Graduating with an MD in 1958, interning at Vancouver General Hospital in 1958-59, and completing a Resident year at Shaughnessy Hospital in 1960-61 I entered general practice with Dr. Adam Waldie on West 10th ave where I stayed for a year. The practice was very busy with a lot of long office hours, obstetrics, surgical assists and house calls.
I had harboured an idea to go into the specialty of Internal Medicine which would require a further four years of residency and a rough set of exams to be become a Fellow of the Royal College of Physicians of Canada (FRCP). The idea was attractive but daunting. Joan and I had married in June 1959 and we were living in a small apartment. She was working as a public health nurse. After a lot of deliberation we decided to spend a year in a completely different location and try and get some perspective on where we were going and what the outside medical world looked like.
Teaching during my post VGH year at Shaughnessy had been rather variable in quantity and quality. There were some excellent focused committed physicians who gave a lot to the Resident group, especially in some of the sub specialities. However there was another group of General Internists, the speciality that I was considering who seemed to be less than motivated by their profession and transmitted this in conversation and teaching. They generally were running marginal private office consulting services and filled in their time by doing paid sessional work at various hospitals and clinics to make ends meet. They were what I would describe as being down in the dumps about their situations. As far as I could tell they were doing a form of General Practice without paediatrics and obstetrics. But lots of Geriatrics and Company medical services. So I have to admit that I was a bit turned off.
So away we went to England. I had arranged through a local dealer to buy a Canadian equipped Morris Minor car to be picked up in Oxford for our use there to be shipped back to B.C. on our return. I was armed with letters of introduction from my professors who had important contacts on the British Isles and were guaranteed to steer me in the right direction for further studies. We visited the Liverpool relatives. Joan’s Uncle Tom Pierce was a retired Liverpool bobby and told me stories of the blitz. Joans Aunt Edith was seriously ill with cancer and died six months later.
One interesting side story about our Liverpool area visit. Joan wanted to get her hair done and “tinted” so after searching around she found a hair dresser in down town Liverpool and made an appointment. Off we went in the Morris through the long Mersey tunnel from the small village of Heswall where we were staying and found the place. I waited in the car and read. Later I looked up and saw a brunette lady walking along who looked vaguely familiar. She got in the car. The tinting job resulted in dark hair rather than the expected blonde. I said nothing!! Joan’s uncle had suggested that we might enjoy going to hear a band that was creating interest and was playing in a night club called the “Cavern”. It turned out that it was a few doors from the hair dressers. Neither of us were interested in “that kind of music." It was the Beatles. Opportunity missed !!
We went down to London and through the Commonwealth Medical Association, who were very helpful, we moved into a north London second floor “ bed sitter”in a ancient row house in Hornsey on the northern tube line. Our landlord and his wife, the Bishops, were pleasant enough. The room was dark and dank and smelled strongly of curry. The previous occupants were from India. The only heat was from an electric heater with two small glowing elements which at full power distributed heat outwards about two feet. We immediately adopted the practice of wearing our heavy sweaters when there. There was an enormous old cast iron bath tub in a closet sized bathroom. “Hot” water was provided by a coin operated water heating device on the wall above the tub called a geyser- pronounce “geezer” by the Bishops. On inserting a shilling it would rumble and belch and finally produce a tiny stream of lukewarm water which fell into the stone cold bath tub producing a cloud of steam. Cold. Joan took to bathing with her sweater on!
Armed with my letter of introduction to Prof McMichael the head honcho of the Hammersmith
Post Graduate Centre I made an appointment and went to see him. He turned out to be an unhelpful grumpy older guy who couldn’t get rid of me fast enough. Not interested in qualifications or letters. Referred me to a program in Edgware Hospital in North London under a Dr. Sowry. Oh well, I registered there and along with a dozen other post grad visiting docs began a series of clinics and classes. The teaching was done mainly by senior registrars - like our fourth year residents. Some were excellent. We had the opportunity, on our own, to attend lectures and demonstrations at other major and famous teaching hospitals in central London like the paediatric centre Great Ormand Street, and Queens Square neurological hospital.
At Edgware II was the only Canadian. Other students were mainly from India, Ceylon (later Sri
Lanka) and one from Kuwait the recently evolving oil producing nation in the Middle East . He was the son of a Sheik and his family were in the high echelon of the rulers of that country. He qualified there and was sent to London to obtain an MRCP, the Holy Grail degree in Internal Medicine and tough to accomplish if you were from out of the country. He arrived with a contingent of servants and a house was provided in the classy expensive St. John’s Wood area. His lordly attitude didn’t go down well with the Brits but they felt that they had to accommodate him maybe for political reasons. He would pull up to the front door in a chauffeur driven Bentley and be handed his stethoscope and then stride in like he owned the place. I thought I could hear the collective grinding of teeth from the inside staff.
