P&S Journal: Winter 1995, Vol.15, No.1
Richard and Sylvia Cruess:A Shared Life in Medicine, Canadian Style
By Peter Wortsman
The dean of Canada's world-class medical school, McGill, and the vice president and medical director of one of Canada's finest teaching hospitals, the Royal Victoria, share a profound commitment to medicine and medical education and to universal health care coverage as provided under the Canadian system. They also share a profound commitment to each other as husband and wife.
If it is rare that two people should remain happily married for four decades and counting, it is almost unheard of for them to rise to pinnacles of leadership in the same profession while pitching in to help raise a family and run a household.
Their recipe for such success is "being willing to share and guarding our home time," says Sylvia Cruess'55, who for the past 18 years has directed the medical administration of the Royal Victoria Hospital in Montreal, commonly known as "The Vic." The rule of thumb is simple, says her husband, Richard'55, the longest standing dean of McGill-or any Canadian medical school: "Whoever gets home first cooks." (It helps that they are gourmet cooks.)
Both tall and sturdy of build, there is something about them reminiscent of Gregory Peck and Ingrid Bergman on a downhill ski in "Spellbound." (Skiing is another shared passion.) Their pride in each other is evident in the weave of their words punctuated periodically by a hearty laugh or the silent complicity of a smile.
Theirs is an extraordinary personal and professional partnership that began when they met as first-year medical students at P&S in 1952 and was formalized at the end of the following year when, despite family opposition, they tied the knot. Sylvia credits the wise counsel of Aura Severinghaus, then dean of students, who calmly assuaged her mother's concern. "We have found that when two students wish to get married," he said, "they do a lot better if they do than if they don't."
Richard describes their medical school experience as nothing short of "pretty wonderful." As a couple, they bonded with their classmates, many of whom have become lifelong friends. And though Sylvia was one of only 12 women in a class of 120, she doesn't remember being treated any differently. She found "the fellows fine and our own group of women particularly self-supportive."
And, like everyone else, they enjoyed access to a formidable faculty comprising many of the medical luminaries of the day. "We had the chance to hear the most exciting parts of medicine in the making, and it was up to us to pull up our socks and make the most of it," says Sylvia. Following wasn't always easy, as in the case of a complex lecture on mucopolysaccharides delivered in a thick German accent by the great biochemist, Karl Mayer-"but we learned to listen." She likewise delighted in the rigor of her medical rotation with Robert Loeb. Among the faculty, Richard most fondly recalls Virginia Kneeland Frantz'22 (mother of classmate and friend, Andrew Frantz'55), whose Introduction to Surgery and Surgical Pathology course was "so extremely well thought out that I came away with knowledge that's still very much with me today."
The strength of the P&S approach to medical education, in Richard's view, lay in the fact that "we were given responsibility in graduated form, with less and less supervision as we went along, so that the transition into an internship was easy." It is an approach that has been imported to McGill.
While Sylvia opted for a career in medicine, later sub-specializing in endocrinology, Richard gravitated to surgery, the field of a favorite uncle. A mechanical bent and his experience with non-paralytic polio as a boy predisposed him to orthopedics.
1955 was the first year of the new computerized National Residency Match Plan, and, to avoid being separated at graduation, they applied to and were accepted for internships in medicine and surgery, respectively, at The Royal Victoria Hospital in Montreal. "We came and instantly fell in the love with the place," recalls Richard. "We just thought that Montreal, the Vic, and McGill were absolute magic-and still do!"
Richard, then still an American citizen, was drafted and spent two years in the Navy at St. Albans. He returned to Columbia-Presbyterian to pursue orthopedic training under Frank Stinchfield and Alan DeForest Smith at the New York Orthopedic Hospital, where he also devoted a year to related basic biochemical research, an uncommon path for an orthopedist at the time.
Sylvia won an NIH fellowship to pursue postgraduate medical training followed by a residency under Elaine Ralli, then head of New York University's endocrine division at Bellevue. She also took on the lion's share of raising their two sons. Her division was responsible for the prison ward and psychiatric consultations in endocrinology, responsibilities she embraced with characteristic gusto and verve. "You really get to know people and you get to see how people handle their life situations," she reflects, "which is one of the reasons this field is such fun. In endocrinology, you're treating lifelong diseases. You have to teach people how to live with what they have."
