December 11, 2018 – Andrew Seal, MD, FRCSC

Dr. Seal is Associate Professor Emeritus of Surgery at UBC. He graduated from Guy’s Hospital Medical School in London, England in 1969. In 1979 he completed his general surgery residency at UBC and obtained his Fellowship in the Royal College of Physicians and Surgeons of Canada.

From 1980 to 1981 Dr. Seal was a Visiting Scientist at the Centre for Ulcer Research and Education in Los Angeles. In July 1981 he returned to Vancouver and joined the Department of Surgery at UBC as a member of the active staff at the Health Sciences Centre Hospital on the UBC campus. He was appointed Associate Dean of Student Affairs in the Faculty of Medicine from 1994 to 1999 and on completion of his term became a visiting scholar at St. Catharine’s College at Cambridge. He returned to UBC in 2000 and became a member of the Division of General Surgery at St Paul’s Hospital in 2003. The Andrew Seal Award in Arts & Humanities in Medicine was established in his honour.

Transcription

Thank you so much Hugh, for the kind introduction. It’s a real privilege to be here with you today and here’s a slide which, this is a very slide heavy talk, so if you can’t see the screen, I would recommend that you move to an area where you can, because I think you’d enjoy it much more if you can actually see the screen. So, if you’re going to move, that’s fine, let me just say a few introductory comments while you’re moving.

You know, the number of people in this audience are colleagues and friends of mine and I’m just thrilled that they’re here. But of course, I don’t know many of you and you know about me from the newsletter. In fact, the newsletter, when I saw a copy of it, was quite prominent in my history. So, you all know me, but I don’t really know many of you. On the other hand, I know that we have so much in common because how many of you are grandparents? Well, there we are. So, you know, we have so much in common. Here are my two grandchildren, they are the light of my life and really that’s what it’s all about now, and I’m sure you share that feeling.

We also have other things in common. The other thing we have in common, we live in the most wonderful part of the world and although it’s raining today, and that never bothers me because I know when the sun comes out, we are just enthralled by where we live. And these are some pictures I took just a week ago. If you remember we had a wonderful few days of sunshine and I was up, took some photographs down in Vanier Park and in Granville Island at False Creek, and it’s a treat on a morning like we had last week to enjoy where we live. And the other thing of course we have in common is that we’re all still here *laughter* and in fact we are here today at the Planetarium. I show this picture because I share a special kinship with the Planetarium, it was where my wife went into labour with our first, our daughter, so every time I come into this building, I remember that day back in 1976. But I want to talk to you about how I got here and my journey, because I think all of you will relate to the fact that we’ve all had amazing journeys to reach where we are today, and we’ve had many influences, people who’ve taught us, people who have advised us, mentored us… And so that’s going to be a bit of a theme as I as I talk today, which I think you will relate to, I know because we all come from different areas, but you all have had backgrounds where people have done things that changed your lives.

Now this talk, as you know, it was introduced with this title “Ars longa, vita brevis”. So, my question is first of all, how many of you can, not the medical people in the audience might be, this is the non-medical people can tell me where this quote might have come from. Anybody? Well, I walk past it every day for four years when I was at school, going to the art school at Harrow. I walked past this plinth that described the building I was painting in, and yes, we did where frock coats on a Sunday, although they don’t anymore, I’m pleased to say. So, Ars longa, vita brevis was on the plinth outside the art school. In fact, it should have been Vita brevis, ars longa, that’s what the quote should be, and it wasn’t until sometime later when I started to have an interest in history of medicine, that I discovered that in fact, it’s written by Hippocrates and it’s the first aphorism of Hippocrates. When you’re a medical student, 2,000 years ago, over the next 2,000 years, you had to learn the aphorisms of Hippocrates, and his first aphorism is Vita brevis, ars longa – life is short, art is long, opportunity fugitive, experience delusive, judgment difficult. So that was the first aphorism of Hippocrates and whenever I give this talk to students, I always like to say that, and particularly to this group today, that the Vita is becoming ever more brittle *laughter*.

