RON STEWART could hear but not speak

C H N  Stewart, a 28-year-old physician fresh out of medical school, could hear but not speak. So he couldn't respond when people talked about "what a promising young physician I was, and if only . . .. . . I'm not dead yet.' I wanted to yell it out. 'I'm alive.' But I couldn't say a word," he said last week in an interview at the Dalhousie Medical School, where he now teaches.
 

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Ron Stewart's long strange trip
Former health minister's career comes full circle and he's not finished yet

By JIM MEEK Staff Reporter  Published: 2007-04-22


IN 1971, RON STEWART was lying in a hospital bed in Halifax with a severe brain injury, a frontal temporal contusion that could have killed him or left him stricken for life with serious mental disabilities.

Stewart, a 28-year-old physician fresh out of medical school, could hear but not speak. So he couldn't respond when people talked about "what a promising young physician I was, and if only . . ."

" I'm not dead yet.' I wanted to yell it out. 'I'm alive.' But I couldn't say a word," he said last week in an interview at the Dalhousie Medical School, where he now teaches.

Stewart made a painful, full ' and improbable ' recovery from that injury, sustained after he drove off a cliff at 3 a.m. in an April blizzard, while responding to an emergency call.

At the time, Nova Scotia's future minister of health had been practising medicine in Neil's Harbour, on the edge of the rugged Cape Breton Highlands National Park.

The accident and its aftermath eventually prompted Stewart to leave Nova Scotia, sending him "down the road" to practice emergency medicine in California.

The full circle of his career eventually brought him home. And now he plans to embark on something entirely different as he contemplates another turning point ' his official retirement next fall, when he turns 65.

But it was back in 1972, in the lotus land of southern California, that the "legend of Ron Stewart began" ' as a colleague later put it.

At the tender age of 29, Stewart won a job as a resident in emergency medicine at Los Angeles County Hospital, beating out 59 other applicants.

On his first night on the job, he treated a gunshot wound for the first time in his life, and the second time, and the third, and the fourth.

Charles Manson, the satanic murderer turned prison pugilist, was a regular customer at L.A. County Hospital, where he'd show up in chains after getting in a fight or going off his meds.

"He had the wildest eyes I've even seen ' he'd look right through you," Stewart later said.

The doc from Cape Breton blazed a trail as a stab- and gunshot-wound emergency care physician in L.A. County, where he also trained 2,000 firefighters in paramedic life-saving.

He even landed a couple of celebrity gigs that would later earn him the sobriquet Doc Hollywood. Television producer Jack Webb hired Stewart as a consultant to the TV series Emergency. He also worked on the show Marcus Welby, MD.

From L.A., the lifelong bachelor moved to Pennsylvania in 1978, where he served as the founding head of the emergency medicine department at the University of Pittsburgh.

There, he was called to scene of a construction accident ' an iron worker had been trapped by a heavy girder. Stewart was forced to amputate his leg from the top of a fire ladder swaying in heavy winds and rain ' 40 metres above the ground.

"It was either lose his leg or lose his life," Stewart later said.

This was a remarkable, heady run for the son of a coal miner ' a boy who grew up within walking distance of the pithead in North Sydney. And it was only after he had moved back to the old neighbourhood in 1989 that Ron Stewart learned that failure was possible.

That's failure spelled with a capital P, for Politics.

Stewart was one of the "three wise doctors" recruited by Nova Scotia Liberals in the early 1990s ' the others were Jim Smith of Dartmouth and the late John Savage, who served as premier from 1993 to 1997.

Stewart arrived as a superstar.

IN PITTSBURGH, U.S. president Bill Clinton had tapped Stewart's expertise in trauma medicine, naming him to his health advisory committee. And his resume already listed more than 20 professorships, 100 published papers and five pages of awards, including two named in his honour.

In the 1993 Nova Scotia campaign, he lived up to his advance billing, jogging through a house-to-house campaign in Cape Breton North.

But he was so distracted in his race to reach every voter in North Sydney that he rapped on one door with no house attached. A neighbour walked up to Stewart and told him the house had burned down months earlier. (This was during another spring blizzard, Stewart told this reporter earlier this month.)

