Against the Tide (14 page)

All of these experiences constituted an exciting and attractive new life. My archaic Irish and public school snob values were healthily upended in a consciously liberating way. It is possible
that I had recovered the egalitarian instincts and fairminded values of my own home, which had been distorted by my class-orientated school experiences. Whatever the cause, after my English
hospital service, I had found my real self, and I was changed irrevocably. In those hospitals in Britain I had met consultants who were among the world’s leading physicians and surgeons, and
yet worked for state salaries. They worked ceaselessly, conscientiously, and with complete satisfaction at their profession. I have always found the cash nexus between the patient and doctor
indefensible. It cannot be a link, and frequently it can be an impediment. It is little wonder that Bernard Shaw could write about it with such satirical accuracy. Being a doctor, with all its
connotations of relieving human distress, was to me such a privilege that I could not consider the need to take money from a patient for any help which I might have given to them. Within this
heterodox attitude to medicine, I found myself to be very much of a misfit with many of my Irish colleagues. Their approach seemed to be just the same as that of the butcher, the baker and the
candlestick maker, that you made the customers pay as much as you could get out of them.

Because of these beliefs, that money should not be made out of the misfortunes of others, I chose throughout nearly half a century in medicine to work for an institution, or for the state,
receiving a salary; no matter what the amount of work or how many hours I attended to patients, no money passed between the patient and myself, and every patient, I like to believe, was treated
with the same care. My sheer inability to compromise on this principle became very clear on one occasion, when a colleague in private practice developed tuberculosis, and died. I was asked to take
on the practice. Since my pay at Newcastle at the time was but £21 monthly, with a lodge, in the interests of my uncomplaining, financially hardpressed wife and family, I agreed to the
proposal. Yet it was impossible for me to continue that form of private practice; I simply could not ask for money from men and women who clearly had difficulty in paying. After a time, I
compromised with the device of a plate on my table in the hallway, mentioning to the patients that they might put into the plate whatever they thought they could afford. This amounted to far less
than the cost of rent of the rooms, the necessary medicines, the drive from Newcastle, and above all, it did not help my patient and long-suffering wife. Yet we decided to discontinue the practice,
while continuing to care for the patients at Newcastle. It was an experience of this kind, no doubt, added to what I had known in my early life, which, in the end, helped to turn my mind towards
finding a way in which I could change life for the underprivileged sufferers from tuberculosis, and ill-health generally, in Ireland. Had my wife and family not shared these beliefs with me, I
could not have taken the adamantine stand on those principles which I did, later on, when Minister for Health.

On 14 January 1944, Phyllis Harrison and I were married at a rather strange ceremony which took place in a small church near Uxbridge. Three people attended. Since none of us knew that a
Registrar should have been asked to attend, the marriage could not take place until the following day. No doubt relieved after the disappointment, confusion and delay of the first day, a Highland
Scot colleague at Harefield, feeling to some extent responsible, drank the only bottle of Irish whiskey which we had for the celebration. There was no conventional honeymoon; to use the phrase of
the time, ‘there was a war on’.

Phyllis was the youngest child of a large middle-class North Dublin Church of Ireland family, all intellectually gifted. Like so many children of big families, she suffered the emotionally
barren milieu inevitable where a parent is already pre-occupied with considerable family worries and work. From a very early age, she believed that she was the last straw for a mother who had given
to the other children the limited capacity for love she possessed. In place of a Christian name, her birth certificate carries the bleak message, ‘female child’. When her mother lay
dying, some thirty years later, her last words to Phyllis, as if she was being deliberately hurtful, were ‘Who is she? Who are you?’

Exceptionally quiet, shy and sensitive, Phyllis lived a home life of uncared-for loneliness. Observant from an early age, sceptical and critical, she noted the squalor and humiliation of the
black face and dirty clothes worn by the wretched man draped in a damp canvas sack who delivered the coal down the long passages and steep stairs of her Victorian home. A surprising child in many
ways, she favoured what she knew of the old Jim Larkin and his work for trade unionists, and became a republican despite her Anglo-Irish background.

