Bedside Manor

At the end of September 1951, I started my first hospital job in England, as a house officer (resident physician) on the acute medical service at Hillingdon Hospital, Uxbridge, Middlesex, where my chief was Cyril G. Barnes, MD, FRCP, affectionately known as “the Baron” - an excellent general physician and cardiologist; I soon realized that he was better than any of the clinical teachers I'd had in medical school in Adelaide, both as a clinician and as a teacher. The hospital in general and this medical service in particular were closely affiliated with St Mary’s Hospital Medical School in London (Paddington). Dr. Barnes, his senior registrar, George Harrison, and the junior registrar, Jack Mickerson, were St Mary’s men. Barnes and Harrison had part-time staff appointments there on Sir George Pickering's service. I met Pickering, a very famous cardiologist and specialist in hypertension and renal disease, a few years later at an IEA conference in Princeton, New Jersey, and from that personal contact came away confirmed in the view acquired at second-hand from Barnes, Harrison and Mickerson, that he was at that time among the two or three top specialists in internal medicine in the UK; I was extraordinarily fortunate to have the opportunity to learn - and I learnt a great deal - from close colleagues of his in a way that came close to learning directly from Pickering himself. I seldom went to St Mary's myself, mainly because I was too busy. But at that stage in my medical career I probably did better staying at Hillingdon and seeing patients with run-of-the-mill acute medical conditions rather than the rare and strange conditions collected in Pickering's wards at St Mary's.

There were some interesting medical highlights: On the night of the American Thanksgiving Day, a young man from the US Airforce Base at Ruislip was brought in comatose, near death, his hands and face twitching strangely. He could give no account of himself. A few minutes later another young air force man was brought in with very severe vomiting and diarrhea, then a few minutes later, a dozen or so others arrived. All became clear then: the first one had been struck down with such severe staphylococcal gastroenteritis that he had catastrophic fluid and electrolyte loss into his own intestines and collapsed unconscious; this also caused the twitching, called tetany; his symptoms and signs resembled those of cholera; (I saw cholera patients with this cluster of signs in Surabaya in Java years later). The food poisoning came from a turkey that had been cooked in the USA, flown over and reheated - a process that left the Staphylococcal enterotoxin intact. This introduction to the epidemiology of food poisoning was a lesson I never forgot. Two other cases that were in adjoining beds at the same time provided another lesson. Both had leptospirosis; one was leptospirosis ictohemorrhagica, rat-bite fever, sewer-worker's disease, the other was the more benign disease, canicola fever; under the microscope, the causal organisms looked almost identical, and the muscle biopsies that I did on both of them also were similar; but the first man died, his liver destroyed by the infection, the second man was hardly even sick, apart from muscle pains and low fever. Hillingdon Hospital is very close to Heathrow Airport and had a small quarantine wing where travelers arriving in the UK with exotic communicable diseases could be assessed. I was off duty on the weekend when a suspected case of bubonic plague led to a few hours of crisis bordering on panic; but I saw a man from Pakistan who arrived at Heathrow when in the early stages of smallpox. He had the relatively mild form of this lethal contagious disease which killed only about 5% of those infected, in contrast to the dangerous variety that killed a third or more of all it infected, but his rash was typical according to George Harrison who had seen many cases in Asia during his war service. I examined the rash closely and felt I would recognize further cases if I should ever see any (I did, during my years at Edinburgh when my colleague Hugh Russell invited me to join him on a visit to the London Hospital for Tropical Diseases where we saw two cases). These experiences with infectious diseases, reinforced by others in the next few years, aroused my interest enough to cause me to consider specializing in infectious diseases. 

