St Vincent’s Hospital Medical Alumni Association

Welcome to the Winter 2016 e-newsletter of your association.

In this edition – in brief

Annual Cocktail Party and Historical Talk 2016

St Vincent’s Hospital Medical Alumni Association…………………………read more

Medical Alumni Association Annual Golf Day, 2016

The 2016 annual golf day was held ………………..…………………….….read more

Australian Honours………………………………………………………...read more

Obituary

Dr John Brenan……………………………………….……………………read more

Book Review

“Kickstart: Recharge Your Life…………………………..………………….read more

From the Archives

Emergency Medicine: then and now……..……………………………….….read more

News from St Vincent’s Clinical School…………………………………….. read more

News from St Vincent’s Hospital..................................................................read more

Postscript …………………………………………………………………... read more

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Annual Cocktail Party and Historical Talk

St Vincent’s Hospital Medical Alumni Association invites you and your guests to the Annual Cocktail Party and Historical Address for 2016. This will take place on Sunday afternoon, July 31, 2016. The speaker this year will be Dr Lynda Campbell whose topic will be “Bodies, bits, bugs and blood: A history of pathology services at St Vincent’s”.

Welcome drinks will commence at 4.30 pm with the presentation to start at 5.15 pm. The venue will be the Chamberlin Lecture Theatre on the ground floor of the Aikenhead Wing (use the entrance in Victoria Parade closest to Nicholson St).The cocktail party will follow the lecture and will end at 8.00 pm.

For more information and a registration form, please contact Ms Sue Mabilia on 9231 2304 or by email Susan.MABILIA@svha.org.au .

Medical Alumni Association Annual Golf Day, 2016

The 2016 annual golf day was held at Greenacres Golf Club in Kew on Friday April 1. A large group of Association members (with handicaps ranging from 7 to 36) enjoyed perfect weather and played on a course in wonderful condition. It proved to be an historic day as the winner of the Doyle-O’Sullivan silver cup was Dr Jill Spargo (pictured below) with a brilliant round of 45 stableford points. Jill is the first woman golfer to win the cup in the eighty years of the history of this event.

Other results were as follows: Individual runner-up: Kerry Breen, 40 points, closely followed by Steve Leitl 38 pts, Michael Westmore 38 pts, Andrew Wyss 36pts, Oliver Larkin 36 pts

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and Jamie Keck 36 pts. The best group prize went to Nick Gelber, Jamie Keck, Jill Spargo, and Justin Porrins (of our sponsor DPM Financial Services). The nearest the pin prizes went to Andrew Wyss (9th hole) and Ben Morris (11th hole) while the straightest drive prize went to Bill Rogers.

Members enjoyed a great day with ample time to socialise with old friends both over lunch and at the dinner after golf. They also benefitted from the presence of touring professional Daniel Popovic who hosted a “Beat the Pro” par 3 hole. The winners took home some very valuable prizes thanks to the generosity of our sponsors who included our major sponsor this year, DPM Financial Services Group (www.dpmfs.com.au ), the Audi Centre Melbourne and Audi Centre Brighton – part of the Zagame Automotive Group, St. Vincent’s Pathology (a long-time supporter) and Zouki Catering, who run the café at St. Vincent’s.

Many thanks also to the staff at Greenacres who looked after our group extremely well, to Sue Mabilia who handles the advertising and registrations and to our golf day convenor David Olive who makes it all happen.

Australian Honours

We congratulate the following St Vincent’s Hospital Medical Alumni who were awarded Australian honours on the Queen’s Birthday, 2016:

Professor James Donovan Best AO, for distinguished service to medicine, particularly in the area of endocrinology, to medical education as an academic, researcher and administrator, and to rural and Indigenous health.

Emeritus Professor Sidney Bloch AM, for significant service to medicine in the field of psychiatry, to medical education as an academic and author, and as a mentor and role model.

