Childhood, Adolescence and University

Childhood, Adolescence and University

Introduction

This is an interesting autobiography. It tells of a simple young boy who came from an intelligent family in a small village in South Africa, who came to be a physician and then through sheer energy, intellectual curiosity and the fortunes of life, became a cardiologist, carved his way through research and by the time he turned 32 was a Departmental head in a teaching hospital.

He migrated to Israel, set up a leading department of Cardiology, trained generations of physicians and departmental heads of Cardiology, placed Israeli Cardiology on the World map, and cared for simple people, Judges, Cabinet Ministers, Prime Ministers and Presidents.

How did the good Lord create this pathway?

Childhood

The Gotsman family hailed from Galicia. The family spread out from Krakow from a small village called Podgorze and radiated centrifugally with our branch migrating northwards to Minsk. Grandfather Jacob was an expert carpenter. The Tsarist Russian government mobilized the Jews to the army and to avoid this prolonged draft decided to immigrate with his wife to England. He arrived in Newcastle, the closest English port and soon found work in the docks working in the local shipyard.  He lived in Sunderland where there was a large immigrant Jewish population and he felt at home.  His first goal was to learn English and I inherited his large library of leather bound novels with gold painting to preserve the books from dust. He was successful and he spoke English without an accent.  The Union Castle Line had a large repair dock yard in Cape Town and he was so successful that they persuaded him to move to Cape Town in South Africa.  The family moved again to another new country and transculture and lived in the immigrant Jewish neighborhood in Roland Street immediately adjacent to the new local synagogue. Jacob prospered, built a specialist work shop at home and he made exquisite and complex productions of furniture with all the local wood and also built the arks for the local synagogues.

He had 5 children.  Fanny the eldest married Mr. Stone and returned to England, and raised a large family. Samuel was killed in action against the Germans in Southwest Africa during the First World War, Israel became the manager of a large brewery, Abraham was a school teacher and later the principal of the primary school in Krugersdorp  and my father, the youngest, was sent to university to learn physics and land surveying.  He was highly intelligent and loved teaching and continued to teach at the University of Cape Town; but during the depression of 1932, the staff of the university was reduced and he found himself unemployed  He joined his brother Abraham in Krugersdorp and taught at the technical college in Johannesburg.  There he met my mother- Ada Kab (Kobrowitzky).  She was one of 6 children.  Her mother had died in 1921 after the nationwide influenza epidemic which devastated the country.  She was the first person, together with her new born baby who was interred at the new cemetery in Krugersdorp.

Krugersdorp, then, was a large suburb on the western side of Johannesburg. It had rich gold deposits and was the centre of the gold rush in the 1880's. It became a thriving gold mining town which had exploded with the influx of the new fortune seekers. Gold was plentiful, money flowed and work was abundant. It was also the major market town for the surrounding farming district.   My maternal grandfather was an expert leather worker and repaired saddles and reins and other leather items on the horses and carts of the farmers, traders and travelling merchants.  He had plenty of work. The family lived and worked next to the central market in the town centre. When the motor car arrived, and the horses, carts and wagons disappeared he turned his hand to cobbling and boot making. This grew into a small factory to make specialized boots for the miners.  I can remember watching him at work with gnarled hands and a protective apron. Twice a week we travelled to Rustenberg about 50 Kms. distance to fetch the leather from the tanneries for the day's work.  We would leave at 5 a.m. in the morning in his old model T Ford car.  The leather had a strong, unpleasant odor but he lived from hand to mouth and had to buy everything for cash. The family lived in a house adjacent to the work shop, but my strongest memory was the outdoor "spooky" toilet and I was terrified of the snakes at night.  He had remarried a pleasant lady with 2 children.  The family had a strong Jewish tradition. They spoke Yiddish at home and although he read English, wrote everything in Yiddish.

My mother was introduced to my father and after a short "shiduch" they were married.

