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Dear Editor,

The last issue of The Square Knot con-tained a mix up concerning Drs.Scrimgerand Keenan. Dr. Keenan was awardedthe Distinguished Service Order (DSO), adecoration given for distinguished ser-vice of any kind by senior officers (Col. &

up); but for juniorofficers it wasgiven for braveryin the face of theenemy. Dr.

Scrimger was given the Victoria Cross(VC) for conspicuous bravery in the 2ndbattle of Ypres in April '15. He was withthe 2nd Field Ambulance (RCAMC) and

had his AdvancedDressing Station in asmall town calledWieltje. The first gasattack was launched onApril 22 and the battleraged for three daysduring which time hewas posted to the 14thBtn (RMR). In all, hetreated over 400 casu-alties under constantshell and machine gun

fire. He evacuated many of the woundedhimself assisting the stretcher bearersand carried an officer on his back, in andout of shell holes and over a moat. Inthree days, he had only four hours sleep.The situation was terribly difficult for the1st Cdn Division as the French AlgerianTurcos on their left had broken in thepanic of the gas attack, so the Canadianshad to fill the hole in the line.

'P Lettersto The Editor

Dr.Saimger

The VC is the highest decoration for brav-ery in the British Empire, the cross itselfis made from the guns of Nelson's H.M.5.Victory. You may not know that Mrs. FaithFeindel is Dr. Scrimger's niece.

P'S.: I should add that at that time Capt.Scrimger was a small man 5' 7" in height,weighing 135 pounds.

HJ. Scott,M.D

Montreal, Quebec

Dear Editor,

Very many thanks for the photos of the'Do' in Montreal when I was made a Pa-tron by the Royal College of Surgeons.You covered it extremely well in TheSquare Knot and we enjoyed the photosthemselves of the main scenes and manyof my friends.

It was wonderful to see so many again aswell as the New President, his charmingwife and Secretary Martyn Coomer.Rachel and I thank you very much.

Harry S.Morton, M.D.

Halifax, N.s.

Dear Editor,

I enjoyed reading The Square Knot au-tumn '99.

However, on page 9, there was quite asubstantial typo in the title of our pre-sentation at the CAGS RCPSCmeeting:"After Reversible Fetal Tracheal Occlusionin ...." should actually read:

CAGSDAVIS and GECKAward- Basic Sci-ence: Lung Growth and Structural Devel-opment After Reversible Fetal TrachealOcclusion In Diaphragmatic Hernia.

Also, we presented the same paper at theSurgical Forum at the ACS in San Fran-cisco 1999.

Thank you,loanaBratu

Editor's Note: The Square Knot regretsthis error.

Dear Editor,

Re: Filth and Despair at the RVH

I recently attended the 40th reunion of theMedical Classof 1959 in Montreal. On Sat-urday, October 16, 1999 at about 0900hours, Ann Van Alstyne, a past graduate ofthe RVHSchool of Nursing, and I took theopportunity to walk around and through

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the RVH, including the Nurses' Residence.We were appalled at what we saw.

We entered the Emergency Departmentthrough the roadway to the ambulanceentrance as it was unclear to us wherethe walking wounded went. The roadwayand associated sidewalk were litteredwith trash. The E.D.itself with its $13 mil-lion renovation lay empty save for onelone woman who was standing at theempty triage station, and the two admis-sion clerks that were doing their best toignore her. Ann and I went to the Radi-ology Department and back to the E.D.where the woman was still standing. Shefinally realised that the triage nurse wasnot going to show, so she went to one ofthe receptionists who told her to wait asthe nurse would return (no attempt wasmade to find the nurse). I went to onereceptionist to find out who was the headof the E.D.to let him/her know what wasgoing on. Neither receptionist knew thename of the chief. We left disgusted withtheir attitude, their lack of knowledgeand their lack of empathy for the patient.

We then ascended the stairs that go un-der and then along side the newer rampfrom the Women's Pavilion (WP) to a floorabove the E.D. The area was strewn withugly paper, card board and beer bottles.Next, we went towards the west end ofthe WP hoping to get to the Ross(we hadforgotten that the way was blocked). Thisarea was desolate and filthy and over-grown with weeds everywhere. Largepieces of wood were missing from a door,stones had falling from the building andfrom an old ramp, and of course the ubiq-uitous garbage was present.

We retraced our steps and went in theUniversity Entrance to the WP and up tothe main floor where a single guard ig-nored us until we asked him if we couldstill get to the Ross from the front en-trance of the WP. He was then most con-genial and wanted us to see the newwalkway going from the 5th (?) ~

(please see Letters, pg.l0)

O.R.TIME-

As we enter the New Millennium, it is compelling to considerwhat problems we have to solve. The first is that we desper-ately need more OR time. Ever since the early 90's, there hasbeen a gradual and insidious diminution of space on the Op-erating Schedule for Surgeons of all specialties. This has beentrue all acrossCanada (especially in Ottawa), but appears more

marked in the McGill Hospitals. There are anumber of reasons - shortage of Anaes-thetists, not enough Nurses, less beds avail-

able and major budget cuts. A Surgeon is most dependent onhospital resources and along with his/her patients "suffers" themost when these are in short supply.

Editorial

It used to be that a Surgeon was assigned one day per weekfor elective cases. In retrospect, those were halycon days. Letus do the math: if 5 cases were done per operating day, thisamounted to 20 interventions per month. Nowadays, theusual allocation is 1/2 day per week or 2 days per month. This,therefore, amounts to 10 cases done per month. After 6months, you will have a wait list of 60 patients! In December,there were 541 patients waiting for General Surgery at theRVH site. When one considers that some of these have re-doubtable conditions such as cancer, inflammatory bowel dis-ease or are awaiting transplantation, one can well understandthe anxiety amongst patients and the harassment experiencedby their Surgeons.

In the MUHC, patients waiting for elective operations in Or-thopedic Surgery may wait anywhere from 1 month to 1year. From September 12th to December 9th last fall, therewere 114 patients awaiting hip surgery, 163 for knees and6 for back operations. On September 1st,there were 19 patients awaiting operationsfor cancer at the RVH. It took three monthsto process them. What is even worse isthat, after going through Pre-AdmissionTests and a long waiting period, the oper-ation can be cancelled at the last moment.

Dr.Nicolas Christou, Head of the MUHC Divi-sion of General Surgery, is working very hardto alleviate the difficult situation. Recently,he prepared OR schedules for the RVH andMGH sites (historic documents in them-selves). In these, there are also Reservedtimes (for allocation by the Chiefs of Ser-vices), High Efficiency ORs, and correlationwith wait lists. Dr. Christou himself has along list of potential patients waiting for

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bariatric surgery - anywhere from 6 months to one year.Surgeons have learned to be quite flexible in adjusting tothese new and difficult times. We have been good. Our Av-erage Duration of Stay is 7.9 days and Same Day Admissionsare 66% for General Surgery. Around 20% of our admissionsare admitted for less than 48 hours. We still do close to 10,000(9,465 in 1999) operations per year (inpatient and outpatient)in the Main Suite at the RVH. This amounts to some 20,000hours. While the volume of cases has remained stable, thehours per case have been increasing. This demonstrates theadded complexity of our cases.

The Division of General Surgery is even currently looking toother hospitals for added OR time. It is felt that we havestreamlined our efforts to maximize the delivery of care in theOR's and on the Wards and that there is very little room forimprovement.

However, problems persist. The media is very pre-occupiedwith the congestion in Montreal Emergency Rooms and theMinistry of Health has responded partially. In 1999, the Min-istry was also pre-occupied with shortening the waiting listsfor cataract and cardiac surgery (In Quebec, there are currently750 patients on the latter list). But for most Surgeons, we feelthat our voice is heard, but not heeded. We all know of pa-tients who went to the United States to have their knees, hipsor back "fixed" because they could not wait any longer. Need-less to say, this is at an increased cost.

It is time that the Ministry works with us to correct this alarm-ing situation so as to enrich the care of our patients .•

"You'd love my Dr.Brodie. His creed is rest, rest, rest, and more rest."

