Hippocratic Oafs
Doctor in the House by Ted Willis
Norwich Theatre Royal, 1995
I knew a medical student once. Nice chap. Met him on my first night at university. We’d been invited to the president’s house for dinner and over the pre-prandial sherry, he started telling me how you amputate a limb. I can’t remember what the main course was now, but I know I only managed to eat about three forkfuls of it.
Medical students are like that. Quite apart from having stomachs made out of old leather, they seem to see the world differently to you or me, and have a completely off-the-wall view of what is acceptable in social intercourse. I suppose this is hardly to be wondered at, given that they must spend a fair amount of their time probing into patients’ secret places and prodding those areas of the body most of us would rather not think about. They need a bluff and cheery disposition to carry it off with aplomb. No good blenching when the mayor needs you to look at her haemorrhoids, or coming over all unnecessary if the local builder needs his hernia palped.
On the other hand, this does have its reassuring side. I mean, who would you rather have poking you about if the need arose – the one with the broad grin and the easy, confident manner, or the stuttering lummox with the shifty eyes and the freezing cold hands who can’t even bring himself to say “Bowels”? Success in medicine, like so much else in life, is as much to do with attitude as ability.
Given that as a doctor the graduate student is going to spend his working life up to his ankles, if not elbows-deep, in the frailties of his fellow-man, it is hardly surprising that so many of them give the impression of being total maniacs, getting up to every prank going, and impudently dragging the reputation of British medicine down into the gutter with them. Many give up their clinical studies in mid-course, realising that they can make a better living as professional humorists.
In fact, there is a school of thought that suggests embryo doctors spend so long studying that they never get the chance to grow up at all. The average student will be at university for three years – or four, if he is particularly hungover and overslept the morning their Finals started. Medical students can expect to be there for seven years at least before they become even junior doctors. And the more sophisticated the area of medicine, the longer the study period. Another friend of mine was specialising in brain surgery, and he was going to be 35 years old before he became fully qualified. As he once put it, he would practically be in a wheelchair himself before he was deemed fit to practise on real heads – a sobering thought.
Not that age is necessarily a bar against high performance, it’s just that the older the student, the more you wonder whether he isn’t just in it for the laughs. In St Thomas’ just after the war, one of the students was a man in his sixties who had been a judge in India and now wished to retrain as a doctor. He was so deaf that it was claimed the only way he could get through his Finals was by waiting until he got a case that didn’t require him to hear anything through his stethoscope.
That same teaching hospital, incidentally, had a refreshingly liberal selection procedure. Positive discrimination was exercised to the advantage of prospective students who could boast any kind of skill that would leaven the other students’ daily grind of study. At least one was taken on with the understanding that he would write the next Christmas revue. Many names now famous in the entertainment industry first trod the boards or pounded the ivories under the auspices of this broad-minded policy.
The real learning, of course, is done on the wards, at the linen face as it were, following the consultant around. Patients have never had to be so patient as when some bright spark of a student starts asking them a whole bunch of impertinent questions that proper doctors have already put to them. Fluid samples for testing flow like water. One student was probably pushing his luck when, assuming a warmer relationship with his patient than was in fact the case, asked breezily, “Blood or urine this morning?” and the patient replied, “Just a cup of tea thanks.”
The lecture hall is no less liable to throw the aspiring student off his stroke. Expert tutors, skilled at putting the knife in, can puncture flummery at a stroke. One hot afternoon the tutor asked, “What are the causes of an enlarged spleen?” The student on the spot stalled: “Well, sir, I think the causes are legion,” to which the lecturer replied, “So they are. Just give us a cohort or two for now.”
When medical students let their hair down they tend to go all the way and make their more normal colleagues appear tame by comparison. But rubbing shoulders on a daily basis with the giblet and the offal as they do, is it any wonder they develop a macabre sense of humour which can seem callous to those not directly involved in the trade? Overheard at a bus stop, one young doctor declared that no one would ever want to leave their body to medical science if they knew what really went on behind those grim scrubbed doors. But perhaps the case of the two young scallywags who were thrown out of college for having a sword fight (or rather, a knife fight) using the genitals lopped from a couple of corpses was a one-off.
There is a theory these days that insists the best doctors are not necessarily the brightest students. Intelligence, common sense and the ability to learn from mistakes are deemed the vital factors, and while good A level grades may indicate the presence of the first, they do nothing to demonstrate the existence of the other two. The feeling is that ‘high-fliers’ may quickly find the everyday routine of clinical practice getting them down through its repetition and tedium. As for those who aim their sights lower, given the reality of modern medical practice, one might say that a good memory and sheer physical stamina are currently the most important qualities for a young doctor to possess, even more than brain power.
It was recently reported that in Israel, medical schools subject all their applicants to an IQ test, and anyone who scores too highly is rejected as being unsuitable to be a doctor. Do brains really preclude all the other qualities required – resilience, sympathy, tact, understanding? We can but wait and see what the next generation produces in terms of medical service.
The only trouble is, doctors hold a monopoly and, for good or ill, their surgery is where we have to drag our ailing bodies off to if anything goes wrong. On the other hand, we may all take heart from another recent titbit of historical fact: it is said that fewer people died during a strike of young doctors in a certain Eastern Mediterranean country than in the preceding period of the same duration of normal working. And no, I’d better not tell you which country it was. In all other respects, I hear, the place is absolutely delightful, and I don’t want their tourist board letter-bombing my pigeonhole…
PS
The brief was to write a light-hearted article to go with Ted Willis’s stage adaptation of Richard Gordon’s Doctor in the House books, so you bet I was happy with that title. I don’t know where it came from. Seems so obvious that it surely can’t be completely original or unique. But luckily you can’t copyright an idea.
I had to stretch a point here and there. The charming first-year student who explained the amputation procedure did so at my request, and I found it so fascinating that I ate my dinner regardless. I don’t think I’ve ever been friends with a brain surgeon. And the ‘blood or urine’ joke is straight out of Victoria Wood – or was it The Likely Lads? I can’t remember now. It certainly sounds too good to be one of mine. Maybe that’s where I got the title too?