Heart Beat: "Have by some surgeon To stop his wounds, lest he do bleed to death." - The Merchant of Venice
"You are wanted in casualty, doctor." I was about to see my first patient. I donned a pristine, new white coat, and filled the pockets with what I then thought were the necessities for diagnosing and curing the ills of mankind. Patellar hammer for reflexes, tuning fork for neurological examinations, opthalmoscope/auroscope for eyes and ears, also clinical torch, were pocketed. All batteries were checked.
Physician's manual for instant cure of everything was added as my vade mecum, plus the British National Formulary (BNF) for drug dosages. Have I got everything?
My stethoscope, worn around my neck like a staff of office in the fashion of the time, completes the illusion. All present and correct and the only factor delaying my entry to world medicine was that I could not get the buttons into my white coat.
With much fumbling and dropping of clips I eventually managed, and thus grossly overloaded I headed for casualty. On reflection, it was just as well I was not facing into dire emergency, as the patient might well have expired before the budding warrior had donned his suit of armour.
I entered a relatively quiet Sunday morning department. (Apparently there is no such thing at the present time.) There were two options available to me on that momentous morning. Firstly, I could stride in confidently and inquire "What is the problem, nurse?"
Secondly, I could creep in the door, explain that I hadn't a clue and throw myself at the mercy of the staff nurse on duty. I immediately chose the latter, and while my greenhorn status was noted by the staff, at least I had asked for help. The person I had asked was the senior staff nurse, a most competent no-nonsense lady who had handled more trauma cases than I could even envisage.
She asked me who I was and where I had sprung from. She expressed colourfully some considerable surprise that I and some others had volunteered to come in a day early. She obviously had doubts about my sanity. I was then led to a cubicle where a student nurse was applying a pressure bandage to a patient's knee.
The unfortunate young victim had fallen on a broken bottle and sustained an ugly laceration. This was bleeding profusely. My new best friend, the staff nurse, suggested the knee should be X-rayed for retained glass and that an anti-tetanus booster would be required.
All was done expeditiously and then I administered local anaesthetic, and scrubbed and masked and gloved, proceeded to stitch the wound. Historic footnote for the Minister, all concerned washed and gloved appropriately. Could I suggest that your Department provide facilities commensurate with human dignity and best medical practice in today's A&E units and in the wards? Then we might have less MRSA infection.
I thanked the Lord for my student residency, and for the kind doctors and nurses who had taught me these skills, and I was well satisfied. A brief tour of the department followed. A few citizens sleeping off the previous night's excesses, a few minor injuries, sprains, etc. but no real problems. "Would you like a cup of tea?" "Is the Pope a Catholic?"
I sat down learning one of the most important hospital lessons. It is not them and us. It is all as a team, and if we can all get along well with each other, it makes the work atmosphere pleasant and conducive to best results. This is not always possible I know, but its importance cannot be overstressed. Strife, egotism and churlish behaviour make for unhappy and poorly performing units and hospitals.
As I was leaving the nurses asked me where I was going. This was not an academic question as pagers were then not part of our equipment and you could only be found through a series of phone calls tracing your movements. You were rather like that "damned elusive Pimpernel".
Even in the short time before pagers were issued we became adept at not being found for certain duties. Philosophic musings and relative tranquillity could not last, nor did they. Added to the basic day's work and trauma calls, came the admissions, many of whom were for surgery on the following day.
Things became frenetic, case histories, physical examinations, blood tests, consent forms, the work seemed endless. The truth gradually dawned; the work is and always will be endless. This was reckoned a quiet day and yet the calls were ceaseless. Casualty provided broken limbs, heart attacks and acute abdomens and miscellaneous grief besides.
More senior help had to be acquired and operating theatres organised. Blood had to be grouped and cross-matched and in those distant days, this was part of our duties, a part that was universally detested. We reminded ourselves that this was only for one day and that our colleagues would appear over the hill in the morning. No more brave Horatius for me, never volunteer for anything!
Karl Marx once wrote, "Almost every one who goes to bed counts upon a full night's rest: like a picket at the outposts, the doctor must ever be on call," Right on there Karl! But how right I did not yet appreciate.
Maurice Neligan is a cardiac surgeon