The actual statue, and you have a picture there, I took the photograph when I went to the island Kos in Greece which is where Hippocrates was born, where he taught students, and he would have studied himself here at the Asclepeions on Kos, which is the health temple to Asclepius, the god of medicine, who was the son of Apollon and in fact, the Hippocratic Oath which we all recite at the start of our practice, begins “I swear by Apollon, the Healer, by Asclepius, Hygeia, and Panacea who are supporters of Asclepius, and by all the gods and goddesses to keep this Earth to the best of my ability.” So that’s the Hippocratic oath. And I’m going to tell you now about my journey through medicine and how it is associated with the history, with art, and the people who taught me as I continued in my career. I went to Guy’s Hospital, that was my medical school in London, not when this illustration was there *laughter* This is the colonnade at Guy’s, anybody here been here to Guy’s out of Interest? So I walked down the colonnade every day for the six years, and just to the left there, the colonnade is a sort of the little part recess and there’s an alcove that was brought to Guy’s from London Bridge, the old London Bridge when it was destroyed but rebuilt in 1831, and this piece was brought from the bridge and I used to pass it every day. And when I went back for our reunion in 2009, it was our 40th class reunion, which means of course next year is our 50th Anniversary class reunion, which I’m looking forward to. But, I sat in that Alcove with two of my dear friends, and one of the important things about life is the friends you make, and you continue, and they were both medical school classmates of mine, Lawrence (name not audible), some of you may know as a surgeon in New Westminster and John (name not audible) who’s an anesthesiologist in Guildford and Surrey, and we’re sitting next to the bronze of John Keats.

Now John Keats, I discovered on my first day of going to Guy’s for my interview, was a Guy’s Hospital medical student, and in fact, as I walked in to the school, the first bust I saw was of John Keats, and I’d been studying him at school so, you know, I really felt this was clearly the place I needed to be. What I discovered when we went in 2007, and I didn’t realize this, that the statue was commissioned to commemorate the life of Dr. Robert Knight. Now, Bob Knight taught us, he trained us, he was a wonderful teacher, and he taught us very much in the Hippocratic tradition, you know medical students today that they have a completely different education. You know, our education was about the patient, examining the patient, taking a good history, the patient, the doctor, and the disease, which is what Hippocrates described. Today, it’s so different. We didn’t have CT scans, we didn’t have ultrasounds, it was very much about the art of medicine much more. And of course, today, it’s much more about the science of medicine. And Bob Knight was one of our teachers and it’s nice for me to recognize the importance he had in our careers, on all of us. This is the old operating theatre at Guy’s in the museum at Guy’s, which I never actually worked in, but you can see this is part of the tradition of the hospital.

So, after I graduated in ’69, I went to see the ship’s doctor which was fun on the SS Acadia, which is known affectionately by the crews as 44,000 tons of lust, thrust, and lust *laughter*. We set off from there to Vancouver, my first visit to Vancouver was in 1970, when we sail up to Alaska for the first Alaskan cruises. It was wonderful summer, it was my introduction to the West Coast. Now, at that time I didn’t know I’d be coming to live here, but I was with P & O for a year and then I went back and taught anatomy at Guy’s for a while, and then I used to do a summary of cruising for the for the full-time surgeons, and in the summer of ’75… So, this is me in when I first went to sea and then in ’75 I look much more like the real thing if *laughter*. Here’s Glacier Bay and I went ashore on the trip, had an interview with (inaudible), who’s a program director of general surgery here in Vancouver, and they were able to offer me a position to come here as a general surgical resident. I started in September of ’75 and moved to Canada, emigrated, and the rest is history as they say. I married my wife the year before and we came here, then our first child was born the following year.

My training as a resident here in Vancouver was really superb. I had wonderful teachers and some of them are here today I’m pleased to say. Here are some of the teachers who taught me some of the important members of the surgical community here in Vancouver that will be familiar to many of you, certainly to the medical people in the audience, Eddy Mackenzie, Hugh Ford, Levasse whose research fellow that I was, Ralph Christensen, Wally Chung, who was the head of surgery at UBC when I worked there, Ted Robins, Henry Little and Ken Atkinson of St. Paul’s, a colleague who is here today from St. Paul’s. All great teachers and they taught me to be the surgeon I became, and you know, it’s important to recognize the shoulders on whom you stand. Now, at the end of my residency, after training in ’79, as a chief resident we were invited to give a round on a subject of our own choosing. And so I decided to choose something that interested me, and I’m just going to ask you a little question here and see how many of you can answer this question again, not the medical people, but suppose one of your family members you brought to the emergency department, a young family member who had abdominal pain that had been going on for 24 hours, it was located in their right lower abdomen, was tender to touch in the certain area near in the lower abdomen, and they were nauseated and vomited up a little bit, anybody think that they might know the diagnosis would be?