Entrance to Bedside Manor, Hillingdon Hospital

Outside the resident's quarters at Hillingdon was a neatly painted signboard with the name of the residence: Bedside Manor. This comfortable modern residence was the best I encountered in all my time in Britain. It had a billiard table, a delightful patio with a lawn where we could play croquet (though few did); a comfortable dining-room and large lounge; and, most wonderful of all, showers rather than the baths that most British accommodation offered in those days. About 12-20 of us lived in Bedside Manor; the numbers fluctuated according to season and on-call duties. About twelve of us were permanent residents, and we came from as many countries and had as many accents - various parts of the British Isles: Glasgow, Dublin, Belfast, Manchester, Cardiff; from New Zealand, South Africa, Australia, Canada. I acquired an ear for detecting differences in regional accents while living in Bedside Manor.  My fellow-Australian was Jim Kalokerinos, a Greek-Australian who among other things was fascinated by the folk-songs of the Hebrides, and was later made an honorary Hebridean in recognition of his painstaking collecting of rare folk songs that he recorded in some instances from the sole living survivor of the era when these songs were known to everybody. Joe Dobson from Christchurch, New Zealand, Sam Axelrod from Johannesburg, Laurie Smith and Peter Butler, two Englishmen from the home counties, Charles Hodes, a Dubliner, Jewish like Joyce’s character Leopold Bloom, Joe Starrett from Glagow, Taffie Rees from Cardiff, Bill Wheeler, a Londoner whom I later visited in a TB sanitorium when his tuberculosis flared up, and who became a life-long friend, were among my mess-mates in Bedside Manor. Somehow the chemistry was just right: we all got along wonderfully well. For me, it provided a broadening, enriching and polishing of character that matured me enormously, adding to my personal stature just as the clinical experience under “The Baron” was enriching my clinical skills.

A corner of the dining room, Bedside Manor 

As in all hospital residency posts, we worked hard, but we played hard too. There were local pubs, occasional movies in Uxbridge, and - most enriching - theatres, prom concerts, Sadler’s Wells opera and ballet. The Royal Opera House  in Covent Garden had taken a direct hit during the Blitz and was not yet repaired in 1951. I went to some of these cultural events with colleagues from the hospital, and to others with a small group of the people whom I had met on the ship coming over from Australia, preserving for a few more months these links with my colonial origins - though over the next few years the ties to Australian friends became progressively more tenuous. Also I discovered the dusty old second-hand bookshops of Charing Cross Road, that had all sorts of fascinating and often dirt-cheap treasures. Penguin Classics were publishing the Greek tragedies then, and I read these voraciously too in 1951-52.  

In December 1951 as a Christmas party at Hillingdon Hospital was winding down I lost my virginity. She was Margaret, Meg, a bubbly red-haired staff nurse from Glasgow, probably a few years older than I and decidedly more worldly wise. She was dating one of the other young doctors at Bedside Manor. But they had a tumultuous noisy quarrel early in the evening, he stormed off and she turned to me as the nearest source of sustenance. Late in the night when everybody was heading for the exit, we were fused together on a sofa in a darkened corner, tongues down each other’s throats, hands exploring sweaty skin under each other’s clothes.  Then she sat up, entwined my fingers with hers, and led me upstairs, asking, “Which is your bedroom?” She had her dress half off before I closed and locked the door and she unbuttoned my shirt and trousers as we fell back on my narrow bed with her asking “Have you got a Durex?” I didn’t. Durex was the brand name of the commonest condoms of the 1950s, that restrained extinct era BP, before the Pill.  In my then virginal state I wasn’t prepared as other virile males would have been. She was undeterred, did a quick mental calculation and decided she’d be safe, her period was due that day or the next. She didn’t need to worry; to her considerable irritation I exploded down the front of her disarrayed underwear before we got near each other. But she demanded satisfaction so my bonus was a tutorial on how to please a hot-blooded young Scotswoman.  This revived my flagging fortunes, and soon I plunged into what she called “The wee hole in ma body.”  She would never let me near her after that one night and not long afterwards she left Hillingdon Hospital.  

