From silver service to sandwiches – how workplace culture and practices changed

Medical staff ate their daily meals in formal splendour at the hospital until the 70s. There were two dining rooms – one for doctors and a larger room for nurses and the rest of the hospital staff including orderlies, pathology and radiology.

Staff were served at lunch and dinner by a maître d’ and waitresses dressed in black skirts, white aprons and white shirts. The tables were set with silverware and linen tablecloths.

A late supper – a cooked meal – was served at 11.30pm for staff on the night shift.

“Everyone ate in the dining room,” said theatre nurse Beverly Howard, who joined the hospital in 1963 as a student nurse. “ Morning and afternoon tea were also supplied. They were fabulous - all home cooked. And on Christmas Day the residents and registrars would all dress up and wait on tables, looking after the nurses. It was great fun. In those days the hospital was like one big family – everyone knew everyone else.”

The dining rituals of the hospital’s early decades reflected the structures of power within the organisation. The surgeons and their fellow medical clinicians were the hospital’s leaders, wielding enormous influence on the small team of administrators, according to Bob Thomas, the hospital’s first Professor of Surgery.

“In the early days, surgeons had to deal with a huge variety of cases and that’s what created the characters of that era – in the crucible of fire type of people, people who dealt with multi-traumas,” Professor Thomas said.

Kings of the hospital

“Surgeons were the kings of the hospital – you did outpatients when you wanted to, if you got in late, patients waited for you. In the operating theatre, if you wanted to go until midnight, you would operate until midnight. That happened at the Royal Melbourne as well. It was part of that era.”

Liz Edmonds, a theatre nurse, started her career at the hospital in the 1960s. She said the professional relationship between nurses and surgeons had evolved to become more egalitarian, since her early years in the surgical division.

Medical staff quarters, known as the Staff Home, in 1953. It had 32 separate, fully furnished bedrooms for registrars and medical staff.

Western Health archives

“In those days the surgeons marched to their own drum,” she said. “The workload on the surgeons at that time was huge, much more than it is now because the place was mostly run by interns and if they had one registrar they would have been lucky.

“Surgeons were treated like and behaved like mini gods in those days . . . But then other workers became more educated and more assertive and nursing training moved to the universities, so nurses valued themselves and their training more highly. The behavioural changes among the surgeons and nurses have just followed changes in society – people know they have certain rights and that you can’t bully and harass people.”

Anaesthetists are another group who work side by side with surgeons. They have also witnessed an evolution in the relationships between surgeons and other hospital staff.

Dr Beth Ashwood, a consultant anaesthetist at Footscray, remembers the early years of her career decades ago when she and a senior colleague had a private scoring system for the surgeons, rating them out of 10 for how difficult they were to get along with. If someone scored a 10, they would arrange the roster so that none of the anaesthetists had to do more than two lists a week with a difficult surgeon.

“When I started as an anaesthetist, and even when I was a junior doctor, a lot of surgeons had a God-like notion of themselves,” Dr Ashwood said. “But that’s changed because there are so many more surgeons and anaesthetists now, so the impact of a few difficult surgeons has been diluted.

“The scope of our work has broadened too. We now provide services for endoscopies and work with physicians. It’s meant surgeons tend to have a greater appreciation of what we do and there’s a greater level of mutual respect.”

According to Professor Bob Thomas, other trends also played a major role in changing the traditional power base of surgeons in hospitals. The rise of nursing and management as professions and the growing financial pressures in medicine reduced the administrative power of clinicians and changed their leadership roles in the workplace.

“From the 1980s onwards Footscray became less idiosyncratic and more of a mainstream hospital. There was a collective view that we must collect data, have greater care and responsibility,” he said.

“Footscray is a far better place now. The teaching of graduates and undergraduates is mainstream, all of the clinical activity and research is mainstream.”

Mr The Hien Pham, Vietnamese interpreter and Outpatients department clerk with Sister Glynis Misquitta of the Antenatal clinic, explaining childbirth procedures to patients in 1987.

Western Health archives

Taking the kids to nightshift

During the 1960’s and 70’s most women faced extreme difficulties trying to return to work if they had young children. Employer and societal attitudes were often hostile to the idea of mothers in the workforce. Formal childcare was rarely available.

But in female-dominated professions such as nursing, practical considerations and nursing shortages in the ‘70s led to more flexible workplace arrangements. Brenda Field, a theatre and emergency nurse at Footscray Hospital, was involved in one of the more unusual, informal solutions to staff shortages during that era.

On a late November evening in 1970, while Mrs Field was in labour at Footscray Hospital about to give birth to her third child, the hospital’s night shift supervisor walked into the room and asked her a question.

Could she help out by returning to work in January on the night shift in the emergency department? The night shift supervisor desperately needed someone to fill in while the night shift nurse in emergency took annual leave.

