Confessions of a Doctor - Stanley Feldman

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part of the anatomy class syllabus in most medical schools. That’s a pity. There is no doubt that the appreciation of the relationships of the various structures of which the body is made up has been invaluable knowledge to me and to many of my colleagues in our various careers. The notion that only surgeons need to know anatomy denies present-day doctors an essential insight into the way our bodies are put together.

      Our anatomy group consisted of an ex-service tank commander with a gammy leg, Brian, a super fit athletic product of a Grammar School, and me, but amongst the other teams working on our body I remember Roy the best. He was an ex-army captain whose father was a doctor. In June that year Roy had been accepted for Medical School to start in September but he had found the commanding officer of his army unit, stationed in the Far East, unsympathetic to his pleas for an early release from the service. Frustrated and cross he had spent a weekend leave with two friends in neighbouring Hong Kong.

      They had all got terribly drunk and on the Star Ferry, on the way back to their base, he had thrown most of the lifebelts overboard. At the subsequent court of inquiry he was asked the rather silly question, ‘What made you do it’ to which he replied, that he ‘could not bear to see all the little fish drowning’. To his delight he was punished by being dishonourably discharged from the army – in time for him to start his medical career.

      Another ex- army student was a little Welshman, Garry. Like many of the students, although he pursued his studies enthusiastically from Monday to Friday, Garry’s life revolved around rugby. On Saturday he was to be found on the sportsground as scrum-half for one or other Welsh rugby team. This was invariably followed by a night of heavy drinking. His Sundays were devoted to God, nursing his hangover in a local Chapel, so that he would be fit for his studies on Monday morning.

      Brian, the star athlete of our group, was soon part of the college cricket and rugby teams, and he spent every Wednesday afternoon training at the college grounds at Cobham – but Wednesday was also a time designated for dissection. In his absence we set about dissecting the body with gusto, and unfortunately this usually left Brian with little more than gristle and bone to examine when he returned to the college the following day. Even now, he attributes his success as one of the leading lights of orthopaedic surgery to having missed out as a medical student on the anatomy of almost everything, except bones, joints and gristle.

      Our physiology professor was a stocky, bad-tempered man. Perhaps his unsympathetic persona owed something to the uncompromising put-down he received when he published his life’s work, a book titled Sane Psychiatry. The review was short and to the point: ‘this book is neither sane nor psychiatry’. The ex-servicemen in our group lost no time in displaying enlarged copies of the review around the college.

      My time at King’s was academically uninspiring – involving a lot of ‘learning by rote’ rather than by enquiry and investigation – however it did lead to friendships that I am delighted to say have sustained to this day. Somehow, all but a handful of the students managed to scrape through the second MB examination. With this hurdle behind us we had our pass to the world of real doctors, the hospital wards and sick patients.

       HOSPITAL LIFE: THE WAY WE WERE

      Teaching hospitals of the 1950s were very different from those today, full of colourful, powerful characters, and distinctly superior to the ordinary hospitals, with their institutional, civic atmosphere. They were run by the doctors for the benefit of their patients and there was a pervasive atmosphere of learning and self-importance. Whether a patient, a doctor, a medical student or a nurse, you were made to feel privileged to have been granted entry to the portals of such an august academy of learning. To understand what it was like for medical students starting their careers at teaching hospitals, you need to appreciate the effect they had on our lives.

      [The very different nature of the teaching hospitals at that time was acknowledged by Lord Beveridge in the recommendations he made for the proposed National Health Service. He suggested they were separated from the service hospitals and specially funded to reflect their importance to teaching, research and innovation. His suggestions were never put into practice.]

      Unlike today’s hospitals, with their large administrative machinery and their attendant army of clipboard personnel checking on targets and auditing performance, they were administered by a small staff, all of whom were proud to be part of the institution and its history. The administration consisted of the hospital secretary and his assistant, a bursar, a financial director, and a supervisor of works, together with their secretaries.

      All the members of the administration demonstrated an unswerving allegiance to the hospital, its reputation, and to its doctors and nurses. This made them as faithful and reliable as any family retainer on a nobleman’s estate. All the members of the hospital staff, whether they were medical or administrative, were indulgent to the medical students – their ‘young gentlemen’. They would turn out to support them for inter-hospital rugby matches and be willing co-conspirators in any student rag.

      There was a Board of Governors made up of distinguished, usually wealthy, personalities, who served in a voluntary capacity. They, together with the hospital secretary, oversaw the general finances of the hospital and helped in the frequent fund-raising events. The day-to-day administration of the hospital was in the hands of a committee of senior consultants. The consultants were important men; they were at the very pinnacle of their careers. As they could advance no further in medicine they often devoted much of their time to promoting their hospital and its students. They would arrive from Harley Street in their chauffeur-driven limousines to be met by their houseman, the most junior doctor in their team. He would help the ‘great man’ (never a woman) off with his overcoat, take his hat and case and convey the ‘lord of medicine’ – accompanied by a retinue of ward sister, registrars, housemen and students – to the outpatient department, ward or operating theatre.

      Towards the end of the war, one famous senior surgeon, attending a meeting at the Royal College of Surgeons, caused a stir when he rose to his feet and embarked upon a lengthy speech after the chairman had invited observations from the audience. He recited his army rank and distinctions, his numerous hospital appointments followed by a list of the important committees on which he served. At this point the audience, embarrassed by his blatant self-promotion, started to become restless. He continued by giving the following explanation for his intervention. He said that when he had arrived, someone in front of him had turned to his neighbour and said quite loudly, ‘Who is that funny looking bugger who’s just come in?’ Senior surgeons in those days expected to be instantly recognised and their importance universally appreciated.

      In the hierarchy of consultants, the surgeon was king. He wielded the right of life or death for his patients by virtue of the scalpel that he held in his hand. Next came the physician, usually in order of seniority unless one of their number had treated royalty or had been knighted, in which case his position in the pecking order was enhanced. Obstetricians, anaesthetists and those serving less dramatic specialities, such as skin or eyes, were usually accorded a less formal greeting.

      It was unusual for there to be less than two or three ‘Knights of the Realm’ amongst the staff, a status more often accorded to them as a result of whom they had treated, or for a post they had held in a learned college, than for any major contribution to the advancement of medicine. This is not to say they did not contribute to the research or new ideas. To the contrary, it was because of their dominance in their particular field of medicine that it often fell to them to introduce a new treatment or a radical new idea.

      In my time at Westminster Medical School its doctors introduced one of the earliest successful techniques of open-heart surgery for babies and children, new methods of anaesthesia that made surgery possible without undue blood loss, the first intensive care unit, the first donor kidney transplant, the first total body irradiation and bone marrow transplant, new techniques of radiotherapy, the vascular pedicle technique for facial reconstruction after cancer surgery, and many less dramatic contributions which saved the lives of hundreds of patients. The hospital’s reputation for innovation and expertise was such that doctors came from all over the world to learn how to perform

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