Stephen Kimber

IWK was written a series of alternating chapters, with a chronological chapter on the history of the institution followed by a “case study” chapter about a medical case from the hospital’s history. To give you the flavour of the book, I’m including two chapters: one on Sarah Baker, a young woman with meningococcal septicaemia, and the second focuses on the intriguing, unlikely back story of how philanthropist Dorothy Killam came to make the children’s hospital named after her late husband a reality.

Case Study
“Those little things mattered so much”

Sarah Baker’s tummy was doing flips. She felt like she was going to throw up. Again. Perhaps it was something she’d eaten, or maybe she was just paying the price for too much fresh air and excitement. Sarah and some friends from Fairview Junior High School had spent the afternoon at a farm near Halifax enjoying one last, late winter sleigh ride through the snow-covered forest.

San Diego seemed like a dream! The youngest of four daughters of Charles and Olga Baker, Sarah had spent her early years in sunny California. But then her parents split up, and Sarah and her sister Jo returned to her Halifax birthplace with their mother. Olga had recently married a naval officer named Dick Neal and they’d all settled into a new condo in Clayton Park on the edge of the Halifax peninsula.

Though Sarah was at that awkward teen age—fourteen-going-on-fifteen—she had adjusted well, thanks in no small measure to a bubbly, outgoing personality and, of course, to her passion for sports. Field hockey, volleyball, basketball… name the sport.

But tonight, all she wanted was to crawl into bed.

Babysitting! She’d almost forgotten. She’d agreed to take on a babysitting job tonight.

“Jo,” she asked her sister. “Could you do it for me?”

Sarah was still throwing up a few hours later when her mother returned home after an evening of bridge with friends. Olga wasn’t especially concerned about Sarah’s stomach bug; they were common enough, but she was careful to remind her daughter about keeping her blood-sugar levels in balance. Not that she had anything to worry about, Olga knew. Sarah was just seven when she was diagnosed with diabetes. She had learned how to inject needles into oranges as a prelude to administering insulin to herself.

Olga did the “mother-comfort-thing,” and then they both went to bed.

***

Anxiously, Olga dialed her sister’s number. Her sister was a nurse; she would know what to do.

It was shortly before seven the next morning, and Olga had woken up to find her youngest child, passed out, on the bathroom floor.

Her first thought was that Sarah must be in a diabetic coma. A little orange juice and she’d be fine, Olga told herself, trying to calm her own rapidly rising anxiety. She tried to lift Sarah from the floor, but she was limp, lifeless.

Call the ambulance, her sister told her, I’ll be right over.

It would be OK. A little orange juice and it would be all OK.

***

Eleanor Lindsay was happy for the break; perhaps she would finally get to catch up on all that paperwork. There were only two patients in her intensive care unit this morning. On typical days, there were from four to six; on bad days, all nine beds might be occupied.

Even the call from the nurse in the emergency department at around 9 a.m. this morning seemed routine. They’d just admitted an unstable diabetic, the nurse told her, and wanted to alert ICU to be ready. Just in case. Lindsay figured the girl would likely end up being stabilized in the ER and sent home to recover. Of course, the doctor might decide to admit the girl to the ICU and keep her for observation for 24 hours. Lindsay assigned one of her nurses to prepare a bed. And went back to her paperwork.

Then, all of a sudden, the phones began to ring. All of them. All at once.

The doctor from ER. Urgently letting his ICU counterpart know what was heading his way. And a nurse from ER, calling to tell Lindsay she’d better prepare an isolation bed. Now!

Sarah Baker was not in a diabetic coma. She was suffering from meningococcal septicemia, a voraciously infectious, swift-moving and deadly disease.

The problem with meningococcal septicemia is that—initially, at least—it isn’t easy to diagnose. Fever, vomiting, headache, cold hands and feet, fatigue, perhaps even convulsions. Those could be signs of any one of dozens of ailments.

But then the meningococcal bacteria, having stealthily wormed their way into the patient’s bloodstream, begin multiplying geometrically, uncontrollably, smashing through the walls of the victim’s blood vessels and causing bleeding into the skin. As soon as the patient breaks out in that distinctive bluish-purple blood-rash all over her arms and legs, the diagnosis is—suddenly—obvious.

Meningococcal septicemia victims are often “well at breakfast—and dead by dinner.” Ten per cent will die, most within hours. One in five ends up with some form of permanent damage—from vision problems to kidney or liver failure, to the loss of toes or fingers, sometimes arms or legs.

Worse, the meningococcus organism is highly contagious. Which explains why the doctors needed to get Sarah out of the far-too-public emergency ward into a controlled, isolated environment immediately.

Within minutes—even before Eleanor Lindsay’s team of nurses had finished readying an isolation room—the third-floor elevator doors slid open and a gaggle of masked doctors and nurses emerged, some pushing IV poles, others carrying charts, all surrounding a rolling trolley. Inside their circle, Eleanor Lindsay caught a glimpse of her new patient. “She was this desperate looking girl who had already erupted in these black spots,” she would remember years later.