I explored as much as I could of the English countryside, and much of Greater London, during those first few months in Britain. Just before I started at Hillingdon, I hitch-hiked up to Scotland, going via the west Midlands, the Manchester by-pass and Carlisle, to Glasgow, and on to Loch Lomond where there was a splendid youth hostel in an old castle. I saw all these spectacular sights in the early autumn, with green leaves giving way to gold, and came back south through the Yorkshire dales in rain-squalls between short spells of watery sunshine with rainbows touching the ground at both ends on the Yorkshire moors. At Barnard Castle there was a roaring fire in the hearth of the old manor-house that was the local youth hostel. In all these places, with the people who gave me lifts, with those I met in the hostels, with people I met in pubs where I stopped for a pint and a sandwich in the middle of the day, I began to overcome my shyness with strangers, learning to exchange ideas about the world as well as about the weather. The rough edges were gradually being worn away. Once I had started at Hillingdon, I continued the same way on my visits to London on the occasions when I was alone - though mostly I went with some of my colleagues from the hospital, or met a group of Australians with whom I shared the delightful process of getting to know London and all it had to offer. My explorations of London covered the City itself - often on my own, because I was like Chiang Yee, the “Silent Traveller” concerned with the art, the architecture and the history. But in Hampstead, Chalk Farm, Kensington, Chelsea, the Bayswater Road, where the Australians lived, the explorations were of pubs and restaurants as well as theatres and cinemas. I had a series of epiphanies, when like Jane Austen’s Emma pierced as though with an arrow, I knew that I was in love with London, and wanted nothing so much as to live there for the rest of my life. I had such moments in Notting Hill Tube station, feeling the blast of air on my face as the train pushed the air in front of it along the aptly named Tube through which it rumbled towards me; as I walked late one night back to Bedside Manor with a frosty full moon outlined against the bare branches of a tree; as I watched a lamp-lighter turn on the gas mantles with a long pole in the lane that runs from the Strand down to the Embankment beside the church of the Knights Templar; as I walked past the liveried footman at the entrance to the Burlington Arcade; as I wandered through the British Museum... and on other occasions too numerous to mention. Such as every morning when I scanned the pages of The Times and the Guardian; and in the evenings as I listened to the 9 o'clock news on the BBC; or as I stood in line to get into the Curzon cinema to see films like la Ronde; and, perhaps most grippingly, at the Last Night of the Proms, when the entire audience stood and belted out “Land of Hope and Glory” while Malcolm Sargent conducted Elgar's Pomp and Circumstance. Yes, I knew at moments like those, that London was where I truly belonged. I wanted to stay there for the rest of my life.

 Piccadilly Circus, 1951 

Piccadilly Circus tube station

General practice in the Barossa Valley

Angaston is a pretty little town at the top end of the Barossa Valley, 90-120 Km north-east of Adelaide. In 1951 there was one doctor and a small hospital with 20 beds. It was named for one of the few British families who settled in the Valley in early colonial times; most are of German origin. In 1951, the original wave of German speaking settlers who had arrived in the 1840s and 1850s were long dead and gone; they had been joined in the 1870s by a further wave of migrants from Germany, disaffected members of a dissident Lutheran sect, and political refugees, including my grandfather Leopold Judell who began his Australian life in a general store at Truro, at the other end of the Valley from Angaston. In the 1914-18 World War, teaching of German had been banned in the schools; yet the local people still spoke English with a recognizably different local accent and odd sentence construction: “Already since six days this pain have I had.”  The Barossa Valley was a close-knit community, and outsiders took a long time to be accepted. I went as an “Assistant with view” (to becoming a partner in the practice); but it was not to be: I knew before I started that I would not be staying longer than the year I had contracted.

The other two principal towns in the Valley are Tanunda at the far end, where one of my friends and classmates was working as an assistant to the local GP, and Nuriootpa in the middle, where another classmate was a long-term assistant to the local GP. The three practices were linked in a loose federation of sorts; this meant that I did some relieving work in the Nuriootpa practice, and my classmate there relieved me - but in reality this rarely happened because I stayed in Angaston most weekends whereas my classmate in Nuriootpa  spent weekends away whenever he could.

