North American surgery lost one of its great leaders last winter. Lloyd Douglas MacLean, MD, PhD, FACS, FRSC, Past-President of the American College of Surgeons (ACS), died in his sleep on January 14 at age 90.
Dr. MacLean was an outstanding clinician whose investigative interests touched on all of the important surgical developments that occurred in his lifetime. Early studies in gastric physiology, transplant immunology, infection, and nutrition preceded his interests in septic shock and organ failure, clinical transplantation, host resistance, and the physiologic evaluation of the critically ill surgical patient. His evaluations of the clinical results of bariatric surgery were leading edge and established the bar for others in this currently relevant clinical field. He was a pioneer in clinical transplantation, the development of surgical critical care units, and the study of bariatric surgery. All of these interests, among others, are reflected in his bibliography, which spans more than 350 publications. He was one of Canada’s leading academic surgeons and a wonderful role model for all of the surgeons in his department.
Born in Calgary, AB, in 1924, Dr. MacLean achieved an exceptional academic record, and he financed his undergraduate and medical school education at the University of Alberta, Edmonton, on scholarships. Following a rotating internship in Alberta, he entered the surgical training program at the University of Minnesota, Minneapolis, where he thrived in the intellectual and investigative atmosphere promulgated by Owen H. Wangensteen, MD, PhD, FACS, chief of surgery.
By the completion of his residency and after earning a doctorate in physiology in 1957 as a Markle Scholar in Medical Sciences, Dr. MacLean had authored 32 papers, many of which were published in the New England Journal of Medicine, The Lancet, and basic science journals. Board-certified in general and thoracic surgery, he was promoted from the residency program to chief of surgery at the Ancker Hospital in St. Paul, MN, where his clinical and academic career flourished.
In 1962, he was recruited to McGill University, Montreal, QC, to serve as professor of surgery and chief of surgery at the Royal Victoria Hospital. In his 27 years in that position, Dr. MacLean established what was considered the premier academic surgery program in Canada. He achieved universal recognition, becoming the Archibald Professor of Surgery at McGill, a Fellow of the Royal Society of Canada, an Officer of the Order of Canada, and the 1988 Sims Commonwealth Travelling Professor. He received the Canada Gairdner Wightman Award, along with honorary degrees from McGill and the University of Alberta and visiting professorships to most Canadian medical schools, as well as many U.S. and international institutions.
Leadership in fractious times
Dr. MacLean held high office in many surgical associations. He was president of the American Surgical Association, the Central Surgical Association, the International Surgical Group, and the James lV Association of Surgeons.
Much of his energy dedicated to surgical organizations, though, was focused on the ACS. In the 1960s, Dr. MacLean was heavily involved with the Pre- and Post-Operative Care Committee and the writing of the first ACS Manual of Preoperative and Postoperative Care. For the next six years, he served on the Committee on Fundamental Surgical Problems, the Surgical Forum Committee, of which he served as Vice-Chair. In 1989, his 29th year of participation, the Surgical Forum was dedicated to him. Additionally, he was ACS Secretary (1982–1983) and served three consecutive three-year terms on the ACS Board of Regents (1983–1992), culminating in his service as Vice-Chair of the Board of Regents (1991–1992). He also served on the Honors Committee (1981–1987); Organization Committee (1981–1985); Central Judiciary Committee (1983–1990); Executive Committee (1987–1992); the Member Services Liaison Committee (1990–1992); and Health Policy and Reimbursement Committee (consultant, 1984–1986, and member, 1993–2000).
Dr. MacLean was Chair of the ACS Clinical Congress Program Committee from 1985 to 1992. These were fractious years due to an increase in specialization and surgical disciplines seeking more program time and independence. His diplomatic skills were evident as the College’s meetings were always successful, and peacefully evolved into the 1990s.
He was elected ACS President in 1993, and his Presidential Address, “Wangensteen’s Surgical Forum: A legacy of research,” is worth reexamining. The speech outlined Dr. Wangensteen’s career, explaining how a restless intellect that constantly questioned the causes of the clinical problems facing his patients would find solutions. Dr. MacLean believed surgeons were physicians who operated—not simply technicians. None of us heard, “What do you mean, you got a medical consult?” more than once.
Influence on McGill’s culture
The Surgical Forum was an integral component of the residency program in Minnesota and, under Dr. MacLean’s leadership, participation in the forum became a significant part of serving and training in the department of surgery at McGill. For residents and junior staff, meeting the March 15 deadline for submitting abstracts for the Surgical Forum was integrated into the rhythm of the year. Presentation and participation were a part of the department’s culture. In the late 1970s, more than half of the Canadian Forum papers were from McGill staff.
Dr. McLean was a leader whose integrity, scholarship, and devotion to the physiological approach to patient care and outcomes data epitomized the caring academic surgeon. A key characteristic that surfaced in morbidity and mortality conferences was Dr. MacLean’s ability to be chair one minute and a regular surgeon with a complication the next. When he had a patient who experienced a complication, as happens to all of us, he could relinquish the chair and allow himself to be quizzed about the case, accepting that there might have been a better approach, as we all had to do from time to time. And when it was time to move on to the next case, he resumed his authority as chair. Thus, he created a level playing field.
There was never any doubt that Dr. MacLean was “The Chief”—and was referred to as such. The winter issue of the department of surgery’s newsletter, The Square Knot, recorded the reflections of his residents and their interactions with him.* Aside from his acknowledged qualities as department chair, a number of common themes emerged, including his modesty, quick sense of humor, decision-making skills, and a remarkable ability to crystallize a problem, paper, or situation into an often-hilarious sentence.
His wit was situational and difficult to translate out of context, but examples from the operating room include: “Let me introduce my opponents for this operation” and, “Here, let me help you…just kidding.” Following a difficult meeting with the other department heads, he was known to burst into the office with, “I have made enough enemies for one day, I am going home.” When we were offered a position in the department, the conversation was brief: “You will start (date) and share an office with . Now see about the details.” Before you could say “thank you,“ he was dictating the letter to the dean and a funding source.
His modesty came through in many ways. We always learned of his awards or presidencies indirectly, if at all. Following receipt of an international award, he repeatedly refused to be nominated for any further recognition, saying, “Let’s spread them around.”
He said that he did not get paid after 6:00 pm and would return home with his boundless energy and extraordinary sense of humor, but also with a full briefcase of work to be completed after dinner. His personal life was full with golf, tennis, gardening, cycling, hiking, skiing, and photography of the children and grandchildren as they grew and prospered.
Dr. MacLean leaves his wife of 60 years, Eleanor Colle, MD, four sons, a daughter, and 10 grandchildren, along with extraordinary memories for those of us who had the good fortune to have worked for and with him.
McGill University department of surgery. The Square Knot. Winter 2015. Available at: http://bit.ly/1Bu1Zxa. Accessed May 11, 2015.