Life and Work
When I returned in the summer of 1983 to become the Medical Director at the Michener Centre, one very unexpected pleasure awaited me. Although Dr. Kathleen Anderson Swallow had retired from the same position 3 years earlier, she was still visiting the 2 campus, 320-acre Michener Hill site on a daily basis; her goal was to complete the 4 year project she had started in 1978. It involved researching and writing a problem-orientated, two page, easy to understand Medical Summary on each of the 1800 residents. The curiosity of a former student and awareness of her reputation soon led to a meeting. It started with a brisk opener: “What are you here for?”…“To see what you’re doing and how you’re doing it.”…“Well, sit down. I’ll take a 5-minute break. It’s easy. Knowledgeable staff fill in the blanks. I dictate the narrative. Anyone can do it.” Four colleagues subsequently tried to profile the medical history of residents with such visual images and concise prose. None attained her standard. Dr. Swallow was still the forthright, articulate, intellectually aggressive, formidable pediatric teacher I recalled from my U of A medical undergraduate days.
Fortunately, the 5 minute break evolved into one evening a week. One by one, limited glimpses of this “lady of many parts” were slowly revealed. There were her favorite artists, the Group of Seven; her classical music collection and an introduction to the CBC musicologist, David Gell; the reorganization of a half century of family philatelic collections; the travel tales from Thailand to New York City; her trips to the Metropolitan opera coupled with Rudolf Bings opera highlights; a near photographic memory; a story to validate any opinion; and a medical mind that only needed to be turned on to see its brilliance.
At the age of 60, when most people contemplate retirement, Dr. Kathleen Swallow closed the US chapter on her life and a decade of work that had focused on reducing perinatal mortality rates in underprivileged and poverty stricken cities of the eastern United States. She had gone there in 1965 at the invitation of her Alma Mater, Johns Hopkins Medical School, to initiate what she coined as the “Better Babies for Baltimore” program. It was funded with $1.2-1.7 M annual grants she obtained from the US Government and involved 70 staff at 36 clinics interfacing with 16 hospitals. Her arrival in Baltimore was characteristically impressionable. No sooner had she discovered there were white telephones for white staff and black telephones for black staff, then all were replaced with beige phones. The program she designed involved an anti-natal risk assessment on all expectant mothers, followed by regular monitoring through pregnancy, confinement, delivery, immediate post-partum and home arrival periods. The elegantly simple program reduced the perinatal mortality rate by 40% in seven years. She received a citation from the President of the United States and numerous invitations to replicate her work. But Dr. Swallow had worked hard and was the first to admit it wasn’t easy “being driven to no sleep, no lunch, no shop talk, cajoling some and canning others.” Then came the call to return to Canada from a former student, Dr. William Cochrane, the Deputy Minister of Health in Alberta in 1974 and the 1967 inaugural Dean of the University of Calgary’s Medical School.
The Call to Red Deer
There was a problem at the PTS/ASH and Deerhome complexes for the mentally handicapped in Red Deer. The two centres were being merged under one administration with 2300 residents. They had no Medical Director.
Dr. Cochrane outlined the challenges this merger faced. Wolfensberger had just spent a sabbatical year in Toronto writing the book Normalization which implored governments and their staff to treat people who were mentally challenged the same as anyone else in the community, using regular education services . While Dr. Swallow concurred with his philosophy, she stopped short of giving such handicapped persons the full authority or responsibility for all their decisions, particularly the healthcare ones. They didn’t have the competence to recognize disease symptoms, the ability to make informed choices and the responsibility to follow the advice given to them and the prescriptions written for them.
Shortly after her arrival the responsibility for the combined Centre was transferred from Health to Social Services, as it was across Canada. Two years later the site was renamed the Michener Centre, acknowledging Roland Michener’s father’s role in the establishment of the Presbyterian or Alberta Ladies College which was originally housed in the main Administration Building. Perhaps the most important reason for returning to Red Deer was that it gave her an opportunity to spend time with her recently retired 89 year old father, Edmonton’s second pediatrician, Dr. Gordon Swallow. As a rural Manitoba born Canadian, it was a chance to come home.