The great depression passed and South Africa emerged unscathed. My father returned to the University of Cape Town as a senior research fellow in the department of physics. Professor Ogg, the departmental chief, had been an expert in crystallography and had shifted into geo-magnetism.  He established a new research and service unit in the department.  The magnetic north varies by 1 to 2 degrees every week and this is essential for calibrating compasses in ships at sea.  A small deviation can change the trajectory of a ship and allow it to deviate many kilometers in the course of the day.  My newly married father rented a house and moved to Muizenburg, or more commonly nicknamed as "Jewsenberg". This eclectic beach-side suburb is located on the Western side of False Bay and is bathed by the warm Mozambique current.  It has long shallow beaches, the ocean is warm and it is protected from the prevailing cold winds.  Mountains rising to the west keep out the cold, wintery Northwest winds.  It is an ideal location to live and it seemed that the entire Jewish population of South Africa would arrive for the summer holidays.  They basked in the sun and lived on the beach.

 I was born in the Mowbray maternity home, a suburb of Cape Town on the 29th of August 1935, in the early hours of the morning.  This was the main maternity hospital in the area, and I was delivered by one of the midwives. I was a big fat baby and my proud parents took me to Muizenberg.   It was a very pleasant early childhood, and my mother had many friends of her own age who had very young children.  There was a long promenade along the beach where we would spend the mornings in the sun and we would end every walk with a sundae at the local ice cream parlor.  We lived a happy, carefree life.  Our house was located near the False Bay railway station and I can remember waiting for my father every afternoon as he arrived on the 5:30 electric train. Later, the Krugersdorp branch of our family bought a holiday cottage near the water and would spend their summers in Muizenberg. This magnificent vibrant community gradually dwindled as the younger members left for the larger towns or migrated to Australia or Canada. It is now a faded beauty and a reminder of how a vibrant Jewish town can lose some of its charm over time.

The outbreak of World War II brought major changes to Cape Town.  Both the German and Allied fleets realized the importance of the sea route between Europe and the Far East. The magnetic observatory was a strategic institution to guide the Allied ships and was moved to a country location at Hermanus. It also removed the influence of the radiation from the exposed wires of the local suburban, electric trains. 

Hermanus is located at the southern tip of South Africa.  The cold Benguella current and the warm Mozambique currents meet at Cape Agulhas, the southernmost point of the African continent. It had a rich history.  The Portuguese and Dutch sailors had found a route to the Far East around the southern tip of South Africa and a halfway station to provide fresh water, vegetables, and meat for passing ships travelling to and from Asia.  Cape Town was the obvious major port of call and was a place to repair ships, wait for other ships in the fleet and allow sick mariners to recover.  The Dutch East India Company built a small colony for their ships traveling from Holland to Batavia (Indonesia).  The Cape became an outstation of the Dutch East India Company's eastern empire, based in Batavia in Java. During the Napoleonic Wars, they were displaced by the British.    

The European ships to the Asian colonies had to circumnavigate the southern tip of Africa and because of the interaction between the two currents it was often windy and misty with heavy fogs. The Agulhas bank is shallow and extends for 80 km from the coast, which explains the propensity for ships to run aground on the rocks. History is rich in ships which had gone aground off Cape Agulhas.  It was the graveyard of many ships, and the survivors explored the neighboring area.  They found a quiet bay where they settled and called it Hermanus Petrusfontein. It has a Mediterranean climate but the north and southward movements of the sun produce two divergent winds.  The southeast trade winds in the summer and the northwest anti- trades in the winter produced warm dry summers and cool wet winters.   The town has the finest and purest air in the country and became a magnet for holiday makers. 

Hermanus is a beautiful village.  It is located between the mountains and the sea. The mountains are covered with a unique "fynbos" scrub and heath and unusual indigenous flowers.  Spring brings a flourish of flora and the multicolored fields cover the land.  It has a very big golf club with many international tournaments and on Sunday mornings I would earn 6 pence for caddying on the golf course.  On Monday, I would spend my earnings and buy the weekly picture books from England which had arrived on the Friday mail steamer.  I loved the "Champion and Triumph" with stories of Rockfist Rogan, the spitfire pilot and his exploits and Gusty Gale the intelligent boy at the grammar school. I also read the monthly Sexton Blake detective stories.  Often I ran a credit at the local paper shop.  "Picture Post" was the popular English weekly and brought vivid black and white pictures of the Second World War in England and Europe.

