The Vasectomy Doctor

by Dr. Andrew Rynne

You have stolen away my young heart from the banks of the Lee.

  This short singing tour was otherwise a great success. The folk clubs paid generously so I came home a lot better off than when I left. In time Christy started to include all the songs that I gave him into his repertoire. In fact two of them are on the very successful Prosperous album and Christy generously acknowledges this on the record sleeve. The Prosperous record, recorded in the basement of this house here, was the precursor and catchiest for the group Planxty. Any time that he sings any of ‘my songs’ Christy in fairness to him always acknowledges their source.

  * * *

  The second last summer before my final year at Surgeons I spent in Naas Hospital under the guidance of county surgeon Jack Gibson. Jack was famous as a hypnotist and would sometimes attempt to operate on people using only hypnosis and no anaesthesia. I have to say that this did not impress me one little bit. I believe in the powers of suggestion and therefore in the curative potential of hypnosis which, at the end of the day, is really only a strong form of suggestion. But to extend this potential to blocking out the pain of surgery would require an exceptionally skilled therapist working with an exceptionally suggestible patient. Jack Gibson may not have had this skill because some of the patients that I saw being operated on and who were supposedly ‘under hypnosis’ were in fact wide-awake and suffering.

  When I’d come home from working in Naas Hospital in the evenings my brother would complain that I washed my hands like a doctor and worse still I smelled like a doctor. I am not sure what washing one’s hands like a doctor means but the reason I smelled like a doctor was because even then they were still using ether as an anaesthetic in Naas. Sometimes I’d be called upon to administer the ether drop by drop onto a gauze held over the patient’s mouth and nose. Ether was and indeed still is a very safe and effective general anaesthetic. One of the minor problems about using it is that it stinks the whole place out and that the person administering it also cannot avoid inhaling some of the stuff and reeking of it afterwards. But there are worse smells than ether.

  The final year is spent living in hospitals, the so-called ‘residency year’. First I am billeted in the Rotunda Maternity Hospital and later in the Richmond Hospital, both institutions being on the northside of Dublin. Obstetrics, at least in theory, is an easy and logical subject. It is also an extremely hazardous one where there are always two people’s lives, health and well-being at risk. The word obstetrics comes from the Latin ob, to stand by or to stare, which is very interesting given that modern obstetrics is the exact antithesis of that and is all about interfering and intervening. For example the Caesarean section rate in most maternity hospitals nowadays would be about twenty per cent, the induction rate would be similar at around twenty per cent while the episiotomies and forceps delivery rate might be as high as forty per cent. In effect nowadays most women entering a maternity hospital to give birth can expect some intervention or other. Totally natural birth in a maternity hospital is the exception rather than the rule. If a woman wants to be assured that there will be no unnecessary meddling while she gives birth then the only way is to arrange for a home birth, a practice frowned upon by maternity hospitals who do not like the notion of any competition. This is a controversy in which I was to become embroiled later in life.

  There is a saying in obstetrics with respect to childbirth that all medical students should ‘see one, do one and teach one’ and that is more or less what we did. In practice in those days competent, if not very sympathetic, midwifery nurses conducted most deliveries and we students were only in the way most of the time. But we did need some hands-on experience and all of us would have ‘delivered’ at least one baby during our ‘midder’ stint. This for the most part meant controlling the baby’s head as it emerged through the vulva and then lifting the baby out and cutting and tying the umbilical cord – not much to it really provided of course that there were no complications.

  We sat around in the tea-room all day smoking cigarettes or in my case a pipe, playing poker and waiting for the alarm bell to go. The alarm bell signalled that a complicated delivery was imminent and that we needed to go at once to the delivery ward to see what was going on. Complications in the main were multiple or twin births; mal-presentation, as for example a breech delivery where the baby comes out bum first; and prolapsed cord, which is a very dangerous situation for the baby. In any of these situations the consultant obstetrician would often exhibit life-saving skills and the whole justification for their existence became quite obvious.

