Rob Ziffer in the Intensive Care Unit at Sale Hospital last week.
Dr Rob Ziffer has seen a lot during his decades of work as a physician at Sale Hospital.
The medical cases presented to him have only been part of a bigger picture that is the workings of the Sale hospital which celebrates 150 years in August.
There’s been changes in staff, advances in medicine, building renovations, variations in services, not to mention numerous consultations with community members, some positive, some not, over the years.
For the young man who at first thought he wanted to be an architect, medicine has provided a career that has seen Dr Ziffer navigate interesting, ever-changing and sometimes treacherous waters but at the heart of all of this has been the human connections he has made along the way.
Growing up in Melbourne and starting his career at St Vincent’s Hospital, then working overseas, he became a physician and then did cardiology.
“I guess there are some facets of medicine as a physician which are more hands-off….and there are some that have a bit of adrenalin in them like cardiology and intensive care. I liked the physiology of the heart and it’s a very common disorder so there’s lots of challenges there.”
In the late 70s married with one child and another on the way, Dr Ziffer saw a job advertised in Sale.
“My wife and I thought we’d try going down to Sale and see how we liked it for a year or two,” Dr Ziffer recalls. “My son was born just two weeks before we moved there. A bit stressful for my wife – she’s a great woman!”
His first memories of the hospital in 1978 was that it was “well established” with a small intensive care unit but overall it was “very different” from St Vincent’s.
“At a bigger hospital, you have a much bigger hierarchy with many more consultants with various skills and sub specialities, you then have registrars and senior people doing training to support you and a whole range of junior staff.
“When I got to Sale there was one unit, one first year graduate and that was it.”
With much responsibility came much learning, according to Dr Ziffer.
“The upside is that it gives you more freedom to develop, you had to make a lot of calls yourself and do the best you could in the circumstances.”
D Ziffer says he worked hard to strengthen the intensive care unit, particularly with nurses to ensure there was a great team to assist.
“At the time, most of the girls had to train out of town which was difficult with their families in town so we developed a system where we ran our own course for their training and it gradually became more formalised and eventually merged with a training course through Monash (University) predominately done in Sale.”
Not long after starting at Sale, the hospital added an oncology unit – the first in Gippsland and later a dialysis unit – a move to ensure regional people could receive high end medical services.
Dr Ziffer said with great allied health, pharmaceutical, pathology and imaging services, Sale became a stop-off point for people from East Gippsland where services might not have been as substantial.
After around three years at Sale, with a third edition to his family, and another physician arriving at the hospital, Dr Ziffer and his family felt Gippsland was truly their home.
“We really liked the area, there’s a great community spirit, the kids settled in school and we made a lot of connections in the area.
“I see people I’ve helped down the street and my problem is I often remember their conditions better than their names,” Dr Ziffer laughs.
Being a physician in the country has meant Dr Ziffer has often ran into his patients while out and about.
“I was fairly tough about people stopping smoking after having a heart attack and I remember running into a patient in the supermarket who was having a cigarette. He rapidly put it in his pocket when he saw me coming and I could see the smoke coming out. I thought I’d go and have a chat to him and see how long he could hold it. In the end, he had to pull his hand out of his pocket because he was worried he was going to burn his pants.”
Dr Ziffer has also had friends turn up as patients.
“The strong principal there is you never do for them what you wouldn’t for anyone else. You can come to grief if you try and do too much, things can get complex, over-treating can become a negative. That doesn’t mean you can’t be friendly, but at a professional level you have to know what your boundaries are.”
During his almost 40 years working in Sale, Dr Ziffer said the advances in medicine had been significant.
“Medicine has become so sophisticated, the rate of progress has been enormous in the way we use information, the rapidity you can get results, the improvement in imagery and pathology.”
He said the hospital was essentially re-built over the years of 87-91 “with a terrific design that really helped”.
As a physician working in intensive care and specialising in cardiology, his own adrenalin has had some serious workouts.
“It’s a sharp sword – terrific when it works and very tough when it doesn’t. It’s a challenge to use it to your benefit and manage the down sides. That takes a lot of experience. That was the benefit of working with a great team of people where everyone supported each other and there was a lot of opportunity to debrief when things didn’t go as well as they could have, to help people through it.”
Working with many great people over the years is something Dr Ziffer has valued highly throughout his time at Sale.
“You form strong relationships, respect them as professionals and value everyone’s input. I really liked working in a horizontal model of care where nobody is supreme, everyone’s contribution is valuable. When you wind back a little bit, they’re the sorts of things you miss most.”
Dr Ziffer has now closed his rooms and taken himself off the hospital roster but still practices around 10 hours a week, including teaching young medical students.
His best advice to them is to “make sure you get the basics right”.
“The basic guts of it is to take a good history, relate to patients and make connections; that’s where you get your information from. Everyone loves talking about something new… but basically most of medicine it still very dependent on that relationship with two people and getting that right is very important.”
And connections are something Dr Ziffer values highly and remembers fondly when he thinks about his long career in Gippsland.
“My best memories of the hospital are the way it works as a people place. A place run by people for the people and because those people are your own community, there’s a lot of compassion there around care which probably goes a bit beyond what you’d get in a professional institution. It’s that quality of people, working together, that has been my favourite part of the hospital.”