The coast is rocky with strong tides and currents and we would swim in the little coves or on the beach to the west of the town.  They were permeated with the the smell of iodine from the seaweed and the salt winds from the sea.  The climate was very moderate and temperate with warm summers and without real cold winters.  There were well worn paths along the coast and at the foothills of the mountains and I would spend hours walking and exploring the hinterland. 

We arrived in Hermanus on the first of January 1940.  We lived in the local Windsor Hotel on the rocky sea front for a few months. We then rented two different houses until finally we bought our own home with plenty of living space.

My father worked at the newly built Magnetic Observatory. It was built to the west of the town in distant scrub covered fields. It had 4 buildings: an office block, a building with instruments for calibration and precise localization, and another block which housed other instruments to monitor the daily variable motions of the North Pole. A 4th block had geodetic instruments for measuring earthquake vibrations and outside in the grass covered fields a variety of meteorological devices. I grew up close to my father and we would spend Sundays taking down and changing the recordings and making the daily calculations. The changes were recorded as graphs on photographic paper. This needed developing and drying like long reels of cine film. He would then measure the changes and use a large desktop calculator to measure the statistical fluctuations. Later this was broadcast to the ships.  It was my interesting introduction to scientific methods and calculations and statistics.

I was 4 years old when we arrived and I started school immediately in the 1st grade. It was a modern E shaped building covered with hewn stone, large windows to let in the light and always cleanly painted. The school had separate English and Afrikaans speaking classes.  The English section was very small and we had 3 grades together in one classroom with a total of about 20 pupils.  Miss Earp Jones, the daughter of the local Archbishop, was an excellent teacher, and I made rapid progress particularly when I learned together with the 2 more senior classes in same class room.

The remainder of my primary schooling was smooth and this continued into high school.  The English and Afrikaans sections merged and the classes became smaller and smaller.  Although English was our home language I soon became fluent in Afrikaans. We were the first matriculating class in the school. The class comprised only 4 pupils so that we received personal individualized teaching.

Memories of the teachers and of school are still etched sharply in my memory.  Mrs. Morkel taught me how to use my hands. She was a practical handwork and modeling teacher. Mr. van Dyke taught me carpentry and we had unusual Friday mornings classes where we learned how to dismantle  and reassemble a telephone, radio and even a motor car engine.  We traveled to all the surrounding factories and learned about paper production, printing, brick and furniture making, jam production, wine making and other common procedures.  This broadened my general knowledge and inculcated in me a spirit of enquiry to understand how everything worked. This has lasted until today. Mr Wessels was the science master and he inculcated a love of science. Miss Ross was a flamboyant red head and improved my English, while the school principle, Mr Jones taught Chemistry and Mathematics. One recalls very strong impressions of childhood that have not faded. This is probably the greatest "memory bump" that has survived.

I was a voracious reader. I read all the books  and children's novels in the school library and then found a rich collection in the Town library. My English was honed by constant practice. G.A. Henty was my favorite author.

My daily schedule was very simple: School in the morning and early afternoon with cheder in the late afternoon followed by an hour or two of sport.  Synagogue was in the evening, supper and then two or three hours of homework and learning. 

The final combination of subjects chosen for the matriculation examination was a little unusual since it was dictated by the needs of the other pupils.  I took English and Afrikaans as a first language and chemistry, geography, mathematics, and accounting.  My father added Latin, Hebrew and a little German.  I graduated as top student in the Province (State).  I was fascinated by Afrikaans and had an excellent teacher in Mr. Joubert.  He taught me the elements of etymology, the history and development of the language from the other Aryan languages, German, Dutch and Flemish.  We studied many texts in each of these languages and this left me with a love of literature and language.  Mr. Joubert was a tall, thin and bald and full of enthusiasm.  He also taught me geography for many years and left me with a legacy of understanding pictures, maps and the world.  My father supplemented my library with books on cartography and physical and economic geography. I learnt how to sketch and illustrate all the difficult points. I had never heard of semiotics but this was the basis of my visual approach to knowledge. Today I am an expert in using the blackboard for teaching to explain and simplify the most complex concepts.   

School was a happy experience. My father was my friend, tutor and mentor.  Our house had a large enclosed veranda which I used as a study and we would sit down in the evening to revise school lessons and study related texts.  He loved books and I had a large library of university text books on the different school subjects. 

