My father had been sixty-four when Billy came along, near the end of his career as a surgeon but still playing the violin he had begged his father for lessons on and had practised every day in the woodshed for exactly an hour. He was still taking photographs too, still sailing. In his fifties, he made two more attempts to leave his practice in Victoria for situations in the United States where he could spend more time doing medical research and less time dissecting out brain tumours and operating on bad backs. But neurosurgery in California had struck him as mercenary, and neurological consulting in Baltimore bored him. Maybe he missed his leaking boats and his darkroom. In his sixties, he ground it out back in British Columbia. The years of wandering were over.
“I’m a cobbler,” he told me then. “People bring me stuff; I mend it.” It was a long way from the young doctor whose early cases had been fodder for the stories I grew up with. The strangest were from his wartime years as a psychiatrist. One patient was a physician with acute schizophrenia who endlessly pencilled perfectly round breasts on reams of toilet paper. My father tried to get the attendants to give the artist some decent paper and a set of coloured pens.
“No pens,” they said.
“Why?”
“They always end up in his rectum.”
That was all I had on the crazy physician, but the other patient files I’d brought along on Vera were different because they told stories that actually involved my father as a surgeon. Occasionally, while I was growing up, he had talked about cases he was especially proud of, or especially upset by. Jimmy Ho, I thought, he never forgot about Jimmy Ho. I bet he’s in this bunch of files — and he was. I started to read.
Jimmy was four when he fell out of bed. Not much happened for a month or so, then he started falling again. His hands shook. He listed to one side, a small sinking ship. My father’s notes were, as always, colourful, and as I read them I began to notice the little things that showed how he felt about his patients.
“We find a four-year-old Chinese male sitting at the desk looking quite well,” he began of the initial examination. But then, “He appeared quite frightened . . . and he could not co-operate in testing the sensory system.” Not “would not,” but “could not.” The narrative of that first visit ends, “I think he has a left cerebellar tumour.”
Remember, this was long before CAT scans. Symptoms were all you had to go on. But my father’s in-office diagnosis was correct: Jimmy did have a tumour. It took more than four hours to tease out a growth the size of a lacrosse ball. Jimmy’s heart stopped on the operating table and his lungs filled with fluid; the surgeons massaged and intubated. His heart stopped again; they restarted it with adrenaline. It was the worst tumour my father had ever seen.
“The post-operative course was stormy,” he wrote years later to an insurance company needing a statement on Jimmy’s condition. He charged the company $15 for the report, which probably gave him some pleasure to write, because Jimmy Ho did recover, and his family never forgot. They moved to Hawaii and began to send letters and photographs. My father’s collection was fat with invitations to Jimmy’s high school graduation in San Francisco, letters of gratitude and career updates from his parents, and from Jimmy himself a record of his grades, his new Schwinn bicycle, and a succession of school photos featuring gigantic horn-rimmed glasses. A wispy moustache appeared, then a wife, a child, a better job. The last letter in the file, more than thirty years after the operation, ended, “All my love through the years.”
The next patient I finally got to meet was known as “The Korean Seaman,” a 21-year-old “struck by a pipe onboard ship in the right parietal region in a way which he finds difficult to describe accurately due to his language difficulty.” Seaman Park had staggered into my father’s office. His head hurt. My father found that “a circle eight centimetres in diameter was completely punched out and a great deal of hair driven into the wound. A fragment of bone was driven in 15 millimetres, pushing the derma before it.” The pipe had struck end-on, like a javelin, cookie-cutting the scalp and creating a mess of buried bone shards. On top of the fracture was a hematoma that needed to be sucked out. When a second operation was needed two weeks later, the young man produced this handwritten note: “I am sorry to give you trouble again. I am not worry about this operation. I trust you. Do my operation please with peace of mind.”
The bill was sent to the shipping agents in Victoria. There is no record that it was paid; many bills weren’t. My father asked for $969, not bad for saving a life. A month later, another Victoria doctor and his wife escorted the refurbished seaman back to Korea. A Christmas card came the next year, with a picture of a delicate painted vase that made me think of the frailty of the human head.
