Baines, Cornelia J.: Why I entered medicine and what it was like to be a student in the 50s

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MEMOIR:

Memoir pages are intended to provide a personal recollection of life at the University of Toronto or events in the author's life which he or she deemed significant. For this reason, these entries are entirely the work of the authors and are not subject to the normal fact-checking or editing of Encyclopedia entries. The editors request that the pages be approached accordingly.

Why I entered medicine and what it was like to be a student in the 50s.

Cornelia J. Baines MD, MSc, FACE
2014.

How could I ever have chosen to go into medicine? After all in the 1940s and 50s, high school vocational guidance counsellors, the routinely inept, insensitive and incompetent souls who misdirected virtually every student towards the SES- (socio-economic status), gender- or race-appropriate clichéd trade or profession, advised bright females interested in medicine to become nurses. In fact I think they suggested alternatives: to become a teacher or a medical secretary.

I made up my mind to become a doctor long before I was in high school. In fact by the age of three I had made this decision for two reasons. First, I wanted to have a sister or brother and I believed that becoming a doctor would allow me to assist my parents to that end. Secondly I wanted to help my grandmother. She, after so many pregnancies, was afflicted with ‘milk leg’ – which was nothing more than a swollen leg secondary to thrombophlebitis in the post-partum period, probably exacerbated by the fact that then mothers were put on bed rest for about 2 weeks post-delivery. It may have been called milk leg due to the notion that milk had flowed down to swell the leg. It could not have been because the leg became pale because thrombophlebitis would have been associated with reddening of the skin. After many pregnancies, the blocked venous drainage led to varicosities (soft, purple, lumpy, venous protrusions of veins under the skin) and eventually some of them ulcerated.
If you think I am dwelling on this overlong, it is because it made a huge impression on me as a child. Frequently when I visited, my grandmother would have to ‘dress’ her leg; this involved unwinding the elastic bandage that always encircled her lower leg and removing a usually pus- and blood-soaked gauze square that covered the ulcer, perhaps 1.5 inches in diameter. The ulcer was surrounded by shiny purple skin as hard and dry as can be. Physicians were totally useless in spite of one hospital admission after another. Her best remedy was Unna’s paste, a medicament with zinc in it, and it did help a bit. She lived with these ulcers her whole life.

Interestingly, although no one in my family had been to university let alone become a doctor, my parents never even hinted that my choice was odd (remember this is in the late 1930s), and never at any time as I grew up did they do anything other than support my ambition. As I grew older, it was disconcerting to realize that the most boring subject I ever took in secondary school was called “Health”, but on the other hand, I was inspired by the books I could bring home from the library – any book about anything medical was of interest. I read about Lister, Semelweiss, Cushing, Osler, Addison, Pasteur, Banting and Curie – and diseases such as leprosy were particularly fascinating.

In the summer of ’49 when I turned 14, my father was able through Masonic connections, to get me a summer job without pay in the Pathology Department on the main floor of the Banting Institute (built in 1930) on College St. in Toronto. There I was able to watch while the surgical pathology specimens from the Toronto General Hospital were cut up for sectioning and subsequent staining. At that time radical mastectomies were the norm for breast cancer and I vividly remember a huge breast being plopped on the cutting board so the pathologist could take a tissue sample to “fix” for microscopic examination. And I remember kidneys being sliced revealing their wonderful internal architecture. In the lab, I would help in the process of staining the slides.

