User:Morilihochili/William McQuillan FRCS

William McQuillan FRCS ... The subject of this piece is William McQuillan FRCS, often known as ‘Bill’, in his professional days as ‘McQ’. He is now long past the allotted span and could be said to have had an interesting life.

His early years were greatly influenced by the Great War without his awareness. His father’s near useless right arm from the Battle of the Somme, his mother’s diaries and the Red Cross Gold medal from her days nursing the wounded were influential as were the photographs in his grandparents’ homes of those he would never know, five in all. These material facts were indicative of the sufferings of millions of people, not least in his family. Much of his schooldays were during the Second World War with all that entailed including learning how to fire a light machine gun while only twelve. All of this created a certain mind set, a sense of unreserved loyalty to everything British and its deserved place on the high moral ground.

He was above average at school and had obtained a University Entrance aged 16. This was below acceptable age; another year at school was a waste of time. A year working on a dairy farm might today have been called a ‘Gap Year’. Hard work in the fresh air with horses was tranquil and satisfying more valuable than a trip to Thailand. As a farm worker he was in a reserved occupation and had to offer himself to serve in HM Forces. Two years spent mostly in occupied Vienna with the rank of Sergeant changed him quite markedly. His first sight of Cologne and other cities throughout the Ruhr was a seminal moment. The Newsreels during the war had shown bombing by the RAF of ‘military Installations’ only. When the Luftwaffe bombed Britain the German airmen were seen as war criminals, vile beasts killing women and children. What had we done in Germany? The realisation that our leaders were responsible was absolutely shattering. The ‘Good Little Brit’ would never be the same again. Added to that was the experience of meeting soldiers from other war time allies and working with former enemies many of them employed by the British Army, an alleged non-cooperation, non-fraternising policy notwithstanding. Here was the evidence if such be needed of the aphorism attributed to Churchill, ‘The first casualty of war is the truth.’ There was more than enough to demand wide reading. Being in Vienna in 1948 showed the incident involving Yugoslavia in a different light and as for the circumstances surrounding the formation of NATO…..…God Lord!, how could people be so easily deceived?

Questions would be asked and a clear pattern developed almost overnight; never again to believe anything especially from our political leaders without clear proof. As he learned more about the Great War and its causes he boiled with rage to realise how much his family had suffered yet they had been told a pack of lies. When the Second War began he had accepted without question what the people had been told, the glory, the tenacity and the righteousness of the cause. When he could call himself an ex-Serviceman he had very different views, mostly evidence based.

The study of Medicine began in 1949; a desire to succeed was strong especially for an impoverished student. He made do by working during vacations in any job where cash could be made. Another unlikely benefit became available. In the early days of the NHS there were serious shortages of staff at all levels, especially of junior doctors. They could only take leave if they could provide a locum for which only students were available. This was perfect for Bill, free digs food laundry a small cash bonus and more importantly much more could be learned than when part of a group. Not only was there much greater patient contact listening to the staff was an additional benefit not normally given to students. It soon became any subject, any time reaching a maximum after Fourth Year when he was employed and salaried as locum House Surgeon in an English District Hospital for the entire summer vacation. The salary was minimal but the experience gained was enormous, even being allowed to do minor and not so minor operations. The detail of this period can be read in ‘Surgeon in the Making’.

The next summer vacation was spent as locum HS in the Regional Neurosurgical Unit when he did minor procedures himself, something that could never happen today For the last six months of his undergraduate career he was part time HS in the Glasgow Eye Infirmary responsible for casualties at night and at weekends. It may be fair to say that on qualification his knowledge and practical ability far exceeded that of a majority of his colleagues. Nevertheless his period as an undergraduate had been far from cosy. Doctors in general and Consultants, especially Professors do not like to be contradicted, nor even asked awkward questions. There are two Professors of Surgery in Glasgow one of whom told McQ he had better stop being a rebel if he hoped to ‘emerge’ .The other threatened to prevent him sitting the Final Examination and only withdrew his proposed sanction when he realised he would have a fight on his hands. If the reader concludes he must have been a rather unpleasant and opinionated young man that view might have some substance.

All newly qualified doctors had to spend two periods each of six months as House Officer before full Registration was given. In the vast majority of such posts especially in Teaching Hospitals the House Officer or Resident worked all the hours of the day and often of the night. Not only was the work load enormous some of the Consultant staff especially the Chiefs were very demanding. That was normally accepted as the reference on which the young doctor relied for further employment was vital for those hoping for a career in hospital work.