***

“Perhaps,” the doctor suggested to Olga as gently as he could, “you might want to contact Sarah’s father and tell him the situation, ask him if he wants to be here too.” Sarah could die.

It was shortly after 6 p.m. on the night of March 6, 1975, about twenty four hours after Sarah had arrived at the IWK’s emergency room, and the day had seemed to tumble from bad to worse to… worst.

Bruce Morton, Sarah’s pediatrician who happened to be in the hospital that morning, had given Olga the initial diagnosis of meningococcal septicemia. Olga had known him since their undergraduate days together at Acadia University. Even there, Bruce’s career path had been so clear other students would refer to him as “Doc.” His mere presence seemed calming, reassuring. He hadn’t understated the risks, but he made them seem manageable. “The worry,” he told her, “is her circulation.”

That, it turned out, was but one of many worries.

By mid-afternoon, Sarah’s condition had worsened. So many things that could go wrong had gone wrong that the ICU doctors had assembled—not once but twice—an in-house group of experts in the unit’s small case room to discuss what to do next. She was, Richard Goldbloom would say later, “about as sick as a child could get.”

***

Why not?… What do you think? What if?… What about?… John Donaldson was far from the only member of the IWK’s medical staff desperately seeking the magic bullet that might save young Sarah Baker. In part, of course, it was simply the unusualness of her case that piqued so much professional interest. But there was also the human reality. Just a few days before, Sarah had been a beautiful, healthy, coltish teenager, full of life and love and vitality. And then, suddenly, out of nowhere and for what seemed like no reason…

Surely, there must be something they could do.

John Donaldson was convinced there was. He was the new resident, a brash young ear, nose and throat specialist. Officially, he had no role in Sarah’s case, but that didn’t stop him from thinking about how to save her. In his previous career in the Royal Canadian Navy, Donaldson had spent time as a flight surgeon at CFB Shearwater in Dartmouth, where he’d served as the medical officer for the Fleet Diving Unit Atlantic and its small diving tender, the Granby.

That experience prompted Donaldson to suggest to Phil Bagnell, a young gastroenterologist who had become one of the consultants to the pediatrician-in-charge of Sarah’s case, they call in the navy.

The Granby’s six-person recompression chamber—designed to allow navy divers to recover from the “bends”—had occasionally been used to treat adult hospital patients, Donaldson explained. Those patients were suffering from a variety of ailments, including gas gangrene, another potentially lethal bacterial infection that can produce gas bubbles in gangrenous tissue.

Sarah had been diagnosed with extreme vasculitis of her lower extremities. Her blood vessels had become inflamed, making it difficult to get enough blood to her tissues and organs. Since she was failing to respond to conventional therapy, Donaldson suggested, why not try her in the Granby’s recompression chamber? Placing her in the chamber would enable the doctors to deliver more oxygen to her dying tissues and perhaps, save her arms and legs.

Donaldson’s navy contacts were eager to help. They told him they would do whatever they could. But… The Granby’s recompression chamber was too big and permanently nailed down to transport to the hospital. If Donaldson could bring Sarah there… Sarah was far too sick to risk transporting her to the chamber.

That they wouldn’t be able to use the recompression chamber was devastating for her doctors and nurses. And sobering. Finally, just before seven o’clock at the day’s last case conference, one of the doctors dared to raise the issue that had hovered, silently, dangerously, at the edge of all of their conversations from the beginning.

“You know, folks,” he said finally, “we have to step back and ask ourselves what we’re doing here. She’s a beautiful girl, and she’s losing all her limbs. Is there a point? Do we want to go any further?”

There was an awkward, uncomfortable silence. It was a legitimate question. A question without an answer.

***

“Oh my goodness!” Eleanor Lindsay was horrified. “Not another disaster…” As she arrived at the hospital for her shift the next morning, she couldn’t help but notice the dozens of police officers and firefighters hovering around the entrance to the building. “My first thought was that there must have been a fire overnight. I was thinking, ‘Now, I’ll have to figure out how to cope with this on top of the girl—‘“

If, that is, the girl had even survived the night…

Lindsay had left the hospital the night before, “feeling shattered and very sad. I knew it was highly unlikely I would see this girl when I arrived in the morning.”

But as she got closer to the hospital entrance this morning, Lindsay began to notice green uniforms among the those of the police officers and firefighters.

The navy!!

During the night, some can-do officials in the military had managed to find a flatbed truck capable of ferrying the recompression chamber across the harbour bridge, discovered a generator powerful enough to operate its compressors and then convinced officials at the Halifax-Dartmouth Bridge Commission to shut down one of the city’s two bridges long enough to allow the bulky, awkward, overloaded, police-escorted caravan safe passage across the harbour span from the base to the IWK.