I found this situation a bit humourus. Understand that the most desired positions for doctors in the National Health Service was to be appointed to a consultant position at a hospital paid a retainer of £ 2000 year, a lot of money in 1960. There was a limited amount of these positions in every area and much sought after. So the hospitals were mainly run by Registrars who had obtained their MRCPs and they were literally waiting for dead man’s shoes. The Consultants had outside practices at Harley street etc. and dropped into “ their” hospital for rounds once a week. They rolled up to the front door in their high end cars. The rest of the staff entered by side or back entrances. On rounds to the wards the Consultant led followed a pace behind by the senior Registrar on the right and the head nurse (the Sister) on the left. Strung out behind were the junior Registrars, the medical students, the visiting docs (me) and finally trailing along GP’s from the community by invitation. There was always only one or two of these, usually from Europe. Not much interest. They were ignored.
One of the outpatient clinics that our group sat in on was dermatology conducted by a famous doctor named Professor M who had authored many books. Our group of eight or nine would file in and be seated on hard benches in the waiting room with the patients. On signal we would file in and stand agains the wall while a patient was presented by the Registrar. No chair was provided for the patient unless they were handicapped or feeble. They stood in front of the Great Man like felons in front of the Magistrate for sentencing. There was a procession of very interesting cases from all over the world and we saw some fascinating stuff. Mid-morning we would be ushered back out to the waiting room to the benches while his Majesty, the Registrar and Sister Ogre would be served tea. We then re enter the clinic room as before. Of our group I was not only the only Canadian, I was the only white guy. As the weeks went by I noticed that the group was dwindling steadily. By the last clinic day standing alone as tea time arrived I turned to return to the waiting room. Suddenly the great man called to me and said “ doctor will you join us for tea." I felt as though I had been knighted. We had a pleasant relaxed visit. He said “so doctor, you are from Canada” which I acknowledged.He asked a lot of questions about BC. Then he leaned closer and said “what do you think of those black bastards” referring to my missing group mates. I was completely taken aback. I concluded that the other members of the group had sensed his racism and disdain and dropped out. It went right over my head. Lesson learned.
So the weeks dragged by. I came to know one of the dead mans shoes Registrars named
Dr. P waiting endlessly for the coveted NHS consultants post. He was a very pleasant guy in his thirties and expressed a keen interest in B.C. He admitted that he was thinking of emigrating so gave him all the information that I could and he reciprocated on the inside dope on the British training situation. I mentioned that I had seen a list of Residencies in the British Medical Journal for training positions at the top teaching hospitals and wondered if I should apply. He quietly pointed out that those were unofficially taken years in advance within the old boy inner system from the top medical schools there and there would virtually no chance of me receiving one. By law they had to advertise them. The best I could hope for would be an NHS “dogs body” spot in a peripheral hospital in exchange for casualty officer shifts in their casualty department intermingled with marginal teaching. The system was plugged from young docs from all over the world intent on getting the golden degree with virtually no hope of even being able to qualify to sit the exams. Slow hissing sound as the air leaked out of my aspirational balloon !!
However it was not all bleak. London was fascinating. We spent many weekends in the incredible British Museum. There were plays and live shows in the Hay Market, Festival Hall. We watched the buskers in Leister Square.The Imperial War Museum was particularly interesting. We met other Commonwealth students and had meals and entertainment in Soho with them. Mr Bishop our landlord was a retired fire captain and arranged a day at the National fire college at Dorking south of London. We used the car to tour all around England and Scotland. The maple leaf emblems on our lapels and car meant that we were well received everywhere once it was established we were not Americans. Stayed at a bed and breakfast in Aberdeen with a Mrs Urquhart who was in Medicine Hat and had a baby in the same hospital at the same time that I was born. She came home to Scotland in 1939 to visit her parents and got caught by the declaration of war and couldn’t get back. What a coincidence.
In the summer we took off for the Continent in the little car and had a great time. In Paris we stayed in a quaint (read run down) hotel in Rue Monmartre near the Louvre and a short distance from the Follies. It was said to be a billet for German soldiers during the war. On Saturday mornings before daylight a farmers market set up right on the street where we could buy any sort of produce. By 10 o’clock it was gone. We found a little cafe right around the corner- Le Cafe de Bonne Amis run by Corsicans who spoke no English. I had to communicate with rudimentary French and sign language with lots of hilarity. Joan was too shy to try any French. They took us under their gastronomic wing and in the morning after our croissant and coffee they would ask us what we would like for dinner which usually resulted as the chubby little proprietor would mime a chicken, a goose, a swimming fish etc. dancing around cackling or honking or mooing. It was only 15 years after the war and the vast tourist industry had not hit its pace so maybe we were a novelty from Canada especially. When we left there was a fond good by and he gave us a bottle of his special wine .
