W. Lougheed Microsurgical Course

"Uncle Bill" died September 30, 2004, after a lingering illness. He was predeceased by his wife of 49 years, Grace, and leaves behind his children Stoney, Bill, George, Joey and Bubba, and his partner Margot, to say nothing of the scores of neurosurgical trainees upon whom he had enormous impact.

[Lougheed] Bill graduated from the UofT medical school in 1947, the same year that Professor William E. Gallie retired from the Faculty of Medicine. By then the principles of the Department of Surgery's Gallie Course were firmly etched and Bill Lougheed proved to be an exemplary product of the department's postgraduate training system. Gallie believed that each resident should explore the basic sciences and to that end Bill was influenced at one point by one of the most imaginative and innovative general surgeons of his time, Gordon Murray, of whom he often spoke. Subsequently his interest in the use of hypothermia involved working with William Bigelow at the Toronto General who legend has it, tried to persuade Bill to forget about neurosurgery and become a cardiac surgeon.

But Kenneth McKenzie appears to have been the primary motivator for Bill to pursue a neurosurgical career that would direct his lifelong dedication to the intellectual challenge of the neurological examination and diagnosis, and the technical aspects of our specialty, for which Bill's flair was quite special. His memory of "KG" is that he "was not so much [as a planner] but as someone who was a great teacher and who was a great surgeon, and who had the ability to come in [to the OR] and just stand there, or even assist you. He didn't do it all himself nor leave you to do it."1 Many of us would say the same about Bill who took a great deal of pride watching us learn to do things ourselves, with our own hands. He was above all else one of our country's greatest teachers of operative neurosurgery.

He flourished under Harry Botterell, who encouraged Bill to pursue an interest in the blood vessels of the brain, disorders of which Botterell considered solvable. Bill was a world pioneer in hypothermic brain protection from cerebral circulation arrest2 , and he became one of the world's first, and certainly Canada's first, neurosurgeon to bring the microscope into the operating theatre. Microneurosurgery was born. He helped design an innovative aneurysm clip for brain aneurysms, performed the world's first long-vein artery bypass for the brain, and was one of the first practitioners of carotid endarterectomy. In his heyday he became nothing less than an international superstar in neurosurgery. 

Bill loved training neurosurgeons at the University of Toronto especially the good ones, and to him we were all good ones. He stressed the value of pre-operative preparations and intra-operative organization. We were disciplined on the behaviour necessary for team work. He demanded that we show respect for all colleagues - the anaesthetist, surgical assistant, and scrub nurse in order to maximize the help they provide, maybe under difficult circumstances, and regardless of their experience, or the time of night, or how tired you were. Bill's relationship while assisting the residents during surgery also ran contrary to the norm, during the 60s and for a long while after. Residents were expected to show up on time, be demure and stand in awe while assisting the responsible surgeon. Bill's style instead was to act as the first assistant, to the resident. He quietly explained the anatomy and technical manoeuvres as the resident guided the blade deeper through the tissues. What most of us failed to recognize for months was that Bill deftly placed the retractor or suction or his own forceps in a position that opened up the anatomy and from there, the next course of action. He could make anyone look good, while maintaining his often heroic patience, and ensuring his usual expert technical result, but still leaving intact the resident's sense of pride and achievement! 

Technical ingenuity, surgical innovation and clinical intuition were Bill's unique and remarkable talents. He thought like an engineer, and solved problems by thinking them through, rather than consulting precedent. He was a natural tinkerer and inventor, whether building a boat, setting up the early operating microscope, or solving a tough brain aneurysm problem. He was long on encouragement, but short on self-satisfaction. He rarely referred to his usual successful results, but rather talked mainly about his mistakes and failures and complications, so that we might avoid them. His own sensitivity revealed itself on occasion in a certain sullen and terse behaviour, but never acrimony. He felt deeply for his patients and it was always plain when he had been injured by a poor outcome. A good surgeon must have a bad conscience, he once explained. Each of us loved Bill for a variety of reasons, such as memories of the gravelly voice, the quiet chuckle, the teaching sessions in D OR that always seemed to reach their zenith at 3:30 in the morning and fuelled by a cigarette and several cups of cold coffee, eyes that glazed over when he talked about Go Home Bay, and perhaps most of all, the sound of his scuffling shoes coming down the corridor toward D OR late at night, while the residents waited for his soothing confidence to walk through the swinging doors. But it was not just that he taught us how to be neurosurgeons. Bill Lougheed was our friend, and a mischievous, fun-loving character, bigger than life and bursting with energy. His chuckle soared on one occasion when he told of an incident involving a food service truck driver who regularly annoyed Bill by taking advantage of his assigned parking spot behind the TGH ER. He related how he had outsmarted the miscreant delivery man because he let the air out of one of the truck's front tires. And, to be complete, the diagonally opposite rear tire as well!

