Dame Norma Restieaux

This biography is based on an interview with Norma Restieaux in 2017 for the Early Medical Women of New Zealand Project.

1960 Graduate

Early life: accepting the challenge of medicine from a young age

Norma Restieaux was born on 16th July 1934, in Dunedin. She stayed in this city as she grew up, and went to Otago Girls’ High School in her later youth. Unsurprisingly, her early years were restricted by the Second World War. Thankfully, no-one in her immediate family was sent to war, but some members of her extended family ended up as prisoners of war overseas.

Norma’s father (Frank Charles Restieaux) was a hair-dresser, and her mother (Florence Jean May (nee Godfrey)) worked periodically as a sewer and cake decorator. Norma was the eldest of the three children in their family. Education was one of the top priorities for them growing up, and her parents were very supportive of her in her academic advancements.

Norma attended Otago Girls’ High School and at that time not all the subjects that were necessary for entry to medical school in New Zealand were taught. For example, while Norma did learn chemistry, there was no physics available and the only way she could learn this subject was by going into Otago Boys’ High School with a couple of other girls who were also interested. Norma’s teachers in mathematics, Latin and music were very influential in her life: they were some of the first mentors to guide her, but they were certainly not the last. Mentors were critical to Norma throughout her development and learning. In her opinion, “throughout your life, your mentors are very important people.” Norma did not have any particular mentors in science while at school, as “no-one was discouraging, but not actively mentoring.” She found that her learning in science at this stage was not as strong as it could have been. Outside of her studies, Norma was more drawn to the academic side of schooling than the sporting side. While she did enjoy tramping, she was more involved in music through her participation in choirs, as well as playing the piano and the violin.

No-one in Norma’s immediate circle of family and friends were in the medical field, but she decided whilst at high school that medicine was the career that she wanted to pursue. When she made this choice, she knew that it would not be easy, but she accepted the challenge.

One event in her childhood which she feels influenced the decision to study medicine occurred when she was admitted to hospital when she was eleven years. Perhaps because this was near the end of the war, both the doctors who primarily looked after her were women. One was Molly Marples, an overseas graduate who went on to become a very distinguished professor in the field of microbiology in Dunedin and coincidentally taught Norma when she was at medical school. The other was an Otago graduate who went on to become a GP in Cromwell. The capable work done by these two women showed Norma that girls could become doctors. She had always been aware of the medical school, and during her hospital stay she was sometimes taken to a medical lecture by her physician so that her medical case could be presented to the students. 

 

Medical intermediate: held back by physics but looking on the bright side

Much like today, the pre-medicine year was medical intermediate, wherein students took set papers and those with the highest grades progressed into the medical course. In 1953, Norma passed all the papers, but her grade in physics was not sufficient to get her into medicine. This did not deter her. Instead, she repeated physics the next year (1954). Through much hard work, she improved her knowledge of physics enough to secure herself a position in the medical course the following year. Rather than being disheartened that she had to do an extra year of study, Norma relished the opportunity to explore some other areas of science, including vertebrate zoology and palaeontology. She recognises that it was essential to ensure that she had a solid foundation in physics, as she needed it for the rest of her career. “Repeating the physics was very important for me because it’s an important subject in the medical field.” At this point in time, Norma’s interest in music was pushed to the side as her time was preferentially devoted to the study of the sciences. 

As Norma’s family lived in Kew, Dunedin, she was able to save money on accommodation by staying at home. She generally used public transport to get to and from lectures, unless she could find a friend to give her a ride. At this stage, a lot of Norma’s friends from school were moving off in different directions. She kept in contact with others who were involved in science, but also made new friends, many of whom she stayed in touch with for a long time.