Returning to Montreal, Richard joined the Department of Orthopedics at McGill, where his research on basic bone physiology and the effects of hormones on bone was funded for 24 consecutive years by the Medical Research Council of Canada (Canada's counterpart to the NIH). Also, in conjunction with members of McGill's large transplant program, he did the work for which he is perhaps best known, his study of avascular necrosis resulting from transplant drugs. He was the first orthopedic surgeon to make the rank of full professor at McGill, where he subsequently served as chairman of orthopedics until his appointment as dean of the Faculty of Medicine in 1981. He has been president of the Canadian Orthopedics Association and was the first Canadian to be president of the American Orthopedic Research Society. Among other key positions, he is a past president of the Canadian Association of Medical Colleges and continues to be involved in educational policy issues. He has co-authored or co-edited four books and numerous papers on a wide variety of orthopedic concerns.
Sylvia's experience at Bellevue, considering what could be done for patients outside the traditional hospital environment, served her well upon her return to The Vic, where a colleague asked her to take over the administration of the Metabolic Day Centre, an outpatient endocrine clinic and the first of its kind in Canada. In 1970, the government instituted one of the first in a series of budget cuts in health care, and the metabolic center effectively took charge of all endocrine cases formerly treated on the ward. Her remarkable success as director of the center brought her to the attention of the hospital trustees, who appointed her vice president and director of professional services in 1977. She has published both in the field of endocrinology and medical administration. Among other positions, she has been a member of the board of directors of the Quebec Medical Association and currently chairs the Committee of the Directors of Professional Services of the Montreal Joint Hospital Institute.
Meanwhile, the forces of social change brought universal coverage in the form of a provincial medicare system, first to Saskatchewan in 1962, then to Quebec in 1970, and later to the other provinces. Universal hospitalization was legislated in 1959.
Together, Richard and Sylvia Cruess have weathered and welcomed the rise of national health care in Canada, which Richard has hailed "the social laboratory in the North," and together they continue to champion its benefits.
"Canadians," he suggests, "have a greater faith in government and more respect for authority than is true in the U.S. It is generally recognized in Canada that government is trying to produce the best health care for the least dollars for the most people."
Sylvia adds, "Canadians are more willing than Americans to live by and with the rules of the game."
In response to criticisms of the Canadian system, notably accusations of health care rationing, Richard is adamant: "Every society in the world rations health care by some means or another. The U.S. has rationed health care by eliminating 35 million people from its system and marginally covering another 15-20 million. We ration health care by limiting access-but limiting access to everybody."
What of the suggestions of a shortage and lag in availability of advanced medical technology? Though the Cruesses agree that Canada may be a little "underteched," as compared to the United States, they argue that their neighbors to the south may be overdependent on the costly benefits of technology and that such an overdependence may hinder good medicine. "The use of technology, which can do wonderful things," Sylvia argues, "can also distance you as a doctor in your relationship with the patient."
As to the material effects of the system for doctors-lower income levels-Richard points out that physicians are still the highest paid group of professionals in the country. And, Sylvia adds, doctors continue to enjoy the unqualified respect of their patients. As medical educators, the Cruesses also are keenly aware of the benefit of Canada's moderate medical school tuition. "Debt does not play nearly as much a role for our students as it inevitably does in the U.S.," Richard says.
"People's motives for going into medicine are probably as varied here as anywhere else," Sylvia notes, "but I think there are few for whom income is of major importance."
Critical of current developments toward managed care for profit in the United States, Richard says, "When you introduce competition as a major factor in the day-to-day life of a physician, I worry where idealism is going to fit in. I see no way in which the marketplace can consider quality of care as a major determinant."
"We've both had opportunities to go somewhere else where we would have earned a great deal more money, and we chose not to," says Sylvia. "Part of it is Montreal, McGill, and our lifestyle here. We couldn't have a more enjoyable and fulfilling academic life. Cooperation far outweighs competition among researchers. It's a special atmosphere in which people really work together."
Despite two busy schedules and extensive professional travel responsibilities (including a trip to Bahrain to coordinate McGill's large residents training program for students from the Gulf States), this high profile professional couple fiercely guard their private life. They remain close with their two grown sons in Chicago and Toronto-"both M.B.A.s and they're going to support us in our old age," jokes Richard. They make time for skiing, gardening, gourmet cooking, and wine tasting-Richard is a Chevalier de la Tastevin, Clos de Vougeot, Bourgogne, France. Committed as they are to the Sante Publique, it seems only apt for two doctors to close the day with the toast: Sante! Your health!