But getting the unit to the hospital was only one of the hurdles. The decompression unit’s compressors needed water—and lots of it—in order to operate. So John Donaldson called the Halifax Fire Department. “I explained our problem to a series of firemen who all wanted to help. Remember,” he adds, “it was winter and freezing).” By the time the recompression unit, still on its flatbed, sat squat in the middle of the hospital’s emergency room parking lot, firemen were scrambling over the roof of the hospital running hoses to bring water to it. But the fire department’s hoses couldn’t connect with the navy’s hoses. “HFD and navy ingenuity solved these problems with a series of connectors and pressure adjustments well beyond my surgical mind,” Donaldson would joke years later.

And they still weren’t done. Getting the unit to work mechanically was merely a prelude to the larger task of getting Sarah into it.

***

“Uh, excuse me,” John Donaldson began awkwardly, knowing he’d woken up yet another nurse. “Are you having your period?…” It wasn’t the smoothest opening line, he knew—“’perv’ of the month, if not the year” came to mind, he says—but Donaldson didn’t have words to waste on pleasantries. “No? Great! Can you come into work right away?”

Donaldson knew they would need plenty of volunteer pediatric residents and ICU nurses to accompany Sarah inside and outside the chamber. The plan would be to bring Sarah, who was still in a coma, into the chamber for treatments once every eight hours for twenty minutes. During each “dive,” she would have to be accompanied inside by a doctor and a nurse with another doctor-nurse team on standby outside the chamber, ready to go in immediately if Sarah suffered a cardiac or pulmonary arrest.

None of the doctors or nurses who volunteered to go inside the chamber—and there turned out to be plenty—could be allowed to do very many dives because of the potential effects of “repetitive diving” on their bodies. And not everyone willing to volunteer made a good candidate. Pregnant women, women having their periods, anyone with asthma or lung troubles, even those who’d had root canals all had to be crossed off the list in case the pressure changes in the chamber created air emboli that could go to their brains.

“The poor nurses,” Elinor Lindsay remembers. “None of them had a private detail to their names that day.”

When she wasn’t recruiting nurses—like Donaldson, Lindsay was often greeted with a, “Have you gone off your rocker?” when she started her question checklist—Lindsay was on the phone to other hospitals’ supply rooms. Sarah still had multiple intravenous lines running into her body. All were attached to glass bottles. The glass would have shattered inside the pressurized chamber. Few hospitals were using plastic bottles. The IWK wasn’t. “Do you have any plastic IV bottles?” Lindsay would ask. If the answer was yes, her immediate response: “Send us everything you’ve got. Now!”

***

Although he wasn’t on the case, John Donaldson offered to do the first dive. “I was able to devote full time to this project without anyone noticing,” he explains today, because Arthur Shane, who was head of the ENT department at the time, gave him permission to disappear. “He just growled, ‘Do what you need to do… Call me if anyone gets in the way.’”

The first dive went, “as expected. There were lots of glitches to solve.” For starters, the chamber was still sitting outside in the frosty late winter air. “We froze our asses off,” Donaldson recalls.

Someone found someone—everyone in the city, it seemed, was eager to help—to install the chamber inside the ambulance garage. But that didn’t make it easier for support services, like members of the dive unit, who still had to remain outside the building during the dives.

Each dive, in fact, was a team effort. Crews from the hospital’s maintenance department would carry Sarah to the chamber with all of her equipment and supplies. Members of the dive unit assisted her in and out of the chamber, and waited outside in case they were needed. Everyone—doctors, nurses, lab technicians, cleaning staff, cafeteria servers in the laundry room workers, even other patients’ families—took a proprietary interest in Sarah’s well-being.

“I still remember some of the hard-ass chiefs and petty officers [on the dive team] making calls to ‘contacts’ in the dockyard to get something they needed,” Donaldson says. “Every day they wanted to know how ‘their patient’ was doing, and each of them had a tear in their eye from time to time… But then we all did.”

***

She opened her eyes? Where was she? And what was with all the water? She was in a submarine, obviously, being taken down under the sea. But why?

There was her dad staring in at her through the window. He was smiling. How did he get here? He was supposed to be home in San Diego? Had he swum all the way from San Diego just to see her?

She tried to remember where she was, how she’d gotten here. The last thing she remembered—but only vaguely—was just after the ambulance arrived. She could remember the attendants. They’d carefully put her on a stretcher and then had to struggle to carry her down the staircase at her mother’s house.

But what had happened after that? How had she gotten here? And where was here?

Suddenly, she was out of her strange water world and into an even stranger world of unfamiliar faces and uniforms. Strangers. Then she saw her dad! He was still smiling. But his hair was dry! How could his hair be dry? He’d been swimming under the water to see her… He had, hadn’t he?

***

The end came suddenly, and not in the way anyone had predicted, or hoped, or even considered. Sarah had seemed to be responding well to the recompression treatments, but then she began to menstruate, and the doctors were faced with the choice that was no choice. “Could we have saved her legs if we’d been able to treat her longer?” Eleanor Lindsay asks rhetorically. “Maybe. But there was no issue there. We could have lost her completely if we’d gone ahead. So it was the lesser of two evils to stop treatment.”

“The first thing I heard was a couple of toes,” Olga remembers. “She might lose a couple of toes. I thought, ‘what a shame?’ And then it was more toes, and then a foot, and…” The doctors now informed her that the best, perhaps only way to save Sarah’s life was to cut off parts of both legs.

