Retirees' Association

Retirees Association of Queen's

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RAQ Members Making a Difference: Rural Medical Care

Beyond the Dark Wood ... by Neil Hobbs, MD, FCFP.

As a physician nearing retirement, and perhaps without the credentialling that marks the progress of many academics, I have often looked on the middle part of my life spent at Queen’s from 1987-2007 as somewhat of a tangled wood "in the thick of thickets, in a wood so dense and gnarled" as Seamus Heaney's translation of Dante has it.

The life "beyond the wood" is really the way I look at the decade or more since I left the Department of Family Medicine and followed several streams of private practice, but always with an eye towards practice in more rural or remote areas of Canada.

Crusoe of Lonesome LakeWhere does this story all start? My earliest memory that I have that I believe is real, (and not imagined) is of somehow escaping over a fence from the front yard of the house where I lived as a young child and, to the embarrassment but relief of my parents, being found by the police. Do such early impulses play out on the character development of one's later life? How I came to an appreciation of practice in less populated parts of Canada is really another story, but the idea of what life might be like there, dates to teenage years growing up in England and my father introducing me to Leland Stowe's 1957 biography of Ralph Edwards, Crusoe of Lonesome Lake. Parents, beware of the books you give to your children! I was enthralled by Edwards' story of heading into the wilds of British Columbia to carve out a life for himself and think that the germ of enthusiasm was sown there first.

After undergraduate medical studies at Cambridge, and as a medical student at St Mary's Hospital, London in my first year of clinical training I was able to go on elective study time to St. Anthony in Newfoundland and Labrador, working out of the Curtis Memorial Hospital there. Later, in the 1970s as a young trained physician I found myself working in Labrador and Moose Factory.

Curtis Memorial Hospital, St. Anthony, NLThen, when my wife and I had become Canadians and started a family, I settled in for 6½ years as a physician in Placentia, NL. It was a chance encounter idly leafing through a medical journal in the 1980s that I came across an ad for an academic position in the Department of Family Medicine at Queen's University…and thus began 20 years in Kingston.

Dr. Balfour Mount, MD
Dr. Balfour Mount, MD

Please don't misunderstand me; my life here in Kington was enormously interesting and I think some good work was done. My family medicine training in the Oxford area of the United Kingdom inspired me with the importance of patient-physician communication (often in the home as well as in the office); and my segue from obstetrics to palliative care was an important course of discovery in the 1990s after I returned from a palliative care fellowship in Ottawa during my first sabbatical. Dr. Balfour Mount's (Queen’s 1963) development of International conferences in palliative care which I attended in the 1980s were a great inspiration.

But sometimes in middle life one may perceive that there is a grain of flavour missing from the choice of dishes one dines on, that is hard to put one's finger on. Is it a missed turning in the path, one’s own incapacity or blindness in some unknown dimension, some willfulness of spirit that leaves one looking for an undiscovered fork in the path that had been missed? I wonder sometimes if this is a particular predicament of immigrants who find themselves in a country that they love, but away from their family of origin, and not the country in which they were brought up in. And as one gets older, it may become more difficult to look for mentoring help in answering important questions such as these. Often in the physician's private cabinet de travail, one is expected to provide answers rather than ask questions...

I was very fortunate in the last decade of my work in family medicine to make the acquaintance of Dr. Wendy Pentland, then in Occupational Therapy at Queen's, who I had invited to a conference on wellness at an undergraduate class to talk about life choices for wellness. It was not long after this conference that I decided that I could do with some personal help in answering my own questions about life choices. One simple but deep question (among others) she asked over lunch was "well, what do you want to do with the rest of your life, Neil?" "Oh, and where do you want to live when you're doing that?" was also a question that I needed to ask myself.

Dr. Wendy Pentland, PhD
Dr. Wendy Pentland, PhD 

 

Within the next year or so I had embarked on the next phase of my life. Our children were grown and independent; and I have a loving life partner, Hazel, who was more supportive than I could imagine or ask for. And perhaps some decisions may be made a bit more easily in this window of one's life. As a result of trying to answer the questions Wendy had posed, the "gnarled roots of the wood" gradually untangled. Within a year Hazel and I had decided to move to "a house in the country" in Sydenham. We found a lovely 1870s log home with a garden ripe for further development and a view with stars at night. (We had specifically asked our real estate agent for the night time view!) And I gradually started thinking about a life beyond academe.

In thinking about returning to work in private practice with a rural focus, I was fortunate early on. A chance meeting with Dr. Brian Kain, when we were both waiting for a train in Kingston, led to his suggestion of work in the Northwest Territories. Brian was Director of the Queen’s Family Medicine program when I arrived in the 1980s. His suggestion led to ten years’ work for about three months each year in the Sahtu region of the Northwest Territories working mainly in Dene communities on the Mackenzie River between Yellowknife and Inuvik. It is a region that includes the small oil town of Norman Wells, but all the smaller communities of Tulita, Délįne, Fort Good Hope and Colville Lake, none of which have populations of over 800 souls. It was only this year that I reluctantly decided not to renew my professional license for the Northwest Territories. The incredible people and the remote beauty of the northern wilderness will always stay with me, actually with us – Hazel and I were lucky enough to travel there together on a number of occasions.

Mackenzie River, north of Tulitain the SahtuNort Island, New ZealandBut a rural focus does not necessarily comprise only “rural and remote” work. Inquiries to two practices the year I left Queen’s, looking for support of vacation time for full-time physicians, led to a number of years of fulfilling and interesting work. I worked for eight years, for four months of the year in Tamworth for two physicians – Drs Sandra Cowan and Laing McFadzean who have been deep in rural practice there for over thirty years.  And I have continued to do “locum replacements” for several physicians at Frontenac Medical Associates on Princess Street. Despite its urban location, many patients at that practice have rural addresses. Further inquiries have led to periods of work back in Labrador, and a whole year as a locum replacement in North Island, New Zealand.

At age 71, next year may be the last year, but who knows? Despite a collection of bionic joints with which good orthopedists in Kingston have thankfully extended my working life,  I remain in reasonable health. The College of Physicians and Surgeons carefully reviews the performance of all physicians, but routinely looks at the performance of physicians aged 70 and older.  After a review last year they declared that I am still functioning at a satisfactory level.  More importantly to me, I have found my way back to the kind of family medicine that I first encountered when I came to Canada. As many professionals may have found, there is often satisfaction to be found returning to work they once enjoyed. Many who write about the nature family practice training emphasize one of its key developmental tasks: to learn to tolerate a degree of uncertainty about the limits of finding all answers to all questions. That need for toleration does not vanish with advancing age. Indeed with humility, curiosity and enthusiasm still in action I may find my way past more tangled roots ahead of me.  

Neil Hobbs is a Family Physician, RAQ member, and not quite ready to retire.