We landed back on the Coast in late November 1960 and spent Christmas with Joan’s parents Harry and Linda Fisher in Victoria. I had written to Adam Waldie from England and told him of my change of plans. In my absence he had several part time assistants but recently Don Rix fresh from a training year had joined him so he wasn’t sure if a third person would work. However he had just signed a contract with UBC to provide three half days a week at the Student Health Service on Campus. Also he was constantly getting requests for short term locums from other practitioners in the area to cover them for illness and holidays as this coverage was hard to come by.
So it seemed that there was lots to do so after the holidays I returned to the familiar surroundings in his West 10 h office to work with Drs. Waldie and Rix for the foreseeable future. The office was as frantic as ever. The practice had a large number of UBC staff and faculty families. The was a lot of paediatrics and obstetrics. In addition I was invited to join the newly formed Division of Family Medicine with thirty members at Vancouver General Hospital. This involved meetings and working sessions in the Outpatients. Once a month we were required to work in the Emergency for a full 24 hours. There were no such thing a specialist casualty doctors. They came much later. We were expected to deal with the non specialty cases that presented themselves. Specialty problems were usually diverted directly to the senior Residents on the particular service and consultants on call. We were left with cases in the General Practice realm where the patient often had no doctor. If they needed admission we were to do it and look after them. This added to the load of our own practices. We were also expected to serve on various hospital committees.
Joan and I found a small ground floor apartment at 8631 Montcalm Street in Marpole that we could afford. I would leave early to do hospital rounds or scrub in on surgeries followed by a packed office. When Rix left to do a pathology residency Adam and I decided that we would rotate calls and weekends. However we both often worked right through the evenings together to cope with the landslide of patients and often house calls. As on my alleged night off I would often finish my list and find people in the waiting room without appointments that Adam had told to “just come in”. The tired receptionist would whisper to me “ he wonders if you could see some of them and there are six house calls so could you do two or three on your way home“? Off with the coat. Back to work. Sorry Joan.
The bright spot to this melee was the days that I worked for half days at the UBC clinic It was housed in the Wesbrook building in the centre of the Campus. The atmosphere was friendly with a great caring staff. There was a 24 bed infirmity on the third floor primarily for students but if there was space we could admit private patients there. The outpatients clinic was on the first floor staffed by administrators, stenographers, nurses and an licences practical nurse. My UBC rugby background made the treating of the sports teams a special pleasure and interest.
The Director was a Scot named Ken Young and Frank Hebb was the other full time physician.
The winter clinic was very busy and we were not needed in the summer. The Clinic had a close relationship with the Faculty of Medicine so specialists from the big hospitals came out for weekly teaching and consulting sessions. Dermatology, orthopaedics, psychiatry, plastic surgery, all provided weekly speciality clinics from September until may. I heard later that the funding of this service was as a result of the special interest of Norman McKenzie the UBC President. If so it was funds well spent.
The winter Clinic was extremely busy averaging over one hundred visits per day. However in peak flu years it would swell to over two hundred and later when I went full time we had over three hundred with extra help called in.
After another year with Adam I had to make a decision. Baby Anne Kathleen arrived healthy in May to great joy and welcoming. We brought her home to our little Marpole apartment where she was such a delight. I would drag in from work and she often would be sitting on her moms knee in the rocker. Later when she heard the door lock click she would start to laugh and say her first word which was “da” as she looked at me coming through the door. A real mood elevator.
We put our heads together. I considered three options:
Continue with Adam in his Wild West practice
Start into a Residency for further four years of training toward a specialty
Take a salaried position full time eg: Provincial TB, VD, UBC etc.
I drew three columns on a piece of paper (which I still have- Joan never threw anything out) with these three choices heading the top of each column. We considered all advantages and disadvantages of each choice ie: future prospects, security, income, time off, etc. and chewed each one over. A partnership with Adam as far as I was concerned would gradually result in my burn out and family burn out. I could see this with Adams family. Lots could be said here but I will avoid details. Four years of a grinding series of Residency training demands with shift work and no guarantee of passing steep exams at the end, and establishing a consulting practice moved things ahead almost a decade. Daunting.
A salaried position such as the Clinic at UBC with more regular hours, reliable time off, pension plan, post grad time, etc. Regular income, no overhead, group practice with daily contact with colleagues. Dealing with bright young motivated people and a lot of sports medicine. Above all dinner with the family and reliable quality time at home.
When written out and studied number three began to look better and better. There was a chance of going full time at UBC as Dr Hebb developed a serious health problem and had to retire. A downer may have been the relatively restricted content of the of the practice without paediatrics and obstetrics with loss of skills and confidence in dealing with these areas.Also there was the relatively modest income but reliable and adequate with regular increments.
While working part time at UBC I was surprised at the amount of significant serious pathology that came through there. Besides the trauma from the sports and from the ski hills frequently I saw the onset of leukemias, early onset inflammatory bowel disease, diabetes and of course acute psychiatric problems such as schizophrenia.