You shouted it out, which is wonderful, and those are the non-medical people I assume. It’s interested to me because it took 5,000 years to get to the point where you could make a diagnosis on the basis of just a few questions and a simple examination, took 5,000 years to get to that point. So, it interested me, what was the history of appendicitis? And that was the subject I chose for my talk for grad rounds in 1979. And it took me in a whole world of history, history of medicine, history of surgery, and it’s been with me for the rest of my professional life. And when I talk to students, I say how much my life has been enriched by studying the history of my profession. In the bottom there, there is a picture of the library at UBC. We have a wonderful history of medicine collection at UBC in the Memorial Library and I spent many, many hours in the spring of 1979 looking at material, going to the original sources, and so on. And I gave my talk, and it was suggested at the end of my talk that I should write it up as a paper because it was interesting to so many people. So I actually then wrote the paper and submitted it to the Canadian Journal of surgery and I got a very nice letter back from the editor, Rob Mclean at the time, who thanked me for submitting, but he said, “you know, if you want to publish it we need to have the illustrations of people you’re talking about in your paper.” Now if you want to use an illustration in an article, you have to get permission from the owner of the illustration to publish it, and what I really wanted to be sure was in my paper was an image of the first drawing that I could find of the appendix. The problem is the owner that drawing was the Queen, Her Majesty the Queen *laughter*.

So, I wrote to her majesty because I wanted to use the illustration that was drawn by the artist of this painting, anybody know the artist, DaVinci. It is a wonderful painting in the National Gallery in London the painting. Ever since I first saw it, and I particularly enjoyed, I noticed that, and I love projecting this, it’s this beautiful portrait from the painting of DaVinci that I think is one of the most sublime portraits in art, but that’s a personal feeling. Anyway, I wrote the to the Queen because I want to use DaVinci’s drawing of the appendix and I got a very nice letter back, you can see she doesn’t actually pay for her stamps which was interesting *laughter* and it came from the Royal Library at Windsor Castle and they said “dear, Mr. Seal,” of course surgeons in England are Mr. not Dr, “thank you for expressing interest in the appendix,” And then I had a form from the Chamberlain that asked me to sign to say that if I’ve ever was going to publish the illustration or talk about it, I would acknowledge that the Queen that was the owner of it. So, I’m happy to do that now. Thank you, my majesty, *laughter*. Now this actually is DaVinci’s drawing of the appendix, and it’s really a drawing of the whole the gastrointestinal tract and the appendix at the bottom right hand corner. You can see there was not published, but it was drawn by DaVinci. Although the actual drawings never were published. They became into the ownership of the royal family in the 1600s and have stayed in Windsor Castle in the library since then. And so there it is on the front of my paper, which I published and together with the story of the history of appendicitis, which are not going to go to in detail today. But if you’re interested, I can have it sort of sent around as an attachment to the club. It’s a Wonderful story.

So after I finished my residency, got my fellowship and then spent a research year away in Los Angeles with (inaudlibe) who was my mentor as a student, as a resident, who is now working in Los Angeles as a surgeon and it was a wonderful year away in my fellowship year, and he was a tremendous mentor to me and seen here with my two kids, again emphasizing how important mentorship is. And his mentor in fact was a great physiologist, Morton Grossman, you can see here, would be known to Hugh of course and other guest gastroenterologists here. And this was a painting I did – a portrait I did of Morton Grossman the year I was in Los Angeles he died, and I presented this to the organization is in their library there. It’s one of the first portraits I’ve actually done.

I then came to start my career, my practice in Vancouver at the Health Sciences Centre Hospital on campus, which at that time was an independent hospital. I suspect many of you in the audience would be familiar with the hospital, maybe even been there as patients. Wonderful hospital, wonderful colleagues I had there for many years and it was a real privilege to work out on campus. The logo for Health Sciences at the hospital… I actually did a painting of that which if ever you were in the hospital in the basement, if you ever have an MRI, it’s right by the MRI scanner. And as Hugh said, my interest during my practice was in inflammatory bowel disease and helping people with colitis and Crohn’s disease, terrible, terrible, terrible diseases for people to cope with. Particularly young people, but at any age, and one of my colleagues that I work with, Ken Atkinson, who sadly died last year, but he and I and a group of the from the hospital and from VGH, George Bowlby (?) put on this program, where we were able to do this reconstructive procedure to be able to save people having to have an ileostomy, if they had to have one for the rest of their lives. And I’m not going to go into the details of the surgery, but an important part of my professional life was the management of inflammatory bowel diseases, you heard, but as a contrast to that I also had another interesting area which sort of fell in my lap in a way that, Ross Davidson who was the Canucks’ doctor at the time, an orthopedic surgeon on campus.