Dr John Timothy Kennedy AM, for significant service to medicine, particularly in the field of otolaryngology, to medical education and training, and to the community.

Professor Joseph Proietto AM, for significant service to medicine in the field of endocrinology, particularly obesity and diabetes research, and as a clinician, educator and mentor.

Dr Bernard Bryan Crimmins OAM, for service to medicine, and to men's health awareness.

Obituary

Dr John Brenan

29/7/1927- 20/3/2016

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It was with considerable sadness that we learned of the passing of Dr John Brenan on March 20th 2016. John, who will be well known to the Alumni, was a key figure in dermatology at St Vincent’s Hospital over three decades and was a significant influence in the course of Australian dermatology over that time. He witnessed an era of modernisation of dermatology as a specialty, to which he made a significant contribution.

John received secondary schooling at Xavier College and then studied medicine at the University of Melbourne, graduating in 1951. He began his residency at St Vincent’s in 1952, however this was interrupted after he contracted tuberculosis of the spine (presenting as a psoas abscess). John recalled nine other residents contracting TB around this time. In 1955 he travelled to England as a ship’s doctor aboard the Waipara to pursue training in dermatology. His 18 months studying dermatology in the UK included house positions in London (St John’s Hospital and St Mary’s Hospital) and Edinburgh. He obtained his MRACP 1959 (and subsequently the FRACP 1970). He was appointed head of clinic in dermatology at St Vincent’s in 1959 and subsequently head of dermatology, succeeding Dr Dennis Clarke, and remained in this position until he retired from the hospital in 1989. For many years he was also consultant dermatologist to the Mercy Hospital and attended the dermato-gynaecology clinic.

John Brenan has been recognised for his great contribution to the Australasian College of Dermatologists. He was a founding member of College and an influential figure in the establishment of the College in 1967. He was involved in setting up the first structured training program for dermatology in Australia. He has served on the College federal council, was chair of the Victorian faculty and served as President of the College (1983-85). In addition, John served terms as an examiner for the College and subsequently a term as chief censor.

John was a great advocate for dermatology and, with his strong medical background, saw the importance of integrating dermatology with general medicine. He saw many changes in

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dermatology beginning with the availability of corticosteroids and then the understanding of the immunological basis of many skin diseases. He had specific interest in immune-based blistering diseases and phototherapy. Through John’s foresight and leadership, St Vincent’s was the first hospital in Melbourne to establish a PUVA (ultraviolet radiation) service. John was greatly influenced by his father, Dr Andrew Brenan, historically a prominent figure in pathology at St Vincent’s. Through his father, John appreciated the importance of understanding the pathological basis of skin disease and clinic-pathological correlation. This interest led him to establish an annual national dermatopathology weekend in 1971 which was initially held at St Vincent’s. John had great personal satisfaction in seeing this grow into the Australian Dermatopathology Society. Annual meetings continue to be held around Australia with participation of dermatologists, pathologists and trainees. The John Brenan prize continues to be awarded annually for the best registrar presentation.

Those who knew John Brenan will recall his jolly laugh, commanding presence and exceptionally good humour. He had a keen interest in sailing and rowing and was a committed family man. He was a kind man who cared greatly for his patients. He took a keen interest in students and was an engaged teacher. He was a wonderful mentor of junior staff and launched the careers of many dermatologists, including mine for which I have much to thank him. St Vincent’s and the broader dermatological community have lost a leading and influential figure. Our condolences and best wishes go to Marianne, John’s loving wife, and his children.

Vale John Brenan, a doyen of Australian dermatology.

Contributed by A/Professor Chris Baker who is the current head of the Dermatology Department at St Vincent’s Hospital.

Book Review

“Kickstart: Recharge Your Life with a Pacemaker or Defibrillator”* by Dr. John England.

Reviewed by Dr Andrew MacIsaac

I greatly enjoyed this book which is written for patients with pacemakers and implanted cardiac defibrillators, but I should start with two disclaimers. The first is that I read the book as a cardiologist and not as a patient. The second is that the book contains criticism of some members of the medical profession and The Cardiac Society of Australia and New Zealand (CSANZ). As the current CSANZ President you must weight my comments with this bias in mind.

