Jonathan Martin Whitfield, MB ChB, FRCP(C): a conversation with the editor

Jonathan Whitfield (Figure 1) was born in Edinburgh, United Kingdom, on September 26, 1946. After attending the Waldorf School in Edinburgh, he entered the University of Glasgow in 1964, graduating in medicine with commendation in 1970. His internship was in Glasgow with 6 months of internal medicine and 6 months of general surgery, and then he went to the Hospital for Sick Children in Toronto for a year of general pediatrics. He returned to Glasgow as a senior houseofficer in pediatric surgery in July 1971. He then went to Auckland, New Zealand, and the National Women's Hospital as a registrar in neonatology for 6 months. Before his return to Canada, he spent 8 months in general medical practice in Papua New Guinea on the island of Bougainville. He completed his pediatric residency at Children's Hospital of East Ontario in Ottawa, Canada, from July 1974 to June 1976. He then went to Denver and the University of Colorado/The Children's Hospital as a fellow in neonatology/perinatology from July 1976 to June 1977. He did another year of neonatology in Toronto at the Hospital for Sick Children and then returned to Denver in 1978, where he joined the faculty of the University of Colorado. He spent a year on sabbatical (July 1987–June 1988) at the Children's Hospital National Medical Center in Washington, DC. In 1991, he and his family moved to Dallas, Texas, where he became medical director of neonatal and pediatric critical care services at Baylor University Medical Center (BUMC) and, 4 years later, chief of pediatrics at BUMC. Dr. Whitfield has produced here at BUMC one of the finest neonatology departments anywhere. He has received national prominence through his lecturing and publications, virtually all of which are in peer-reviewed medical journals. Additionally, he is a great guy and a very popular member of the BUMC faculty.

Figure 1.

Dr. Jonathan M. Whitfield during the interview.

William Clifford Roberts, MD (hereafter, WCR): Dr. Whitfield, I appreciate your willingness to talk to me and therefore to the readers of BUMC Proceedings. It is January 23, 2004, and we are in my house. Dr. Whitfield, could we begin by talking about your early life, some of your early memories in Edinburgh, and your parents and siblings?

Jonathan Martin Whitfield, MB (hereafter, JMW): I was born in a small hospital called the Elsie Inglis. This was in the oldest part of Edinburgh—close to Arthur's Seat, the famous hill that overlooks Holyrood Palace, where the kings and queens of Scotland used to reside. To this day, when the kings or queens visit Edinburgh, they stay at Holyrood. The new parliament of Scotland now resides there. I was born to Miriam Theresa Whitfield and Robert Percy Whitfield (Figure 2). I was the first of 6 children.

Figure 2.

Parents Robert and Miriam Whitfield, c. 1996, in Herefordshire, United Kingdom.

My mother came from a German/Jewish family. My maternal grandfather was a prominent lawyer in Berlin. He had the foresight, unlike many of his relatives, to realize what was going on in the 1930s and managed to get exit documents to leave Nazi Germany. My mother sailed from Hamburg to Leith, the port of Edinburgh, on September 3, 1939 (her birthday), which was the day Neville Chamberlain declared war on Nazi Germany. She came across the North Sea in a terrible storm. She came by herself as a 19-year-old. All of her family members went different ways to escape. During her passage she became terribly seasick. A rather mysterious character followed her all over the ship. She was on the upper deck, and he was following her. Who this mysterious gentleman was, she did not know, but she does remember vomiting upwind from this man and catching him full force. She never saw him again!

She arrived in Edinburgh with a typewriter and some necklaces and pearls from the family as her only possessions. She managed to get a job as a nurse's aide during the war. That must have been pretty tough because she, of course, had a German accent and was very poor at English. The British were not too crazy about the Germans at that time. Jews trying to escape from Germany had to have sponsors to get their visas. My godfather, Theodore Houghton, was her sponsor. He owned a large estate outside Aberdeen, Scotland. My dad was on the estate helping on the farm because he was a conscientious objector. He and my mother met on the estate during the war and married towards the end of the war. I was born after the war ended.

My mother was the youngest of three. Of her two older brothers, the youngest left Germany in 1933, about the time the Nazis came to power, and he emigrated to New Zealand. He's in his late 80s now. He became a professor of economics at Christchurch University. I have a number of cousins and family in New Zealand. Her oldest brother escaped Berlin about the time my mom did. He studied architecture in Britain and later became a leader in town planning and architecture at the University of Auckland in New Zealand. My mother's father, who had been a lawyer in Germany, was interned during the war on the Isle of Mann, a small independent island in the Irish Sea between England and Ireland, because he was viewed as a potential foreign combatant. I think he had a jolly good time. He never was able to get a license to practice law in Britain.

My dad's story is also very interesting. He was the youngest of 9 children and was from a very staunch Methodist family in Austwick, Yorkshire, England. I loved to visit the family farm called Hobbs Gate. It stayed in the family until recently. My father's father died when I was about 6 months old. He farmed cattle and sheep in Austwick. I think my dad was an afterthought because there was a difference of >22 years between his oldest brother and my dad. I believe he was somewhat doted upon and mollycoddled but ended up getting a good education, which was quite unusual at that time. He went to Skipton Grammar School. That part of the world has been shown in the movie Calendar Girls and the BBC series All Creatures Great and Small. The most amazing thing about my dad is that he was certainly familiar with helping on the farm but became a gifted musician. He learned to play the cathedral organ by cycling regularly from Austwick to Lancaster Cathedral, 25 miles away, for lessons. His love and knowledge of music had a huge impact on my life. Music was a very prominent part of our upbringing. We were all expected to play an instrument. My dad was wonderful on the piano and a great accompanist. I took up the flute. He and I play together to this day.

WCR: Did your mother play an instrument?

JMW: No, she sang. When the two of them performed together, she sang and Dad played the piano. It was very much like Lloyd Kitchens on the piano and his wife, Connie, singing.

WCR: Of the 6 children, all of you played some instrument?

JMW: We started with either piano or recorder or violin. The sister right after me, Sylvia, is a big singer. She sings in a choir every week in Herefordshire, England. They go around the county entertaining at nursing homes and hospitals. She loves to sing. She, incidentally, is a lobbyist in London for the Steiner Waldorf Schools Fellowship. She's worked very hard over the past 10 years trying to obtain state funding to help with the development of Steiner Waldorf Schools.

WCR: When were your parents born?

JMW: My mother was born in 1920; my father, in 1919. Both are still living.

WCR: What is your mother like?

JMW: As a young woman, she was very good looking, always outgoing, and sociable. To this day she remains a real raconteur. She loves to tell stories and anecdotes just like my grandfather (Opa) did. In his 80s, my grandfather lived with us in Edinburgh after his wife (my grandmother, or Oma) died. He had an incredible mind. He could recite from memory Goethe and Schiller in German for hours on end. He was very knowledgeable. He wanted to expose his grandchildren to German literature. He loved to play chess, but he didn't like to lose. My grandmother must have been brilliant because I remember watching her beat my grandfather at chess every single night! As a German refugee in Glasgow, she did the housework, ironed, stitched, and kept the house together. My grandfather was not permitted to work as a lawyer. He taught the grandkids how to play chess. I played chess with him in his later years but it wasn't until he was in his 80s that I could beat him. That would always depress him, so I learned to throw the game to cheer him up! It made his day when he beat his grandkids at chess.

WCR: You mentioned that your mother was a good storyteller and very warm and outgoing. What was your father like?

JMW: He was more taciturn, a true Englishman. He was less outgoing but enjoyed the fact that my mother was very social. He was a very hardworking and committed individual and made a living working on farms and market gardens and often doing other very menial types of work despite his good education. When I was about 10 years old he decided he needed to further his higher education, which had been cut short by World War II. He went back to college when we were in middle school and high school, and he became a special education teacher. He had to work hard going through college and keeping ends together with all of us kids. He sacrificed a lot to do that.

WCR: Did your mother go to college?

JMW: No. She had some nursing training. The war and circumstances around it interrupted her going to college in Germany. Her brothers went, but she never did.

WCR: What was home life like in Edinburgh? Could you describe your house?

JMW: My dad moved a lot. Two homes around Edinburgh stick in my memory. Penicuik House Garden Cottage was one of the most primitive places to live, but amazingly I have the fondest memories of it. It was a rundown cottage attached to a huge walled garden on the old Scottish estate of Sir John Clerk outside Edinburgh. My dad took care of the garden and managed to support us as a family while he went to college. The walled garden was like the “Secret Garden” (Frances Burnett story) for us. It had 20-foot-high walls enclosing 2 acres. It contained a feast of fruits and vegetables that had been planted over the years. The cottage that went with it was somewhat primitive. I would wake up in the mornings and the walls would have moisture on them from the condensation and dampness of the Scottish climate. Nevertheless, it was the greatest place to be because we were in the country. We had goats and hens and had the greatest times. We children were not aware of the fairly primitive conditions in which we were living. We enjoyed it immensely. I remember overlooking the property from a 70-foot fir tree that I climbed. I would sit at the top of it swaying in the wind, overlooking this huge garden. My mother would always be very alarmed to see me atop this giant fir! I'd dream about my future. I still have very fond memories of doing that.