- TheNew Yorker

3

Upcoming

Events

February 10,2000

Rocke Robertson DayVisiting Professor: Dr. Marc SwiontkowskiChair, Orthopedic SurgeryUniversity of Minnesota Medical School

February 17-19,2000

Symposium on Colorectal Disease in theNew MillenniumFort Lauderdale, Florida.

February 24, 2000

General Surgery DayVisiting Professor - Dr. Ori RotsteinProfessor of Surgery & Head, Division ofGeneral SurgeryUniversity ofToronto Healthcare Network

April 9-14,2000Royal College Accreditation of allPrograms

April 12-13, 2000E.J. Tabah Visiting Professor in SurgicalOncologyDr. Alfred M. CohenMemorial Sloan-Kettering Cancer Centre,New York

April 19, 2000Urology Research DayVisiting Professor: Dr. Laurence KlotzUniversity ofToronto

May 3-5, 2000

Annual McGill Orthopedic Visiting ProfessorDr. Ian J. AlexanderAkron, Ohio

May 18,2000

Fraser Gurd DayVisiting Professor: Dr. Dhiraj ShahChair, Vascular SurgeryAlbany Medical Center

June 1-2, 2000

Stikeman Visiting ProfessorshipDr.William A. BaumgartnerCardiac Surgeon-in-ChiefJohns Hopkins Hospital

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Dates to

Remember

September 21-24, 2000

Annual MeetingRoyal College of Physicians & Surgeonsof CanadaAnnual Meeting of CA.G.S.Edmonton, Alberta.

September 20-23, 2001

Annual MeetingRoyal College of Physicians & Surgeonsof CanadaOttawa, Ontario.

September 25-28, 2002

Annual MeetingRoyal College of Physicians & Surgeonsof CanadaOttawa, Ontario.

..............................................................................................................................

Were You There? Hyperbaric Chamber, RVH 1963

4

~ the provinces has decreased from 30.6% in 1980 to21.5% in 1996. The provinces facing their own fiscal problemshave in turn decreased spending in the health field. Canada isalmost unique in that the percentage of gross domestic

product (GDP) spent on health actuallyHealth Crisis decreased from 1990 to 1997. During

(continued from pg.l) that same period, private funding ofhealth care in Canada increased from

25 to 30%. Many think it should be even higher to relieve thepressure on the public system.

Mr. Ralph Klein, Premier of Alberta, has suggested that private"clinics" could provide surgical care if such services are inade-quately provided by the publically funded system. He men-tions hip replacements as a current need. He says his newsystem will comply with the Canada Health Act.

Even M. Claude Castonguay , the father of medicare in Que-bec, thinks the public system has reached its limit. He favorsa system of tax credits to encourage innovative approaches tocare. "Si I'octroi de credits est justifie dans des secteurscomme Ie multimedia, leur justification serait encore plusgrande en sante." As Arnold Aberman, former Dean of Med-icine, University of Toronto has said "Decriminalize medicalacts between consenting adults and allow patients to pur-chase more medical care than the government provides':

Indeed, why not encourage a parallel private system if 30% ofthe care is already private? There are several reasons. First,mostof the 30%, i.e., nursing home care, drug costs outside the hos-pital and non-physician professional services were never cov-ered by medicare and have always depended on insurance orout of pocket expenditures. The current problem is that we arespending lesson those services that the populace really expects,i.e., efficient and prompt care for acute and life threatening ill-ness. Canada has moved from second in expenditures per capitato fifth in the very brief period 1990 to 1997. We spend 9% ofGDPon health, but this figure is significantly lower in Quebec.David Naylor, a Canadian expert on health care delivery, haspointed out that spending in Canada has actually decreased17% for hospitals, 7.7% for physicians, but has increased 21%for drugs and 50% for home care. The changes have been ac-comp~ished with the cooperation of the profession, but notwithout adverse effects on patient care. Furthermore, the rateof these changes has been profoundly disturbing for the pub-lic, physicians, and nurses.

The public's discontent is principally focused on the long wait-ing lists for operations which have been redefined as electiveor non-urgent, and on the overcrowding of emergency rooms.While many factors contribute to these problems, the bureau-

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cratically mandated bottlenecks within the hospitals are im-portant factors. Despite the incredible decrease in length ofstay for acute care, the penury of rehabilitation and nursinghome beds results in occupation of acute care beds for longerthan necessary. The chronically overcrowded emergencyrooms similarly result, in part, from the lack of in-patient bedsto which patients needing hospitalization can be transferred.

How will private clinics alleviate these problems? The answerwould appear to be that the operators of these clinics willmake the investment in the leasing or building of facilitiesand in the provision of the equipment and supplies. The re-turn on their investment will come on the profit generated bycharges for the use of the equipment and the provision of sup-plies (drugs, prosthetic devises, lens, etc). Citizens able to af-ford the services will be offered the opportunity to use theseclinics. However, the services of the physicians and surgeonswill continue to be borne by the public purse. Thus, it wouldseem that we will have a two tier system subsidized by pub-lic funds. I have no problem with the private practice of med-icine as long as it is funded entirely by the private sector andconforms to established standards of practice.

If, as Mr. Klein proposes, more extensive procedures such as to-tal hip replacements are to be done in the clinics, the situa-tion becomes even more complicated. Who will provide bloodbanking and laboratory services for these procedures? Willthe private clinic be allowed to pay nurses, inhalation thera-pists, and physiotherapists higher salaries that those paid inthe public systems? And where will the patients go aftersurgery? Will they be competing with the patients from thepublic services for available rehabilitation services? Who willbe responsible for quality assurance in these clinics? Tax cred-its, such as suggested by M. Castonguay, would more directlysubsidize private clinics, but would require another layer ofbureaucracy to decide who would or would not be eligible fora given credit. We already have one bureaucrat for everyphysician in Quebec. Would the operators have to be residentsof the province or could they be entrepreneurs from Dallas?

Others have suggested a registered health savings plan (RHSP)that would allow boomers to save up to $10,000. per year taxfree for their old age. Most do not now take advantage of theRRSp,but the real issue is how does this solve the problem ofthose who would not be able to afford the RHSP?

I am not arguing for the status quo because there are very se-rious problems in our cherished single payer system. Nationalpolls show that six of ten Canadians assessed the health sys-tem as Excellent or Very Good in 1991. By 1996, only four often made those ratings, while one-quarter of ~

~ respondents rated the system as Fair or Poor. In1998, an international survey found that 18% of Americans be-lieved that recent changes harmed their system's quality of careas opposed to 46% of Canadians. These polls emphasize the ex-tent to which the public equates high-quality health care withaccessto a stable hospital system. We should spend more onthose aspects of care that we know work and less on those as-pects that are unproved with their inherent bureaucracy.

Another reason to support hospitals is the maintenance of stan-dards of practice which have been highly developed and refinedin hospitals. Morbidity-mortality rounds, tissue committees,peer review rounds, outcomes analyses have all been developedin the hospital and are the basis of excellence in practice.

Much of the really alarming information on decline of healthservices remains anecdotal. Likewise, there is frustratinglylittle information on areas in which we excel. Health researchto document national and local results provided by our systemis urgently needed. The use of life expectancy at birth or atage 65 is not a sufficient measure of outcome of the system.

In summary, critics of the Canada Health Act suggest thatmulti-tier care is a fact of life. Workmen's compensation boards

Dc.Beaulieu and P.Nault .om the Depart·ment of Vascular Surgery at the C.H.V.O.in Gatineau, Quebec

would like to remind everyonethat there is a meeting of the "En-tretiens Vasculaires" May 5th and6th, 2000 in Hull, Quebec. Invitedspeakers from the Mayo Clinic andthe University of California, los An-

geles will attend. Furthermore, Dr. Archana Ramaswamywill be presenting on two topics: Outcomes of Ruptured AAA

in the Elderly and Intra-operative duplex ultrasound during

carotid endarterectomy surgery. •

Vascular Surgeryat (.H.V.O.

