I never wanted to be a doctor; my mother made me do it. When I told her I wanted to be a stand-up comedian she said, “Comedian, schlamedian. Okay, but become a doctor first.”
In 1947, there were eight University of London teaching hospitals. I was rejected by seven of them and was sure this was because I did not play rugby. To get a place at several of these hospitals, one had to be accepted for pre-clinical work (anatomy, physiology, biochemistry, and pharmacology). I did mine at Kings College in London. In anatomy we were divided into groups of six. By chance, when it came round to dissecting the penis, it was the turn of the only woman in our group. At the end of the session, she gave a very concise summary of the parts concluding with, “And this is the glans at the proximal end.” The instructor said, “You mean the distal end.” She replied, “If may be distal to you sir, but it’s always proximal to me.”
At one hospital, a member of the admissions committee asked me what I thought of Marx. My 17-year-old brain immediately realized it was a catch-22 question, especially if the questioner was a communist. So I cautiously replied, “Some of his views were acceptable but many were not.” As I left the room, I realized I had been asked about (Jean-Baptiste) Lamarck, not Karl Marx.
My last hope was St. George’s Hospital where there was no admissions committee. The dean, sitting with his feet up on his desk, commented that my academic background was satisfactory. He then asked me if I played cricket, to which I was able to say, yes. He said, “Good, you’re in. We need more student cricketers to play in the weekly staff vs student matches.” I never did play cricket at St. George’s, opting instead for the rowing club and dramatics.
A few months after starting clinical work, each student was interviewed by the preceptor of studies. When I told him that I wanted to become a pediatrician, he said he thought I was the least likely in my class to become a consultant and told me to aim for general practice. I left his office more determined than ever to specialize in pediatrics.
In my first surgical rotation, I was assigned to urological service. Gingerly holding a retractor, I was asked not to shake so much as I was pulling on delicate gut. Near the end of the radical prostatectomy, the surgeon said, “Pass me a whistle-head catheter, sonny,” to which I replied, “What is a catheter, sir?” The surgeon immediately asked the head nurse of the operating rooms to bring out a complete tray of catheters. She suggested that he should stop the bleeding first. She was instructed to pass a warm pack that was pushed into the patient’s lower abdomen, and I was then given a very detailed demonstration of catheters that is still indelibly imprinted on my mind.
On my second surgical rotation, the surgeon told us that the first case was private and we would have to wait outside the operating room. However, when the patient who was awaiting a hemorrhoidectomy was anesthetized and draped, we were invited in and the surgeon said, “This is the asshole of a lord. You will note it has the same size, shape, color, and texture as any other asshole. If you remember this, you will become better doctors, however little you learn from me.”
This surgeon was subsequently knighted by the Queen.
On the obstetric and gynecological rotation, the chief asked me what I would do if a woman had a massive bleed at World’s End. I wondered what the woman and I were doing at the end of the world. I was so naive, I did not know that this was the name of a pub near the hospital.
Upon graduation, I was given one of the coveted internships—casualty officer—at my own teaching hospital. Today one would need several years of postgraduate training for this position.
In 1952, still in my 22nd year, I walked to St. George’s on my first day of work with a halo round my head. My daydreaming was abruptly arrested when I noticed numerous ambulances occupying the whole front and sides of the hospital and patients on gurneys leading to the emergency department. As I arrived, the head nurse of the operating rooms, who had been put in charge of the casualty department at age 60, asked me if I was the new boy. She then explained to me that the Queen had just had one of her garden parties and that many people had fainted when she appeared. They were taken by ambulance to the nearest hospital, St. George’s. This nurse then took my hand and led me from gurney to gurney saying, “You get up and go home; you can sit in a chair; nurse, get this one a cup of tea and then she can go home,” and so on. At about the 10th patient, she said, “Doctor, admit this one.” I asked her why and she said, “He looks ill. Get a prescription pad and write ‘coronary thrombosis, please admit’ on it.” In fact this was the only patient I admitted that day and he did turn out to have a CT. My high regard for nurses has remained with me to this day.
On another occasion, a patient limped in late on a Friday complaining that he had sprained his ankle playing soccer. After examining him and his X-rays, I could not be sure of a hairline fracture. He asked me if he could play the next day and I advised against it. The following evening, two other interns were talking about an idiot who had told the Wayne Gretzky of professional football not to play that day. This had affected millions of pounds in bets on the football lotteries. I slowly sank in my chair until my white coat covered most of my face.
My next job was intern at the German Hospital in East London. On my large ward, one patient had chronic constipation (yes, we admitted such patients then) and another was in for treatment for chronic diarrhea resulting from a massive colectomy for Crohn’s disease. The ward sister and I were checking urines in the sluice (interns checked all patients’ urine themselves). From a washroom cubicle, we heard the grunting and straining of the man with constipation. Suddenly, another man rushed into a cubicle and we heard “plop, plop, plop.” From cubicle number one, a Cockney voice said “Blimey mate, I wish I was you.” From cubical number two, a Jewish voice replied, “I voulden be so sure, I h’aint got mine pants down yet.”
My third intern rotation was at Whipp’s Cross Hospital in northeast London, following which I became a pediatric intern. The senior resident on this service was writing his MD thesis on enuresis. He was trying out a device that rang a loud bell as soon as urine contacted it, aiming to abruptly awaken a bed-wetting child. The first night it was used, the bell woke up all the children on the pediatric ward except the bed-wetter.