The author, Dr John England, is a practising cardiologist who not only cares for many patients with cardiac pacemakers and implanted defibrillators but is also a pacemaker

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recipient himself. This book is a resource for pacemaker patients and their supporters. It is written with insight, wit and passion. It does not contain the obscure and dense terminology of clinical cardiology. Its vernacular and free flowing style provides a directness often lacking in medical communication. It is written from the heart and contains some wonderful imagery of guardian angels looking over the welfare of patients with cardiac arrhythmias. It aims to relieve the concerns of pacemaker recipients by demystifying how pacemakers and defibrillators are inserted and function.

I would also encourage clinicians to read and absorb its many insights into the experiences and anxieties that patients go through during the course of their illness. The book contains anecdotes on the way patients’ perception of medical communication and care are often at odds with the doctor’s own perspective. The opening section on patients’ questions to a cardiologist’s secretary sets the tone for the book. If you were ever in any doubt about your secretary’s role in demystifying ‘doctor talk’, reassuring patients and improving their welfare, this would be rapidly dissolved within the first few pages of reading.

We live in a world dominated by technology. It is a source of wonder and makes a significant contribution to our constantly improving health. This book reflects on the interaction between human frailty and medical technology. Kickstart: Recharge Your Life with a Pacemaker or Defibrillator reminds us of the obligation for doctors to be primarily motivated by their patients’ welfare. This at times may require doctors to challenge the medical establishment. Some of John England’s patients have suffered complications, in particular lead displacements following pacemaker insertion. He relates his efforts to have these complications acknowledged and prevented. This led him to lobby for the establishment of a public registry of pacemaker outcomes. He reminds us of the importance of quality assurance programs and the transparent reporting of outcomes. At times we may be confronted by the stark reality of patient complications. This can lead to denial and a temptation to “shoot the messenger”. The medical profession should celebrate those who bring these inconvenient truths into the light. We are reminded by John England that one complication is too many. Medical technology can bring us almost miraculous benefits. It is the medical profession’s obligation to ensure that it is delivered with kindness, compassion and skill.

Dr John England graduated through the St Vincent’s Clinical School and is now a practising cardiologist based in Katoomba and Mudgee, NSW.

Dr Andrew MacIsaac is the Director of Cardiology at St Vincent’s Hospital Melbourne.

(*A second updated edition of this book has recently been published under a slightly different title: Kickstart: Everything You Need to Know About Living with a Pacemaker or Defibrillator. Paperback, published by Brandl & Schlesinger Pty Ltd, $24.95)

From the Archives

Emergency Medicine: then and now

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In 1960, the new Daly Wing (along with the new Aikenhead Nurses Home) was officially blessed by Archbishop Simonds and opened by the then Governor of Victoria, Sir Dallas Brookes. Its significance to the hospital was akin to the new Inpatient Services Building which was opened in 1995. The Daly Wing included thirteen new wards, four operating theatres, a new outpatients department with two outpatient operating theatres, and on the ground floor (where the outpatient clinics now stand), a state of the art Emergency Department, known then as the Casualty Department. Notably the new Casualty Department was self-sufficient, incorporating an operating theatre and a second procedure room used primarily for plastering fractured limbs. It also had its own radiology room, with the capacity for taking plain xray films.

The Casualty Department design incorporated a “front of Cas” section of five cubicles for walk- in patients of the type that a general practitioner might see. This section was linked by a long narrow corridor to the “back of Cas” where more serious problems were seen. The “back” consisted of eleven cubicles for emergency cases, a large bathroom, a small ward of four beds for overnight stayers and a “blue room” for VIPs. The operating theatre, procedure room and xray room were all located here.