I recall several incidents to illustrate an acute psychiatric situation. One miserable cold November day a student rushed into the clinic to say that there was a completely naked girl standing in the cold rain and wind in a parking lot across the street. One of our nurses, Audrey, who happened to have post graduate training in psychiatry grabbed a blanket and we rushed over to indeed find a pathetic thin girl completely naked shivering and mumbling. She initially resisted the blanket but finally allowed it. As we coaxed her slowly over to the Clinic, I gently asked her why she was doing this and she replied “ I’m a Pisces and we have to keep our skins wet." Quite delusional. Required prolonged hospitalization and treatment of her schizophrenia. This is the age when these symptoms of schizophrenia can surface.
One other evolving psychosis was in a handsome young nineteen year old whose family I happened to know. He came to see me one day saying that he was concerned that some of his professors could read his mind and he wanted them reported to the police and president.He went on to a full blown paranoid psychosis . Another young man developed the delusion that his male hormone testosterone was destroying his brain so he made several attempts at self castration by putting a tight ligature around his testicles which gave him so much pain that he abandoned it and tried to crush them with a rock!! More pain. He asked me if there was some pill or method surgically that would solve his problem.
There was plenty to test diagnostic skills in spite of the attitude of some community physicians that it was a modified first age station. Of course there were lots of sniffles and coughs but there are a lot of those in community practices too.
Subsequent discussions at UBC were encouraging. The entry salary was recognized, at least on paper, to be below the the level from community practice and they were bound by their salary scales for all departments. As a leveller however, as with others in the faculties of medicine and dentistry,I would be allowed to be listed as being employed four fifths time with one fifth permitted outside practice.As it turned out there were sessional half day contracts to medically supervise selected nursing homes which dove tailed with the UBC arrangement. This was certainly an attractive situation as at this employment level at the Clinic I would still be eligible for all of the fringe benefits. The outside practice which would supplement my income would bring the whole package to an attractive level. It also kept me dealing with heart failure and many complicated medical issues.
In the middle of our deliberations and planning we welcomed with great joy our second daughter baby Alison Joan a beautiful healthy wonderful addition to our family, a sister for Anne. In the interval between babies we recognized that we needed to improve our housing arrangement and Joan began a detailed search of possible housing. She accumulated a scrap book with listings and we travelled around the west side viewing various places and fantasizing. Details are in my previous story. Suffice to say we found a beautiful old colonial place where we lived happily for 57 years. Our little girls had a home.
On September 3 rd I started at UBC as a four fifths time physician. Right then our son Craig made his welcome and very happy appearance. A truly wonderful little boy adored by everyone. So we had three under age three. Joan reasoned that if she was going to stay home for one that she might as well complete the desired family group so it came to pass. Busy times with help and support from Joan’s parents, my mother and my sister Jean.
Work at UBC began with a bang. Besides the students we looked after all campus emergencies. I spent the first hour sewing up a construction Forman’s head after he was hit by a power shovel. No hard hat ! On top of the out patient clinic the Physical Education Faculty required medical review of all of the University rep teams so this required trips around campus. There was extra help brought in for these.
Just before my arrival a new Director was appointed. Dr. Archie Johnson was a specialist in Internal Medicine. He was in private practice for many years at a large poly clinic in downtown Vancouver. Besides some clinic work he provided liaison with the University and downtown hospitals. The Clinic had a part time psychiatrist whose position was very quickly expanded to a full time position and later two Residents in Psychiatry were added from the teaching program. The Clinic had a full time x- ray technician as well as a full time lab technician.Two radiologists visited several times a week to review films. The clinic worked closely with the Counselling centre and there was close liaison with the Deans and heads of various University departments. The Clinic continued to expand to accommodate increasing demand for services especially with the continued increase in the number of students.
I was fortunate in having the opportunity to spend several months in some big name Ivy League American Universities that had well developed Clinics and Sports Medicine programs.Chief among these were Harvard, Princeton and Yale.I made some great contacts and came back with some good ideas for our clinic.
In the later years our load was somewhat lightened by the formation of the high profile Sports Medicine Clinic and the Family Practice Clinics on Campus. One specialist in Sports Medicine split his time between between our Clinic and theirs so there was good liaison between the two.There was a busy travel and immunization program which was very busy.
The 1960’s were a decade of unrest in Society generally . The Hippy era, LSD, “ free love” and the birth control pill all vibrated through Universities. Burn the brassieres, drench with pungent “musk” oil, bathe infrequently was often the behaviour. The Vietnam war raged as the decade progressed and we became aware of young American students avoiding the draft appearing on Campus where they could find a bed and use facilities including showers in the gyms and relatively cheap meals. Some affiliated with their home fraternities here. We even had them camping on Wreck Beach and in the woods. Some presented themselves, as university students , to the Clinic for care which we did free of charge.
Some interactions were memorable. One busy day one of our nurses informed me that there was a very young American couple had presented themselves for help and maybe I should see them next. In the examination room a pale thin girl was laying in fetal position with a anxious pacing young man with a sweater on that read HARVARD in big letters. I introduced myself and tried to initiate a conversation with her .Silence. Suddenly she looked up, glared and screamed “ get out of here you f******g capitalist pig ! “. Not a good start. It turned out that he had received his draft notice and decided to make a run for it. His girlfriend age 17 living with her parents climbed out of her window and took off with him to Canada. She regretted her decision and became withdrawn and complained of feeling unwell. When I went out in the corridor Archie was standing there and I said “ do you know what I am ? I’m a f*******g capitalist pig”
?
