The Montreal Gazette, November 24, 2004

Sébastien Lavigne owes his life to delicate surgery at The Children’s

By Warren Perley

Neurosurgeon Jean-Pierre Farmer was plotting his moves with surgical precision in what would be an eight-hour marathon operation as he marked the shaved skull of 5-year-old Sébastien Lavigne to pinpoint the location of the young boy’s brain tumour.

Outside the operating room at The Montreal Children’s Hospital of the McGill University Health Centre (MUHC), Sébastien’s parents, Renald Lavigne and Hélène Tessier of Terrebonne, prayed for “a small miracle." Just hours before the operation that September day in 1997, Renald had held Sébastien in his arms, rocking him while they sang Frère Jacques and Au Clair de la lune.

Tessier recalls asking Dr. Farmer whether her son could die on the operating table in the attempt to remove the tumour the size of a golf ball from his brainstem. The reply: “No - but there are no guaranties with this kind of surgery, and he is acutely ill."

It was estimated that without the operation, Sébastien would have only three months to live. For more than a year prior to the operation, his health had deteriorated drastically - vomiting, dizziness, migraines, as well as problems with his sight, hearing and speech.

The operation went well, but Dr. Farmer elected to terminate the procedure after a large part of the tumour had been removed and after the boy’s heart rate began to destabilize under anesthesia. The doctor planned on a second stage of surgery once the decompressed brainstem and the residual tumour had reconfigured themselves.

A Magnetic Resonance Imaging (MRI) examination after surgery revealed 60 to 65 per cent of the tumour had been removed. Two months later, after a repeat MRI showed that reconfiguration had occurred and after Sébastien showed clinical improvement, Dr. Farmer and Dr. José Luis Montes, head of pediatric neurosurgery at The Children’s, operated on their patient a second time to remove another 35 per cent of the tumour.

Sébastien, who turned 12 on Sept. 3, has made a full recovery. He is able to take part in physical activities, such as skating and biking, with friends and his younger brother, Jonathan, 9. But his real passion is reading, writing science-fiction stories and creating games.

His recovery is one of thousands of positive stories that have been recorded since The Montreal Children’s Hospital first opened its doors in 1904.

The Montreal Children’s Hospital gets support from generous donors

Parents such as Renald Lavigne and Hélène Tessier, whose children have been healed by the hospital’s dedicated doctors and nurses have come to understand the critical support role played by the Montreal Children’s Hospital Foundation, which has raised in excess of $175 million in private donations since it was set up in 1973.

The foundation, headed by Louise Dery-Goldberg, has a mandate to raise public awareness and funds for the purchase of medical equipment, renovation projects, programs and research. Equipment such as the multi-million-dollar Frameless Stereotactic System, a combination of hardware and software which allows neurosurgeons to take pictures of the brain in slices 1 1/2 millimetres thick using MRI and to transform those images into a three-dimensional reconstruction of the brain, as Dr. Jean-Pierre Farmer and Dr. Jose Luis Montes did in the case of Sébastien Lavigne.

The three-dimensional, reconstructed brain images are then transferred to a console in the operating room and superimposed on the actual brain images the surgeons see through their microscopes as they operate. Called neuronavigation, the three-dimensional images enable surgeons to determine more precisely the outside edges of the tumour so that they can plan the best surgical approach to avoid removing healthy brain tissue when they dissolve and aspirate the tumour with micro instruments.

Before the advent of such advanced computerized imaging, surgical interventions in the brain could leave patients impaired due to the inadvertent destruction of healthy tissue. In the case of Sébastien, Dr. Farmer and Dr. Montes were able to remove only the benign tumour - which was compressing the brainstem but had not grown tentacles into the brain itself - without damaging their young patient’s healthy tissue.

Bilingual Dr. Farmer, who was educated at McGill University’s medical school before doing his neurosurgery fellowship at New York University Medical Center, says equipment purchases by the foundation have kept The Montreal Children’s Hospital on the cutting edge of pediatric services in North America.

“It’s clear that we’re privileged to work in such an advanced environment,” Dr. Farmer said in a recent interview. “The foundation has allowed us to play a leading role in pediatric surgery. We have nothing to envy of our colleagues in the U.S.”