At the end of the driveway off Victoria Parade that now leads to the outpatient clinics, there was an ambulance loading bay and an adjacent entrance for the “walking wounded”. Here a waiting area was supervised by an experienced nurse. Although the term “triage” only came into hospital use later, the nurse’s task was to decide whether patients should be directed to the “front” or the “back” of Cas and how urgently they should be seen.

The long corridor joining the front and back of the Casualty Department also served as the main thoroughfare for junior medical staff walking from the RMO quarters to the Daly Wing and for senior medical staff walking from their carpark. Halfway along the corridor was a large tea room and medical staff toilets. Probably by accident rather than by design, the tea room quickly became a very popular spot for morning tea for medical staff – junior and senior - from all over the hospital. It may also have been the quality of the scones that attracted people. If you wanted to speak to a colleague, this was the place to come to. In a way, it became the “nerve centre” of the clinical staff of the hospital.

“Cas” as it was known was generally quite busy. The annual report for 1965 shows a total attendance of over 40,000 patients. However, the workload was not evenly spread, allowing some latitude in staffing arrangements as discussed below. There was no such thing then as “going on bypass”. If the department was busy, new arrivals lay on trolleys in the corridor, sometimes sharing the space with outpatients on trolleys waiting for ambulance transport to take them home.

So far, much of this description probably does not sound too different from the modern Emergency Department but there was a huge difference and it was in the manner in which “Cas” was staffed. The department was run for most of each 24 hours by first and second year medical graduates! In the “front of Cas” patients were seen by JRMOs (interns or HMO1s in current language) assisted by a third year trainee nurse. The “back of Cas” was staffed by an SRMO (HMO2) assisted by one or two JRMOs. The SRMO basked in the title

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of “admitting officer” (AO). Much of what the JRMOs learnt was taught them by the SRMOs or the senior nurses. The xray room in Casualty was staffed by a radiographer in working hours and one could be called in after hours – but even then the xrays taken were interpreted by a JRMO or an SRMO (as “wet films”) until reviewed the following day by a radiologist.

All JRMOs and SRMOs spent a 3 month term working in “Cas”. The SRMOs worked 12 hour shifts as AO. As well as being in charge of the Department, the AO’s role involved taking phone calls requesting urgent admission to hospital. New chums soon learnt that a key question to ask was whether the potential patient had ever attended another public hospital. If so, the caller was politely advised to contact that hospital. If the department was very quiet, the SRMO on duty at night would often retire to bed, leaving the JRMO in charge. Another arrangement sometimes agreed between SRMOs was to work 24 hours on and 24 hours off. This was probably only possible because of the opportunity to take a nap after midnight when on duty.

Fortunately, “Cas” was also staffed by very experienced permanent nurses, assisted by trainee nurses. The nurses, and indeed the whole department, were supervised by a Sister of Charity with nursing qualifications who was present for the waking hours of most days. That Sister and the experienced nurses provided wonderful guidance and support for the novice doctors. Recognising the need for more senior oversight, in 1965 the hospital created the position of part-time Casualty Surgeon and thus on some days, in the daytime, a young surgeon was present to offer support. This position was usually filled for 2-3 years at a time by surgeons just returned from training in the UK. As well as back up of this type, around the clock there was always a “receiving” medical registrar and a “receiving” surgical registrar physically in the hospital who could be called to rapidly come to assess and assist in the care of patients. Each was backed up by an honorary general physician and general surgeon who were on call (although these never included the “inpatient” physicians and surgeons!). Later, a casualty registrar position was created. The specialty of emergency medicine was still a long way off.

The nature of the work included typical medical emergencies (acute asthma, acute pulmonary oedema, chest pain, drug overdoses for attempted suicide, and haematemesis and melaena) and surgical emergencies (acute abdominal pain, fractured limbs). Gunshot wounds and stabbings were very infrequent although the author recalls the fortunate recognition of pulsus paradoxus in a young man with a stab wound to the front of his chest. An urgent thoracotomy and a single purse string suture to the stab wound in the left ventricle by a cardiac surgeon saved him from death by cardiac tamponade. Violent behaviour placing staff at risk was very rare despite the quite frequent presentation of drunks who had injured themselves. The abuse of other drugs was well in the future and most of the generation of medical and nursing staff from the 1960s were never exposed to marihuana or heroin overdose or to the ravages of “ice”.