 

Medical school: taking an extra year to pursue her research interests

With her improved physics knowledge, Norma successfully progressed into medicine the second time that she applied and started in 1955. Norma noticed a definite change when she moved from medical intermediate into medicine. She found the content much more concentrated and focused. “You also knew you were studying subjects which were of great relevance to you, and although your background in the sciences were very important, you were now moving into different territory.” The first year, which comprised entirely formal lectures, was very full-on. The main subjects that were taught were anatomy, physiology and pathology. “The subjects … were all new, and the people lecturing them expected you of course to be performing at the appropriate level.” While there was time for a degree of socialising, the students knew that they needed to work hard to keep up to date with the new learning. Norma enjoyed all the subjects which were covered but had a particular interest in physiology. The third year of medical school was similar to the second, in that it was also entirely pre-clinical. It built on what had been taught in the second year and introduced new subjects which were not part of the second year teaching, such as microbiology and biochemistry. Norma’s enjoyment of physiology was reflected in her results, as in 1956, she received both Distinction in Physiology and Biochemistry and the John Malcolm Memorial Prize in Physiology and Biochemistry.

There was a natural gap between the third and fourth years, as clinical work began in the fourth year. Rather than progressing straight into clinical work with the rest of her classmates, Norma chose to spend a year (1957) doing research in physiology. Thus, at the end of 1957, she gained a Bachelor of Medical Science in Neurophysiology. Only three students in her class did this extra year of research, and they each had a different project that they focused on. Norma chose to take this unusual step because of her interest in physiology and research, and because “it seemed to [her] a good challenge and a good way of developing additional skills.” Professor Satchel, a physiologist, was her supervisor. Norma and the Professor decided on the project together. The BMedSci option is still available to medical students today and has become more popular over the years.

Norma was keen to begin clinical work when she entered her fourth year in 1958: “Well, I think one looked forward to the change, because it was a progression, and it was into the area of, as you might say, medicine in the more practical sense.” When she re-entered her studies, she was part of a new cohort. The large amount of work that was undertaken allowed her to work with the new members of her class. Across their fourth and fifth years of clinical training, the students rotated through all the specialty areas. Some of the specialists liked teaching students, while others were less fond of it. “I think it is quite difficult at that early stage – fourth and fifth year, to go onto a ward, and become part of that ward activity, because the people in charge of the ward are very senior. Some of them liked medical students around more than others. So, it’s a varying experience.” 

At the end of her fifth year (1959), Norma spent time in New Plymouth Hospital undertaking an elective as was required for everyone at this stage of training. She chose New Plymouth in order to gain experience working in a smaller hospital. She recalls working with a pathologist, a radiologist and a female surgeon (Jean Mary Sandel) who were all “very good” at what they did, and all acted as mentors for her. Norma found it encouraging to see a woman who was so well-respected in her role as a surgeon. The scarcity of female role models in medicine at the time is demonstrated by the fact that only two of Norma’s lecturers were women: Professor Marples, who lectured in microbiology (and had treated Norma years earlier), and Professor Heslop, who only began lecturing in pathology during Norma’s sixth year, but who was a good lecturer, powerful researcher and long-term acquaintance of Norma’s. The main hospital in New Plymouth is now the Taranaki Base Hospital which was built in 1972. 

The sixth year of medical training (1960) was also clinically based. Norma spent it at Dunedin Hospital because she liked both the city and the people who worked there. Most of her friends who by now had completed their non-medical degrees had left Dunedin, so she flatted with fellow medical students near the Oval. The examinations at the end of sixth year were challenging for Norma, as they were for all her classmates. She was glad to complete her medical school training, although she was aware that it was just the first of many challenges to come in her career. There was only a week to wait between the final exams and graduation. Norma graduated in December 1960 with credit. Her recollection of this day was that “the graduation was a wonderful time. Everyone of course enjoyed it.” She also described the event as “a great reunion” because the students who had been assigned to Wellington and Christchurch for their clinical training all returned to Dunedin. Family members were able to attend the capping ceremony.

Norma was one of 16 women to graduate in her year. As the medical school was physically separated from the university campus, the medical students were more likely to socialise with the other women in the class. For Norma, socialisation throughout her university years involved a small amount of alcohol and no smoking. Within their course, they were more likely to associate with others in the same year level and women were more likely to mix with other women.