WCR: What was the cottage like? Did all the kids stay in the same room?

JMW: The cottage consisted of a row of single rooms that were attached to huge greenhouses. After coming in the front door, if you turned right you went through the kitchen and my parents' bedroom to get to the children's bedrooms; if you went left, you had to go through a living room to the bedrooms. We had an inside toilet, running water, and a wood Raeburn stove with a bath behind a curtain. We took baths once a week. We had our first telephone, one with the separate earpiece. I still remember the number—Penicuik 119. My mother used to love to talk to her friends. It was a shared line. One great entertainment for the kids was to pick up the earpiece and listen to the neighbors' conversations.

WCR: The cottage was how far from Edinburgh?

JMW: It was about 7 miles outside of Edinburgh.

WCR: How did you get to school?

JMW: I had to walk or cycle from the cottage about 1.5 miles to the bus stop. The bus would pick us up and take us to Edinburgh. My parents were very committed to education even though they were of limited means. Every one of us ended up going to the Steiner Waldorf School in Edinburgh. Despite the fact that my father moved a lot to keep body and soul together, we always fortunately went to the same school. That was my anchor because I went there from kindergarten until university entrance. It was an unconventional school by many standards, but my parents were very committed to this form of education.

WCR: What is Waldorf education?

JMW: This was something very important in my parents' lives. The Austrian philosopher/thinker Rudolph Steiner (1861–1925) founded the anthroposophical movement. He was a spiritual scientist. Right after World War I, the manager of the Waldorf Astoria Cigarette Company in Stuttgart asked Steiner to help design a school for the workers' children in the factory. That education movement has grown from there and is a very prominent private educational system around the world. What is unique about the educational system is the basic philosophy that underpins the curriculum: that an individual is a threefold being—body, soul, and spirit. The curriculum is designed to nurture and develop the threefold nature of a child. A Waldorf teacher would say that a lot of modern education emphasizes the intellectual side of education too early and doesn't nurture the inner being of the child in an appropriate fashion.

The curriculum looks very unusual to conventional pedagogues. They would say, “Geez! Those kids are going to be left behind because they are not reading, writing, and doing arithmetic in kindergarten and first grade.” Instead, the kids are being told stories, and the imaginative powers of the developing child are being nurtured. We learned foreign language even in kindergarten. I learned French and German by listening to and mimicking German and French games, a method meant to incorporate language into the inner being of the child. Testing is not used until high school, and a class teacher is assigned to each student through eighth grade. It's an unusual approach to education but one that has gained a lot of respect around the world.

WCR: That was free of charge?

JMW: No. It was a fee-based school. I was very fortunate to receive scholarships because of my parents' passionate belief in the system, and I think the school went out of its way to support poorer families, like ours, who were committed to this form of education.

WCR: All of your siblings got scholarships also?

JMW: Yes.

WCR: Was dinner a big deal in your family when you came home from school? What was the nightly meal like?

JMW: Yes, it was. When we had all gotten home and done our homework and chores around the house, all 8 of us would sit down together. Before we were allowed to touch a piece of food, there would be a quiet time with grace. To this day, when my family gets together and certainly when I get together with my siblings, we still say the family grace and bless the meal before we begin. It was a very centering time of the day when people would share what happened. It was a special time. My mom would make sure that she cooked something special every night, even though she had little in the way of resources. There would be food out of the garden and fish once a week. If we were very lucky we would get a piece of meat occasionally, but a lot of our meals were vegetarian and basically from our garden.

WCR: Who dominated the table, your mother or your dad?

JMW: My mom. My father was fairly quiet.

WCR: Your mother was Jewish from Germany. Your father was Methodist from the United Kingdom. What religion were you?

JMW: Protestant Christian. Again, the effect of the anthroposophical movement on my parents comes into play. Steiner helped some breakaway Lutheran ministers in Germany found the Christian Community Church. I was brought up with little Jewish exposure. All the kids went to church every Sunday and studied the Bible.

WCR: Did you read the Bible at home?

JMW: My parents certainly did. They didn't force that on the kids in any disciplined type of way but, yes, the Bible was an important part of our lives. I remember all the holy Christian festivals throughout the year—especially Easter and Christmas-being very special times. Many of the traditional festivals of the Christian calendar were given special attention by my parents and were made a part of our lives. I particularly remember Advent, with the wreath and a new candle being lit each Advent Sunday. We would sing carols and read something from the Bible as we prepared for Christmas. At Christmas, the Christmas tree would not go up until Christmas Eve. In the European tradition, our presents would be under a candlelit tree. There would be a reading from the Bible before we'd be allowed to get our presents. On Christmas day we would all go to church.

WCR: How far was church from your home?

JMW: It was a small church in Edinburgh, about 6 or 7 miles away.

WCR: Did you take a public bus?

JMW: We did take a public bus, but my maternal grandmother (Oma) was very industrious. She was the one who kept body and soul together for Grandpa and herself. She got a car (a green Austin 10) when I was about 9 years old. It was a big excitement at that time. We could borrow her car because my dad taught my grandmother how to drive. She was almost 70 years old when she learned to drive. She was a very determined woman. I do remember that it was somewhat frightening to be in the car when she drove because she never quite understood the mechanism of the clutch. We would “jackrabbit” around town. She took off with people blaring their horns at her. When Grandma got too old and her driving became dangerous, the car became our vehicle. I still remember the registration of that car: BUS 174. I learned to drive on that car, too. That was how we got about for years. Everyone and everything was transported in that car, including 2 goats in the backseat on one occasion.

WCR: Was there alcohol in your home growing up?

JMW: None.

WCR: Did your parents smoke cigarettes?

JMW: Dad smoked a pipe and occasional cigarettes.

WCR: Did anyone in your school have a particular impact on you?

JMW: One unique thing of the Waldorf system of education was that each group of children had their own “class teacher” through the first 8 years of schooling. My elementary school class teacher was Sylvia Brose, who couldn't stay the whole 8 years; as an Australian, she came to the United Kingdom specifically to learn the Waldorf system and then returned to Sydney when I was in grade 4 and founded the Waldorf school system there. Ms. Brose was a tall, articulate, striking woman with very strong character. I don't think she had a lot of faith in me particularly, but she made a big impression on me. It was the gentleman who took over from her as class teacher, Lawrence Edwards, who undoubtedly had the biggest influence on my early life. He believed in me and encouraged me. He was a master musician and a master mathematician. He had gone to Oxford or Cambridge. He came from a monied family but was an anthroposophist and believed in the Waldorf school system. He basically donated his time to the school. I was fortunate to have him as a class teacher. At the end of each year our class performed a play. In most schools, each class performs some sort of skit or demonstration, recites poetry, or has a musical recital. We always had a play. Mr. Edwards invariably selected me in the lead role. He promoted my ability to go on stage, learn lines, and speak in public. He also encouraged me to take up the flute. He was himself a master musician who wanted to develop a school orchestra—he picked all the instruments he needed and assigned them to various kids in the class!

WCR: How did you get money to buy the flute?

JMW: One of my generous aunts paid for the flute. I used to play in the school orchestra, with Lawrence Edwards conducting like a Leonard Bernstein. Invariably he had composed the piece that we played. We rehearsed every week. I put a lot of energy into the flute in those years and became passionate about orchestral music. Edinburgh is the home of an international music festival. My dad took me to a concert at the Edinburgh International Festival about 1952.

WCR: You were about 6 years of age?

JMW: Yes. I remember standing outside for hours to get the last tickets to sit on the steps in the “gods” of the Usher Hall, the big concert hall in Edinburgh. They cost 2 shillings and sixpence. I sat on the steps. The place was absolutely packed. I will never forget it. The Boston Symphony Orchestra, with Pierre Monteaux conducting, played Schumann's piano concerto with the great French pianist Robert Cassadasus. Listening to the orchestra and the soloist and the whole electric atmosphere of the concert hall made a huge impression on me.

Four years later, I managed to get a job selling programs for the Scottish National Orchestra. Every Friday night I sold concert programs and was paid a small amount. The best part of the deal was the ability to grab any empty seat and listen to the concert for free! I'd get the best seat in the house. Over a 4-year period, I got to know the whole orchestral repertoire.