  There was a man in our class by the name of Jimmy Martin. Jimmy was a self-made man in that before he could enter medical school he had to do the leaving certificate as an adult by attending night classes, while during the day he ran a small supermarket on Lower Rathmines Road. His dream and one ambition was to become a doctor and he would often say things like: ‘Just imagine lads, in two years’ time we will all be doctors and earning good money and we will be out on the golf course twice a week and leading the good life.’

  I do not know where poor Jimmy got his false vision of what doctoring is all about but he died only a few years after qualifying – perhaps from disappointment and disillusionment. But he was an amusing and droll Dub. When my turn came to deliver my first baby Jimmy was at the looking-on stage. After the delivery he and I went across the road to Mooney’s for a pint where student and obstetricians alike were wont to frequent. As we sipped our pints of Guinness Jimmy said to me: ‘Jasus, Andy I loved the way you delivered that baby. I particularly like the way you caught it as it flew by.’ This of course was a rather irreverent reference to the fact that many of the women delivering babies in the Rotunda in those days were ‘gran-multips’ meaning in plain English that they had given birth to five or more babies already. As such then their deliveries were often, thought not always of course, quick and uncomplicated affairs where the baby arrived without the need of even minimal intervention.

  After three months’ residency in obstetrics it was off to the Richmond Hospital to gain some in-house experience in medicine and surgery. Here we slept in dormitories divided into rather primitive cubicles and we drank around the corner in Church Street if I was not otherwise engaged with music or ballads. In this place too we played poker deep into the night – five cards and seven cards ‘stud poker’ where the stakes were high and the incidence of bluffing even higher. Bringing girlfriends into this sanctuary was allowed but not encouraged. One night my girlfriend and I stole the bed of a colleague who was on night duty. As a precaution against interruption we pushed a wardrobe across the door, which was at the bottom of the bed. Sometime in the middle of the night my colleague came off duty and not unreasonably went looking for his bed back. In pushing his way into the cubical he pushed the wardrobe right on top of us and then proceeded to climb over the back of it in order to communicate his desire to retrieve his bed. So there we all were, girlfriend and I on the bottom, the wardrobe on top of us and finally my displaced colleague on top of that and he giving out yards.

  Final exams were taken in two phases. At Christmas during the fifth and final medical year we did our so-called ‘smalls’, which consisted of paediatrics, psychiatry, ophthalmology and ear nose and throat surgery. The following June we took our medical, surgical, obstetrical and gynaecological practical and written examinations. I passed the lot of them first attempt, not with any particular distinction it must be said but a pass is a pass and with something approaching ease I became a doctor at long last.

  Graduation day is one that no doctor ever forgets. It’s been such a long, long haul. Two years trying to get through pre-med were followed by five intensive years first of anatomy and physiology and then pathology and pharmacology and finally paediatrics, obstetrics, gynaecology, medicine and surgery. Throughout most of these years I consider myself extremely lucky to have been able to find some paid work through singing and playing the tin-whistle. Not only did the money come in very handy but also the diversion away from medical sch
ool was therapeutic and afforded a better-balanced view of things. Graduation is at least the end of the beginning. On this happy day you recite the Hippocratic oath and collect your certificates upstairs in the elegant banquet hall. Afterwards we all had planned to get drunk in Rice’s pub down the street. We met there all right but after three or four pints the notion of actually getting drunk did not appeal and we dispersed happily.

  Now is the time for some serious decision-making. Six weeks before graduation Ann and I marry in the church in Haddington Road. There is a child on the way. There are serious times ahead for all of us and nothing had better go wrong.

  CHAPTER 7

  Canada

  After graduation from medical school one has a number of critical choices to make, all of which will have life-long consequences. Like most of my colleagues I had more or less made up my mind what way I was going to go long before I graduated. First of all there is the question of internship. One year working in a teaching hospital is mandatory for all medical graduates before they are fully registered as doctors. Before that, registration is only provisional or temporary. So the first question is, where will you do your internship year, in Ireland or abroad? The next question is what do you want to do after internship? Do you want to become a general practitioner or some kind of hospital consultant? If you want to become a consultant you need to start lining yourself in one particular direction, if a general practitioner, in a different direction.