Dr. Montes said The Montreal Children’s Hospital is one of only two Canadian hospitals - the other is The Hospital for Sick Children in Toronto - and one of 17 across North America with a fellowship to train pediatric neurosurgeons. Candidates for the program already have about seven years training as neurosurgeons before they begin training at The Montreal Children’s Hospital of the MUHC.

“If it were not for private funding through The Children’s foundation, The Montreal Children’s Hospital would not be on the cutting edge,” Dr. Montes said.

The hospital’s annual operating budget of about $76 million comes from the Quebec government and covers salaries and general supplies such as drugs, medical instruments, prostheses and implants. In the fiscal year ended March 31, the foundation raised an additional $14 million, of which 50 per cent went toward the purchase of advanced medical equipment and technologies, said Diane Borisov, the hospital's interim associate executive director.

Of that $14 million raised by the foundation, about $3.2 million came from community events such as golf tournaments, curling and cycling competitions, car washes, bake sales, dances and runs, as well as events such as the ABC Awards Ball and Pedal For Kids, said Valerie Frost, foundation director of special events. In 2004, there were almost 300 community events planned, including a three-day radiothon by Standard Broadcasting Montreal, which raised $1.2 million.

Donors support the Montreal Children’s Hospital Foundation in a variety of ways, thereby contributing to the improved health and well-being of children and adolescents. For example, the Gift Planning Program incorporates the benefits of estate planning and the tax advantages of long-term giving through financial vehicles such as life insurance, annuities and endowments. Donors support major projects - including renovations, equipment and research - by giving a monthly gift, by being a Governor or by contributing to In Honour or In Memoriam tributes.

In total, the foundation recorded 50,000 donations last year.

For more than 30 years, a volunteer board and several committees have governed the Montreal Children’s Hospital Foundation. Their role is to ensure that the foundation is managed in the most cost-effective manner.

The foundation has its origins in 1973 when - after the death of his only daughter, Penny, from leukemia - John (Jack) Cole established the Penny Cole Foundation to support research in pediatric hematology/oncology. Due to his experience at The Children’s with his daughter, Cole also spearheaded the concept of the Montreal Children’s Hospital Foundation and became its first chairman. His support of The Montreal Children’s Hospital spanned more than 50 years, until he passed away this fall.

Louise Dery-Goldberg, president of the foundation for the last six years, points out that aside from fundraising, a lot of effort is put into raising public awareness about the quality of service and medical breakthroughs pioneered at The Montreal Children’s Hospital over its long history.

For example, the hospital had the world’s first respirator, later known as the iron lung. It performed the first operation to repair congenital heart defects in Canada and it set up the first pediatric psychiatry department in the country. It was the first pediatric hospital in Canada to establish a department of medical genetics and a centre for children with learning disorders.

After becoming a teaching hospital connected to McGill University’s faculty of medicine in 1920, nurses set up home-care programs for very ill children - an early precursor to outpatient care. And it was due to the hospital’s pioneering spirit that the government passed regulations to have Vitamin D added to milk.

Today, the hospital has 170 beds and more than 1,700 pediatric specialists, nurses, technicians, managers and support staff. In 2003, more than 180,000 patients were treated - 64,000 through emergency and about 120,000 in clinics, day surgery and intensive ambulatory care.

Diane Borisov said the hospital focuses not only on diagnosis and treatment, but also on prevention through counselling and public education.

Hugh and Martha Hallward, co-chairmen of The Children’s centennial celebrations this year, have long-established connections to the hospital on both sides of their family. Martha Hallward’s great-uncle - the Hon. Sidney Fisher, minister of agriculture in Prime Minister Wilfrid Laurier’s cabinet - was one of the hospital’s founding directors at the beginning of the 20th century, as was Hugh Hallward’s grandfather, Hugh Graham (Lord Athelson), publisher of the Montreal Star.

Both Fisher and Graham greatly admired Dr. Alexander Mackenzie Forbes, a young orthopedic surgeon at the Montreal General Hospital, who was a driving force advocating the establishment of a children’s hospital to treat the many youngsters who suffered from bone tuberculosis, congenital defects and complications of acute illness.