The costs associated with the undergraduate degree meant that Norma needed to work during her summers to earn the money to financially support herself. These jobs varied from year to year: during the summers, Norma and a friend travelled between Glenorchy, Cascade Creek and Lake Ohau doing hotel  service. Another holiday break was spent working at the psychiatric hospital at Seacliff to gain more medical experience. Yet another job was at the Cromwell Hospital helping to deliver babies; this ensured that Norma performed the total number of deliveries that was required of students by the end of their fifth year. She also gained experience helping with deliveries at the maternity hospitals in Dunedin (Queen Mary) and Christchurch (St Helen’s). 

 

House surgeon years: 1961-1962

As was customary, Norma was a house surgeon for the first two years post-graduation. 1961, the first of these years, was spent at New Plymouth Hospital. Since she had spent time there during her fifth year, she had already worked with the staff and was familiar with the environment. Unsurprisingly, she now had to take on more responsibility as a house surgeon than she had during her fifth year. An advantage of working in a smaller hospital was that she was required to take on more responsibility than she would have  at a larger hospital. Norma was able to live on-site. There were mixed quarters provided for the house surgeons and some houses were available for those who already had families. The New Plymouth Hospital had all the sub-specialties. Norma rotated through general medicine and general surgical and obstetrics services. She spent time with two good physicians, and thought that she would like to become a physician herself. She also spent time with an obstetrician, and though she enjoyed this specialty, she knew that this was not the lifestyle for her. Whilst there, Norma was “privileged” to be surrounded by excellent mentors. She had a registrar who supervised her, and a consultant who supervised both her and the registrar. If there were fifth year students around, Norma was able to help them. 

Norma chose to move back to Dunedin Public Hospital for her second year as a house surgeon (1962) as she knew that the physicians there were all very good. During this year, she rotated through the general medicine services, including respiratory, cardiology, neurology and endocrinology. By this stage, she knew that she wanted to train to become a physician, and cardiology was the specialty that she was inclined towards. 

 

Registrar years: 1963-1964

Norma’s next two years were spent as a medical registrar. She was based in Dunedin, but spent the first year at Wakari Hospital and the second at Dunedin Public Hospital. During her first year, Norma did two general medical rotations, with additional experience in rheumatology, gastroenterology and infectious diseases. There was only one registrar on each rotation at a time. This allowed them to have their own particular job and to receive a lot of guidance from those more senior to them. It was competitive to get into one’s chosen placement. In this first year, Norma did not get the position that she applied for as it was granted to someone more senior than her. Wakari was a new hospital which had just opened up, and she had a “wonderful time”, finding the hospital a “great place to work”. She worked under “some really great people” while she was there, including Sir Edward Sayers, who she regarded as an excellent teacher and physician. 

Her second year as a registrar, 1964, was spent at Dunedin Public Hospital. This time, Norma did get the placement that she wanted, giving her the opportunity to spend the whole year in the Cardiology Department. As part of this, she was able to see and use all the newest technology that was available at that time, including pacemaker implantations, electrical cardioversion and cardiac catheterisation. This was an exciting time for her. In this position she worked for Professor John Hunter, who became her mentor in cardiology. While she was a second year registrar, she sat, and passed, the Royal Australasian College of Physicians exam (MRACP 1964). 

“First pacemaker was put in when I was there – John Borrie did that. John Hunter had just come back from overseas, and was setting up the technology involved with cardiac catheterisation in cardiology patients. They developed the first small intensive care unit for patients who had experienced heart attacks. So, all those things were certainly just coming aboard as I was doing my second-year registrar. Cardiology certainly looked like a speciality  that was going to move ahead in terms of advances in technology and opportunities to do more for people.”

 