My second job in pediatrics was on the dean’s service at Hammersmith Hospital and postgraduate medical school. One four-year-old I admitted, when asked where she slept, replied, “With Mummy, except when uncle comes.” I asked who uncle was. She replied, “I don’t know. It’s a different uncle every night.”
My next move was to the Victoria Hospital for Children (Tite Street), which was part of the St. George’s complex. I was initially an intern and then the resident medical officer (RMO). The RMO saw all emergency cases after 5 p.m.
One night a lady presented with a “sick” baby. I asked her if that meant the baby was ill or vomiting. She said that I was the doctor, not her. I then asked her if she thought the baby was in pain, had a temperature, difficulty in swallowing, and so on. To each question, she replied, “I don’t know. You’re the doctor, not me.” Somewhat frustrated, I said, “Take all the clothes off and I will do an examination.” When I looked up from my notes, I found the mother standing stark naked before me.
I then became neonatal resident at Hammersmith Hospital. I was the only live-in resident and a maid brought me tea every morning at 7 o’clock. Once when my wife stayed overnight, the maid ran off in a great hurry. I ran after her to explain that the woman in my bed was my wife. She replied, “Yes doctor, we understand, we fully understand.”
With a view to becoming an expert in pediatric chest diseases, I next accepted a residency at Plaistow Hospital and the East Ham Chest Clinic. I was taught how to do pleural biopsies. My first one came back with the re port, “normal liver tissue.”
On a ward round the sister complained that many patients were spitting. The chief, a short man, stood on a stool and began a dissertation on the dangers of spreading tuberculosis and other diseases. As he was talking, a patient at the far end of the long ward deliberately spat and the sputum landed on the chief’s jacket.
This job included working two evenings per week at a rheumatology clinic and I soon found the cases I saw there more interesting than the mundane chest work. Thus, my final residency, which was at the Middlesex Hospital in central London, was in physical medicine and rehabilitation (PM&R), which in those days included rheumatology.
After completing my training in PM&R, I was at a loss as to what I should do next. Having trained in pediatrics, chest diseases, and PM&R, I reluctantly decided to do a general practice traineeship.
Between jobs, to help make ends meet, I sporadically worked for the London Emergency Call Service, which covered single-practice doctors who wanted a night or weekend off. I was paid £1 for a 4-hour shift from 8 p.m. to midnight and provided with a car and a two-way radio with a call signal. Mine was “Doc Dog.”
I always seemed to be called to treat patients who lived on the highest floors of apartment blocks without elevators. One evening I was instructed to see a lady in apartment 12. Just my luck, the block consisted of 12 apartments, one on top of the other, and again, no elevator. The patient had pain in her shoulder when trying to touch the tip of her opposite scapula. I asked her how long she had had the pain and what had her family doctor told her. She replied, “Three months, but I don’t like to trouble him. He always seems so busy.”
Toward the end of my traineeship, I began looking for a practice. A few were comic, even if sad. One office had no indoor sink. In another, the ophthalmoscope had no battery. “Yes, but the patients don’t know,” said the doctor. One GP told me he was making money grafting eyebrows to the backs of the heads of bald men. Another was injecting milk into the buttocks of any private patient with an allergy, including asthma.
I eventually found a compatible GP in the east end of London with more patients than any single doctor could handle. When I told her I would like to join the practice, she said, “Well you can’t.” I was taken aback and asked, “Why?” She replied, “Because asking you to join my practice would be like asking a racehorse to pull a cart of shit. Now get out of here and decide whether you want to practice pediatrics, chest diseases, or rehabilitation medicine.” Strong words, but sage advice.
The G.F. Strong Rehabilitation Centre in Vancouver, with its large adult and child outpatient services and in anticipation of an increase in in patient beds to 150, accepted me as a full-time consultant. I arrived in Vancouver in January 1962 and remained at the centre until my retirement 33 years later. I added FRCPCs in pediatrics and physical medicine and rehabilitation to my previously obtained DCH and DPhysMed. I soon be came the assistant medical director, and later, director of the child and adolescent service.
At a cerebral palsy clinic, I suggested that a child be prescribed “a below knee” brace. One of the staff whose second language was English came to me puzzled by my recommendation, since abalone was very expensive.
An Aboriginal child with a hemi plegia was referred to me from Fort St. James. As I knew physiotherapy services were sparse there, I gave the mother a comprehensive, typed list of a series of home exercises. A year later the patient was re-referred. When I came to re-examine the child, I thought a miracle had occurred as all signs of the hemiplegia had disappeared. It soon dawned on me that this child was smaller than the one I had seen a year earlier. When I confronted the mother, she said, “Well Sarah saw Vancouver last time, so I felt Jessica should see it this time.” (The Department of Indian Affairs had paid for their airfare and maintenance.) I ended the letter I sent to the referring doctor with, “Now I’ve seen everything.” She replied, “Until you’ve practised in Fort St. James, you ain’t seen nothing.”
About 17 years ago, it became popular at rehabilitation centres to change the terms used for people seeking medical help. I was asked to make some recommendations for new definitions. I treated this rather frivolously in order to forestall the committee making any premature choices. My definitions were:
a. Trainee—a person learning how to drive a locomotive.
b. Client—one who solicits favors.
c. Inmate—a state of matrimony.
d. Resident—a doctor who wants to be in a higher tax bracket.
e. Patient—one who does not know what he or she should be called.
Having retired years ago, and despite many years of accomplishments, satisfaction, and a good deal of humor from medicine, I sometimes wonder if I should have fought harder to become a comedian. But then again, who needs that when their 2-year-old son, when asked what his daddy did for a living, replied, “My daddy is a docker, and he makes people sicky”?