Making the most of opportunities

An interview with Dr John Cullen

Takapuna’s Dr John Cullen MNZM has been described as the “father of orthopaedics” in New Zealand, with an illustrious career as an orthoppaedic surgeon spanning nearly 60 years. He is New Zealand’s 131st Olympian, as well as a man who has pursued his vision for a new way to organise surgical practices and the training of orthopaedic surgeons. Most recently he was the driving force behind the transformation of a section of the Lake Pupuke shoreline in front of North Shore Hospital. Christine Young talked to him about his achievements in medicine and beyond.

All this seems far removed from his early life. John Cullen was born in Greymouth and lived his first seven years at the tiny village of Ikamatua, 50km north. In 1945 his teacher parents shifted to Fiji, where his father was headmaster at the Fijian mines school at the goldmining settlement of Vatukoula on the main Fijian island of Viti Levu. Fijian schools in those days were segregated (Fijian, Indian and European) so seven-year-old John was unable to attend the school his father taught at. Instead, for the next seven years, he boarded at Suva Boys Grammar School, and travelled home to his parents only three times a year.

In 1952 the family returned to New Zealand, where his father was head of the Nūhaka Māori school on the East Coast between Napier and Gisborne. John spent two years boarding at Napier Boys High School before being accepted for medical school at Otago University. It was, he admits, a “different” background to many of his peers.

In Napier, unlike in Fiji (where “you played cricket one day, rugby the next” and other sports on any other day) involvement in different sporting codes was more circumscribed. John began by playing rugby, but after having a try disallowed (he thought unfairly) he “went to the next field”, switched codes and took up hockey. He was included in the team for the secondary schools’ national tournament, “did well”, and “went from there” he says simply of his progression to the New Zealand team that played at the Rome Olympics in 1960 (and came fifth – still the highest placing ever except for the gold the New Zealand men’s hockey team won at Montreal in 1976) and the subsequent 1964 Tokyo Olympics.

In fact, at one stage at university, he abandoned hockey for a time. With what seems characteristic tenacity, he resumed his involvement in the sport, and says now that it is an example of how taking opportunities as they arose has led to his many career successes. For example, continuing to play hockey at Otago opened up the opportunity not only to go to the Olympics, but also achieve a scholarship to Oxford> There, he was invited to play for Oxford, gained a “Blue” twice in the Oxford team that played Cambridge – and gave him access to the university establishment (and perhaps the insights that led to his lectureship and later Associate Professorship at the University of Auckland Medical School – not to mention an MSc from Oxford in 1981).

But we digress. By the time he was selected for the team for Rome, John was a fifth-year medical student with exams imminent. “It was a big thing for me and for the medical school,” he says. The team was away for some time, as they not only played in Rome but also toured India and Pakistan, and the university arranged for John to sit special exams on his return. 

John completed his university studies in 1961 and moved to Palmerston North, where he spent two years as a house surgeon followed by a year as pathology registrar. By then the Tokyo Olympics loomed. After competing there, he decided it was time to retire. Little wonder. Juggling a rapidly developing and challenging career with top level sport was no mean feat. As a house surgeon he was rostered, on top of his regular day, to work every second weekend and every second night. To get time to ensure he could play hockey each Saturday, and to fit in the necessary fitness work, he had to swap shifts with his partner house surgeon, and work four nights a week. “There was quite a bit of time involved,” he admits. “It was difficult to do your job and maintain the necessary level of fitness. You wouldn’t do it now.”

In addition, sports in New Zealand in those days were still amateur. None of his trips overseas were paid for in any way – players had to raise all their own funds, and the only things he ever received free, he says, were a tin of Bournvita and a pair of hockey boots. The rest he did with “lots of support from family and others”.

Having retired from Olympic level sport, John continued to play hockey into his mid-fifties. He only fully retired from the game when his body gave a clear message via “a few” torn muscles.   He shifted to cycling, and has completed more than 30 overseas cycling trips, including to Argentina, Tasmania, Italy, France and other parts of Europe. Confined now to New Zealand, he has recently returned from cycling the 186km Round the Mountains trail near Queenstown with family, and a five-day trip in Northland.

But back to his career. Olympics over, “I needed to decide where I was going to go in medicine,” John says. He decided surgery suited him best and moved to Dunedin where he was mentored by an orthopaedic surgeon. From there, on the back of his academic and sporting success, he was awarded the previously mentioned scholarship to Oxford attached to orthopaedic surgery. “The die was cast.” He headed to Oxford in 1968 with wife Margaret, who he acknowledges gratefully “for her encouragement, support and tolerance over many years”, and their three children.

