The following is an excerpt from Chapter 54 (1973-1974) of Book 3.


            ‘Why the hell do I still feel like a young man?’ Philip asked himself, when he’d passed the dreaded sixty year mark and knew he was now considered a Senior Citizen. As if to reassure him, new developments began to come in rapid succession from all sides. At St. Matthew’s Hospital he found himself suddenly placed on several key committees: the Infection Committee, the Tissue and Audit Committee, and the new Angiography Committee. At the Memorial he was approached to take over from Dr. Abel as Chief of Surgery, which he refused, and to take on the post of Chairman of the Joint Credentials Committee, which he accepted.
            Both George Proctor as administrator and Cedric Blore as chief of staff were insistent that Philip Bosnar should reconsider his refusal to become Chief of Surgery. In reply, he pointed out that he’d already held more than his fair share of top hospital appointments before coming to San Pete and wasn’t looking for any more, but he promised to give them his final answer in one month. When he discussed the matter with Bruce Campbell and Jim Appleton they were very persuasive, insisting it was a major breakthrough in the hospital power structure; that after ten years of being frozen out of the surgical decision-making process in both hospitals it was essential for him to seize the opportunity on behalf of the Health Center.
            His two anesthetists added their weight to the arguments until he agreed to accept the appointment, but only on condition that there be no interference from either the Memorial medical staff or administration, as he intended to run the department as fairly as possible, without political fear or favor.
            No sooner had Philip Bosnar accepted, than Gus Pelletier was appointed Chief of Surgery at St. Matthews, replacing Frank Brady. Brady was a no-nonsense type of surgeon, but his rough and tough manner concealed a keen mind and a good deal of intellectual sophistication. Over the years, Philip had grown to respect the man and was happy to note that the feeling was mutual, and that Brady’s political opposition had become progressively less over the years.
            Pelletier, on the other hand, was a smoother surgeon but less sophisticated, and his political opposition to the Health Center remained undiminished. He would certainly get along very well with Mike Callaghan, the E.N.T.(ear, nose, and throat) specialist who was the new chief of medical staff at St. Matthew’s.
            It was Callaghan who got the lion’s share of the Health Center’s E.N.T. work and showed his appreciation by maintaining an attitude of cold hostility toward the clinic and its doctors; his main targets were Jarvis, Appleton and Bosnar, and he knew that Bosnar wasn’t prepared to let this go unanswered. When Gabor Nagy arrived in the city as a second E.N.T. surgeon, he presented his resumé to the Credentials Committee, and this gave evidence of good training and experience but no Canadian Fellowship degree in his sub-specialty. Since there were a few anesthetists and one or two medical specialists who still had their privileges without their Canadian Fellowship, it was decided to grant Nagy most of the privileges he requested on the laundry list. Any additional requests would be cleared with Callaghan.
            After a while, Nagy started to get more and more referrals from the C.H.C. physicians, based on the quality of his work, and Callaghan raged that this was clear evidence of the Health Center’s animosity toward him. Maybe that could or should have been a factor, but in truth it simply wasn’t. Later on, Callaghan complained to Philip - as Chairman of the Joint Credentials Committee - about his competitor’s periodic increases of privileges, and Philip had to remind him that the request for these new privileges was submitted for Callaghan’s approval on each occasion and had been passed with his consent. Callaghan’s usual reply was that he forgot, or that he’d never given his approval. In any event, aside from the grumbling, complaints and unceasing innuendoes by Callaghan, the work of Gabor Nagy steadily expanded in volume and scope, and there were no repercussions.
            When it came to the subject of Canadian F.R.C.S. specialty qualification, it soon became clear that as far as future applications were concerned, the Joint Credentials Committee covering both hospitals would have to take a firmer stand. In future, all specialist applications would be required to possess a Canadian Fellowship in the particular specialty or subspecialty. However, interim privileges could be granted if the exams were to be taken within a six month period by the applicant.
            There were two interesting situations that arose in connection with this important issue. The first was an application sent to the Health Center in January 1970 by an orthopedic surgeon practicing in a small community about halfway between Thunder Bay and San Pete. He was Siegfried von Taublitz, ex-military surgeon in the Luftwaffe, with impressive German credentials in orthopedics but none in Canada. Appleton wrote to tell him that there were already two highly qualified orthopods in San Pete, and even if he were accepted by the C.H.C. medical group he would be turned down by both hospitals.
            Six months later Taublitz was accepted at both hospitals as a solo orthopedist, and by 1974 there was a mounting array of complaints about his work; these were being cautiously whispered but never openly addressed at a committee level. Fortunately, by the time it became Bosnar’s responsibility, the problem had already been resolved by Taublitz’s decision to curtail his orthopedic work for reasons of ill-health.
            The second situation concerned Fred Mansfield. He was a serious and hard-working G.P. who joined the Center in ‘69 and left one year later to take his postgraduate training in head and neck surgery. He and Percy Blythe, who also stayed with the group from ‘69 to ‘70 and left to train in Ophthalmology, were given substantial loans by the medical partnership to enable them to take their specialty training, on the understanding that they would be given specialist appointments at the C.H.C. on their return. It was accepted without saying, that as soon as they received their Canadian Fellowship, the clinic would press for their specialist privileges at both hospitals.
