Many doctors, now as then, leave Ireland for ‘a few years’ with the genuine expectation and plan of returning home after five years or so. But some never come home and end up spending the rest of their lives in exile in the UK, in America or Canada. We knew dozens of Irish doctors like that and I always thought there was something very sad about them and we were determined that this was not going to happen to us. What would happen is that they would set themselves up in practice in some fairly smart location, start making decent money, build a swimming pool and a tennis court and start living the so-called ‘good life’. The next thing their children start going to school and making their own friends and before they know it the prospect of returning home to Ireland and starting all over again simply does not appeal. This is human but it is also sad.
Maybe I am reading this all wrong but when I heard doctors like that say how wonderful their lives in self-imposed exile were and what a good ‘choice’ they thought they had made and how happy the children were and so and so forth like that, I always felt that they were deluding themselves and were in denial. I found their attitudes to be more defensive than sincere and expressed with hidden sadness. Because at the end of the day the song is right, there is no place like home and there is no place like the country you were born and reared in, whatever its inadequacies may be. But perhaps not everyone shares that feeling as strongly as I do. Be that as it may we were quite determined not to make things too cushy for ourselves so taking up roots again would be no real hardship.
We chose well. In those days Mitchell, Ontario was sleepy, drab and dreary. With its population of some 2,000 souls this place just sat there with one road going into it and one road going out of it. All on the flat, some aspects of this little town, with its many wooden facades, bore some resemblance to a studio set for a Hollywood western. At any moment now the doors of the Grand Hotel will burst open and there will be a shoot-out between the good guys and the baddies.
There were no fewer than eight churches in Mitchell, each with its own small congregation. These were: First Lutheran Church, Free Reform Church, Grace Lutheran Church, Jehovah’s Witnesses Kingdom Hall, Knox Presbyterian Church, St Vincent de Paul Catholic Church, Trinity Anglican Church and United Church. That’s a lot of churches for a community of 2,000 people which I think speaks for itself. This is almost ‘Bible Belt’ stuff. Mitchell, like practically all small rural farming communities right across Ontario was populated largely by ‘good God-fearing people’. The problem for us was that they were too good and too God-fearing for our taste. But there was no going back now and we would just have to see if we could root out some people with a bit of go and a bit of spice to them, not afraid to have a drink or to sing a song or play a tune or to curse a little or tell a dodgy story. Or in other words we were looking for real people, fallible, venial and slightly profane people. We needed to avoid serious Church-going teetotallers if we were to survive in these backwaters.
Another problem with living in such remoteness was that very many people in this area were not well-travelled and not well-read and seemed to have little interest in or knowledge of the greater world beyond their own boundaries. Good debate or intelligent discussion was therefore very hard to find. Of course one has to appreciate that these people were in the main second- and third-generation descendants from the original settlers. That if you like was their culture and as such was interesting in itself. But it took an awfully long time for it to sink into my head that ‘culture’ is not just about music and language and so on. Descendents from settlers also have a story to tell and a culture to be respected.
The winters were long and hard. It started to snow sometime in October and there was snow on the ground every day from then on through to mid-April or so. In the evenings most people stayed at home and watched ice hockey or curling on their TVs. The roads were kept passable most of the time through a system of routine snowploughing, salting and gritting. During particularly bad blizzards things might get out of control and there would be a few days every winter when roads became impassable and everything closed down. At times like these snow-machines or ‘Skidoos’ became the only mode of transport.
One such blizzard occurred in the early winter of 1972. At around midnight I received a phone call to tell me that there was a woman in labour at a farm outside of Monkton, about ten miles away. I was also advised that the local snowmobile club was on its way to pick me up and take me out there. This is a journey that will stay with me to the end of my days. I am in a caboose or sleigh hitched to the back of this very strong snowmobile holding onto my doctor’s bag and peering out from time to time to see how we are going. I can only marvel at the bravery of these two men, one guiding us and the other towing me along. Our speed is perhaps fifteen miles an hour. The temperature is thirty degrees below. We are heading into a frozen abyss. Nothing makes sense and the full moon gives us light. Only the tips of the telephone posts and some telephone cable give us a clue as to where the roads might be twelve feet below us. This is unreal.
Eventually and by some miracle we arrive at this farmhouse to be greeted by a very relieved farmer. Upstairs I find his wife in the throes of labour. The baby’s head is crowning and all is well. Like the good obstetrician that I am I stand idly by and do nothing other than mumble a few words of encouragement and allow nature to take its course. In a few minutes a fine baby boy is born and I cut the umbilical cord and deliver the placenta. Downstairs the men drink tea. I deliver the glad tidings from the bedroom upstairs and ask for a whiskey. There is none in the house. These people are after all ‘good and God-fearing’ and have no use for alcohol.
