Patricia Mackay (nee Wilson)

Class of 1948

This biography is based on oral interviews with her two daughters, Colyn and Indi Mackay, conducted in Melbourne by Prof Cindy Farquhar and secondary material in the public domain, including two professional body interviews. Photos have been supplied by family members. Secondary material is listed in the bibliography. This biography has been collated by Rennae Taylor.

Family History and Early Childhood

Pat Mackay’s daughters know very little about their mother’s family history, childhood and school days in New Zealand. Pat shared with them in later life that she found out in her early teens that she was adopted. Richard and Beatrice (nee Gow) Wilson were her adoptive parents. From the BDM register, the Wilson’s, who married in 1912, had one stillborn child in 1918 and adopted Pat in 1926. Beatrice would have been forty and Richard forty-eight years of age at this time. (1)

Pat grew up in this only-child older parents’ family, a somewhat conservative, simple, wholesome upbringing but one where she was happy and encouraged to achieve in her education, which was at odds with the norms of her community in the late 1930s.

The family lived in the South Otago town of Balclutha,  where her father worked as a stock and station agent, and her mother, who had a degree, (3) did some part-time teaching but generally was a homemaker. Pat, with her mother’s encouragement and influence, became a very dedicated student. It is likely that her love of knitting, cooking, and baking (which she was known for in later years), was encouraged by her mother. Her primary school years included learning the piano and Irish jig dancing, which she enjoyed. (4) She was a lover of the outdoors, and while never excelling in sports, she enjoyed many of them, including skiing and tennis, into adulthood. In later life, her son Eric fondly recalls a skiing holiday with her in Aspen, USA, where, at age 75, she was still trying to execute the perfect snowplough turn. Her daughter said her mother was a great lover of animals, particularly ones which were abandoned or unwanted. She loved cats, beginning with her first one, Geordie, and had many over her lifetime. As a young girl, she became the owner of a one-eyed chicken after begging her parents to let her keep it as a pet.

Pat started high school at the age of eleven and remembers being embarrassed as she was the smallest child in the school. Far more embarrassing was the hat her mother bought for her – it was to last throughout high school, and the first year, it was down around her eyes. Pat vowed she would never make her children wear clothes that they would need to grow into. (3) She graduated from the South Otago High School in Balclutha in December 1942 and was joint dux. (5) They did not offer enough subjects at her high school for admission to medical intermediate, so she did the extra subject (possibly Physics) at home on her own and did not tell her mother she was doing this. (3)

University and House Surgeon Years in Dunedin

Following her graduation from high school, Pat was admitted to medical school based on her marks. (2) At 16 years of age, she became one of the youngest students to qualify for a bursary to medical school. (3) She commenced her studies at Otago Medical School in early 1943 and graduated six years later in 1948. (6)

She is unsure why she wanted to enter the field of medicine but she was determined to succeed. (3) It is unknown where she lived during her university years. Her daughters feel she would have continued to be very serious about her studies but would have participated in social activities as time permitted. Following graduation, she spent two years as a house surgeon and a year as a registrar at Dunedin Hospital.

It was during this time that Pat was drawn to the area of anaesthesiology. As a junior doctor and often with little training, she would be called upon to take on the role of anaesthetist and found she enjoyed it. In later years, she recalled being asked to do the anaesthetic for a Caesarean section. The surgeon had said the baby was dead, but Pat was able to ensure the baby was born alive and healthy, (7) and from this time, she decided her career pathway would be anaesthesia. (2) In an oral interview, Pat mentions Dr John Russell Ritchie being a positive influence on her as he became Director of Anaesthetics at Dunedin Hospital in 1949 and brought a more attractive academic bent to the discipline. She reminisced that he would usually get the anaesthetic machine for his cases, and she would need to use open ether or high spinal anaesthesia for hers. (2)

Anaesthesiology Training

Postgraduate training in anaesthesiology was not available in NZ, so in 1952, Pat went to Melbourne, trained at The Austin Repatriation, The Alfred and The Royal Melbourne Hospitals, and obtained her Diploma of Anaesthesia (DA) at the end of the year. She then travelled to England and spent a year at Oxford, where she gained her DA in 1953. The well-known NZ-born British anaesthetist, Sir Robert Reynolds Macintosh, was a professor of anaesthetics at Oxford during this time, and Pat enjoyed the strong academic atmosphere. In 1954, she was elected to membership of the Faculty of Anaesthetists of the Royal College of Surgeons.