The next summer I got a job at the Toronto Western Hospital pathology lab (Dr. Chester Maclean was the chief pathologist) and this time I actually was paid, although I forget how much. I felt very grown up, wearing a white lab coat and having lunch with all the lab technicians. And while there I got to recognize a Dr. Donald Wilson who at that time was carrying out the first interventions involving open heart surgery. You knew when the operations went badly because he appeared in the halls looking totally dejected and miserable. In 1951, before I entered medical school, I had another laboratory job in the Banting Institute, this time on the fourth floor and research-based. Dr. Charles Best, co-discoverer of insulin in 1921 with Sir Frederic Banting, was head of the department and I had a chance to see him frequently and talk to him occasionally. My job description was not very interesting because a lot of my time was spent feeding rats and that required mixing dog food and grains in a large white pail using my hands to squish all the ingredients together. It also involved being stared at by huge white rabbits with horribly inflamed red eyes – they were involved in some kind of eye research with which I was not associated. My supervisor, Jim Salter, was an interesting man who collected Japanese wood block prints and I purchased two from him that still hang in our living room. Later, in 1956 when I worked at the Best Institute (constructed in 1950) I met an older technician who knew a lot about the events associated with the discovery of insulin. Her story was that Charles Best collaborated with Banting only because he lost a bet – if he had won he would have had his preferred summer job elsewhere. By 1956 I was married to a classmate, Andrew Baines and pregnant. I decided to leave medical school for a year in order to be with our soon-to-be-born daughter. I kept on working until close to term and during that time came to conclude very definitely that I was very unlike my husband - laboratory research was not for me. I hated flame photometers that required constant adjusting, and scales that never gave the same reading twice, to say nothing of the hideous experiment we were doing. It would never be allowed now by ethical review boards. We wanted to study the effect of potassium infusions after trauma, and therefore slung white rats up in rows, administered crush injuries with clamps to their rear legs (they squealed and peed) and then infused potassium. Awful! I hated it, but I did it and never questioned it.

On the other hand, what is ethical and what is not ethical is increasingly being confounded by spurious political rectitude. One does not want to make animals suffer needlessly. However, was it truly less ethical to make rats suffer in the hope that the knowledge gained would improve treatment of humans with crush injuries, compared to sending Canadian soldiers to Afghanistan where more than 150 would be killed and hundreds of others would be maimed in order to bring democracy to that country – a goal that certainly has not been and never will be accomplished by outsiders? While active years later on the University of Toronto Research Ethics Board I listened to a colleague talking about how unethical it was for a self-administered questionnaire to list only five options for ethnic origins the last one of which was ‘other’, because “it would make respondents who chose ‘other’ feel slighted and inferior”!!! Current ethical priorities are often absurd.

Not all my summer jobs were in laboratories. Working as a waitress in 1952 at the Bigwin Inn and again at the Digby Pines in Nova Scotia in 1954 did not advance my medical ambitions but allowed me to escape Toronto. The vagaries of human behaviour demonstrated by hotel guests were richly revealed. Vivid memories from Bigwin Inn include a plump and oily, middle-aged, balding man inviting me to his room to give him a manicure and sundry American tourists surprised to discover they had free access to sugar for their coffee! They thought we still had war-time rationing. Others daintily sipped the water in the finger bowls. Also memorable was Frank Leslie, the owner, a rather pathetic man given to singing “Ain’t She Sweet” accompanied by the dining room trio led by Chicho Valle. Leslie made his money as a Bay Street broker. It was at Bigwin Inn that I learned how to set a table properly and carry a tray with ten covered dinner plates on it. Yet another summer job taught me the miseries and ennui of being a filing clerk. For one whole summer while working for Revenue Canada I did nothing but file returns for people whose names began with McN in a huge and sweltering room crammed with other students, all of us toiling tediously to pay tuition fees.

As a high school student it never entered my head that I would not be accepted into Medicine which was naïve because at that time (1953) there were quotas for Jews and women, and it was a given that any doctor’s son was guaranteed admission. However, my academic standing was very high on graduating from Runnymede Collegiate Institute, and I was accepted into first premeds. I was interested in no other course described in the university syllabus. A major appeal for me was that the two premedical years included a mandatory English Literature course plus two other optional courses; the options I chose were philosophy and anthropology. These were amplified by appropriate science courses: physics, biochemistry, organic chemistry, zoology and others. I dearly wanted to have some exposure to the humanities included in my post-secondary education. By the time I arrived for our first classes in September 1953, I had completed all the required English reading, a huge list including everything from Tom Jones to Moby Dick. Philosophy was a bit of a disappointment – David Hume was the only philosopher who made sense to me. As for Anthropology, that was a mind-blowing experience. We had an American professor by the name of Ted Carpenter and he changed the way we looked at the world we lived in. He helped us see all the subliminal messages in movies and advertisements for Coca Cola and cigarettes – in short to understand for the first time what lay beneath the surface of the culture we were living in.