Olga Neal couldn’t help where her mind led her. Her daughter was just fifteen. Girls that age are especially sensitive about how they look. And how would she look with two missing legs? How will she cope, Olga Neal asked herself? How will she cope?

She must put those thoughts out of her mind, she told herself. She pushed open the door to her daughter’s hospital room, smiled at the sight of her. She would have to tell her the truth.

***

“Gidday there,” Sarah Baker-Horne begins a cheerful, upbeat email from down under. These days, she lives in Ahaura, a small town on the west coast of New Zealand, with her husband Ian and their two teenaged sons, “tall, strong beautiful young men.” When she isn’t mending fences on their hobby farm, Sarah works at her local school, in the library and as a teacher’s aide, helping children having trouble learning to read. In her spare time, she paints watercolours. “I love nothing more than finding a spot, usually my kitchen table and trying to create a beautiful painting.”

She may now be nearly thirty-five years and a world removed from the events of 1975 that changed her life forever, but she keeps the memories close at hand. “As I write,” she notes, “on my wall is a certificate from the Diving Unit noting my success going down to a depth of sixty-six feet. It’s dated 15 April 1975… Though being treated with the chamber didn’t, in the end, save my legs, it did save my life and I will be forever grateful to those involved.”

Her road to recovery was long and bumpy. After the initial operation to amputate parts of her lower legs, Sarah spent five weeks in the IWK. There was another operation, more recovery time and rehab time.

Surprisingly, Sarah’s most vivid memories of her time in the hospital are positive ones. Soon after the first operation, while she was still in the ICU and the doctors were in the middle of making “really difficult decisions about circulation in my feet,” Eleanor Lindsay broke a few hospital rules so Sarah’s sister Jo could make Mexican tacos to celebrate her fifteenth birthday. “I’ll never forget that taste, or how wonderful it felt to be doing something so normal in such a unique environment. Thank you Eleanor!”

She remembers the time one of her sisters visited “with a hickey on her neck,” and a nurse covering it with a bandage so the visiting doctor wouldn’t see. “We just thought it was hilarious.… Who would’ve thought that the IWK was a place where humour was rife? There was still much to be enjoyed and, serious as the situation was, there was humour, and hope.”

And time. “I have memories of my hair being totally matted at the back and of a lovely nurse taking the time to wash it and then spend hours getting rid of the tangles. Those little things, they mattered so much.” Like John Donaldson, the doctor who wasn’t even supposed to be treating her, “coming in and playing chess with me. There was no rush, he just allowed me to voice my fears and reassured me that all would be okay, in time.”

She needed that. “I also have memories of blood red bandages being soaked off in a bath, and tears and tears flowing. This was the first time I had seen my amputated limbs. I was held close and allowed to cry, probably even encouraged to cry.”

How did she end up living in New Zealand? That story too begins at the IWK. “During my rehabilitation, a physio by the name of Wendy Oliver took me under her wing and introduced me to Coach Doug Wright and sport for the disabled. She took me down to the gym where the Nova Scotia Flying Wheels wheelchair basketball team was practicing… I was always an athlete, and just because I’d lost my legs didn’t mean that this side of my life needed to end. I spent many years involved with sport for the disabled, and was able to travel all over Canada, to Europe, to parts of North and South America. It became a huge part of my rehabilitation as well as my social life.

“Travel became a joyous part of my life and led to me heading to New Zealand to experience life here with another sister Libby. As a result of my travels, I met and fell in love with my future husband, Ian Horner. I had two gorgeous children, Sam and Bevan. I worked in a tearoom, skied New Zealand mountains, worked in schools, became an artist, farmed, owned our own business… and even lived through breast cancer.

“Life is full of surprises. You learn so much from life’s experiences. My experience in losing my legs, dealing with loss and knowing that life is good, and worth fighting for, made me a perfect candidate to deal with breast cancer as well.”

Today, she says, “I think I’m right smack dab in the middle of life’s next challenge, having two big ol’ teenage sons who think they know it all. I need all the resources I can put my hands on to handle this challenge.”

_________________

“Why should I say yes to this?”

“Such a handsome man…” she said. Bill Cochrane couldn’t help but agree. Even if he had disagreed, which he didn’t, he probably would have agreed anyway. The man being referred to, after all, was Izaak Walton Killam, or at least a full-length portrait of the late financier, and the woman admiring his image was his wife Dorothy.

Cochrane, John Plow and Les Single, a partner with Duffus, Romans, Kundzins, Rounsefell, the Halifax architecture firm the Board had hired to design its new hospital, had come to Killam’s luxurious New York apartment at 120 East End Avenue on this American Thanksgiving Day to meet face-to-face with Dorothy Killam. Their goal: to convince this childless widow the memorial she really wanted to build for her late husband (a man who had said he didn’t want buildings built in his honour) was a children’s hospital in a part of Nova Scotia where he’d spent little time and she had passed almost none.

They figured they had about an hour.