I must have been about 12 or 13 years old when I decided I needed a new flute teacher. Since I used to go not only to the concerts, but often to the rehearsals, I figured out how everything worked. I went on stage in my short trousers, blazer, and school cap during a break in the rehearsal before the concert that night and approached the principal flute of the National Orchestra and said, “Please sir. Would you give me lessons?” He looked down his nose at me and said, “Sure. I'll give you lessons. I live in Glasgow and you will have to come there on a Saturday morning. That's the only day I'm not rehearsing or giving concerts.” I agreed and was so excited by this that I forgot to ask the cost. My mother was horrified. She told me I was not going until I found out how much it was going to cost. The next week when the orchestra was rehearsing I went and asked, “How much is it going to cost me?” He looked down his nose at me (this little urchin) and said, “Seven shillings and sixpence.” I delivered bottles of milk and papers in the mornings and saved the money for the train fare to Glasgow. About once a month I would take the train and go to the home of the principal flute of the Scottish National Orchestra. He would come out in his pajamas and his dressing gown and meet me at the door. I think he enjoyed teaching me because he got to play the piano. He was obviously a master musician. He got to accompany me and pass on all the tricks of the trade of playing the flute. I had some wonderful lessons from David Haslam. I think he is still one of the lead flute players in Britain. He now conducts the Northern Sinfonia Orchestra.

WCR: How long did you do that?

JMW: About a year or so. It was one of the great experiences of my youth.

WCR: How much did you practice the flute each day?

JMW: I practiced from 30 to 60 minutes every day. I'd play with my dad, of course. We played together a lot. For a time I was getting pretty good at it, but when university entrance exams neared and my studies for medical school increased, practice dwindled.

WCR: Did you play sports?

JMW: One of my teachers, Dr. Moffat (we called him “Dockie”), was passionate about rugby and cricket. Dockie managed to put together a really good rugby team when I was in high school. We were very competitive. Although we were a small school of 200 kids-about 16 kids in each of the 12 classes-we took on some of the big established Edinburgh schools, like George Watsons or Heriot Watts. We won a lot of our matches. I played wing three-quarters, I used to love being out there on the field, racing with the ball down the pitch. I wasn't the most talented rugby player, but I thoroughly enjoyed it. That was in the wintertime; in the spring and summer, we played cricket. I used to be fairly competitive in that, too. I wasn't a star, but I enjoyed it.

WCR: I gather there really wasn't a lot of money around the house, but were there books around the house?

JMW: A lot of them and a lot of music.

WCR: Did your parents read much?

JMW: Yes. My parents loved to read and encouraged us to read. Regrettably, I was a very poor reader, but they absolutely insisted that I be a member of the public library. I went on Saturday mornings and borrowed books. It was a tough task to get me to read for pleasure. My mom struggled with that for years. To this day I am not a great reader. My wife devours several books a month. I'm lucky if I read one every few months.

WCR: Was home a pleasant environs? Was there much fussing or bickering?

JMW: No. We had the usual sibling rivalry type of stuff. It was generally a very harmonious household with the family doing a lot of things together. Nearly all our activities were either with the siblings or the whole family. With my siblings, I played hide and seek, played in the garden, went on long walks in the Pentland Hills outside Edinburgh, went swimming in the river, climbed trees, took the goats for a walk, fed the hens, and picked fruit.

WCR: Did you learn German growing up?

JMW: Yes. We learned it in school. German was the main foreign language that was taught at our school. I didn't speak it at home. My mom would lapse into German with her German friends. She didn't go out of her way to speak German to the kids. I didn't grow up bilingual in that sense; I wish I had. I can get by with German to this day. German and French were taught starting in kindergarten all the way through the Waldorf School.

WCR: What did you do in the summertime?

JMW: In summertime I went to my relatives' farm called Staggarth in the north of England, where my dad was brought up (Figure 3). Auntie Dora (one of my father's older sisters) and Uncle Fred adopted me in the summertime. I went there from age 6 on. I took the train from Edinburgh, an all-day trip. I went by myself, usually in the guard's van with the guard looking after me, and I was met by my aunt. I spent the whole summer working on the farm with Uncle Fred. I absolutely loved it.

Figure 3.

At Staggarth Farm, Yorkshire, in 1956, the year Uncle Fred and Aunt Dora replaced the horse with a tractor.

WCR: Did Dora and Fred have children?

JMW: I didn't realize it at the time, but they had just lost their youngest daughter, who was 9 to 12 months older than me. She died from a brain tumor about a year before I started going there, just after the war. I think that is why Aunt Dora was so happy to have me there. She looked after me like a son. It was a primitive time on the farm. There was no electricity. It was a dairy farm with all the animals milked by hand. When they did get electricity and got the milking machines installed, it had an enormous impact on their daily schedule. They didn't have any tractors, just horse and cart. I helped take the milk in the kits to the road end by horse and cart. I was there to witness the change from 19th-century to 20th-century farming.

WCR: There wasn't enough money in your family for all of you to take family vacations?

JMW: No. As I got a little older, there was a little bit more money when Opa (my mother's father) came to live with us. He helped us buy a house in Edinburgh about a mile from the school. This was a beautiful house with a great view of the Pentland Hills at 59 Colinton Road in the heart of Edinburgh. We could come home for lunch on our bicycles. The transformation going from the cottage to that house was like dying and going to heaven.

WCR: How old were you?

JMW: I was 11 or 12 (Figure 4).

Figure 4.

Representing Scotland in the United Kingdom finals of the Master Therm competition of 1959, Olympia Exhibition Hall, London. He was the runner-up, winning £50.

WCR: You had 4 or 5 more years at home before you went to the University of Glasgow. Where did the money for college come from? Did you apply to other universities?

JMW: Yes. We had to take the university entrance examination, which involved doing either Scottish exams or the English Oxford and Cambridge exams. Our school chose the Oxford and Cambridge exams. We took the “ordinary,” or “O,” levels on 7 or 8 subjects—such as German, mathematics, English, biology, chemistry, and physics—and then the advanced-level entrance exams. It is still done that way. Students pick the appropriate subjects (science if you want to go to medical school). I chose physics and chemistry. In high school, I mastered those subjects at a very high level (at least first-year university equivalent here). Students who get an adequate grade in that test have a chance of getting accepted into medical school. I applied to several and got accepted in a couple. I decided to go to Glasgow, a 30-mile train ride from Edinburgh. I got entry there straight from high school, when I was 17.

WCR: Do you know where you ranked in your class when you graduated from high school?

JMW: There was no ranking in the Waldorf system. However, only 3 students remained after the “O” levels. The most talented teachers tutored me. David Masterton, a graduate from my school, had gone to Edinburgh University to do an honors degree in physics. He decided, just like Lawrence Edwards, my class teacher, to give back to the school as a teacher because of his passionate belief in the system. He coached us in advanced physics in high school. The other teacher was also a playwright and a wonderful chemistry teacher, Jack Ronder.

WCR: Did all three of you go to medical school?

JMW: No. Matthew Johnson (a classmate through all 12 years at the Waldorf School) died from Hodgkin's disease about 20 years ago. He was the brilliant guy of the trio—a mathematician who studied mathematics and physics at Aberdeen and then became a nuclear engineer. Ian Bruce studied biology, and I believe he is now a biology teacher.

WCR: How did you get interested in medicine? I assume there were no physicians in your extended family.

JMW: There weren't any physicians. My mother's Jewish heritage came into play as I think back on it. She influenced me greatly by getting me to read books about medicine. One such book was George Sava's The Healing Knife. Dr. Sava was a Russian surgeon who trained in Italy and Austria and ended up in England after the Bolshevik revolution. He became one of the great Harley Street specialists. He wrote several best-selling books about his experiences with patients. The books had very rich descriptions of the patients whom he came in contact with. I was about 14 or 15 years old when I read these books and decided I wanted to be a physician.

Another influence was through one of my classmates, Tessa Ellis. Her dad, Professor Ellis, was the Regius Professor of Pediatrics of the University of Edinburgh. Occasionally I was invited to their country house on weekends. I think my mother fostered that relationship because, obviously, he was a very prominent physician in the Edinburgh community while I was growing up. I talked to him and asked him what it would take to get into medical school. He encouraged me and told me that I should apply. Lawrence Edwards, my mother, and Professor Ellis all encouraged me to try to get into medical school.

WCR: Obviously, you lived on campus?

JMW: I had to live in a residence hall or in “digs,” as we called them. The latter was usually a room in a Glasgow flat. Glaswegian landladies were renowned and cooked your meals. God help you if you were late! The first year of medical school, I rented a room within walking distance of the campus and shared it with a classmate.

WCR: Were you on scholarship at the University of Glasgow?

JMW: In Great Britain at that time, the government paid tuition for everyone, irrespective of means, and provided a maintenance grant for living expenses. That is about to change, but that was the British system at the time.

WCR: Did you have much opportunity to take classes in literature and history?

JMW: I went straight from high school into medicine in the Scottish system. To get in, you have to focus on science. By age 14 or 15, my general education came to an end. That's one of my big regrets and one reason I admire the American system, where a general education is required before medical school. In the Scottish tradition, students go straight from high school into professional schools as undergraduates, not as postgraduates.

WCR: You started in university in what year?

JMW: In 1964.

WCR: How many students were in your medical school?

JMW: There were 220 in my class. Glasgow was, and I think still is, the largest medical school in the British Common wealth.