  I found these decisions very easy to reach. Quite frankly I had had enough of medical school and lectures and ward rounds and exams and autopsies and living from hand to mouth and borrowing money and being a burden on my poor parents. I was twenty-six years of age, newly married to Ann Hughes and our first child was on its way. I wanted to do general practice and Canada was full of opportunities in this regard, offering rotating internships specifically designed for that discipline. Everything medical in Ireland was a struggle in the late 1960s. There were too many doctors and competition for places in practice or in training was fierce. And in any case there is a long history in Irish medicine of doctors going abroad for a few years before settling back home. Travelling broadens the mind they say and going to Canada for internship and a few years general practice may have been among the best decisions of my life although at first it may not have seemed that way.

  Hamilton, Ontario, where we were to spend the next year of our lives cooped up in a hospital apartment is, or certainly was, a singularly uninspiring polluted industrial city, nestled, if that is the right word, on the shores of Lake Ontario. If you were stupid enough, as we were, to go sunbathing in Hamilton you ended up covered in tiny iron filings. You wouldn’t get a tan at all; it would be more like a sheen. Brendan Behan is accredited with saying of Hamilton, Ontario: ‘I could not be blasphemous enough about that place.’ This outburst is thought to have been inspired by Brendan’s failure to locate any kind of alcoholic beverage in the city on a Sunday when he arrived there, a bitter disappointment that we were to share with Behan on our arrival in that God-forsaken place.

  Canada, or certainly Ontario, had the most restrictive drinking laws at that time. There were no pubs at all, none whatsoever. If you had to drink, and certainly there was very little encouragement for you to do so, then you had to go to a licensed government-run ‘beer store’ to get beer or cider or lager or drinks of that kind. If you wanted spirits like whiskey or gin or vodka or if you wanted wine, you had to go to another government-run ‘liquor store’. These two kinds of controlled outlets were never in one and the same place, nor for that matter were they ever even remotely adjacent to each other. They closed all day Sunday so the Sabbath was strictly observed. You had to sign a form saying how much alcohol you had purchased and everything was made as unpleasant and as difficult as possible for you to get a few drinks for your fridge. It was all a big deal and a guilt-ridden operation.

  Here we were, two young people, graduates of one of the liveliest pub cultures in the world and suddenly we find ourselves in this Canadian industrial wasteland. No pubs, no singing, no music, no craic. But help was to be at hand. There were other Irish in town and there had been other Irish in town for generations and they, just like we were feeling now, had missed the good social life of back home. Under the inspiration and leadership of one Pat Cassidy and one John Roach in 1952 they formed the Irish Canadian Club up on the escarpment overlooking the city. I can honestly say that it was this Irish Canadian Club that, more than anything else, eased our way into life in Canada and helped us retain some degree of sanity and balance. Normally I would steer clear of my countrymen when abroad. For example if in Madrid or Rome or Boston I would not dream of going into an ‘Irish pub’ but would rather give them a wide berth. But this was different and we were hungry for something approaching normality and Irishness.

  Every Friday night this place would come alive with songs and dance and music and general craic. We made some great friends with fellow musicians and singers like Chris and Peggy Jones, Raymond Reynolds and Loo Crowe from Dublin, and Tommy and Nelly Curran from Carlow. While the majority of club members were southern Irish Catholics with their Canadian husbands or wives, there were a small but significant number of northerners there too, though of what persuasion we never knew nor asked nor did it seem to matter one iota. Whether nationalist or unionist they all pitched in and contributed to the general enjoyment of the place. We sang and played Irish and Canadian folk songs and music, Nova Scotia and Newfoundland being the source for most of the Canadian stuff. Peggy sang:

  Fare well to Nova Scotia

  The sea bound coast.

  Let your mountains dark and dreary be.

