Reflections of a young man in medicine in the dim and distant past – another country

Back in the day, being a junior doctor in a hospital was perhaps even worse than it is today. Dr Garrett FitzGerald on how he measured the hat size of patients and encounters they may have had with mousetraps

After the intern year in a Catholic institution in Dublin, only two jobs were offered in Medicine at the next rung of the ladder in the mother-ship. If you were not successful in being selected and wished to specialise in medicine, it was accepted that you should get the next plane to New York or Toronto and become forgotten.

There were a few alternatives of course, such as committing to a year or two in a bush hospital (professional hari-kari at the time) or abandoning your aspirations by defecting to radiology, pathology, or similar lonely pastimes close to lapsed-doctor category.

Even psychiatry had arrived onto the menu, but you sidled off to it without fanfare and didn’t share your decision openly. One of the ablest men in our graduation class astonishingly elected for this latter pathway. It was whispered at the time, sadly it must be said, that he was probably ‘not well’ in himself.

There had been a few others in our year who were clearly at high risk of becoming psychiatrists; some as low as ‘even-money’ with the bookies. Some of these men (nearly all men in those days!) did, and wise heads nodded knowingly – poor chaps.

What was unthinkable for survival was to take the road less travelled to the interior.

Even more fantastical was the unheard of notion of applying to the other Catholic institution, the republican one. Four reasons for the mythical status of such a move: (a) it never happens; (b) we have our own, thank you; (c) the Liffey is there for a reason; and (d) piss off, Vincent’s!

Having been recently married and with a babby on the way, the emigrant ship was not an option for me.
With an increasing sense of doom, I responded to an advertisement for the post of Senior House Officer in Medicine at the Mater Misericordiae Hospital. Mirabile dictu, I was invited for interview.

The two pin-stripers and the tweedy man lay in wait in a fine room whose vast window gave them great opportunity for seeing me coming. After the usual enquiries about my origins and rugby history (they were, reasonably, unimpressed), it was time for the kill.

The charming one asked if I would be willing to work one night and one weekend in three. What could I say, a babby on the way?

The bald one went for the money shot. Would I be willing to work two nights and two weekends in three? Live-in on duty, no overtime payments, buy or bring your own food, if you don’t take it, have a nice day (and life). Welcome to the twilight zone of the medical bound boy.

I was assigned to a severe workaholic consultant from dawn on July the first. It took me some time to adapt to five-hour ward rounds, the fifty beds, the endless calls to ‘peripheral’ wards, the three four-hour out-patient clinics weekly, and the return of the monastic/celibate life.

One of the stranger duties had to do with the midnight urine samples. On my nights ‘on’, I had to wait for results of the semi-quantitative glucose levels in the urine of all the diabetic patients throughout the hospital. In those days of yesteryear, diabetes was a disease of the urine.

It was not permitted to write the orders for the next day’s insulin dosage until the midnight urine results were in.

At about midnight plus 30 minutes, the hospital-wide round-up began.

By one-thirty, if everyone concerned had voided on command, the day came to a welcome end.

Occasionally, an unreasonable octogenarian would not oblige, and there could be a further reduction of sleep time. Ward-rounds or outpatients were at 8.15am every day.

The discipline extended into the actual performance of the duties. For each patient there was a multipage document to be filled in.

Every conceivable clinical question had to be asked on every bodily system every time.(Being an honours type chap, I would add extras like, “Do you have any pigeons or cage-birds at home?” or “Has your hat-size increased recently?” and (almost!) “Did you ever catch your thingy in a mousetrap?”

Examination findings too had to be recorded in minute detail – again on every system (Rinne-Weber test, rolling of epididymis, visual fields etc. etc.) In time, I noted that we were including no assessment of the parietal lobes or tests for skin elasticity in our worksheet and threw them in for free.

Sadly, every patient had to undergo a rectal examination as part of this exhaustive (for patient and me) assessment, no matter what the patient’s age or complaint.

All in all, while there were valuable lessons in clinical rigour and discipline in the thoroughness, so much of it seemed a waste of time. The closest comparison I can make in the hospital scene nowadays is the massive expansion of non-work which consumes large portions of nurse- and lay-management’s time.

You do not see much of this to-be-sure-to-be-sure ‘t’-crossing in private hospitals, which means most of it is unnecessary.

It took me many years afterwards to shake off the lifestyle of the clinical Trappist. It was all very thorough, well-meaning and committed, and I worked with, and for, highly decent people, but it dealt a near-fatal blow to work-life balance.

Nowadays, it would not be tolerated. This sort of stuff was engineered by our own colleagues, some of the close-to sadomasochistic persuasion; not by employers or civil servants.

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