Growing Into Medicine (10 page)

Pollington, the nearest village, is nine feet above sea level, half way between Selby and Pontefract. Although geographically in the West Riding, the landscape is that of Lincolnshire, flat and featureless. Sea mist sweeps in from the coast. In those days before the clean air act it met the dirt-laden wind from the industrial cities to the west, depositing the resultant grime over our hut.

Each weekday I drove to Doncaster in Ralph’s Austin Seven and caught the train to Sheffield. With no useful hill in the vicinity the car had to be pushed for several hundred yards when it refused to start. I blessed the groups of borstal boys who got me going on more than one occasion with much laughter and cheers as I disappeared into the gloom. Some of those journeys were the worst I have ever made. The best hope was to fit myself behind a lorry and stay within a few feet of its rear light. The car had no heater so the only way to clear the windows in winter was to scrape the ice off and I could not stop every few yards to do that. Instead I wound the windscreen open and allowed the murk to freeze on my face.

The energy needed to get into the city did not leave enough to do justice to my new university, where several members of staff took trouble to accommodate my needs. The syllabus did not match the one at Bristol in every detail. Smallpox vaccination had been covered
at Sheffield before I arrived. The professor of infectious diseases arranged for me to have a private session with him. He attacked me with the scratch needle to demonstrate the technique, before insisting that I do the same to him. We both survived.

One of the great differences between the patients in Bristol and those I was now meeting was in the inmates of the medical wards. The lasting image of Professor Bruce Perry’s beds is of rows of women with heart murmurs, whereas in Sheffield it was the huge men’s wards that remain stamped on my memory. Almost all the patients were suffering from bronchitis and emphysema or fullblown silicosis, as a result of life-long exposure to coal dust. The hacking and coughing went on day and night. A cup-like covered spittoon, which must have held at least half a pint, sat by each bed. In the bottom a small quantity of water prevented the sputum sticking. These containers could be completely filled with deeply stained phlegm before the end of the day.

For the three weeks before the final exam I moved into digs in Sheffield and crammed. Then I returned to Bristol for the papers and clinical tests. The worst experience was the midwifery practical where the external examiner was Will Nixon, professor at UCH and a great friend of my father. He was the nephew of my father’s senior partner in Chippenham and wanted to write a book. With no personal experience of general practice he had asked my father be his co-author. At the end of my case the local professor shook his head and turned away. Will insisted I be given a second case and a second chance. When I read his inscription in the copy of their book,
A Guide to Obstetrics in General Practice
, published in 1953, I had mixed feelings:
To Ruth, who after reading this book should have gained a distinction in the Obstetric Finals examination at Bristol!
I was not failing, as I had imagined, but being grilled for a possible distinction.

7

Hospital and Home

A new regulation, first introduced in 1953, the date I got my degree, required all doctors to spend a year in residential hospital jobs before being allowed to practise. I knew I must complete my training – but leaving my new husband for at least five nights a week set up many tensions. Later I was grateful that I had been caught by the new demands, for I had not been a very diligent student and would have been a hopeless doctor without the concentrated experience I gained.

The hospital nearest to our wooden hut was Pontefract General Infirmary where I was appointed as a house physician. Ralph worked in the evenings, having some time off in the afternoons to compensate. On the nights I did get home he was already back at work, not getting in till 9 or 10 o’clock, by which time I was often asleep, having been up several times during the previous nights. I had alternate weekends off but he only got one a month. On those rare occasions that we were free to go to the cinema together he wanted to watch nothing but westerns. I found them violent and hid my eyes in his jacket every time a gun was fired.

Most of his interests were alien to me. He had a passion for classical jazz, while my musical taste had not developed beyond the Gilbert and Sullivan beloved of my father. The martial arts and all things Japanese fascinated my husband, especially the Samurai code of chivalry with its emphasis on loyalty, honour and bravery. He took up archery and shot down the long corridor of our hut. He read about Zen Buddhism and headhunters in the forests of South America. He played chess.