I was very successful at school and was top student in the country in the Junior Certificate Examination (10th grade) and second top student in the Matriculation Examination (12th grade).

Life was free and easy. The village was small and everything within walking distance. There were no pressures of time and my good performance at school was achieved by regular daily learning. My understanding was good, the ideas and concepts were clear and my memory sharpened by constant repetition.

The radio was our main source of information from the outside world. We had a large Marconi receiver and we erected a special antenna to receive the BBC broadcasts from London. Reception was possible in the evenings only and we would listen carefully to the 8PM news. I followed the progress of the Second World War carefully and the Cape Times, the main English newspaper from Cape Town, also arrived in the late afternoon and carried daily maps of the progress of the war in North Africa, Italy and Europe after the D-day landings. We were not aware of the extent of the holocaust, but I have vivid memories of the progress on the fighting on the different fronts.

I was not a great sportsman but played tennis,  was a lock forward in the rugby team, ran the 440 yards in athletics, but was an excellent wicket keeper in cricket, with the safest hands in  the town.  Pam Hands, an ex Springbok, international player was an enthusiastic local cricket coach and he taught me how to bat, keep wicket and even how to be an excellent spin bowler.  I loved cricket and my father made sure that I had my own bat, pads and wicket keeping gloves. All were expensive items on our limited budget.

Hermanus was a big fishing village and my mother would give me one shilling every day to buy fresh fish from the fishermen who returned with their afternoon catch.  I would walk down to the old harbor after school.  There was an inlet in the bay between steep rocks which was protected from the tides and the winds. The fishermen would go to sea in their small rowing boats which had a small fore sail and they sought and followed the fish shoals in the bay. When they returned they would lift the boats from the water physically, and then pull them onto the slipway.  The women would help to remove the superficial scales and the innards of the fish.  The fish came in all sizes and tastes and the slipway had a strong fishy smell. Part of the catch was sold directly in the harbor market; the rest was placed on ice and transported to neighboring market towns. I became an expert on fish and had to identify the non-kosher strains.

The old harbor in Hermanus

There were many Hermanus old families who had lived there for three or four generations and who had played a prominent role in developing the town. I mixed freely with the younger generation. 

Apartheid was very strong. The mullato (coloured) populations were segregated from the whites living in their own villages of Mount Pleasant and Hawston and there were very few blacks.

We had two family physicians. Dr Cohen was an assimilated General practitioner from Germany who had repeated his last three years of study at the University of Cape Town while Dr. Taylor had retired from the Indian Medical Service and had studied in Scotland. He gave me my first medical textbook: William Osler's Principles and Practice of Medicine.

Transport was difficult.  We could not afford a motor car and there was no railway line in Hermanus.  We would take the 10:30a.m. (charabank) bus to Bot River and catch the 12 p.m. train to Cape Town. The train had to pass over the Hottentots Holland mountain pass and because of the steep climb the 60 Km ride took 4 hours. The train crawled along the climb with the engine emitting thick clouds of black smoke: it arrived at Cape Town at 4 p.m.  The trip took all day and the return trip was equally tiring.  Later there was a direct bus to Cape Town but I could never afford the 10 shilling fare.  When I went to university I would hitchhike home for the weekends.

Being Jewish was not popular in the town, and my nickname was "Joodjie".  I learned to box and wrestle for self defense and once or twice a week I had to defend myself on the way home from school.   The social life was hard and I had few non-Jewish friends. 

Hermanus had a typical Jewish enclave.  The families were second generation Jews from Lithuania or Russia.  The 15 families were either shopkeepers or hotel owners.  The town had a lovely synagogue, built with gables in the Dutch style. We painted it once a year and kept it clean and trim.   Mr. Chaim Falkoff was the local reverend: he taught the children, conducted the daily synagogue services and acted as the local shochet (ritual slaughterer). He would slaughter a sheep or cow once a week, sufficient for the needs of the community, and on Thursdays would come to our house to kill one of our chickens for Shabbat.  For many years he tutored me for an hour after school. I mastered the prayers, a little Hebrew and some Bible, but his native language was Yiddish and mine was English.  I missed out on a really thorough Jewish education. The small community managed a daily minyan (quorum) for prayers.   I had a good voice and although I really did not understand all the Hebrew could conduct the services. The other Jewish children were sent to boarding schools in Cape Town so that my sister and I were the only Jewish children at the local school.  We tried to observe Shabbat and maintain a modicum of kashrut.  Joe Smith, the local Jewish green grocer, would visit Cape Town on Wednesdays and bring kosher food, cold meats, sausage and salted herring. My mother was friendly with the other Jewish women, but my father had little in common with the other Jewish merchants or hotelkeepers.