WCR: How many medical schools are there in Scotland?

JMW: Four.

WCR: What about England?

JMW: There are a lot more in England. All the major cities have a medical school.

WCR: When you entered medical school, it was the first time, other than the summers with your aunt and uncle, you were away from home?

JMW: Yes.

WCR: How did medical school strike you? Did you find it a lot more difficult than high school? What were some surprises?

JMW: The last year of high school when I was tutored in physics and chemistry stood me in good stead because the first year of medical school covered zoology, botany, physics, and chemistry. In the Scottish system, that year is used to sort out the class. We started off with 220 students, but by the end of that year 20 or 30 kids had dropped out. I'd done so well with the physics and chemistry at high school that when I went to university the material was all very familiar to me. At the end of the first year I ended up with distinctions in chemistry and physics. I got off to a flying start. I studied hard. It was just before calculators came in. In high school, I knew how to use a slide rule and became very quick with it. I could run through physics problems double the speed of everybody else. I finished all of the medical school physics exams long before my classmates. I ended up near the top of the class. Interestingly, physics was called natural philosophy, in deference to the rich academic heritage at Glasgow that went back several hundred years (the school was founded in 1451) (Figure 5).

Figure 5.

His alma mater, the University of Glasgow, founded in 1451.

We got our natural philosophy lectures in the same lecture theater where Lord Kelvin, the inventor of the Kelvin scale, used to lecture. All of the veterinary students, dental students, and medical students used it. It was huge and steep, with tier upon tier of seats in an ancient lecture theater. It got to be a little boisterous there at times. It was tough to keep 300 kids under control with one junior assistant faculty member teaching us physics. The pranksters at the back of this huge, steep lecture hall would torture the poor guy. Every time he turned to do an equation on the board with his back to the first-year medical students, the guys at the back would put marbles on the steps. The marbles would begin to roll down the steps—bump, bump, bump—getting faster and faster as they went down. This would absolutely enrage the physics professor. He couldn't see straight and definitely could not see who committed the transgression! We would get a lot of entertainment from that. A lot of the kids didn't do very well in physics. Some of them had to resit for the exam and still didn't pass. They were gone. That first year was a big weeding-out process.

For labs, we were divided up alphabetically. I fell in with a group of W's. To this day one of my best friends in the world is a W—Wilson. I had a great time socializing and going to the pub for the first time and the student union. I joined the sailing club at the university and learned to sail (Figure 6). I had the best time. It was a fantastic 6 years. Have you ever seen any part of Doctor in the House?. Some of our pranks were similar to those from that British television series and were too numerous to tell. Let me show you this from my yearbook.

Figure 6.

First time in a sailboat, the Firth of Forth, 1960.

WCR: Oh my! “110 Arrested as Police Break Up a Party” (Figure 7). Did studies come easy for you or did you have to work to make those good grades?

Figure 7.

Newspaper clipping from medical school days.

JMW: I was pretty disciplined, but I would characterize myself as a crammer. I could plan my studies 4 to 6 weeks before an exam. It was the “do-or-die” type of exams with me. We didn't have the ongoing assessment like my son has gone through at the Baylor College of Dentistry. Every week he has exams, and they are all marked. At university we had one exam at the end of the semester and either you passed it or you didn't. They were all essays, no multiple choices. We had to have total recall and be able to organize ourselves. We had to write legibly and spell. I would study hard. I'd be really tense and then forget about it and be off doing my partying, sailing, and socializing.

WCR: Who had particular impact on you in medical school?

JMW: It was the time of my life in terms of camaraderie. The most wonderful introduction to the medical fraternity was our proctored dissection class in anatomy. We were assigned in groups of 6 to each body in a huge anatomy dissection hall. It took us about 18 months to do anatomy. There was a big emphasis on this—the superficial landmarks, all the relations of the organs, very old-fashioned medical school teaching-which was very good if you wanted to be a surgeon. All the W's sat around the body and dissected for hours each day. We would hear anecdotes from our instructors, who were all young trainee surgeons. This was our first introduction to the anecdotes and experiences of clinical medicine.

Every Monday afternoon after lunch, we would have our dreaded anatomy “viva.” The instructors would go around the table and ask us to describe some aspect of the body from the previous week's dissection. Typically it would be, “Describe, Mr. Whitfield [with emphasis on the Mr.], the posterior relations of the left adrenal gland.” They would mark on a grade card what they thought we were worth. Invariably, it was a beta, rarely an alpha. One thing they loved to do was sit there and grill us. A student who got a D had to come in on Saturday morning when the professor of anatomy was there and do extra “remedial” anatomy classes! The instructors loved to grade with a beta and look us right in the face and then add a delayed minus! I got a lot of beta minuses and occasional alphas. I did pretty well in anatomy.

At the end of the second year, final exams were held in anatomy, biochemistry, and physiology, and they are, as one says, do or die. Once beyond “second MB,” the student is pretty well set for the last 4 years. You can imagine that everybody got very uptight about the anatomy exam because that one was very challenging. Wilson and I were sitting in the anatomy library one day while our classmates were uptight studying. We devised an impossible but fake anatomy paper and made believe that the professor of anatomy had posted it as an example of the type of questions we should prepare for. I typed it out carefully. It was really obscure stuff—lymphatic drainage of the left arm and the posterior relations of the parathyroid gland. I posted it in the anatomy library and stood by and watched. All my classmates came to read it and wrote down the questions. They all went off and studied. The professor of anatomy also saw this prank exam. He studied it, ripped it off the wall angrily, and put it in his pocket. Three weeks later we went into the anatomy exam in one of the old examination halls on campus. I was one of the last to go into the exam and I could see everybody groaning. I sat down and looked at the paper and every one of those questions I had posted as a prank was on the exam. Needless to say, I had not spent too much time learning the topics!

WCR: Dr. Whitfield, would you talk a bit about any faculty member at the University of Glasgow who particularly influenced you during medical school?

JMW: Some professors on the faculty in Glasgow at that time were very colorful and made a lasting impression on students. They had a system of assigning tutors to students in the first year. I got Dr. William Hamilton. I can't say that he was particularly colorful. He was a fairly dour Scot Presbyterian pediatrician-endocrinologist who really believed in hard work, sacrifice, and frugality. He was my tutor throughout the 6 years. I was introduced to pediatrics very early on at the Royal Hospital for Sick Children at York Hill. He would take me onto the wards and into the autopsy room. The first autopsy I saw was of a child from the slums of Glasgow who had died of typhoid fever. That autopsy made a huge impression on me. I was attracted to pediatrics very early in the preclinical years because of that chance assignment of a tutor. He encouraged me and helped me through medical school.

The number of faculty I can think of who helped me is incredible. One example was Ian Donald, the professor of obstetrics at the University of Glasgow. He was a colorful character. He was well over 6 feet and had red hair; he was a real raconteur, a master clinician and physician, who made a huge impression on the medical students. Through his tenacity and drive, he managed to build the Queen Mother's hospital. In the 1960s, it was state-of-the-art. I remember how distinctly he had designed the operating rooms. Medical students and others could sit around over the top of them and look through one-way glass down into the operating room. We went there for our weekly tutorial with him. He would sit us on the benches over the operating room while his senior residents and fellows operated. They couldn't see us, but we could see them. There was a microphone/loudspeaker system between the observation gallery through the one-way glass. The effect of Professor Donald's booming voice coming unexpectedly for those poor senior residents doing a cesarean section or hysterectomy was something to behold! He would boom down and say, “Dr. So and So, would you describe for the medical students exactly what you are doing?” Everything would stop and the resident would describe with temerity the particular procedure he was doing.

Professor Donald was an innovator in obstetrics. He was the physician who described ultrasound for the first time. When I was going through medical school, he was developing that technology. He would keep a copy of the ultrasound picture for the record and then make a second copy and, like a movie star, sign it on the back and give it to the mother. He had quite the ego.

Although most of our exams were essay format, many were oral. Professor Donald was renowned for getting students into the obstetrical examination, leaning across the table, and saying, “Mr. So and So, take my pulse.” (He had atrial fibrillation because he had rheumatic heart disease.) Puzzled, the student would take his pulse. Then he would ask, “If I were pregnant, how would you manage me?” This would invariably confuse even the best students. Whenever he lectured, he would insist that the senior resident from the cardiology division come to the lecture and bring the defibrillator with him, just in case he needed defibrillation. He was quite the character.