I enjoyed the work very much. I had several interesting, even challenging medical experiences. There was an epidemic of mumps soon after I arrived in the Barossa Valley, my introduction to epidemic surveillance - memorable among other things for having to cope with the predicament of a family new to the town and knowing nobody. They all got mumps at the same time, both parents rather badly, and their brood of children too, all sick at the same time and utterly alone. I went in daily with meals and milk for them, to keep them alive as much as to see how they were doing. The Barossa Valley is a wine-growing district, notable now for excellent red wines. It was notable then among the alcoholics of South Australia and beyond as the place to be if one wanted to be as near as possible to the source of supply of cheap fortified wines like port and sherry. I saw more cases of acute alcohol poisoning and delirium tremens in six months in Angaston than in all my active clinical lifetime thereafter, including six months a few years later in the acute psychiatric receiving hospital in Adelaide. An unforgettable medical emergency occurred on Easter weekend when I was the only doctor in the Barossa Valley, the others all having decamped to the Oakbank picnic race meeting about 100 Km away. On the Saturday afternoon I was called to see a family of Latvian immigrants who had gone mushrooming. Unfortunately they threw away all the edible mushrooms and cooked and ate the puffballs and toadstools, which evidently resembled edible varieties of fungus that grew in their part of northern Europe. They were all very ill, the smaller children of the family especially so. They had some of the features of muscarine poisoning, and the children also had severe fluid and electrolyte loss from vomiting and diarrhea. I put intravenous drips into the smallest children, careful to avoid over-hydrating them, and had an anxious time trying to identify somebody in Adelaide who could advise me how to handle this situation. After several fruitless phone calls I made contact with an old friend, Bob Hecker, 2 years senior to me, who was embarking on a specialist career in internal medicine. We agreed that it would be best not to try to move them to Adelaide, at least two hours travelling time away even if I could persuade an “ambulance” (a station wagon containing a stretcher) to take them in their incontinent condition. The IV drips helped restore the children’s fluids, and with Bob advising me over the phone at intervals, I titrated suitable doses of antidotes of atropine and sedatives. Fortunately all survived, which no doubt demonstrated the recuperative powers of the healthy human body more than our medical skill. It was a satisfying medical experience from which I learnt a lot about management of emergencies and established some confidence in my ability among the nursing staff at the little hospital in Angaston. Soon after that the hospital matron asked me if I could give some lectures to the new nurses - my first experience of teaching, and a most enjoyable one that I would have liked to continue longer.

As well as the office in the doctor's home, I had to see patients in two branch offices, both some distance away - one was on the far side of the low range of hills that descended towards the River Murray valley, and in the little car that was provided for me, it was almost an hour's drive each way, most of it through sparsely settled grazing country, too little rainfall to support the fruit trees and vineyards in the basin of the Barossa Valley. Often as I drove to and fro I disturbed mobs of kangaroos, and I saw goannas, wallabies, wombats and other Australian wild life.  It was pleasant to get away on these weekly excursions, to make the house calls to the handful of housebound sick who required home visits, drink cups of tea with them, and exchange ideas. I suppose in these days of cell phones, fast cars, and rare or non-existent home visits to the sick, that relaxed way of life for country doctors is extinct.  Once at least however it would have been good to have modern communications. I had just finished and was on my way back to Angaston when an urgent call came in for me to see a small child who was convulsing.  I was pulled over by a policeman in a village half way back to Angaston, turned about and retraced my steps, forcing the little old car to far above its usual running speed of about 35 miles per hour. The convulsions were over by the time I got back to the farm where the sick child was in bed sleeping peacefully, but with a high fever and the tell-tale spots on the inside of his cheeks that made it easy to diagnose measles. The farm was so isolated that I brought the child back to the Angaston hospital where it was logistically much easier to care for him. Measles in those days was still potentially life threatening when it struck infants and tiny children. Fortunately that child recovered quickly.  

I got involved in the community life of Angaston to the extent of attending local council meetings and joined a club where I played badminton, where I met and mingled with others in my age group – all of them young married couples, so it was not a suitable setting to form a long-term relationship with a young woman, much as I wanted to do so.

At home with the elderly doctor whose house I was sharing, life was far from happy. My first inkling that matters were not as they should be was the episode of the blue vase. One day at lunch he flew into a rage at the appearance of this little vase containing a few flowers from the garden. One of his enemies had put this vase there, it was part of a sinister plot. Over the next few weeks similar episodes of strange conversation made me reluctantly accept the fact that I was working for a man with a paranoid psychosis, or perhaps dementia. Several times he came into my bedroom in the middle of the night, waking me to tell me about his enemies' latest evil plot that he had discovered or thwarted. His wife had given up and had left to live in Adelaide. He had a son several years my junior, whom I remembered vaguely at school; this son was then less than half way through medical school, destined eventually to join his father. Neither the absent wife nor the son were helpful; both urged me to stay in the house with him, to keep him company and do all I could to help him over this patch of nervous tension he was going through. It was easier said than done. I stood it as long as I dared, but after several occasions when he told me he had a loaded rifle by his bed, in case the enemies got into the house, I decided to leave after six months instead of staying for the originally agreed year.

A few weeks later, I embarked on a ship for London, where I would seek experience in hospitals of the British National Health Service, and where I would meet again my father whom I had last seen in 1939 when I was 12 years old.