I did not have hobbies. My energy had been focused for six years on passing exams and trying to please people. My mother gave me a subscription to a postal course in household management. Each month a copy arrived with details of cleaning, organising and cooking that should have been a great help in my domestic life. I was furious that she should imagine I had time or energy for such reading and consigned them to the rubbish bin unread.

If we had gone for any sort of pre-marital counselling surely we would have been warned against such an ill-fitting union. Some force had propelled me headlong into the alliance, at the age of twenty-two. Perhaps I was afraid of being ‘left on the shelf’, an unrealistic worry as I was reasonably attractive and did not lack admirers. Unmarried women were common in those days, not because they had chosen such a condition as might be the case in the modern world, but as a legacy of the First World War when the male population had been so reduced. My father’s eldest sister was one of them, stuck at home to look after her elderly mother and handicapped younger brother. I might have been worried that I would become somewhat fey like my aunt Cooty if I remained single. I prefer to believe that some unconscious good sense led me to choose a man who, while not obviously the most outgoing and helpful, was a much better match for my temperament than he appeared to be on the surface.

Now in the second year of our marriage I was spending my days and many of my nights in the company of a motley collection of doctors. I am deeply grateful to Leo Mulrooney, an attractive Irishman who supported me through the first few months. We had no casualty consultant and only one junior in what would become known as Accident and Emergency. The rest of us helped out on a rota basis. The majority of patients were miners with crushed toes or pieces of grit stuck in their eyes. I learned about the rusty ring such foreign bodies could leave in the cornea if not removed adequately; but the most important lesson for me was to look for the injury that was not obvious.

One day a patient was brought in with a damaged shoulder. I
suspected a fracture, dislocation or both, and having filled out the form for an X-ray, I turned away. Leo happened to be passing. He twitched back the blanket covering the man’s legs.

‘What about this?’ he asked, removing a temporary dressing that had been applied by the ambulance men.

I looked down at a huge laceration of the thigh. The wound was at least ten inches long and deep enough to expose the bone. Although conscious, the patient was too shocked to complain.

‘It might be a good idea to X-ray this too? Then we can see about getting him patched up.’

I felt my face burning as I realised how cursory my examination had been. After this experience I insisted on examining every part of all casualties, often almost ignoring the obvious injury. As I looked for the damage I might be missing, some patients complained. ‘It’s not my head [leg, back, stomach] it’s here doctor, my HAND,’ or some other part of their anatomy in which they were feeling pain.

After a while, a second Irishman joined us. He appeared to live in order to bet on horses, but never discussed his results. If he passed his cigarettes round with a smile he had probably won. If he sidled up with a murmured ‘got a spare ciggy?’ I knew his luck was out. I was never a heavy smoker but I kept a crumpled packet in the pocket of my white coat for those occasions.

I had graduated from the short white coat worn by students to one that reached below the knee. It had capacious pockets for my stethoscope, patella hammer and British National Formulary (BNF) – and of course my handkerchief. (I have never managed to wean myself onto more hygienic tissues.) The coats were provided by the hospital. A clean one arrived in my room about twice a week, so strongly starched that the sleeves were often stuck together, crackling as I pushed my arms down. If it got spattered with blood, pus or excrement I had to descend to the laundry to try and find a replacement that fitted.

Of course we scrubbed up for the operating theatre but even in the middle of the 1950s we were beginning to be blasé about infections, relying heavily on the magical antibiotics. The insights
gained by my ancestor Lord Lister who was the first person to argue against the idea that pus was ‘laudable’, and Pasteur who discovered microbes, were being ignored. Now, the increasing number of organisms resistant to even the most modern antibiotics has led to changes. When I questioned my daughter, who still works in hospital, she replied, ‘No white coats. The rule is “Bare below the elbows. One plain ring, no stones. No wristwatch. Wash or disinfect hands before and after every patient contact.” I think the suggestion is that you wear freshly laundered clothes every day. Many doctors in acute specialities wear scrubs now [the garb for the operating theatre]. BNF lies around on the drugs trolley. Stethoscope usually round neck – not that it gets used as much as it should with reliance on tests etc, but that is probably just me.’

Me too. I am horrified by the stories I hear from friends who been sent for tests without any clinical examination.

