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In 1964, in advance of the initiation of open-heart surgery, a surgery laboratory was opened in the Clinical Research Centre (CRC) — the Tupper was not yet completed — and as a second-year resident, Dr. MacDonald was introduced to the excitement and pitfalls of research and became the first resident in the clinical program.

Also in 1964, a boyhood friend (then a third-year medical student) was admitted with major gastric bleeding secondary to chronic kidney failure. Unfortunately, Halifax did not yet have a dialysis program and Boston’s Peter Bent Brigham Hospital (PBBH) was the only centre in North America still offering kidney transplantation. Though Dr. MacDonald tried to make a case for his friend to receive treatment in Boston, the logistics of transfer were excessively complex, and he passed away in Halifax. This tragedy induced Dr. MacDonald, with the help of Dr. Don Hill, to develop techniques for vascular access which led to the start of a dialysis program. Dr. MacDonald went to see the then Professor of Surgery about starting transplantation in Halifax and arrangements were made for a fellowship in Boston at the conclusion of his surgery training. In 1967 he began a two-year traineeship at the PBBH and Harvard University under the tutelage of Dr. Joseph Murray (a Nobel Prize winner in 1990). By late spring of 1969, a transplantation program was established at the Victoria General Hospital (VGH) in Halifax.

Bringing new ideas to Nova Scotia

In 1966, after hearing a lecture on ‘Treatment of Shock,’ Dr. MacDonald approached the speaker, Dr. Lloyd MacLean, about the possibility of spending a few months with the McGill ‘Shock Team’ in Montreal. The physician team would travel to the bedside of a patient in shock at any of the McGill hospitals, but there were no nurse members. Upon his return to the VGH, Dr. MacDonald approached the Surgery Department to instigate a similar unit with the addition of full-time nursing staff—an intensive care unit. There were none in Canada and only a few in the U.S. so the concept was novel and initially resisted, but it went from novelty to necessity and grew to encompass other specialties and recruit a full-time anaesthetist as director in 1976.

With colleagues, Dr. MacDonald initiated clinical trial programs in both cancer and transplantation, added liver and pancreas transplantation, and developed many of what are now standard drug protocols in the field. With two fellow Cape Bretoners, Dr. Mahmoud Naqvi and Dr. Carl MacDonald, Dr. MacDonald introduced laparoscopic general surgery to eastern

Canada in 1989. They trained their colleagues and changed forever how gall bladder disease, appendicitis, colonic disease and other conditions are treated. Dr. MacDonald’s additional procedural and program developments include total parenteral nutrition, immunotherapy of cancer, H₂ blockers and proton inhibitors in peptic ulcer, anti-gastric reflux operations, surgical treatment of morbid obesity, and percutaneous transhepatic cholangiography.

Stay curious

“The best care anywhere should be the best care everywhere,” shares Dr. MacDonald.

He believes physicians should not only apply this motto in their own practices but encourage this for all of health care, and that important innovations from elsewhere should be rapidly adapted locally. “Persistent curiosity about why things work or don’t work is an essential attribute in physicians and a distinguishing characteristic of those who advance their fields,” says Dr. MacDonald. “Fortunately, today’s medical students seem to have this in abundance.”