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Biographical entry Lichter, Ivan (1918 - 2009)

ONZ 1997; MB BS Witwatersrand 1940; FRCS 1949; FRACS.

Born
14 March 1918
Died
12 June 2009
Occupation
Specialist in the care of the terminally ill and Thoracic surgeon

Details

The recent death of Ivan Lichter ONZ has deprived New Zealand medicine of an extraordinary talent. Not only did Ivan have a very successful career as a thoracic surgeon but he went on to become a leading authority and visionary in the care of the terminally ill patient.

Ivan was born in South Africa and graduated from the University of Witwatersrand (Johannesburg) in 1940. After spending some time in the South African armed forces, he specialised in thoracic surgery and built up a successful practice.

He married Heather Lloyd in 1951 and they had four children: twins David and Jonathan who both practise medicine, Barry a journalist and Shelley who is also practising medicine.

South African politics and a strong anti-semitic movement saw Ivan move his family to New Zealand in 1961. He told me that his choice was either to go to some place in Texas or to a place called Dune Din (!) in New Zealand. Thankfully he chose the latter, where he joined John Borrie. Between them they provided the thoracic surgical care for the lower half of the South Island.

It was my pleasure to be Ivan's registrar in the 1970's as I was starting out in my training. Ivan was a meticulous surgeon. He bought a systematic and very disciplined approach to surgical issues. His pre-operative assessment always started with a thorough history and examination and then a careful review, in strict chronological order, of the radiology and other investigations. A complete picture was established which allowed the optimal planning for treatment.

He also had a strong interest in research. He was the first in the world to use oesophageal motility studies in clinical medicine. He had modified a standard nasogastric tube to allow the recording of oesophageal pressures at three levels - five centimetres apart. It was not the most refined of devices and the motility studies became known as the 'chunder studies' - I suspect Ivan was unaware of this. His initial papers were not accepted for publication due to the reviewer's lack of understanding of oesophageal physiology. However, he was recognised by those that were to become world leaders in this field and they corresponded with Ivan on a regular basis.

Ivan was a pioneer of overnight pH studies - this being done with a rather industrial pH probe which had to remain in the oesophagus overnight. However, the information gathered allowed him to take a rather more scientific approach to hiatus hernia surgery than was possibly the 'norm' in the 1970's.

He also took a keen interest in undergraduate education. He was an advocate of clear concise record keeping and he championed the same discipline that he bought to the operating room to this aspect of clinical medicine. The principle of SOAP - S(subjective), O(Objective), A(Assessment) and P (Plan) - was promoted by Ivan and the patients' notes had pre-printed forms with these headings. He felt that this lead to a logical and more accurate approach to patient care.

He participated in College activities and was, for a period of time, an examiner in cardiothoracic surgery.

Ivan was fundamentally a shy person. It is also fair to reflect that he did not suffer fools lightly. Outwardly he did not display a great deal of emotion and for this reason Ivan was considered by some to be somewhat 'cold' and distant. Although those of us who worked closely with him knew differently, it came as a surprise to his colleagues when Ivan moved into the emotionally demanding field of caring for the terminally ill. He is considered by many to be the founding father of the modern hospice movement in New Zealand.

This new direction for Ivan was really an extension of his philosophy that the needs of the patient were a clinician's prime concern. In the 1970's he was holding multidisciplinary meetings regarding his patients which included all medical and allied health personnel involved in their care. They were held in the Chapel of Wakari Hospital and became known as the 'prayer' meetings, but they left a lasting impression on a surgical Trainee - probably more interested in cutting than cuddling at that stage - that what we do as surgeons in the operating room is only a small part of overall patient care, and that the non physical needs of the patient are as important as the physical needs, if not more so.

Ivan retired from thoracic surgical practice in 1982. By this time his interest in palliative care was a passion. He had been influenced by Kubler-Ross's work - particularly by her book "On Death and Dying". He left Dunedin in 1986 and moved to Wellington to become director of Te Omanga Hospice where he remained until 1993.

Ivan was awarded New Zealand's highest honour, the Order of New Zealand (ONZ), in 1997 in recognition of his contribution to medicine and in particular for his promotion of the principle of holistic patient care. He also published widely in this field.

The exodus of talented medical practitioners from South Africa has been of benefit to New Zealand for a number of years, and no more so than when Ivan Lichter decided to make his home here. Ivan's contribution to New Zealand medicine has been immense. As a skilled thoracic surgeon he helped many patients and as a mentor he instilled sound surgical principles into his trainees. However, I suspect his greatest contribution came at a time when most surgeons would have chosen retirement. Ivan developed an interest that turned into a passion that saw him at the cutting edge of caring for the terminally ill patient. The benefits that have accrued as a result of this are immeasurable.

Richard Bunton

Sources used to compile this entry: [Republished by kind permission of the President and Council of The Royal Australasian College of Surgeons from In Memoriam (http://www.surgeons.org/member-services/in-memoriam)].

The Royal College of Surgeons of England