London: 1965-1967

In 1965, Norma moved to London, where she spent the next three years. Medical staff were encouraged to travel overseas at this stage of their training and a grant was made available to contribute to expenses. It was hoped that they would gain knowledge and experience to bring back to New Zealand at a later stage: “That was the good thing about that period; the people coming on staff were coming back from overseas with the new skills.” London was a popular place for young New Zealand doctors to go for further training. Norma was not able to secure a position before she arrived in London, so she could only apply for positions once she was over there. The London graduates who were competing for the positions had a head start as they already knew doctors in the hospitals from their registrar years. Despite the fact that John Hunter had recommended her, Norma was not granted the coveted position she applied for at the Heart Hospital, as it was appointed to a London graduate instead. She did, however, take another position which came up at The London Hospital; that of a cardiology registrar in the renowned Cardiology Department. In this role, Norma was exposed to all forms of cardiology. Although it was even busier than her registrar years in New Zealand had been, she found it “challenging” and “exciting” because she was “learning new things all the time” and was focused on what she really wanted to do. The two cardiologists who Norma primarily worked with were Sir Wallace Brigden (a “very superior clinician and cardiologist”) and Lawson McDonald. Norma was involved in the new advancements which were occurring while she was there. This included the establishment of one of the first coronary care units in London, which she worked on with Sir Wallace Brigden. She was also involved in research around acute myocardial infarctions and specifically noradrenaline levels in acute myocardial infarctions. Along with this came the exciting opportunity to attend the cardiology meetings in London, where she was not only privy to hearing others present  their revolutionary research, but also had the opportunity to present her own findings. One talk which stands out for Norma was a visiting speaker who presented his results from the first coronary bypass grafting. 

Norma’s clinical work was predominantly with adults. A lot of her patients from the East End of London had been affected by rheumatic fever, resulting in valvular heart conditions. Most of these patients were at least 40 years, but some with this devastating condition were younger. At this stage, the only established surgery was valvotomy to split open narrowed valves, but cardiologists like Sir Brian Barrat-Boyes were beginning to do valve homografts (replacing a damaged valve with a donated human valve) which were revolutionary in the treatment of this condition. The London Hospital kept up with the newest technological advances, including cardiac catheterisation, which Norma was able to gain experience with. During Norma’s first year in London, she sat, and passed, the Royal College of Physicians exam – MRCP(Lond) 1965. Her contribution to the British Cardiac Society involved undergraduate teaching and giving seminars at The London University.

Although her clinical work was incredibly busy, Norma made the most of being overseas. She travelled as much as she could and was able to pursue her interests in drama, theatre and music. She rented an apartment through the hospital, which she shared with a paediatrician. At this stage, Norma was still unsure about what she wanted to do in the future, but she ultimately wanted to return to New Zealand.

 

Boston (September 1967 – 1970)

Norma had kept in touch with John Hunter while in London, and through this connection, she gained the opportunity to work in Boston as a fellow in the paediatric field of cardiology. She spent three years at Boston Children’s Hospital, a renowned hospital associated with the Harvard Medical School. Her first year at this hospital was spent doing research in the field of vectorcardiography in congenital heart disease; this gave her the opportunity to present at the American College of Cardiology meetings. Norma’s second and third years were spent gaining experience in all aspects of paediatric cardiology and cardiac surgery. As part of this, she trained in cardiac catheterisation and other techniques. Professor Alex Nadas was in charge of paediatric cardiology at this hospital. He was a leading paediatric cardiologist in the USA and a pioneer in this field. He was a superb clinician and mentor for Norma.

Norma found the environment in Boston very competitive, and thus very challenging. She noticed a distinct cultural difference in Boston compared with London. The British structure was much more hierarchical, while the American system involved everyone in the team (including nurses) having specific knowledge, which meant that they each had a key role in ensuring success. The American system was also much more competitive. If Norma encountered a problem, it was regarded as her responsibility to fix it, although she could seek help for major issues. There was a high standard expected of her. The hours that Norma and her colleagues worked were very long and she was under a lot of pressure. This was reflective of the time, rather than the culture of the specific hospital she was at. Even though Norma had described the hospital as supportive, there was no formal counselling to help her deal with the stress and pressure. Norma’s reasoning for why she put up with this high-stress environment was simultaneously pragmatic and noble: “Why did we do it? Well, we had patients out there who were in need of assistance. I think that was the philosophy of course, of everyone at that time. I’m not saying it was a good thing. There were times I can recall when you’ve been very tired; you’re not at your best when you’re tired, but if you have something you need to do for someone, you finish it.”

Norma regarded her paediatric work here as a great opportunity to gain experience working with children. She saw a lot of young patients who had congenital heart problems, along with their families. The work was quite different from what she had done in London, which had been with adults. Most of the paediatric patients she saw presented as blue babies or babies with holes in their heart. At this stage, operations for congenital heart conditions were just beginning. However, they were complicated, since the cardiac bypass operation was not yet well-developed. The first person who devised the technology for a bypass for a blue baby was Helen Taussig. Norma was able to hear her when she came to Boston, and she found it “a very special occasion” to hear the woman who had been involved in such ground-breaking technology. 