Professor Mackey was another influence. He was one of the professors of surgery and one of the earliest clinicians I came in contact with in my third year. For 2 hours almost every morning during the last 4 years of medical school, we sat at the bedside of a patient. Typically, there would be 6 of us sitting around a bed. We would take a patient's history and do an examination. Then we would discuss the differential diagnosis. We eventually got to the treatment plan. Professor Mackey was absolutely passionate about the dangers of smoking. He would routinely search the poor patient's locker. It was embarrassing. He would go through all of the patient's belongings. (Everyone in Glasgow smoked at that time.) If he found tobacco, he would scold the patient in front of the medical students. He was so passionate about not smoking that it was 2 strikes and you were out—and he was known to throw the patient off his ward. He was also a stickler for dress and decorum. One day when waiting for him to go on ward rounds, I realized that I had forgotten to wear a tie. “Whitfield, where's your tie?” I answered, “Sir, I forgot it.” “Home,” he said. “You are not coming on my ward without a tie.” He was known to order medical students to get haircuts (remember, this was the 1960s!) before they were allowed on his ward. I received the Hunter Medal in surgery from Professor Mackey my third year.

WCR: How did you finish up in medical school among your 200 or so classmates? Where did you rank? Or do you know?

JMW: I don't know the exact number, but I was one of 10 or 15 students who graduated cum laude. For me, this meant that in a 6-year course, I hadn't failed a single exam and had my fair share of distinction orals along the way. One or two students got summa cum laude.

WCR: How did you decide on the internship?

JMW: That was a very random type of process in those days. There was a very different emphasis in medical education. The medical students got all the attention. The Regius Professor of Neurosurgery, Bryan Jennett (of the Glasgow Coma Score fame), taught me personally on several occasions. He and I hit it off just great. He'd say, “What does the gentleman in that bed have ?” I said, “Sir, it looks like he has acromegaly.” He'd say, “Very good, Whitfield. Would you like to do neurosurgery?” He tried to encourage me to go into neurosurgery.

The senior faculty really got involved with the medical students, whereas the postgrads were somewhat neglected and disorganized. It isn't the way it is in North America. There, as a postgrad resident, you had to find a mentor in the area that you thought you liked. You sat down with him to figure out where you should do your residency and with whom. You really had to have a sponsor to get through the system. There wasn't any organized postgraduate system at that time. There is now. I did well in the surgical specialties as an undergraduate.

To get registered with the General Medical Council, I had to do 6 months of general surgery and 6 months of general medicine. I applied to be the “houseman” for Professor (later Sir) Andrew Kay, the Regius Professor of Surgery. I don't know how many applied for it, but I was selected. A “houseman” was literally just that—someone who lived on the wards for 6 months. There was a small call room in between the male and female surgical wards. That was my home for 6 months after graduation. It was assumed that if you were Andrew Kay's houseman, you were set for a career in surgery. Before I became his houseman, I had pretty much decided that I really wanted to do pediatrics. There were no available jobs in pediatrics for 2 years in Glasgow. So I applied to the Hospital for Sick Children in Toronto for a year overseas (we all valued the ETNA, or “been to North America,” experience). I returned to Glasgow to continue pediatrics there. Professor Andrew Kay, as my mentor, had arranged my first senior houseofficer job with the pediatric surgeon at York Hill. Regrettably, he and I did not hit it off. He seemed resentful of the fact that I'd been to North America and pooh-poohed everything I had learned during my ETNA experience. It didn't work. My career in pediatric surgery came to a premature end and I got out of surgery. I pursued training in general pediatrics.

I had to rethink my career direction at that time. I traveled for a couple of years to New Zealand and Papua New Guinea and ended up back in Canada to finish my pediatric residency at the Children's Hospital of Eastern Ontario in Ottawa.

WCR: When you went to Toronto, was that the first time you had been out of the United Kingdom?

JMW: No. I had been to Europe every summer when I was a medical student. I'd been to North America once in 1968. I went to a hospital in Youngstown, Ohio, as an extern. It was a time in the USA when foreign medical graduates were recruited. There were all sorts of enticements to get us to come to various hospitals in the USA. As a fourth-year student, I spent a summer in North America and ended up hitchhiking across Canada.

WCR: How did you get the money to go on those vacations in continental Europe?

JMW: In my first year of medical school, I became aware of a seasonal program in the seed potato business in Scotland called “roguing.” The east coast of Scotland is very fertile, and farmers grow a lot of seed potatoes. They are very pure and high-grade potatoes, and the crops all are very valuable. The Ministry of Agriculture trained students to recognize potato varieties and potato diseases. We went to a training course and then either inspected the crops for the Ministry of Agriculture as a summer inspector, as my friend Wilson did, or worked for the roguing company pulling out diseased or errant varieties of potatoes so that the potato seed crop was as pure as possible, as I did. If the inspectors came and found a high percentage of purity, then the farmers could sell. It was like gold; they could sell those potatoes for a fortune. At that time we were paid for every acre we rogued at the equivalent today of $35 to $50 an acre. The roguing season lasted for 4 to 6 weeks when the crops were in flower in the early summer. We would all work like crazy as roguers or inspectors. We'd make a ton of money, which would last for the rest of the summer. In the last few years of medical school, we had our own roguing company—Roguing Enterprises! As students we went to Italy, Greece, and Israel.

WCR: How much time did you have off in the summertime?

JMW: The first 4 years of medical school, I finished in June and returned at the end of September. During the last 2 years of medical school, there were no summer vacations; we worked clinically in the hospitals.

WCR: How did you meet your wife?

JMW: She was an assistant head nurse on one of the pediatric floors at the Hospital for Sick Children in Toronto.

WCR: You went to Toronto in 1971. What attracted you to her?

JMW: She was a vivacious and beautiful Canadian girl. I fell in love. She has been a great partner and friend. She has been very supportive of my career and has put up with all the traveling. She's been supportive of all the jobs I've had and places I've been to. She's a great mom to our 3 children. We were engaged July 19, 1972 (her 25th birthday) while I did a general practice locum tenens job in Pubnico, Nova Scotia, and married in February the following year (Figure 8).

Figure 8.

Married Clare Anne Larabie in Ottawa, Canada.

WCR: How did Toronto strike you? How did you like it?

JMW: It was very different from Glasgow. It was much more organized and disciplined. Toronto's Hospital for Sick Children was the largest children's hospital in the world at the time, with nearly 1000 beds. Every published largest series of whatever illness or disease had come out of that hospital. Cardiology was particularly strong there. There was a ward for cystic fibrosis, a ward for leukemia, a ward for heart disease, etc. It was much more sophisticated, bigger, glittering, and organized than what I was used to. It made a big impression on me, but I was very homesick for Scotland the first year. It was tough for me to be that far away from home. I missed Scotland a lot, but finding Clare Anne helped. She came back to Scotland with me. The surgical debacle occurred. We ended up going to New Zealand for 6 months, where I did a neonatal residency, and then to Papua New Guinea, where I was in general practice. I was very fortunate in New Zealand because I got to work with a couple of the leading lights in perinatal medicine at the time. It was a very good experience. I returned to Canada and resumed my residency in Clare Anne's hometown of Ottawa.

WCR: How did you get the position in New Zealand?

JMW: When I was in Toronto, National Women's Hospital in Auckland advertised. I remember thinking that I wouldn't mind doing that. I had been introduced to neonatology in Toronto. Though I was expected to go back to do surgery in Glasgow, on a lark, I filled out the application and sent it to Auckland. I didn't hear from them for a year and assumed I had not been selected. I returned to the pediatric surgery job in Glasgow but, as I have said previously, that did not work out. One day when things were not going well in Glasgow, a letter came: “You have been appointed registrar in neonatology at the Auckland Hospital System at National Women's Hospital, beginning January 1.” It was a great “gap year” because I was exposed to some really interesting people. Bill Liley (later Sir William of Rhesus isoimmunization fame) was there. He described the first fetal treatment intervention—namely, intrauterine transfusion. After watching Rh-Sensitized fetuses die from hydrops fetalis, he had the fortitude and skill to transfuse packed red blood cells intraperitoneally through the mother. These cells were absorbed by the fetus and treated the anemia, often dramatically reversing the hydrops. This was a major breakthrough.

Another person I came in contact with was Mont Liggins, the brilliant research obstetrician investigating mechanisms of parturition. He noted that the premature lambs from his study group that received corticosteroids were unexpectedly surviving at a very immature and previously lethal gestational age. (They die of hyaline membrane disease akin to premature human infants.) He and a neonatologist, Ross Howie, did the first randomized controlled trial of antenatal steroids to mothers presenting in premature labor. The results were dramatic. The hyaline membrane disease was either prevented or attenuated by antenatal steroids. The publication of this seminal work (legend has it!) was spurned by The Lancet, The British Medical Journal, and The New England Journal of Medicine! It was finally published in Pediatrics. It was the first description of how antenatal steroids given to the mother 24 hours before delivery improved fetal lung maturation. This single intervention was, in my opinion, responsible for one of the greatest advances in perinatal medicine in the last 50 years and must have saved countless children! I think it is deserving of a Nobel Prize.

WCR: How do you give the steroids?

JMW: We give 6 or 12 mg of betamethasone, 4 times or twice, respectively, parenterally to the mom. Given for at least 24 hours before delivery, the drug has a profound effect on the severity and the incidence of hyaline membrane disease and decreases the mortality rate of the premature infant. It's had a dramatic effect on the practice of high-risk obstetrics. It is interesting that it took roughly 25 randomized controlled trials and another 20 plus years before the National Institutes of Health convened a consensus conference that declared this intervention to be the standard of care!