She considers love to be the only civilized dynamic of relationships in an egalitarian society; it was typical of her, rearing our own family, to say, ‘you should spare the rod and you
should spoil the child’. It was she who supplied the rational structure to back my own instinctive powerful feminist faith. With growing knowledge and experience of practical politics on the
left during fifty years in the harsh testing grounds of Irish public life, she reinforced her conviction that the proper path for us to follow was that of social revolutionaries. She accepts the
Marxist analysis of society, and what some have described as its mechanistic coldness, as mediated for her by that fine Italian socialist philosopher and political martyr, Antonio Gramsci.

Her socialist attitudes were absorbed from two gentle ladies, Miss Savage and Miss Beck, who taught her at the Church of Ireland Sunday School. Phyllis did not get a conventional academic
education at university level, though she did attend both the College of Art and Miss Read’s school of Pianoforte in Harcourt Street. This did not prevent her from applying her fine intellect
to the unravelling of the complex emotional processes by which we humans are motivated. Because she rarely accepted or judged the act or comment by its superficial meaning, at all times she looked
behind the facade of behaviour for a deeper explanation and understanding. She was always moved so much more easily to compassion than to anger. Believing as we both do in the psychodynamic effect
of childhood experience in determining later behaviour, forgiveness came more easily and resentment was rare. The arcane world of psychology has in Phyllis lost a creative, original, ruggedly
independent and adventurous mind. Happily for me and for our two daughters, Ruth and Susan, psychology’s loss has been our inestimable gain.

Her special virtue for me was not alone our loving relationship, but, within this, her inexhaustible patience. She could help me find my way back out of the maze of emotional defence mechanisms
with which, after the dissolution of my family life, I had learned to surround myself. Her patience was needed in abundance. While it is true that I have gained most from our relationship, we each
complement one another’s intellectual and personality needs.

Once the war was over, it was very tempting for us to consider continuing to live and work in what we both felt to be congenial company and surroundings. Yet we believed that now that our
responsibility of making a contribution to the allied struggle against fascism was over, we would and should return to Ireland. With the experience I had gained we would try to create similar
conditions of care and efficiency for our fellow countrymen.

Unhappily, because I was a ‘Trinity Catholic’ I was suspect and unwelcome within the state medical services. To admit to a medical training in TCD, irrespective of the quality or
extent of one’s subsequent training, was an automatic disqualification from posts in any of the local authority sanatoria, the only sanatoria which provided medical care for public patients
suffering from pulmonary tuberculosis. There were plenty of doctors ready to treat private patients, but this work did not interest me. Eventually I was offered a post with a salary of £21
monthly, and a lodge, at my former hospital at Newcastle, Co. Wicklow.

While I was glad to return to Ireland, I soon realised that nothing had changed at Newcastle or, indeed, at any of our hospitals. Indifference, apathy and complacency that amounted to sheer
neglect prevailed everywhere. Our sanatoria were staffed for the most part with one or other of Peter Edward’s categories: drunks, dope addicts, or simply lazy bastards. There was, of course,
one exception, the gentle, hard-working and talented Dr John Duffy of Dublin Corporation.

It was impossible to work to any real purpose with the substandard, ill-equipped facilities in our own hospital. I decided to meet the more active of my colleagues in the tuberculosis service.
After a number of such meetings, we decided to try to form an association of doctors concerned with the disease. I also lobbied the Red Cross and members of the trade union groups to see if they
could help. We hoped to raise enough funds to build a properly-equipped 250-bed sanatorium. People expressed their full support and sympathy for the idea, but nothing was done.

Incredibly, our attempt to form a TB association was sabotaged by religious complications. Those of us who had started the project hoped to include doctors from all hospitals concerned with
pulmonary tuberculosis. Invitations were sent to Dr Synge, a distinguished Fitzwilliam Square physician and brother of J. M. Synge, and Dr Rowlette. Both were fine physicians, neither of whom was
interested in financial gain. To my surprise the steering committee, of which I was not a member, received an instruction from the Catholic Archbishop of Dublin, Dr John Charles McQuaid, that he
would not permit Protestant doctors to sit on our committee. The committee accepted this ruling, the usual practice at the time at all levels in the country. Dr Rowlette and Dr Synge were excluded.
The association was established, but did nothing to establish the primary physical needs of tuberculosis services. It was surely naïve of me to expect that collectively they would do much more
together than they had done singly over the years.

