Dr. Peter Humphreys (Figure 1) is an emeritus professor in the Department of Pediatrics at the University of Ottawa. He graduated from McGill Medical School in 1966, receiving the Holmes Gold Medal for excellence. He went on to complete his internship at the Royal Victoria Hospital in Montreal, followed by a pediatrics residency at Boston Children’s Hospital, Harvard University, and St. Mary’s Hospital in London, England. He then completed his neurology training at the Montreal Neurological Institute (MNI) at McGill University in 1973, before joining the Department of Pediatrics at McGill as a staff neurologist. In 1979, Dr. Humphreys was recruited to establish the Division of Neurology at the University of Ottawa and the Children’s Hospital of Eastern Ontario (CHEO). Over the course of his career, he held several key leadership roles, including president of the Canadian Association of Child Neurology (1989–1991), president of the CHEO Research Institute (1997–2009) and program director of both the pediatrics residency program (1982–1988, 1989–1991) and the pediatric neurology residency program (1984–1999) at the University of Ottawa.

He is widely regarded as one of Canada’s most respected pediatric neurologists. The many neurologists he has trained – and continues to train post-retirement – attest to his clinical expertise, profound knowledge of neuroanatomy and his remarkable ability to share his passion for pediatric neurology with trainees and colleagues. His distinguished career was recognized with the 2021 CACN Henry Dunn Lifetime Achievement Award.

This interview was conducted by Lauren Strasser, a recent graduate of the CHEO pediatric neurology residency program and current neuroinflammatory and epilepsy fellow at SickKids Hospital in Toronto.

LS: What inspired you to specialize in pediatric neurology?

PH: That didn’t come early on for me. What attracted me to medicine was just the scientific aspects of it, even though there were no physicians in my family. The fact that I was the oldest of five kids probably had a lot to do with my attachment to working with children, and eventual specialization in pediatrics. My journey to neurology began in medical school at McGill University when I did a neuroanatomy course in second year. I found the anatomy of the nervous system and especially the brain fascinating.

LS: Who were your early mentors or colleagues who most influenced your career, and what lasting lessons did they share with you?

PH: The first person who was instrumental in pointing me in the direction of neurology was Francis McNaughton. Francis McNaughton (see Figure 2) was a senior neurologist at the Montreal Neurological Institute when I was in medical school, and I met him during the neuroanatomy course. I was just totally impressed with him as a human being. He had a terrific capacity to make people feel at ease and genuinely expressed interest in what they were doing and how they came to be interested in medicine. He didn’t just have a life in medicine, he had a very broad range of interests. He was interested in history, in art and in music of all kinds, especially classical music. I watched him doing histories and physicals on adults with neurological conditions and was just totally impressed with the kind way in which he was able to make people feel unthreatened. He was able to relate to each person on their own merits. He was a person that was very influential in where I wound up, both in neurology and the kind of neurologist that I became. I learned from him the importance of not being completely focused on spending all my time continuously learning neurology – although I did spend a lot of time with that – but also to keep on learning other things. What I chose was keeping up on reading literature and history, and also keeping up on my interest in classical music. I believe that that sort of broadened my attitude to clinical medicine and helped me in relating to families of the patients that I was seeing.

The second person who influenced my decision to go into pediatric neurology was Gordon Watters (see Figure 3). He was the first full-time neurologist at Montreal Children’s Hospital, but I actually met him at the Children’s Hospital in Boston, where I went to do my pediatrics training and first neurology rotation. He was instrumental in helping me decide that although I was committed to three core years in pediatrics, I wanted to do pediatric neurology. The reason for this was simply that he was a brilliant clinician who related extremely well with patients, just like Francis McNaughton; in addition, he also taught me the importance of constant learning throughout your life. He had always kept up with the medical literature and he had a vast array of literature articles with which he was familiar, all kept on in a system of index cards, a system that I copied when I started my neurology residency. Eventually, of course, it became out of date once new electronic methods of storing information came along – but the general principle of this is still very important.

In the third year of my pediatrics training in the Boston program there was an opportunity to trade for a senior position in London, England. I’m originally from England, and I have relatives there, and it was sort of a natural thing for me to do. This was at St Mary’s Hospital in London – where Prince William and Princess Kate’s children were born – and they sent the equivalent of a senior resident to Boston each year as part of this exchange. I had already chosen at the end of my second year to do neurology following my core pediatrics training, and was accepted to the program at McGill prior to going to London. I actually was the first resident in the neurology program to follow a parallel course in pediatric neurology. Everybody previously headed for pediatric neurology practice did the adult neurology program, which obviously included some pediatric neurology. So I began my neurology training program with six months in pediatric neurology and then went over to the adult program.