Norma had the opportunity to present the results of her own research at conferences. If one’s research paper was accepted, then the author was required to present. Norma enjoyed presenting at these large conferences, but it required a lot of preparation and courage as there were many cardiologists in the United States who attended. In addition to the knowledge that she learnt through her clinical work, she also read journals in her own time to keep up to date with all the newest research. 

While training in Boston, Norma was surrounded by other doctors training from Germany, Canada, France, South America and Mexico. They were all there to learn so that they could take knowledge back to their home countries to improve the cardiac treatment there: “and the people you were working with, of course, were there for the same reasons as yourself, which is to gain as much information as you could, to train as well as you could do.” Norma felt a responsibility to perform well, as she knew that people’s perception of her would reflect back to give an impression of New Zealand. The precedent Norma set must have been a good one, as she paved the way for more trainee New Zealand doctors to travel to Boston and train at Children’s Hospital. 

Norma described her salary as “adequate, but only just”. With this money, she was able to do some travelling around North America. However, since her time was restricted, most of her travelling was in relation to conferences that she attended. She did not have the money or time to travel back to New Zealand for a holiday, so communication with her family primarily occurred through letters, which were cheaper than phone calls. 

Norma also commented on the wider American context while she was living there. There was a lot of political unrest. 1968-1969 was, of course, a key time for the Black civil rights movement. This was just after Brown versus Board of Education, when Black children were being bussed to white schools.

“At that time, just of interest; there were the riots, in relationship to the racial issues, and the hospital was close to the area called Roxbury which was the Black area, and that was when they were undertaking the first bussing of the Black children to other areas in the town.” Norma remembers that there were one or two Black people working on staff in the hospital, but not in the Cardiology Department with her. This was also the time of the Vietnam War and the first moon landing. 

 

Back to Dunedin (1970-2004)

After her long training period overseas, Norma returned to Dunedin, bringing with her all the knowledge she had gained while abroad. Having completed her fellowship, her training was finished, and she came back to a post as consultant cardiologist and University lecturer. Although she could have stayed in the “exciting, dynamic, challenging” environment in Boston, this did not tempt her as she knew that she would have a greater impact in New Zealand. John Hunter offered the position to her as he needed more cardiologists on staff and particularly one with paediatric experience. “At that time, when I came back, we had three cardiologists and another one came after me. Each of the cardiologists was bringing in something new from overseas.” Norma’s home city had changed in her absence. Dunedin Hospital now had a well-established Coronary Care Unit, and Norma was able to meet her nieces and nephews who had been born while she was away. It was easy for her to adjust to the changes in the city. The general approach of the Dunedin Hospital (which was, of course, much smaller than that in Boston) allowed Norma to work with both adults and children. She was pleased to be able to work with adults again as she had trained to do this. Children with congenital heart conditions were initially treated in the paediatric ward (meaning that Norma could treat them easily), but they were gradually moved to Starship as there were so few cases.

Norma’s appointed position required her to spend half her time working clinically and the other half for the university medical school. The students she primarily spent her time with ranged from their fourth year up to registrars. Norma gave them formal lectures and teaching on the wards. This was not her first experience of teaching as she had also done some teaching in Boston. Norma was fond of teaching, finding that “it was always very satisfying to be able to hand on knowledge I’ve gained, and to see other people progressing with it”. She noticed that the medical school had progressed while she had been away; the students dressed more casually, and clinicians had more interaction with the second and third year students than they had in her day. Overall, Norma reported that the students “were always very good to work with, and it was great to be able to see them learning and advancing, and getting confidence.” For the registrars, she was not just a teacher, but a mentor. She was able to introduce them to her contacts overseas and help them train for their written and clinical examinations. Mentors had been very important to Norma as she trained, and she was able to pass this on to the next generation of doctors-in-training.