While in the UK, she also enjoyed some travelling with her classmate Beryl Howie, who was doing postgraduate training in Obstetrics at Oxford.

Pat returned to NZ at the end of 1953 and spent about six months as the junior anaesthetic specialist at Dunedin Hospital, as well as taking up a position as a lecturer in anaesthesia at the University of Otago. (8)

Early Career in Melbourne, Marriage and Motherhood

While at the Royal Melbourne Hospital, Pat worked with their first director of anaesthesia, Dr Norman James. In 1954, he offered her a position as a specialist anaesthetist and assistant director of anaesthesia, which she recalls was an offer too good to refuse since she already had a romantic interest there – Dr Ian Mackay. (2) Her daughter thinks she met Ian in 1952 while working at the Austin Repatriation Hospital. During those early Melbourne days, Pat, along with her cat Judy, flatted with her anaesthesia colleague, Dr Gwen Wilson, while Ian continued his postgraduate research and training in autoimmunity in both the USA and the UK before settling back in Melbourne and marrying Pat in 1958. He went on to become a pioneer in the field of autoimmunity and was regarded by his colleagues as a perfectionist. (9)

They had five children relatively quickly. In 1959, they had fraternal twins (one of each), Charles and Colyn, then Eric in 1960, Indi in 1961, and Ian in 1964. In addition, through the years, Burmese cats, including Thatcher (named after Margaret Thatcher) and Rufus, were added to the household. Children had a significant impact on Pat’s career. In her oral interview, she said she always kept a little hand in doing some private work when they were young, but until the youngest became relatively independent, she didn’t focus on her career. (2) She also had part-time home help for eight hours a day. Mrs Stead, whom the family called Steady, was an integral part of the family for twenty years and provided another mother figure for her children. When Mrs. Stead went home at the end of the day, quite often, the children would accompany her for the drive to the hospital so Pat could do her pre-operative rounds for the following day.

Pat and Ian maintained the traditional roles of their 1960s era. Ian did not involve himself in the activities of the household, which Pat was very capable of handling. He would arrive home, go to his study until teatime, and then go straight back to his study. They built a strong, solid relationship, which worked for them. In the 1991 Balclutha newspaper article, Pat said she was not a feminist but believed women had to be as good as men “and then that little bit better” to get to the top in their career. (3)

Anaesthesia Career Development

Once her youngest child was relatively independent, she became a visiting anaesthetist at the Royal Melbourne, which eventually became a full-time position. In the end, she became the Chairman of the Department of Anaesthetics from 1984 to 1991 and, from 1992, became a consultant anaesthetist. (10)

During her years as a clinical anaesthetist, she mainly focused on neurosurgery anaesthesia. In the early years back at the Royal Melbourne, she encountered a lot of difficulties, which she endeavoured to sort out. The career of the anaesthetist had a low profile – they were only regarded as essential to give anaesthetics. However, surgeons coming back following World War II were demanding more anaesthesia specialist input, particularly in the areas of thoracic, vascular and neurosurgery because of the war injuries they had been exposed to. (11) In addition, there was a shortage of anaesthetists, so they had to create senior honorary posts as well as senior registrar positions. Pat and her colleagues were eventually able to establish that anaesthesia was an essential service within the hospital, and the education of their registrars gained greater prominence. (2) She established the acute pain service and introduced a new and improved anaesthetic chart. (12) Pat also felt strongly that they needed to move out of the operating suite and take part in hospital activities. She became involved in such groups as the Pharmaceutical Advisory Committee and the Medical Advisory Committee. (2)

