Discovering a forgotten letter triggered some ambivalent recollections of different times, when doctors where seen as omnipotent and patients suffered for it.
It is a rare occurrence that I tidy my desk. There are usually more pressing tasks. But I couldn’t put it off any longer and after filing away paperwork, one foot deep, I came across a hand written letter from my previous boss, Tony Axon. Tony gave each of his juniors a nice handwritten letter of support and Best Wishes when he retired after 40 years service.
Tony developed Gastroenterology in Leeds from humble beginnings some 40 years ago. In those days, gastroenterology, and endoscopy in particular, were not seen as “worthy” medicine. It didn’t help that medics and surgeons in Leeds were at a war footing, with fisticuffs in the corridors. In this infertile soil, Tony Axon built a comprehensive gastroenterology firm which included cutting edge technologies such as ERCP.
I wonder if Tony felt any unease over handing over “the keys to the Firm” to his young apprentices. Sadly any feeling of responsibility to “the firm” has now long disappeared from the National Health Service. Most of our young trainees work a full shift pattern with little sense of being united in the workings of a “firm”. They understand that they are nothing but small wheels within a larger machine. In contrast, in my generation, we thought that we were the machine.
Of course, the old system had to change. I do remember the 110 hours of continuous on call, covering all medical admissions from Friday morning to Monday afternoon. If you did grab some sleep, the nurses would phone you with the latest urinary outputs or ask if it would be OK to give a couple of paracetamols. Each ward you covered had “IV’s”, which you had to make up and administer. The nurses wouldn’t lift a finger as “it was not part of the nursing model of health care provision”. The result was not no IV’s were given on time and “slow intravenous infusions” were 10 second injections. I was surprised to learn that ringing in the ears was not an inevitable side effect of IV Frusemide. Perhaps it was wrong to tell patients that “you have to choose between hearing and breathing - you can’t have both!”
“See one, Do one and Teach one”, was the way you learnt day-to-day procedures. And we did EVERYTHING! Urinary catheters, suprapubic catheters, arterial lines, central lines, lumbar punctures, chest drains, liver biopsies, pleural biopsies, temporary pacing, shocking people out of AF, Swan-Ganz measurements, blood gases and chemotherapy. The ECG machines were particularly challenging. The leads ended with small suckers and these little buggers would always fall off at the crucial moment. With skill you could press the start button and then quickly but gently drape both hands over as many of the suckers as possible to keep them in place.
I now realise, that my generation is unique. The generation before me, had very few practical procedures and doctoring largely involved furrowed brows, a limited number of blood tests and lots of bed rest. Conversely, the generation after me has delegated the responsibility for procedures to other departments. Now the liver biopsies are ultrasound guided. Chest drains are only placed by respiratory physicians. Pacing is done by cardiologists.
But it wasn’t all bad. I fondly remember the after-wardround coffees when we would laugh and exchange anecdotes. I remember the story of the vagrant having a VF arrest in A&E. When the defibrillator shock was administered, all his flies jumped out of his hair, in beautiful synchrony! I recall the patient who had a VF arrest in the middle of a sentence. He fell back unconscious onto the pillow. Glancing at the cardiac monitor, I gave him a thump in the chest. To my surprise he immediately sat up again and shouted “OUCH - WHAT DID YOU DO THAT FOR!?!”.
Our camaraderie translated into a deep sense of loyalty. Nobody took any sick leave. Absence would land colleagues in impossible situations. If you didn’t come to work, your colleagues would have to pick up twice their normal workload, see twice as many patients in clinics or the ward round would last 6 hours instead of 3 hours. Acute medical takes were busy, usually with 20-30 medical admissions. This was an era when patients were stockpiled on trolleys in A&E and women gave birth in corridors next to heart attacks and acute abdomens.
I recall feeling particularly rough in the middle of a Medical Take, I checked my temperature to find it to be 38.7 ⁰C. I phoned my wife for a moan and ask for her opinion about taking some ampicillin. “Don’t be an idiot, take a paracetamol and GET ON WITH IT!!!”, was the reply. What did I expect from a doctor?