Please visit the website for more details:http://www.rocler.qc.ca/entretiens-vasculaires

Andreas Nikolis, M.D. (R-4)

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in each province provide parallel systems with built-in queuejumping. Other affluent patients are jumping the queue toobtain MRls by paying an illegal fee for examinations usingpublicly purchased equipment. Some Canadians are seekingcare in the United States. Those who support our systemworry that a private tier would be parasitic. It would limit it-self to highly remunerative services and at the same timewould be luring clinicians from the public sector. There is nodoubt that first-dollar coverage has led to more equitable ac-cess to health services and greater spending on care for thosein lower socioeconomic brackets. Polls once again are reveal-ing. Sixty percent of Canadians reject the concept of a twotier system. The support that exists for some form of parallelsystem is related to fears that the public system is deteriorat-ing. "Reform of the system" has in the past meant more bu-reaucrats making more plans. Perhaps it is time to dispensewith the micro-management at the center and direct themuch needed increase in funding towards the institutions cur-rently delivering care to the sick. Rather than move to a twotier system, lets save the first system first.

Editor's Note: The Square Knot thanks Dr. Maclean for con-tributing this article as the first one of the new millennium,our 22nd edition. •

Tee TimeA golfer was addressing his ball, getting ready toshoot. As he was about ready to hit, a voice cameover the PA system. "Will the gentleman on theladies' tee please move back tothe men's tee': He lookedup and then resumed ad-dressing the ball again.The voice again - "Will theMan on the RedTeesmoveback to the White Tees!!"He looked back at thestarter's shack and said,"Will the man on the PAshut up so that the man onthe ladies'tee can hit his sec-ond shot':

6

Auto Sutu~ Company, Canada and the McGillHospital Group has had a long-standing relationship, whichdates back to the late 1970's. The Montreal General Hospitalwas one of the first to embrace what was then a medical cu-

riosity, the surgical stapler! Through theyears, technology has developed at lightspeed, whereas today, most surgical in-terventions are performed by MinimallyInvasive instruments developed and in-troduced by United States Surgical.

Auto Sutureand McGill

As technology has developed, so has theneed for proper training methods in both thetraditional and the new surgical procedures.Both residents and established surgeonsalike realize that to stay at the cutting edgeof surgery, training and education are para-mount to their success rate, which translatesinto the utmost in patient care.

The latest development in education is theAuto Suture Centers of Excellence. A fullyfunded training center dedicated to the de-velopment of surgical residents and new sur-gical concepts has been established at TheMontreal General Hospital, headed byDr. Gerald Fried. Auto Suture Company hasbeen a supporter of the Center of Excellencefor over 5 years now, and are very proud ofthe accomplishments that have taken placeduring that time. The McGill Group Center of

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Excellence has grown through the years and now enjoys thereputation as one of the top surgical training centers, not onlyin Canada, but also among the Centers in the United States.

We would like to take this opportunity to thank and congrat-ulate Dr. Fried, his staff and the McGill Hospital Group for theircontributions to development of new and challenging train-ing concepts, and we look foreword to continuing to be an im-portant supporter in the future .•

Vince GiammariaTYCOHealth care Canada...

TAuto SutureCanada

7

Dr.Gerry Fried demonstrating the laparos(opy Skills Station

...............................................................................................................................Lloyd D. Maclean

DayVISION FOR THE FUTUREOn November 25th, a meeting ofsurgeons of the McGill Departmentof Surgery was held at the Omni

Hotel here in Montreal. Chaired by Dr. J.L. Meakins, the topicson the agenda were as follows:

• Review of the Year (Dr. J.L. Meakins)• Residency Program

- Royal College Accreditation(Currently, all the Surgical Programs are "approved").

- Number of Residents

• TaskForceon Processesof Core(Drs.P. Metrakos & EdHarvey)• Mission Statement• Recruitment and Retention Committee(Dr. M. Elhilali)

- Memorandum of Agreement (See elsewhere in thesepages for more about this).

• Principles of Resource Aliocation(Dr. J.L. Meakins)• Plans for the Future(Dr. J.L. Meakins)

Afterwards, there was a delightful cocktail party followed bydinner in the Salon Printemps .•

EOM

Chairman's Message- By Jonathan L.Meakins, M.D., D.Se., F.R.C.S.C., F.A.C.S.

OnSaturday, January 1S, the McGill Depart-ment of Surgery held a retreat for staff and residents, as wellas invited nurses and anesthetists, at the Mcintyre Medical

Sciences Building. Our thanks toDean Abe Fuks, Dr.Hugh Scott and Dr.Denis Roy for their participation.More than six years have passed sincethe last Department-wide retreatand much has changed in the in-

terim. Financial and human resources are tight. Access tothe O.R., I.CU and beds becomes more difficult almost witheach passing day. Our Departmental mission and values

might seem obvious, but it is apparentthat not all share exactly the same vi-sion. A declaration of a common mis-sion, values and goals was the first stepin defining our priorities. From there,the principles against which we evalu-ate ourselves and base the allocation ofresources can be defined and enunci-ated. Drafts of a Mission Statement, ofcriteria for prioritizing the allocation ofresources, and of a Memorandum ofAgreement between the Departmentand its recruits had been circulated ex-tensively since the fall. The retreat wasdesigned to come to closure on thesesubjects as well as deal with a varietyof other issues on the horizon.

Message From

The Chair

';\~\

Dr.Jonathan L. Meakins

The morning workshops addressed issues pertaining to thestructure of the Department under the following topics: Mis-sion Statement, Memorandum of Agreement for New Staff,Core Program, Research, and Information Services/InnovativeTechnology. The afternoon sessions addressed clinical man-agement issues under the heading: Models of Surgical Care forthe 21st Century and O.R.Efficiency.

In addition, all the teams were assigned the topic "Criteria forPrioritizing the Allocation of Resources': These criteria willeventually be the PRINCIPLESupon which the Department willallocate its resources. The fourteen criteria established by theDepartment of Surgery at the University of Toronto were the

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template for discussion. The definitions and order of impor-tance established at U. of T. were used as a guide. These arethe same criteria presented last November at Lloyd D.MacleanDay. On that occasion, participants were asked to rank the cri-teria in order of importance, but only 18 of the 50 or so at-tendees handed in the ranking sheet.

Such an exercise may appear futile given the current paucityof both human and material resources. However, as resourcesbecome available, their eventual allocation will be based uponthe ranking the Department has given each criteria. Fifty ofthe 63 participants at the Retreat rated each criteria from 1 to5, with 1 being the highest score and 5 the lowest. The re-sults are presented in the following table and compared to theranking used at U. of T.

Criteria for prioritizing allocation of resources (in order of im-portance):

RAN K AT MCGILL

CRITERIA AND OVERALL SCORE

Rank at Criteria and overall scored Rank

McGill U. ofT.

1 Excellence of patient care (58) 12 Excellence in research (69) 43 Importance of clinical service (70) 24 Excellence in teaching (75) 35 Excellence in innovation (85) 56 Terms of recruitment (90) 117 Long range plans (116) 88 Full-time vs. Part-time status (130) 109 Administration (139) 610 Fellows (142) 1311 Cost of program (148) 912 Determination of program size (153) 1213 Status of prior commitments (181) 714 Non-insured services (191) 14

The McGill Department has re-ordered the Toronto templatein several ways. Most striking is the "Terms of Recruitment"which we ranked sixth in importance. This is linked to ourcommitment to our younger members, as evidenced by thenewly implemented Memorandum of Agreement (MOA). TheMOA will be featured in the Spring issue of the Square Knot.The obligations of the Division, Department, Hospital and Fac-ulty to our recruits will be spelled out in the MOA as will ourexpectations of them. This is the Department's way of recog-nizing that our future depends on our new blood ~

8

~ and that commitment to our recruits is the key tokeeping them at McGill.