            In due course, both men returned in justifiable triumph with their specialty courses completed. Both found themselves, right away, under considerable downtown pressure not to rejoin the Health Center. In the case of Blythe, a studious chap whom Philip liked and respected very much, the pressure translated into a stupid conflict with Jarvis over the set-up of his new department. Each wanted a free hand in the final selection process and the unfortunate result was that Blythe left town to set up independent practice in Sarnia. As for Mansfield, who returned as devoid of humor as when he left, he informed the medical partnership that he had decided to practice downtown.
            As reported to Philip by the newest clinic surgeon Jack Stevens, Mansfield was explicitly warned by his downtown advisers not to rejoin his clinic.
    "In a way, Phil, I’m glad you weren’t there when he came up to tell us about his decision."
    "I was tied up with my delayed last case. We didn’t get started ‘till after two o’clock."
    "Well anyhow, Mansfield told us he’d been to see John Duncan this morning to find out where he stood as far as referrals were concerned."
    "He went to see HIM before coming to see US?"
    "Hold your horses, Phil, there’s more. Duncan warned him that if he rejoined the C.H.C. he’d get no referrals at all from the solo doctors, but if he went downtown the clinic doctors would be bound to use him on an ever-increasing basis."
    "Well, that certainly made it plain enough the war’s still on. I’m surprised to see it come right out into the open. At least Duncan can be given credit for not concealing the fact."
    "Wait!  As a result of the morning’s interview Mansfield decided to open up his office downtown, and told us so."
    "For Christ’s sake, Jack, why didn’t you throw the self-serving gutless bastard out of the building?"     "We all knew that’s what you’d have done, but not everyone has your fierce sense of loyalty."
            At the next meeting of the Joint Credentials Committee - covering privileges at both hospitals - Philip recommended Mansfield for interim privileges pending his forthcoming F.R.C.S.C. exams, because of his excellent training program in England. An official confirmatory letter was sent to Mansfield, who then asked for a personal interview with Dr. Bosnar. Philip arranged to see him privately in the boardroom immediately after the next surgical ward rounds at the Memorial.
            Mansfield seemed ill at ease, and said he wanted to know which privileges he’d been granted on the laundry list.
    "All those in the head and neck surgery column. The limitations are those of your own conscience."     "In what way."
    "You know what you can do well, in the interests of your patient, and which cases you’d sooner refer to a special center."
    "What about restrictions?"
    "Nobody is restricted unless there’s clear evidence of diminished performance or ability, and anyone who tries to restrict your privileges on any other grounds will have me to reckon with."
    "You mean you won’t hold it against me that I left the clinic?"
    "Now that you bring it up I have to say that I don’t think much of you as a person. A real man would have told Duncan that he and his rednecks could go to hell, rather than submitting to threats of professional boycott."
    "Will the group get its own head and neck surgeon?"
    "If we get the right one I’d be in favor of it. If you’d carried on with us you’d have got all the head and neck work that is now done by all three group surgeons, and mine is a fair amount, as you know. Moreover, any other surgeon doing good head and neck work at the present time will retain his privileges in that department."
            The interview was over and Mansfield didn’t look very healthy. In a way Philip felt sorry for him. He was, after all, the product of his own ‘Me First, Me Now’ generation, with an entirely different set of values from those of his elders. These were the inglorious days of expediency, infidelity, and materialism.
            As far as the administration at St. Matthew’s was concerned, Philip had been very happy with Shawn Dunleavy, the pleasant Irishman who replaced Prentice as administrator, and the C.H.C. surgeon looked forward to a more pleasant relationship with the Sisters’ hospital. It was true that Callaghan, as chief of staff, still tinged that institution’s activities with venom where C.H.C. staff members were concerned, but the new Mother Superior seemed a more decent individual than her predecessors, and all the other Sisters were friendly and cooperative.
            Gus Pelletier and Philip Bosnar integrated their weekly surgical ward rounds so that the subject matter of their cases didn’t clash, and Philip was pleased to note that their attendance was steadily increasing, especially at the Memorial. At St. Matthew’s, Philip gave credit for this increase to the excellent presentations of the pathologist, a gifted East Indian scholar who spent considerable time and effort preparing his material for the rounds. At Memorial it was the change from Rudi Abel, who - although Philip liked him very much as an individual and thought he’d been unfairly treated by the ‘Old Guard’ - wasn’t very good at running ward rounds, and hadn’t made much impact as Chief of Surgery.
            Abel was a Jewish refugee from Hitler’s Europe, and had left Czechoslovakia with his family at the time of the Sudeten crisis, then settled in England long enough to complete his surgical training and serve with distinction in the British Army before emigrating to Canada. He’d been friendly from the very first, but had never shown any interest in joining the C.H.C. and was evidently committed to throwing in his lot, for better or worse, with the downtown solo practitioners. He got very little referred surgery and derived most of his surgery from what was in fact a general practice. Oddly enough, he got quite a few of his referrals from Tony Donovan, who also handled a fair amount of family practice along with his Ob.Gyn. specialty, and who received in return any of Abel’s female patients with the slightest hint of a problem in the field of obstetrics or gynecology. On a personal level, the two were poles apart in background, outlook and manner, but like Cassidy and Pelletier, they got along well.

