An eminent G.P. retired last week at the grand age of 80 and, ironically, for health reasons. He embodied a breed of doctor who treated the person as well as the illness and whose worldview embraced that other great medicine: humour.
Dr James Kenneth Nicholson inhabited the dingy back-room of an ancient house in Toronto’s East End. The hazard of fumigation was always present, since, contrary to fashion, he insisted on smoking a pipe, cheerfully asserting that, at his age, it was unlikely to kill him. The house itself reflected its occupier: increasingly creaky and quirky, and inviting speculation as to its history. On the walls of his “surgery” were displayed medical credentials alongside many photos of Dr Nicholson shaking hands with Pope John Paul II, or Yasser Arafat, or President Reagan. All faked by a friend and admirer and gleefully displayed to hoodwink the unwary.
In the waiting-room, whose cracked plasterwork and ceiling suggested imminent collapse, were displayed agricultural tools and a few old surgical implements – suggesting that there was not much to choose between them. But there were also framed newspaper cuttings and memorabilia, notably a squash racquet given to Dr Nicholson by a champion player he once beat in a friendly game. On the bookcase behind the receptionist’s makeshift desk, there was a rusty scythe indicating the imminence of the Grim Reaper – another sign of his errant humour.
Dr Nicholson was true to the Oath elaborated by the Greek physician Hippocrates, who laid the foundation for a rational approach to medicine. Hippocrates was the first to categorize illnesses as acute, chronic, endemic and epidemic, and to use terms such as “exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence.” The Greek physician Galen was also one of the great physicians of the ancient world and performed many audacious operations, including brain and eye surgeries. The Muslim world had the works of Hippocrates and Galen translated into Arabic, and Islamic physicians engaged in significant medical research long before colleges of physicians were established in Europe, laying the groundwork for today’s wonders of medical science.
There is a wonderful modern version of the Hippocratic Oath that Dr Nicholson might have appreciated. It was penned in 1964 by Dr Louis Lasagna, former Principal of the Sackler School of Graduate Biomedical Sciences and Academic Dean of the School of Medicine at Tufts University, and it reads:
“I swear to fulfil, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I will not be ashamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”
This is an apt description of the philosophy of Dr Nicholson of Toronto, who will be sorely missed and to whom his many friends, patients, and admirers wish long repose and enjoyment in his retirement.