In the 1950s, final results for university students were always published for each academic year in the Toronto newspapers. Not only did you learn who passed and who failed, you also learned your ranking. Thus it was while at work during the day. I learned that I had stood first in my first pre-meds class. This was no cause for celebration. I came home to 89 Meadowvale Drive at the end of the day and sadly told my mother that I had stood first, and it was a certainty that Andrew (who actually would become my husband) would never take me out, which is to say never ask me out for a date. I had fallen for him the first time I saw him in early September, standing outside the Physics Building before a lecture – he wore a wonderful brown tweed English riding jacket and was smoking a pipe and leaning on a cane because one leg was in a cast following removal of a torn meniscus. All that first year he continued dating a high school sweetheart, Marilyn Bevis, whom I could not stand. She had a big nose and was cheeky enough when our fencing master paired us for a match in class, to look coyly at me and say “Oh please don’t hurt me, I am just a little girl.” Yuck.

One of the consequences of being first in the class was that I automatically became a candidate for a scholarship. Dean Farquharson interrogated me in his office. I was asked if I intended to get married. I said I would if I chose to but I had no immediate plans. I was asked did I intend to go up north and provide medical services where they were really needed. I responded that I intended to stay in Toronto. (In the early 50s absolutely no attention was paid to Canada’s north.) From a southerner’s perspective it was virtually empty, unknowable and uninteresting. However the first signals triggering interest in the north came from our Anthropology Professor Ted Carpenter who taught us so much about Eskimo carvings, explaining that according to tradition, they should be smooth and fit comfortably into a hand. Frequent handling would impart a lovely patina on the surface of the carving. Furthermore any piece had to be in proportion from every possible perspective. Now, carvings are often successful from only one perspective and frequently they are so big they can scarcely be lifted. Later, people like Glenn Gould would extoll the north. So much has changed.

Not surprisingly having failed to give the requisite answers to the Dean, I did not get any scholarship. The person who did was male, Jewish, and told the Dean he intended to go and work with Albert Schweitzer in Africa at a Christian mission. He came out from the interview immensely amused and satisfied with himself. Consistent with Dean Farquharson’s evident disapproval of women in medicine even considering marriage was a song we women were taught to sing. It began: “Medicine or a man. You can’t have them both so they tell us..” I cannot remember the words which followed, but that was the prevalent belief in society at that time.

Still other experiences reinforced how frequently people believed female medical students were necessarily strange, unacceptable and even abnormal. Some of my mother’s friends questioned her acceptance of my studying medicine because everyone knew, “a woman in medicine could not possibly be normal” whatever that meant. When I worked as a waitress at the Digby Pines hotel in Digby, Nova Scotia, blind dates were sometimes arranged with officers-in-training from the Cornwallis armed forces base. On the one occasion I agreed to participate in this arrangement, the young officer assigned to me refused to accept the date before he even met me simply because I was a medical student. A number of male students in the class of 5T9 individually rebuked me for taking a place away from a male student. They insisted I would never justify my education or be useful. (One of these “male chauvinist pigs” (MCP), Paul Grose, who actually dated me later, now remembers with much amusement having challenged me in this manner. His daughter went into medicine. Serves him right! He does now graciously recognize the error of his ways.)

I found it bizarre at the time that European men had no hang-ups about female medical students while most North Americans were perturbed by them. Andrew was clearly an exception.