Thirty or forty years ago doctors enjoyed a popular respect, born of a mixture of gratitude, mystification and fear. Only this could account for the fact that no matter how clearly in virtually
any Western country the case has been made for radical change, the money-making part of our health services remained unchanged or even, from the doctors’ point of view, simply improved. From
the actuarial point of view, as well as in a professional sense, there is no logical or valid reason why a national health scheme should not be based on a salaried system of payment. Such is the
successful practice in our limited state health services as they apply to infectious diseases in Ireland. The nearest comparable profession is that of the salaried nurses, than whom there is no
finer group of individuals in service to the community. Yet the ‘best’ general medical practices in Ireland are based on the crude donkey-and-carrot money stimulus. Unlike the salaried
postman, who is trusted to deliver every single letter given to him, the doctor cannot be trusted to work conscientiously for a salary like everyone else. Together with his colleagues in the law,
the doctor must have a sweetener in the form of a fee every time he serves each individual in the community. Contemplate the success of the postman’s union or busman’s union were they
to demand payment for every letter delivered, or every ticket checked. What about paying every nurse for every bed made and for every post-operative painkiller given when needed?

Time and again through recent history the medical profession has successfully resisted a fair and even distribution of their services all through the community. One of the results of the
fee-for-service medical practice system here has been an enormous growth in the cost of the health services without a significant increase in their efficiency.

It was the practice for Dublin consultants of varying specialities to visit our patients at Newcastle in an advisory capacity. There were many conscientious consultants whose conduct was
selfless and impeccable, but there were also those who simply used the hospital to unload those patients from whom fees could no longer be extracted. These consultants could be callous and careless
about keeping sick men and women, who were not paying, needlessly waiting. They would then stroll into the consulting room as if the delay was of no importance.

One evening, after a considerable wait for the consultant, one such clinic began, attended by Harry Kennedy, a friend of mine. Harry, a journalist of considerable distinction, had written widely
from a liberal point of view on many subjects in the
Irish Times
, then a liberal newspaper under the editorship of R. M. Smyllie. However, because he had preferred to help others with
whatever money he had, he remained relatively penniless. He had frequently watched the long-suffering patients treated with cavalier indifference, and could no longer tolerate the injustice of
it.

It was a hopelessly uneven struggle. On the medical side was the imperious, tall, impeccably-coiffed consultant, who dyed his hair jet black until he was in his mid-seventies. His hands were
carefully manicured. He wore a gold seal and pendant watch across his taut, well-stretched waistcoat, and flourished that useless hallmark of his omniscience, the stethoscope. He was clearly a busy
man and in a hurry. There was obviously little to be gained in financial terms: anyway he had a social committment, a dinner party.

The journalist was a small tubby unhealthy-looking man, sandy-haired and pink-faced. His well-worn pyjama trousers had slipped down on his hips. But his powerful thoughtful eyes, of a
distinctive brittle blue, told of a mind of power and courage not often encountered. Public patients had been taught to behave submissively but there was no submission here. Too late, the
consultant realised that this was not just another bucolic ‘grateful patient’. Instead this tousled, half-dressed, terminally ill man slowly looked up and, in his clear musical voice
whose origins were in the Glens of Antrim, asked the consultant if he had any understanding of the measure of the mental and physical stress of the father or mother, wife, son or daughter,
represented by the huddled weary patients still waiting outside the door. He asked the consultant was it his practice to treat his wealthy consulting room patients in this way; was it money or
medicine which most motivated or concerned him? Were his patients divided into the sick rich and the sick poor? Did he believe that the sick poor could suffer and feel pain and separation and even
avoidable or inevitable death less than the sick rich? He declined to submit to the cursory examination, took a dignified leave of all of us present, and left the room to the deeply embarrassed
consultant. This was a moral victory for my courageous friend, yet there was no doubt who would win in the end.