            Jim Appleton was going through a depressing period of disillusionment, undoubtedly compounded by family problems on the home front. In a way he was the agent of his own misfortunes. Among several of those closest to him, Philip had repeatedly urged him to delegate more of his duties and responsibilities to an assistant medical director; both Peter Lawton and Kevin Lam, an excellent family physician with a special interest in psychiatry, would have been willing and able to do the job. Appleton always promised he would comply but never followed through, and as a result he was spending longer hours at the Center and less time at home, where the growth of his children through the difficult teen years of rebellion was fanning the flames of marital discontent and sharpening his own impatience.
           Two years previously, the partnership had decided to increase Appleton’s productivity income in order to bring it more in line with that of the other family physicians. It was found that his stipend as medical director failed to compensate for the time lost in his practice, and consequently his productivity. The long overdue move to increase his compensation failed to diminish his growing discontent, however, as he watched his beloved Health Center appear to lose its idealistic base in a growing wave of materialism.
            Eventually, he felt impelled to produced a document entitled: ‘Principles, Standards and Goals revisited’. In this presentation he vented all his frustrations, but at the same time he also planted the seeds of disaffection between himself - as their chosen leader - and the rank and file of group M.Ds, who were far from endorsing Socialism. Philip felt he must write him a personal reply, both as friend and advisor. The medical director’s memorandum had been written in a vein of disappointment, disillusion and despair, and although it might have some relevance for some of the medical staff, it was grossly unfair for others, and Philip’s letter to Appleton registered his feelings in strong rebuttal.
            ‘I’m afraid you’ve painted a black picture with too broad a brush.’ he wrote. ‘Your accusations are justified without question as far as some of the G.P.s are concerned, but are unfair to some of your most capable and loyal specialists. Memoranda containing blanket criticism may be a satisfying exercise against frustration, but they may also prove self-destructive. As medical director, you have the power and the obligation to voice your disapproval on a one-to-one basis in the privacy of your office. It should be balanced with expressions of approval delivered in the same manner. Only in this way will you separate your supporters from your opponents, encouraging the former and discouraging the latter. The place to debate broad principles and their relation to pragmatic decisions should be the regular meetings of the medical partnership.’
 
            The past year had been an interesting one. Phil and Patty flew out to Vancouver where their daughter now lived with her family. Neville had gone through several promotions by his firm and had now been transferred from Edmonton to the Vancouver store, where he enjoyed the position of assistant manager. The Sternway family was happily ensconced in a pleasant and spacious town house in North Vancouver, a short distance above the swaying Capilano suspension bridge, the one that had given such a thrill to Florian and Jamie when they were little children so many years ago.
            Martina was growing into a lovely child of five, with silky hair the color of ripe corn and large eyes the color of cornflowers. She was the object of her parent’s adoration, especially that of her father who treated her like a royal princess, while her mother loved dressing her up and selecting her dolls. As for her 3-year-old brother Paul, he was a sturdy little chap who was the apple of his mother’s eye but tended to lose out for affectionate attention from his father, whether he was being treated as a little man or because his sister’s radiance was too dazzling. Both children had the coloration and facial characteristics of the Sternways, but that could change in time, and perhaps after puberty the Bosnar-Clancy double helix would start to assert itself.
            A delightful addition to their enjoyment of the trip was the visit by Patricia’s youngest sister, wearing her smart modern nun’s uniform. Sister Josephine was bright, emancipated, and lovable; a worthy sibling to Philip’s beloved wife. She thought it hilarious when her brother-in-law suggested that if he’d met her first, he might have married her instead and Patty might have become Sister Patricia; but she still blushed at the thought. Here, Philip felt, was a true daughter of Vatican 2, and he knew in his heart that they had established a deep bond of affection and friendship which no difference of birth or faith could ever loosen.
            Florian drove her parents and Sister Josephine around the city, with its sights, stores, and restaurants, and discovered that her saintly aunt loved red bathing suits but hated any sort of seafood. Sister Josephine was taken up to Grouse Mountain on the aerial tram-lift, and thrilled to the breathtaking view of the city below and the skiers taking off nearby on their downhill run. Patty and her sister stayed on for a week, but Philip had to get back to San Pete as he’d arranged a return trip to the Cleveland Clinic, where he looked forward to checking on some of the latest advances in vascular surgery. As he gave her a goodbye hug, he couldn’t help feeling that his vivacious and attractive sister-in-law should never have been constricted into a life of celibacy, when she might otherwise have enjoyed the blessings of married life and children, without foregoing a life of good deeds and devotion to God.