One of the best-known early supporters of a separate Montreal hospital for children was Sir William Osler, himself a Canadian-born graduate of McGill’s faculty of medicine who, in 1889, became the first professor of medicine at Johns Hopkins University in Baltimore.

Dr. Osler wrote a letter to the founding directors, which read in part: “Such a hospital as you describe would be of the greatest help and benefit. …Will you kindly put me down as an annual donor?”

The hospital rented premises for $20 a month at 500 Guy St., just south of Sherbrooke St., and opened its doors on Jan. 30, 1904. Even in its incipient stages, the new hospital - with a bilingual name and brochures in English and French - drew tremendous support from the citizens of Montreal.

In November 1903, a downtown teachers’ college sent a cheque for $445.20 - the proceeds of an art sale by the children of Montreal. A ladies’ hospital committee was set up and began raising funds through bazaars and bake sales; in the fall of 1903, its first dance at the Windsor Hotel raised more than $400. In October 1904, the public school children of Montreal held a city-wide bazaar in the gymnasium of the Montreal High School, raising $6,483.30 for the new hospital.

“The Montreal Children’s Hospital has always been a first-class institution,” Hugh Hallward said. “People in the community are proud of it. We need such a facility dedicated to the care of children, who require different care than adults.”

Martha Hallward said all five of her children and her seven grandchildren have had occasion to use the hospital’s services over the years. “The doctors and nurses at the hospital are absolutely wonderful,” she said. “The centennial celebrations have allowed us to raise the profile of the hospital and let the public know just how good the facilities are.”

Remaining centennial events include Growing Up in Montreal, a year-long exhibition at the McCord Museum, which started in October. It focuses on childhood in the 20th century, with special attention paid to the influence of The Montreal Children’s Hospital.

On Sunday, Dec. 12, the centennial-year celebrations will close with Fête Folie, a family day at the chalet on Mount Royal for families and friends whose lives have been touched by the hospital.

Looking ahead, a key goal for the MUHC is its redevelopment plan, which calls for a health centre at the Glen campus, including a state-of-the-art children’s hospital and a downtown campus at the Montreal General Hospital site. For the foundation, the challenge is to raise $300 million in private donations to make this plan a reality.

Marc Courtois, current chairman of the board of the Montreal Children’s Hospital Foundation, is heavily involved in the new Best Care For Life capital campaign which will be officially launched in the next few months.

“We’re getting positive feedback and we’re seeing some real leadership from traditional donors to the hospital,” said Courtois, a retired investment banker who worked at RBC Capital Markets until 2001. “This is a real community-building exercise to meet the challenge of growing health-care needs driven in part by rapid technological improvements.”

Like others involved in The Children’s foundation, Courtois’s hospital roots run deep. As a child, his pediatrician was Dr. Jessie Boyd Scriver, who was among the first four women to graduate from McGill’s faculty of medicine in 1922 and had a distinguished career as a pediatrician. Courtois’s father was heavily involved in the hospital’s last major capital campaign from 1989 to 1995, and his wife, Alexandra, is a volunteer with the foundation and was co-chair of the 2003 ABC Awards Ball for The Children’s.

Dr. Arthur Porter, the MUHC’s CEO and director-general since last April, is proud of the development plans for the Glen campus.

“We envision the future Montreal Children’s Hospital on the Glen site to be the beacon for pediatric health care excellence in the world,” he said in a recent statement. “The Children’s will continue to advance its expertise in - among other ultra-specialized fields - genetics, trauma, cardiac care, brain behaviour and development, and musculoskeletal care. …We’ll ensure that our pediatric research projects give our patients access to the latest treatments, medications and procedures.”

Parents such as Renald Lavigne and Hélène Tessier, whose son Sébastien received a new start at The Montreal Children’s Hospital, understand the importance of expanding hospital services and the fundraising which is needed to support such ambitious plans.

“We saw first-hand what these donations mean,” Tessier said as she watched Sébastien talking with Dr. Farmer during a recent visit to the hospital. “Our son is alive because of the generosity of donors who have given to the Montreal Children’s Hospital Foundation. This is a great hospital which serves the needs of all the children of Quebec and deserves our support.”

Warren Perley, a former career journalist, is president of Ponctuation Grafix, a marketing and graphic design studio (www.ponctuation.com).