Dr. Bernard Langer in 2016.Courtesy of Dodge Baen
Dr. Bernard Langer, an icon of Canadian surgery, died of a major stroke on Feb. 23 at the age of 89. He was a pioneer in liver, biliary and pancreatic surgery – having performed Toronto’s first liver transplant, at University Health Network (UHN) in 1986. He was an outstanding leader as chair of the University of Toronto’s Department of Surgery, building its strengths in all the subspecialties of surgery and innovative surgical training and mentorship. He developed a powerful research orientation that ensured ongoing progress in surgery. He was also a committed educator, and, under his leadership as president, the Royal College of Physicians and Surgery launched the important Clinician Investigator Program to teach a new generation of physician investigators.
“During the last 50 years I have been honoured to work with many truly outstanding individuals – the one who made the most impact on academic surgery was Bernie Langer,” said Alan Hudson, a prominent neurosurgeon and former chief executive of UHN. “His leadership has effected change at the university, [and in] the province and the country as well as the international arena. I never saw anyone accomplish more while minimally drawing attention to himself. He was a giant in surgery.”
Bernard Langer was born in Toronto on May 23, 1932, the sixth child of Joe and Pearl Langer, who immigrated to Canada from Poland in 1910, escaping persecution and pogroms. His mother was 42. He was 10 years younger than the next sibling and his mother died when he was eight years old – he became independent early in life. After attending Harbord Collegiate, he was accepted into the University of Toronto’s medical school, despite the quota on Jewish students at the time. He graduated as gold medalist and class president in 1956. At 22, he married Ryna Manson, then 19. The partnership lasted 68 years and was the cornerstone of his life.
Dr. Langer chose surgery as his specialty, training in general surgery at the Toronto General Hospital (TGH) and doing a fellowship in surgical oncology at the MD Anderson Cancer Centre in Houston, followed by a year with the renowned research-oriented surgeon Francis D. Moore at the Brigham Hospital in Boston.
Dr. Langer was arbitrarily assigned to the liver group. He gained his surgical credentials when he became a fellow of the Royal College of Physicians and Surgeons of Canada in 1961. He was the first Jewish surgeon appointed to the TGH, specializing in general surgery and focusing on liver, bile duct and pancreatic surgery. He said he became an accidental liver surgeon; the procedure had not been done at TGH as the highly vascular nature of the liver made surgeons hesitant to try.
Dr. Langer performed Toronto’s first liver transplant, at University Health Network (UHN) in 1986.Courtesy of the Family
He was visionary when he established a canine liver-transplant program and did the first liver transplants at TGH in 1986, in partnership with gastroenterologist Gary Levy. Interestingly, Dr. Langer’s son Jack Langer was part of the team that performed the first Toronto pediatric liver transplant at the Hospital for Sick Children, led by the elder Dr. Langer. This all led to the formation of the Multi-Organ Transplant Program, which performs more than 200 liver transplants every year.
In 1982, Dr. Langer was appointed R.S. McLaughlin Chair of the University Department of Surgery as well chair of the Division of General Surgery. In its 180-year history, the department has been chaired by legendary surgeons Clarence Starr, William Gallie and William Drucker – and has included pioneers such as Gordon Murray, William Mustard, William Bigelow and Robert Salter. When Dr. Langer was appointed chair, it had a great reputation in clinical surgery, but with all the remarkable advances in medical science and major changes in society at the time, he recognized that it was not well positioned for the future.
Dr. Langer’s leadership in the following decade made a huge mark on surgery in Toronto and Canada. He saw the serious need for surgeons who were well-trained for medical research and the need for much improved education of surgical residents, considering that he felt his own surgical and research training were less than ideal.
However, he needed resources to transform the department. So he boldly began a group practice plan that pooled departmental clinical earnings and compensated his faculty not only for their surgery but also for education and research. This plan was later copied by surgery departments in most Canadian university teaching hospitals,
In 1985, Dr. Langer started U of T’s Surgeon Scientist Training Program (SSTP). This program demanded a two-year commitment to research with a well-established scientist and led to a master’s or PhD degree. To date, 450 surgical residents have completed this program, having received full salary support with limited clinical duties. The long-term result over 40 years is that today’s Department of Surgery attracts some $100-million of research funding, produces numerous publications and is a world leader in modern surgical practices.
“This training model was widely emulated in clinical departments across Canada and worldwide,” David Naylor, former president of the University of Toronto, says. “It took vision and courage to see this through, but Bernie Langer had both traits in abundance. A brilliant and gifted leader, the Department of Surgery he helped build is, today, one of the best in the world.”