* * *
Men have just landed on the moon and it is a large general practice that I have inherited from my colleague, Jim Town, and it grows larger by the day. But I am young, enthusiastic and energetic. By the time I am ready to leave Mitchell and return home to Ireland for good this practice will have grown to twice its original size and number about 5,000 people. That in today’s terms is a very large single-handed general practice. Age-wise it is an ‘old’ practice with the majority of patients being over fifty years of age. There are young women and their babies too, of course, but Mitchell is not the kind of place that would attract a lot of new residents, so the age profile of the practice was of necessity older. There is only one other doctor in town, Dr Prithem, and he is in his seventies and does no house calls or after-hours work. To my shame I never met Dr Prithem nor shook his hand. There was a chiropractor in town as well and he did a roaring trade. The competition for patients was, if you like, non-existent. I was seeing up to seventy patients per day, which was a huge workload. All patient visits were paid for by a state insurance scheme on a fee per item of service basis. There was no private practice as such. The fee was commensurate with the service given. You got paid so much for a consultation, so much for suturing a laceration, so much for carrying out a pap smear, syringing ears or setting a fracture. Practice was varied, interesting and very lucrative.
Mornings were spent at the local hospitals where all general practitioners had admitting rights and were expected to visit and care for their own patients, only seeking specialist consultation where necessary. We also delivered our own patients’ babies, assisted at surgery and performed minor surgical procedures like tonsillectomies and vasectomies. At first I used a hospital in a place called Seaford, ten miles north-west of Mitchell, but there was a lot of squabbling going on there between the GPs and the one consultant surgeon who happened to be Nigerian. The arguments and disagreements were ostensibly to do with who should or could do what surgical procedure but I suspected that there was a good deal of racist overtones as well. I soon tired of this unpleasantness and switched my allegiance to a bigger and much better place – Stratford general hospital about ten miles south-east of Mitchell. Here they had several consultants in all the major surgical and medical fields and the atmosphere was convivial and pleasant. Hospital practice was always a learning experience and I could never unders
tand why GPs in Ireland are excluded from hospital practice and why they so meekly put up with the situation. When I returned to Ireland I greatly missed a hospital dimension to general practice but could raise no support among my colleagues for any changes to the status quo.
* * *
I did my first ten vasectomies in Seaford Hospital with the patient under general anaesthetic and GP Dr Paul Brady showing me what to do as best he could. You could never teach someone how to do a vasectomy other than if the patient is asleep. Imagine the anxiety you would cause a man if you tried to teach someone how to do a vasectomy on him while he was awake and listening to you tell your student to cut this and inject that. I know some of my colleagues disagree with me on this point but I believe that there’s a limit as to what can and cannot be taught using a live and awake person as teaching material and that limit is surely vasectomy.
I say Paul Brady was doing his best to show me how to do a vasectomy because at the end of the day the operation is an entirely tactile one. It is all about feel and touch and not about seeing as is usually the case in surgery. If right-handed you retract the testicle gently with your right hand and gently palpate the contents of the spermatic cord with your left thumb below and your index and middle finger above. You know you have found the vas by the feel of it. Gray’s Anatomy describes it as feeling like a ‘whip cord’ but since very few of us these days know what a whip cord is, never mind what it feels like, Gray’s description is not much good to us. I describe it as feeling like, and being about the size of, a very under-cooked piece of spaghetti. But there is no mistaking it. You either have it or you have not got it. It is never a maybe. Once you can routinely and quickly isolate the vas and anchor it between thumb below and index and middle finger above then you can do a vasectomy because the rest is relatively easy.
It took me about fifty vasectomies before I was confident enough to be able to carry on doing them without needing someone at hand to step in for me should I get into difficulty. Before I returned from Canada to Ireland I had done about one hundred vasectomies, all under local anaesthetic. I did vasectomies in Canada for the same reason that I did tonsillectomies – GP were expected to be able to do that kind of thing there. I had absolutely no idea at the time that vasectomy was to play such a major role in my life when I returned to Ireland a few years later. It simply did not occur to me that one day I might be the first Irish doctor to perform a vasectomy in Ireland.
To support a practice of the size that I had in Mitchell required that I employ two full-time secretaries and a full-time nurse. I had five inter-connecting examining-rooms and the nurse would always be one room ahead of me preparing a patient for examination or giving a vaccination or weighing a patient or taking their blood pressure or undressing a baby and generally smoothing the way for me so that my time with the patient could be focused and as brief as possible. My nurse, Anne Rowland, made life so much easier for both patient and doctor. We worked well as a team.
One day old Ned Horan came in to see me. Ned had Parkinson’s disease and was generally bothered and hard of hearing. ‘Ned, please take your shirt off and hang it in this closet here and I will be back to see you in a few minutes,’ I said in my usual breezy way pointing out the closet to him and off I go to see another patient while Ned is getting ready.
After about ten minutes I go back to the room where I thought I had left Ned Horan and there is no sign of him. ‘Where in the name of God has Ned taken himself to?’ I ask myself, worried that he has wandered off into another examining-room and caused no end of consternation and embarrassment. Then I spotted it. Down at the bottom of the closet there is the toe of a boot sticking out. My next thought is that he has gone and hung himself – stranger things have happened in doctors’ surgeries (or offices as we called them in Canada). I rushed over to the closet and flung the door open and there is poor old Ned Horan and he holding on to the coat hook at the back of the press for his dear life.