This is such a contrast to the education of the children in the "Schtetl"  Baruch Goldstein, an elderly rabbi from Worcester, Massachusetts described his childhood in Mlawa, a Polish town half way between Warsaw and the German border.  One quarter of the population was Jewish and their activities were concentrated around the "shul gasse".  This had 3 synagogues and an old and a new beit midrash.  The Jews belonged to all streams of religion and the younger generation participated in different political youth groups.  The religious learned in the yeshiva where the emphasis was on mitzvot and prayers.  They spoke Yiddish and immersed themselves in Talmud.  The older children were sent to more advanced yeshivot in the well-known centers of Poland known for their excellence.  The children wrote and spoke Hebrew and understood Aramaic and the Talmudic discussions and systems of learning.  They emerged as mature Jews. There were other groups where Zionism and Hebrew were important and a third group who had been influenced by general learning and the so called enlightenment and "haskalah".  

This is in such contrast to my own childhood and probably similar to most of the Jewish children of my generation in South Africa. We were born Jewish and maintained tradition. The importance and understanding of the simple mitzvot were not emphasized and I barely understood the subjects in the Talmud and the importance of Rashi and the other commentators.  The Jewish community had grown away from the Jewish education and religious environment.  It was a watered down existence which I discovered many years later when I became a professor in Durban.  I think that my lack of understanding hastened my aliyah to Israel.  I wanted to understand and use Hebrew and understand my origins.

University of Cape Town – A New World

I was fortunate to be awarded several scholarships to study at the University but it was a difficult decision to choose a profession. I was very keen on mathematics but my father vetoed this decision and we decided on actuarial science.  This would be mathematics with a financial future in the field of insurance. 

Next to my mother's little gift shop was a large lawyers office. Frikkie van Zyl was a young medical student who was wooing the lawyer's secretary.  When the lawyer appeared he would take refuge and tea in my mother's shop.  He persuaded me to try medicine.

I had not studied physics, zoology or botany at school and I used the long summer vacation to prepare for the first year studies. When I arrived at the university I had already prepared large portions of the syllabus.

The University of Cape Town was located at a bend in the foothills of Table Mountain with a spectacular panoramic view, over Table Bay and the Cape Flats but it was isolated and 8 kilometers from Cape Town.

The University was the premier university of South Africa with a long tradition of excellence and scholarship. The medical school was established in 1930 and many of the Professors had been recruited from England or Scotland. The aim was to produce a well rounded general practitioner based on the Scottish Model. The medical staff were great teachers rather than high powered research orientated physician scientists.

The University was a different experience and a culture shock. I was housed in University Hall. It was built in 1946 as a temporary structure to house returning servicemen following World War II, six blocks of single rooms facing an outside verandah. It was nicknamed “Belsen” as it consisted of renovated Army Barracks

As a young 16 year old boy from a country village I was catapulted into a new, unfamiliar life style.  I lived in the older University dorms but within a Jewish micro ghetto.  We did not mix with the Afrikaans students and the English students did not mix with us.  The prejudices were great and the English students controlled the sports fields. My greatest extra-curricular activity was the debating society.  I polished my English and learned how to speak intelligently, spontaneously and fluently. The Debating Society was the incubator for budding politicians and I entered University politics.  In my first year I also joined an outreach program to coach underprivileged black students in science and mathematics to prepare them for the University entrance exams.

The studies were easy except for Botany. I went to the lecturer and explained my problems and she gave me an extra hour of individual teaching every week. I would wake up at 5AM and prepare the material and I had a wonderful time. I also did a course in mathematics as I still had actuarial science at the back of my mind. I made many friends and have continued to be in contact with them for the past 50 years.