The study of medicine is constantly developing in order to improve treatments. Norma was always very open to adjusting to new technologies and refining her practice and teaching accordingly. One example of this was the introduction of cardiac ultrasound which reduced the need for vectorcardiography, as the ultrasound allowed for non-invasive diagnoses of heart problems in both children and adults. 

Norma’s incredibly successful career (which is documented in the images from her CV) continued to advance once she had returned to Dunedin. Notably, she became the Head of Department of Cardiology at Dunedin Hospital in 1975. In 1977, she became an Associate Professor of Medicine at the University of Otago Medical School. In 1991, she became the first female president of the New Zealand Medical Association (NZMA). Her many achievements were formally recognised in 1992 when she became a Dame Commander of the British Empire for contributions to medicine and particularly cardiology. 

Norma had a long involvement with the Royal Australisian College of Physicians (RACP). She was the first woman to be invited to join the Board of Examiners for the college. This involved examining registrars who had to sit a written as well as a clinical examination to attain membership of the college.

She subsequently was Chair of the examining board for several years. Norma was also Chair of the NZ Committee of the RACP and as such represented the New Zealand arm of the College as well as representing New Zealand on the Australian Board.

As part of her university role, Norma was Chair of the medical admissions committee of the University of Otago. This committee determined which students were admitted to the medical course. The admission from medical intermediate was solely based on grades achieved. However, some students were able to enter through a ‘special’ category (postgraduate students and those from other walks of life). Applicants in this category were interviewed.

 

Retirement: time for herself (2005-present)

Norma retired gradually, initially moving to part-time work for about three years. During this stage of partial retirement, she gave up teaching, but continued her clinical work until a returning doctor from overseas was able to fill the role. It was around 2005 when Norma retired completely. Although she found it hard, she was philosophical in that “it is a fact of life, that sooner or later someone is going to retire”. She chose to cut herself off completely from her work, and instead enjoyed the freedom of her retirement. Amongst the aspects which she has enjoyed are the increased opportunities to travel overseas, in particular to Australia, as well as having more time to spend with her nieces, nephews and friends, and having time to pursue her musical interests. She has also continued in her pursuit of knowledge through her involvement with the University of the Third Age, a group who give lectures about interesting topics (such as politics). Both of Norma’s siblings have also ended up in Dunedin after their travels away. Her sister grew up to study physical education but changed to a vocation in teaching, while her brother works for the Otago Harbour Board.

Norma was a trail-blazer in many aspects of her life, including working in the Cardiology Department in Boston, being the first female president of the NZMA and being the first female on the Board of Examiners. She felt pressure to do a good job, in order to set a precedent for this to continue in the future. She explained this eloquently when talking about being the first female on the Board of Examiners: “You’re trying to do that all the time, so that it becomes second nature that if that person is a good examiner, it doesn’t matter what sex or what colour; they’ll be invited to be an examiner. Over the years, that certainly has become easier, but certainly there would be entrenched views among those male examiners who knew everyone – they knew all their colleagues very well, and they’d examined together for a long period of time. So, having me come in and sort of push them apart a bit, I think they accepted it pretty gracefully.”

In ‘Anatomy of a Medical School’, Dorothy Page described Dame Norma Restieaux as a “superb teacher and gifted clinical cardiologist”. When asked what she was most proud of in her career, Dame Norma’s reply outlined the three most important aspects for her: contribution as a cardiologist to patient care, contributing to medical advancements, and passing on her knowledge to future generations of doctors by teaching.

 

Further details of Dame Norma’s illustrious career can be found in her Curriculum Vitae: CV PDF

Bibliography:

• Dame Norma Restieaux interview transcript
• Dorothy Page: Anatomy of a Medical School, page 297
• Victor Hadlow. ‘Sandel, Jean Mary’, Dictionary of New Zealand Biography, first published in 2000. Te Ara – the Encyclopedia of New Zealand, https://teara.govt.nz/en/biographies/5s1/sandel-jean-mary (accessed 2 December 2020)
• Taranaki District Health Board. (2013, July). Base Hospital Opening. Pulse: the newsletter of the Taranaki District Health Board. Retrieved from https://www.tdhb.org.nz/news/documents/Pulse_2013_07.pdf