The Action Plan
Her size-up was quick. The action plan began at the local hospital where she went on rounds to find community-based family physicians who would work at her Centre. She used her persuasive genius to convince 4 physicians to add the Centre’s residents to their practices. It was, as she said, the responsibility of the Profession to guarantee such care. To make their work easier, she established her own hospital style 24 bed nursing and convalescent unit. It was made necessary because the health authorities had not factored the Michener Centre population into their calculations. She then presented at a series of community service clubs to inform them of what went on behind the doors and gates of the biggest employer in Red Deer. She called upon the community to become recognized as the premiere and most receptive city in Canada for community living. At the same time, she sat with other provincial leaders to assist them with the implementation of an act unique to Alberta, the Dependent Adult's Act of 1977, which provided for legal guardianship and trusteeship for mentally handicapped people.
At the Centre she established the “Flying Squad” or a VON/Home Care nursing service which answered calls for emergency care assessments throughout the north and south sites. Undergraduate students from the University of Alberta were invited to Michener Centre to learn about Developmental Pediatrics, Medical Genetics and the care and treatment of the mentally challenged. A Genetics clinic was established to clinically screen patients, analyze their family histories and provide counseling. The suspected sex-linkage of macroorchidism with mental retardation led to a mass physical examination of every male at Michener. Six were found. The results were published as one of the first descriptions of the Fragile X Syndrome6. The arrival of serum testing for Phenytoin and Phenobarbital in 1975 meant a crash program to revise and substantially lower many of the antiepileptic dosages for the 40% of the residents who had seizure difficulties and received these medications. The old description of Hepatitis as “infectious” and “serum” was superceded by a new antigen test which confirmed them as Hepatitis A or B. It stimulated another survey of all residents. In the process Dr. Swallow found Michener Centre had a reservoir of over 60 residents, one half of whom had Down Syndrome, who were carrying the Hepatitis B virus and for whom blood precautions and universal protective measures were necessary. An outbreak of Influenza A in the fall of 1977 led to the identification of 168 contacts. Their infection rate was double those who were vaccinated. The vaccination policy was immediately revised to include everyone.
By 1979 Dr. Swallow was at her retirement age. She was asked to continue. Only when her successor was in place could she totally immerse herself in her final project, summarizing life-long medical histories of 1800 residents. The source data was extracted by her assistant, Mr. R. Bentley, RN, and then dictated into her now famous Swallow Guardianship Reports, recommending a guardian and/or trustee be appointed for medical and surgical decision-making. They were such unique summaries they still represent the major medical source of information describing the medical events in the life of every individual to that date. From her perspective they also represented the basis for future clinical research. That was to be the icing that gave the mammoth project flavor and the incentive to be finished.
The Post Michener Centre Years (1980-83)
Unfortunately, her future had become clouded. In 1980 she felt the first symptoms of weakness in her legs. She diagnosed herself as having Amyotrophic Lateral Sclerosis, or Lou Gerig’s disease. Stoically she booked an appointment with her old U of A friend and Chief of Neurology, Dr. G. Monckton. He confirmed the diagnosis, together with the dreaded 3-year prognosis for her survival. It was a year and a half before she became clinically affected enough to tell anyone. That allowed her game plan to continue. More importantly, it deflected any evidence of sadness or pity from the staff. Comments, empathy and compassion were patently unwelcome. When she couldn’t climb stairs, she used a ramp to get to her office. The task was still of over-riding importance. The only thing that was important was maintaining her schedule of appointments and completing the reports. She tried to teach others but no one paralleled the skills and writing talents, let alone the ability to integrate their observations and prognosticate, that she possessed. By mid-1983 the job was 95% done and she was wheelchair limited, with more important end of life decisions to face. Whereas in 1952 when she had given so much hope to those afflicted with polio, now she found herself disabled, with the roles reversed.
To those who knew her, she was a unique professional. As she taught others, so she demanded excellence of herself first. She was cognizant of her diverse range of talents and interests but was careful to keep the friends with whom she shared each interest autonomous and literally segregated from each other. A rare composite glimpse of her breadth of interests came only as friends visited from around the world and fanned her dying embers. They came from fields of music and opera, theatre and art, medicine and nursing. Her eyes glistened with excitement as she encouraged them to continue to pursue their common interests or discharge her final instructions.