Sadly the negative attitudes extended into the teaching environment in the hospitals. Male clinicians rebuked me for my single-pearl ear-rings and for wearing high heels on the ward because “physicians do not wear ear-rings or high heeled shoes”. One horrid obstetrician, Bill Oille, reduced me to tears during an oral examination with his withering mockery. He did not like the way I described the three stages of labour although I remain convinced I was quite accurate. During a surgery lecture at the Toronto General Hospital, the greatly esteemed Chief of Surgery presented a woman with breast cancer prior to her scheduled surgery. She was rolled in on a gurney, made to sit up, stripped to the waist and then he flapped her breast back and forth and up and down for the instruction of well over a hundred students. Amazing how much has changed.

The women in the class of 5T9 had the privilege of being the last to undergo initiation in their freshman year. Only the women were subjected to this, not the men. In the fall of first premeds, this event was always organized by the women in the year ahead with the assistance of some male fraternity members. It was not enjoyable. We each were given a hogshead, a real pig’s head complete with blood and gore, to carry around from one site to another as we progressed on the planned itinerary. The heads were cold, clammy and very heavy. After we were blind-folded, our hands were plunged into cold porridge with distasteful remarks being made as to what actually was there. Questions designed to embarrass if not humiliate were thrown at us. It was not pleasant. None of us in 5T9 wanted to inflict this experience on anyone else, so there never was another initiation to my knowledge.

Nevertheless, the girls in second premeds were really good types and one of the nice things they did was to decorate blue corduroy caps with appliqués – one in the back saying 5T9 and another in the front that was a skull and cross bones. Indeed most of my memories are good ones. We enjoyed the comfortable women’s lounge in the basement of the Medical Building (replaced in 1966 by the concrete Medical Sciences Building) distinguished as the place where Banting and Best had conducted their experiments. Previously it had been known as the Biology Building, occupied as early as 1877. Our lounge had comfortable upholstered couches and chairs and was a nice place to meet, although chiefly for the premedical students. My mother actually volunteered to make lined curtains with pinch pleats to cover the windows. After the building was torn down, such facilities were rendered co-ed, cold and large with arborite tables and noisy chairs.

I remember with so much gratitude the thoughtfulness of two classmates, Bernie Slatt and Gerry Rosen, now both dead, who invariably came to sit with me as soon as I arrived for the first lecture of the day if no other girls had yet arrived. They seemed to realize that being the only female in a room full of males might be a bit uncomfortable. So they kept me company until another girl arrived and then they would wander off to join their friends. These two also took me to a Chinese restaurant in Chinatown; at that point going to a restaurant was a rare experience for me and I had never eaten Chinese food.

Not only was our premedical education fascinating, but so too was our medical education, even though some lectures were sufficiently boring that Andrew and his friends would stay in the student lounge and play bridge. We had superb clinicians like Dr. Ken Butler, who entertained us in their homes and were outstanding teachers. We had lecturers like Professor KJR Wightman (aka Kajer) who were an inspiration and who set us an example by treating patients with respect. There were exuberant class parties – in particular winter parties at the farm of Peter van Nostrand where we enjoyed skating on his pond. There were ‘smokers’ funded by pharmaceutical firms, held in bars, where everyone in the class (except me) smoked prolifically – what a joke! In fact smoking was even permitted during lectures in hospital lecture halls. There were the annual elections for positions such as class president, president of the Medical Society and chairs of various committees such as sports and arts and letters. This entailed visits to classrooms at the end of the lecture where the candidates relied solely on telling the most filthy of jokes, not all of which I understood but clearly appreciated by the class. I never even thought of objecting. There were weekends at Hart House farm where I found myself responsible for planning, buying and preparing the meals for minor multitudes. And last, but certainly not least, there was Daffydil. It was so much fun. I was in the chorus for just three years because in our second medical year I was married (December 28, 1956) and within a year our first child was born. Andrew joined Daffydil late in his medical school career and conducted the orchestra while I stayed at home and looked after our baby. Gerry and Bernie gave memorable solo performances. Some of the girls (not me) got in the chorus line. The music in our years was wonderful, directed by Paul Steinhauer (later to become a child psychiatrist), a warm and lovely man who never got cross at rehearsals but would just look slightly crestfallen and say “Aw gee guys….”. We liked our lyrics and still remember them: “Daffydilians we are proud as proud can be of this our latest Daffy Daffydil. When you see it you’ll say it’s great ,..”. and so it went. Many years later some of us re-assembled to sing and record selected songs under Paul’s direction. A lovely memory!