WCR: You trained under and with some of the major innovators in neonatology?

JMW: Neonatology is a very young specialty. I believe that was why I was attracted to it at the Hospital for Sick Children in Toronto; it clearly was a specialty that was just about to blossom and was “the” specialty to go into. The technology and innovation attracted some of the best people in pediatrics at the time. Neonatology did not even have its own subspecialty boards until 1977. The teachers from whom I learned and their generation were the pioneers of neonatology as a specialty of pediatrics in its own right. I was fortunate to be exposed to many of them.

Paul Swyer, with whom I trained, was the head of neonatology in Toronto in the 1970s; he pioneered mechanical ventilation of the newborn, and I was there to witness that and learn from him. These were very exciting times. Only a few years before as I went through medical school, some infants just lay in oxygen in the incubators and either they made it or they didn't. Paul Swyer and his group transformed the specialty overnight by providing a meaningful intervention that resulted in survival of babies that previously would have died.

When I spent a year of fellowship in Colorado, I was fortunate to work with a group of talented pioneers of my specialty. Their names included Fred Battaglia, Lulu Lubchenko, Jerry Merenstein, Doug Jones, Jim Lemons, Mike Simmons, Joe Butterfield, Rod Levine, and Watty Bowes, all leading lights in neonatology/ perinatology.

WCR: How did Clare Anne react to Scotland?

JMW: She has always loved Europe, loved Scotland, and loved traveling. Before I knew her she had hitchhiked around Europe and North Africa herself. She's quite a free spirit and quite adventurous.

WCR: How did both of you react to New Zealand?

JMW: We really enjoyed New Zealand, but when all was said and done, we found it to be too isolated from our families, she from her sister and me from my parents and siblings and friends. We decided to settle in Canada.

WCR: You mentioned that after your initial training in New Zealand, you spent 8 months as a general practitioner. Where was that?

JMW: In Papua New Guinea. There was a very practical reason for going to such an apparently remote spot. Locum tenens were popular with New Zealand and Australian residents at the time, and I didn't have enough money to get a pregnant Clare Anne, Mark, and I back to Canada! It was 10 months before the next residency session began in Ottawa, and I needed to earn money and to keep body and soul together. One resident put me in touch with a general practitioner in Port Moresby in Papua New Guinea. They were looking for somebody to start a branch of their practice on the island of Bougainville, just south of the equator, that belongs to Papua New Guinea. It was fairly primitive. However, there was a huge copper mine there and a large community of miners with a lot of Australian expatriates who needed a general practitioner. I was provided with a house, a houseboy, a car, and a salary. Clare Anne and I felt like we had died and gone to heaven. The beaches were beautiful, so most days we swam in the gorgeous ocean after work. We had a great time. However, I had some hair-raising general practice experiences.

I remember one patient, who had become a bit disillusioned with the copper mine physician and came to see me for a second opinion. He was a surveyor for the mine. He visited me in the office (under our house built on stilts) and said, “Dr. Whitfield, I've really been dragging recently. I'm just not feeling like myself. I can't scramble around the mountains like I used to.” He was in his mid 30s, a strong-looking guy. I examined him in the Glaswegian style (as I'd been taught every morning for 4 years). He had clubbed fingers and the loudest precordial murmur of aortic insufficiency. I asked him, “When did you have rheumatic fever?” He'd had it as a child in Germany before he emigrated. I asked, “How long have your hands looked like this?” He told me, “Just over the last 6 weeks. They have been giving me tetracycline and I've been getting worse.” He obviously had subacute bacterial endocarditis. Unfortunately, that very night, before I could make arrangements to get him to the mainland, he had a stroke. His wife called me in a panic and said, “Dr. Whitfield, you predicted that this could happen.” He was unconscious in the small native hospital there. We got blood cultures and started him on broad spectrum antibiotics. They sent a plane and I took him to Port Moresby, but he died. I felt terrible that I had not jumped all over his case that morning and gotten him out to the mainland.

Another patient came to the office one day and said: “Doc, I couldn't go to the mine for the last couple of weeks. I've had chest tightness and I'm a bit short of breath.” I said, “Why don't you go down to the hospital and have an electrocardiogram and wait there until I come and read it.” I went down to the hospital after clinic to look at the electrocardiogram. He had had a massive myocardial infarction. I couldn't find the patient. He had disappeared. We sent out the mine police to look for him. He had a little hut in the bush in the back of beyond. We located him 2 or 3 days later. I told him, “You've got to go into the hospital on a monitor.” He said, “Why do I need to go to bed now? I feel much better.” He refused to stay in the hospital and survived despite it all.

On another day, a pale l0-year-old came in with his dad. I sent him to the hospital to get a complete blood count. His hemoglobin was 2 g/dL. He had a huge spleen and liver. He had hookworm and malaria combined. He was bleeding from his gastrointestinal tract and hemolyzing in his spleen from the malaria. We had to transfuse him very carefully so that we wouldn't throw him into heart failure. He left the hospital feeling great a few days later.

One of the senior managers of the mine loved to come to the office for psychotherapy. One day he called me and asked me to come to his house. I walked into the front door with my black bag and immediately smelled the melena stools. He was lying in his bed, pale as a ghost. “You never told me you had a peptic ulcer.” He said, “I didn't want to worry you.” He had been bleeding from this peptic ulcer for a week before he asked me to come see him. He was in bad shape—hypotensive and tachycardic. To get blood, we got volunteers to come into the blood bank. I started the transfusions that night. His blood pressure came up nicely, but this just worsened the bleeding. I spent a long night keeping this guy alive pumping blood into him. The more I put in, it seemed, the worse he bled. Fortunately there was a surgeon there. I knew we had to do surgery, but the surgeon was an Indian. This white Australian was not going to have any Indian operate on him. I had to beg and cajole him to allow the laparotomy to find the bleeder in his duodenum. We saved him, but he sure went through the mill. (So did I!)

WCR: After New Zealand and New Guinea, you went back to Ottawa, Canada. Ottawa was where your wife was from. You finished your training in pediatrics there. Did that work out well for you?

JMW: Yes, I finished my training at the Children's Hospital of Eastern Ontario. It opened the year I went there. I was the first resident to be on call in that hospital. The facility and faculty were wonderful. I decided there to do neonatology.

WCR: From there you went where?

JMW: I went to the Children's Hospital at the University of Colorado in Denver to do a fellowship with Joseph Butterfield, one of the pioneers in neonatology. The University of Colorado was known to be one of the best places in the world for neonatology. The previous year I had been to the Society for Pediatric Research in Denver and had fallen in love with the city. I felt it would be a great place to train. The following year I returned to Canada and finished my final year of fellowship with Paul Swyer at Toronto's Hospital for Sick Children. I took the fellowship exams of the Royal College in pediatrics and was set for a career somewhere in Canada in neonatology. However, I was invited to apply for a junior faculty position in Denver. After a lot of soul searching, we decided to take the job at Children's Hospital in Denver. That was 1978. That was my first staff job.

WCR: You were born in 1946, so you were 32 years old at that time. How did that work out?

JMW: It worked out pretty well. I was a member of the clinical faculty, and we had residents and fellows. A couple of us on the faculty decided that we would do something that was completely unheard of at the time—go into the private practice of neonatology. That move caused a major furor in Denver. Ironically, the entire clinical faculty including myself and my partner ended up practicing together at the Children's Hospital. I ended up staying there until I came to Baylor in 1991.

WCR: How did it come about, Jonathan, that you came to BUMC?

JMW: Bob Kramer, Boone Powell, Jr., and Bob Hille were having problems with the pediatric program at BUMC in 1990 or thereabouts. They had concerns about getting the program to grow, recruiting faculty for the pediatric intensive care unit, and ensuring the quality of care in the neonatal unit. Dr. Kramer contacted Dr. Butterfield, my boss and mentor. He asked him if he would consult on the organization of the pediatric program at Baylor. By this point, I had been on my sabbatical to Washington, DC (Figure 9), and I was board certified in pediatric intensive care as well as neonatology and pediatrics. Dr. Butterfield came to me and said, “Hey, Jonathan, why don't you go to Baylor and do that consultation on my behalf? You're the one with the background. I don't have the background in pediatric intensive care that they are so interested in.” Another faculty person from the University of Virginia in Charlottesville (Tom Marsaro) and I ended up being consultants. We listened to the story and wrote our report.

Figure 9.

With Batman (Adam West) in the pediatric intensive care unit at Children's National Medical Center in Washington, DC, 1988, during his sabbatical year.