Although no stockbroker ever surfaced, she acknowledged she was a self-taught observer of the market, but found it too uninteresting, and spent only sufficient time to significantly supplement her penuric pediatrician’s pension. Reminiscing was not her style. Educating, teaching and learning was. She took annual trips abroad to follow her operatic and theatric interests. Her travels led her to rarely frequented countries from which she always returned with unique memorabilia and an imprinted memory of experiences for future use.
Dr. Swallow liked to make a visible impact. High boots, short skirts, a large hat “to keep the sun out of your eyes” and no chairs were the order of the day at the office. Needless to say, they were not evident in her Karsh-like portraits. But they gave her large physical stature emphasis and added considerably to her “presence”.
Admittedly eclectic in her interests, she usually had an underlying theme or rationale behind all her endeavors. She focused on the theme of mother and child in the 150 piece Eskimo collection that she donated to the Red Deer Museum. The sunflowers she grew in her garden always gave her an uplift when they bloomed.
A compleat person, she did not suffer fools gladly, particularly those who encroached upon her time, and especially those who were unwilling to listen and learn. Her ability to size-up any scene was legendary. Where there was a problem, whether it was medical or non-medical, it immediately led to the formulation of a solution. Each one was attacked with gusto and precision. “Memos should be no longer than half a page, including salutation and closing. Otherwise they won’t be read and certainly won’t be followed.”
She loved to raise the challenge at hand, usually one notch above what her colleagues and coworkers thought possible. She would then proceed to intellectually stimulate or, if necessary, verbally provoke her staff to levels of performance they thought impossible. Therein lay her greatest satisfaction as she sought to bring out the abilities and talents that she recognized in others. Whether it took candid cajoling, persuasive provocation or compelling enthusiasm, the ingredients were always there. She could be innovative and impressionable, make her point indelibly and then add a sprinkle of humor to ice it. “Heart sounds can be learned by listening to your favorite music, one instrument at a time.” She once challenged her students to describe their heart sound findings. Unknown to them, the patient had dextrocardia, or a heart on the wrong side of the chest. The story was often retold for emphasis. Then there was her soft and considerate side. When strikers were walking the mid-winter picket lines in Michener Centre’s first strike, she set up and replenished a coffee urn on her nearby lawn, “compliments of your employer”.
Money, though precious, was never an object. When an Edmonton landlord didn’t want to rent to her because she was a lady, she asked what he wanted for the building and bought it on the spot14. However, when a planned program was short of it, she could be very resourceful. If the dollars weren’t there, the work still had to be done. She was not the salesman you wanted to cross, as you usually came out second best, but always with the satisfaction and luxury of having solved a problem with her. The greatest reward she allowed was to spend time in her presence.
Another testimony to her talent was in the architecture of her will15. It did not have a short half-life. Her $50 000 Eskimo collection was to be funded with another $25 000 cash so that further acquisitions could be made and others encouraged to add to it. She recognized that it would be far better to leave the collection in a small community like Red Deer, to grow and be prized, rather than be absorbed as an undifferentiated part of a larger one. Her love of music, which she inherited from her mother, found a final expression in a “free to the public” memorial concert she sponsored in Edmonton, posthumously, and dedicated to her parents. Her instructions were to feature the Richard Eaton Singers from the U of A along with segments of the Edmonton Symphony. It was an impressive salutation for the 500 who attended it16. Finally, she directed that the proceeds from the sale of her Group of Seven collection form the basis for a continuing Pediatric scholarship at the U of A’s Department of Pediatrics.
And even now her spirit endures, particularly in the community she last joined. As she demonstrated throughout her life, and particularly to those with whom she worked at Michener Centre, “My candle burns at both ends;/ it will not last the night;/ But, ah, my foes, and oh, my friends - it gives a lovely light”17.
Author’s Biography: Robert Lampard, M.D. was a student of Dr. Swallow’s (1960-64) and followed her as the Medical Director of the Michener Centre in 1983. He was born and grew up in Red Deer, and worked at the Michener Centre as a third-year Med student in 1963. His avocational interests focus on Alberta’s medical history.
Degrees: Fellow Royal College of Physicians of Canada (FRCP(C)), Fellow American Academy of Pediatrics (FAAP), Masters in Public Health (MPH), Fellow Royal Society of Health (FRSH).