The Emergency and Casualty department in 1978.

Western Health archives

Mrs Field was unsure how she could oblige – she was about to give birth and had two young children at home.

“My husband Ivan was a shift worker on the railways and he often worked nights,” she said. “So I asked the supervisor what I should do with my baby and she said, ‘Just bring the baby in with you’. So that’s what I did.

“I’d take her into work in the pram and if I didn’t have time to breastfeed her, the orderly would go and get a bottle of milk from the nursery in special care.”

During the next 10 years, when Mrs Field’s husband was on night shift, the three young Field children accompanied their mother to work and fitted in.

Sometimes the siblings helped their mother wash the suture sets. One night they helped her undress a drunken patient because no one else was available.

But most of the time the Field children slept, tucked into beds in the south room, a small room at the rear of emergency reserved for psychiatric patients or drunks suffering delirium tremens, otherwise known as the DTs.

If the south room was occupied, the Field offspring slept in the children’s ward until their mother finished her shift.

“The south room was a little private room which you could lock,” Mrs Field said. “It was an area where we, as nurses, used to hide patients for the night if we didn’t think a patient was ready to go home but who the doctors had told us to discharge.

“All the staff in the kids’ ward knew my children. The orderlies and the cleaners were wonderful, they all looked after my kids. There’s no way that would happen now. But in those days everyone knew about it and accepted it.”

It was an era when only one nurse and an orderly worked the night shift in emergency. There was no clerk. A junior doctor or resident was on call.

“You learnt very quickly how to assess patients,” Mrs Field said. “ If I had to ring the resident they wouldn’t always come straight away. They’d be asleep in the doctors’ quarters after working all day and being on call all night and they were exhausted. They preferred me to have two or three patients ready for them before making the call.”

The hospital’s surgeons often walked through casualty on their way home, even in the early hours of the morning, just to check if any newly arrived patients needed immediate surgery. Mrs Field remembers one particular night when a young resident rostered on the night shift learnt a valuable lesson.

“Jack Swann, one of the senior surgeons, came in one night on his way home and asked if anyone needed surgery and I told him I thought one of my patients had an appendicitis. He asked me if the resident had seen the patient. I said I’d tried to get him to look at the patient but he wasn’t taking any notice of me.

“So Jack Swann went over to the resident and told him off. I’ll never forget what he said: “In future you listen – if one of the nurses tells you a patient is most likely to have an appendicitis, then they are most likely to have an appendicitis.”

Nurses as cleaners

In that era nurses were expected to clean the instruments, the theatres and the wards as well as care for patients.

Mrs Field remembers tedious hours spent cleaning the metal needles and glass syringes – flushing each needle with soapy water, rinsing it and then cleaning it with methylated spirits.

Nurses cleaned each patient’s bedside table and tidied patient lockers. One of the worst chores involved removing the trolley wheels from the portable screens, cleaning the wheels and reattaching them.

Patient overcrowding was common on night shift in emergency, with people sometimes waiting for six hours before being attended to.

On busy nights drunken, violent patients were especially difficult for Mrs Field and the orderly to control.

“We had a patient who was an alcoholic going through the DTs and threatening to kill us,” she said. “So we put him in a room on the first floor and shackled him to the bed and left him because we had work to do.

“By the time I went back to check on him the bed was empty and the window was open. He’d jumped out of the window. Luckily he landed on a ledge below the window and he’d only fractured a femur.”

It was one of many memorable nights in a career at Footscray that began when Mrs Field graduated from the hospital’s nursing school in 1961 and ended in the mid-1980s.

“It was a fabulous era to work in, we were taught discipline and respect. The charge nurses ruled the wards and you did what you were told, practically without question. They were great days and I’ve remained friends with the people I trained with.”

The Field family’s bond with Footscray Hospital continues. Karen Field, the youngest sibling who once helped her mother wash the suture sets, is a nurse in the emergency department.

The 90s – a more diverse surgical workforce emerges

The overwhelming majority of surgeons in Australia until the early ‘90s were men from Anglo-Saxon backgrounds. From then onward the cultural mix of surgeons broadened as more women and people from non-English speaking backgrounds began to enter medical schools in large numbers.

However, women continue to be severely underrepresented among surgeons. Fifty-two per cent of medical students in Australia and New Zealand in 2013 were female but women make up just 9 per cent of fully qualified surgeons, according to data presented at the Royal Australasian College of Surgeons’ 2015 annual congress. Women account for 28 per cent of people entering surgical training but are at least twice as likely to leave the programs compared with men, either for their own reasons or because they were terminated.

Meron Pitcher, a senior general surgeon at Sunshine Hospital, is one of the first female surgeons to have been employed at Footscray Hospital. She was appointed in 1993 by Trevor Jones, and soon afterwards established the first specialist breast cancer clinic at Sunshine Hospital.

