurted out. Well, he was not renowned for getting out of his cot in the middle of the night and I certainly felt that it was not warranted. He continued: ‘Put him on the end of my list this afternoon and I will redo it.’
I was very annoyed but did as he requested. My annoyance was amplified when he took out my catgut sutures which closed the rent in the urethra and put in his own in the very same place and closed the wound. I said nothing but it was apparent to me that he wanted to put the case on his own private collection of ruptured urethras as they were hard to come by. He had embarrassed me but such is life I thought.
To complete my surgical qualifications, I was required to sit for the Australasian Surgical Fellowship and so, towards the end of 1967, I made the trip to Melbourne to face the examiners at the College in Spring Street. Having already passed the English Fellowship, I was fortunately not obliged to sit the written paper, needing only to have an examination on live patients by the College court of examiners.
With my sister Elvia as a backseat passenger, Sadie and I set off for Melbourne in our trusty second-hand Austin Lancer (once again bought from long-suffering Pat Faulkner). Unfortunately it proved to be not-so-trusty and a few kilometres out of Keith, it spluttered and stopped. A couple of passers-by stopped to help and diagnosed a faulty petrol pump. They obligingly offered to drive on to Keith and arrange for the RAA to come out which they duly did, and we eventually continued on our way.
In Melbourne, I fronted up for the exam and things were not going too well until I came to an examiner from The Queen Elizabeth, Bob Magarey, whom I helped regularly as a surgical assistant in private. The case I was given was a straight-forward gall bladder problem. Bob Magarey was well known for his ‘window’ operation, a choledochoduodenostomy which he performed on every gall bladder he took out, supposedly to avoid the problem of stones being left behind in the bile duct necessitating further surgery. It was a procedure not without its own problems and generally not accepted.
Bob put his arm around me and said to his fellow examiner, ‘Don’t be shy Ross, tell Mr So-and-so (his fellow examiner) about the window operation, I’m sure he would like to hear.’
Without this intervention I surely would have failed, an experience which befell my brother-in-law John Fisher, after he returned from England with his fellowship. Bob happened to be Chairman of the Court of Examiners, very senior in the College and I knew he would not listen to any dissent from his co-examiners. I passed, and Sadie, Ellie and I enjoyed several champagne cocktails at the College reception at The Windsor Hotel in Spring Street that evening.
Noel eventually retired in 1969 and I was fortunate enough to be appointed to the vacancy caused by his retirement in 1970. I was the last appointee to a Senior Honorary Surgical position in Adelaide, as Don Dunstan changed the system and we became ‘Visiting Staff’ in 1971. Our positions were then paid for the first time, as opposed to ‘Honorary’, which brought no remuneration.
READ Chapter 12
RG Johnson 