After three posts as House Officer, promotion to Senior House Officer and then Registrar was rapid albeit without having passed the Fellowship Examination. Many aspiring surgeons took a year or more off from clinical work to learn the vast amount of Basic Science forming the First Part of this examination. McQ spent the greater part of his time working on the clinical side, and struggled until the First Part was passed with the Second Part in Clinical Knowledge taken almost immediately.

His basic surgical training was in the Glasgow Teachings hospitals; the pattern from the past repeating itself but more significantly. Junior hospital doctors rarely come into conflict with their seniors; McQ did. Many of the Consultants were limited in their experience and ability. Many of these men had no choice but to do everything as it had been done by the Chief and some expected the same pattern from any junior. It will come as no surprise to the reader to know that McQ frequently rebelled. One his more polite arguments was to suggest if this pattern had always been followed the red hot poker would still be in wide use. To be sent to the Surgical Staff Committee for the crime of insolence could have been the end of his career. He was fortunate in meeting a group of men capable of arriving at a decision on the merits of the case, who knew both parties to the dispute. He received a word of advice, and knew he must try to keep his mouth more tightly closed.

His period as Registrar in Glasgow was interrupted when he was found to have a shadow on a chest X-ray. Although the lesion was considered to be ‘closed’ and thus non-infective his Chief at the time, not his favourite surgeon although the feeling was mutual made his position clear. ‘Get out of here. I won’t have you coughing your bugs over my patients.’ Another more sympathetic opinion was to take a rest. This might not have been easy but for the offer of a post as Ships Surgeon on a passenger liner bound for India. To say this was a highly intense and challenging period is dealt with in detail elsewhere. The title is ‘Take a Rest’.

On completion of his voyage his chest X-ray was clear but to his dismay he was sent back to work in the same unit. Relations with the Chief had never been good but when he was blamed for the death of a small boy for which the Chief himself was responsible there was only one thing to do, resign. A period as an assistant in General Practice was a job but wise council prevailed and he was re-appointed as Registrar to the Royal Infirmary Having completed basic surgical training in Glasgow he went to Edinburgh with the Fellowship of their College to study Orthopaedic Surgery. The need to become specialised was clear, change was on the way. Orthopaedics was chosen for a variety of reasons. Firstly the remit was wide covering the entire locomotor system. Secondly it would expand and thirdly, experience of some Consultants in that specialty was such as to assure him he was not likely to fail to reach that level.

There are huge differences between Glasgow and Edinburgh, the subject of many anecdotes, true and fanciful. This difference was indicated by two small happenings. On having been appointed as Registrar in Edinburgh Royal Infirmary the Professor’s response was to suggest he was going over to ITV. Another Glasgow moment was somewhat more indicative of the differences. A party of Americans visiting Glasgow offered the usual pleasantries with only one significant question, “Say, Professor, the people from Glasgow are known as Glaswegians, the people from Dundee as Dundonians. What do you call people from Edinburgh ?” The reply came from the Senior Lecturer, until them silent, “We call them c- - - - -.”

However there were very real differences. The work load in Edinburgh Royal Infirmary was minute by comparison with Glasgow. Whereas the Casualty Department in Glasgow known as The Gate saw in excess of 300 patients per day, in Edinburgh although the same department saw all General Surgical outpatient consultations the numbers rarely reached one hundred. The attitudes of the medical staff to one another were also very different. In Glasgow it could be held to be ‘informal’, respect but without frills. In Edinburgh junior medical staff stood in line at 9 am to greet their Chief on arrival and carry his bag hat and coat to the ward and accompany him back usually around 11 am. He soon realised he was in the middle of a feud. The General Surgeons had ruled for years and deeply resented the arrival of Orthopaedics as an independent specialty. The Professor of Orthopaedics had come from London with a huge reputation. At first sight he seemed exceptional, doing operations unknown in Glasgow and clearly determined to build a large Department. The junior staff were under constant pressure not always fair or balanced to such an extent that some could not cope, those who protested were dismissed, in all an interesting but on occasion an unpleasant experience .Yet within a few months he was promoted to Lecturer and only two years later Consultant. To reach this Grade only eight years after qualification was very rare in those days. This had happened in spite of the fact that his relations with the Professor on occasion were frosty, indeed twice he had offered his resignation only to be asked to remain. Things were no better at Consultant level. Hard work contributions both clinical and academic were his saviours, but increasing isolation was the outcome. Challenging accepted medical ‘truths’ is never the route to popularity of little consequence to McQ. To express the view that too many operations were being done unnecessarily might have been heeded in some places but Edinburgh was not ‘some place’. Speaking out in public against the Merit Award system, doing the same thing about the method of operation of the professional body, the British Orthopaedic Association were indications that whatever he was he was not a cipher. This did not add up to an easy life. Marital breakdown was another problem to bear when he found that looking after three small children albeit part time is itself hard work. Renting a farmhouse was a perfect solution but for the distance from the city.