Pat was at the forefront of developing Quality Assurance meetings where cases were discussed behind closed doors with the anaesthetic registrars. This eventually grew into the independent body of the Victorian Consultative Council of Anaesthetic Mortality and Morbidity in 1976, which received and reviewed voluntary reports about possible anaesthesia-related mortality and morbidity occurring in Victoria with the goal of continuing to identify opportunities to improve the quality and safety of anaesthetic care. (13) Prof Alan Merry wrote the following tribute to Pat in the ANZCA bulletin in March 2013: (14)

The inaugural meeting of the Quality and Safety Committee of the Australian and New Zealand College of Anaesthetists was held on Sunday May 4 in 2006. Dr Patricia (Pat) Mackay, retired anaesthetist and Emeritus Consultant to the Victorian Consultative Council for Anaesthetic Mortality and Morbidity, was one of 11 participants. The committee was the outcome of the combined recommendations of two taskforces established by Professor Michael Cousins during his presidency: the Data Taskforce (chaired by Dr Michelle Joseph) and the Integrated Approach to Quality and Safety Taskforces (chaired by Pat). Thus Pat was not only present from the beginning of the Quality and Safety Committee, she was substantially responsible for its creation.

In 1991, with the encouragement of her husband, Pat took on the role of chairperson of the Victorian Consultative Council on Anaesthetic Mortality and Morbidity. She found that since mortality is in the public domain, reports were forthcoming, but it was slow to build up the confidence of the anaesthetists to report morbidity due to their fear of breaches of confidentiality. Pat, in her oral interview, said that during her time on the council, there had never been an episode of disclosure. Through these meetings, she felt they had definitely influenced the change of practices, including the dangers of hypotension during anaesthesia and of Haemaccel causing anaphylaxis. (2)

Pat believed the monitoring equipment introduced over the years also had a major influence on safety. In the early years of her career, blood pressure monitoring was done manually. When asked what she considered the most important piece of monitoring introduced, which changed patient safety, she responded with oximetry, which enabled continuous oxygen saturation monitoring. Early in her career, all anaesthetics would have been done in the operating room, and there was no such thing as day surgery, which became so prevalent later. (2)

Pat was also involved from the beginning in the Australian Patient Safety Foundation, which started in 1988 to advance patient safety in anaesthesia care. This has been partly achieved through the development of systems to collect, aggregate, monitor and analyse incidents related to patient safety with a focus on identifying vulnerabilities and implementing corrective measures rather than merely counting incidents. (15).

Other career positions Pat held over the years were: (10)

• Senior Sessional Anaesthetist at the Royal Melbourne Hospital (1965-)
• Acting Director of Anaesthetics at the Royal Melbourne Hospital (1965)
• Associate Director of Anaesthetics at the Royal Melbourne Hospital (1977-1978)
• Chairman of the Department of Anaesthetics at the Royal Melbourne Hospital (1984-1991)
• Consultant Anaesthetist at the Royal Melbourne Hospital (from 1992)
• Secretary of the Australian Society of Anaesthetists (1956-1962)
• President of the Australian Society of Anaesthetists (1966-1968)
• Civil Consultant to the Royal Australian Navy (1956)
• Director of Footscray and District Hospital, Melbourne (1958)
• Member of the Board of Management of the Mansfield Hospital (from 1990)

When interviewed by the Otago Daily Times in 1991, she said one of the disappointments during her career was the failure to become president of the International Association of Anaesthetists, but she had managed to achieve most of what she wanted, as well as bringing up five children. (2, 3)

Her children do not recall her talking much about her work and the responsibilities she had. She never complained about chauvinism in her medical school training or during her career. The only mention she made of it was during a World Congress held in England. As the Australian president, she should have been on a particular committee, but one of the Europeans said to her, “We’re not good enough”. (2) Earlier on in her career, she was occasionally mistaken for a nurse but felt that was understandable. Her grandson, who works in intensive care medicine, said he has been told by many who worked with her what an incredible doctor she was and, as a person, how admired and respected she was. Her daughter said she had a way of just managing very quietly to put people in their place when faced with resistance.