Beside me in the cockpit, Charley lifted his own head and made a sound I hadn’t heard before, a kind of whimper. His ears stood out like wings.
“He kept writing to me, you know.”
Despite the heat in Skerry Bay, my father was still wearing the checked wool jacket. Charley turned three rapid circles and went back to sleep.
“He wanted advice on his condition, but he didn’t want his physician to know. Dr. Lee, I think it was.”
“What did you tell him?”
He looked at me sternly. “The only thing I could tell him. That there were many good doctors in Korea.”
“So you actually remember this Korean guy? The details, I mean? The hematoma, all that stuff?”
“Was there a hematoma?” He pulled the folder out of my hands and leafed shakily through it. “Oh yeah, there was. But no, I don’t remember it. Details like that, you don’t. Nobody could.”
“So you just kept the file because it turned out well?”
“Most of them turned out well.”
But not all, even in this tiny sample he’d left. One was a two-year-old Indigenous boy, whose folder was marked “subdural; child abuse.” The notes said, “I saw this little boy shortly after his admission to Emergency with the story of having been spanked by his mother and subsequently losing consciousness.” He had a subdural hematoma, a dangerous, pressure-producing bleed, which was removed. But, “in the Recovery Room the boy went quite flat. We took him back to the operating room because it seemed likely he was bleeding again. This was true. By the time I had lifted out the bone flap, the child had died.”
Why did he keep this file? It was the briefest of histories and the sorriest. Was he especially moved by the child’s case? Why did he add, in his notes, “It should be specifically noted that at no time was any sign of external injury to the head present”? There was an autopsy, which found some bruising on both legs, but nothing in the file suggested charges had been laid. Maybe he simply feared legal complications down the road. I knew better than to ask him about this one.
My father surely had mixed reasons for hanging onto Sergeant Maxwell’s file. His interminable handwritten letters were always addressed to “Dr. John Edgar Harvey B.A., M.A., M.D., Ph.D.” — I could practically taste the bile. “Possibly it would have been better if the scalpel had slipped in 1966. NO — that is not fair to say — you are so skilled!”
Sergeant Maxwell had an aneurysm — a burst vessel in the brain — which my father repaired in 1966. But the sergeant had a mental problem that couldn’t be surgically removed: he refused to accept repeated rejection from the Canadian Pension Commission. Once, he left a demand that my father write to the commission stating that he was “invalided out of the Royal Canadian Mounted Police due to service conditions causing an aneurysm to rupture.” That particular letter went on for nine pages, alternately fawning and berating. The letter ends, “I really feel I was summarily dismissed from your office today!”
“A nutcase,” muttered my father, still perched behind Vera’s wheel. “I should have climbed out the window when I heard him coming.”
“Did you help him out with his pension problem?”
“Of course not! If that’s the kind of conclusion you’re going to draw from my stuff, I want it back.”
Sergeant Maxwell’s letter was written two weeks after the fateful operation on Billy. Charley yipped in his sleep, and I was alone again in Skerry Bay.
***
High standards to the end; no fudging with the truth. That was my father all right, and those patient files had just confirmed it. Where had those traits come from? His upbringing in a small Alberta town may have accounted for some of it, but all I knew of those few years (he left home at sixteen) was the relentlessly rosy picture he painted in his own memoir. The bigger influence was almost certainly a role model, and for him that could only be one person: Dr. Harvey Cushing. Cushing was my father’s hero. My father even had a copy of Cushing’s first biography, by the surgeon-historian John F. Fulton.
Fulton’s biography was clearly the “official” one, written shortly after its subject’s 1939 death of lung cancer at age seventy (like so many doctors of my father’s time, Cushing was a chain smoker). Here was the saintly if prickly Cushing. Even so, it was easy to understand why my father had idolized the man. They were peas in a pod: multitalented, peripatetic, indefatigable, authoritarian. Cushing’s biographer described him as a perfectionist with the temperament of an artist and the enduring patience of a scientist; that sounded like someone I knew.