We started to see patients, being hockey players, with this strange groin problem. We then discovered to be this condition, which we described as the sports hernia, as you may have heard of people with sports hernias. And we had all sorts of hockey players in the NHL come to visit us at the hospital over a number of years, which was as I say, quite a contrast in my management of inflammatory bowel disease. It got me a few tickets *laughter* I even had Shaq come and visit me one day from Los Angeles, which was quite an event. He arrived in the dead of winter, 7’2″, and he walked into the clinic wearing a full-length fur coat. It was like seeing the yeti walking in. *laughter* So this is in the ’90s and it was such an important part of my life, ulcers were my clinical work and my work with patients as was with students and all the things that we did with students whether it was teaching, mentoring them and you can see students here in my house, practicing at the house. And this is a group of students in Prince George, they went to talk about the history of surgery, and so my period of time as the Associate Dean was a such a special time in my life and special treat for me to see my dear friend Bruce Finning here who has followed me as Associate Dean for student affairs at UBC.

Teaching a history of medicine and surgery was something I thought was important, because the students didn’t really get much history at all. And for me, it was at enriching part of my life, and I have quite a big collection of books, which I’ve accumulated over the years which I’ve taken to show the students and as Hugh said, a lot of these illustrations tell us so much about the history of the profession, the important moments in history that can be expressed in art, and for example, here’s William Harvey explaining the circulation of the blood of King Charles. The first this is such an important painting here, the first use of ether anesthesia in Massachusetts General Hospital in 1846 that’s transformed surgery for patients. And this character here Joseph Lister who introduced the whole concept of sterility and sterile procedures, so with the combination of anesthesia and sterile procedures, transformed surgery in the 1800’s to what it is today.

So, it’s not surprising that at the end of my term as Associate Dean, I had a sabbatical which and I chose, as you heard, to go to Cambridge and I had a wonderful year as a visiting scholar at Saint Catharine’s college. And again, talking about mentorship and people that make an important part of one’s life, in this illustration here in the garden of the Masters College, this is Sir Terence English who was the Master of St. Catharine’s, and he was my first teacher in anatomy in 1964 at Guy’s when he was a young man from South Africa who came to play rugby at Guy’s, but also to teach. And so, I was able to reconnect with him. This is now in the year 1999 as the Master of St. Catharine’s, and next to him is Bill Heal. And Bill was my mentor as a medical student and then became a very close friend, and his contribution to the history of surgery has been so important in the management of colorectal cancer, which has transformed the treatment of colorectal cancer worldwide. Here we are with our delightful, lovely wives, both of whom are from Guy’s Nurses, and Bill was at Guy’s, I was at Guy’s the nurses were at Guy’s and the rest is history. There was something in the air at Guy’s *laughter*.

While I was at Cambridge, the privilege for me was that I can choose where I wanted to go. Do lectures and meetings and something that caught my eye was this talk on the maps of Leonardo da Vinci. And I didn’t really know that DaVinci was a cartographer. But in fact, as I discovered in the talk, what DaVinci would do is he would go to towns and he would walk through the streets, and then he would end up doing a drawing as if it was an aerial photograph, most remarkable images of these towns in Italy as you can see here, he would map out of the streets by walking through them. Amazing. So, at the end of the talk, I introduced myself to Martin Clayton and said that I was visiting scholar from Canada, I was a surgeon, and I much enjoyed it, and he said, “oh, you know, we have DaVinci’s anatomical drawings at Windsor, you might be interested in coming to see them.” And I said, “well, that’s fantastic, I would love to do that.” And so, he then sent me this formal invitation, I had to fill out another form for MI5, saying that I wasn’t going to do anything naughty when I was at Windsor Castle.

And so, it was that we found ourselves, my wife and I, in February of 2000 at Windsor Castle. You were escorted through the Henry VI Gate, into the inner sanctum and found ourselves brought to the Royal Library, which of course is not a public library, and you can’t go into the library at Windsor. So, it was a very special moment for me. It was just my wife, myself, and Martin Clayton who was the keeper of the library. And he brought me all of DaVinci’s anatomical drawings in boxes, and for the next two and three hours, I sat there, one by one, with my white gloves on of course, taking out all of DaVinci’s drawings. It was a wonderful moment of my life and these drawings are just spectacular. You may or may not be familiar with them, but they are remarkable pieces of art that relate to medicine of course. And suddenly, I was holding the drawing that I had asked the Majesty if I could use in my paper. This is now 20 years later. So, it was just one of those moments in one’s life that I’ll never forget. Even now talking about it, I get chills in my spine, there I was holding this drawing, DaVinci on the paper, the one that I’d used in my talk. And then after I had spent some time at the library, we toured Windsor Castle, and I was able to thank her Majesty for her generosity *laughter*.