At another doorstep, the candidate found a real medical emergency: a future constituent having a heart attack. The physician in Stewart had enough sense to start cardiac massage and get the man to hospital. After the patient was stabilized, the politician in Stewart had enough smarts to ask for the patient's vote. And that, he later said, was "the start of the slippery slope."

On May 25, 1993, Stewart triumphed over popular Tory cabinet minister Brian Young, the only Cape Breton Conservative given half a chance to win his seat. Then came the tough job of governing, with Stewart in the health portfolio and Savage at the wheel.

A measure of their reforming zeal can be taken from a health policy paper released by the Liberals during the 1993 campaign. Home care, universal access, preventive medicine, a first-rate emergency-responder system, a broader role for nurses in primary care ' all of these were promised by the Liberals.

Stewart's quixotic crusade also included an attack on doctors ' he wanted to change the way they were paid, and in some instances to replace them on the front lines of medicine.

Criticizing this agenda at the time, former Conservative health minister George Moody depicted Stewart as a man whose policies were out of touch with reality. Looking back today, Stewart's colleague Mike Murphy sees a man who was something of a prophet.

"In our world, he's so far ahead of us that there are people who call him a visionary," said Murphy, the head of anesthesia at the Queen Elizabeth II Health Sciences Centre.

Stewart was on the leading edge of health reform in advocating preventive medicine and reforms to emergency medicine, Murphy said.

He also said that bringing in a modern emergency medical system (EMS) may have been the high water mark of Stewart's political career. Murphy should know. Stewart appointed him to head up the EMS effort.

What impressed Murphy more about Stewart's tenure as health minister were his pioneering attempts to introduce a modern home-care system in Nova Scotia ' well before the idea became fashionable.

"He was two or three decades ahead of his time in terms of home care," said Murphy, the same man who called Stewart a legend. "I don't think he consciously foresaw the demographic changes and nursing shortages that would drive home care. It's as if he just knew, somehow."

So what went wrong' Even Stewart agrees that he could not implement all the reforms he promised ' many are still in embryo today.

"Let's face it," Murphy said. "Some people think Ron's an . . . asshole. He just assumes people will follow him but he sometimes can have difficulty enlisting people in his cause ' in getting people to march in line with him."

Stewart had the vision, in short, but he couldn't always get the troops in the trenches to march in lockstep. "I'm a very impatient person," he says. "I believe that my political life brought that out more than anything."

When he was minister of health, Stewart says he was "passionate" about reforming Nova Scotia's health system. "But passion is blinding. It can be destructive when you have responsibilities as deep and all-encompassing as those of a minister. I recognize that now."

Looking back, Stewart now says he was "bruised" but "not traumatized" by his career in politics. "But I put it behind me. Once I left, I was gone."

IF POLITICS wasn't a formative experience for Stewart, his boyhood in Cape Breton was.

His father Donald, who died in 1993 at the age of 86, provided the future doc with his first experience in emergency medicine. (His mother Edith, 91, is alive and well and living in North Sydney.)

Stewart says he was "about seven" when his dad came home early from the mines ' "right after school" ' carrying his handkerchief in his hand. Inside the hankie was the finger he had lost in the pits.

"He stopped home to have a cup of tea, then he walked up to the hospital to have his finger sewn back on," Stewart said. "I've never seen anything like that in my life."

Still, Stewart remembers the "joy" the miners took in their work as much as he does their toughness.

"Everyone knew who they were, everyone knew where they fit. In a sense, the docs and lawyers and bosses were the outsiders in our community."

Stewart figures his childhood gave him the sense of "purpose" and great "capacity for happiness" that has taken him through life. Lord knows he needed both those qualities ' and his faith as a lifelong Presbyterian ' when he returned to his practice in Neil's Harbour in 1971 after recovering from his accident.

His cognitive abilities had been restored, but a lingering speech impediment made some patients wary of their doctor after Stewart returned. He realized, in fact, that many patients simply avoided seeing him.