            The Cleveland Clinic’s peripheral vascular department was somehow not the same exciting place he’d known just a few years before. Beven was the new chief, while Humphries had found a fresh challenge in the world of computers, and was deeply involved in his project of computerizing the entire institution in a giant interacting network of integrated management and information. Beven was doing excellent work, especially in liver transplantation, but aside from that there was really little that was new for Philip to see or absorb.
            In the evenings after dinner, he stayed glued to the TV screen, as the tragic drama of Richard Nixon’s exposure and humiliation was re-enacted in fascinating but horrifying detail during the Watergate Committee Hearings. He wondered if the President’s agonized thoughts ever drifted back to the time when he prosecuted (many would say persecuted) the luckless Alger Hiss, and destroyed his name and career on far less convincing evidence. As Philip watched history unfold before his eyes it seemed strange that parameters of decency were now being expounded at the hearings by a southern senator, Sam Ervine, just as anorthern judge named Joseph Welch once brought a sense of decency to another committee that was besmirched by a northern senator named Joseph McCarthy.

            One day Phil and Patty were discussing their parents. She had lost her father - whom she worshipped - when she was a small girl and he was still a young man. He was a construction supervisor for the county and was walking home one evening when he was hit by a car that apparently went out of control, or at least that was what the driver said. The young man who drove the car belonged to a prominent local family and the police showed little enthusiasm for a follow-up investigation; so that aside from a small insurance policy it was up to the widow to bring up her large family as best she could. Mrs. Bridget Clancy was a woman of strength and character. Fortified by a profound religious faith and the love of her children she managed to give them the start in life she’d once hoped for herself, with resounding success. Some thirty years after the loss of her husband she died suddenly as the result of a heart attack, and Patty grieved beyond words.
            Philip’s mother had been in failing health for some time, and she finally consented to enter a nursing home as long as her beloved Rafael came with her. They had been comfortably ensconced in a pleasant seniors’ establishment for some time, and Philip decided it was high time that he told his father exactly how he felt about him. A similar letter to his mother was pointless, as she was much too confused to absorb anything beyond what she’d always known: that he loved her dearly and admired her fearless attitude toward life. The letter to his father was much easier to write than he imagined.

    ‘My dear Dad:

     Now that I have passed my first sixty years of life I feel impelled to tell you how I have felt about you ever since I was a small child. Aside from the deep love I have always had for you, just as I have for my dear Mum, I have always had a boundless admiration for your unfailing goodness, your optimism and your courage in the face of adversity.
    Even though I could never match your shining example when it comes to application of the golden rule, you have been my constant inspiration to go through life doing what I believe to be right, without fear or favor, and never to settle for expediency.
     Whatever my meager accomplishments over the years, they have been important to me mainly in the joy I know they have brought to you. And why not?  Without your constant wishes for my success to urge me on I doubt if I would have gone as far as I have, and without your example I may have lacked the courage to face some of my challenges.
     I consider myself a very lucky man to have a father like you and my pride in your qualities as a human being make me exhilarated and inspired. I could never repay you for what you have given me.
                      I love you, Dad.

                          Philip.’

            Two weeks later, Philip received a phone call from Clayton telling him that their beloved father had just died at the local hospital. He’d passed away with a happy smile on his still handsome face, sitting up in an oxygen tent, and his last words were, "Clayton, be a good boy and read me Phileep’s letter again."  Philip felt as though the center of his universe and being had collapsed, but was unable to comprehend the depth of his grief. One hour later, the emotional dam suddenly broke, and he covered his face as the sobbing started and continued into the night. His world would never be quite the same again.



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