LS: What was your experience like founding the neurology division at Children’s Hospital of Eastern Ontario (CHEO) in Ottawa? What were some of the early challenges you faced in building the department?

PH: After I completed my training and finished the Royal College program, I was at the Montreal Children’s Hospital for six years, which is where I was eventually recruited by CHEO five years after it opened in 1974. With a few exceptions, they had mostly academic generalist pediatricians on staff who were collated together from the pediatric programs at the General Hospital and the Civic Hospital. Anyway, it was they who recruited me from Montreal to the CHEO program. I started in September 1979 as the first full-time neurologist at CHEO, with a mandate to grow what eventually became the division of Neurology at CHEO. All of the generalist and specialty full-time staff were very welcoming and cooperative. It was a nice environment to start trying to build something. Frank Sellers, the interim chairman of the department of Pediatrics was very, very welcoming and cooperative and gave me a lot of help. The EEG lab already had several full-time technologists and, at my request, they got me a brand new and up-to-date EMG and nerve conduction apparatus, the first one that the hospital owned.

I already had an idea about a candidate for a second full-time pediatric neurologist: Daniel Keene, a graduate from the McGill program in 1980 who had various interests in coming to Ottawa. So, he came as a second pediatric neurologist a year after me, and eventually wound up as a major part-timer with a private office outside the hospital.

So that was how things began and over the next few years the division was built. The third full-time staffer was also from McGill, as might be expected, and that was Pierre Jacob, a neuromuscular disease expert. The fourth full-time person was not from McGill, but from the pediatrics program at Ottawa. She was in the general pediatrics program and got interested in neurology after rotating with us on an elective, and that was Sharon Whiting. After completing her pediatric training in Ottawa, she then did part of her neurology training in the adult neurology program in Ottawa, followed by pediatric neurology training in Vancouver. She returned to CHEO in 1986, where she spent her entire career, eventually becoming my replacement as Division Head, plus chief-of-staff at CHEO, an Associate Dean at the University of Ottawa, and a highly respected leader in the field. She had a particular interest in pediatric epilepsy and even pursued additional training in this area at a program in Miami, Florida. The fifth person, Sharon Parnes, came at around the same time as Sharon Whiting. She was an American who went to the McGill program with an interest in neonatal neurology, was interested in coming to Ottawa because her partner had a job here, and so applied and we gladly accepted her. So those were basically the beginnings of the pediatric neurology program during the first six or seven years.

LS: Follow-up question to the above, if you were the only pediatric neurologist in Ottawa, who did you go to if you had any questions or if you didn’t know what to do about a case?

PH: Well, that would depend on the case, obviously, but I got to know a number of the adult neurologists at the Civic and General Hospitals, before they combined in the mid 1990s to form the Ottawa Hospital. They were extremely helpful, especially Robert Nelson, who was invaluable. He was the head of neurology when I came to Ottawa, and he was just fantastic.

LS: I see that in your early professional career, you started with an interest in neuromuscular neurology. However, you later came to be interested and devoted much of your career to disorders of brain development. What sparked this interest and what motivated you to change paths?

PH: Well, yes, so the specialty training that I did in my residency was in neuromuscular disease, although I was interested in all aspects of pediatric neurology. When Dr Pierre Jacob came along, he had a very similar background in neuromuscular neurology and was very interested in a possible move to Ottawa. He had also trained in the McGill program and brought us one tremendous advantage: he was able to teach in French to the bilingual University of Ottawa medical students. Attracting Pierre Jacob to CHEO was going to be a significant benefit for the Francophone teaching program at the University. That was one of the principal reasons I recruited him, and by that time, I was also starting to develop an interest in brain developmental problems.

Now, how did that come about? Well, first of all, when I was at the Montreal Children’s Hospital, they had a clinic which was run by Neurology for children with cerebral palsy. Preston Robb, a former head of Neurology at the MNI, used to consult at the Montreal Children’s Hospital and established a regular clinic there for kids with cerebral palsy. Anyway, not too long after I started in Montreal, he convinced me to take that clinic over and I became increasingly fascinated with early injury patterns to the brain and therefore with the development of the brain in the context of this clinic. I did more and more reading around these topics. I was also invited, after I’d been in Ottawa for about five years, to start doing a clinic at the Ottawa Children’s Treatment Center (OCTC), the place where children with developmental disorders and cerebral palsy were followed and treated in Ottawa. That increasingly got me more and more interested, particularly because Pierre Jacob began taking on the lion’s share of the EMG and nerve conduction studies as well as most of the clinical work in that area. As a result, I spent less and less time doing that and more and more time working in the developmental clinic and reading literature on brain development.