In Pontefract the general surgeon covered our work in casualty, but if he was in the operating theatre we had to cope until he could escape. One young man haunts me still. He had a severe head injury and was semi-conscious, suffering from cerebral irritation, making him throw himself about so violently that two porters and two nurses had to hold him down while I tried to cut the surrounding hair and clean the wound. Was that brain I could see? I could not be sure. I stitched it up as well as possible – too well. When the surgeon eventually made his way to the ward he decided to leave my sewing undisturbed. Despite antibiotics it became infected and the boy died three days later. My boss admitted to me that he should have taken the boy to theatre and done a proper job but he had been deterred by my tidy, superficial work. We were not wilfully negligent, just two human beings doing our jobs but making mistakes. As so often happens, the grieving parents were some of the most grateful I have ever met, donating a large sum of money to the hospital for the ‘care’ their son had received. Another defensive skin tightened round my feelings.

At the beginning of my hospital work I was the only woman
resident. Both the medical and surgical registrars had qualified in India. The former was the best doctor I have ever met. My trust in his judgement was absolute. Although he was half my father’s age he was more knowledgeable. If ever I were in a large-scale disaster, that man is the person I would like by my side to make the decisions. I was particularly grateful for his help when a severely asthmatic young woman was repeatedly admitted to the ward. She was often
in extremis
and we had no steroids. I had to make do with subcutaneous adrenaline, intravenous aminophylline, given very slowly, oxygen and a tight hold on my panic. Thank you Ramu, for seeing me through those nights.

The surgical registrar was brilliant. I played chess with this man who was not even sure of all the moves but still beat me with a flourish. He was neat and quick when operating but I did not trust him to make good clinical decisions. One patient had been using an electric sewing machine and somehow got her wrist in the path of the needle which had broken and left a piece inside. My knowledge of the anatomy of the wrist was by this time rusty but I remembered our anatomy teacher and her crippled hand. I phoned to ask the registrar to come to casualty.

‘That’s all right,’ he said airily. ‘You are quite capable of getting it out.’

I knew I was not. ‘Sorry,’ I said, ‘I’m not going fishing around in the wrist with all those vital structures so close together.’

He disappeared and the next thing I heard was that the consultant was planning to remove the broken needle in the operating theatre under a bloodless field. (A tourniquet is applied from the fingers up to remove blood from the limb and stop any more entering for the brief period of the operation.) I was shocked that the registrar had asked me to do something he would not attempt himself.

One doctor from West Africa was an enormous liability. His weekends off, when he was away from the hospital and which always lasted four days, were a comparatively peaceful time for me, even though I was doing the work of two people. At least at that time I had the authority to try and rectify his blunders. When he was
present he did not examine patients or take their blood pressure but wrote down any number that he thought might be suitable. Drug prescriptions were inaccurate. He made advances to the nurses, who came to me in the belief that I could rescue them, and their patients, from the worst of his excesses. At that time there was no suggestion that I should act as a whistle-blower and report him to the authorities. Today I would be severely censured for not doing so.

Until this time, in common with many of my friends, my contacts had been exclusively white and middle class. My experience of working with doctors of different ethnic groups, brought up and trained in different cultures, taught me that such factors were far less important than individual personalities. In Britain in the twenty-first century the opportunity for that lesson will normally occur in nursery school.

Despite the lack of supervision, long hours and excessive responsibility, there were some ways in which our life was better than that of junior doctors today. We always had a nurse to help us undress the patient and move them in the bed when we carried out an examination, something I understand that even consultants cannot expect nowadays. The turnover of patients was not so fast and each ward had an experienced Sister who knew them well. We always had access to tactful but invaluable advice if we were humble enough to ask for it. This was particularly true on the children’s ward. I had sat in on a few outpatient clinics and walked round the wards occasionally as a student, but I knew nothing of sick children. Paediatric care was part of the house physician’s remit so I ‘took over’ the ward on my first day. Of course, I did no such thing. Sister told me what to do and I did it. She had held the ward together for many years and with her extensive experience she had kept the children safe from the worst mistakes of generations of newly qualified doctors.