Two more personal glimpses of Pat, which developed during her career, were her enjoyment of a gin and tonic most evenings, which seemed to relax her after a day spent at the hospital before changing hats to take on the responsibilities of wife and mother. She was also somewhat addicted to Australian Football League footy tipping. This started in 1980 when she won the Hartwell Hospital football tipping competition. Over the next thirty-five years, she entered many tipping competitions, and her children made sure tips were placed for her last round, which finished with a near-perfect round. (7) 

Awards

The following awards Pat received indicate the high esteem she was held both by her medical colleagues as well as the community. (12)

• 1999, Australian and New Zealand College of Anaesthetist Medal
• 2001, Woman in Medicine Award from the Australian Medical Association (AMA) for her long-standing interest in anaesthesia safety. (16)

Dr Mackay has promoted emergency concepts for mechanical ventilation in patients with impaired respiration due to head injuries, polyneuritis, tetanus and myasthenia gravis. This established the beginning of modern intensive care management at the Royal Melbourne Hospital and foreshadowed the development of dedicated intensive care units worldwide in the 1960’s.

• 2001, Centenary Medal of the Order of Australia
• 2008 Medal of the Order of Australia
• Life membership in the World Federation of Societies of Anaesthesiologists.

In her oral interview, Pat indicates the award that gave her the most gratification was the 2008 Order of Australia as it was not only based on her anaesthetic career but also her community involvement (2) , which included being on the board of both St Michaels Grammar School and Mansfield Hospital (north-east of Melbourne) where the family had a little cottage at the foot of the mountains. Pat loved the outdoors and, throughout most of her life, enjoyed skiing.

The Patricia Mackay Memorial Australian and New Zealand College of Anaesthetists (ANZCA) Research award was established with a generous donation from her daughter, Indi Mackay, to support special interests in quality and safety in patient outcomes and the related identification and reduction of adverse events.

Retirement

Pat retired in 2005 but continued on the ANZCA Quality and Safety Committee. Pat and Ian had travelled quite a lot during their career days, as Ian enjoyed going to conferences. In these latter years, when they were not at their smaller retirement home in the suburb of Albert Park, they increasingly enjoyed their time at their mountain property at Merrijig, west of Mansfield and their beach property at Anglesea, southwest of Melbourne. Pat enjoyed the mountain setting, which reminded her of her NZ childhood.

In her retirement years, Pat was able to enjoy more time with her family, which included ten grandchildren. She enjoyed her knitting and made some beautiful articles. She would have been delighted that her granddaughter, who also chose a career in medicine, has her own podcast on knitting called ‘Two Purls in a Pod.’ She also loved her garden and was devoted to her cats. She became an enthusiastic bridge player and enjoyed playing every week at the Lyceum Club. Her love of cooking continued. Her family and dinner guests continued to enjoy her desserts, which included golden syrup dumplings, puffy pavlova, and apple square. Pat created a collection of her best desserts for family and friends and called it ‘Pat’s Pantry’. Copies were given out at her funeral.

On 2 September 2015, after 57 years of marriage, Pat died quite quickly after spending two weeks in hospital and about three days in palliative care. She was eighty-nine. She was thankful she never had to leave her own home for aged care facilities. When asked by her doctor about advanced management, all she said was, “I don’t want to be kept alive; I’ve been in too many intensive care units”. Ian survived her by five years and died in 2020 at the age of 98.

Conclusion

In 1896, the first women’s hospital in Victoria operated by women, the Queen Victoria Hospital, was opened in Melbourne. The money to fund this hospital was financed by encouraging the women of Victoria to give one shilling each. In 2005, the Shilling Wall was created at the Queen Victoria Women’s Centre.