Equally interesting is the lesser importance given to the "Sta-tus of Prior Commitments': Comments of the group leadersare not all in, but the low ranking (13th) suggests that, in thistime of rapid technological change and evolving clinical ap-proaches to classic surgical problems, we must be very sensi-tive to ongoing performance, other commitments and theneeds of patients. Also of note, "Full-time Status" was seen asmore important at McGill than in Toronto and "Administration"as less important.

Thesecriteria are reflected in our Mission Statement (see below).The Statement was written with our historic values in mind,but via an independent process. That the criteria for prioritiz-ing the allocation of resources and the Mission Statement are

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in consonance is validating and clearly defines our values.These criteria can now legitimately become the Principlesupon which we allocate resources.

Having established the relative importance of these Principles,the Department must now refine the definition and the meth-ods of evaluation of each. These will be featured in the Springissue of the Square Knot. •

..............................................................................................................................

Mission StatementTHE MISSION of the Department of Surgery is the pursuit ofexcellence in comprehensive, patient-centered surgical care,teaching, research and evaluation of technology. The Depart-ment's foremost responsibility is to its patients. To fulfill itslarger role, the Department must also lead in the developmentof new knowledge and techniques, in the transmission of theseto its communities of students, and in their application for thebenefit of all society at large.

TOTHIS END,

The Department will provide for its patients of all agescomprehensive care of the highest quality, in a timely, ef-fective, and efficient manner. Clinical care will be evidence-based wherever possible, and patient-centered outcomeswill be monitored.

In fulfilling its educational mission, the Department will pro-vide to its medical students, residents, fellows, as well as to itscommunity of surgeons, the programs and learning environ-ment to stimulate their curiosity and creativity and, to developthe professional skills and human qualities required to deliverspecialized surgical care.

The Departmental research programs will encompass basicscience, clinical investigation, health service studies, and eval-uation of technology and clinical care delivery systems. The

Department will train surgeon-scientists and surgeon-educa-tors for its own renewal, as well as for the province, countryand the international community.

The Department will promote the development of new tech-niques and technologies, evaluate them for safety and efficacy,and define the methodology for their introduction into clini-cal practice .•

...................................................WelcomeAboard

~

Dr. John Antoniou joined TheJewish General Hospital in theDepartment of OrthopedicSurgery on January 1", 2000. •

~ level to the main building. Wedid this to please his enthusiasm. As wecrossed to the Main, we of course couldnow see the crap and corruption men-

tioned before from the van-tage point of height, and itlooked no better. Prior toleaving the Wp,we asked theguard about patient floors

and he said that only two were used and(sadly) the rest had been commandeeredfor the administration.

Letters(continued from pg. 2)

We took the Main elevators to the eighthfloor and crossed to the Ross. It was de-serted except for those in the Cafe. Wewent to the lobby at the front entrancewhere someone was about to enter theelevator. He told us that patients wereonly on the 3rd and 5th floor and the restof the Rosswas inherited by administra-tion. The place looked as though it had-n't been painted since I was in residency.

We then went out through the front en-trance of the Rossand down the hill intothe old Nurses' Residence. This part of thegrounds was better kept than the onespreviously mentioned. The stairwell lead-ing to the residence looked unkempt butnot strewn with garbage. The residenceitself looked its age, but was not shabby.It was sad to see that a place that hadbeen home to so many outstanding nurs-ing students was relegated to a researchrather than an education centre. Ofcourse there was the ubiquitous housingfor administration. We left by the sidedoor of the residence and back up thestairs and down the Ross Road to PineAvenue as the front door to the Residencewas closed. At last we were in sunshineand the pile of unkempt buildings thatwas once our place of work and homeaway from home many years ago was be-hind us forever.

Ann and I had two comments to make toone another as we left. First, the staffmust be terribly demoralised, witness theE.D.and the fact that no one stopped us

in our travels to ask if we needed help oreven to observe whether we were steal-ing anything. Secondly,we were sure thatGilbert Turner would have mobilised thespirit and pride of the professional staffand of the RVH Volunteer Organisationsto get out and clean up the joint, if therewas not enough money in the budget topay for upkeep and repair. We thoughtthat our generation would have re-sponded, why at least has not the surgi-cal staff of your generation responded??

Lastly, who made the asinine decision tolocate the new University Hospital so farfrom the University Medical School andfrom the patients in central Montreal thatget their care from the present hospitalsites. I, for one, will not contribute to sucha poorly conceived plan. Make use out ofthe RVH,the MNI, the Pathology Buildingand the' old University Medical Schoolsites so that there is a symbiosis with theMedical School for education and basic,but especially clinical research!!Warmest regards,

James RMackenzie, M.D.

Calgary, Alberta

Dear Editor,

Addendum to MUHC'sTransplant History.

I would like to expand on your history oftransplantation at McGill, and to includemore details on pediatric liver trans-plants. As noted, Dr. Pierre Daloze car-ried out several unsuccessful transplantsin the early '60s (the pre-cyclosporin era)at the Notre Dame Hospital, one on avery small baby. In the cyclosporin era,the MCH was the site of the next at-tempt, unsuccessful also, under the di-rection of Drs. Pierre Daloze, HerveBlanchard, and Frank Guttman, in 1983.However, on Dec. 4th, 1985, Drs.Guttman, Blanchard and Jean-MartinLaberge carried out a successful livertransplant on a 13 month old girl withCrigler-Najjar syndrome. She is now fif-teen years old, doing very well in school,

THE SQUARE..z~a charming young lady. She is the firstCanadian long-term survivor of 10 kg.

At about this time, the Regie urged theUniversity of Montreal and McGill to forma joint children's program at Ste Justineand the MCH. A place was also reservedfor a future adult McGill program by theRegie. In 1986, the first transplant wascarried out at Ste Justine Hospital withthe surgeons of both hospitals participat-ing. Since that time, the joint programhas carried out over 146 operations. Thishas gone on with surgeons available atthe moment, including Jean Tchervenkov,and more recently, Dickens St. Vii andMichel Lallier. Jean-Martin Laberge con-tinues to play an active role.

Frank Guttman, M.D.

Montreal.

Dear Editor,

I continue to enjoy reading The SquareKnot from cover to cover. In fact, it islikely the only publication that receivesmy full attention!

Having completed my 10th year of life asan attending general thoracic surgeon, Ifind myself remembering my very excel-lent general surgical training at McGill Uni-versity and the Royal Victoria Hospital. Iam currently very busy in private practicein Chicago and still involved in the activi-ties of the ACS,STS,ASCO,GTSCand ACCP.

Regards to all at the RVH who may re-member me. I think about you often ..

Jemi Olak, M.D.

Lutheran General Cancer Care Center

Park Ridge, Illinois

Editor's Note: The Square Knot thanksDr.Olak for her generous cheque .•

10

T.tum of the centu~ has been an exciting timefor McGill General Surgery Residents. Amongst other develop-ments, this last year has seen the creation of a new entity

within the McGill GeneralSurgery Training Program, theGeneral Surgery Residents'Committee. In order to ad-dress resident related issueswithin the training program,the Residents' Committee

was founded on February 17, 1999 by multiple, interested ju-nior and senior residents in General Surgery. The Residents'Committee continues to receive strong support from both theHead of MUHC General Surgery, Dr. Nicolas V. Christou, andthe General Surgery Program Director, Dr. Judith Trudel. Asdefined by its constitution, the mission statement of the Res-idents' Committee involves the following: "to work in the in-terests of residents in General Surgery, promote a close liaisonand cohesiveness between residents and staff, to be achievedthrough education, communication and social activities, all tofurther knowledge and increase morale': The Residents' Com-mittee convenes on a monthly basis, and meetings are opento any and all General Surgery residents who wish to partici-pate. The Committee nominates and elects residents to cer-tain positions of responsibility. These include Secretary,Treasurer,Ombudsman, Director of Education, Director of Com-munication, Social Director and Chairperson. We are granteda generous budget of $6000. per year from the Division ofGeneral Surgery in order to fulfill our mandate.

