Introduction: My Life and My Credentials

I was born in Wellington, New Zealand, on Sunday June 25, 1950. My father was a surgical registrar at Wellington Hospital and my mother had been a secretary when she met him. My very early life was in England where my father achieved his Fellowship of the Royal College of Surgeons of Edinburgh before bringing his young family back to the North Shore of Auckland, where he went into practice first as a General Practitioner and then as a General Surgeon. Medicine, and my name James, were well established in the family. My Father was christened James, but always referred to as Jim. My Grandfather was also James (known as Bossie) and was a General Practitioner and Anesthesiologist in New Plymouth and my great grandfather Robert was a General Practitioner in Naseby, Otago. All were graduates of the University of Otago, and I was to break the mold by attending Auckland University Medical School.

I grew up in Milford, a seaside settlement on the North Shore of Auckland. We lived right on the beach which made for a wonderful childhood. I lived through the arrival of television to New Zealand, the opening of the Auckland Harbour Bridge, and the advent of decimal currency. I was raised a catholic and attended St Joseph’s Primary school and Rosmini College in Takapuna. In 1968 I was in the first class to attend the new Auckland University School of Medicine. My interest in surgery was kindled during my clinical rotation in year IV and reinforced by an externship at St Joseph’s Hospital in Lorain, Ohio, in 1971. During my time in Lorain I visited the Cleveland Clinic, never knowing that I would have a career there. I graduated from medical school with 41 of my classmates in 1974 and after a house surgeon year entered the Northern Regional Surgical Training scheme. While a house surgeon I met my wife to be, Lois, who was a nurse on a men’s medical ward. Ward 28 was one of the old-fashioned wards in the Wallace Block, a long room with beds on either side. This was not ideal for the early stages of courting. We married in 1977, while I was on my pediatric surgery rotation and our first child, James (Jamie) arrived in 1980. I received my Diploma from the Royal Australasian College of Surgeons in 1981 and spent a year as a senior registrar at Greenlane Hospital. I had always been interested in research and had actually spent a year fulfilling a Senior Scholarship awarded after Medical School, studying comparative anatomy at the Department of Anatomy under Professor John Carman. This taught me research methodology and discipline, so that when, in 1982, I started 2 years of research in the Department of Surgery at Auckland Hospital, I was ready for the demands of academia. With Professor Graham Hill I studied malnutrition and its effects on human physiology. Bryan Parry, Ross Pettigrew, David Haydock and I ran the Nutrition Support Service while I considered career options. Normally, nascent New Zealand surgeons spend some time overseas after gaining their Diploma, waiting in line for a suitable job to become available back home. Graham Hill had come to New Zealand from Leeds in England, the home of the doyen of English colorectal surgery John Goligher. Like a good mentor, Graham had set me up with a job there, in the north of England. However, a chance meeting in Hobart, Australia (of all places) led to an opportunity to spend a year at the Cleveland Clinic, in Cleveland Ohio, under the tutelage of Dr Victor Fazio. Victor was an Australian Colorectal Surgeon, leader of one of the top Colorectal Units in the world. It was the home of Rupert Turnbull, who meant as much to American colorectal surgery as Goligher did to English. The plan was to move my family, which by now included a little girl called Emma, to Cleveland for a year, and thence to Leeds, before returning home at some unforeseen time in the future. In late June 1983, four uncertain and nervous kiwis arrived in Cleveland, Ohio.

Cleveland was not all wine and roses. The bank had lost what money we were able to scrape together, and we had little credit. We were stuck in the Clinic Inn for 10 days until the money was found and we could rent an apartment and arrange a couple of cars. At that time there were 4 surgeons in the Colorectal Department: Fazio, Ian Lavery (another Aussie), David Jagelman (ex St Marks, and English to the core), and Frank Weakley (American, who coined the term “No Touch Technique” for Turnbull’s brilliant preliminary vascular isolation technique used to resect colorectal cancer). There were 4 fellows: John Oakley (Aussie), Steven Pilipshen, George Moro and me. There was a cadre of other foreign fellows in other departments, and the wives bonded together to help each other survive. This was reassuring to husbands stuck at the hospital for the entire week. Halfway through the fellowship year the job at Leeds fell through and so the Churches faced an uncertain future. Fazio came to the rescue with the offer of a Clinical Associate year, where I would be a junior staff with some clinical responsibility and an ability to bill independently. This meant taking and passing the Boards for an Ohio License. It also meant more money (the fellowship salary had been $24K), and the opportunity to organize colonoscopy in the department. One year as a Clinical Associate led to two and ultimately to a job offer to come on staff. I guess I had made a favorable impression on the bosses. After much discussion Lois and I decided to accept. This required us to return to New Zealand and apply for Green Cards from there. It also meant that the Clinic had to jump through numerous hoops to get us back. We left Cleveland in July 1986. There were no jobs available in New Zealand, and the year I spent there in private practice showed me that colorectal surgery did not yet exist as a specialty. So back we came, in March of 1989, bringing our third child and second little girl, Lucy, who was one and a half.

In March 1989, John Oakley and I joined Vic Fazio and Ian Lavery to make an Antipodean department of Colorectal Surgery. Frank Weakly was just doing office proctology and David Jagelman had left to head up the Colorectal Surgery Unit at the new Cleveland Clinic Hospital in Fort Lauderdale, Florida. David had asked me to take over the Familial Polyposis registry that he had lovingly built, and I was honored to do this. It was a career defining decision as I soon became enraptured by the field of genetics and hereditary cancer. It overlapped with other interests in biology, colonoscopy, polyps, colorectal cancer, and surgery. As a fellow and Clinical Associate, I had also developed interests in anorectal physiology and the new subspecialty of disorders of the pelvic floor, while anybody on staff at the Cleveland Clinic had to be an expert in Crohn’s disease and ulcerative colitis. Thus began my 32 years. The unique practice at Cleveland, with high volumes of very complex cases, with referrals from everywhere, with partners who were at the top of their field, set the stage for a rewarding career. This website will contain things I have learned during these 32 years. I hope that some of what I have learned is useful to others, and will allow readers to be more successful clinically, academically, personally, and spiritually.

Auckland Medical Students Committee 1971: Rosie Kingham, Grant McLean, Innes Asher, Grant Gillet, Ross Boswell, Me, Anne Bollard, John Faris

Department of Anatomy, University of Auckland, 1975. That’s me with the moustache. Professor John Carman is in the suit.

My father, operating at Lister Hospital in Takapuna

Playing rugby for Rosmini College against the Old Boys in 1967

Daughter Lucy operating on her doll’s hemorrhoids

Brother John and I, Milford beach, 1961

Department of Colorectal Surgery, Cleveland Clinic, 1992. Front row: Lavery Church Fazio Oakley Weakley Milsom. Middle row: Cyrko Farmer Eggenberger Hull, Alexander. Back row: ? Strong, Stolfi, Tjandra, ?

My father James Escott, my great grandfather Robert, my grandfather James Stuart, and me, on my graduation from medical school in 1974. This photo was published in the Auckland newspaper.