Both men had interests far beyond neurosurgery, and Fulton’s book includes lengthy extracts from Cushing’s diaries and letters, revealing a note-taker and observer with a dry, naturalistic style. It was easy enough to find similarities. Art, for instance. Cushing sketched prolifically: he drew fellow surgeons, a country inn, the preferred route into the third ventricle. My father’s artistic side, apart from the sheaves of unpublished essays I found on side-punched computer paper, was best expressed through his violin and his photography. And lineage: both men came from a long line of physicians. Both were formidable workers who rarely took holidays, both were popular with their patients, and both were feared but respected by nurses, who may be the best judges. It was an O.R. nurse who wrote the following poem about Cushing, and the doggerel could easily have described my father:
C is for Cushing
So cleverly cursed
If he ever gets sick
He will never be nursed.
Cushing was a details man who took every aspect of his patients’ care personally. Sleep and holidays were well down the list, and he got the same dedication out of his assistants. But when Cushing lost a patient, he was hardest on himself. When I read this stuff, I sometimes had to remind myself it was written about another man, not my father. I did once ask a local doctor, who had worked with my father, what he was like in the O.R. “No comment,” he’d said.
The Great War of 1914–1918 produced the biggest explosion in head trauma the surgical world had ever seen. Harvey Cushing did two tours in Europe, one of them in a casualty clearing station behind the lines at Passchendaele. Neurosurgery took a bloody leap forward in those years, and the slippery operating tables behind the trenches became a sort of high-speed testing ground for surgical treatment of head wounds.
So much could go wrong with the brain: fractures, infections, growths, and the awful squeezing that destroyed the central nervous system so that people lost their senses, endured unimaginable pain, went mad. At first, surgeons were lucky if they got out before the patient bled to death; bulging of the brain often meant you couldn’t even close the skull up again. Cushing’s first foray “inside the box” was to relieve a former sea captain of the coruscating pain of trigeminal neuralgia (tic douloureux), a disorder of the largest facial nerve. He chloroformed the man in 1899, trephined his cranium with hammer and chisel, and dissected out the bundle of nerves connecting the brain to the trigeminal nerve. The captain lived another forty years, pain-free, while his surgeon built brilliantly and relentlessly on that first great success. And despite the extraordinary advances since Cushing’s time, brain surgery still means opening up the box with burrs and saws, clamping off pulsating forests of blood vessels that insist on obliterating the field, finding your way through a blancmange of neurons that control everything from a wiggle of a toe to the wink of an eye, then accomplishing what you came to do and getting the hell out.
Outside the hospital, Cushing was revered, admired, emulated — but it doesn’t appear that he was much liked. He turned on the charm when it suited him, apologized strategically, and intrigued with the best of them. He was the prototype of the egotistical, imperious surgeon. He often shamed his assistants into doing things they felt were beneath them, like emptying bedpans or cleaning up vomit.
A much more recent biography by Michael Bliss is less sparing of Cushing’s defects than Fulton’s, but more illuminating for me. Bliss’s book recreates not only the man but his times as well, so I understood that it wasn’t simply that my father regarded Harvey Cushing as the role model for a caring, competent surgeon, he also revered the system that had produced Cushing, that Cushing had perpetuated and changed, and that had taken root from New England to the Midwest and produced an unbroken line of surgeons who thought like Cushing, acted like Cushing, and took their inspiration from him. It was virtually guaranteed that anyone who came out of that system, for generations after Cushing, had it firmly in mind that they were leaders.
My father was one of those. In the late 1940s, when he was studying for his Ph.D. in neurosurgery in Chicago, Cushing had been dead ten years, but his legacy was alive and well. Cushing began the tradition of the neurosurgeon as the star of the hospital, something my father picked up in Chicago and imported, for a while, to Vancouver and Victoria. When I was growing up, this role was well entrenched in the public mind; having a father who was a “brain surgeon” — well, what could have topped that?