Heartbeat: "Mortality weighs heavily on me, like unwilling sleep" - (John Keats)
That's a gloomy start and to accentuate the feeling of despondency, it is a uniformly grey day and it has been raining all morning. The cause of my lowered spirits was the news of the death of a friend and colleague who at one stage was the other half of our complement of two surgical registrars in the Mater.
I wish my friends would stop dying; it is quite unsettling and me only in the prime of life. Have you noticed how the prime of life seems to stretch toward the horizon like a rainbow's end as you advance in age? I remember a colleague asking us all in exasperation, after dealing with the very concerned family of a senior citizen: "Who would want to live to 94?"
The answer, of course, is anybody of 93.
Gerry had been a great colleague, an ideal one, as you made your first faltering passes with the knife. He was completing his term when I arrived and was a rock of sense with a leavening of experience. Placed just above me on the surgical ladder, he helped me climb in the best tradition of surgical training.
I remember asking him on one occasion why he had decided upon a surgical career. He told me that he had been inspired by Mr Hackancut. I looked aghast at him. "He's the worst surgeon I know," I protested. "I accept that," he replied patiently, "but I reckon that if he can make a good living from surgery, then anybody can!"
Gerry went on to become a plastic surgeon of great repute in the United States but always kept in touch with us at home. God be with you now Gerry in a place where your considerable skills are now presumably redundant.
It strikes me that notwithstanding the huge changes over the centuries in the practice of surgery, one thing has remained constant. That is the sure conviction that as young apprentice surgeons we could operate more skilfully than our clumsy seniors. The trick was not to show this too obviously, as it could have career-ending consequences. It was only to be shared with fellow tyros usually in circumstances where tongues were loosened by drink. Even in such circumstances you had to be careful. The whistleblowers (informers) were always among us and a snide remark to the consultant like, "Mr Neligan thinks you couldn't cut your way out of a paper bag"could also have a deleterious effect on your prospects.
The tinted glass of remembrance leaves mostly good memories. The times you erred and had to be bailed out existed but you consciously suppress such recollections and console yourself by thinking they must have been few enough. It was not a career pathway that could be delineated by disasters.
One certain thing from early days and throughout a surgical life; I was never bored. Tired, bad-tempered at times, scared witless at others, feelings of helplessness and inadequacy, all these were part of the continuous process of learning the art. Ennui was not.
Every passing day brought a little more of that invaluable commodity, experience. Surgery could not be learned from books alone, important as they were in our foundation. Instead observation, assisting and then operating with supervision, then without, is the via dolorosa of the surgical trainee. Sir Astley Cooper, one of the great anatomists and early surgeons, wrote: "I have made many mistakes myself; in learning the anatomy of the eye I dare say I have spoiled a hatful; the best surgeon like best general is he who makes the fewest mistakes." Mind you, the same surgeon also wrote: "My lectures are highly esteemed, but I am of the opinion that my operations rather kept down my practice." We live and lived in more accountable times.
Illustrative of the continual change in medical practice is the story of the treatment of peptic ulceration. As a surgical registrar scarcely a general surgical operating list did not feature patients with this condition undergoing one or other of the myriad operations devised for its relief. It was held that hyper secretion of acid (HCl) was the primary causative agent and many of the surgical procedures addressed this fallacy. We now know that this condition is largely caused by an infection with an organism, H. Pylorii, so it is hardly surprising that the surgical results were disappointing. Indeed it is almost axiomatic that if many operations are devised for a condition, it is usually because none of them gives uniform satisfaction.
The complications of such ulcers, notably perforation and bleeding, took up a goodly part of our early emergency work. My diary records three such operations seriatim from 10pm on Christmas Eve to 4am on Christmas morning. No sympathy from the consultant; in surgical parlance, I was learning my way around the abdomen. The discovery of the causative organism and its successful treatment meant that many of these operations have followed bleeding, cupping and the leech into oblivion.
The consultant surgeons then had no contracts, no 33-hour week. Honoré de Balzac wrote of the earlier generations: "The glory of surgeons is like that of actors, who exist only in their lifetime and whose talent is no longer appreciated after they have disappeared."
Most who I have been privileged to know would wish it no other way.
• Maurice Neligan is a cardiac surgeon.