Obituary - Professor Alan Clarke

On Sunday 21 January, Alan Clarke died following heart surgery at Christchurch. Alan had a rich life of three careers as Dunedin surgeon, Dean of the Christchurch School of Medicine, then crusader for the Burwood Spinal Injuries Unit. He was farewelled by his close friend the Rev Bruce Hansen at a packed Knox Church in Merivale, Christchurch.

Alan was born in New Plymouth on 12 December 1932 where his father John Maxwell (Marcus) Clarke practised as a general surgeon. His mother had been a theatre nurse. When Marcus went to war Alan’s mother took the young family to her brother’s Manawatu farm. His uncle taught him the usual rural childhood skills like milking, animal care, shooting, and so forth, engendering a lifelong love of rural life and the countryside. At the local sole teacher primary school an early interest in science was strongly encouraged. He dreamed to fly because the farm was close enough for Alan to bike to and gaze at the Ohakea military planes.

His father returned after six years abroad. Alan's memories were of someone who suddenly turned up from nowhere and told him what to do. The family moved to Auckland where Alan went to King's College where, through the Air Training Corps, he was awarded a two-year RNZAF flying scholarship. Father with stern good sense insisted that he apply himself to becoming a doctor and ruled out flying. Medical intermediate was at Auckland University. The next years as a medical student were at Knox College in Dunedin, graduating MBChB in 1956. On the way he picked up three academic awards and Otago and New Zealand University Blues for athletics. He was 1956 Australasian champion hammer thrower but more importantly in that year he became engaged to arts student Jane Malloch of Waikouiti who was to be his constant companion and support for the rest of his life. He met Jane through the Student Christian Movement.

He followed his father by choosing surgery as his specialty. Initial post-graduate training including neurosurgery was in Auckland and Dunedin. Later he and Jane travelled to Britain. On route he achieved fame through an emergency craniotomy to relieve a crew member's subdural haematoma with instruments hastily made by ship's artificers. At Glasgow's Western Infirmary he trained under Sir Charles Illingworth.  Alan abhorred the bullying style and had frequent occasion to address the contempt of junior staff shown by seniors. His FRACS followed in 1961 and he practiced general and vascular surgery in Dunedin as Senior Lecturer in Surgery. In 1970 he was appointed Ralph Barnett Chair of Surgery. He researched intestinal absorption, liver regeneration and peptic ulcers. He developed a keen interest in research funding and administration regionally and nationally. 

According to Knox College roommate David Stewart, Alan emerged with Robin Irvine, John Hunter, and Tom O’Donnell as the "Four Young Turks" of the School of Medicine which at the time was experiencing a severe crisis of chronic under-resourcing. This group lobbied long, hard and successfully for a major review of the School. The resulting Christie Report proposed staff and curriculum restructuring and foreshadowed the establishment of the two clinical schools at Christchurch and Wellington (Clarke and O'Donnell later became Deans of these schools, respectively). Alan, in particular, was developing and espousing forward looking curriculum ideas.

In 1979 Alan was diagnosed with bladder cancer and underwent intensive radiotherapy then major surgery, followed by severe complications. His recovery was uncertain but for his determination. The episode reminded him of life's caprices so he promptly fulfilled his early dream by gaining his private pilot licence and his own light aeroplane. He was troubled by the inconsistency of cancer treatment throughout New Zealand, leading to the far-reaching document "Cancer Consensus Manual" in 1984.

His Dunedin experience had prepared him for Deanship at Christchurch School of Medicine in 1986, a post he held for 8 years of challenges. Course lectures were poorly attended yet students achieved well in exams. This supported his notion of a decade earlier that the lecture course had more tradition than value. He tackled this head-on, advocating abolition of lectures. He could see the benefits in self-directed learning in small groups within clinical situations in wards and beyond. This radical change required the courage to outflank traditionalists, and gain support of liberal colleagues and the confidence of apprehensive students.  It was all fuelled by Alan's immense energy.

