Montréal, Quebec, Thursday, November 29, 2012

It is an honour to be asked to give the Edith Aston-McCrimmon lecture and a special pleasure to have her family here today.

When I think of a life worth living, I think of Edith. She would have been fourteen when I was born. Fourteen years is a significant age gap. She could have been my babysitter.

The McGill School of Physiotherapy was born in response to the physical and psychological needs of injured soldiers as a result of the Second World War. Edith’s longstanding commitment to the growth of rehabilitation science was no doubt influenced by the sober aftermath of this war.

Two decades after this war ended, we entered a radically different social climate: the sixties. The civil rights movement and President Kennedy’s call to bring disabled people out of institutions and back into the community created a heady, “we can do anything” young society.

It was in this era that I began my studies in physical and occupational therapy in the combined diploma course called POTS.

Let me begin by describing the remarkable evolution of our profession over the past century and how my life was tied to its success.

In the sixties, there was an emphasis on freedom and fairness, which impacted on rehabilitation science. Town planners, architects, government officials and rehabilitation experts consulted physical and occupational therapists as to how they should adapt the workplace for the disabled.

Rehabilitation services began moving from large institutions into the community. This was particularly important for occupational therapy.

In 1971, Dr. John Bockoven wrote in the American Journal of Occupational Therapy: “It would be unfortunate if occupational therapy were to limit itself by continuing to be satisfied with running dinky little side shows in large mental institutions.”

Although these are unkind words, Dr. Bockoven was trying to move occupational therapists away from arts and crafts and to broaden their treatment mandate. Professional independence born of respect became embedded in rehabilitation practices and the precursor to the community-based services we see today.

The freedom and fairness ethic also questioned the way children were being treated. Although it took many decades, children were now being diagnosed with learning disorders rather than being labeled badly behaved.

This was an enormous step in adapting schools and curricula to bring out the best in every child. Special schools were being closed and disabled children were moving into regular schools. During this period, I worked as an occupational therapist at The Crippled Children’s Centre (now Holland Bloorview) and later in Kingston in a psychiatric facility for children.

The seventies also led to collaboration between therapists and engineers when thalidomide, the drug that relieved pregnant mothers of nausea but robbed their babies of limbs, spearheaded an advance in prosthetics. Our present-day advancement in prosthetics is exemplified by runner Pistorius’s flex foot cheetah blade or prosthetic foot. Soldiers with amputations are skiing, playing soccer and engaging in all manner of sports in light, flexible, manufactured limbs.

I’m sure some of you have volunteered for Soldier On, a wonderful program of sports re-adaptation.

It is now, as it was in my day, exciting to be a physical or occupational therapist. 

Let me speak personally now. Although armed with a POTS diploma and the enthusiasm of my generation, my working life, unlike Edith’s, was cut short due to the fast-track reproduction course that ended with a fifth daughter born in London, Ontario.

By the age of thirty-four, I had five daughters less than seven years of age. Three were in diapers. David was the dean of Western’s Faculty of Law and fully engaged in his career. At times, I would look out my kitchen window at the clothesline and wonder what on earth I was going to do.

My stark reality was that I felt exhausted. I recognized that if I didn’t partner with my family doctor to find ways to improve my health, I was not going to leave the house.

My doctor put me on a health regime that ended with me running 8 km six days a week. Some days I’d pass through his office, give him a hug and just keep on going. In a sense, I had to administer my own rehabilitation.

It was serendipity, at that time, that Western University opened a degree program for diploma-holding physiotherapists. As a now mature student, I was thrilled to be back in the rehabilitation world that was again striking new ground.

Studies on the effects of the negative heel on back pain, rehabilitation clinics for executives after having a heart attack, and the oxygen costs of limping were areas of research for physical and occupational therapists as they forged through the seventies.

In 1979, our family moved from London to Montréal, where David became principal of McGill. Wellness became our family mantra and before long, the Johnston family was running on the McGill campus. During a Terry Fox Run, our two youngest were photographed running in their bare feet.

Our daughters were all under eleven years of age when they arrived in Montréal. They didn’t speak a word of French. I made them cue cards to get to the washroom. Three of the girls had to repeat their school year in order to reach an acceptable level of French to keep up with the other students. As a consequence of growing up in Montréal, they now speak several languages beyond English and French.

