November 17, 2010
MIN Creative Writing Exposition 2010
By: Gerlad Corcoran
It is unusual to see a US doctor extolling the virtues of
Canadian medicine! My exposure to it was over 40 years ago
and was not in any of the big cities of the Canadian provinces, but
in Argentia Newfoundland. I was stationed at the 80 bed Naval
Hospital at the US Naval Air Station, Argentia, Newfoundland.
In one of the neighboring towns was a "cottage hospital", one of
many which were located around the province of Newfoundland and
Labrador mostly in the larger outport villages. The doctor
stationed at that hospital was excellent, expert and
efficient. He practiced a style of medicine not seen for many
years elsewhere in North America. We could use some of that style
today.
The doctor, John Ross M.B., was originally from Scotland, I
think; at least he had a soft burr in his speech. He went on
to live in Australia and then did some surgical training in
London. He was the chief (and only) medical officer at the
hospital in Placentia, just outside the Main Gate of my base, and
my brief acquaintance with him was a milestone in my training and
allowed me at a young age to reach an advanced level of medical
maturity.
Shortly after my arrival to take command of the hospital on the
naval base, I was at the Officer's Club and was told by someone
that there was a Canadian doctor there from the Placentia Hospital
whom I simply HAD to meet. I assumed he would be a poorly
trained doctor stuck in this outport because he was not sharp
enough to be working in a big-city hospital. I was young
enough and cocky enough to be sure that all of the talented doctors
were over at Memorial Hospital in St. John's. He was quite
gracious, and I was pleased to hear that he had served some
mini-residencies of sorts, and apparently had the minimum training
for this posting. How much I had to learn!
He seemed anxious to show this Yank doctor what his shop was
like and, in the interest of community relations I arranged to meet
him and tour his little hospital the next week. I didn't
think it would take long as there would not be much to see.
No directions were needed to find the hospital; the town square
consisted of Sacred Heart Church, the Trading
Post, the gas station and the hospital. All other structures
were homes. There was no industry or workshops. Opposite to
the church was a two story building, the size of a New England four
bedroom colonial. Its identity was marked by a Pontiac ambulance
(recognized by the big Red Cross) that was parked outside.
I was warmly greeted although he apologized for it not being
very busy, but that did give me the opportunity to see almost
everything there. There was a clinic on the first floor with
waiting room and two exam rooms, one of which served as a trauma
room. There was also a full OR just inside the ambulance
entrance. We chatted about the commonality of our
specialties and he was very interested in the care of the
servicemen. I explained that I was doing Obstetrics and some
Pediatrics, thereby treating mostly dependents.
John treated me to a cup of delicious soup (fish-based of course
and NOT "fried in maggoty butter") and a sandwich served in the
small kitchen with the nurses and other attendants joining us, and
he invited me back the next week to assist him in a
hysterectomy. (I had asked him quite pointedly how he got
along with no assistant at his surgeries.)
When I asked him how he felt about where he was, he said he was
very happy. I could see the nurses and other personnel
treated him like a God and each one had a story about some family
member whose life had been saved by him. He wanted for
nothing. The fees were set by the government, but all the
food and bakery goods and presents left on his doorstep were not
included in the compensation. If he wanted anything (except
some time off), he had only to ask and his patients would see that
it was supplied
That visit began my real medical education. Medical School
was busy and thorough, and we learned a lot, some of which was even
pertinent to treating patients, but it was a very rudimentary
education.
I arrived slightly early a week later, not wanting to interfere
with any of the routine. I changed into scrubs and soon
thereafter John arrived. He changed, but didn't scrub, but
instead went into the OR and proceeded to induce the
anesthesia. When the machine was set to his liking and the
gases flowing through the mask, he joined me at the scrub
sinks. He explained that if this was anything longer than 30
or 40 minutes, he would have incubated the patient. The
nurse, although not certified as a nurse-anesthetist as ours was on
base, was very competent and he had trained her himself; and so we
began.
I did assist him in painting the operative area with betadine
and in arranging the drapes, but as God is my witness that was the
last thing I did to assist. John used the self-retaining retractors
and he did everything else. Oh I held a couple of Kelly's and
he was never impolite, but every time I went to get a bleeder or
expose some tissue plane, he was there ahead of me. About the
only thing you can do in the presence of such competence and skill
is to be humbled…and I was. ---not humiliated, but humbled. We
finished about 29 minutes after induction without rushing and
without incident. The patient's anesthesia was lightened for
the last five minutes and so she was able to talk to him and thank
him before we left the room
I tried to tell him how impressed I was, but he would have none
of it and said that any competent physician could do what he
did. He had some patients to see in the clinic and I stayed a
while and talked with the nurses trying to probe into this set-up
and find out how risky it really was. They didn't defend him,
but matter-of-factly told me, "No, they couldn't recall any
operative or post-operative death." "No, we haven't lost any
babies at all… No, the infection rate was non-existent. It
was clear to me that the care was excellent; as good, if not
better, than any in the "big city".
Things got very busy at the base after that, as we had to move
the Navy hospital from one side of the base to the other and that
consumed most of my time. I did see him at the club from time
to time, but then he wasn't there and I understood he had
contracted some hepatitis and went back to England for a
while. His replacement was a shadow of what John had been and
spent most of his time packing people into ambulances to travel to
St. John's.
About a month before my tour was over I learned that John was
back and true to his character, he amazed me again. As I
said, he had access to basic equipment but not to some of the
disposable set-ups that we had. If a case came in he could
make up a kit and sterilize it, but it took extra time and just
wasn't the same. So it was not unusual for our on-call doctor
to field some requests for equipment. I was on one weekend
when I learned he was back.
Friday evening a request was received for a chest tube
set. It seemed that two cousins were out duck hunting in a
dory, and the shotgun went off, hitting the patient obliquely but
causing considerable loss of tissue and a collapsed lung. John put
in the chest tube and patched him up but had to send him off to St.
John's for some extensive skin grafting.
On Saturday afternoon, we got a call that he had a baby with a
dangerously high bilirubin and would we mind loaning them an
Exchange Transfusion set. I learned later that one set of
transfusions did it and the baby was fine.
And the final touch was the call at 2 AM Sunday morning, that
they had just brought a fellow in from a car accident on the
Trans-Canada Highway with one pupil dilating and so they needed a
burr-hole set. The patient had his intracranial pressure
relieved and did fine. Obviously John Ross was back. No
other doctor could do so much so well.
So, if Canadian Medicine was populated by John Ross's ilk, the
US would do well to imitate it. At one time we did have it
all in the United States. We had a country where 75% of the
doctors were generalists, handling most complaints and referring to
specialists only when needed. Now the ratio is the reverse
with 75% of doctors specializing in some field or other, and only
25% in Primary Care.
Where is the balance? For all their dedication and
hard work, these Primary Care doctors received the lowest
recompense. But the rewards of a career in true primary care
transcend mere money. In "De Senectute" Cicero
tells us that looking back on a life well spent in "Seeking
knowledge, practicing virtue and performing right actions, brings
unspeakable comfort to the soul". That satisfaction is
priceless.