The McGill GeneralSurgery Residents'

Committee

Despite its youth, the Residents' Committeehas addressed multiple issues and accom-plished several goals. In order to improve andfacilitate communication amongst residents, acalendar concerning all program activities in-cluding teaching events, is mailed to residentson a monthly basis. In addition, an e-maillist-serv was formed. Social activities orga-nized by residents were enhanced withmonthly TGIF beer & pizza gatherings, and awelcome/initiation for first year residents(with appropriate ceremonies). A monthlyResident's Journal Club was restarted. Withthe support of Dr. Christou, the Residents'Committee revised the Staff and Service As-sessment Forms in order to better address ed-ucational issues relating of residents.

THE SQUARE!:!~

We have purchased reference material and hardware to aug-ment the computers and books already present in the Resi-dent Resource Centre at the Royal Victoria Hospital, and theRea Brown Room at the Montreal General Hospital. Both ofthese resident resource rooms are relatively new additions tothe program, and demonstrate the generosity and commit-ment of Staff towards residents.

In addition, the Residents' Committee drafted a list of propos-als for the training program. The concept of an Academic HalfDay,one of the key proposals, was received with great enthu-siasm by staff. In partnership with residents and Dr. SarkisMeterrissian, a weekly General Surgery Academic Half Daywas organized, and begun January 12, 2000. The AcademicHalf Day provides protected teaching to all General Surgeryresidents from 1:00 to 6:00 PM every Wednesday afternoon.The Academic Half Day has already proved to be an immenselypositive addition to General Surgery teaching, and promises tobe a great strength for the program in the future.

Current issues for the Committee include improving residents'Internet-based operative logs, addressing call schedule require-ments, the election of Staff and Resident Teaching Awards andthe planning of a ski trip. As residents within McGill GeneralSurgery, we are keenly committed to our program. We are ex-tremely fortunate to receive immense support, both financiallyand in spirit, from the Head of General Surgery, the Program Di-rector and from individual Staff members. We hope that as res-idents, we may contribute to the further great success of theMcGill General Surgery Training Program. •

Andrew Jf Seely, M.D.Chairperson, McGill General Surgery Residents' Committee

~The General Surgery Residents'Resource Center

Room 59.48, RVHSite of the MUHC was opened on October 7th, 1999.A special "thank you" to Christou for all his efforts in making this room a reality for our residents.

11

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Division of Surgical Research- By Lawren(e Rosenberg, Director

liThe abdomen, the chest, and the brain will forever be

shut from the intrusion of the wise and humane surgeon."- Sir John Eric, British surgeon, appointed Surgeon-Extraor-dinary to Queen Victoria, 7837.

The increasing pace of in-novation and technologicalchange, combined withheightened competition forresources, have been the

principal drivers in the creation of the MUHC. The Depart-ment of Surgery is no less immune to the tremendous up-heavals that we experience almost daily. The bottom line is,that if we are to survive and prosper as a world-class de-partment in this new order, we must become more compet-itive in all spheres of activity.

Research in Surgeryat the Crossroads

BEST ATTRACTS BESTAn organization that has leading intellect, can attract bettertalent than its competitors can. The best people want towork with the best people. Recruiting, developing and cap-turing individuals' intellectual capabilities has been the keyto strategic success for most knowledge-based enterprises(e.g. Mayo Clinic).

This has rarely been a problem with respect to clinical activ-ity; however for research, we now stand at the crossroads. Be-coming more competitive means striving for excellence inresearch; and to do so, requires that we raise the bar higherthen ever before.

The Conference Board of Canada, one of the country's leadingeconomic think-tanks, recently issued an urgent call for gov-ernments and institutions to wake up and start building aculture of innovation as the engine to drive productivity.Canada is falling behind the pack in several key measures ofinnovative behaviour- like the proportion of GDPspent on re-search and development, the number of researchers workingon new technology and the number of patent applicationsmade. The same comments might be applied to our Depart-ment locally. In the end, institutional performance is directlylinked to an organization's capacity to innovate. In a way, thisis also the driving force behind the MUHC.

THE SQUAREi:!5:13

Intangibles are fast becoming substitutes for physical assets.What makes intangible assets so valuable? One big differenceis that when you're dealing with tangible assets (e.g. a build-ing or equipment), your ability to leverage them- to get addi-tional value out of them- is limited. With knowledge assets,youget what economists call "increasing returns to scale." That'sone key to intangible assets: the larger the network of users,the greater the benefit to everyone.

/S THERE A DOWNS/DE TO KNOWLEDGE ASSETS?Knowledge assets are very expensive both to acquire and todevelop. And they're extremely difficult to manage. While thebenefits that come from knowledge assets can be enormous,they are much more uncertain than the benefits of tangibleassets, e.g. when you invest in a tangible asset, you always getsome kind of return. But when you're building a knowledgeasset, you could quite possibly end up with nothing. Nonethe-less, Pierre Belanger (V.P. [Research] and Dean [Faculty ofGraduate Studies and Research]) has recently written that thetwin objectives of the university are training and the discov-ery of new knowledge. The product of the university isknowledge.

Knowledge building, innovation and scientific-technologicaladvance are the critical ingredients for growth and competi-tive advantage today. It is these elements that must differ-entiate the McGill Department of Surgery from departmentsout in the community and at other universities.

RESEARCH CHALLENGES THAT MUST BE ADDRESSED

o The Department must seek to establish a competitive natureas well as a competitive position in the country and inter-nationally; and then put in place a strategy to maintain it.

f} The Department must adopt a culture of excellence in re-search in keeping with its Mission Statement. This meansestablishing, and rigorously enforcing, high standards in theconduct of research.

@) As a corollary, an infrastructure of support to nurture researchactivities within the Department must be established.o New sources of revenues must be sought. In this regard,

intellectual capital can be a revenue generator, as well asan image-enhancer. Resourcefulness must become as im-portant as resources.o As part of the process of prioritization currently underway

with respect to clinical activities, the Department mustidentify the specific areas of research which it will support.

Advances and innovation occur at the edge, i.e. at the bound-aries of different fields rather than within single fields- a trendthat promises to continue and accelerate. A recent ~

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TAssociation of Canadian Medical Colleges, The As-sociation of Canadian Teaching Hospitals, The Alumni and

Friends ofthe Medical ResearchCouncil (MRC)Canada and Part-

ners in Research present

Year 2000 - A Celebration

of Canadian Healthcare

Research. This calendar is

a dedication to Canada's

leading historical and contemporary medical scientists.

Millennium Calendar

2000Canadian investigators have led the way in cardiac research -

from the experimental for a few, to the mainstream for many;

from inside and out; from a century ago until yesterday. The

beat goes on. February is Heart Month and it is fitting that

Dr. Ray Chu-Jeng Chiu be among other medical researchers

THE SQUARE..z5:15

recognized for his work in the field

of cardiac research during this

month. It reads:

"Dr. Ray Chu-Jeng Chiu - Knowing

that the heart muscle, unlike other

muscles, does not need rest, Dr.

Chiu set out to find a way to adapt

muscle from the back so that it can

help a weak heart to function. In

an amazing combination of bio-

chemistry and surgery, he accom-

plished what he set out to do and he now takes his place

among medical research pioneers."

Dr. Ray C-J.Chiu

The Square Knot congratulates Dr. Chiu and wish him contin-

ued success in his research projects .•

EKL

........................................................... , .

CANADIAN RESIDENTMATCHINGSERVICE

The rumour in medical education when I first joined CaRMS

(or CIMS as it was then known), was that the match was ac-

tually done on Charles Caster-

CaRMS Goes Onto ton's kitchen table. There may

/I II have been some truth to that, as<'f. The Net it was a manualsY5tem with suchftf::J crude security as a locked and

« ~ taped up office where the cleaning staff were denied entrance<i >

until the match was completed. Well, those days are long

gone. This year, CaRMS moves into the new millennium by

going electronic via the web. The CaRMSBoard of Directors

announces two new electronic procedures to enhance and

stream line the matching process.