It was, concedes, Single, “very nerve-wracking.”

Dorothy, whom Cochrane remembers as “extremely thin and pale” after hip surgery, met them at the door, seated in a wheelchair and attended by a butler who pushed her wherever she wanted to go. To Cochrane, Dorothy initially seemed a “somewhat formal, direct, businesslike lady who controlled the conversation to a large extent.” But the more she talked—and listened—the friendlier she seemed.

Midway through their pitch, however, she suddenly turned to Cochrane and asked him to follow her—instructing the butler to wheel her into another room. There, they had admired the portrait of her late husband. The painter, she said, had captured Izaak very well. Cochrane couldn’t help noticing Killam’s “rather cold, piercing eyes.”

Though he’d never heard of Dorothy before yesterday, Bill Cochrane certainly knew the outlines of Izaak Walton Killam’s life. Born in modest circumstances in Yarmouth in 1885, Killam had parlayed a banking apprenticeship and a stock-broking position at Royal Securities into a hugely successful career as a financier—buying, merging and building companies into massive profit-generating businesses. The other thing Cochrane knew about Killam was just how little anyone really knew about him.

“He never liked making speeches, never liked the limelight, even hated having his picture taken,” his biographer, Douglas How , would report many years later. “For years he would be known as the ‘mystery man of Canadian finance,’ an enigmatic figure, a man with reputation for being secretive, cold, tough, brilliant but primarily unknown.”

Killam’s only real obsession appeared to be making money. When he died in 1955, he left an estate valued at eighty three million dollars.

But as for the rest of his life? In 1933, Maclean’s magazine wrote that Killam “sometimes goes to a hockey game and now and then to the theatre, at both of which he displayed all the enthusiastic interest of a blind man in an art gallery.” He rarely smiled. In 1927, the Toronto Star reported at one raucous party where people were telling jokes, “a young lady seated next to the financier turned to see him sitting silent and unmoved. Half a dozen wisecracks received their applause and then, as one bright effort put the group in a state of collapse, she remarked gently, ‘Mr. Killam, if you don’t smile, I’m going to scream.’ Even then,” the reporter wrote, “he didn’t smile.”

All of which made his choice of a bride a tantalizing, gossip-worthy puzzle. Or perhaps not. In later years, Dorothy would tell people she had decided, on the very night she was introduced to a “tall man with the eyes of an owl” at a party in Montreal in 1921 that she would marry him. They were wed a year later when Dorothy was just twenty two and her husband nearly thirty seven.

Dorothy Brooks Johnson was born in St. Louis, Missouri, in 1899. Growing up in privileged circumstances, Dorothy became extremely competitive, an Olympic-calibre “crack swimmer” who strived to be the best at anything she tried. She hired experts to help her with her tennis game, and read books and took lessons to play bridge better. When she took up golf, Izaak Killam promised her one hundred dollars if she broke one hundred for eighteen holes in her first season. She did—“by hounding professionals to correct her faults.”

If Dorothy and her husband shared that perfectionist’s obsession, they were opposites in most other respects. Noted Doug How: “She was an extrovert, gregarious and full of fun; she loved parties, social life, liked being with famous and interesting people, especially men… Together they formed a patrician balance between introvert and extrovert.”

Killam happily indulged Dorothy’s desires to live, as one observer put it, “a fairytale life with herself as the princess,” spending a million dollars a year “on houses, on retinues of servants, on travel, on clothes, on entertainment, on fishing, on jewelry.”

Servants? Anne Byers, the wife of the man who would become Dorothy’s lawyer and chief advisor, recalled the first dinner party she attended at the Killam home in Montreal. “At the door, there were three different people who helped me off with my coat. The butler took one sleeve, the sub-butler another, and the maid took my scarf.”

Dorothy collected expensive jewelry. Her baubles and trinkets, explained one prominent jeweler, constituted “one of the finest private collections in the world.” Izaak bought them for her without complaint.

After her husband’s business interests took them more frequently to New York during the 1940s, Dorothy became obsessed with the Brooklyn Dodgers baseball team. Izaak encouraged her to buy the team.

In addition to their comfortable, rambling old house in Montreal, the Killams owned two other equally luxurious homes in Nassau, one next door to where the Duke and Duchess of Windsor lived for a time, and the other on an island a mile away. “Guests,” reported How, “might lunch at one, have dinner at the other.”

But Dorothy was far more than a glamorous appendage to her taciturn husband. Killam respected “his wife’s judgments and opinions, especially those concerning people,” How noted. “Night after night in the library of their Montreal home, he would spread out his papers and ‘think out loud’ about his problems. Mrs. Killam would listen and respond to an occasional question, or sometimes ask a question of her own. He was schooling her for a future when he wouldn’t be around, when she would have control of the empire he had built and the millions he had made… He once told someone she had the best business brain of any woman he ever met.”

“He started by teaching me the ABCs of finance,” Dorothy explained, “and, by the time he died, I had the XYZs.”

