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Friday, October 26, 2012

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

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