Toronto Surgeon Nicholas Obney Helps Hernia Patients Recover and Get Back Home Fast
There is on the outskirts of Toronto a white colonial-style mansion set in a verdant 27-acre landscape, where bluejays and cardinals twitter among red maples and Norway pines in summer, and rabbits and pheasants skitter across the snow in winter. It has a tennis court, a putting green and a waterfall, and looks altogether like a plush resort. It is, in fact, sometimes called "the Shouldice Hilton." The "guests" there have only one complaint: They need hernia surgery.
Dr. Nicholas Obney, 64, is chief of the medical staff of what is known officially as the Shouldice Hospital, and he has personally performed 28,000 hernia operations there. Because the hospital's surgeons use techniques pioneered by its founder, E. Earle Shouldice, in the early 1940s, recovery from hernia surgery at this hospital is so fast and the total cost so cheap that 49 percent of the patients come from outside Canada.
Actor Chuck Connors, opera star Jon Vickers (who gave the nurses singing lessons) and Michigan Gov. William Milliken would be in any U.S. chapter of Shouldice hernia alumni. The oldest patient was 100, the youngest 4 weeks old. Twelve hundred people are on the current waiting list for hernia operations at the 89-bed hospital. One reason: The whole package, including surgery, costs about $800. A comparable operation in Chicago averages $2,500; in New York, $3,000.
A hernia is a protrusion of an organ through a tear or defect in the abdominal muscle wall. It often causes severe discomfort and eventually should be repaired to prevent complications. Obney performs three or four hernia operations each day, and neither he nor his nine Shouldice colleagues do anything else. They use Shouldice's original technique, which entails cutting through all the muscle in the hernia area and then separating the layers of muscle tissue, closing the hole by overlapping each layer and securing everything with fine stainless steel wire.
The hospital is renowned for expertise. One of every 100 patients is a physician. Only one in every 200 Shouldice patients needs a second operation for the same hernia; the U.S. average is 16 out of every 200 patients.
Their success derives in part from postoperative procedures. There are no TV sets or telephones in the rooms. Patients are encouraged to stay out of bed, and must walk a long flight of steps to get to the dining room. Getting patients back on their feet fast originated with Shouldice, who noticed that children who refused to stay in bed after their hernia operations seemed to get well faster. Most Shouldice patients are on their way home after three days.
If they come back, it is usually for the annual reunion, a party held at the Royal York Hotel in downtown Toronto. These days Obney is always the guest of honor, and at the hotel he supervises checkups of many of the ex-patients, 1,500 of whom showed up last January. (There have been about 140,000 hernia patients at Shouldice since 1945; 96 percent of them have been males, who are especially vulnerable to hernias because of weakness where the sperm ducts and blood vessels pass through the abdominal wall.) Dr. Blaise F. Alfano, executive secretary of the Society of Abdominal Surgery, says many U.S. doctors have copied the Shouldice method: "Shouldice results are excellent."
Born in the Ukraine, Obney emigrated with his parents to Toronto, where he was a brilliant student throughout his school years. His father, a machinist, borrowed $300, and Obney worked summers on a farm to pay his tuition at the University of Toronto. After finishing medical school in 1942, Obney entered the Royal Canadian Army Medical Corps. On his discharge, a superior recommended him to Shouldice, who was just starting in his new hernia hospital. Obney joined Shouldice in 1946 and has been at the hospital, which was originally just a six-room home, ever since. He took over as chief surgeon after Shouldice died in 1965. Obney has been married for 38 years to the former Stephanie Kasyn. "I was smart," he says. "I picked a girl who was of the same religion—Ukrainian Orthodox—and the same background. My father used to tell me: 'You have enough trouble in marriage without asking for it.' He wasn't educated, but he certainly was a wise man."
Obney, who had no formal surgery training, now passes on Shouldice's techniques and his own refinements to about 100 doctors who visit each year to look over his shoulder in the operating room. He says even a top surgeon needs to perform 200 Shouldice hernia operations to master the techniques and still needs a crack operating room staff. "It is like a dance team that performs onstage," he says. "You have to do it together in a way that you don't miss steps."
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