While she continued, and even expanded upon the many self-indulgences she’d enjoyed during Killam’s lifetime—she bought Villa Leopolda, a stunning twenty-five-acre estate on the French Riviera, for which she paid three-million dollars. The villa, with its spectacular view of the Mediterranean and Cap Ferrat, was owned at one point by King Leopold of Belgium, who kept his mistress there, and Gianni and Mariella Agnelli of Fiat fame, who helped make it, in the words of New York gossip columnist Suzy Knickerbocker, “the most breathtaking, lavish, most publicized villa in the south of France.” Dorothy enjoyed summers at the villa, winters at her mansions in the Bahamas, springs in her apartment New York and autumns in the family homestead in Montreal.

Dorothy Killam also turned out to be a very astute businesswoman. Deciding she was “not going to be pushed around” following her husband’s death, Dorothy hired her own lawyer to look out for her interests. But she looked out for her own interests too. Having “studied all the angles,” she soon decided—against conventional wisdom and expert advice—to sell off most of the assets her husband had accumulated. She sold at a good time, made a lot of money—thirty-five-million dollars alone from his shares in Mersey Paper—and invested the bulk in short-term bonds that not only provided her with all the income she could spend but also continued to grow in value.

In 1960, The Ladies Home Journal described her as a “dainty, dark-haired, quick-humoured woman who entertains modestly and dresses with quiet elegance,” but was also one of the richest women in the world. The magazine estimated her net worth at two-hundred-and-seventy-five-million dollars, making her a “runner-up for the richest woman in the world sweepstakes.”

The question, of course, was what she should do with all that money when she died. There were no children to whom she could pass it on. But there were plenty of suitors. She was almost literally under siege from people who wanted a multimillion dollar contribution to this or that worthy cause. Many were people promoting the same causes her husband had rejected during his lifetime. No wonder she built walls of lawyers to screen out most of them. Which, Bill Cochrane understood, made this morning’s personal audience in her New York apartment so significant.

Though Izaak Walton Killam was something of a tightwad, he did, at one point, prepare a will stipulating that if his wife died first, the proceeds of his estate should be given to charity. But he never got around to deciding to which charities. In the end, he’d told Dorothy, he was “too sick and tired” to bother, and that if she survived him, she’d have to figure it out for herself.

But he did offer her advice. He wanted the money to remain in Canada, he told her, with the emphasis on projects in his native Nova Scotia. And he wanted his money to help advance developments in the fields of medicine, science and engineering. There were also ways—as Dorothy explained to Bill Cochrane while they stood together this morning admiring the portrait of her late husband—Killam didn’t want his money spent. Most notably, he didn’t want his estate squandered on contributing to charitable capital campaigns such as… well, such as the one Cochrane and his group were proposing.

“Why should I say ‘yes’ to this?” she demanded.

Cochrane was nonplussed. “Times have changed in the ten years since your husband’s death,” he stammered, desperately trying to explain his way out of the box she had created for him. “Perhaps his attitude would have altered,” he continued hopefully. “Given that this very worthy project is needed by the children in the Atlantic provinces, he may well have changed his mind.”

Dorothy didn’t respond directly, and the conversation continued until, at last, she invited them to stay for lunch.

Over lunch, she pressed for more information. Would there be an orthopedic ward for children in the new hospital, she wanted to know? Yes, there would, Cochrane answered. At which point Dorothy told them how impressed she’d been with the orthopedics department at the New York Medical Centre where she’d had her hip surgery. Did they want to see the facility? Cochrane indicated they’d be keen to see it at some point, never imagining Dorothy would immediately telephone the hospital’s administrators to tell them she had friends visiting from Nova Scotia who would like to see their children’s orthopedic ward, and how was three o’clock?

Despite the fact it was American Thanksgiving Day, “a large line of people, including the president of the centre, the head nurses and orthopedic doctors, as well as residents and other staff” were there to greet them—or at least her. When Cochrane apologized for having dragged them away from their Thanksgiving dinners, the head of orthopedics quietly explained that “Mrs. Killam had been very kind in the past and would probably continue to be supportive in the future.”

Invited to return to Killam’s apartment for what turned out to be a “wonderful meal,” Dorothy Killam continued to question Cochrane about the proposed hospital. “Will you have good people at this hospital, scientists and physicians, to provide the highest quality service?” Yes, he said. In fact, he had recently encouraged some of his current bright young doctors to go away to Harvard and Cleveland for further training so they could return better teachers and researchers. Oh yes, Dorothy responded. She understood an anonymous donor had provided funds to underwrite just such training. That was true, Cochrane allowed, but, unfortunately, the fund was only available to those training in Canada.

As soon as she heard that, Dorothy turned to John Plow. “There’s no stipulation that people should have to take their training in Canada,” she told him. “I want you to call Donald McInnes (then the chair of Dalhousie University’s Board of Governors) and make sure that’s changed so they can go wherever they want.”

The anonymous donor, Cochrane thought to himself, was no longer quite so anonymous.

Though they left that night with no commitments—other than a modest-for-Killam seventy-five-thousand-dollar pledge toward the capital campaign and the promise Dorothy would consider a “more substantial gift” at some point in the future—Cochrane was now optimistic Dorothy Killam would turn out to be the “sugar momma” they’d been looking for.