My family life was highly charged after we arrived in Montréal. Yet I didn’t want to abandon my life in the rehabilitation field, having obtained my bachelor of science. Part-time jobs were not readily available and full-time work seemed difficult with a large family. Pursuing an academic program had proved more flexible than working.

It was a second serendipity that I could enter the newly minted Applied Masters in Rehabilitation Science. For this degree, I worked with Dr. Malcolm King on his research in High Frequency Chest Wall Oscillation or HFCWO.

This research addressed the fact that chest wall percussion (tipping and clapping) used by physical therapists was not effective in clearing the small airways of mucus.

The high frequency experiments required the collaboration of researchers within and outside of the school. Imaging facilities at the Montreal General Hospital were available to us in the evening. Using these external resources provided an effective means of advancing rehabilitation science.

Before using high frequency on patients, we tested the apparatus on heavy (three-pack-a-day) smokers. I used my husband as a non-smoking control. To do this, he had to submit to oscillation wearing a dirty, dog-smelling chest wall vest.

High frequency is now commonly used for mucus clearance in cystic fibrosis. Today, the chest wall jacket looks more like a fashion statement than a dog jacket.

Interdisciplinary studies are not new to rehabilitation. For my doctorate, I examined the coordination of respiratory muscles during normal and stuttered speech.

The research was carried out at the Meakins-Christie laboratories and resulted in three published papers and a strain on my family.

Used as controls, they all had to swallow esophageal and gastric balloons to measure pressure across the diaphragm. “A little shot of xilocaine and a sip of water. It’s easy,” I’d say.

With my doctorate finished, the question arose as to what I would do next. In 1998, Dr. Robert Zatorre at the Montréal Neurological Institute began imaging studies comparing brain activity in musicians, Mandarin speakers and stutterers.

A post-doc in this area was enticing. But I decided to pursue what I had wanted to do for decades: write fiction. This took me into another academic domain, Humber College’s Creative Writing Program.

A year after making this decision, we uprooted ourselves again when David was appointed president of the University of Waterloo, where we relocated to a hundred-acre farm in the heart of Mennonite country.  We were surrounded by “horse and buggy” neighbours, and I began a new career owning and managing a stable with thirty-nine horses. I had never touched a horse until I ended up on a farm in Waterloo.

This might seem a light year away from rehabilitation science, but horses are in constant need of rehabilitation. It is not farfetched to say my knowledge of physical and occupational therapy saved my bacon.

So let me end by bringing my life to the present day. This POTS grad is indeed married to the GG. I don’t know whether to be ashamed or proud to admit that David and I are slightly older than the boomer generation.

But against this admission I might confess that we bicycled over two thousand kilometres this summer. The boomer population, like us, has high expectations of life expectancy and lifestyle satisfaction.

In considering community- and home-based medicine, it is more beneficial to work upstream by promoting good health in people rather than working after the fact to treat their disease.

This is a great opportunity for physical and occupational therapists to support proactive physical and mental wellness in the people they treat by making their homes and lifestyle something that can maximize the way they live.

This is especially vital for our growing older population. Such an approach keeps people out of institutions. We just closed many institutions. Let’s not open them up again. 

The Governor General’s Office can be a powerful force. During the next three years, David and I hope to spotlight the way our society is recognizing and treating mental illness and promoting mental health.

We all know that the face of mental illness ended up on the street when institutions closed their doors once patients could be medicated. However, there was one important element missing. Without a caring family, the most vulnerable of those released to the community became homeless.

David speaks publicly about Canada as a smart and caring nation or people with keen minds and kind hearts. There is a great need in approaches to mental health for smart or innovative interventions supported by caring professionals, volunteers and families.

Rehabilitation professionals such as you work in hospitals, clinics, schools, public residences and private homes. My hope is that in your well-educated capacity, you will always be alert to the mental well-being of your patients. You can be the first link towards getting professional help beyond your rehabilitation services.

Necessity is the mother of invention. I reinvented myself many times, taking advantage of the advances in rehabilitation science over the last four decades.

It never occurred to me as I rolled up my sleeves to oscillate chest walls or make people swallow balloons that I would end up in public life. Nor did I anticipate running a hundred-acre farm. But with each new opportunity, I grew as a person and had a great deal of fun along the way.

I would like to wish you the best in your careers. Whether you are a seasoned therapist or just starting out, never stop learning and adapting to the changing health care world. And make sure as you pass through life’s opportunities that you have fun. 

Thank you so much for inviting me here today.