Confessions of a Doctor. Stanley Feldman
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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.
THE MATRON
The matron’s primary duty was the protection of her nurses and making sure that the patients did what they were told. She wielded great power and even the senior surgeons walked in fear of her. She ruled the wards through her acolytes, the ward sisters. Woe betide any student who crossed the ward sister, he would become a pariah and his life made miserable. Even the consultant could not intercede to save him from Sister’s wrath.
Apart from controlling the day-to-day running of the ward, they made sure the patients received the best possible treatment. They might even question some aspect of a patient’s treatment with the consultant in charge if they felt it was inappropriate. It was they who made sure the ward was properly cleaned and the food was up to standard and that the patients ate the meals provided. They had the power to hire or fire any recalcitrant nurse, maid or orderly. Today, they have lost that power; they work in shifts so that overall responsibility is divided. They have little influence on the performance of the catering and the cleaning staff who are the responsibility of the various management teams.
THE DEAN
When I first arrived at the medical school, the dean, Sir Adolph Abrahams, was a distinguished physician of the old school. His brother was Harold Abrahams, the 1938 Olympic medallist of Chariots of Fire fame. The only times I ever saw him were in the library when, always attired in the pin-striped trousers and black jacket that were de rigueur for a gentleman of his distinction, he would invariably be reading the morning papers – even in mid-afternoon. When his brother joined him he would hold forth like any grumpy old man on any topical inequity or on how far the personal habits of the students had degenerated since his times. Unfortunately they were both pretty deaf, so their quiet, private conversations would echo at high decibel level around the hallowed quiet of the library, much to the amusement of the students.
Sir Adolph was succeeded by Dean Harding, a handsome, approachable orthopaedic surgeon who was a bachelor and a misogynist. I never discovered his first name: he was always fondly known simply as ‘Dean’. He was totally different from his predecessor – whereas Sir Adolph was aloof, Dean Harding was one of the boys. He enjoyed the students’ jokes and the sense of fun and high spirits. On one occasion, when he was attending a rather drunken party at a flat occupied by a group of senior students, there was a police raid. A neighbour had complained about the noise and suggested the house was being used as a brothel. As the police arrived the dean was being smuggled down the back stairs. The next day he received an official complaint from the local constabulary. He assured them, with due solemnity, that appropriate steps would be taken to punish the offenders.
The deans of the medical schools were always on the lookout for potential donors who would endow a new facility for the school. So it was that the dean of a nearby medical school readily agreed to host a lunch for a visiting Arab potentate and his retinue before accompanying them, in their limousine, to an inter-hospital rugby match. Promises of lifelong friendship and support were exchanged amidst champagne and savouries. It was only when the ‘before and after’ pictures were printed in the college magazine that the dean recognised the Sultan as one of his own students and the retinue as students from other medical schools, all in flowing robes and hired fancy dress.
THE SURGEONS
The senior surgeon at Westminster Hospital was Sir Stanford Cade. If the surgeons were the kings of the medical fraternity, Sir Stanford was their emperor. Born in Russia and educated in Belgium, he never lost his guttural foreign accent or his old-world charm. He was a famous cancer surgeon with a prodigious memory and a terrifying bedside manner. He was a pioneer of radium treatment for cancer and he carried a tin tobacco box, full of radium needles, in the back pocket of his trousers. When the occasion arose he would select some of them for insertion into a patient’s inoperable tumour.
From time-to-time some of the radioactive needles would fall onto the theatre floor, necessitating the theatre staff to scrabble around on their hands and knees to find them. They would be retrieved and picked up with unprotected hands, washed under running water from a tap and replaced in the surgeon’s tin box, but neither Sir Stanford, nor any of the staff ever suffered from any ill effects of exposure to the radioactivity. Today such an event would set off a full-scale radiation alert and would result in the immediate evacuation of the operating theatre.
Sir Stanford was a legend in himself. Once he embarked on a new project he would not rest until he was the acknowledge master of the subject. It was said that within a year of taking up stamp collecting he pointed out a forgery on sale at a stamp auction. Within two days of seeing his first case of the rare skin disease Kaposi sarcoma (now seen quite commonly in patients with HIV), he had read every paper published on it, irrespective of the original language.
It was rumoured he obtained the figures for the outcome of his surgery from the obituary columns of The Times, which he read avidly every day from cover to cover. If Lady X’s obituary was not there she was noted down as having survived his surgery and presumed to be still alive. He was a tireless, terrier-like surgeon. He knew no bounds when there was a cancer to be excised. He would go on cutting out bits of the patient’s anatomy until all signs of tumour were extirpated. He was said to have once remarked that, ‘There is no tumour too big that if you pull hard enough it won’t came away’. He was a pioneer of pelvic evisceration (colloquially known as the hemi-humanectomy) for extensive cancer involving pelvic structures. It often necessitated removing the bladder, rectum, the uterus and vagina and any part of the pelvic skeleton that the cancer had invaded. He saw cancer as a very personal affront that had to be fought, no matter what the cost to the patient.
Sir Stanford expected total commitment and enthusiasm from his staff. Once you became his houseman you signed on for six months of indented labour: there were no weekends off, no half days and no holidays. Often, his operating sessions would not end until before midnight. On one occasion a houseman complained to Sir Stanford that he felt unwell and asked if he could have a weekend off. Sir Stanford replied, ‘By all means, but if you go, don’t bother to come back’. That weekend the unfortunate houseman suffered a perforated gastric ulcer and found himself undergoing