He grinned and replied “ Charlie you’re no capitalist”. We managed to sort things out with the help of the counselling service and the American Embassy.
I worked contentedly in the UBC student clinic from 1963 until 1990 and had numerous adventures and interactions with the students. In 1980 the new UBC hospital was completed and we were invited to move our unit into this new facility . We had misgivings as we would lose our little invaluable infirmity . However we were told that we would have first call on twenty beds for priority student admissions. So we sat down and drew sketches of possible floor plans for the allotted space on the ground floor ideal with the new emergency next door and radiology and lab nearby. We said goodbye to the Wesbrook building which was eagerly sought by microbiology and some research units. All went well. We were the first clinical unit in the hospital. When meeting with the new Director of the hospital he said he had never heard of protected beds for students.They would be hospitalized in line along with the general public with their same criteria. Our Wesbrook infirmity was wonderful as we could quietly admit students sick in the Residences into this small unit with some motherly care. Severe mononucleosis was good example.This facility was missed.
In the first year of our occupancy the new hospital Emergency opened. The problem was that there was a shortage of medical staff to put in it. Casualty offers were still a decade away. So we were asked if we would provide temporary coverage when our Clinic was open. The first morning that they opened their door an elderly man who had fallen in his bathroom and cut his head was brought in for treatment. I assessed him and sutured his laceration- the first sutures inserted in the new hospital !
I never regretted my choice of careers. The UBC work was busy and rewarding in many ways. I was with my family and near the kids growing up. I was usually home on weekends except for the occasional acute problem or a significantly ill student in the Infirmary to be monitored. Sometimes there were memorable situations. There was an International conference of mathematicians meeting on Campus .President Walter Gage phoned one Sunday and asked me to attend to an ill Russian participant in one of the university residences.
He was a pathetic sight in bed huddled under a blanket . He spoke no English. Standing on each side of his bed were two big men in suits, one spoke English . Trying to assess the situation was challenging. I would ask a question, the English speaker would then address the patient and then there would be a prolonged exchange between all three in Russian. Then the translator would turn to me, often with a one word answer- usually “Nyet” or no (eg:no pain).
This went on for some time. I couldn’t make head nor tail out of the story. I examined him as best I could and found nothing. The next day I heard that he was on a plane back to Russia and that he had been trying to defect. The two “ attendants” were KGB “ supervisors”. All rumour but plausible.
The hippy era presented us with unique problems.LSD, marijuana, on top the usual alcohol scene created all sorts of challenges. Timothy Leery was the high priest of the drop out culture. The mantra of “ don’t trust anyone over age 30” was reflected in all sorts of behaviours that made the delivery of medical care to them problematic at times.Parents were sometimes confused and directed their anger toward the University and its agencies blaming it for “allowing” the counter culture and behaviours that had enveloped their kids.
The Clinic kept expanding staff and programmes. Psychiatric services evolved with the appointment of a full time consultant, several part time and two Residents in psychiatry.
It was said that the UBC student health and medical services were the best in Canada at that time and we had visitors from similar facilities to review are set up. During the FLQ crisis I Quebec two young medics from Quebec presented themselves for a tour. Remarkable was that they both were bearded and dressed like Che Gueuvera the Revolutionary. I knew that they both spoke English but only spoke French between themselves in front of us. The revolution on display.
The other memorable Campus visit was from the American counter culture guy Gerry Rubin. We were forewarned and briefed on his techniques for creating general Campus havoc.We were advised that he would invade the Campus in noisy procession and cause a group disturbance similar to a mini riot in front of some building or facility. In our case the target was the Faculty Club at the end of Main Mall.
We had meetings and made counter plans. Rubin’s usual plan was to get the Police involved by creating a disturbance and then have one of his supporters phone the police reporting a riot .When the police arrived there would be a tussle and hidden containers of chicken blood would be splashed around followed by screams of police brutality.
The planners asked the Police to ignore all riot phone calls except from President Walter Gage. When the riot fizzled they decided to “invade” the Faculty Club which was a private facility. The staff welcomed them in, offered them coffee( the alcohol had been hidden) and invited them for lunch. There was an ornamental pool at the back with large plate glass windows around the big busy lunch room over looking it. One of the counter culture bearded specimens stripped off his clothes and in full display climbed into the pool. The diners ignored him. When he climbed out the manager offered him a towel.
So Rubin and his revolutionaries slunk away off the Campus. No riot. No reaction at all by the community. In spite of the onlooking students participating, many of them laughed at them. Canadians were so dull. I heard that the revolutionaries went back across the border probably in disgust. There was not a single injury.
I retired from the UBC clinic in 1990 after 30 plus years, part time then “ full” time ( four fifths). I continued with my three nursing home contracts of two sessions a week and filled in occasionally back at the Clinic for illness or holidays.This left me with more time off and in the early 1990’s allowed some limited travel with Joan who was having some health issues.