I became close friends with Bob Kramer and kept in contact. He asked me, “Why don't you come to Baylor and run both the pediatric intensive care and neonatal units?” The person who preceded me at BUMC was a legend, but Bob Kramer felt that neonatology needed a new direction. The previous year, a high-risk obstetrician had been recruited (Whitney Gonsoulin), and a lot more high-risk deliveries were occurring. One thing led to another. I went back and forth trying to decide whether to stay put in Denver or come to Dallas. Things had really settled out nicely in Denver. The kids loved it. Nobody wanted to leave. But BUMC was an opportunity for me to run my own neonatal unit and to do some pediatric intensive care. I would run both units. I wasn't about to get that opportunity at the University of Colorado. There were too many other bright individuals around. I would wait forever in line to get a job like that. It was one of those once-in-a-lifetime opportunities, and I decided I needed to go for it.

WCR: You came to BUMC when?

JMW: In September 1991.

WCR: How did Clare Anne and your kids react to the move?

JMW: They didn't like the idea at all. My kids cried when they knew we were going to leave Denver. We had a wonderful house, an old lodge on Lookout Mountain (where Buffalo Bill's museum is), just outside Denver in the foothills that overlook the city of Denver to the east and the Rocky Mountains to the west. We had bought the 80-year-old lodge when it was in really bad shape. We had remodeled and rebuilt it. It was a beautiful big old place with 2 or 3 acres around it. We had horses. The kids just loved it. Leaving that was not easy.

WCR: This was aprofessional career move. How did things work out in Dallas for you? Were you pleased with BUMC and pleased with Dallas?

JMW: The first 2 years were absolutely dreadful (ask John Anderson or Mike Emmett or Dan Polter). There was a battle royal between the old-guard neonatologists on the one side and the new on the other. I was brought in and appointed director of the unit, but the old neonatologists, including the old director, didn't retire as predicted. I regretted coming to Dallas those first 2 years. It was miserable. Boone Powell and Bob Hille were very supportive of me. The other person who got me through those first 2 years was Reuben Adams (chief of obstetrics), who gave me pep talks in his office to keep me going. Many were very resentful of my coming. Finally, things sorted themselves out.

I am reaching the end of my neonatology career, and I am committed to ensuring a smooth transition. After a national search, BUMC has hired a neonatologist who will take over from me in July 2004. I look forward to a future in which the department will continue to provide excellence in patient care and become known nationally and internationally not only for first-class care in neonatology but also for innovation and research.

WCR: There are a lot of readers of BUMC Proceedings who are not physicians. Can you describe what neonatology is and what you do every day?

JMW: Neonatology is a subspecialty of pediatrics. The focus of neonatology is the sick newborn during the first 28 days of life, the so-called neonatal period. Neonatologists are generalists in that period of life. We take care of both premature and full-term infants who are sick and have not yet made the normal transition to being a well newborn (Figure 10). We deal with a lot of very premature infants. Also, we see infants with congenital malformations, serious infections, congenital heart disease, and disorders of every organ system. It's a hospital-based specialty. Increasingly, over the past 30 years, neonatology has involved very high-tech intensive care interventions, particularly mechanical ventilation to treat respiratory failure. We have a lot of expertise in pulmonary function, mechanical ventilation, blood gas monitoring, hemodynamic instability, and shock. The specialty has been fortunate in the past 25 years to have experienced many significant advances and breakthroughs in treatment and care of babies. Surfactant therapy, for example, is one of the major breakthroughs in all of modern medicine.

Figure 10.

Caring for a newborn at Baylor University Medical Center, c. 1995.

The story of neonatology in the past 30 years is really a parable of modern medicine. We have seen wildly successful interventions as well as some misguided interventions that have resulted in disaster, and they have really challenged the very core of what medicine is all about. I've been fortunate to practice and participate in some of the major advances in neonatology during my professional career. These advances allow us now to save infants even at the threshold of viability at 23 and 24 weeks of gestation. This may be a two-edged sword, with survival alone not being a good measure of success. It's been a very exciting specialty to be a part of. It has grown from a virtually hands-off/wait-and-see passive specialty to one that is very proactive with high-tech interventions.

WCR: Can you describe a typical day? When you arrive in the morning, what do you do?

JMW: I begin the day with a silent prayer for guidance and strength to meet the upcoming challenges. We have “check-out rounds” with the nurse practitioners and physicians who have been on duty the night before, during which we review the new admissions who have come in as well as those babies who have had problems. After this I grab some breakfast and view all the x-rays that have been taken in the last 24 hours to make sure there aren't any acute problems needing immediate care, such as endotracheal tube or catheter malposition. I then see each of the neonates on my team (we have 4 care teams in the neonatal intensive care unit). After evaluating the patients' fluid and electrolyte balance and their nutritional and respiratory needs, we interpret their blood gases and write a set of orders that will be the plan for the following 24 hours. We discuss the plans with the bedside nurses and the nurse practitioners on rounds. After we're done with rounds, elective procedures such as inserting arterial or central lines are carried out. Of course, we go to any high-risk deliveries and deal with transport requests as needed. We let the parents know what's going on and try to help them the best we can through the crisis of having their child, who may or may not make it, in the intensive care unit.

WCR: What time do you get to BUMC in the morning as a rule? What time do you wake up in the morning?

JMW: Typically, I wake up about 5:45, and I'm usually at BUMC by 7:00 AM.

WCR: What time, as a rule, do you leave the hospital at night?

JMW: If things are going well, I check out with my colleagues around 5:00 PM. By the time I finish with office work, I'll get home about 6:30 or 7:00 PM.

WCR: Do you get called much at night?

JMW: Yes. Until recently, I was on call about every fourth night and every third weekend. Recently, we've managed to recruit more neonatologists to BUMC so it's much more civilized, and since January 5, 2004, the neonatologists stay in the hospital when on call at night.

WCR: How many neonatologists are there at BUMC?

JMW: There are 10 at BUMC and 3 in the affiliate hospitals for a total of 13 in the Baylor Health Care System.

WCR: And you are all in the same group?

JMW: We are all part of a national group called Pediatrix Medical Group, which has about 650 neonatologists nationwide. Physicians of the Pediatrix Medical Group care for nearly 25% of all the neonatal intensive care days in the USA.

WCR: How many babies do you generally have in the intensive care unit?

JMW: Typically we have 60 to 70 babies. The unit is designed to carry 72 infants.

WCR: How many babies are delivered at BUMC a year?

JMW: About 4500. A lot of the high-risk moms from East Texas are referred to our high-risk obstetricians. On any one day, 25% to 30% of the deliveries at BUMC may be high risk. A lot of those babies, on average 2 to 3 a day, end up in the neonatal unit. We have 750 to 850 admissions a year into the neonatal intensive care unit, and the average length of stay is just over 3 weeks: some of the smallest babies stay 120 days or more, and some of the bigger ones stay only 3 or 4 days. Some need intensive care every minute of every day for 4 months. That takes not only a neonatologist but a whole multidisciplinary team including superb bedside nurses, who can recognize the changes in a status of a newborn that herald danger, as well as nurse practitioners (who are advanced practice nurses), who interpret the minute-to-minute changes in blood gases, electrolytes, and fluid balance. I am very proud of the neonatal nurse practitioner program, which started in 1992 and has grown in reputation and size. The neonatal nurse practitioners along with the registered nurses are responsible for the excellent outcomes we see at BUMC. Dietitians, respiratory therapists, social workers, and chaplains are important members of the team. The care of the newborn requires a huge team of individuals to make sure these kids get constant attention.

WCR: You are working at the hospital 11 or 12 hours a day. How much of that time are you on your feet?

JMW: It depends on whether I'm on call or not. In a typical clinical day, I look at patients and sit at a computer terminal in the neonatal intensive care unit. (We have electronically generated medical records in the neonatal unit, which are not yet available anywhere else in the hospital.) We prepare our notes, round with the nurse practitioners, sign the orders, etc. I am at the computer or on my feet on a busy day 8 hours easily. Some nights we are up for hours on end. A lot of the bad stuff happens at night. Deliveries have a way of happening in the middle of the night. A lot of what we do is in the wee hours.

WCR: The nights you are on call, do you get much sleep?

JMW: No. It's napping. If it's a quiet night, I might get a few hours of sleep, but typically I'll be up several times and get 2 or 3 phone calls. Neonatology is not a specialty for those who cherish their sleep! That's why I am going to slow down come summer 2004 and retire in another couple of years. It's a very demanding specialty.

WCR: You are still a young man. You are 57 years old. What do you mean “retire from it”? Then what are you going to do?

JMW: That I don't know. I'm not quite sure what I am going to do professionally, but it will be something that doesn't involve being up at night.

WCR: When you are not on call, do you truly not get calls? Are you really off?

JMW: From an administrative point of view, it's pretty good at this point. In the early days it wasn't. I was on all the time. Now, there are so many talented people in the department, I am not bothered much at all.

WCR: If you are not on call on the weekend, what do you do?

JMW: I try to beat Robert Jackson at golf! I love to play golf.

WCR: What is your handicap?