Vera

My mother Vera Last, 1958

Vera (Grannie) feeding Rebecca, 1958












I need to balance unkind things I've said about my mother Vera Last with praise for her indomitable spirit and sense of purpose in raising two rambunctious boys on her own - a single mother - from the early 1930s.  The fruits of her labours were highly successful passage through school and university of her two sons, myself and my brother Peter. She supported and sustained us, instilled in us values of hard work, industriousness, diligence, single-minded pursuit of excellence. Throughout our childhood she demonstrated extraordinary devotion as she raised us on her own, ensured that we had what we needed to succeed scholastically. There were innumerable happy times as she explored the Adelaide Hills and accessible holiday spots with us in her little car, singing from her small repertoire of vintage 1920s and earlier popular songs in a voice that had much more enthusiasm than talent. She always kept us in close contact with our extended Judell family - her brothers and sisters and their children, our cousins. And she maintained an active social life with bridge and tennis parties among her friends and golf in the brief winter months.

Lester Judell, Vera Last, Eric Judell, 1960

Vera with two of her surviving three brothers











Vera means true. I've never known anyone whose name more accurately reflected who and what she was.

Autumnal miracle

Looking west from my balcony, 20 October, 2012

Elderly horticulturalists all agree that this year's autumn colour displays are the best in living memory, and driving around Ottawa I have to agree with this judgement.  Every time I'm out and about I berate myself for not bringing my camera to try to capture some of the colours, incandescent, translucent, fire red and liquid gold that, barring autumnal gales, look set to continue for weeks more yet. These two images snapped from my balcony at breakfast time today don't come close to resembling the reality, and my balcony views are a pallid reflection of many realities on nearby tree-lined streets.  It's advance compensation, so to say, for the black and white world that will replace this annual autumn miracle when winter arrives a few weeks from now.  I'm making the most of it, and basking in the warm sunshine of Indian Summer which this year seems longer, more languid, more sensuously pleasurable, than ever before. Long may it last!

PS: Here are more photos I took a few days later:

Looking north-east from my balcony,
October 20, 2012

The Internship Year

When I graduated in December 1949 it wasn't mandatory to spend a year doing a supervised internship before being granted a license to practice medicine independently – that became the law a few years later – but it was unusual for new graduates to go directly into practice.  I think only one of my classmates did so, joining his father and others in a small group practice. Adelaide followed the prevailing pattern of Australian medical schools and those in many other countries, with a system of rotating internships: new medical graduates moved through a series of supervised training positions usually at two-month intervals. All posts included general medicine, general surgery, many provided 1 or 2 months in ‘casualty’ – the emergency department – and some included anesthetics.  I had all these, and one month each of orthopedic and neurosurgery, infant care, and long term chronic care.  It was a good mixture of experiences but by no means the best. The ‘best’ rotations went to the top graduates, who had first preference among the clinical chiefs, that is, it was based on performance in the final examinations. I did well in all but one exam, my internal medicine ‘long case’ clinical (practical) exam, in which I failed to detect an elusive heart murmur. I passed that clinical examination by a hair’s breadth, and consequently graduated some 10-15 places lower than otherwise would have been my fate.   

I graduated well enough to get a reasonable rotation, not well enough to get the pick of the best of them. I was happy at the thought of being able to put behind me the long hours of study, and bewildered, even dismayed at the prospect of having to decide what I wanted to do, medically speaking, with the rest of my life. It was assumed that whatever else we did, most of us would first go into general practice, and I did that before the ink was dry on my medical degree certificate, working as a relieving GP in a country town about 50 miles north of Adelaide. It was a scary experience. On my first night in that practice, I had to deliver a baby, which went well enough; but then the placenta wouldn't deliver, and all the time the woman was bleeding, first a trickle, then more, then yet more and more until I began to worry. It was probably all perfectly normal, but I had never delivered a baby without somebody else standing by, and here in the labour room of a small country hospital, I was utterly alone - the duty nurse had gone off about her business, leaving me to fend for myself on a hot and sweaty night. It was my first medical "emergency," a self-made emergency. It ended safely in due course after what felt like hours, was actually less than an hour. It was the beginning of a stressful few weeks.