Looking back, he is satisfied it was a good choice. He enjoyed the surgery, and was, as the saying goes, in the right place in the right time. New ways of treating orthopaedic injuries and issues were emerging. When he started, most broken bones were treated with a combination of plaster casts and traction – and long stints in hospital for many patients. Now, he says, a femoral fracture, that previously involved traction of up to three months, is now treated with the insertion of rods, and the patient is out of hospital in a matter of a couple of days. “There are cost savings, and the end results are better,” John notes.

He was lucky, he says; in his early career he operated on patients with neck, spine and shoulder issues as well as hip and knee injuries. He wasn’t expert, he admits, “but you were exposed to a wider range of surgeries.” Gradually, he narrowed his focus to and developed his expertise in total knee and hip surgeries.

When he returned from Oxford in the 1970s, New Zealand was on the cusp of developments in orthopaedic surgery. While hip replacements were being done here at that stage, John was at the forefront as other total replacement surgeries (knee, shoulder, elbow, ankle…) were developed. He did the first total replacement knee surgery in New Zealand. His career developed rapidly.

“It was a period where you had to learn by the book,” he comments, rather than at the side of a more experienced surgeon. Without the  “apprentice” system, you may not have the same guidance, he adds, but it meant that doctors learnt what is most relevant to them.

He spent just a few months at Middlemore, then moved with two other surgeons to start an orthopaedic service at Auckland Hospital. Twelve years ago, he started the orthopaedic service at Waitemata District Health Board.

“Starting the orthopaedic service at North Shore Hospital was not something I’d thought about, but thought I should do it anyway.” It was another example of an opportunity taken, though he admits it was “personally taxing, as some colleagues were not keen on an independent unit at Waitemata. But sometimes you have to stand to one side and do what you think is best.” 

North Shore is now the biggest orthopaedic service in the country, with more than 20 surgeons.

John has long been an advocate for more structured teaching and learning, especially as surgeons are far more likely these days to become highly specialised in one area of surgery. This advocacy, as well as his response to requests (demands?) to save money, led to two of John’s major achievements: building a specially designed free-standing elective surgery centre, designed to drive efficiencies as well as more effectively manage elective surgeries, and the more recent development and opening of the Waitemata District Health Board Clinical Skills Training Centre at North Shore Hospital.

“Over the years,” John says, “you get bombarded with requests to save money.”  He thought the way District Health Boards went about doing this – what he calls “removing the scones from the tea room” – was not the way to approach it. Most costs in medicine are related to people, he says, and he believed that if they could do the same operation in the same operating room with the same team (surgeon, nurses, anaesthetist…) “we could develop efficiencies”. The idea was to operate and manage more effectively with fewer people; by asking more of the consultant surgeons, a whole tier of staff could be removed. John wrote to the Minister of Health and after a trial at Waitakere Hospital saved more than 20% of costs in patients staying overnight, gained approval to build the Elective Surgery Centre (ESC) on the North Shore hospital site.

John is officially described as the clinical sponsor of the project. With the opportunity to oversee the dual ESC and Whenua Pupuke–Waitemata Clinical Skills Training Centre projects, at age 70, John stopped operating and – he hesitates as he describes the role – became the clinician giving advice as to how it should work. “I had the expertise and the vision about how to make it work, and the building had to conform to that. It was built so it allowed new ways of working to happen.”

It was only four years ago, however, that John “deliberately deregistered” himself (“to remove any temptation”) and officially retired as a surgeon. Despite so-called retirement, he is as wary of the term now as he was when interviewed at that point.

“Retirement to me is an odd concept.” While people talk about it as an opportunity to have time to do things you want to do, he says he’s always done things he wants to do. “Retirement is difficult to understand. It has always been important to me to look forward to doing things and to have a specific project. I would be lost without things to do, whether it was in sport – doing it and doing it well; surgery, doing it and doing it well, or landscaping...” – the latter in reference to the lakeside transformation from a willow-clogged swamp into a landscaped garden in front of Whenua Pupuke–Waitemata Clinical Skills Training Centre that allows easy access to the lake for hospital patients and staff and the public, and links with lakeside restoration work and a walkway created by Auckland Council.

John remains employed by the Waitemata District Health Board, and 12 months ago joined the Board of Well Foundation, that supports the Waitemata District Health Board and with which he has had much contact over the years. He hints at another project that he hopes will get off the ground soon and likely be completed in the next couple of years.

It’s clear this achiever is far from retired in the ordinary sense of the word. At the same time, he is able to reflect on his career to date.

“For me it would be a disappointment at the end of one’s life to look back and say ‘I wish I’d done…’ I’ve tried not to do so, so when opportunities have risen, I try to embrace them even if they are inconvenient at the time.”