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Pause for ought

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AS HE REFLECTS ON A LONG CAREER IN SURGERY IN IRELAND AND CANADA, AND AS A MEMBER OF THE CANADIAN FORCES HEALTH SERVICES DEPLOYED TO AFGHANISTAN, IRAQ AND HAITI, DR VIVIAN C MCALISTER, FRCSI (1987) SAYS LUCK HAS PLAYED A HUGE PART IN HIS LIFE AND CAREER. HE IS CURRENTLY PROFESSOR EMERITUS IN THE DEPARTMENT OF HISTORY AT THE UNIVERSITY OF WESTERN ONTARIO

Dr McAlister has been honoured with the Order of Canada for ‘his seminal contributions to and leadership in the military and civilian surgical communities, as a medical practitioner, researcher and educator’.

Growing up in Terenure, Vivian McAlister attended Loreto on the Green and St Mary’s College in Rathmines before completing his secondary school education as a boarder at Castleknock College. His grandfather Patrick O’Dowd was a doctor, who graduated early in the 20th century from University College Dublin. His father John McAlister was a dentist, so there was medicine in the family.

“I can’t remember ever making the decision to become a physician,” says Vivian, via Zoom from his home in Canada, “but I applied to medical school and Trinity offered me a place in March of my final year of school, prior to completing the Leaving Certificate. I started in September 1973, having just turned 17. Professor Ronan O’Connell [former President, RCSI] was one of my classmates. I would cycle from Terenure into Trinity for lectures with Paul Burke FRCSI (1983) who was a year ahead of us.

“What was unique about Trinity at that time was that after your first two years of basic science education, you were assigned to one of Dublin’s many small hospitals for the rest of your training. I went to Sir Patrick Dun’s where I was part of a very small community of physicians, trainees and students, all of whom virtually lived in the hospital on Grand Canal Street. It was like being part of a family and echoed the experience I had in boarding school, where I lived with the boys for five years. I am still friends with my classmates from Castleknock and with my fellow students from Sir Patrick Dun’s and Trinity.”

After graduating in 1979, Vivian completed an intern year, with six months of surgery followed by six of medicine. During that period he considered a career in surgery, but a shortage of surgical training places saw him taking up a series of short house-officer jobs including one in Harcourt Street Children’s Hospital and another in St Vincent’s Hospital.

“Jobs were very, very scarce in Ireland at that time,” he recalls. “I thought perhaps I’d be a general practitioner, and I think if I had been offered a job I probably would have taken it and stayed in Ireland as a family doctor. But instead I left Ireland and went to the far north of Canada to practise as a general practitioner.”

At the age of 25, Vivian was already married to Christiane and had three young daughters, the youngest of whom was born just a few weeks before they left Ireland.

“I don’t remember being nervous at all,” says Vivian. “I was excited, looking forward to the opportunities. And we were extraordinarily well prepared as Irish-trained physicians – we were equipped to deal with just about anything.”

Vivian and Christiane initially planned to be in Canada for just a year.

“Once I started travelling, though, I got hooked. Medicine was extremely flexible. You could be what you might call a travelling physician, you could work your way around the world, doing short-term jobs. At first I worked in a place that was dependent on a mine and when the mine shut down, they didn’t need me any more. Then we moved to the southern part of Saskatchewan, on the prairie, where I was a general practitioner for almost four years. Among my patients were Indigenous Canadians, who reminded me of patients from rural Ireland. When we had our Canadian citizenship, we decided to come back to Ireland so I could do some surgical training. I intended to go back to Canada as what we call a community surgeon – a non-specialist surgeon, or general surgeon working in a smaller hospital.”

From 1985 to 1990, Vivian worked as a surgical registrar in Ireland, in various hospitals including, for a time, in Enniskillen during the Troubles, an experience for which he is grateful. During this period he sat for the primary and the fellowship exams at the same sitting.