JMW: Unmentionable, in the 20s. I just took up golf with my wife about 5 years ago. The pair of us play a lot together. We like to play with the Jacksons at Lakewood Country Club. That is one of our things to do on a Sunday. When I have more time I'm going to get reasonably good at it. I think I'll get my handicap down a little. I'll never be a scratch golfer. I started too late. People don't understand that. When you tell people you were born in Scotland, they assume you have to be a scratch golfer. It's not true in my case.

WCR: Other than golf, do you and your wife do a lot of things together?

JMW: Every night we do a crossword puzzle together.

WCR: From the New York Times?

JMW: Not quite yet. Monday, Tuesday, and Wednesday maybe, but Thursday, Friday, Saturday, and Sunday, no. The puzzles get more difficult as the week progresses. The one that is our favorite right now is the crossword puzzle in USA Today, which is moderately difficult. My wife has a real talent for it. We sit in the living room and do it separately. When we both get stuck, we share, and we always manage to solve it together.

WCR: How long does it take you to do one?

JMW: Last night my wife had it done in 20 minutes. I've never seen her do it that fast. She's getting better and better. It's really irritating me. It's like my grandfather and grandmother with the chess. I'm still struggling at an hour and she says, “Okay. Enough. I'm going to help you.”

WCR: You are a modest man. Do you have hobbies outside of golf and crossword puzzles?

JMW: I enjoy skiing. All my kids are good skiers because we spent so much time in Colorado. I love to hike and climb the mountains. I have climbed about ten 14,000-foot peaks there (Figure 11). My big thing from Glasgow days is sailing. I've had many dinghies over the years, and I now have a small racing yacht, a 24-foot J boat. Just recently I had a fishing boat built, and I'm looking forward to cruising and learning to fish for salmon in the Northwest. I've always loved the ocean. I was in the navy as a reservist when I was a medical student (Figure 12). I don't know how I did it, but by hook or crook they let a Brit join the US Navy. I'm proud to say that I am an American US Navy reservist, although I'm inactive now (Figure 13). For many years I would charter yachts in the Virgin Islands and sail “bareboat” around the islands. I always enjoyed that. Now I have the boats in the marina a few steps from our retirement home in Point Roberts, Washington (Figures 14 and 15).

Figure 11.

At the summit of Quandry Peak (14,200 feet) with son Andrew, c. 1998.

Figure 12.

Royal Naval Reserves: at the Portsmouth Direct Commissioned Officer School (bottom right). Was a temporary acting surgeon sublieutenant about to be ordered to get short back and sides!

Figure 13.

As a reservist in the US Navy Medical Corps, a position he has held since 1988.

Figure 14.

Retirement home in Point Roberts, Washington.

Figure 15.

On the Nicola Clare cruising the Georgia Straits in Washington State, October 2003.

WCR: How much time do you take off a year?

JMW: Up until now I've probably taken off 6 weeks a year. My replacement, Craig Shoemaker from the University of California, is coming February 2004 and will be taking my job, and I plan to take more time off.

WCR: You are going to step down as chief?

JMW: In July. I said I wanted to go through the 100th anniversary year at Baylor and I wanted to see my oldest son finish dental school. He's finishing on May 18, 2004. For me that was a good time to step down and have more time to do the things that I like to do outside of medicine, such as boating and hiking, and get into doing those liberal arts things I've never had time to do. I'm looking forward to focusing on music again as well as taking painting and language classes. I'll do a lot more traveling and spend more time with my siblings back in Britain. I'll work here part time through 2006, and then I'm going to hang it up—at least the neonatology.

WCR: You don't do any general pediatrics?

JMW: Not any more. I used to do pediatric intensive care. Last year, I began an outpatient clinic, which I'm very proud of. It's called the TINY TOTS Clinic (acronym for The Infant and Young Toddlers Treatment Specialty Clinic) (Figure 16). It's a novel concept in my specialty—outpatient neonatology. If you think about it, a lot of these little kids go through the nursery and we have all invested time and energy in them, sometimes for 3 or 4 months. When they are ready to go home, at times they still need a little bit of oxygen, a diuretic, or a monitor because they are subject to apnea, and there really wasn't any good place to send them. The general pediatricians don't feel comfortable with them, and they take up too much time. These poor kids were falling through the cracks and were ending up in emergency rooms. The Baylor Health Care System Foundation with the Crystal Charity Ball helped us raise enough money to start this clinic. It was something I dreamt about for years. I thought it was a real deficit in the neonatal programs around the country: caring for the babies released from the neonatal unit but not 100% well. It takes them a year or two to get back into the mainstream of childhood. They really needed the expertise and help of people who had an interest in their disorders to transition them into good health. The Tiny Tots Clinic is on the fourth floor of the hospital, and it is fantastic. The parents just love it.

Figure 16.

With two graduates of the neonatal intensive care unit (Laura and Natalie Rathjen, age 7 years).

WCR: Maybe you will spend more time there?

JMW: It's possible that I could spend some time helping with that. We've hired a pediatrician now to help with it. I'm looking forward to being able to do work like that later on.

WCR: What is your house like here in Dallas?

JMW: It's a great house. I love it. It was a little bungalow when we bought it in 1991. It was a tiny 2-bedroom cottage just off the lake. My wife is a superb designer. She should have been an architect. Clare Anne worked with an architect to remodel it. We pulled the whole thing down and redid it. It has a beautiful view of the park and the lake and beautiful grounds. It has lovely oak floors and is bright and airy. It's a very comfortable place to live.

WCR: Other than the first 2 years in Dallas, you've all enjoyed Dallas?

JMW: Yes. When we moved to Dallas in 1991, we left my oldest son in Denver to finish high school. He remained there as a senior and stayed with one of our neighbors. He applied to college at schools around the country but selected Southern Methodist University. He went there and had the best time of his life. After graduating, he spent a couple of years in Washington, DC, as an aide on the Hill and had a very interesting job with Senator Murkowski of Alaska. He was basically his aide de camp and went to many interesting meetings and places, including the White House for senatorial dinners! The best tours of the Capitol were with my son, who knew every nook and cranny on the Hill (Figure 17). He went to dental school at Baylor and will finish in another couple of months. Before beginning to practice in July, he is going to climb Mount Kilimanjaro in Tanzania. Mark loves to travel!

Figure 17.

The best tours of the Capitol were by son Mark, aide de camp to Alaska Senator Murkowski, 1999–2000.

WCR: What does your second son do?

JMW: Andrew has had an interesting life (Figure 18). He went to American University in Washington, DC. He became enthralled with the whole political system and Washington, DC, when we lived in Annapolis (during my sabbatical year, 1981). He studied political science and wanted to be one of those guys “on the Hill.” He got involved in various offices there during his undergraduate years. Before he graduated, he ended up getting a job as a publicist for the Discovery Channel in Bethesda, Maryland. He did that for 2 years and did well. He loved the Washington, DC, scene. One day he decided he wasn't going to sit in a cubicle in front of a computer monitor making phone calls selling Discovery products.

Figure 18.

Andrew on the Great Wall of China, 2001.

He sold everything, including his car, and went off to Communist China and taught English in an elementary school for a year. He then went to Thailand and did the same in Bangkok. He returned and stayed in our mountain home in Colorado and worked as manager for guest relations at the Copper Mountain ski resort. One day we were chatting and I said, “What are you going to do when you grow up?” He said, “I think I'm going to go to law school.” He's in his first year at Gonzaga. He's a very outgoing people person. He's 6'7” tall with red hair. I took him to my lawyer to do the will a few years back. My lawyer, who is very short, looked up at Andrew and said, ”Andrew, you must be a basketball player at college.” Andrew looked down at him and drolly intoned, “No, I'm not a basketball player. Are you a miniature golf player?”

WCR: What about your daughter?

JMW: My daughter, Niki, got married last summer in Colorado (Figure 19). She married a really great guy, Tom McCrory, who works in the title insurance business. Niki had a circuitous route to college but I am proud that she got a bachelor's degree in English literature from Colorado University in Boulder and is now a second-year student at Denver University Law School. She is working in the public defender's office and beginning to plead her own cases. She is going to be a great lawyer (Figure 20).

Figure 19.

With family at daughter's wedding: Mark, Jonathan, Niki, Tom, Clare Anne, and Andrew, July 19, 2003, Frisco, Colorado.

Figure 20.

With daughter Nicola Clare (Niki), Easter 2001.

WCR: Is your son Mark going to practice here in Dallas?

JMW: He has a plot of land in the State Thomas area of Dallas where he is going to build an office. There are no dentists in that area, and a lot of people are moving in. He predicts that 5 years from now it's going to be a really good spot to have an office.

WCR: I didn't have a good grasp on neonatology. This specialty has come along since I finished training. Jonathan, on behalf of not only me, but the readers of BUMC Proceedings, thank you for taking the time to do this, for being so open, and for letting so many of us get to know you better.

JMW: It was a real honor and a pleasure for me. I appreciate it very much.