Gordon V. Watters, MD

As a youth Gordon Watters faced a difficult choice encountered by many other bright products of the Canadian Prairies; hockey or school. For a time, he excelled at both. Born (1928) and raised in Winnipeg, he interrupted his undergraduate studies at the University of Minnesota, where he would later star as a first team All-American forward (1951) for the Golden Gophers, to play a year of semi-pro hockey for the San Francisco Shamrocks (1948-49) of the Pacific Coast League. Attracting the attention of the New York Rangers, Gordon had a difficult decision at the end of that year; continue his dogged pursuit of the NHL (teammate and fellow Winnipegger Wally Hergisheimer would play for the Rangers and Black Hawks) and lose his NCAA eligibility or return to school to complete his degree. Fortunately for child neurology, he chose to return to school to complete his degree in Psychology, Magna Cum Laude. When asked many years later what prompted this decision to give up on the prototypical Canadian male dream, he replied with the somewhat quixotic answer and a sly wink; “Have you ever seen the movie Slap Shot?”¹

Gordon would return to Winnipeg for his medical degree at the University of Manitoba followed by a rotating internship at the Winnipeg General Hospital, and his initial year of training in Pediatrics at the Winnipeg Children’s Hospital. His training in Pediatrics would be completed at Cincinnati Children’s Hospital followed by a year of training in pediatric pathology.

Intrigued by the diagnostic challenges of the then ‘black box’ of neurology that appealed to his innate attention to detail, Gordon moved on to train from 1960-63 in Child Neurology at the University of Chicago under the aegis of the gifted clinician-educator Douglas Buchanan, the Child Neurology Society’s first Hower Award recipient. Buchanan was a Scot, formally trained in Glasgow, Cambridge, and Queen’s Square with a rigorous, classical and utterly methodical approach to neurology. Charismatic and analytical to the highest degree, Buchanan was celebrated for his bedside skills and passion for teaching that made his Saturday morning teaching rounds the stuff of neurological myth². Gordon modeled himself on Buchanan, and those who knew both men always remarked on the similarity, though Gordon was always noted to be more modest and self-effacing and not as sharp a dresser.

The circumstances of his US work visa mandated that Gordon return to Canada upon completion of his neurology training. This he did, returning to Winnipeg where he became the first child neurologist on the Canadian Prairies and the only one in the vast landmass between Toronto (Stobo Prichard) and Vancouver (Henry Dunn). After the requisite years in Winnipeg, he returned to a Faculty position at the University of Chicago together with Charles Barlow. When Barlow moved to Harvard and Boston Children’s Hospital, where he would establish the Longwood Program that would be the model for pediatric neurology, he was able to bring with him but one Faculty member and he chose Gordon Watters³.

In Boston for four years, Gordon was given an opportunity to observe firsthand another legendary clinician, Randolph Byers. Byers’ meticulous skills at longitudinal observation together with his strong commitment to the welfare of children under his care became woven into Gordon’s neurological paradigm for the remainder of his career. Together with Barlow, Gordon helped forge a leading training program and the skill of attracting trainees committed to a career in academia. It is as an educator that Gordon would make his lasting impact on his chosen field.

It was also during his time in Boston that Gordon was a productive and influential researcher whose basic observations still influence child neurology. He focused on cerebrospinal fluid (CSF), its basic physiology and pathophysiology. Gordon established basic normative data on CSF turnover, including kinetics, and that of CSF albumin and IgG⁴. Further investigations would include the pharmacokinetics of CNS/CSF drug delivery in infants, as well as observations on acquired hydrocephalus and brain edema.

It was Preston Robb, a founder of Canadian child neurology, who in 1969 would recruit Gordon back to Canada. Robb, who was taking on leadership positions at the Montreal Neurological Institute, needed someone of stature to assume leadership of child neurology at the Montreal Children’s Hospital and McGill University. Gordon was joined at the MCH that year by pioneering neonatologist Mary Ellen Avery, who was appointed in 1969 Chair and Chief of the Department of Pediatrics. While Avery would only remain in Montreal for 5 transformative years before returning to Boston as Chair at Harvard, Watters stayed in Montreal for the remainder of his professional and academic career. When asked why he chose Montreal over Boston the answer given again with a sly wink was; “The Habs”.

As Division and Program Director for a quarter of a century (until 1994), Gordon focused on establishing a rigorous prodigious training program that emphasized academic excellence. Either directly or indirectly (as his trainees populated diverse academic centres in Canada) he could lay claim to training more than half the child neurologists in Canada. Trainees almost invariably chose academic career pathways and include to the present (2022) two Hower Award recipients, a Sachs Awardee, two Vice-Deans, four Department (Pediatrics) Chairs, 8 Division Directors, two Canada Research Chairs, three endowed Chair holders, a provincial Cabinet member, and international leaders in epilepsy, autism, neurooncology, neuromuscular disorders, neurogenetics, leukodystrophy and neurodevelopmental disorders.