Clinical work alone was demanding but did not exclude original work clinical and research in many aspects of the subject. These included the Natural History of many conditions with emphasis on osteoarthritis of the hip, psychogenic factors in illness, limb reconstruction and vascular repair after injury, peripheral nerve injuries, sports injuries, sundry fractures, in short too many subjects and too little time to develop. Nevertheless many papers were published, or read in this country and abroad in three languages. Yet this was both a happy and productive period in his life. Having his family with him for half of the time available was a great joy. Professionally it was a productive period being an ABC Fellow visiting Units in Canada and USA, The offer of Chief of Orthopaedics in Toronto General Hospital was declined with some regret. Guest Lecturer at the American Trauma Society and at other centres at home and abroad were indications that his work had some merit if not always accepted. As guest lecturer at a centre in the UK his introduction as ‘the man who will destroy your private practice’ was quite pleasin had the meaning been different. The appointment as Chevalier de Grace de L’Ordre Militaire et Hospitalier de St Lazarus de Jerusalem allowed him to wear the sort of regalia and decorations much loved by the Royals and of as much significance. It was worn once before being given away.

To be asked to apply for the Chair at the Royal National Orthopaedic Hospital was accepted with serious reservations. The subsequent interview was unusual; he thought he might have killed two members of the Appointing Committee, but he had made up his mind he would accept only on his terms. He was not offered the post. There was no consolation that the successful candidate lasted three months.

A major change came when the Royal Scottish Nursing Home was closed as financially non-viable but it housed his consulting premises. For this and other personal reasons he decided to try to mount an operation to continue its use. A business man, a recent acquaintance was enthusiastic promising to provide funds. With three others chosen for their expertise on different aspects the project was launched. More businesses come to grief because of inadequate capital than from any other cause. McQ’s naivety had meant that ‘due diligence’ on the businessman had not taken place; he was not what he had purported to be. Making profit from sale of the premises was his sole objective. From the beginning it was all downhill. If he had not had enough to do the additional load was catastrophic.

The happenings of the next few years are only of interest to those addicted to horror stories. Everything that could go wrong did exactly that. The high level of stress over some years had been kept under control or so he had thought by self medication. Backache since a laminectomy for disc prolapse some years before had become chronic made well nigh intolerable as a consequence of the other burdens.

In the animal world there is often only one or at most two killers in a pack of hyenas. When the quarry has been killed or fatally injured others from the rear until then silent move in to grab their share. A similar happening occurs in man.

Resignation on medical grounds was the only answer while the mess from the Nursing Home disaster was cleared up. The real diagnosis was simple, ‘burned out’. Homeless, jobless, penniless but with massive debts were a difficult combination but bankruptcy was rejected. He was astonished by his elder daughter’s firmly expressed view, ‘You can turn this round.’ Not too many people are fortunate enough to be given this level of understanding and support.

The first priority was obvious and much sooner than might have been predicted he was able to act as locum while a friend of many years standing went on leave. It is common to have lots of acquaintances; real friends are less common, but beyond value and praise when they provide much needed help and support. Fortified by this experience the next few months were spent in similar capacity in a variety of hospitals in the UK and abroad. Standards in the UK were extremely variable.

While working in Australia he received a call from one of the teaching hospitals in Glasgow asking him if he would help out. This hospital in contrast to others in that city was very quiet often seen as the ‘private’ prerogative of the middle class on the wealthy South Side While it was satisfying to be back in a teaching hospital, the leisurely atmosphere and over treatment were not conducive to his preferred pattern of work. Time hung heavily but provided an opportunity to continue his other interests especially the history of Europe in the Twentieth Century.

