The Vasectomy Doctor (14 page)

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 house
wife'. 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.

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 al
ways a learning experience and I could never understand 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.