These were the turbulent times of the health reforms and the re-forging of relationships between universities and new crown health enterprises. He described his task as "educating" each of the new and often short lived managers. Equally the University sector was being restructured. Through all of this he remained a cheerful advocate for his staff, students and researchers. He fostered close links with the Canterbury Medical Research Foundation and other research funding bodies. He and work colleagues and others commuted to and from Dunedin in his aeroplane, Cessna ZK-EXE.

He found time to drive and edit the a multi author book "Understanding Cancer" aimed to help folk to cope with their disease. As a practical man he was a painter, both in the artistic and house maintenance senses. He continued his interests in family, ornithology, poetry and church.

In 1991 he fell from his porch roof. He suffered a paralysing spinal injury. As a result of this experience he expressed vehement dislike of clinical practices which excluded the patient from the therapeutic team. He objected to the impersonal nature and the lack of privacy of the ward rounds. Typically he demanded their abolition.

Now seated in a wheelchair he returned - in record time, according to Allan Bean - to his role as Dean.  His new trick was 'wheelies' - precariously balancing his wheelchair on only its two big wheels for many minutes at a time. He became despondent about his plane which required operation of throttle, rudder pedals and the wheel. Old friend Tim Wallis told him not to be silly, and together they imported a simple T-bar connecting his wrist to the pedals. Alan was aloft, happily commuting as before. 

His contributions to medicine were recognized publicly in 1995 when he was bestowed Companion of the Most Excellent Order of St Michael and St George.

Never one to rest, he moved straight from Dean to Director of the Spinal Injuries Unit in 1994. He was an avid advocate for patients to manage their treatment and rehabilitation with doctors as advisors. He encouraged patients to understand their own condition. Of course this required that they were self directed and motivated, traits not shared by all. His infectious energy and motivation meant that he could never accept the status quo. He vigorously changed the external environment of the Spinal Unit to positively foster rehabilitation. Among his efforts was planting, with a Polish forester, a Robinia nursery at Burwood to occupy clients and provide future funds for the Unit. 

Alan's new specialty was perceived as lack-lustre so he set about raising its profile to attract proper attention and funding. An early outcome was the Burwood Spinal Trust which evolved to the New Zealand Spinal Trust as a firm foundation for spinal research by professional researchers and by patients.  He conceived, raised $1m for, and set up the Allan Bean Centre for Research and Learning with a major emphasis on the provision of knowledge on spinal injuries. Alan never shirked at inveigling others to freely contribute their skills to the Unit.

As if this was not sufficient he then set up the Burwood Academy of Independent Living to fund and encourage the wider aspects of rehabilitation regardless of cause, be it physical, psychological or circumstantial. His latest task was a garden and playground at the Academy. Approval has been obtained for construction to commence in February.

Alan described himself as a 'surgical consumer and survivor'.  He was characterized by good humour, a keen sense of fairness for all, and the ability to be seized by a passion. He had not only energy to see these passions realised but also the facility to enthuse and harness the expertise and energy of others. He was a keen family man, who enjoyed his family’s support in return. Alan Maxwell Clarke’s outlook on life is epitomized in the last paragraph of his CV. 'In December 1991, eight months after my accident, an old lady said to me "At your age you are very lucky to become a paraplegic - you can start your life all over again."'

Alan Maxwell Clarke (1932-2007), CMG (1996), MBChB (Otago 1956), ChM (Otago 1969), FRACS (1961).  Survived by his wife Jane, sons Richard, John and Alistair and daughter Fiona.

Prepared at the request of Jane Clarke by Alan's colleague as Academic Secretary at the Christchurch School of Medicine, Max Abernethy. Acknowledgements to Jane Clarke, David Stewart, Jim Clayton, Bruce Hansen, Allan Bean, Andrew Hall and many others.

References

Cancer Consensus Manual (incomplete)
Understanding Cancer
A Vision Realised: Christchurch School of Medicine, University Otago 1972-1997.
C Moore, G Rolleston, J Riminton and A Hornblow.