Within the hospital and child neurology community, Gordon was renowned as a clinician, meticulous in both the elicitation of a detailed history and the complete physical exam. He had a remarkable way of asking just the right question or eliciting the specific physical sign that made the diagnosis clear and indeed obvious. Much of this skill lay in his ability to set the child and family at ease. No diagnosis seemed too esoteric or rare to be beyond his grasp. However, he always retained his idiosyncratic diagnostic ‘ace in the hole’; the ability to elicit a history of migraines from any parent and assign to almost any neurologic symptom, short of coma and brain death, a possible migrainous etiology.

Trainees at the McGill Child Neurology program can recall four simple props that were essential elements of their training with Gordon. 1) A clicking pen, the ballpoint of which Gordon would use at weekly brain cutting sessions to demonstrate either normative brain anatomy or the subtleties of pathologic diagnosis that was being lost as neuroimaging became more refined and powerful. The same clicking pen, when clicked repeatedly, would be a valuable auditory cue that a meandering, sloppy trainee presentation that better right itself quickly. 2) A 3 by 5-inch blank index card would serve Gordon as a concentrated and focused compendium of a child’s essential case information, available for quick recall and use as a visual cue to illustrate how diverse elements came together to yield a diagnosis or a therapeutic pathway. Often the writing would be enhanced by a quick simplistic drawing to illustrate the expected lesion. 3) A nearby a simple metal filing cabinet containing in meticulously catalogued folders the accumulated wisdom of child neurology. Inside these folders were papers culled continuously from the scientific literature; initially ripped out of journals or requested as a reprint, then photocopied. Frequently in attempting to resolve a diagnostic quandary or a trainee’s question, Gordon would get up from his seat, open a drawer in the filing cabinet and with utter precision quickly pluck a file that would provide both the answer and a comprehensive review of the topic in question. Before Google search he was the ultimate pediatric neurology search engine. 4)Four framed formal photographic portraits affixed to the wall behind his giant desk that loomed behind him in direct view of trainees at morning rounds. These were photos of Douglas Buchanan, Charles Barlow, Randolph Byers and Preston Robb. These were Gordon’s heroes and a constant reminder that we stand on the shoulders of giants before us and are but a link in a narrative chain.

Gordon’s clinical service at the MCH included a multi-decade involvement in its Northern and Native Health program long before EDI and social justice were terms in medicine. Gordon was the point person for calls and patients from Northern Quebec (Cree and Inuit) and the eastern Canadian Artic. For many years Gordon would take a trainee along on week long on-site clinics on Baffin Island (Frobisher Bay/Iqaluit) where dozens of Inuit children gathered from remote villages from a land mass the size of Western Europe would be seen. For the trainee it was a highlight of their training and also a powerful personal demonstration of social and health inequity that remained a vivid memory long after training was completed. As part of his service to Northern Quebec, Gordon played a key role in describing a novel and frequently fatal neurologic condition amongst the Cree people; Cree Leukoencephalopathy/Leukencephalits^5,6.

Gordon achieved the rank of Full Professor at McGill in the Departments of Neurology/Neurosurgery and Pediatrics. He retired as Professor Emeritus in 2007 to enjoy quality time with his wife Pat, his two daughters and son, and grandchildren. The choice he had to make as a youth between sports and education turned out ultimately to be a false one. He was given a Lifetime Achievement Award from both the Child Neurology Society (2008) and the Canadian Association of Child Neurology (2019). He was also inducted into the University of Minnesota Sports Hall of Fame (2003). A Hall of Famer in both worlds.

REFERENCES

1. Shevell M. Gordon Watters, MD: A Brief Biography. Pediatr Neurol 14; 182-184.
2. Ashwal S. The Founders of Child Neurology. San Francisco: Norman Publishing; 1990
3. Maski KR, Spurling Jeste S, Darras BT. Child neurology: Past, present, and future; Part 2: Present training structure. Neurology 74; e17-19, 2010.
4. Cutler RW, Watters GV, Hammer JP. The origin and turnover rates of cerebrospinal fluid albumin and gamma-globulin in man. J Neurol Sci 10;259-2658, 1970.
5. Black DN, Watters GV, Andermann E, et al. Encephalitis amongst Cree children in northern Quebec. Ann Neurol 24;483-489, 1988.
6. Black DN, Booth F, Watters GV, et al. Leukoencephalopathy among native Indian infants in northern Quebec and Manitoba. Ann Neurol 24;490-496, 1988.

Michael Shevell MDCM, FRCP, FCAHS
Chair, Department of Pediatrics
McGill University
Pediatrician-in-Chief
Montreal Children’s Hospital-McGill University Health Centre