Dr. Langer developed a stellar reputation for clinical and technical excellence. He was a gifted teacher and taught residents, step-by-step, how to do complex operations while doing them.
“He was truly uniquely gifted as a surgeon, with a marriage of superior judgment and technical virtuosity that could turn a potentially dangerous situation into an effortless and a successful procedure,” his friend and surgical colleague Bryce Taylor said. “I never heard him raise his voice even in the most complex and challenging operative cases that demanded total uninterrupted concentration for many hours – indeed, he was energized and remained cool, thanking the whole operating team at the end. He was truly a surgeon’s surgeon.”
Dr. Langer’s leadership as chair of R.S. McLaughlin of the University Department of Surgery as well as chair of the Division of General Surgery made a huge mark on surgery in Toronto and Canada.Courtesy of the Family
Dr. Langer emphasized to his trainees the importance of making personal connections with patients. He personally cared gently for his patients. Cheryl Reznick, for one, remembers him visiting her postoperatively, lending a hand as she got out of bed and putting on her slippers to help her to the bathroom.
His management style was visionary. As a strategic thinker, he could readily distill complex evidence into its elements – he often said, “If you don’t stand tall enough, you can’t see far enough.” He was decisive, demanding, insisting on teamwork and accountability. He was a tough negotiator requiring regular reviews of faculty.
John Wedge, successor to Dr. Langer as chair of the Department of Surgery, described Dr. Langer as being economical and softly spoken – the more critical the issue, the softer the voice. “The room was completely quiet as he spoke, everyone straining to listen. He commanded the respect and full attention through clarity of thought and a droll sense of humour. He was a much admired and valued role model for effective and principled leadership.”
The next person to serve as departmental chair, Richard Reznick, remembers well how Dr. Langer once encouraged him when he proposed to combine his surgery with a focus on medical education. Later, when Dr. Reznick was chair, Dr. Langer went to see him, giving the famous Langer look, and said, “If you try to make everybody happy, you won’t be doing a good job.”
Colleagues knew Dr. Langer as “The Hawk”– as Dr. Taylor recalled at his funeral – an endearing term as he soared above the rest, always saw the big picture, was aware of the minute details on the ground, made things look easy, but if one was reckless in remarks or patient care, the talons would descend – you would learn a lesson, not soon to be forgotten. He would say, “Good enough is not good enough.”
Dr. Langer retired from surgery in 2002 but joined Cancer Care Ontario as a senior consultant, developing standards of surgical care, outcomes and education for community surgeons. He became president of the Royal College of Physicians and Surgeons in 2000 and during his two-year tenure created a national Clinical Investigator Program akin to the SSTP in Toronto. This led to the formation of the Canadian Patient Safety Institute, geared to patient protection. He was heavily involved in health care policy and oversaw submissions to the Romanow Commission on the Future of Health Care in Canada.
Dr. Langer personally made a huge contribution to academic surgery by writing 188 peer-reviewed papers and giving 112 lectures in his discipline in Canada, the United States, Europe and Asia. He received many honours including, most notably, his investiture as an officer in the Order of Canada in 2002, election to the Canadian Medical Hall of Fame in 2015 and the establishment of the Bernard and Ryna Langer Chair of General Surgery at the University of Toronto.
A reunion was held in 2012, when 49 of 65 former hepatobiliary and transplant fellows gathered from Europe, Australia, Saudi Arabia, South America, the United States and across Canada to honour Dr. Langer. Jim Rutka, the current chair, said, “Dr. Langer’s reputation continues to permeate and influence the practice of hepatobiliary surgery in Canada and throughout the world.”
The eminent surgeon also had fun. He had been a superb swimmer from his student days, when he played water polo. Later, he was an accomplished fly fisherman, being on New Brunswick’s Miramichi River with family and close friends casting for hours with a cigar in his mouth, fishing for salmon or arctic char. He became an artist, crafting beautiful stained-glass creations. In his spare time, he was a loyal follower of the Toronto Blue Jays, despite the emotional highs and lows.
To Dr. Langer, despite all his accomplishments, he was most proud of his very talented family, to whom he devoted much time, especially at their large riverside farm, which offered no television or telephone but plenty of music, cooking, skiing, hauling wood, games and good wine.
After his death, his family remembered his hands, not only for their surgical skill – “fingers long and slender that taught them how to tie their shoes, that deftly tossed flies to greedy fish and transformed glass into beauty” – as well as his eyes, voice and wisdom.
Dr. Langer leaves his wife, Ryna; his four children, Jacob (Jack), Pearl, David and Michael; 11 grandchildren; and three great-grandchildren.