We would daven (pray) at the little, old Observatory Synagogue next to the medical school but the old reverend had a bifid beard and always wore sharp pointed well polished shoes but  the cotton wool plugs in his ears, and the elderly members of his congregation did not attract me. The rundown shtieble (Synagogue) was not to my liking.  It lacked "hadar" (beauty). I would spend Shabbat with my student friends’ families in Oranjezicht, a suburb of Cape Town.  I would enjoy the services in the large elegant and well kept Gardens Synagogue that had a cantor and choir.  It had decorum and cantorial music and Rabbi Abrahams who had trained in London and spoke excellent English explained the services and the background to the weekly Torah readings.  The building had two large Moorish spires.

In my second year I continued in the same residence and I walked to the adjacent medical school. Anatomy and Physiology dealt with human beings: the subjects excited me and really aroused my interest: I intensified my studies.  We were divided into small groups for more individual learning and I often acted as the leader of the group.  We spent long hours in the, anatomy laboratory and dissecting room and I was able to teach my fellow students the intricacies of the structure of the human body.  We studied physiology texts together but Prof. Budtz Olsen was my favorite physiology mentor.  He would come with into class with large multicolored pictures and diagrams to teach the different physiological pathways.  He would stand me in front of the class and invite me to explain the diagrams.  Today we would do this with power point presentations, but his simple systems were just as effective.  I came to understand physiology in depth and have never lost my interest.  Even in clinical teaching I still use diagrams and drawings. 

Pathology in the 3rd year was more difficult.  Prof. Thompson, an explosive redhead from Glasgow, with bushy pointed eyebrows was an integrator, but Golda Selzer and her young registrars were analysts and all the diseases groups were neatly classified.  We spent much time in the post mortem room. I acted as leader to a group of students in the museum which had the most unusual and extensive collection of pathological specimens.  We also devoted hours to examining histological slides.  We were a happy coherent group who became close friends. Today this pathological material is freely available on the Internet, stored in an electronic format and this permits easy access and allows immediate retrieval and storage.

I moved to Medical Residence that was housed in a much more elegant building and again we segregated ourselves into our own tight Jewish micro environment but now we were joined by the Catholic students.  This residence was formal with ties, jackets and gowns for dinner; it was modeled on the Oxbridge system.  The residence was part of the Medical School- Hospital complex with a two minute walk to the Faculty teaching facilities and a four-minute walk to Groote Schuur Hospital.  We were a closely knit group of students and after 60 years we are still in contact.  To-day I communicate through "skype" regularly and speak to one of my old fellow students at least once a week.

Jill Waynik was my first girlfriend, a relationship which developed within the medical school class.  We learned and prepared for the examinations together. 

The 4th year brought another major change.  The clinical years introduced real clinical medicine and direct contact with the patients. We wore long white coats, stethoscopes to listen to the heart and patella hammers for eliciting tendon reflexes. We felt like real medical students and budding doctors as we walked the wards and interacted with the patients.  The teaching was very good.  We met with a Medical tutor three times a week and learned how to take a careful history and examine the patients.  We were divided up into groups of 8 students.  The tutor would select a patient with a specific physical sign, such as a systolic murmur or consolidation of the lung in pneumonia or an enlarged nodular liver.  We would elicit the physical signs and then discuss the differential diagnosis and pathophysiology.  The tutors were senior physicians in private practice who contributed their time to teaching the students.  Less successful teachers were sent home.  My favorite tutor was Robbie Slome with long black hair and a sunburned face.  He had a wonderful manner of presentation, control of the class, spoke well and was able to make the material simple and understandable.  He used diagrams to demonstrate points and we would come away understanding and remembering the material.  He taught me the basics of cardiology which I have still preserved.   Twice a week we met as a class of 120 students in a large lecture hall and had a demonstration of a patient with a specific symptom such as shortness of breath or diarrhea.  The two professors, Mersky and Eales had a well-organized program to cover the entire field of medicine in a methodical manner.  The teaching program was practical, and simple.  The teachers were in their 40s and they all had extensive experience.  There was a large reservoir of other physicians waiting to take their place so that   the competition was fierce and the standards high.   