When another call came from a former colleague then President of his Professional Association asking him if he would be interested in the post of Professor in the University of Addis Ababa his response was immediate. This proved to be an unusual situation being in the control of a subsidiary known as World Orthopaedic Concern and a similar American group OOI. It was certainly not the normal method of appointment of academic staff but he took up the offer to visit Addis and make his own judgement.

The incumbent Professor was an Englishman of few words who had the reputation of being expert on the problems of the Third World. His accommodation was in a rat infested slum where the evidence of the allegedly concluded civil war was not an adjunct to sleep. If that introduction brought its own thoughts the sight of the hospital, the Black Lion or Tikur Anbesa was disturbing. At first it seemed like any recently built building until the broken windows, the dirt and squalor in the surrounding area gave a hint of what would be found within. Ward C3 housed the Orthopaedic Department with a cupboard as the Professor’s office. The stench was quite nauseating arising from choked near dry lavatories, infected wounds, bodies in beds with or without stinking mattresses or sheets, more water on the floor than in the sinks, relatives lying on the floor all in a gloom as only limited light came through the filthy windows. The words appalling squalor cannot convey the ghastly sight. It was a veritable charnel house. How British surgeons could have worked there as long as they did was a complete mystery.

A tour of the hospital indicated that other wards were similar but none quite as bad as C3 until the ‘Military Ward’ was reached also under Orthopaedic control. This ward was full of former members of Mengistu’s Army with sundry wounds, all neglected with little sign that anything significant had been done for them for weeks or months. The more modern construction had provided en suite bathrooms in all of the side rooms. Every last one was broken, dry and stinking, a travesty of a hospital The operating suite would have been more suitable as a slaughter house.

Little was seen of the staff, all trainees with the exception of an Ethiopian General Surgeon seconded to help out who said precisely nothing. This was some challenge.

The route home was via Geneva where the daughter already mentioned in the text was continuing her own medical career. Sitting in the sunshine having lunch on the lakeside brought forth the thought that the wealth on display was probably greater than the GDP of all of Ethiopia. Aloud came the comment, ‘I just do not know what to do’ The answer might have been anticipated; ‘it’s perfectly obvious what you should do. You have talked about nothing else since you came off the plane. It sounds as if the crowd who seem to be running the thing are pretty weird but if you can work with the Ethiopians it might just be right for you. It will do you more good than what you are doing for the moment. Try it for a couple of months and if it doesn’t work put it down to experience.’

A phone call from the incumbent sounded very positive. ’I have arranged everything especially with the Americans. A contract is in the post. Come as quickly as you can.’

The idea that some electronic assistance might be provided was laughed out of court but a small version of today’s laptop was bought together with reams of paper as this was in short supply. Arrival in Addis was more pleasant than before; the sun shone and the welcoming committee consisted of an over effusive Ethiopian the link man to the Americans. His instruction was firm. ‘You go straight to the Dean’. With no time for a tidy up, sitting outside the Dean’s Office for almost an hour did not help. His first question was a surprise, ‘What are you doing here’. The obvious answer was met by an even more surprising comment. ‘There is no job here for you.’ It was deemed unwise to bring out the ‘Contract’ from the inside pocket.’ If that is the case I will go back on the next plane.’ ‘Are you a Scotsman? was followed by the information that Scotland was his second home having graduated in Edinburgh and he was a Fellow of the Edinburgh College .The mood changed dramatically as they agreed they had both been victims of a misunderstanding.

‘Why don’t you stay for a week or so, look around and we can talk later.’