The sickest patient was placed in the first cubicle off the corridor (cubicle number 6) and here much urgent resuscitation took place. This cubicle was positioned at the point in the corridor where medical staff walking to and from all the other services housed in the Daly Wing made

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a sharp turn away but could hear and often see much that was happening in cubicle 6. As a result, spectators often gathered – and at times made themselves useful. As resuscitation equipment and manoeuvres became more complex, cubicle 6 needed enlargement. This was achieved by demolishing the wall between it and the adjacent cubicle 7.

“Cas” in the 1960s provided much real experience for fifth and final year medical students who were rostered on a regular basis throughout the year and lived in for that time. They not only saw a lot of acute medical and surgical cases but they were expected to contribute by undertaking much of the suturing of lacerations, putting on plasters and inserting intravenous drips. More than any other undergraduate experience, this time contributed greatly to the confidence that a final year student was going to need the following year. It also helped to make the student feel involved in the life of the hospital.

“Cas” also saw a lot of “regulars”, usually homeless men who would wander in feigning illness to get a warm bed for the night. The best known of this class was a man known as “Gunner” Kelly. Mostly they were not turned away but many received a compulsory warm bath as part of their care.

Computers had not been invented so patient location, status and provisional diagnosis was tracked on a large whiteboard in a cramped central workstation shared by nursing and medical staff. For those like “Gunner” Kelly, status was often recorded as “for B@B”.

Perhaps the busiest time that “Cas” experienced was in 1963 as described by Bryan Egan in the history of the first 100 years of St Vincent’s, when the William Booth Salvation Army Men’s Hostel burnt down and many men with severe smoke inhalation overwhelmed the department. Some were declared dead on arrival. The quietest may have been New Year’s Eve in 1965 when not a single patient attended the department between 6.00pm and midnight.

In the 1980s, the Casualty Department was gutted and rebuilt. As part of the rebuilding, the corridor and the tea room were lost. Although probably not anticipated by the architects, this also meant the loss of the central communication hub that was the old “Cas”. In its new shape, it became the Emergency Department and now had a full-time director. With the disappearance of the corridor, the new Department seemed to become an island isolated from the rest of the hospital.

News from the Clinical School

Correction: Apologies for a typographical error in the last newsletter. The Stephen Rosen Prizes for Clinical Teaching were awarded to Dr Antony Tobin and Dr Manisa Ghani in 2015.

Stephen Rosen (10/8/66-7/10/2003) was a highly regarded Consultant Physician at St Vincent’s whose great contribution to teaching and mentoring is recognised as outstanding and inspirational.

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The prizes for clinical teaching are dedicated to his memory and are presented by his parents Nathan and Helen at the Graduation Mass prize ceremony each year.

News from St Vincent’s Hospital

In past editions, we have arbitrarily extracted some news items from the St Vincent’s Hospital monthly newsletter known as the Font and the St Vincent’s Foundation newsletter, known as The Pulse.

Please note that these two newsletters have now merged. To give the reader complete access to this news source, the hospital has provided the following link:

http://www.svhm.org.au/aboutus/newspublications/pages/theFont.aspx.

Just click on the link and you will be taken to recent issues of The Font.

Post script

If you have read this far, it is likely that you enjoyed this issue. Did you know we have over a thousand alumni on our books for whom we do not have email addresses? Some of these people might be your friends and colleagues. Please do us a favour by passing this newsletter on to friends or alternatively alerting friends to the opportunity to register with the Association on our web site at http://stvincentsmedicalalumni.org.au/ . And tell them that membership of the Association is free!

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