First, in the 2000 match, applicants and programs alike will be

able to go in to the Internet to check the accuracy of their

rank order lists at CaRMS. Eachparticipant will be given a per-

sonal identifier that will allow them to confidentially confirm

the rankings as they appear in the CaRMScomputer. By mov-

ing to an electronic confirmation process, CaRMScan extend

their rank order list deadline until February 22, allowing stu-

dents and programs longer to make their final decision.

Secondly, the match results will be available on the Internet

for the 2000 match. All applicants and programs directors can

use the personal identifier to go into the CaRMSweb site and

see their final match results. The vacancies available for the

second iteration will also be posted on the Internet. The

match results will be posted for the unmatched students on

March 13 at noon ESTand for matched students on March 15.

The results for the second iteration will also be available on

the Internet and the end of March. CaRMSwill continue to

mail a hard copy of the results to programs and applicants.

By 2002, all application procedures and matching results will

be electronic. The application will be available on the web

and will be sent electronically and participants will be able to

put their rank order lists on the web instead of mailing it to

CaRMS. The goal in introducing all of these innovations is to

provide more time before the graduating student has to make

a career decision and enhance confidence in the match.

CaRMS is hosting an Interview Forum at the ACMC annual

meeting in Whistler, B.C.on April 29. There are many chal-

lenges in scheduling and conducting interviews and we hope

that this forum will provide a blueprint to help programs meet

those challenges and will assure students that their concerns

are being addressed .•

Sandra Banner,Executive Director

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,{eoZ~!l8SPIOHweA60Ad

,{Ait6AnsleAitUit9

D.Vi",•• !A~et was in-vited as a guest speaker at the 4th com-bined meeting of Spinal and Pediatric

Section of the Western

KUDOS II Pacifi~ ~rthopaed.ic.. AssoCIation held In

Pattaya, Thailand inOctober. During this

convention he gave two instructionalcourse lectures entitled: Management ofUpper Cervical Spine Injuries and Manage-ment of Lower Cervical Spinal Injuries. Dur-ing the conference, he also gave twolectures, one entitled Combined Approachfor Scoliosis and the other Revision Surgeryfor Spinal Deformity.

Dr. Ray c'-J. Chiu wasan Invited Faculty at theRocky Mountain HeartFailure Symposiumsponsored by the Inter-national Heart Instituteof Montana, USA onJuly 10-11; at the Na-tional Cheng Gung Uni-versity Medical Collegein Taiwan on September16; at the Heart Failure

Society of America in San Francisco onSeptember 24; and at the American Col-lege of Surgeons Annual Meeting Post-graduate Course in San Francisco onOctober 14, 1999 where he gave a lectureentitled Myocardial Failure: Current Cellu-lar and Molecular Concepts. He was in-vited as a Special "MillenniumLectureship" for the Formosa MedicalAssociation Meeting in Taipei, Taiwan onNovember 12, 1999. Dr. Chiu was ap-pointed as an Associate Editor of theCanadian Journal of Cardiology. He was 1..-..1 """-"appointed as a member of the ScientificAdvisory Board of Hearten Medical inTustin, California; and Acorn Incorporatedin Minneapolis, Minnesota, both compa-nies developing new surgical devices for

Dr.C-J.Chiu

the treatment of heart failure. He wasalso appointed by the US National Insti-tutes of Health as a member of the StudySection on "Surgery and Bioengineering':Through the McGill Office for TechnologyTransfer, Dr. Chiu filed a US patent (withDr. Kevin Lachapelle) on a "PorcupineDevice" for transmyocardial mechanicalrevascularization procedure; and an-other patent (together with Drs. Do-minique Shum-Tim and JacquesGalipeau) on myocardial stromal cell im-plantation for myocardial regeneration. Acontract to develop the latter is being ne-gotiated with a new biotechnology com-pany, Bioheart Incorporated of the UnitedStates. Dr.Chiu is also the Editor-in-Chiefof a new journal entitled "Cardiac andVascular Regeneration: Angiogenesis andMyogenesis, Basic to Therapeutics':

THE SQUARE!:i!:I17

Dr. Gerry Fried was a discussant at apresentation of a Cine Clinic on Thoraco-scopic Vagotomy for Marginal Ulcer givenduring the meeting of the ACS in San

Francisco on October 12th. Gerrywas also the presiding officerduring a Symposium on Un-

usual Problems in Surgery pre-sented at the same meeting. InFebruary, he was an Invited

Speaker at a conference on MedicineMeets Virtual Reality in NewportBeach, California. The title of his talk

was The MISTELS Program for Trainingand Evaluation of Laparoscopic Skills. Healso was an Invited Speaker at the Soci-ety of University Surgeons meeting inToronto where he spoke on Principles ofInanimate Training and Evaluation ofLaparoscopic Skills.

Dr. Nick Christou'sson Velos Christouwas married to An-gela Houston onJanuary 15th, 2000following the Depart-ment of Surgery Retreat.

Dr. David Fleiszer was invitedto speak to a medical group inVictoria, B.C. in January on Mini-mally Invasive Breast Surgery. InFebruary, he was the Keynote

Speaker at the University of Ot-tawa Faculty Retreat and spoke on Us-

ing Computers in Medical Education.

Dr. Philip H. Gordon has been namedPresident of the American Society ofColon and Rectal Surgeons. Further, atthe meeting of the ACS, he was themoderator for a panel discussion onAnal Canal Carcinoma. He also gave alecture entitled Total Mesorectal Excisionof the Rectum.

Dr. Jean-Martin Laberge attended thePlenary Session of The Society of Obste-tricians and Gynaecologists of Canada(SOGC).The topic of his presentation wasMalformation in utero: Ie point de vue duchirurgien neonatal.

Dr. Richard Margolis of the JGH wasnamed as one of the top 100 personalitiesof the last century in the millennium issueof the Montreal Gazette on January 1st. Hejoins the following other iIIus- ~

Former Dean Dr. Richard Cruess waspromoted to Officer of the Order ofCanada. Previously he wasa Member of this order.Dick Cruess is recognizedas an innovator in the fieldof professionalism and ethicsin medicine. Congratulationsfrom TSK.

Dr. Helene Flageole was therecipient of the Surgical Teach-ing Award which was pre-

sented at the Annual CPDPChristmas Banquet at the MontrealChildren's Hospital. Dr. Flageole isa warm individual, forthcoming

and above all a dedicated teacher. TheDivision of Pediatric General Surgerycongratulates her and is honored to haveher on its team.

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~ may soon be available. L-Selectin Diminishes Leukocyte-EndothelialCell Interactions In Vivo.

Dr. Gerald Fried - The Florenz and DavidBernstein Award. He is establishing a Cen-tre to develop a method for training andevaluating laparascopic skills.

Achievements

Residents

and Fellows

Dr. Stephen Korkola (R-4 resident inCardiac Surgery) presented a paper at theSociety of Thoracic Surgeons in Florida inFebruary entitled Mechanical (Needle)Transmyocardial Revascularization Im-proves Blood Flow to Ischemic My-ocardium Following Angiogenic Stimulus.

Drs. Ayman Linjawi, Fawaz Halwani,

Bruce Jamison, Michael Edwardes,

Maria Kontogiannea and Sarkis Me-

terissian presented a paper in the Surgi-cal Oncology part of the Surgical Forum atthe American College of Surgeons entitledUsefulness in Molecular Markers in EarlyBreast Carcinoma.D.lon.Brat •• Iong with

Drs. Helene Flageole, Jean-

Martin Laberge, Saundra

Kay and Bruno Piedboeuf

presented a paper in the ses-sion on Pediatric Surgery of theAmerican College of Surgeonsin October entitled LungGrowth and Structural Develop-ment after Reversible Fetal Tra-cheal Occlusion inDiaphragmatic Hernia.

Dr. Lorenzo Ferri wasawarded the Canadian Infec-

tious Disease SocietyTrainee Award forbest presented ab-

stract for his submis-sion entitledDiminished Leukocyte-Endothelial Cell Inter-ations at Remote Sites

in Intra-abdominal Sepsis: ARole for Soluble L-Selectin.