So, let’s go back to the paper again because the other thing in the paper that meant so much to my studies of the history of appendicitis, was in fact that the drawing of the DaVinci’s was not the first drawing of the appendix and in fact, the first published drawing was this one down here, which was actually by Andreas Vesalius, it was published in 1543. Vesalius is such an important person in the history of medicine and the history of surgery. He was professor/teacher in the University of Padua, and he published this amazing book in 1543 and have an absolutely superb copy of this at UBC Library. This is the frontispiece of this book called De Humani Corporis Fabrica Libri Septem on structure of the human body and seven books and this is one of the great woodcuts of the 16th century showing Vesalius dissecting in the center of the anatomy theatre in Padua. And the drawings in this book are just remarkable to see, because for the first time the human figure was being reproduced anatomically correct. Students before this were looking at images like this, while trying to treat their patients. So, you can see that they wouldn’t get too far. But now we have these brilliant drawings published by Vesalius, published in 1543. And each one of them is remarkable with the drawings of the skeleton, the muscles, but then it was discovered that in fact the artist in the background of these figures had drawn the landscape of the of the hills and that of the scenery in Northern Italy, which are also an interesting part of the of the drawings.

When I was in Cambridge, I discovered, I would learn that there was a coloured version of this that was sort of known, but it was in the basement of the rare books and manuscripts department in the library, and I met with the curator of the library and he said, “well, you know, I’ve never seen this book maybe you should get it out.” And there was this frontispiece, this woodcut, now in glorious color and it’s thought that this may have well even being the presentation copy for Prince Charles V’s son, Prince Phillip II. But these drawings were just spectacular, and they sort of brought the whole image to life and each chapter begins with what are called historiated initials and I show you these because I imagine you may not have seen these and it’s nice to see something that very few people have actually seen, because this book has never been published. Each initial, and these are only about 4 or 5 centimetres in size, tells a story about medicine and here you can see the young (inaudible) pulling up an animal. This is where they’re boiling the skulls to take the tissue of the skull, and again each letter here has its own little story behind it. The one of the bottom here intrigued me, I don’t know whether you can see it on that side, this is the picture here because I wonder what this was about, you know, there’s a whole story about grave robbing and I thought that’s what this represented, but in actual fact what they’re doing here is, this is how they cleaned the bodies to get the flesh off and they would put the body into a box with multiple perforations on it and then place the box a Stream for 10 or 12 days and the water would go through the box and it would just clean the body of the flesh and so that’s really what this image is about. Quite wonderful.

Here is another one which intrigued me too, this was the figure that begins the chapter on the muscles of the rectum *laughter*. When I learned of this, I wondered whether this is where you get the expression that a bird in the hand is worth two in the bush, but I’m not sure *laughter*. And some more initials, this one on the bottom is quite interesting, the V, as you can see the person here is having a venesection with their arm over a pole, and that’s how they took the blood from the arm, bloodletting, and that’s where you get the Barber’s Pole from. The Barber’s pole relates to the use of the pole that was used to move the blood back and forth. And I love this picture, this is someone assuming that they’re getting their hair cut *laughter* in a barber shop in Scotland somewhere.

So, going back again to this paper of mine which is so interesting and which I learned so much from, this character down here which you can see was actually the Abraham Grove’s a surgeon from Fergus, Ontario, performed the first appendectomy in North America in 1883, and a nine-year-old boy on a kitchen table. But I wanted to finish this talk the appendicitis with visiting the Royal College of Surgeons in in London, because this individual here is Frederick Treves, and Frederick Treves operated on probably the most famous person to have had appendicitis, which was Edward VII just before his coronation in 1902. And I went to the library in the Royal College of Surgeons in London, and I was interested in looking at some of their archival material of people that I was interested in studying and one of them was Esley Cooper which I haven’t talked about here, and the other was Frederick Treves. Now Frederick Treves, you may know is his name because he wrote The Elephant Man which I’m sure you’re familiar with perhaps and you maybe have even seen the film, these actually are the pictures of John Merrick, The Elephant Man, in his book.

When I was into the library, the librarian who was a young librarian, she hadn’t been there very long, she then gave me a box of all of the writing they had of Frederick Treves, a fantastic treasure trove of information. Passages from his notebooks. The first case all sorts of handwritten notes about the case of Sir John Millais who was president of the Royal Academy at the time, second one was the case of Sir Henry Irving, a great actor who had inhaled the nozzle of a spray, he was praying his throat, it was a lovely story that he wrote about, and then the third thing I found was this account of the illness of Edward VII in June of 1902. And in this box were 120 pages of notes that Treves had written about the appendicitis of Edward VII. I was so excited to see this, and I went to the copy room and copied everything. I copied all the papers, all the notes, and then went back to my desk and then I look through the box to see what else it was and there was a letter from the palace saying that “under no circumstances should anybody be allowed to see Treves’ writing without the permission of the royal family” *laughter*.