Since I wanted to be with our daughter during her first year of life, I left the class of 5T9 to which I was so bonded. My father was bitter in his conviction that I would never return to medical school. However I did. Joining the class of 6T0 was not easy – they all had established their social networks and I was busy being a mother and wife as well as a medical student. (Interestingly it was only at the time of our 45th reunion that I came to recognize what an interesting class 6T0 was.) By the time I graduated in 1960 it had become clear that my health was not up to enduring the rigours of internship as it was then, so I started a different path, working as a Cancer Research Fellow for several years at Toronto Western Hospital, able to do so because my parents enjoyed looking after Nickie.

Under the direction of a haematologist Dr. Dorothy Leigh and based in the long since demolished Alexandra Wing (at the Toronto Western Hospital), radioactive isotope tests were administered. Now I wonder whether this radiation exposure played any role in my developing a lymphoma and two other cancers. We conducted badly designed clinical research that involved my giving injections of 5-fluoro-uracil to terminally ill cancer patients in the hospital. I remember two in particular. A man in his 60s was dying of pancreatic cancer, a dreadful death, and he complained because up until then he had never been sick, so why should he be dying now? He clearly was very frightened which amazed me because he was a Baptist minister. Belief in an afterlife in heaven failed to help him. The second case was terribly upsetting, a lovely young woman dying of acute leukemia, thin and pale and confined to bed, her mouth all stained with Gentian blue to counteract fungal infections. She was engaged, and because of her imminent death, the wedding was performed in the hospital room. The husband was so caring, often bringing her roses and she was always so happy when he was there. It was tragic to be with them.

Somehow Dr. Leigh and I wrote a paper that was actually published in the Canadian Medical Association Journal. Later, a British respirologist by the name of John Patterson met me in the hospital elevator one day and inquired quite kindly: did I realize what an inexcusably bad paper we had written? He was right – our research totally lacked any valid design and could make no conclusions. I would have been gob-smacked had I known that I would end up in epidemiology and become competent in research methodology.

After three years abroad we (now a family of four) returned to Canada in 1968. My first professional activity was as medical consultant for The Medical Post starting in October and then in 1970 I finally was able to begin my internship. Yet another amazing example of rigid MCP-ism was the result. Because of my health problems, Dr. Irwin Hilliard, chief of medicine at Toronto Western Hospital, invited me to do the internship half time and with half pay over two years. But my male colleagues refused to recognize that arrangement when they planned the rotation schedule. They stated bluntly that I would “have to bloody well suffer as much as they did.” To my surprise I survived and completed the internship (it was much less rigorous than it would have been in 1960) in one year which was much to my advantage. With my license, finally I was able to do clinical practice in the medical out-patient clinic even if only part-time, while continuing with The Medical Post.

But then I started to get perturbed by what I was observing in the clinic where I saw that much of medical practice was not evidence-based. My perturbation was increased when the routine accreditation process gave the hospital only conditional approval because of the conduct of the outpatient department. This led me to go as a part-time student to McMaster University to get a master’s degree in Design, Measurement and Evaluation – and there was wonderful serendipity because at the same time my daughter was doing a master’s at Mac in engineering! None of what I learned ever was applied in the outpatient department. My completion of master’s program was followed by a year’s sabbatical in Oxford. In August 1981, on returning from Oxford, I began my long association with the Department of Preventive Medicine and Biostatistics, that became the Department of Public Health Sciences, that became the Dalla Lana School of Public Health. Not all smooth sailing, but as I write, I am still here, more than 10 years after mandatory retirement! I have to admit my career has been very interesting, not least because of my role in the Canadian National Breast Screening Study. Since I am still active in my mid 70s (three published papers, one chapter and two letters to the British Medical Journal in 2011) and since the university is still giving me a wonderful office (I wonder for how much longer), I truly am very privileged.