At the same meeting of theACS in a session on CriticalCare, Dr. Lorenzo E. Ferri

along with Drs. Dan Swartz

and Nicolas V. Christou pre-sented a paper entitled Soluble

THE SQUARE..z~19

Dr. Pascale Prasil (R-S - Pediatric Gen-eral Surgery) presented at the 30th An-nual Meeting of the Canadian Associationof Pediatric Surgeons (CAPS). Her presen-tations were 1) Spontaneous Pneumotho-rax in Children: The Role of the TubeThoracostomy and Video-Assisted Thora-coscopic Surgery; 2) Should Malrotation inChildren be Treated Differently Accordingto Age?; 3) Delayed Presentation of a Con-genital Rectovaginal Fistula Associatedwith a Rectosigmoid Tubular Duplication,Spinal Cord and Vertebral Anomalies. Dr.Prasil also presented at The InternationalSociety of Paediatric Oncology (SlOP). Thetopic of her presentation was Manage-ment Decisions in Nephroblastomatosis.

Dr. Andrew Seely won a Canadian In-fectious Disease Fellowship

for his abstract en-titled Alterationsin NeutrophilCytokine ReceptorsMediating NeutrophilApoptosis in the Cir- V\. I ~

culating and ExudateMilieu.

Dr. Daniel Swartz hasaccepted a LaparoscopicSurgery Fellowship at the Uni-versity of Maryland in Balti-more, July 1st.

Dr. Jih-Shiuan Wang, a car-diac surgeon taking a sabbati-cal leave from Taipei VeteransGeneral Hospital to do re-search in Dr. Chiu's laboratory,will present a paper on Mar-row Stromal Cell for CellularCardiomyoplasty: Feasibilityand Clinical Advantages at theAmerican Association for Tho-racic Surgeons in Toronto onMay 3'd.•

Dr.LorenzoFerri

Dr.Andrew Seely

EOM

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CENTRE HOSPITALIERDE!'UNIVERSITfDE MONTREAL (C.H.U.M.JIt seems that Montreal will have two superhospitals. In Jan-uary, it was revealed that the Government has approved a pro-

ject to build a C.H.U.M.on 5 hectares in Rose-mont. This 900 milliondollar institution willmerge the Notre-Dame,St. Luc and H6tel-Dieu

Hospitals. It appears that I'H6pital Ste-Justine will keep itsvocation for children.

C.H.U.M. The French

"Superhospital"

This new development compares with the M.U.H.C. whichis for an 850 million dollar centre in Glen Yards (MontrealWest) by 2004.

Appointed as Head of the new C.H.U.M.,Mr. Gerard Douville

THE SQUARE..z~

is well known at McGill having been the Executive Director ofthe M.G.H. and then Head of the M.U.H.C. in 1997.

In the interim, there exists a plan proposed by Dr. RaymondCarignan which stipulates that the two "major complete"hospitals will be I'H6pitai Notre-Dame and I'H6pital St. Luc,whereas the H6tel-Dieu is to be a Clinical ResearchCentre withsome 250 beds, of which 50 are to be reserved for research.

There is some concern over the number of beds committedfor each hospital. The C.H.U.M. superhospital will have 850beds, about 400 short of the current 1,241. The M.U.H.C. net-work currently is comprised of over 1,100 beds, while its pro-posed superhospital will have between 680 to 830 beds. Dr.Nicholas Steinmetz, one of the M.U.H.C.'s planning direc-tors, affirms that the extra beds are not necessary becausethe superhospital will run more efficiently and diminish thelength of hospital stays.

It is expected that the C.H.U.M. should be ready by the year2007 .•

..............................................................................................................................

St. Mary's Celebrates

Its 75th Year

ST. MARY'S HOSPITAL hascome a long way since itsfounding in 1924 by sur-geon Dr. Donald

Hingston. At that time, St. Mary's Memorial Hospital consistedof 45 beds and was administered by theSisters of Saint Joseph.

In 1999, the 316 bed institution affili-ated with McGill as a community hospi-tal has as its points of excellence -Obstetrics, Oncology, Geriatrics and Fam-ily Medicine. Its global budget is 58million dollars and the St. Mary's Foun-dation has collected 2 million dollars indonations for 1998-1999. The hospitalemploys some 1,600 staff and there areclose to 300 physicians and surgeonswho attend the some 12,000 patientshospitalized each year.

Amongst others, two busy sections are theEmergency Room with 28,000 patients

treated per year, and it has the largest Obstetrical Center inMontreal with 4,000 births per year.

The Square Knot congratulates this fine hospital. •

St.Mary's Hospital

21

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~ While only McGill surgical residents rotate throughsurgery, family medicine residents and medical students fromLaval rotate through other specialties. Most of the hospitalpersonnel including non-surgical staff usually get to know theresident and often invite him or her to social activities, sports,outings and receptions. The surgeons themselves go out oftheir way to treat the resident to lunch, dinner, BBQs,boatrides and even skidoo rides. An anaesthetist will also, on oc-casion, take the resident on a hydroplane ride over the breath-taking northern landscape of hundreds of lakes and rivers.

The surgical residents are housed in a comfortable buildingadjacent to the hospital, each with a private room with tele-phone TV and sink. There is a common kitchen for the 5 itin-erant MDs. The hospital provides a stipend for the resident tocover travel expenses and invites him or her to any hospitalevent, often carried out at some of Val-d'Or's very fine restau-rants. There is a movie theatre and a sports complex withpool, gymnasium and a free-weight room available for asmall fee. Nature is, of course, the number one touristical

THE SQUARE..z~23

attraction of the region, with multiple skiing and hikingtrails as well as a picturesque beach on Lac Blouin which isopen to the public during the summer months. Tourists mayalso be taken down to visit a fully operational gold mine inthe outskirts of the town.

There is no question that this three-month rural rotation hasbeen one of the most valuable experiences of my residencyto date and that it has improved and solidified my surgicaland diagnostic skills tremendously. The degree of experi-ence that I have acquired by doing over 225 cases myselfcannot be under estimated. In what concerns the staff, I canonly be grateful to have had the opportunity to work withthree surgeons that are vibrant, in touch with the current ad-vances in the field and who have now become wonderfulfriends. I believe that McGill can boast Val-d'Or as a truegold mine for its surgical residents and hope it will continueto support this rotation as it has in the past. •

...............................................................................................................................

Department of Surgery Christmas Cocktail Party

at the Ritz Carlton Hotel

Lt. to Rt.: Marie Monaghan, Mary Bouldadakis, Line Dessureault, Ennia Mulfati, Rita Piccioni and Betty Giannias

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TSth Annual Royal Victona Hosp~alliV<'r TransplantFund-Raising Dinner was held on November 21, 1999 at MilosRestaurant. As always, it was a great success. This year's hon-

orary president was Mr. YvanCournoyer, of the Montreal Canadiensand once again Mr. Ted Blackman ofGAD emceed the event. A total of 220people including patients, pharmaceu-tical representatives, physicians, andfriends of the Liver Transplant Program

attended the semi-formal event. This year, we raised over$50,000 making this our most successful effort to date.

5th AnnualLiver Transplant

Fund-Raiser

We were also pleased to announce that Dr. Jonathan Fridellwas awarded his Master's Degree in Experimental Surgery af-ter toiling in my laboratory for two years. Another one of myresearch fellows, Dr. Antonio Di Carlo, was awarded the firstever Michael Cohen Liver Transplant Fellowship, and hewill be

Dr.Michael Lichter, Christos Manioudakis (Founder of the Liver

Transplant Fund) and Dr.Jean Tchervenkov.

Dr. Tchervenkov presenting an award to Dr.Jonathan FridelJ for research.

THE SQUARE..z5l25

continuing with his research for another year.

