As he completed his surgical training at the University of Toronto, Wayne Johnston struggled to choose an area in which to specialize.
He eventually decided on vascular surgery – a move that had far-reaching implications. Dr. Johnston, who died in Toronto at age 80 of pancreatic cancer in June, became known as the forefather of vascular surgery in Canada, influencing the discipline and countless surgeons globally over five decades.
“I’d say that there were few people in the world that have had a greater impact on vascular surgery,” said Barry Rubin, who was trained as a vascular surgeon and hired by Dr. Johnston at Toronto General Hospital.
When it came to battling vascular disease, Dr. Johnston was a triple threat, serving as a TGH surgeon and a University of Toronto researcher and professor. Vascular surgery, a means of repairing blood vessels outside of the heart and skull, is a separate specialty recognized by the Royal College of Physicians and Surgeons of Canada. It was formerly part of general surgery.
“Wayne led the effort for it to be identified as its own separate specialty in surgery,” said Dr. Rubin, now the medical director at the Peter Munk Cardiac Centre in Toronto.
Based in Toronto throughout his career, Dr. Johnston founded the U of T’s vascular surgery division, chaired it for 25 years and spurred the creation of the Royal College’s vascular surgery program. As a result, he led the training and certification of generations of vascular specialists. He excelled at medical politics as well, holding leadership positions with many groups. He co-founded the Canadian Society for Vascular Surgery and negotiated the merger of two such U.S.-based societies into the Society for Vascular Surgery, of which he was the first Canadian president, in 2007-08.
In other leadership roles, he co-edited the seventh and eighth editions of Rutherford’s Vascular Surgery, a reference book used by all of the world’s vascular specialists, and was the first Canadian to serve as editor-in-chief of the peer-reviewed Journal of Vascular Surger, from 1996 to 2003.
He was a pioneer in many ways, developing vascular ultrasound procedures and technologies, securing 34 years of consecutive funding from the Canadian Institute for Health Research in the process. He guided the world’s largest study on abdominal aortic aneurysms, the Multicentre Canadian Aneurysm Study, which has sparked less invasive treatments. And, he led the world’s first major study on balloon angioplasty – helping the technique become a common solution for clogged leg arteries.
“The first thing that we do, after we talk to people for a while and examine them, is get an ultrasound, and it’s all because of the contributions that Wayne made,” Dr. Rubin said. “He’s also the reason why we treat certain diseases the way that we do. We used to operate on narrowed blood vessels; now, the worldwide standard is putting a balloon in a vessel and expanding it.”
Although Dr. Johnston stopped doing surgery around 2008, he continued to advise patients, conduct research and teach until his health declined in 2021.
Graham Roche-Nagle, a Toronto General Hospital vascular surgeon who trained and worked with Dr. Johnston for several years, inherited some of his patients when he retired from operating. “They still talk about how good he was to them,” Dr. Roche-Nagle said. “Even recently, I was looking after a 93-year-old. Dr. Johnston had done a bypass on her 40 years ago – and she was still going strong.”
Dr. Johnston was named a member of the Order of Canada in 2018. He is the only Canadian, thus far, to receive the SVS lifetime achievement award (in 2009). Still, he did not think he was good at biology – a key component of medicine.
“There were too many mysteries, whereas physics and mathematics were purer sciences to me and they were much easier for me to understand,” he said in an interview done by SVS.
Kenneth Wayne Johnston was the oldest of two sons born to an engineer father and a mother who had a brief career as a nurse. As Wayne grew up in Toronto, his mother and maternal grandfather, a pharmacist in Collingwood, Ont., influenced his career choice.
“I think my mother saw me as a surgeon from when I was born,” said Dr. Johnston during a 2012 video interview conducted by fellow Society for Vascular Surgery members and posted on YouTube. “She had an obsession, I think, with surgeons from her nursing training, and I had to put that behind me, but finally decided to do medicine and, indeed, eventually surgery. That is what she wanted me to do. I like to think I chose it, but it’s hard to know.”
He graduated second in his U of T medical school class behind his future wife, Jean Turley, who became a clinical neurologist. But Dr. Johnston almost failed in his quest to train as a surgeon at the university because he balked at a requirement, set by the head of the surgical training program, to only do research in the first year. Dr. Johnston pointed out that he had completed two summer Ontario Cancer Society fellowships at hospitals in Windsor and Toronto.
“He said, ‘Well, if you don’t do this, where will you go?’” Dr. Johnston recalled in the SVS interview. “I said, ‘McGill.’ I had not applied to McGill. So, that was the first time in my life I’d ever played a card I didn’t have. He said, fine, I didn’t have to do research.”
Dr. Johnston planned to complete a PhD in pancreatic surgery in the middle of his surgical residency. But he switched to vascular surgery to help build the discipline’s profile because cardiac surgeons, who were doing all of Toronto General Hospital’s vascular surgery at that time, preferred to focus on their specialty.
“They were getting busier with their hearts and vascular was falling by the wayside and was not stressed. I saw a vacuum in an area with a great technical challenge and that was too much,” said Dr. Johnston, who finished his U of T surgical training in 1971.
After completing a surgical fellowship at King’s College in London, he spent his entire career at TGH and the U of T. He was tireless in his work, toiling six and a half days a week and tending his beloved garden on Sunday afternoons.
“He was a machine, but he was never aggressive – he was always gentle,” said Dr. Rubin, adding that he treated everyone equally.
Despite his busy schedule, Dr. Johnston strived to make the most of his time with Dr. Turley and their two children, bypassing positions offered outside of Toronto because of his wife’s career and the family’s interests.
“He was 110-per-cent dedicated to his work, to his patients and his research and his teaching – in a really inspiring way – but I always felt like he was an extremely committed family man,” said his daughter, Andrea, in an interview. “Although his hours were really long, and he was always working, when he was with my brother and I and my mom, he was ever present.”
Andrea, a former professional modern dancer who is now an occupational therapist, recalled how her father scheduled family vacations in conjunction with his guest lecturing engagements across the globe and was actively involved in her dance activities.
“My dance world also became his world,” she said.
Dr. Johnston shared his passion for photography with both of his children. Using a laundry room in the family home as a darkroom, he taught his son how to develop and print photographs off film and, later, how to process digital images.
“He had an early interest in computers and in their application in supporting the quantitative analysis that his research required and in facilitating administrative tasks,” Matthew said. “He shared this with me by teaching me how to write simple programs on his HP-85, displayed on its six-inch black-and-white monitor and saved onto its tape drive. This was quite unusual for the early 1980s.”
The University Health Network Foundation has established a memorial fund in Dr. Johnston’s name for research and treatment of vascular disease. As well, the Toronto General Hospital’s vascular ultrasound laboratory has been renamed in his honour.
Approximately a month before Dr. Johnston died, Dr. Rubin and Dr. Roche-Nagle, with their colleague Paul Walker, told him about the renaming plan. Dr. Johnston was overwhelmed by the honour and ranked it on par with his Order of Canada membership, Dr. Rubin said. A few hours before Dr. Johnston passed away, he was shown a picture of the sign for the facility that now bears his name.
“It’s profoundly emotional that he died knowing that his legacy had been cemented,” Dr. Rubin said.
Dr. Wayne Johnston was predeceased by his first wife of 49 years Jean. He leaves his second wife of two years Elizabeth Cain; daughter Andrea and son Matthew; four grandchildren and brother Doug.