HEART BEAT: The queue of patients that first morning surgery seemed endless. The majority had problems that were easily handled - prescription renewal, minor ailments, certification re work status, etc.
Some patients sought items like cotton wool, antiseptics or bandages; perhaps a reflection of the poverty of the times. There was a leavening of potentially serious cases that required further investigation or treatment. In general, this was easily arranged by a call to the relevant admitting team in the hospital or more directly to the consultant team that you thought should see the patient.
Occasionally an ambulance would be required to bring the patient to the A&E department of the relevant hospital. Combined care obstetric patients were also seen. These were patients whose pregnancy was jointly managed by the GP and the hospital.
I must say they filled me with disquiet and I hoped fervently that when their time of delivery arrived, I would not be on duty or that there would be time to see them safely to hospital. I did not fancy the midnight home delivery scene.
Thankfully my luck held, or prayers worked, because no such task befell me.
On your day as duty doctor in the health centre, you were required to provide the emergency and night cover for all the patients at the centre. You also had the private patients of your own practice and frequently would be covering one or more of the other doctor's practices also.
That first day having staggered back to the home base I prayed again for a quiet evening. Dis aliter visum (Virgil, Aeneid bk.2), these Gods dictated otherwise.
The doctor's wife handed me a long list of calls to be made, both in the public and private end of the practice. She also helped me plan a route in this unfamiliar area. Fortunately it was summertime and destinations were readily found.
I felt in keeping with my predecessor Oliver Wendell Holmes's quatrain:
"Tis a small matter in your neighbours care
To charge your fee for showing him your face
You skip up stairs, inquire, inspect and touch
Prescribe, take leave and off to twenty such."
Maybe Oliver was right to stick to the day job; I don't think he would have made it as a poet.
Young and inexperienced as I was, I quickly realised that many of these calls were to old folk, sick and frightened, maybe living alone or with an elderly partner.
Very often you were admitted to the house by helpful and concerned neighbours. Sometimes it was not medicines, tests and diagnoses that were required; rather sympathy, reassurance and, above all, time.
At the other end of the scale, there were worried mothers with sick children, with everything from slight temperatures to life- threatening illnesses. Also mixed in this melange were the real medical and surgical emergencies.
There were heart attacks, severe asthmatic attacks, diabetic comas, epileptic seizures and just about anything else. Surgical emergencies included fractures and acute abdominal problems to be graded and dealt with. It was like trying to cover the ills of the ages of man in one brief period.
I went from local authority housing to well-appointed estates and to one very large halting site. The circumstances were very different, but the problems were the same. I met no hostility and was never conscious of danger.
The same does not unfortunately apply today, and there are areas in our cities, as there are in cities throughout the world, where the house call is simply too dangerous. Then, everybody appeared anxious to help and did so to the best of their ability.
All of course were not saints; there was the gentleman whose backside was liberally peppered with buckshot as he crawled through a pub window at 4am. I knew the surgical registrar on duty in the Mater would thank me profusely for sending this case in at that hour.
Another man who sustained a very unpleasant double fracture of his leg while trying to eject a wandering horse from his garden was informed by the Gardaí that had he been successful, he would have been responsible for any further depredations committed by the animal.
His response on hearing this bizarre fact was so politically incorrect and so vehement that I think it completely masked the pain of his wound. I learned several new words and combinations.
These were the days before mobile phones and returning to base usually found a new list of calls waiting.
On days in which you were not the duty doctor life was easier, as you only had the patients of the home practice to contend with.
In my one gripe about this time in my life, I noted that statistically I seemed to have a lot of time as duty doctor. I was really grateful to my senior colleagues for allowing me attain such experience, because I am sure they enjoyed the night work just as much as me!
In the surgeries I began to understand what priests in the confessional experience when faced with a scrupulous penitent. It is hard to describe the feeling when the patient opposite you falls heavily into the chair and proceeds to rummage in a voluminous bag, finally producing a written list of symptoms and complaints. At least unlike the priest you are not sitting in the equivalent of a wardrobe, but the urge to cut and run must be the same.
It was not the life for me, my star was there to follow; but I enjoyed my time and was left with the highest respect for the hardworking caring brotherhood who continue to look after the primary care of this country. They are second to none.
Maurice Neligan is a cardiac surgeon.