In the discussions in London he had made it clear he had no desire to live in the accommodation used by the previous incumbent. The linkman knew nothing and so there was no choice. ‘Looking around’ was almost sufficient to get on the next plane. The victorious forces were everywhere, menacing machine guns on every corner, heavier weapons at strategic points, sufficient to deter any aimless wandering. It did provide a chance to meet the staff and make an assessment. Eighteen in all including three Graduates from an exam just taken they were an extremely scruffy bunch, dirty clothes, unshaven, even the sole female of the group seemed to pay little or no attention to her appearance. Their basic medical degree had been obtained in various places, Addis, Gondar another medical college in Ethiopia, Russia and Cuba. The auspices were not encouraging. Fortunately they seemed to have at least a working knowledge of English. A simple written exam would give some indication of their knowledge. A student in Biology would have done better

Ethiopia itself was something of a mystery .Little information beyond the basic had been available in the UK; population in excess of 50 million, largely rural more than fifty tribes and as many languages, few large towns. The Language Department of Glasgow University had been unable to help with the lingua franca, Amharic. A paperback suggested a highly complex, obscure language with a near unique script. That would have to wait. The Amhara, not the largest tribe were the most powerful by dint of subservience to The Emperor for countless years. The medical staff were virtually all of this persuasion as were the members of other University Faculties. The Department of General Surgery had seventeen Consultants and 60 trainees; all exhibited unveiled hostility. What on earth had he taken on? He had almost made up his mind to go home when he was asked to talk to the Dean. ‘I have always opposed the concept of independent specialties here where there are few enough doctors. However we have so much disease and illness affecting the limbs it is right our juniors should know something. I propose recommending you for the Post of Professor at the next meeting of Faculty. How do you feel about that?’’ Assuming I shall have an independent Department I will be delighted to accept.’ .’Good; begin whenever you wish. If I can help you in any way just ask’

So began what was undoubtedly the most difficult, the most frustrating but possibly the most important even successful part of his career. One aspect pleased him significantly he would be a member of a committee of one.

Two tasks had to proceed synchronously; substantial improvement in the fabric and fittings; producing a proper curriculum and the steps needed for implementation.

The technical aspects of the former seemed surprisingly simple. Another Scot met at a function in the British Embassy ‘knew’ about water and sanitation in general. The basic problem was blockage of every drain. Funds came from a variety of sources while a French NGO had the personnel to do the job. A ward opposite C3 was almost as bad but had no inmates. The solution seemed simple, until the General Surgeons became involved. They had no objections to the ward being upgraded but then they would take it as it was ‘their ward.’ The Ministry was feckless but ruled for temporary use of the ward for Orthopaedics. While the work was in progress every possible trick from threatening the work force, stealing their implements to pouring filth on to the site was tried but the work went ahead. When completed the ward bore a passing resemblance to any in the UK. Transfer from C3 did not take place as the General Surgeons asked if a similar change could be made to the Military Ward. This was agreed with alacrity as the infection rate in C3 had been 70% hence it would remain ‘temporarily’ as the Orthopaedic Septic Ward while B3, the upgraded one would be used for ‘clean’ cases. The Military Ward was given the same treatment and immediately taken over by the General Surgeons for their private patients. The Operating Suite, a travesty of a site for surgery was upgraded. All attempts to do the same for C3 were blocked.

Establishing a proper teaching base was relatively simple. A curriculum of sorts constructed by the Americans was recovered from the British Council. It was quite unsuitable and was replaced by one based on the requirements of the Edinburgh College. This passed through the appropriate University Committees with ease.

Soon after arrival an elderly American had arrived, Board Member of OOI to ensure ‘their programme’ was being carried out correctly. It took some time for him to grasp that the Department was under the control of the person appointed by the University of Addis Ababa. While they were welcome to visit any suggestion of ‘open season’ on Ethiopians had ended, a necessary sanction as some of the ‘volunteers from OOI’ seemed to think they had a sovereign right to do as they chose. .Relations deteriorated, the salary such as it was stopped and thus ended phase 1.. . ..

While all this was going on local politics reared its ugly head. The Dean and some twenty other senior University personnel were fired. His successor was a very different individual; personal physician to Mengistu, on friendly terms with Ministers in the new Government he knew how to play the game. An invitation to join a group of ‘the only people who matter’ was rejected politely ‘I only came here to teach’ Conflict arose when he decided to appoint the most senior of the graduates to the post of Assistant Professor. This man was quite unsatisfactory, lazy, ignorant of basic principles a very poor doctor and surgeon. The thought that this man might take over in due course compelled resistance to the proposal. There was also a possibility that a Faculty Committee could appoint him as Head of Department. A battle began lasting almost two years only ended when the Dean decided to leave. It was to prove to be a Pyrrhic victory.