Over 500 names of special women are inscribed, celebrating their roles as mothers, grandmothers, caregivers, sisters, friends, colleagues, and community members. Pat, the quiet achiever, encompasses most of these roles. Her name is included on the wall – a tribute from The Retired Anaesthetists Group. (17)

Patricia Mackay has been one of Victoria’s outstanding anaesthetists over the past 50 years. She was President of the Australian Society of Anaesthetists in 1967-8, Director of Anaesthesia at the Royal Melbourne Hospital from 1984-91 and then chaired the important Victorian Consultative Council on Anaesthetic Morbidity and Mortality for fourteen years. She was awarded Women Doctor of the Year in 2000.

Bibliography

1. Births, Deaths & Marriages Online Wellington: Internal Affairs NZ Government; [16.05.2024]. Available from: https://www.bdmhistoricalrecords.dia.govt.nz/
2. Ball C. Dr Patricia Mackay, OAM [Oral interview]. ANZCA [16.05.2024]. Available from: https://www.anzca.edu.au/about-us/our-history-and-heritage/oral-histories
3. Paterson V. Top anaesthetist visits home town. Otago Daily Times. 1991 01.02.1991.
4. The Competions: Instrumental Evening Star. 1935 31.08.1935.
5. South Otago Balclutha High School Breakup. Otago Daily Times. 1942 12.12.1942. Available from: https://paperspast.natlib.govt.nz/newspapers/ODT19421212.2.11
6. Business Announcements: Professional. Otago Daily Times. 1948 30.12.1948. Available from: https://paperspast.natlib.govt.nz/newspapers/ODT19481230.2.8.7
7. Dulhunty K. Trail-blazing leader in anaesthetics was a pioneer for patient safety – and a great cook. Sydney Morning Herald [Obituary]. 2015 23.10.2015. Available from: https://www.smh.com.au/national/trailblazing-leader-in-anaesthetics-was-a-pioneer-for-patient-safety–and-a-great-cook-20151023-gkhc2j.html
8. Mackay D. Patricia (Wilson) Mackay OAM (1926 – 2015): WikiTree; [updated 07.09.202216.05.2024]. Available from: https://www.wikitree.com/wiki/Wilson-97661
9. Bogdanis DM. Obituary for Professor Ian Reay Mackay (1922–2020): A pioneer Autoimmunologist. Mediterr J Rheumatol. 2020;31(1):2.
10. Mackay, Patricia (1926 – ) Melbourne: Encyclopedia of Australian Science and Innovation; 2003 [updated 28.04.200316.05.2024]. Available from: https://www.eoas.info/biogs/P004343b.htm
11. Anderson W, Hunter C. ‘Wars Have An Overflow on Everything’: Interview with Ian R. Mackay and Patricia Mackay Health and History. 2013;15(1):13.
12. Lives of the Fellows: 1956 Melbourne: Geoffrey Kaye Museum of Anaesthetic History; [16.05.2024]. Available from: https://www.geoffreykayemuseum.org.au/fellows/fellows-1954-onwards/patricia-mackay-wilson/
13. Victorian Consultative Council on Anaesthetic Mortality and Morbidity, Triennial report 2015-2017. Melbourne: Safer Care Victoria, State of Victoria , Australia; 2019.
14. Merry A. Tribute to Dr Patricia Mackay. ANZCA Bulletin. 2013;22(1):2.
15. Runciman WB. Lessons from the Australian Patient Safety Foundation: setting up a national patient safety surveillance system—is this the right model? Quality & Safety in Health. 2002;11(3):6.
16. AMA announces prestigious health and medical awards: Australian Medical Association Limited; 2001 [16.05.2024]. Available from: https://www.ama.com.au/media/ama-announces-prestigious-health-and-medical-awards
17. Shilling Wall Melbourne: Queen Victoria Women’s Centre; 2019 [16.05.2024]. Available from: https://www.qvwc.org.au/shilling-wall/