Serendipity and the joy of surgery

Cate Swannell
Med J Aust || doi: 10.5694/mja18.0204C1
Published online: 2 April 2018

Professor Tony Holmes, AO, has trained some of the world’s best craniofacial surgeons at the Royal Children’s Hospital and helped through his Jigsaw Foundation …

YOU wouldn’t pick Tony Holmes for a man who has ever wavered at the sight of blood, given his reputation as one of the world’s finest craniofacial surgeons. But that’s exactly what he was in the early days of his medical training.

“I had a good time going through medicine,” Professor Holmes, founder of the craniofacial surgical unit at the Royal Children’s Hospital in Melbourne and the Jigsaw Foundation, tells the MJA. “The worst thing for me was that I was quite squeamish.

“Talk about the man who faints at the sight of blood, I was it. I just couldn’t stand it.”

At the time Professor Holmes had a hankering to be a “clever physician” like the ones he was seeing during his hospital visits as a University of Melbourne medical student in the mid-1960s.

“The neurologists were like Sherlock Holmes, deducing all these wonderful thing, finding clues. The surgeons were the grunt and sweat men wearing gumboots, so I had every intention of being a physician.”

But then, at several crucial moments in his career, Professor Holmes credits the light touch of serendipity with changing his direction.

“The other side of my life was that I was building everything – cars, radios, model airplanes – I loved working with my hands,” he says.

“While I was doing my surgical rotations, I met a few surgeons who said ‘you’ve got lovely hands, you should be doing this’. One of them finally said ‘you’re mad trying to be a physician, do surgery’.

“So, I changed direction and started doing the first part examinations for my surgical training in my third year, which was fairly late.”

While nurturing a secret love for reconstructive surgery – “at the Royal Melbourne in those days plastic surgery was still considered slightly second class, so I didn’t tell anyone until the last minute” – Professor Holmes became a general surgeon. His training included two rotations in New Guinea.

“By this stage I thought I was a bit of a young hot shot,” he says. “I was a ‘top gun’ and I went to New Guinea thinking this will be a breeze. And I was absolutely shot down.

“What I saw wasn’t what we saw [in Melbourne]. The kids had congenital deformities; there were also burns like nothing on earth. Also, the adults were all chewing betel nut, so there were many getting dreadful oro-facial head and neck cancers.

“I came back and said right, I’m going to be a reconstructive surgeon. Back then general surgery was generally ablative – you cut things out or chopped them off.”

Serendipity played its part once again.

“The first plastic surgeon in Australia, Sir Benjamin Rank, had semi-retired and become the Chairman of Studies at the Royal Melbourne, and he was the first person I went to,” Professor Holmes says.

A year later Sir Benjamin set up a fellowship in Bristol in the UK, and wanted Professor Holmes to take it up, but a literature search told the younger man that the US was the place to be. He inferred this to Sir Ben.

“He was furious, but 2 months later he was invited to America to receive an Honorary Fellowship from the American College of Surgeons, the president of which happened to be the most senior plastic surgeon in the country, Dr Joseph Murray.”

Over a few glasses of red wine Sir Benjamin mentioned Tony Holmes’ name, and that’s how he ended up with an invitation to Harvard Medical School.

“How lucky can you get?” he says.

Shortly after arriving at Harvard, Professor Holmes was hit by the revelation that set in stone his chosen specialty.

“The big thing was that half the job was in the Boston Children’s Hospital. I had never really treated children before and within one week I knew what I wanted to do. That was the epiphany.

“The thing I really enjoy about kids is they have no emotional overlay, they’re straight. Whereas with adults you’ve got a surgical problem, but you’ve also got every other problem and fear they’ve got in the world.

“With paediatric patients there are actually three patients – one gets the surgery and the other two are the hardest to handle.”

Two years into his time at Harvard, Professor Holmes was operating with the best in the business, was well ensconced and was having a ball. He had very nearly decided to stay in the US forever.

But then along came another piece of luck in the shape of a head-hunter from the Royal Children’s Hospital in Melbourne, who had arrived at Harvard chasing the signature of one of Professor Holmes’ contemporary colleagues, paediatric cardiac surgeon, Roger Mee.

“Roger and I were the same vintage, and he said to this guy ‘why don’t you head-hunt Tony Holmes too; he could do craniofacial surgery’. And they said, ‘what’s that?’ Long story short, I was offered the job at the RCH.”

In 1979 Professor Holmes founded the RCH Craniofacial Surgery unit and remained its Head until 30 years later. Today he is still a senior plastic surgery consultant with the unit and at 72 is “fit as a fiddle” with no plans to retire.

“It’s been a fantastic journey and I’ve loved every minute – every day of my career,” he says. “I was lucky in that I found the right fit for me.”

Luck, he says, is a vital part of finding the right career pathway, but today’s medical students need reminding of that sometimes.

“There is always an element of luck in life, but the difficulty is recognising it when it strikes you and then following it through,” he says.

“I tell students to look at their own personalities and see what it is that gives them their jollies. They should keep their eyes open because they don’t know what opportunities might suddenly become apparent.

“If you find something that really tickles your fancy, follow it. Patients want doctors who are passionate about what they’re doing to look after after them.

“My other message is that you’re going to meet forks in the road. The one you should take is not the intellectual one, but the one your heart follows rather than your brain. If you intellectualise decisions, including in relationships, then you’re probably going to fail; but if you go with your heart you’ll probably win.

“It’s happened for me and is still happening.”

  • Cate Swannell



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