‘What in the name of Jesus are you doing in there, Ned and will you come out of that at once?’ I said to him more relieved than cross.
His answer was a classic: ‘I’m doing the best I can doctor,’ says he, implying that it was my fault that he was in there in the first place. When I asked Ned to hang his shirt in the closet he, being as deaf as a post, thought that I had asked him to hang onto the coat hook himself at the back of the closet and, thinking this to be some kind of new treatment as it were, he complied and in his own words did the best he could. Isn’t it quite extraordinary what people used to do if a doctor advised it? I will tell you one thing, that day is long gone and maybe it’s just as well.
* * *
I had been in Mitchell for about six months when suddenly and out of the blue the authorities approached me and asked if I would take on the duties of county coroner. This was considered at the time to be something of a ‘plum job’ carrying as it did some status and authority and indeed not a little excitement. It didn’t take me long to accept the offer with enthusiasm and they gave me a book to read and some preliminary instructions on how to conduct a coroner’s court and when to hold inquests and so on. The only downside as I saw it at the time was that I was required to swear an oath of allegiance to the queen of England as part of the initiation process to becoming a coroner to Perth County. This kind of oath-taking stuck in the craw somewhat but sure who would ever know and what the hell, I didn’t mean one word of it and I did want to become a coroner.
I was busy enough at it too. What with seeing sixty to seventy patients in the afternoons in the office, visiting patients in hospital and assisting at surgery in the mornings, making house calls and being on call seven days a week, now on top of all that I was on call to the police at any moment, day or night, to visit the scene of a fatal accident, shooting, stabbing, murder or suicide. And suicides there were a plenty. In rural Ontario during the long cold winters farmers developed what was then referred to as ‘cabin fever’, a usually mildly depressive illness that we now call seasonal affective disorder or SAD syndrome. And they killed themselves, usually out in their barns either by hanging or shooting themselves. They typically shot themselves by placing the muzzle of a twelve-bore shotgun into their mouths and discharging the gun by using a length of binding-twine tied to their big toe and the trigger. When you were at a scene like this you would see brain tissue and fragments of skull embedded into the barn roof twenty feet above the unfortunate victim. These poor men must have led lives of quiet desperation. It was all so sad really. What is in the mind of a man who does this to himself?
And then there was the time that all the hot water ran out in an apartment block in Stratford. When the janitor went to investigate the cause of this he made a grim discovery in one of the basement flats. A young man lay face down in a full bath of water with the hot tap still running, now cold of course. He had been there for five days, a rope of ‘soap on a rope’ was wrapped around his neck, the soap itself long dissolved and gone. I ordered a post mortem because the whole thing looked so odd. This revealed a fractured skull with subsequent brain haemorrhage and damage. What appeared to have happened was that the young man, a known alcoholic, had slipped backwards and struck the back of his head off the taps and that was his undoing. I will never forget the smell in that bathroom.
There were road traffic accidents too, of course. These in the main were brutal, careless and horrendous carnages that will stay with me for all time. The worst of these, and they were all bad, actually happened in the village of Mitchell one Saturday evening. Drag-racing was all the rage at the time. To drag-race, two very powerful or souped-up cars line up at a given line and rev their engines up to maximum revolutions per second. On a given signal the drivers then let the clutch in and the cars take off like a rocket down a straight line. Whoever crosses the line first, 500 yards down the road, is the winner. Drag-racing is strictly for mindless morons. On a properly laid out circuit it is not too dangerous. But when a few young men attempt a bit of drag-racing down the main
street of a village on a busy Saturday afternoon then you might expect some trouble. When the same young men are all fired up on booze and drugs then trouble is inevitable.
They used the traffic lights at the top of the street as a signal to start the drag-race. Things were going well enough until one of the cars lost control, mounted the pavement and ploughed into the innocent Saturday evening shoppers. Five people were killed instantly including the driver and his back-seat passenger, a young fellow called Beatles Bailey who I knew as a patient of mine with a drug problem. The three dead on the street included a young woman and her boyfriend. Her entire leg and buttock had been ripped clean away from her body by the impact and when I arrived on the scene seconds after the accident I could only look helplessly on as she rapidly exsanguinated from this massive wound and died in my arms. Her heart and brain were looking for blood but there was none. It was all out on the pavement in front of me and I could not put it back nor staunch its flow.
Afterwards I ordered an inquest into this wanton waste of young human life and the jury recommended a greater police presence to deter illegal drag-racing and greater fines and punishments for those caught so breaking the law. I have no idea if these recommendations were ever implemented. Coroner’s courts then, as now, had minimal influence on society and human behaviour. A coroner’s mission statement in Canada at that time was ‘we speak for the dead to protect the living’. And while I understood that fully and indeed felt honoured to have been entrusted with such an onerous task, I remain sceptical as to how well this system works. Perhaps the best that can be said is that at least we tried.
The Vasectomy Doctor Page 11