Again, we walked the wards in pairs of students, choosing patients who had classical stories or physical signs.  Each member of the pair would catechize his partner.  At night, we would study the textbooks and complement our knowledge.  In a short time I became an intelligent student and had acquired a fundamental basis of medical knowledge. When I consider this period in retrospect I marvel how a malleable young student's mind can absorb, understand and remember so much information.

We interacted with our tutors who provided real personal examples and good mentoring.  There was always time for questions and personal dialogue.  It was medical school education at its best. 

We learned obstetrics and spent 3 months in residence in the maternity hospitals.  We lived in the hospital so that we were on 24-hour call and available to observe and treat the patients. We worked in small groups with only 4 – 6 students in a group. The registrars were very helpful and enthusiastic and we really received individual teaching.    The maternity hospitals were very busy and we acquired extensive practical experience. The work was an revelation. The patient would be admitted with frequent recurring lower abdominal pain. We would examine her and then monitor the pain, her response and check the foetus. As the pains became more frequent we would measure the opening of the mouth of the womb, and then when fully dilated help her to deliver the baby. Many of the patients were complex with malpositions of the baby, and these had to be corrected. The drama of the baby's arrival, the delivery of the placenta, the careful anticipation of bleeding of the bare uterine wall and the prevention of subsequent infection added tension to the unfolding drama. The care was meticulous and the goal was a healthy well developed baby and mother. The surroundings were unique: the mother and her attendants, the sterile labour ward, the smell of the antisepsis, the baby covered in amniotic fluid, the blood and even the placenta contributed to the deeply emotional medical environment. I was completely at home with these new experiences, and later in Rhodesia found great satisfaction with the deliveries. These were sometimes marred by complications: the feet were in the wrong direction, the head was malrotated, the uterine contractions were sluggish, the mouth of the uterus would not open, or the placenta would not separate. The residents were experienced and these problems were overcome and treated. This was free medicine at it's best. The physicians their small salaries and treatment and hospitalization was free. Hadassah could learn much from this free social system. 

The fifth year comprised surgery, gynecology, pediatrics and the surgical specialties.  Again the teaching was dogmatic but we learned the simple basic principles which I have never forgotten.  Prof. Jannie Louw, head of surgery, was a short, energetic, cutting surgeon.  He hated "scratching" in the patient's body and every movement on the operating table was perfectly coordinated.  I made a point of assisting him on Tuesday and Friday mornings and would scrub for hours.  He was an expert at gastrectomy and other complex abdominal operations.  Every operation followed the same precise pattern and it was easy to learn from him.  He was meticulous in post operative patient care and I would follow him around the wards.  On Friday nights he would be the emergency duty surgeon and since there was much physical violence and trauma, I learned how to deal with simple life threatening emergencies. He would operate on the perforated ulcers, intestinal obstructions and ruptured aortic aneurysms. I spent most of my days and nights in the hospital and would rise at 5 in the morning to study the textbooks. James Louw, the head of gynaecology was another meticulous surgeon and with 7-8 expert movements would perform a hysterectomy in under an hour. He had large hands, and seemed to work slowly, but each step was deliberate and accurate, that one rarely saw any bleeding. He would close the abdomen himself and maintained that the patient only saw and remembered the final abdominal scar.

Since Jill and I worked and studied together at night, I would often take her home and spent the night in her parents' home. 

Her father, Ivan Waynik, was the busiest and most respected general practitioner in Sea Point.  He taught me a great deal about treating people as sick human beings and not as impersonal diseases.  He charged a variable fee depending on the patient's income but if the patient was totally indigent, there was no fee: instead he would give him the shilling for the bus trip home.  He was up early and out of the house before 5 a.m. He persuaded the surgeons to operate on his patients in the very early morning so that he could act as the assistant and see the pathology first hand.  He would make his first house calls on patients before morning surgery at 9 a.m. and would visit patients again at lunch time and after evening surgery, often not returning home until 10 p.m.  We spent many hours together discussing medical problems and new treatments. 

My other friend was a co-student, Lionel Opie, who was 2 years my senior, and he would show me interesting patients and explain the pathophysiology of the diseases. Later he was awarded a Rhodes Scholarship and went off to Oxford to study cardiac physiology under Krebs, the Noble laureate.