Another experience in that practice introduced me to medical ethics, on which we’d had a single lecture near the end of our final undergraduate year. The lecturer, an elderly former president of the state medical association, warned us against sexual involvement with our patients, told us we must never procure abortions, and gave us a tutorial on how to complete official documents like death certificates. That lecture didn’t prepare me to deal with a task my boss assigned me on my first day in the practice: I was to give a 40-year old woman daily injections of penicillin but warned on no account to tell her what the injection was or why she was getting it. She was having a course of penicillin because her husband, the mayor of the town and my boss’s golf-playing partner, had brought back some gonococci as a souvenir of a business trip.  She wasn’t stupid. The first time I saw her she asked me if I was giving her penicillin, and was it because her husband had given her a dose of the clap. I was truthful. I answered “Yes” to both questions.  All hell broke loose.  I was almost fired on the spot, saved only by the hard fact that my boss would not have been able to get a replacement for me, and was leaving next day for annual holidays.  I learnt the importance of telling patients the truth – a task my boss had failed dismally to perform.  I was young and inexperienced but I knew he was in the wrong and I was not.  It didn’t help but it did make me feel better.

My internship year was much like those of more eloquent writers than I who have devoted books to the subject of this rite of passage into the medical profession. We worked intensely hard, often going without sleep for a couple of days, getting rich and varied experience. I mastered several techniques: giving complex anaesthetics, inserting needles for intravenous sedatives into tiny veins on the back of the hand, even the back of the forefinger, passing endotracheal tubes, doing minor surgical procedures like removing sebaceous cysts, and common surgical operations like removing acutely inflamed appendixes, repairing simple inguinal hernias, reducing simple and compound fractures of the wrist, ankle, forearm; and the minor procedures of acute medicine - lumbar punctures, putting up intravenous drips, etc. I soon became competent at these technical procedures, and got better too at dealing with people, the part of the work I enjoyed most.

But I remained undecided about the ultimate direction in which I might move as my medical career unfolded into maturity. My experiences included both extremes of age: I started the year at the Mareeba Babies' Hospital, a semi-chronic care institution, full in those days of sickly infants with the mysterious condition called Pink Disease, not identified until some years later as mercury poisoning caused by ingesting mercury in teething powders. Later I had a month at the Magill Old Folks Home, a chronic care division of the Royal Adelaide Hospital, where the incurable, “boring,” elderly kinless were sent to die a lingering death. We all hated this posting, it wasn't “real” medicine, we had the perception that there was nothing we could do for these patients; all too often they died at night, and we had to get out of our warm beds, drive all the way out to Magill, and certify that they were really dead. How callous and uncaring we were! The highest aspiration that some of us who did that rotation could imagine was to find witticisms to add to the voluminous case-notes that had accumulated about many of the patients who had been there for years. Looking back now I cringe with embarrassment and guilt at my callousness and lack of compassion.  

In other ways the month at Magill was a time to relax, there were few emergencies and nobody harassed us, so we could enjoy the beer-sodden party life of the residents' quarters. We played as hard as we worked, much influenced by role models, registrars (senior residents) a few years ahead of us, who had themselves learnt how to live it up from their predecessors. We had the doubtful privilege of being influenced by some men of an older generation, who had been away at the war and had returned to the teaching hospital system to learn from those who would examine them for the higher examinations in medicine, surgery, obstetrics etc that were required before becoming bona fide consultant specialists. Some of these men were really wild, letting their hair down after stressful experiences during the war.  I had to treat one of them for an acute episode of malaria one memorable weekend (I made a blood film and saw for myself the malaria parasites and disintegrating red blood cells). He was on the way to a career in gynecology. Others were heading for internal medicine, or general or orthopedic surgery, having already done a great deal of war surgery; two who were our immediate seniors were younger surgical registrars who taught us how to drink beer, fry eggs in butter, spin dinner plates out the windows on the upper floors of the building where we lived (“Flying saucers,” we called these dinner plates as they broke with satisfyingly loud crashes, when they hit the ground or the building across the parking-lot if they glided far enough). One night two of them went into the Botanical Gardens that adjoined the RAH, swam under water in a duck-pond, and pulled down under the water a couple of mallards, drowning them before bringing them back for others of us to pluck and clean so they could be grilled over an open fire on the third floor veranda of the residents' quarters. They taught us also many dirty songs, and how to play billiards on the battered old table that had been part of the furniture in the residents’ quarters for generations. On another occasion, not during my time, some of them blocked the drain in one of the bathrooms, sealed the cracks in the door with putty, and filled the entire bathroom with water to window level, getting in to swim in the pool thus created through the window from the third floor balcony. All went well for a few days until the cleaners reported that they couldn't get into this bathroom, and had the door broken open. The resulting flood severely damaged the stored medical records on the ground floor of the same building... It was a long time before that episode was forgotten!