Bill Lougheed was proud of all of us. He taught us how to act in the operating room, to resist the sometimes powerful temptation to impugn the reputation of other surgeons in building our own, to be honest about surgical results and constantly, to think about how to improve, and to be organized and efficient in the operating room, and out. His life ended knowing he held the affection, loyalty and respect of several generations of men and women he helped become neurosurgeons. And his legacy will live on in the little bit of Bill that all of his former residents carry around with them, in the care they provide, and the teaching they do. And Bill's spirit at the University of Toronto is manifest so very importantly in the post-graduate Lougheed Microsurgical Course, established in his honour years ago. This semi-annual week long endeavour is provided for and attended by all Canadian neurosurgery residents. All of these things were far more important to Bill than international stardom.

J. Max Findlay
Robin P. Humphreys

1 MORLEY TP (ED). KENNETH GEORGE MCKENZIE. 1892-1964. TORONTO:.FITZHENRY & WHITESIDE, 2004, PP 57-58.
2 LOUGHEED WM, SWEET WH, WHITE JC, ET AL: THE USE OF HYPOTHERMIA IN THE TREATMENT OF CEREBRAL VASCULAR LESIONS. J NEUROSURG 1955; 12:240-255.

October 26-30, 2020

Many thanks to Ms. Sandra Vetiska for her help in organizing and coordinating this course, including arrangement of corporate sponsorship.

Thanks also to Ms. Sandi Amaral for registration and logistical support.

On behalf of all participants, thank you for your contribution. They will have a lasting impact on the training of all the soon-to-be neurosurgeons that participated.

Charles River

Codman Specialty Surgical

De Puy Synthes (Johnson & Johnson)

Integra

Leica

Covidien-Medtronic, Sofamor Danek

Penumbra Inc.

Storz

Stryker

Surgi-One Medical Technologies

Thermo Fisher Scientific

VWR International Laboratory Supplies

Zeiss

October 26-30, 2020 

Dr. Vivek Bodani
Clinical Associate, Cerebrovascular Surgery, Division of Neurosurgery
Toronto Western Hospital, UHN

Dr. Joao Paulo de Almeida
Clinical Fellow, Open and Endoscopic Skull Base Surgery
Cleveland Clinic

Dr. Jorn Fierstra
Clinical Fellow, Cerebrovascular Surgery, Division of Neurosurgery
Toronto Western Hospital, UHN

Dr. Fred Gentili
Professor, Division of Neurosurgery
Staff Neurosurgeon, Toronto Western Hospital, UHN

Dr. Aristotelis Kalyvas
Clinical Fellow, Neuro-oncology and Skull Base Surgery
Division of Neurosurgery, Toronto Western Hospital, UHN

Dr. Eric Monteiro
Assistant Professor, Department of Otolaryngology-Head & Neck Surgery
Staff ENT Surgeon, Mount Sinai Hospital

Dr. Leonardo Olijnyk
Clinical Fellow, Cerebrovascular Surgery, Division of Neurosurgery
Toronto Western Hospital, UHN

Dr. Vitor Pereira
Professor, Department of Neuroradiology
Staff Neuroradiologist, Toronto Western Hospital, UHN

Dr. Ivan Radovanovic - Course Director
Associate Professor, Division of Neurosurgery
Staff Neurosurgeon, Toronto Western Hospital, UHN

Dr. Taufik Valiante
Associate Professor, Division of Neurosurgery
Staff Neurosurgeon, Toronto Western Hospital, UHN
 

October 26-30, 2020

Dr. Chris Ahuja, University of Toronto

Dr. Saira Alli, University of Toronto

Dr. Jetan Badhiwala, University of Toronto

Dr. Michelle Kameda-Smith, McMaster University

Dr. Spyros Karadimas, University of Toronto

Dr. Jessica Rabski, University of Ottawa

Dr. Suganth Suppiah, University of Toronto

Dr. Lauren Zarnett, University of Western Ontario