Female surgeons breaking barriers

Dr Pitcher trained as a general surgeon and was accustomed to the male dominated environment of medical school and surgical training in the 70s and 80s.

“I was used to being the token female – when I did my surgical fellowship only about five per cent of surgical fellows were women and many of them moved into ophthalmology,” she said.

“I think I was Footscray Hospital’s first female general surgeon. So I stood out like a sore thumb.

“When I arrived at Footscray I think Susan Thistlethwaite, a plastic surgeon, was the only other female surgeon in the Division of Surgery. But I have to say that the hospital’s surgeons were overwhelmingly supportive towards me.

“Earlier in my career, when I was doing my surgical training in the UK I worked out that there were advantages to being a woman in a predominantly male profession, whether I liked it or not.

“I figured out that women would probably prefer to see a woman about their breast problems rather than a man. Hospitals were starting to develop specialties and centres of excellence so I got a position at the Royal Marsden in London to develop my skills in breast surgery and breast cancer.”

Surgery has never been a family-friendly medical specialty because of its long hours, unpredictable overtime and weekend calls to check on patients. In 2014 women were least likely to be found in training programs for orthopaedic, cardiothoracic, neurosurgery and vascular surgery, according to the data presented at the College’s annual conference.

Dr Pitcher’s mentor and colleague Mr Trevor Jones, said all hospitals were grappling with the problem of how to attract more women into the specialty of surgery.

“Now that the majority of graduates are female, we’re having difficulty recruiting because surgery is not seen to be a specialty attractive to women, particularly those who want to have families,” said Mr Jones, a senior surgeon and the hospital’s former Clinical Services Director for Peri-operative and Critical Care.

“Because of this burgeoning need for junior staff, we’re tapping into the international market to find extra surgeons. But these countries need their own doctors.”

One of the last male bastions

Orthopaedics is one of the most traditional male bastions of the specialties. The demographic profile of surgeons at Footscray’s orthopaedic unit has changed dramatically over the past 25 years. Its head of unit, Phong Tran, hails from a family of Vietnamese refugees. He was two years old when he arrived in Australia with his family in 1978.

At the age of 34 he was appointed head of the hospital’s orthopaedic unit, making him one of the youngest surgeons to lead a surgical unit at a Victorian teaching hospital.

His successful journey as a surgeon is representative of many others from Asian backgrounds whose families arrived in Australia as migrants or refugees during the 70s and 80s. The collective presence of these aspirational families and their offspring has turned medicine into a multicultural profession and broadened its social mix.

“Traditionally ortho-surgicial teams were seen as big footballers with our knuckles dragging on the ground but we’ve changed,” Mr Tran said. “We’re more metrosexual, so to speak. The ethnic mix of people in the unit has changed and there are now more people from ethnic backgrounds in the unit than there are Anglo Australians.”

However, more effort was required to encourage women to consider orthopaedic surgery. This was despite some examples of women who had successfully managed to combine motherhood with their careers in orthopaedic surgery.

“Because the training goes well into your 30s and it’s hard to do part time surgical training, women do not often see it as a viable career option,” Mr Tran said. “That’s a real shame because women offer a different insight on life than we do as men.

“More women need to be encouraged to enter surgery. That’s why we’re trying to nurture the interns and it’s great to see that half of the residents and registrars are female.”

Giving back to the patients

Hai Bui, a senior surgeon, has a similar family background to Mr Tran. He arrived in Australia in 1988 as a 19-year-old refugee from Vietnam. Mr Bui lived in a housing commission flat in Ascot Vale while learning English and attending Maribyrnong High School. He earned an almost perfect score in his Year 12 exam and later graduated from Melbourne University’s medical school.

Hai Bui, an upper gastrointestinal surgeon, arrived in Australia as a 19-year-old refugee in 1988. Mr Bui is holding the ‘UNHCR identification card for Indochinese displaced persons’ that he was given as a young refugee. His background as a young refugee has helped him empathise with many of his patients. His family’s migrant story is typical of numerous surgeons who have chosen to work at Western Health.

David Johns

He is now an upper gastrointestinal surgeon, specialising in laparoscopic gastric and oesophageal surgery. He chose to work at Footscray because of his affinity to the working class backgrounds of many of his patients.

“When I look into my patients’ eyes I see my parents sitting across the table from me,” he said.

“I can relate to the hardships in their lives and I can help them improve their lives.”

Mr Tran chose to work at the hospital for similar reasons. “Part of the reason I love working at the Western (Footscray Hospital) is that you can make a big difference to people’s lives, especially people who aren’t well off and who don’t have private medical insurance,” he said.

“The Western is the best place to work in terms of me giving back to society. Coming to Australia as a refugee and being able to treat refugees and people who are socially disadvantaged is the best thing I can do. I’ve been rewarded well in Australia with my career and it’s important to give back.”