So he packed his bags in his old car and drove to Los Angeles in 1972. His Volvo sported a bumper sticker California or bust ' a parting gift from the staff of Buchanan Memorial Hospital in Neil's Harbour. His colleagues also gave him a signed original of a Charles Shultz Peanuts comic strip.

Peanuts played a role in his recovery ' it was an index of his progress. At first, he couldn't get the jokes. And even today, his eyes well up when he remembers lying in a hospital bed, crying in frustration because he couldn't understand a simple comic strip.

Today, Ron Stewart takes the lessons he learned as a patient 36 years ago into his teaching at Dalhousie Medical School.

"The first rule is that the patient is a human," he says. "And so is the doc . . . The God complex can really go awry in this business."

Humility's an important lesson, then. At a second-year class on April 11, Stewart said that Victorian-era nurses were better than docs at anesthetizing patients with chloroform, because "they actually witnessed" the horrid consequences of overdose ' including frequent death.

That evening, Stewart, who sings tenor and plays a pretty mean church organ, gathered students and community members into a theatre at Dal's Tupper Building for a Dalhousie Medical School choir rehearsal. (A former student, who asked not to be named, said Stewart has a "lot of bcorder collie in him . . . He's always herding his flock.")

Choir practice, an exercise in writing a collaborative short mystery story (one sentence per writer) these are not conventional teaching methods. But Stewart says they are at the heart of the Medical Humanities Program, which he now heads.

"Making their lives richer makes doctors better practitioners," he said. "Working collaboratively, building relationships with patients ' this is the heart of good medicine. You can't be a good physician until you're rewarded internally and that relationship is generated by your relationship with patients."

Stewart said he learned that lesson a long time ago, even before his 1971 accident, when he worked with veteran public health nurse Isabel MacDonald "north of Smokey."

"She knew every family from Neil's Harbour to Meat Cove," Stewart said. "And because people trusted her, she prevented more illnesses among her patients than I could ever cure in lifetime of practice."

That experience helped drive Stewart's effort to introduce new models of care while he was minister of health in the 1990s. Today, he's beating the same drum at the medical school, trying to rescue young docs from the shrink wrap of their own egos.

"People say so-and-so's a good surgeon but he has a lousy bedside manner," he says. "And I say if he can't connect with patients, he's just a carpenter. The relationship is crucial."

Stewart jokes that he's now reached the age where people are trying to "round him out" of his career whether he wants to slow down or not. And after a lifetime of trips to the podium, new honours keep pouring in.

Last September, the University of Pittsburgh endowed the Ronald D. Stewart Chair in Emergency Medicine.

That same month, he was named to the Order of Nova Scotia. He is also a member of the Order of Canada.

And on Thursday night, he handed the Ron Stewart International Prize to third-year medical student Jennifer Ahmed at a ceremony in Halifax. (The prize is awarded annually to a student who exemplifies commitment to humanitarian work overseas.)

Does Stewart plan to slow after turning 65'

His friend Mike Murphy figures Stewart, whom he calls a "closet narcissist", will stay active for two reasons: he loves the limelight and he's genuinely altruistic. "Ron doesn't have a selfish bone in his body."

Stewart's own plans are to enter a doctoral program in medical history, focusing on evolving trauma care in the First World War.

"I'm also going to divest myself of all my worldly possessions," he says, meaning he plans to give away his house in Halifax and summer property on the Bras d'Or Lakes in Cape Breton.

Both will be incorporated into a "permanent foundation to fund the Medical Humanities programs (at Dalhousie). That's what I'm going to direct the rest of my life towards."

Stewart says this is a practical plan, adding he will provide for himself in addition to starting the foundation.

Murphy looks at it another way. He says, flatly, that Stewart "is missing the part of the brain that understands money . . . It's just not there."

Either way, Ron Stewart will keep running hard for the future.

After all, he's not dead yet.   ' 2007 The Halifax Herald Limited


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SOURCE http://communications.medicine.dal.ca/newsroom/neurosurgeon.htm


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