So now, I had this document and I thought the best thing was just to leave, which is what I did, and I have this document now at home and I don’t know how the time is, maybe there is time just for me to read something from this which I think you might enjoy. Again, this has never been published, and I’ve got this document, not quite sure what I’m going to do with it. I’m sure you’ve all seen perhaps The King’s Speech. I think it’d be wonderful film of the King’s appendicitis on the basis of Treves’ writing. But I just want to read this to you a little bit because it’s such a marvelous description of… he operated on Edward VII in Buckingham Palace, they create an operating room there and there was concern that he was supposed to have had his coronation, but he developed this abdominal pain. There was some thought that he might have had cancer. And so, Treves writes, “the operation was conducted from beginning to end in absolute silence, it was only interrupted at one point when I reach the swelling at a depth of 4.5 inches, I found the mass to be very hard and said so. So, Thomas Smith, having in mind the persistent rumor that King had cancer, asked me if it felt like a growth and I was compelled to reply that it did. In another moment however, I drove in the knife whereupon the contents of the abscess escaped with a violent gush and the anxiety as to a growth was at an end, such a matter as could be collected measured about a plank. The condition of decomposition showed that it was of sound standing,” and this is the bit that I really love, they then followed the irrigation of the abscess cavity and he describes, “to obtain a good flow of water, I called in a very tall footman who was outside on duty, placed him on a chair with his back to the King and made him hold a large irrigator above his head, and this he did like a machine, the cavity was washed out with many quarts of sterilized water until the upcoming fluid is absolutely clear.

I’m afraid that the footmen gave some account of his astonishing experience in the servants’ hall and that some talk traveled since beyond the walls of the palace. In no other way can the lurid account have been given in certain papers can be explained.” So, that’s just amazing, the idea of this footman standing, holding the irrigator above the King just caught my imagination. But this is the interesting thing is that I then, subsequently, read the biography of Frederick Treves by Stephen Tremblay, and Tremblay’s description is interesting, he says, “before giving an account of the King’s operation, the author must insert a rather unusual apology to the reader. When the operation was over, Treves wrote a full account of it. To a biographer it is probably the most important single document written on by the subject. The original is in the Royal archive at Windsor and the copy is held at the Royal College of Surgeons Library in London. Unhappily the authorities at the archive refused the author of permission to consult this document.” So now, there are actually three documents *laughter*. One in Windsor, one in the Royal College, and one in basement. I don’t think anyone is going to tell the MI5 about that. So that’s the story of the King’s appendicitis.

So, I came back from my sabbatical and, as you heard, my practice moved to St. Paul’s. Since 2003, I’ve had many happy years at St. Paul’s with great colleagues, doing wonderful work, and it continues at St. Paul’s that the work there is superb, and I, over the years, have mentored and taught many students and residents and it’s always a great treat to see them go on to great careers themselves. And on my last day, my last final operating day was in 2010, and I had the good fortune to have my son, who was in his final year as a surgical resident, come and assist me on my last day, and one of my residents took photographs of us that day, and I was able to turn them into a painting, which is one of my prized possessions is that painting of my last operation is actually going to be hanging in the in the new residents room at VGH.

So, I’m just going to end with a little bit about the art side of my life, before I finish, and the influences. One of them was before I came to Canada, I was a student at the Brighton College of Arts. This is Harvey Daniels who was one of my instructors there, a great British printmaker, and he was the one who told me I should study Matisse. Matisse has been somebody I’ve studied for many, many years and, as you can see, to the point that I was actually trying to emulate some of his work in my studio with my kids beside me.

I went to the Emily Carr college when I started my practice in 1981. I actually went to the Emily Carr college for five years in their extension program on Thursday night with Ken Wallace who was the painting instructor. For five Years on a Thursday night, I would come from UBC, change, get on my bicycle, and cycle down to the Emily Carr painting area for four hours, which was a wonderful way to spend the next five years, and then I developed my own studio. I was taught by Gordon Smith on weekend workshops, one of the great artists we have here in Vancouver, as you know, he’s in his late 90s, still paints every day, and his last exhibition at the Equinox was just outstanding. I hope some of you will have seen it. It’s always a special treat to see what Gordon Smith is doing, and the last show was wonderful. The other artist who was a big influence for me was Toni Onley. Onley was a patient of mine and he then invited me to come one day and paint with him on Spanish Banks just the two of us, and it was a very special day to be in the presence of a real master. I mean, Toni was the greatest water colourist that there’s ever been. You know, they talk about Turner, well he was our Turner, a wonderful, wonderful artist. And he taught me about watercolours, and watercolours being something I have developed, and I love working in watercolours. This is one that I did recently, the Victory Square for the Remembrance Day.