I had many extracurricular activities.  I ran the Medical School Council and we had a large outreach clinic in the colored area of Elsies River.  Jill and I, with a bevy of students would spend the evening examining the ill, indigent patients under the supervision of volunteer doctors and prescribed and dispensed the relevant treatment.  This free medical care was a great boon to the little town.  Sicker patients were referred to the out-patient clinics at the hospital.  The hospital also provided free medical care to those who had a minimum income.  We learned how to respect patients and understood that free medical care was in no way inferior to private practice.  This is another basic tenet that has guided my own practice of medicine.

I moved into top gear in my final year.  The volume of knowledge that we were expected to understand and remember was infinite.  We worked hard, walking the wards, interrogating and examining the patients and studying the books.  It was all done in pairs—and I was never "a lone wolf" . 

I graduated at the top of the class. 

I was now a proud fully fledged doctor, and my mother would introduce me as "My son the doctor." 

Unfortunately, my relationship with Jill waned and she went to Salisbury where she met a young general practitioner who returned with her to Cape Town to help and eventually inherit her father's practice.  The newlywed couple have lived a very happy life together and raised 5 lovely children.  The separation, for me, was a serious psychological blow.

1952 was the year of my internship.  The young "22-year-old spring chicken" started working at Groote Schuur Hospital.  My first 6 months was served in surgery with Jannie Louw, the chief of general surgery.  I had planned a career in surgery and I was very happy working for this "tough trooper".  He ran a tight ship and was a full time university surgeon without private practice.  He would tackle the most difficult operations and looked down on his colleagues in the private sector.  He was superb at gastrectomies and thyroidectomies and could remove a gall bladder in an hour. The work was meticulous, the operating table was neat and clean and every operation a planned procedure.

The internship was a fine educational experience. I lived in the hospital and worked very hard. Surgery became the centre of my life. Diagnosis was simple and direct and surgery often curative. The smell of the operating room and the anaesthetics: scrubbing, gowning and donning the gloves in the operating room and the exhiliration of opening and repairing the human tissues became part of my daily life. This was the reason that I opted later for invasive cardiology. Bobby Forsythe, another fine and forceful senior surgeon with a mop of white hair, deeply involved in private practice, made a very interesting prophecy: he predicted that organ transplantation was the future and that I should take off time to learn immunology.

The second half of the year was devoted to Internal Medicine under Prof. Frank Forman. I was not built for the process of diffuse differential diagnosis which was in sharp contrast to the precision of the surgeons. The physicians were excellent, the patients very sick and the junior physicians patient and would spend time with me explaining the reasons for diagnosis and management. We were a happy group of Jewish interns and became close friends. We deputized for each other and would help on the other wards when the co-interns were overwhelmed with work.

I would have continued a career in surgery but 3 months after I started my internship, my father died suddenly in Hermanus. 

This was another major psychological blow.  He had suffered from severe angina pectoris and was limited in his exercise capacity. He was an obstinate man and although I booked appointments for him with the senior physicians in Cape Town he never kept the appointments. He woke up one night and passed away suddenly from a cardiac arrest. I was unprepared for his sudden demise. My main pillar of support had been extinguished. The Chevra Kadisha arrived in Hermanus, our small village, where we lived with short trousers, sandals and open necked shirts, in top hats and striped morning suits and without any compassion buried my father.  The shock of the death and the burial caused a deep emotional schism between myself and my maker.  My father left behind my sick mother, Gloria, my 16-years-old sister who was ready for university education and Arnold, my 9-year-old brother.  Our house still had the same 1600 pound mortgage which my father had taken in 1942 and been unable to redeem. My mother had a pension of 40 pounds a month which never increased to cover inflation.  The remainder of the year was difficult, and it became apparent that my mother was unable to continue with her little gift shop.  She sold the house in Hermanus and moved to Sea Point, a coastal suburb of Cape Town with Arnold. 

I looked around for an assistanceship in Cape Town but the salaries were very low. Frankie Forman suggested that I move northwards to Rhodesia and recommended that I join Ray Mossop in Gatoooma. He was offering 150 pounds a month plus a furnished house. I accepted it gracefully.

I sent Gloria to university, but she was unable to concentrate on studies and left with me for Rhodesia.

I closed the happiest period of my care free life.