  For when I’m far away

  On the briny ocean tossed

  Would you ever heave a sigh or a wish for me?

  Most Canadian folk songs have a nautical twist to them while most of their music has an unmistakable Irish or Scottish feel to it.

  Hamilton, with its population of some half a million people, had large communities of various nationalities including an Italian-speaking district, a Polish-speaking district and a German-only region. Each of these regions would have had ethnic markets selling foods germane to the country in question. But the overall feel and ethos of the city was WASP or White Anglo-Saxon Protestant whose seriously boring and killjoy attitudes seem to hold sway; hence no drink available anywhere on Sundays. Down in the interns’ lounge we had a soft drinks machine converted into a bottled beer dispenser and so we were able to beat the system to some small extent.

  There were two linked hospitals – Hamilton General Hospital where we lived beside the Stelco steelworks and where the air was pretty foul, and the Nora Henderson Hospital up on the mountain where the air was fresher and a bit cooler. I chose a rotating internship with two months each in paediatrics, surgery, medicine, ears nose and throat, obstetrics and finally accident and emergency where drunken Indians plagued us all night long. These hospitals were affiliated to McMaster University faculty of medicine, the first medical school in the world to recognise general practice as a specialty in its own right. There was a lot of serendipity in all of this but as it happens the teaching was good and the orientation towards my chosen field of general practice could hardly have been better.

  That autumn of 1968 our son Lorcan was born. Life takes on a more serious hue and things are never quite the same again. Because I must carry on my responsibilities as an intern I am somehow torn between the worries associated with new parenthood and those of career. I have a sense of unhappiness emanating from my wife Ann who I think now feels somewhat trapped and discontented. These feelings of ours may be the very beginnings of a marital disharmony that would eventually engulf us. Travelling up to the Nora Henderson Hospital in my open-topped, yellow MGB a song is playing on the radio with the words ‘Such are the dreams of the everyday housewife’. I do not know what in fact were supposed to be the dreams of the everyday housewife. But it was the whole concept of her being described as everyday that I
found very depressing and this somehow found resonance in my worrying marriage. I do not think that either of us was really ready for the permanent roles we were now going to have to play.

  * * *

  Winter is setting in and we are all a bit homesick. There are twenty-two of us interns, twenty men and only two women which even for that time was a disproportionate gender mix. Today the women would outnumber the men two to one. This is a diverse group of young doctors from all over the world with David Lintern and I being the only Dublin graduates in the place. David bought a black and white TV and after one week brought it back to the shop complaining that there were too many advertisements on it and that he no longer wanted it. And the strangest thing was the shop gave him a full refund with no quibbles. His wife Margaret was a great source of comfort and strength to Ann when Lorcan was born.

  Downstairs in the interns’ lounge was a big board with notices of all sorts pinned on to it. Most of these were to do with vacancies for doctors needed to work in hospitals or in general practice. At any given time there would be fifteen or twenty such notices pinned onto this although as the intern year started to draw to a close the number of notices started to increase. During my last month of internship there were at least six ‘general practices for sale’ posted up on this board. It really was just a question of where you wanted to go, city or country, small town or big town. The world was at our feet. The further from a major centre you chose, the cheaper the practice was to buy. One in particular caught my eye: Dr Jim Town with a growing practice in a place called Mitchell, Ontario wanted out and was giving the practice away for a nominal charge to cover instruments and equipment. I phoned Dr Town, told him I might be interested and arranged to meet him.

  There was a certain method to this madness of choosing to go into the boondocks to take on a general practice when equally I could have chosen a nice university city like Toronto up the road or even nicer still, London, Ontario, 200 miles down the road, or Stratford, Ontario, just ten miles from Mitchell. In any of these places we would have had theatres, cinemas, good restaurants and so on. But I deliberately chose some place less attractive because I did not want to get caught, I did not want to get sucked into a system that might have made it difficult or nearly impossible to pull up roots and come back to Ireland after four or five years. For that was our aim and on that we kept focused.