“I studied for both at the same time. The College said to me: ‘Look, you’re not getting your fees back if you fail the primary!’ I did a course in the College for the primary. We all worked in hospitals at the same time and we’d come into College in the evenings and at weekends. at was another very strong group, which included Professor Cathal Kelly FRCSI (1990) [now Registrar of the College]. Again, I felt I was part of a ‘family’ team in which we supported one another to do well.”

Vivian passed both exams at the first attempt and became a Fellow in 1987.

“I wasn’t part of the surgical training scheme and I let it be known that I was going to go back to Canada,” he explains. “And as a consequence of that, I found that doors opened for me. The senior registrar programme was very structured, but I was able to design my own training the way I wanted. I was doing vascular surgery with Vincent Keveney and Denis Mehigan FRCSI (1981) in St Vincent’s, when Niall O’Higgins FRCSI (1970) asked me if I would be interested in doing a job with him. He was developing cancer surgery and liver transplantation, but also as professor he was involved in teaching. So I was to be the surgical tutor, and registrar. at was a brilliant job. I did it for 18 months, and it really set me off on my path and I decided to become a specialist surgeon, rather than a community general surgeon as I had originally intended. Niall helped me get a job in London, Ontario, where I did a clinical fellowship with Bill Wall in liver surgery and transplantation from 1990 to 1992. at both helped my surgical training and gave me the entrée back into the Canadian scene that I wanted.”

“Surgeons have a very privileged role in society, and with that privilege comes the responsibility to pay back...”

On completing the Canadian fellowship exams, Vivian took a job as a liver transplant and general surgeon in Halifax, Nova Scotia. “By my good fortune again I was part of an excellent team of surgeons and we provided care for the Atlantic provinces, covering Newfoundland, New Brunswick, Prince Edward Island and Nova Scotia,” explains Vivian. “That gave us a very important role within the whole Canadian context of liver transplantation. We would travel anywhere in those areas for organ donors but generally the patients came to us. I did quite a bit of telephone care in co-operation with their local physicians. So we were one of the very early programmes doing remote care that has become more popular in recent years. We were three surgeons looking after liver transplant patients, and we worked with our two physician colleagues. The five of us were pretty tightly knit, and we were able to look after these patients to the highest standard. We were also part of the kidney-pancreas transplantation programme.”

Vivian stayed in Halifax until 2001, when he was recruited back to London, Ontario, to work on the multi-organ transplant team. In addition, he carried out liver surgery, ERCP and general surgery.

Major McAlister, as part of the NATO Training Mission - Afghanistan, at a meeting with physicians in Kabul in 2012.

Vivian was deployed seven times in total – five times to Afghanistan, and once each to Iraq and Haiti – with each deployment lasting between two and four months.

“In Halifax, I had been a teacher for several military surgeons,” he recalls. “And there were military surgeons in Halifax who were my colleagues. So I knew the system very well. And in my own background, my grandfather Charles McAlister was a soldier. I was conscious of it, but I never thought I’d act upon it. After 9/11, I was asked to give a talk on the history of surgery at a national meeting. I reviewed our role as military surgeons of the various conflicts. And I made a comment that our war in Afghanistan might be forgotten in the future, a bit like the Boer War now. Somebody in the audience made a cutting comment saying: ‘Well, you’ve got to remember, it is a war.’

And I remember being stung by it, and I went home and I thought about what he had said and about how Canada had been extremely good to me in terms of the opportunities it had given me. Surgeons throughout the world have a very privileged role in society, and with that privilege comes the responsibility to pay back and so, if the country is at war, and the soldiers are at risk, surgeons have to be available for them. I knew there was a shortage of surgeons in Afghanistan, and so I volunteered.”

Vivian made his first trip to Afghanistan as a civilian in 2007, after which he decided to join the Canadian Forces. He commenced six weeks of basic training in 2008 at the age of 52.

A surgical station to support a casualty collection point in Iraq in 2017.

“It was terrible,” Vivian recalls, “but I managed. There was another gentleman there who was a little older than me and he was very fit. We stuck together. He’s one of these guys who’s a runner, and I’m not at all, I hate running. So he said to me: ‘We will be first and second every time we train.’