That culminated in my doing a sabbatical year in 1988–1989 at the Beth Israel Hospital in Boston, in the laboratory of Albert Galaburda, an adult neurologist with an interest in early injuries to the brain. Here I did some basic science research with a rat model for the development of acquired focal neuronal migration injuries to the cerebral cortex. In addition, I analyzed serially-sectioned entire brains of several humans with a history of dyslexia all of whom had been found at autopsy to have multifocal microscopic cerebrocortical lesions apparently acquired late in fetal life. Both of these projects led to a number of published papers. That sort of nailed it down, I would say, at least that’s where I spent the rest of my career with that domain as a focus.

LS: How did you become involved in Rett syndrome, and how did you go about establishing the Rett syndrome clinic at CHEO?

PH: Rett syndrome is a rare disorder, but it isn’t quite as rare as it initially appeared. I did see a couple of patients when I was in Montreal, and then saw the occasional patient in the clinic at the OCTC after my clinic was started there. Sometime in the mid-1990s while in the clinic at OCTC, I saw a patient with Rett syndrome whose mother, as I subsequently learned, was devoted to the development of the Association for Rett syndrome in Ontario and to developing a Rett syndrome clinic at CHEO. Her name is Terry Boyd, and she is real go-getter.

I would continue to see more and more girls with Rett Syndrome who were increasingly directed towards me, in part by Mrs. Boyd. I started attending Rett Syndrome Association meetings in the States, where I learned about several dedicated Rett syndrome clinics. Ultimately, a Rett syndrome clinic was established at CHEO. It didn’t open officially until 2007 but actually got underway in September 2006; we started attracting patients from all over eastern Ontario and western Quebec, and that was primarily due to the drive of this one mother.

LS: Over the course of your career, what has been the most significant changes or advancements in the field of pediatric neurology, and where do you see the fields going in the future?

PH: Well, from the time I first started on staff at the Montreal Children’s Hospital in 1973 and when I finally retired from clinical practice at the end of 2017 there were two things that were huge. The first was the incredible changes in investigative neuroradiology, which completely transformed the discipline and the knowledge base. When I was a resident in neurology, the only investigative technique for visualizing the inside of the head was a pneumoencephalogram – a barbaric procedure that involved injecting air via a lumbar puncture and letting it bubble up into the head to outline the brain, and causing the worst headache that everyone who required them ever experienced. The first development to come along was CT scanning, followed not too long afterwards by MRI technology and then by positron emission tomography, as ways of being able to visualize the brain and the spinal cord. These were things you could only dream about and that changed entirely the approach to investigating the brain and led to an enormous explosion in recognition of new disorders based on analysis of brain anatomy, especially by MRI. While that was obviously the case for both adult neurology and pediatric neurology, for somebody with an interest in developmental brain disorders, it was just astonishing. So much so that I started going over to the Ottawa General Hospital (now the The Ottawa Hospital - General Campus) to do prenatal neurology because of the various imaging studies done on pregnant women and the identification of all sorts of genetic and in-utero-acquired developmental brain disorders. So that was number one.

The second incredible explosion of information came from genetics, especially molecular genetics, which was right up my alley as well. This led to the identification of an extraordinary number of new developmental neurological disorders, as well as identifying the cause of disorders that had been recognized but for which the cause was not known. Rett syndrome is a good example: it was identified clinically by Rett in the 1960s but it wasn’t until 1999 that the MECP2 gene was identified as by far and away the most common etiology for a Rett syndrome phenotype. It also identified other disorders (such as CDKL5 mutation syndrome) that overlapped clinically with some features of Rett syndrome but were rarer and gradually separated out from Rett syndrome.

LS: One of the qualities people consistently admire about you is the immense kindness and patience you show to everyone around you. What do you believe is most important in providing compassionate clinical care, and how do you sustain that throughout your career? Additionally, in a time with such high rates of burnout in healthcare providers – do you have any advice on managing burnout and maintaining healthy, caring relationships with peers and patients?

PH: Well obviously, in large part my personality didn’t come from training in medicine, although it’s been modified. Primarily it has to do with my upbringing and what I inherited from my parents. So that’s obviously the starting point.

