Читать книгу Confessions of a Doctor - Stanley Feldman - Страница 8

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 these new medical miracles. In the 1950s and 1960s it was common to have between ten and 20 foreign doctors watching ‘the master of his craft’ performing some new deed of surgical skill or using some new technique or instrument that he had designed. They were exciting times.

Inevitably there was huge competition to join the junior staff and to learn at the feet of the master. Not only had the aspiring trainee doctor to demonstrate his medical prowess, he also had to fit in with the particular ethos of the department.

As the powerhouses of new ideas in medicine, it was only to be expected that teaching hospitals included in their numbers more than their share of eccentrics and prima donnas. However, by the 1960s the established medical hierarchy was under strain. Newly appointed consultants, often returning from years spent in the services, were less affluent and less beholden to the old traditions. As a result they were more amenable to the erosion of their status by the seeds of egalitarianism that had crept in with the advent of the National Health Service.

This effect was also felt by the nursing staff. After all, only 40 years earlier, before the First World War, a girl (almost invariably from a middle-class home) who chose to become a trainee nurse at one of the great London teaching hospitals would either have paid for her board and keep or, as was the case at St Thomas’ Hospital and Westminster Hospital, be charged for their training. Nurses worked six days a week and were encouraged to use their day off to make their own uniform (material usually provided by the hospital) or for religious devotions.

Even as late as 1955, ‘Nightingale’ nurses at St Thomas’ Hospital were not permitted to speak to a doctor until he had first addressed them. They were obliged always to address him as ‘doctor’. By the end of the 1950s, nursing had become a more open profession, even in the teaching hospitals. A career in nursing was available to any who were suitably able and was no longer restricted to middle-class ‘gals’. As it also provided a way in which ‘the right sort of gal’ could meet up with an aspiring doctor, there was considerable competition for nursing posts in the teaching hospitals of the day.