We took off from Paris and headed south using bed and breakfasts and modestly priced hotels. In Limoges we went to the wonderful world famous China museum which somehow survived the war. We ended up in the Dordogne valley where then tourists were unknown then. At one village the village, called Paderac I think, the local asked if her class could try out their English on us and it was really fun. There was a small stream running through the village and there were women washing clothes in it thumping them with rocks. The wine was unbelievable and when I asked if they exported it they looked shocked and replied that they drank it all!! I didn’t blame them. Same with the cheese. Since it was all local and not pasteurized and considering the frequency of bovine TB and brucellosis I was leery.
We had a wonderful day visiting the prehistoric painted Lasceaux caves only discovered in 1943. Memorable. Later closed to the public as visitors breath moisture was promoting mould growth starting to destroy paintings. They built an exact replica for the public.
Heading for Italy through the St. Gothard pass in the Dolomites and made our way to Milan. it was very interesting. Unfortunately La Scala opera house was closed for renovations. Lots of other sights. The Rome Olympics were on and we thought we would stop at Venice on our way to Rome. However we were advised against Rome as being very crowded with no accommodation etc We found out later that this was not true with lots of room .We turned around after visiting Venice and headed north again. Venice was fascinating. We walked to the top of St. Marks which smelled like a giant toilet from people peeing at every turn of the climbing ramps.We watched wonderful band concerts in St. Marks Square. Our Hotel Gorhiza was comfortable enough but later we calculated that baby Anne was started there. So lucky place.
There were many other stops back into France and then into Germany where we had the best food and accommodation of the whole trip. In Munich we went to the Reich’s Museum where the displays were exceptional but had no war content. I had read about the famous Hofbrau House the beer garden where Hitler tried his coup in the early 1920s and resulted in jail where he wrote Mein Kampf the Nazi manifesto. It was bombed flat but rebuilt as an exact replica.There was an oompa band with lots of lederhosen and hard looking middle aged guys with empty pant legs and sleeves from the war. The bok beer was served in heavy litre steins with big handles. The servers were huge women who strode around carrying these multiple heavy vessels. We ordered one each. Big mistake. Joan sipped a little of the nearly black stuff so I enjoyed the atmosphere and eventually downed both. I recall that on leaving I couldn’t get my legs to work very well.
The next day we went to dinner and when the food was put in front of Joan she suddenly jumped up and made a bee line for the ladies room. She was suddenly nauseated. BABY ANNE HAD ANNOUNCED HER PRESENCE.
So through Germany, stops at Vienna, into the Netherlands (lots there). Joan left a trail of nibbled cream crackers on the road which controlled her nausea fairly well. She didn’t complain but I knew she wasn’t feeling great. So back to London.
During the fall in London we had to reconsider our situation. Money was limited so we had to have a source of income which meant my doing an NHS locus in a casualty in the boonies. Joan took herself off to a local outpatients clinic and had an interesting experience. She was processed on registering with a rather surly older nurse who put her in an inner clinic waiting room and told her to take off all her clothes. There were a couple of other completely naked women sitting there.There was no gown provided so she sat with her sweater around her shoulders. In the examining room the doctor motioned her to get up on the table where with a word he examined her and was about to leave. So finally she said “am I?”
"Are you what?" he asked.
"Pregnant" she said.
"Yes" he said and walked out. At the door the nurse handed her a pill box labelled “THE PILL with the instruction “ Take one daily." It was apparently a mix of iron and ? Vitamins.
Not a very positive experience. Later we found out that deliveries were done at home with a local midwife or in ancient nursing homes. Complications were attended to by a “Flying Squad” that would transport the woman to a local Casualty.
When relating this experience later we were told that the NHS was under increasing pressure from people from other countries who were appearing in Britain and using the Service with the costs to the tax payer. Maybe this was partly the cause for Joan’s reception but we weren’t exactly from a completely foreign country what with Joan’s trace of a Liverpool accent and my Commonwealth origins whose made a major contribution to WWll success. Who knows.
So if we remained in Britain we would be cloistered in a small smelly apartment facing the cold winter with Joan alone while I was working and at the end of her pregnancy in may a delivery set up that we didn’t feel to good about. No family supports. We made our decision. Home before Christmas. I attended a last eight weeks of teaching clinics and we completed our exploration of London. We experienced Guy Fawkes day and in November were on the plane for home.
End of Part One