Our Guest of Honor this year was Dr. Pierre Daloze. He was pre-sented with a Certificate of Recognition from the Liver TransplantProgram at McGill University in commemoration of his contribu-tions to the field of liver transplantation in Canada, being the firstsurgeon to perform a liver transplant in Canada in 1970 .•

Dr.Pierre Daloze (first surgeon in Canada to perform a liver transplant

in 7970) and Dr.Jean Tchervenkov.

Newscaster TedBlackman, former Montreal Canadiens Hockey Player

Yvan Cournoyer and Christos Manioudakis.

Dr.Peter Metrakos, Director of Pancreas and Kidney Transplantation at the

MUHC and Dr. Nicolas Christou, Head of Division of General Surgery MUHC.

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T.UGHTS ONANEWCAREER(Otherwise known as retirement)

In May 1997, I was away from Montreal, missing the annualbanquet at which I was to receive kudos and a gift on retire-

ment. I was sailingon a "leg" from Pa-peete to Bora-Borain the South Pacificwith a friend whowas sailing around

the world. Since I did not speak when presented with my re-tirement gift from the Department of Surgery in1998, Ithought it might be opportune to obey EdMonaghan's requestfor contributions to The Square Knot.

Dr. Guttman's Thoughts

On a New Career

A few words about my first career. I graduated from McGillwith a B.Sc.(Honours Physiology) in 1952, and studied medi-cine at the University of Geneva. Studying at a first classschool of medicine in the middle of Europe in the '50's was agreat gift. I trained in general surgery at the Jewish Generaland in pediatric surgery at l'h6pital Sainte-Justine. I beganprivate practice in 1965. At the time, one did not sign out at5 p.m. in case a potential referring doc would ask you to sewup a laceration or examine a possible appendicitis. I began tocarry out research in the labs at Ste. Justine in graft preserva-tion, studying several normothermic and hypothermic solu-tions, as well as adopting cryobiological techniques to thisfield. An exciting prospect was to consider the possibility offrozen organ banks as was the case with unicellular units suchas RBC's. I worked with many collaborators over the years, in-vestigating preservation of segments of bowel, kidneys andislets, with support from the MRCfor 15 years. Unfortunately,efforts at long-term low temperature preservation of wholeorgans have eluded science. The geometry of a whole organis just too complex. Simply put, water freezes faster than itthaws as the process proceeds through the organ. Conse-quently, while it is fairly easy to affect a uniform freeze, thaw-ing requires some process which is ultra rapid to avoiddamage. Sporadic successwas obtained using microwave con-vection. later, I branched out into immunological modifica-tion on small bowel transplantation with the great help ofJean Tchervenkov.

I was, even for the time, unusual in that I went from privatepractice to academia, not the reverse. I became Associate Pro-fessor at McGill and at the University of Montreal in the'70's.Thanks to the support of Tony Dobell, I became Head of the

THE SQUARE..z~27

Division of Pediatric General Surgery at the MCH, and Profes-sor of Surgery in 1981. I believe I was the first Jewish Full Pro-fessor in General Surgery at McGill. I came to appreciate thestrong support of David Murphy, Herb Owen, Lloyd Maclean,Dave Mulder and Joe Meakins. I want to thank them for theirsupport. I also want to thank Joe Meakins and Jean-MartinLaberge for their kind remarks at the annual banquet.

I have always strongly felt that surgeons are not comparable togeneral practitioners, radiologists, pathologists, psychiatrists,etc., some of whom are able to function into their 70's com-petently. I do not know when the cut-off age is reached. I doknow that I was trained by surgeons working into their '80's andI was telling them what to do (and doing it) while still a juniorresident! While I now ski better than I did at 35, I felt like WayneGretzky; it is better to leave while you are still ahead.

And I had another reason. I wanted to get on (while I stillcould) with my goal of writing a biography of a well-known(in his day) liberal French-Canadian (si j'ose m'exprimer ainsi)politician Senator Telesphore-Damien Bouchard (no relation).For the past 15 years, I have been tutored by Professor BrianYoung of McGill's Department of History. He guided my studyof Quebec history. I have used the past three years pro-ductively and recently sent the manuscript to several publish-ers. So I hope to be able to invite you all to the book launch-ing in the near future! In January, I began a qualifying year fora Master's degree in History at Concordia University and haveturned in two term papers so far.

Too often, because medicine is such an overriding passion, wehave no outside interests. We are living longer and longer. Iurge all my younger colleagues to think about what theywould like to do when they change careers.•

Chuck Nevitt, North Carolina State

basketball player, explaining to coach

JimValvano why he appeared nervous

at practice: liMy sister's expecting a

baby, and I don't know if I'mgoing to

beanundeoranaun~ -1986

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THE FIFTH ANNUAL H. ROCKE ROBERTSON VISITINGPROFESSOR - OR. MARC F. SWIONTKOWSKIDr. Swiontkowski is Professor and Chair in the Department ofOrthopaedics at the University of Minnesota. He obtained his

undergraduate and medicalschool training in California.His internship and residencywere spent at the University of

Washington in Seattle, and he did fellowshipwork in Davos, Switzerland before returningto North America to work. He has receivednumerous awards and honors during his ca-reer. His fellowships have included the pres-tigious North American Travelling Fellow inOrthopaedics and the international ABC Fel-low in 1989. In 1997, he received the high-est award for research by the OrthopaedicResearch Society - the Kappa Delta/OREFClinical ResearchAward for his work on out-comes research in trauma. Dr. Swiontkowski

Visiting Professor

Dr.Marc F. Swiontkowski

THE SQUARE...z~

has been instrumental in the implementation of muscu-loskeletal outcome instruments in mainstream orthopaedics inNorth America, and has s strong influence on modern or-thopaedic thinking.

On Thursday, February 10th, 2000, at the MGH Surgical GrandRounds, he gave a talk on Outcomes Research Movement: Why,How, Who?? The morning consisted of academic program pre-sentations by the residents. The winners of this session were:

o F.Dupuis

f) Dr. G. Elder

e Dr. L. Morrison

Dr. A. Pusic

Following a luncheon with the surgical residents, Dr. Swion-tkowski then went to the Montreal Children's Hospital and aftercase presentations gave Surgical Grand Rounds. His topic wasFemoral Neck Fradure Management - Pediatric to Geriatric. •

EKL

29

..............................................................................................................................

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We can't do itwithout you !

Write to us ! Send us your news !We want to hear from our readers!

If you have any information you want published inTHE SQUARE KNOT, comments about our newsletter

or suggestions, we want to hear from you!Send submissions to:

E.D. Monaghan, M.D .• Editor· THE SQUAREKNOT· The Royal Victoria Hospital687 Pine Ave. W., Room: S10.26, Montreal (Quebec) Canada H3A 1A1

(ALL US at: (514) 842-1231, local 5546 FAX US at: (514) 843-1503E-MAIL USat:[email protected]

[email protected]@muhc.mcgill.ca

Sponsors of the McGill Department of Surgery................................................................................................................................................

_ ETHICON ENDO-SURGERYt.::IJI a ~~ company

.:. MERCK FROSST USSTCca

THE SQUARE=-=zo....~

E.D. Monaghan, M.D.Editor

Emma LisiAssistant Editor

Marie M. (imonCopy Editor

The Audio VisualDepartment ofThe MontrealGeneral HospitalDesign & Layout

Les Servicesgraphiques, P.R.Printing

All photographscourtesy of TheMcGillSurgery Department

McGILL SURGERYALUMNI&FRIENDSContributions of $50.00 are appreciatedin ensuring the continued publicationof "The Square Knot" and supporting McGillSurgery Alumni activities. Pleasemakecheque payable to the McGill Departmentof Surgery and forward to Maria Bikas,McGill Surgery Alumni & Friends,The Montreal General Hospital,1650 CedarAvenue, Room: 06-136,Montreal (Quebec) Canada H3G1A4Telephone: (514) 937-6011, ext.: 2028Fax: (514) 934-8418.

MOVING?If you change your address, or if you knowsomeone who would like to receive thisnewsletter, please drop us a line.

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