***

Weeks later, Dorothy announced she had not only decided to donate three-million dollars toward construction of a modern children’s hospital and research facility but also that she would be moving her own official residence from Montreal to Halifax, in part so she could take a more direct hand in planning a fitting memorial to her late husband. Before the year ended, she had put the for-sale sign on the Montreal home she and Izaak bought forty-three years earlier and signed a lease for a large new penthouse apartment on Spring Garden Road, a few blocks from the hospital.

When she arrived in Halifax in May 1965 for a two-week visit, her apartment still wasn’t ready, so she rented the top two floors of the city’s finest hotel, the Nova Scotian, including the suite used by visiting royalty, as headquarters for her, her lawyer and her army of servants and helpers.

By that point, Dorothy was already deeply enmeshed in the details—large and small—of the project. She’d flown John Plow, Arthur Peckham, a Toronto-based hospital consultant, and Andris Kundzins, the Halifax-based lead architect, to her winter mansion in the Bahamas for consultations. These were, in truth, less consultations than opportunities for Dorothy to tell the men what she had in mind.

Soon after she landed in Halifax, a special Saturday morning board meeting was convened so the architects could show Dorothy their latest plans and the board could formalize arrangements for her gift. Bill Cochrane, who wasn’t on the board, was asked to greet her and introduce her but then leave as the detailed financial discussions began.

An hour later, he got an urgent call at home from the hospital’s general manager, telling him to get back to hospital immediately. It seemed Dorothy Killam wasn’t happy. In fact, she was angry. And she wanted to know where Bill Cochrane had disappeared to.

“Come and look at this,” she commanded as soon as he arrived, leading him to the model of the hospital, which the architects had so proudly unveiled. There are too many angles. The windows are too small. It’s facing the wrong way. Where are the pillars? What about the children’s playground on the roof? It was not, she told Cochrane and the now “rather solemn, quiet group of people” gathered in the hospital’s board room that morning, a fitting memorial for her husband. The architects had botched it. They should be fired. She’d bring in her own architects from New York to replace them and do the job properly…

Cochrane listened to her litany of complaints with alarm. Bringing in another set of architects now would only delay the already too-long-delayed project. He tried to convince her to give the Halifax firm a second chance.

At first, she was unmoved. Izaak Walton had always told her people should only get one chance to do a task right. “And you’re asking me to give a second chance to your architect?”

Cochrane tried again, assuring Dorothy that the architects could make—would make—whatever changes she wanted. He turned to Les Single, the architect’s project manager, who nodded in vigorous, hopeful acquiescence. Eventually, Dorothy relented. She’d see what they came up with, she said.

“Boys,” Single said to the assembled architects, “we need a new set of drawings.”

Another crisis averted. It would not be the last.

***

That same night, at around 10:30 p.m., Cochrane got a telephone call at home from Dorothy’s lawyer and chief adviser, Donald Byers. Mrs. Killam, he explained, would like to pick him up in a few minutes in her car and take him on a tour of the Halifax area so she could show him some of the architectural ideas she had in mind as well as to look at the potential sites for the new hospital.

At 10:30 at night? By now Cochrane knew better than to question Dorothy Killam’s occasional eccentricities. But he could still be surprised. As they drove down University Avenue past the proposed site of the hospital next to the existing Children’s, Dorothy noticed the old City Hospital located “somewhat” in front of where the new hospital might block the view from the street. “Buy it and tear it down,” she instructed Byers, who was along for the ride. As delicately as he could, Cochrane pointed out that the building was owned by the provincial government, which might not want to sell, and, besides, it wasn’t blocking “too much” of the view of the new hospital. Dorothy paid him no mind. A few minutes later, she noticed that the view of the new hospital might be similarly blocked from the opposite end by the Provincial Laboratory building. “Call [Premier] Bob Stanfield,” she said to Byers. “Find out if we can buy it and remove it.” Cochrane was about to interrupt when he felt a warning tap on the leg. It was Byers, hushing him. By the time he was dropped off at home at midnight, Dorothy had decided the old wooden Halifax City Home would have to go too.

Over the following week, Dorothy continued to meet the architects to make her vision clear. The main problem, as she saw it, was that the hospital entrance, as envisioned by the architects, was to be on South Street. Dorothy wanted the building to face University Avenue where it could become “the axis of an enlarged complex of buildings associated with Dalhousie University.” The problem, says Les Single, is that a hospital’s interior layout is created in relation to the positioning of its entrance. Changing where you entered the building meant rethinking everything inside. They, of course, agreed to rethink it all. Just as they “yes, ma’amed” when Dorothy said she wanted a far more appropriate and substantial memorial lobby to honour her husband. Their eagerness to adjust and accommodate became even greater after Dorothy told the board she was willing to increase her planned contribution to the new hospital to five-million dollars.