Yeah, this is just some other paintings of mine over the years, different sort of styles. We love going to Italy, or rather we are italiaphiles and we love painting. This is from Cinque Terre in Italy. This is from a painting I did of Umbria. And traveling is such a huge part of our life also. Here we are when we went to Machu Picchu, a painting I did of Machu Picchu, then Antelope Canyon. Anybody been to Antelope Canyon? One of the most amazing places to go to, it just blew me away when we went to Antelope Canyon. And I brought back images and started painting in the studio, some of the places we’ve been to in Antelope Canyon. And the one that was published in your letter, was of me in the studio this year. I was interested in doing some images and drawings of the athletes of the Winter Olympics and the Paralympics Games, which I really enjoyed, and I found that was wonderful. I really enjoyed it this year. And this is my last painting, which I did about two or three weeks ago after I returned from Antigua, where I was with the Health for Humanity volunteer organization, operating on patients in Antigua in Guatemala. A great group came from Vancouver, organized through one of the anesthesiologists at St. Paul’s, Joe Del Vicario. They do wonderful work and I was there for one week, but they were there for three weeks operating on people who would not otherwise had have treatment.

So, I got to finish actually where I started, and I want to finish with this painting that I did sort of… we’re back to the beginning of the talk, if you like, we’ve come full circle, because this is a painting I did of the Temple of Apollo on Kos. And I presented this to the graduating medical class in 2002 at their graduation ceremony together with a poem that I wrote for them, and I’m just going to finish with the poem I wrote because it sort of ties everything together that we talked about. A life of meaning, if you like, going through so many interesting things, but this was I felt a nice way of tying it up. And so, this is a poem I wrote, and I call it “A Way of Life.” These are words for the class of 2002.

A ferry carries us across the sea of time to ancient Cos
Where high upon a hill we stand and feel a touch of history’s hand
For here it was our art began
With words of wisdom from one man
And still today by him we’re taught
That art is long, but life is short
And too there are as vectors three
A paradigm of simple spoke
The patient, the doctor, and the disease
And then of course, Hippocrates
A man whose oath recited still
Echoes from that sacred hill
Where trees and pillars standing tall
Can be symbols for us all
Ethics, truth, integrity
Compassion, trust, humility
A way of life for us to follow
From this Temple of Apollo.
*applause*

Q&A

Question: When you travel, do you photograph and then paint from the photographs? 

Answer: Yes. I’m not I’m not a great plein air artist. I like to take photographs and then come back to the studio.

Question: We have heard that the appendix may not have any obvious function in the body, yet it’s a source of a great deal of pain to a lot of people. Could you elaborate on the question of why we have an appendix? Does it have a function? 

Answer: I’m the wrong person to ask actually. You have to talk to a higher being for that. *laughter* Of course the appendix is actually quite large in some animals. In certain animals the appendix is enormous, but it certainly has no purpose that we know of in humans other than being a real thing when it gets obstructed and it does get obstructed many times. But the history of appendicitis is interesting, and if you’re interested, I could have the papers sent around. You might read about it because it’s a fascinating story actually because it tells you about the history of surgery too. How we go from, you know, the discovery in the 1800’s to where we are today.

Question: How would you like to see the medical school curriculum reflect some of your interest in arts and humanities and fine arts? 

Answer: The question was how the curriculum might change in terms of the humanities. In effect it is changing at least to say, our curriculum is now talking about the arts and humanities. Students are given flextime. It’s an issue that actually is very prominent in some schools. They have a history of history of medicine program at Queens, which we don’t have here. On the East Coast, John Mary started the humanities program at the University in Nova Scotia. And so we’re in our early days, and we are in discussions about how to introduce it. But you know, the curriculum is so large the problem is, if you want to bring something into the curriculum you have to then take something out of it. And that’s where the challenges with the curriculum, is sort of what goes and what stays? And so, it’s not easy. For me, I just think it’s also important to encourage students in the arts. I actually started something called a spring gala here in the 90’s when I was Associate Dean. Every year, students perform a wonderful, wonderful gala, they would perform they’re musicians or dancers, and it’s the highlight of the year. And so there is that opportunity have an art show every year now, where students can display their art. And so, I think there’s an awareness of the importance of the humanities in medicine much more than they used to be and I think it will continue.

Question: I was just wondering what you feel about this young people today get so much information from their smartphones. They stream movies, TV shows. What’s your impression of the art of television in its portrayal of medicine? 

