14 March 1918-12 June 2009
The recent death of Ivan Lichter Onz has deprived New Zealand
medicine of an extraordinary talent. Not only did Ivan have a very
successful career as a thoracic surgeon but he went on to become a
leading authority and visionary in the care of the terminally ill
Ivan was born in South Africa and graduated from the University
of Witwatersrand (Johannesburg) in 1940. After spending some time
in the South African armed forces, he specialised in thoracic
surgery and built up a successful practice.
He married Heather Lloyd in 1951 and they had four children:
twins David and Jonathan who both practise medicine, Barry a
journalist and Shelley who is also practising medicine.
South African politics and a strong anti-semitic movement saw
Ivan move his family to New Zealand in 1961. He told me that his
choice was either to go to some place in Texas or to a place called
Dune Din (!) in New Zealand. Thankfully he chose the latter, where
he joined John Borrie. Between them they provided the thoracic
surgical care for the lower half of the South Island.
It was my pleasure to be Ivan's registrar in the 1970's as I was
starting out in my training. Ivan was a meticulous surgeon. He
bought a systematic and very disciplined approach to surgical
issues. His pre-operative assessment always started with a thorough
history and examination and then a careful review, in strict
chronological order, of the radiology and other investigations. A
complete picture was established which allowed the optimal planning
He also had a strong interest in research. He was the first in
the world to use oesophageal motility studies in clinical medicine.
He had modified a standard nasogastric tube to allow the recording
of oesophageal pressures at three levels - five cenitmeters apart.
It was not the most refined of devices and the motility studies
became known as the 'chunder studies' - I suspect Ivan was unaware
of this. His initial papers were not accepted for publication due
to the reviewer's lack of understanding of oesophageal physiology.
However, he was recognised by those that were to become world
leaders in this field and they corresponded with Ivan on a regular
Ivan was a pioneer of overnight pH studies - this being done
with a rather industrial pH probe which had to remain in the
oesophagus overnight. However, the information gathered allowed him
to take a rather more scientific approach to hiatus hernia surgery
than was possibly the 'norm' in the 1970's.
He also took a keen interest in undergraduate education. He was
an advocate of clear concise record keeping and he championed the
same discipline that he bought to the operating room to this aspect
of clinical medicine. The principle of SOAP - S(subjective),
O(Objective), A(Assessment) and P (Plan) - was promoted by Ivan and
the patients' notes had pre-printed forms with these headings. He
felt that this lead to a logical and more accurate approach to
He participated in College activities and was, for a period of
time, an examiner in cardiothoracic surgery.
Ivan was fundamentally a shy person. It is also fair to reflect
that he did not suffer fools lightly. Outwardly he did not display
a great deal of emotion and for this reason Ivan was considered by
some to be somewhat 'cold' and distant. Although those of us who
worked closely with him knew differently, it came as a surprise to
his colleagues when Ivan moved into the emotionally demanding field
of caring for the terminally ill. He is considered by many to be
the founding father of the modern hospice movement in New
This new direction for Ivan was really an extension of his
philosophy that the needs of the patient were a clinician's prime
concern. In the 1970's he was holding multidisciplinary meetings
regarding his patients which included all medical and allied health
personnel involved in their care. They were held in the Chapel of
Wakari Hospital and became known as the 'prayer' meetings, but they
left a lasting impression on a surgical Trainee - probably more
interested in cutting than cuddling at that stage - that what we do
as surgeons in the operating room is only a small part of overall
patient care, and that the non physical needs of the patient are as
important as the physical needs, if not more so.
Ivan retired from thoracic surgical practice in 1982. By this
time his interest in palliative care was a passion. He had been
influenced by Kubler-Ross's work - particularly by her book "On
Death and Dying". He left Dunedin in 1986 and moved to Wellington
to become director of Te Omanga Hospice where he remained until
Ivan was awarded New Zealand's highest honour, the Order of New
Zealand (ONZ), in 1997 in recognition of his contribution to
medicine and in particular for his promotion of the principle of
holistic patient care. He also published widely in this field.
The exodus of talented medical practitioners from South Africa
has been of benefit to New Zealand for a number of years, and no
more so than when Ivan Lichter decided to make his home here.
Ivan's contribution to New Zealand medicine has been immense. As a
skilled thoracic surgeon he helped many patients and as a mentor he
instilled sound surgical principles into his trainees.
However, I suspect his greatest contribution came at a time when
most surgeons would have chosen retirement. Ivan developed an
interest that turned into a passion that saw him at the cutting
edge of caring for the terminally ill patient. The benefits that
have accrued as a result of this are immeasurable.
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