All but three of our immediate seniors were men. The demographic transformation had not yet struck the medical profession. My class was the first with an appreciable proportion of women and for some years it was the only one. Among our registrars (senior residents in modern terminology) there were 3 women, a neurosurgical trainee, an anesthetist and a woman heading against strong opposition into obstetrics and gynecology, at that time an exclusive domain of men. The modern male-female 50-50 balance in the medical profession was still some 10-15 years away in the future. Several women in my class were among those who began to shift the balance.

That year as hospital resident was the first time I had lived independently away from home, cutting the ties that had bound me tightly to my home and my possessive mother. Probably the bonds had been unusually strong because of the combination of my mother's personality and the break-up of her marriage. She had always been unwilling to let me go, always insisted on a detailed accounting for my every action whenever I came home after being out of her sight. The year at the Royal Adelaide Hospital began to liberate me from this relationship, which only then I realized was stifling me. I began to realize then that this relationship was one way in which I was different from my peers, all of whom had broken free from parental surveillance many years earlier, often while still in school. 

The experience of so many clinical rotations in the short space of a year did nothing to help me resolve the doubts I still had about what kind of doctor I wanted to be. I enjoyed and was good at many of the clinical tasks I had to carry out, perhaps most of all the fine manipulative skills that required proficiency with a needle or a scalpel. Yet I was sure I didn't want to be a surgeon. Equally surely, I didn't want to be a psychiatrist. In those days, mental disorders were disturbing to contemplate and mostly they were mysterious and frightening, a great gap in our clinical training. I didn't learn anything about mental and emotional disorders until several years after I went into general practice, consolidated the little I'd learnt by targeted experiences during my epidemiological training. If I lent towards anything, it was the obvious direction that almost all of us took, towards general practice. Yet I had much uncertainty about this too, partly because I lacked confidence in my ability to function on my own, partly because the field seemed to me to lack much intellectual stimulation. I still wanted most of all to be a writer.

Late in the winter of 1950, just after the Korean War began, I escaped for a two-week spell relieving a doctor in a country town about 150 miles north of Adelaide and enjoyed this experience of general practice much more than I had when I had briefly worked as a country GP just after graduating. Yet I didn't feel ready to embark upon a career in general practice at the end of the internship year at the RAH. Like most of us, I applied for a six-month period as house officer at the Adelaide Children's Hospital. I also considered enlisting, joining the Australian contingent that was preparing to deploy to Korea. I've sometimes wondered how differently my life might have turned out if I had served in that forgotten, unfinished war.

During 1950, along with all the others who lived in the residents' quarters at the Royal Adelaide Hospital, I had many close encounters with large numbers of cockroaches. The building was infested big time. If one of us went into the kitchen of our quarters late at night and turned on the light, the entire table top and the benches beside the sink were a moving carpet of purple or black carapaces, long antennae waved as if gusts of wind blew across them; they made a sinister sounding rustling noise but were otherwise silent, unlike some of us, especially the women residents who had been known to scream at first sight of them, although like the rest of us they soon got hardened to the sight. The largest of them were two or more inches long and if we could suppress our disgust at the sight, they were really rather beautiful with their shiny carapaces and long, gracefully waving antennae.  Ten years later when I was learning medical entomology during my public health training, the delightful expert who taught that component of the course told us two interesting things about cockroaches: they are scavengers that clean up organic waste, much as carrion birds in India dispose of rotting meat from animal carcases; and, surprisingly, they do not carry any human diseases.  Cockroaches, therefore, do not deserve the revulsion they arouse in so many of us. Years later in 1978-79 when we lived in an apartment in Manhattan that was heavily infested with the New York variety of cockroaches we had many house guests and once when I was awakened in the small hours by screams of a squeamish woman who was staying with us, I tried to reassure her with these two facts about cockroaches. Not surprisingly, I failed to convince her. As for me, I admire them more than they disgust me.