Answer: Well, you know, I think people are always fascinated by medicine. People who are not in medicine. I mean I remember watching the series called Dr. Kildare, you probably heard of it. Well Dr. Kildare was something everybody wondered about. I mean the idea of having a view into the medical world. And even now, there are a number of medical shows. They tend to, I think they glorified little bit and I think what’s missing very often is the humanity side of it. The there was a series recently on the Knowledge Network of the emergency department at VGH. It’s a wonderful series actually, I thought it really portrayed people working together in the environment where everybody was contributing. I think the important thing, which I try to tell students and residents and people I work with, it’s about a team. I mean medicine is teamwork all the time, you are dependent on the people you’re working with. And sometimes that doesn’t necessarily come across because I think it wants it wants to be theatrical, and so the theater is not quite the same as real life, I don’t think. I’ll never when I went to my interview at Guy’s, I was 17 and I found myself sort of some at some point during the morning before my interview, I wandered up into the mezzanine floor in the surgical building, and I suddenly found myself looking down on an operation. And you know, I was 17. I just was mesmerized by seeing what was happening the operating room and I think what impressed me was that they just seemed so normal. People were just working, and there was no fuss, people were doing their thing. And I think the students find when they come into the operating room, how organized it is. It’s not exciting, unless things happen to go wrong… It’s just everybody doing their job. It’s a working environment. I think again that doesn’t necessarily come across in a lot of dramas because it’s not dramatic enough. You have to have people bleeding and resuscitating to make it exciting.

Question: There is more and more artwork on display in the hospitals and it’s be told, and I believe it, that it helps patients and helping the people working there. What’s your opinion about that? 

Answer: You know, I think that’s absolutely right. I think the arts are very comforting for the patients. VGH has a wonderful art collection as does St. Paul’s. You know, you can walk through the halls of VGH or St. Paul’s and see wonderful paintings. Music also. Music is very important for patients. And actually, when I operate, I always like I always like to have some music in the operating room. In fact, one of my patients brought me her CD. She said, “I want you to play this during my surgery.” It was very comforting to her. So, I think that the arts and medicine are very much… the two are combined. And I think the environment needs it. You can’t help noticing when you go into a room, a sterile environment, there are no paintings, even now if you go into an office building there are no paintings, it feels sterile. And as soon as you go somewhere where there’s a painting, you react to that space. And I think patients certainly react to that, I know that. I’ve had a lot of patients come with my exhibitions and they liked the idea that I paint, it seems to me. That in itself is sometimes quite comforting and I have patients who have given paintings to me.

Question: Just wondering when your next exhibition might be?

Answer: I got so much work that I do need to have another exhibition. I’ve had a few over the years, and I think it’s time to have another one. I’ve accumulated lots and lots of work, and if there is, I’ll let you know. 

Question: What is the status of Appendicitis non-surgically?

Answer: Non-surgical appendicitis? Well, you know, it’s a good question and the treatment of the appendix is sometimes done conservatively when you’re uncertain. But I’ve always felt that if you made a diagnosis of appendicitis and it’s clear that you have somebody who has gotten, what we call, an acute abdomen, that it’s not doing them a favor necessary just to watch them. And the aspect of surgery that is so important is judgment. Not so much the actual doing it, but when you do it, and when you intervene. The last thing you want is somebody to have Appendicitis who dies of appendicitis, and sadly that happened to Frederick Treves, his daughter. His daughter was 17, she developed appendicitis and he decided not to operate and watch, and she died. So, you know, it’s a disease that has to be respected, because it is potentially something you can die from. So, I’m an advocate for intervention rather than not.

Question: Could appendicitis be food related?

Answer: I don’t think, at least that I know of, that there’s any evidence that that food can cause appendicitis except that sometimes you operate on patients that actually have a blockage of their appendix with something called a fecalith, where a little ball of feces can be stuck in the appendix, and that sometimes can cause appendicitis, but whether food itself, any particular food stuff causes appendicitis, I don’t think there’s any good evidence for that. 

Question: What’s the effect on your art of laparoscopic surgery? 

Answer: Well, you know, it’s interesting that you ask that because I think that question really relates to how surgery has changed, the history of surgery. You know, I mean everyday things happen in medicine and surgery, there are advances. I never was a laparoscopic surgeon, my surgery was what we call, open surgery or very much, old-fashioned surgery, if you like. A lot of training things and all of that about Intervention surgery, which is a tremendous advancement for people. You know, when I used to have to take somebody’s gallbladder out, they’d be in hospital for a week. Now you can be at home the next day, or even the same day. So, there’s a big change with laparoscopic surgery. Same with robotic surgery, where you actually as a surgeon don’t have to be operating at the operating table. You can be at a remote from the table using a robot. So, surgery has really changed, and I tell the students that in their time as students that they’re going to see incredible change. In fact, I think now is an amazing time to be a medical student,because the changes are so dramatic


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