Dorothy didn’t get everything she wanted. She loved the look of Greek and Corinthian columns, for example, and thought they should be part of the hospital’s dramatic entryway. Remembers Single: “We had to find a nice way of saying, ‘That’s not on,’ that it would make it look like a museum when what we needed was something that would be in keeping with children.” Dorothy relented on that, but the architects did eventually redesign the hospital façade to incorporate an unusual arched window design Dorothy wanted copied from her villa. (Dorothy flew both Aris Kundzins, the chief architect, and Arthur Peckham, the hospital consultant, to France so she could show them “some of the architectural features of her villa she wanted built into the new Children’s Hospital.” And then proceeded to make even more changes. “She even made changes to her changes,” Kundzins later marveled.)

During the many back-and-forth discussions over what the new hospital should look like, Dorothy would sometimes muse that perhaps a hospital really wasn’t the right project for her. “The committee got very nervous,” admits Single. “The money was still on a string.”

Which may explain why the architects’ operating mantra became, “If she wants it, she gets it.” At one point, Dorothy suggested putting a swimming pool on the roof of the hospital for the nurses. The architects dutifully went away, designed a rooftop pool and had a model made to show her. When they unveiled the model, Dorothy’s instant and appalled response was: “What’s that doing there?” The pool quietly disappeared from future drawings.

But Dorothy did more than hector the architects during her Halifax visit that spring. She also began settling into the city she planned to call home. In less than two weeks, she had joined the First Baptist Church and became a member of two social clubs.

Following a black-tie dinner with local luminaries at the home of Board President Kathleen Rowan-Legg on the night before she returned to New York, Dorothy asked Cochrane to sit beside her on the couch. She told him how pleased she’d been with the warmth and friendliness of the people she’d met in Halifax and that “she very much looked forward to living in the city when she came back from her home in southern France.”

Adds Cochrane: “She remarked to me that, on her return, she and I would get together to see what else was required in the way of support for scientists, staff and equipment to ensure the hospital would be first-class.”

It was not to be. Her May visit would turn out to have been Dorothy Killam’s last visit to the province in her lifetime.

***

The news was as shockingly unexpected as it was disconcerting. Dorothy Killam was dead.

She’d arrived at La Leopolda in June. At first, she continued to entertain her guests but, by the middle of July, she was in such great pain she couldn’t get out of bed. “Doctors were called in and hovered over her,” Douglas How writes. Though she was “very weak from internal bleeding,” she continued to negotiate—by wire and by phone—with the president of Dalhousie University, Henry Hicks, about her latest scheme to create a second memorial to her husband on the Dalhousie campus.

“Late on the afternoon of July 26, she said she’d like to leave her bed and have tea on the terrace overlooking the sea. Instead, she fell back to sleep. Later, the internal bleeding recommenced and, at about 1:30 on the morning of July 27, she died.” She was sixty five.

What now?

***

The answer was not long in coming. Having spent years considering how to order her estate and continuing to tinker at its edges almost literally up until the day of her death, Dorothy’s will “was detailed in its complexity, precise in its instructions, even historic in its implications. It was also flexible enough to be workable.”

Its gifts, as her Halifax lawyer, Donald McInnes, blandly understated it, were “princely.” Her largest bequest—to Dalhousie University—totaled thirty-million dollars and was to be used ”to help in the building of Canada’s future by encouraging advanced study.” She donated another sixteen-million to the University of Alberta and the University of Calgary, and fifteen-million more to the Canada Council. Her goal: to help build Canada’s future by encouraging advanced study.”
As for the Halifax Children’s Hospital? Dorothy’s will provided not the original three-million dollars she had pledged just over six months before, nor even the five million she talked about in May but an incredible eight-million dollars, enough, in the words of Richard Goldbloom, Cochrane’s successor as Physician in Chief, to create “a total revolution.” Dorothy’s donation enabled the new hospital to fulfill Bill Cochrane’s goal of becoming “one of the places to study children’s diseases, launched research in a variety of fields [and] attracted budding doctors from various parts of Canada and elsewhere.”

***

Ironically, Bill Cochrane wouldn’t be around to see his dream come to fruition. “I’d gotten very interested in medical education,” he explains simply. In 1967, he got a call from the Academic Vice President at the University of Calgary offering him the opportunity to build a brand new medical school at the university. At the time, there was no actual building in Calgary and not a single faculty member had been hired. “What an opportunity!” he says now.

Despite that, leaving Halifax wasn’t easy. He’d spent close to a decade putting all the pieces in place. He’d begun the process of transforming the Children’s Hospital into a more research-oriented institution, and, in the process, made it more regional. And, of course, he’d been instrumental in convincing Dorothy Killam to provide funds to allow the hospital to reach the next level.

“It was very, very difficult,” he says now. “I had no reason to ‘go from’ Halifax, but I had a new opportunity I wanted to ‘go to.’”

In July 1967, Cochrane left the Halifax and the Children’s Hospital to take up his new position as Dean of the University of Calgary Medical School.

By then, contractors had already begun to break ground for the new Izaak Walton Killam Hospital for Children! But it would be nearly three more years before the hospital would welcome its first patient.