“Then there was medical officer training. You could break that one up and I did it in bits and pieces, because every time I was scheduled to train, they’d send me overseas instead. The peculiarity of that one was not only that I was older, but for part of it, I was teaching part of the course while for another part I was a student.”

Vivian says his family were supportive of his decision, even though they must have been very worried about him.

“My family was very generous. They thought it was crazy, I suppose, at the beginning, but they understood my rationale, because I’ve always been serious about our commitment to citizenship in Canada. With hindsight, I think it caused a lot of distress. But the Canadian Forces provided as much support to ameliorate that as possible, so I was able to communicate while I was overseas. At times I had to be careful not to communicate too much, because if I was constantly on the phone to them, they might miss a call one day and think something had happened to me.”

Vivian was commissioned as a major in 2008. As the Canadian Forces had closed their military hospitals, he was seconded to the hospital he was already working at in London, Ontario and was able to keep his existing job. He continued to make academic contributions to transplantation but now also focused on combat surgery. He described the pattern of injuries caused by the anti-personnel improvised explosive device and he designed a vehicle for “far-forward surgery”.

“Externally, you would not know I was in the military at all as we didn’t attend the hospital in uniform,” he explains. “The only difference was that I was available to the armed forces for training others, and for exercises or deployment. Occasionally, I had to tell my colleagues: ‘I have to go and do this.’ I was part of a magnificent team who covered me for all of those deployments, sometimes at very short notice. I was on four ‘on call’ lists at the same time – liver transplant, kidney transplant, general surgery, ERCP. And I’d just send a quick email or phone and say: ‘I have to go, can you manage?’ And they’d all say yes immediately.”

Vivian was deployed seven times in total – Five times to Afghanistan, and once each to Iraq and Haiti – with each deployment lasting between two and four months. While he says he never regretted the decision to sign up, he did dread the deployments.

Dr Vivian McAlister in Field Hospital in Afghanistan

“I didn’t consider the consequences too much,” he says, “although I knew there was a bit of luck involved. Once or twice, I got worried that maybe the luck was going to run out. But once you’re there, you just do the job, and once I was home, I was delighted.”

When Vivian signed up, the age of retirement had been 55, but that was extended year by year and he ended up staying until the age of 63, leaving with the rank of Lieutenant Colonel. At one stage, he was the oldest person in the Canadian military. When he turned 66 earlier last year, he retired from clinical practice.

“It was the right time,” he says. “I worked hard all my life and the types of things I did are all critical types of surgery – high stakes, for the patient, surgery. I was also involved in teaching, and I trained a good cadre of replacements for myself; some went elsewhere, but several stayed and took over my job. So my job was well cared for and I was superfluous to their needs. I wanted to get out before I made an error.”

Now Vivian is a Professor Emeritus at the University of Western Ontario, also known as Western University. Now attached to the Department of History, he is undertaking research and writing on the history of medicine.

Of his three daughters, Chloe is a general surgeon in Toronto, Chryssa is an ophthalmologist in Kitchener and Chioni is a civil servant in Ottawa. He and Christiane have eleven grandchildren, which he says takes up quite a bit of time.

“We don’t remember paying as much attention to our own children as these grandchildren,” he laughs. “I have family in Dublin and we come back once a year and they visit us here too. So we’re very lucky that communication is so good between Canada and Ireland. It’s almost like living in different provinces of Canada.”

In 2019, Vivian was honoured with the John McCrae Memorial Award, presented to current or former clinical health services personnel of the Canadian Armed Forces for exemplary service, and with a lifetime achievement award from the Canadian Society of Transplantation. In 2020, he was made an officer in the Order of Canada.

“I’m very grateful and touched,” he says. “I don’t know if it’s the same for everybody but at my age I find I get emotional so easily. These things don’t come out of the blue. No matter what you do, how good you are, it’s up to your colleagues to nominate you and to go through those tedious processes of getting supporters and things like that. So that’s what they’ve done for me. If these were awards for teams, I’d be much happier.” ■

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