What I gradually became increasingly convinced about is that in medicine it’s extremely important, no matter how devoted you may be to the discipline – let’s say of neurology – that you maintain interests outside of your chosen field. Your clinical skills will be improved, and I think also the risk of developing burnout will be diminished. It doesn’t matter what those interests are – all I can say is what helped me. I mean, there were times when the going got tough in my career, but I always had other things to fall back on. One was music. I played a couple of instruments when I was growing up and I developed a devotion to it, particularly classical music but also to jazz. It’s a bug that I got from my father, who was an excellent pianist and loved classical music. So, I kept on increasing my knowledge of classical music and listened to it whenever I was getting uptight or worn out and that was tremendously helpful. Find something, it doesn’t have to be music; it could be physical activity, gardening or anything else other than medicine.

The other thing that I didn’t really develop until I was in medical school was a passion for reading fiction and short stories. There’s a person I have to thank for that, and I don’t mind just expanding on that a little bit. I had taken literature courses in high school and undergrad and enjoyed them, but never really caught the bug until the summer between my first and second year of med school. I did work in a research lab for one of the geneticists at McGill, and there was another soon-to-be med student working on the same project with me in the same lab – and that was Peter Rosenbaum (see Figure 4). Peter eventually became a developmental pediatrician and is a full professor at McMaster University. That summer he quickly became one of my best friends and has remained so ever since. Like me, he is also an aficionado of classical music, but that summer he got me into reading fiction, a habit I have maintained ever since.

Whenever I was feeling a bit burned out, I would sit down for a few hours and just read a novel or listen to music. Everybody’s going to have something different that helps them relax and see things in a different light. I think it’s important early on to identify how you can broaden your life, not just because it will help you deal with stress, but also, I think this makes you a better clinician. It increases your understanding of other people, people who don’t have a knowledge of medical matters. I think being able to see things more from their point of view, rather than strictly from the medical standpoint is vital in being a good clinician over a long period of time.

Figure 1. Dr. Lauren Strasser (left) and Dr. Peter Humphreys (right).

Figure 2. Dr. Francis McNaughton (1906–1986), Neurologist, Montreal Neurological Institute and Royal Victoria Hospital.

Figure 3. Dr. Gordon Watters (1928–2022), Pediatric Neurologist, Montreal Children’s Hospital.

Figure 4. Dr. Peter Rosenbaum, Developmental Pediatrician, McMaster University.

Figure 5. Tree on Vancouver Island.

LS: What core lessons do you strive to pass on to your trainees – both clinically and personally?

PH: Much of this is what I’ve already said above. One additional recommendation: I think it’s very important from the get-go to do what I learned from Gordon Watters and that is to have a systematic way of reading scientific literature on a regular basis, and keeping track of what you’ve read. So, when a patient comes up and you’re not sure what’s going on, you can go back and review up-to-date information that you’ve gradually accumulated. It is an extremely helpful thing to have set up from the beginning.

LS: When preparing for this interview, you had sent me a photo of a tree (see Figure 5) which you felt summarizes your legacy as a teacher – can you explain this photo and what it means to you?

PH: Basically, that’s a symbol for how one’s career goes. As an early trainee and physician, you stand on the shoulders of your predecessors. For me, I stood on the shoulders of not just the two neurologists I mentioned, but also the child development specialist and friend, and they, in turn, stood on the shoulders of their predecessors. As I increasingly realized over the course of my career and through the relationships with the many residents who rotated through the pediatric neurology program at CHEO, that perhaps to some extent they were being influenced by me and by other people in the division. They were going to be standing on our shoulders. And it will always be like that.

That picture is kind of a symbol for that phenomenon. I’ll explain why.

It’s a tree. Yes, there are many like it, especially on Vancouver Island. When you go walking on the trails along the west coast of Vancouver Island, you come across scenes like this, where you have this great big tree with a wriggly root system above ground.

If you look carefully, you’ll see that it’s standing on – and rooted into a recumbent tree trunk – a predecessor whose “career” is now over. There are many such trees lying next to the path with little trees that are just beginning to grow out of their trunks. When I saw one of those trees for the first time, it struck me that it was a kind of image of how we develop as our lives unfold, building on the lives of our parents and our teachers.

LS: That’s a great analogy Dr. Humphreys, and I can personally attest, on behalf of the many residents you have taught, that you have certainly made a lasting impact on our careers as both a teacher and mentor.

Thank you very much as always for your wisdom and for participating in this interview.