The teaching base was extended to include trainee general surgeons and after another battle of more than a year the undergraduates were included. This was a demonstration on how to create a rod for his own back. Yet as had been his experience in the UK teaching bright young students is a wonderful experience. Whatever the young Ethiopians lacked it was not intelligence or enthusiasm. To feel like the Pied Piper was a daily occurrence.

The hostility from the General Surgeons and many others had one cause; anything improving the hospital was pro-Government and thus had to be opposed even if any such improvements would benefit all the Ethiopian people. A general view was widely held, namely that the Ethiopians of any tribe or class are superior to every other nationality. They had a God given right to be given everything they might need to such an extent to be referred to by others as a ‘nation of beggars’. After a while it was made clear that Ethiopians only tell a foreigner what they think he wants to hear Once this behaviour pattern was understood life was easier but scarcely satisfying.

When WOC, OOI or whoever was providing the salary decided to cease to pay the future looked bleak. A chance encounter with an English Doctor with her own practice, research and commercial interests including close relations with USAID proved very helpful. She made it quite clear that as wounded from past conflicts and even more recent violence were being treated USAID would certainly provide funds. This proved to be the case including replacing the absent salary at a comparable figure, less than might be made doing a few medical reports in the UK but enough Funds were also made available to fund other projects, purchase of text books, equipment and instruments provided they were of US manufacture. All of this made a huge difference while the material and moral support from the British Ambassador, the local communities of British, Greek, Japanese, French and Armenian citizens and the massive support from ICRC made the work possible with substantial improvement on all fronts. Invitations to several of the many Embassies in the city were great morale boosters and hugely improved the diet.

Seven trainees achieved graduation; two of the best were appointed as Assistant Professors thus reducing his personal work load.

It had been clear for some time that to take the Department forward radical measures would have to be adopted. Sending people to UK or USA was not only pointless but harmful. They would see little or nothing of the major problems in Ethiopia and become affected by the Western demand for gadgets. A good example was given by the behaviour or lack of it of the only Neurosurgeon in all of Ethiopia. This man had spent a year in Bristol and on return to Ethiopia complained he could do nothing without scans. A CT scanner provided by the Japanese lay and rotted in the car park as there was nowhere to put it, no one to operate it and even then it would have had no effect on treatment options. Yet he continued to try to obtain another while patients died from conditions eminently treatable by surgery.

Arrangements were made for the two Assistants to go to Belfast, the best trauma centre in UK to do a special course, six months trauma and six months basic science. This was part of a proposal to UNDP for funds to take the Department forward. In addition contact was made with the Dean of the University of Witswatersrand with a view to sending senior trainees there where they would see and have to treat problems common in Addis, for example, bone and joint infections, poliomyelitis ,neglected wounds, case material no longer seen in the UK. The offer to help with any aspect of training of the young Ethiopians was generous. It came as no real surprise when it was rejected outright by the Medical Faculty. There were projects in UNDP costing many millions on which the Government procrastinated but the submission had been viewed favourably. It was interesting to look back over one small aspect. All surgeons have ‘special’ cases where they may feel the work they did was of inestimable value. If the truth be told in many cases there was someone else who might have done the job. In Ethiopia, there was no argument over many cases often of considerable magnitude not seen in the UK..

An incident of no consequence to the health of the Ethiopians was to have massive effects. An attempted assassination of Mubarak, President of Egypt brought an immediate clamp down on foreigners. Life in Addis for many British became difficult. While awaiting a response from UNDP a study of all the medical facilities in Addis had been carried out on behalf of UN. The many ex-patriot employees were very happy with the result as the findings made Addis a posting of special hazard with many benefits to those from elsewhere. If they were happy McQ was not as pressure began to be applied in various ways. In every aspect of living the Ethiopians went into top gear in an endeavour in which they excel, ripping off the foreigner. He concluded he had done enough and left with only one bag and a falsified contract that his absence would simply be long enough to secure more funds.

Doing locum jobs on return to UK showed the NHS in a very different light. Massive expenditure on the treatment and even more waste from over treatment of trivia was in extremely sharp contrast to what he had seen and done in the previous four years. Retiring to a cottage in the country with his memories was the solution. This also provided the opportunity to write in some detail about four years in Addis Ababa, published by Acorn and entitled, ‘Black Lion.

Returning to UK was more difficult than might have been anticipated. This was attributed to ‘culture shock’ in reverse .Life in the cottage is also is the subject of a text named ‘Cottage garden’.