Tuesday, December 8, 2015
Making of a Child Psychiatrist (34): Back to the Grind (4)
There were consultants at King’s whom you grew to love. They were gentle and brilliant teachers who had a firm belief that their role in life was to share with you all that they had learned. One such was Dr. Bruce Pearson, who was a real gentleman in the true sense. He wore a three piece suit, winter or summer, and always had a fresh rose bud pinned to his lapel. Ward rounds were wondrous affairs as we explored the subtlety of medical practice. He had the ability to make strong relationships with his patients, who obviously revered him. This was no superficial smarminess, but a core belief that if your patient truly respected everything you stood for, not only would it enhance the doctor-patient relationship but it would also provide the optimum environment for cooperation and cure. It was not a reverence from the patient, but rather a deep belief that this man knew exactly what was best. I was to learn over the years, in particular during my years in general practice, that if you did not take the time, if you were distracted by other issues, if in truth you were not sure you liked the patient, then this would dent the relationship. Whenever a patient seemed slow to recover, not only did you have to re-explore the diagnosis and your management, but you had to gently enquire whether they had believed your summary and advice, and had been willing to try your treatment. It was an amazing revelation much later on to be able to examine the bathroom cabinet of a patient who was not doing well. Often they were not doing well because they had not taken the prescribed tablets. And it took quite a long time for me to learn and accept that it was not their fault. On reflection, you had not believed in yourself, or had been distracted that day, or had not taken the time to truly engage them, or could not be bothered with them as people.
Such lessons began in those first months of ward rounds. And they were there in the teaching of Bruce Pearson, if you had had time to reflect and absorb the lessons. From then I also wanted to be a gentleman doctor. I had not been born into that class of people known as ‘gentlemen’, but that would not stop me from wanting to be a gentle man.
There were other senior doctors who were ‘difficult’. They were brusque; sometimes with patients, more often with us students. They were prone to demean you in the face of your colleagues and the patient. While over time you could gain an admiration for their diagnostic and therapeutic skill, they were edgy or prone to fly into rages if they perceived you had not done a good enough job. These days, I might have wondered about their personal life, or their upbringing, or their alcohol consumption. But at the time I was just to young, and too terrified. You just had to survive.
I guess one of the issues that I saw in some of the senior staff at King’s (and disliked intensely) was a certain arrogance. When you think about it, these people (mostly men at that time), had ‘made it’. They came from ‘the right’ families (very often with strong medical traditions), had been to the right schools, had developed the right contacts, and now held senior positions in one of the best medical institutions in London. They had ‘made it’. They were entitled to behave as they pleased, and if you got in the way, or did not perform to their standards then you were not worthy. On balance, my memory suggests there were more surgeons in this group than there were physicians. But there were some outstandingly ambitious physicians who, like many surgeons, simply treated people like bodies (or sometimes ‘like dirt’). I was always uncomfortable with those attitudes, but as naïve as I was at the time, I was more prone to blame my own ineptitude and try to avoid too much of the spotlight on ward rounds.
But life was about more than work and ward rounds. We would retire to the medical school, have a brief lunch in the refectory and then enjoy student life in the common room. My bridge skills came in handy, and I soon became part of a loose group that played almost every day. Over time I must have made a name for myself, because I ended up with the privilege of playing for King’s in a University of London championship in which we did quite well. In fact we thought we were so good that my partner and I thought it would be a grand idea to go down to East Dulwich bridge club and see how we racked up. We had a great evening chatting with the blue rinse set, and absorbing second hand cigarette smoke, but at the end of the evening we were stuck almost at the bottom of the table for the night. We left with our tails between our legs, determined never to challenge a bunch of old ladies again. In contrast, there was a highlight that was to happen much later in the months leading up to our final medical exams (when I should have been studying of course). I had the privilege over some months in the Med School common room to brush up the bridge of Miss India Reita Faria who, in 1966, was the first Asian to win the Miss World title (and not because of her bridge). At the time, she was a medical student at KCH, but later qualified and married an endocrinologist Colin Powell in 1971; the family live in Ireland. Ah, the brushes with fame!
There were so many opportunities to avoid study (if you tried hard). I joined the squash club. This may seem strange, but I had first learned squash with my parents’ young friend Kiah Bastian during my three months in Adelaide. He had taught me the basic game play, and some strategies, and we had played almost every week. From memory, my Jan also played squash with his partner Jan. So it was always a social occasion. Anyway, there were squash courts on campus and, with the help of a number of med student colleagues I began to work very hard on my skills and fitness. Given I was never a very sporty person, it always amazes me how good I became (or thought I had). I began to play competition squash, and found myself travelling all over London with one of 5 or 6 med student teams challenging on a London University College ladder. It was all good fun, always ended up with a beer or two, and we managed to win several team matches over the next three years (or so my memory tells me). So when I was tired of the bridge or conversation in the common room, there was usually a colleague who also had their squash gear in a locker, and we could breathe new life into tired brains smashing a small black ball around four walls.
Another escape from work was rugby. I had never really thought of myself as good at rugby but, seeing as it appeared to be the thing to do, I joined the Rugby Club. This entailed at least one practice a week a shortish walk from King’s to Dog Kennel Hill where there was a sports field and a smallish pavilion. I am not sure how it happened, but perhaps my squash induce fitness perhaps gave an impression of litheness and speed. After several early practices, I found myself being chosen as a wing forward in the KCH Seconds. I was honoured, bemused, scared and somewhat overwhelmed, but joined the coach on several Saturdays joined in the expressive language and jokiness, and played. Then we would all have showers, or sit in the communal bath with a bunch of other extremely muddy med students and swap stories of prowess. After the game, back at Dog Kennel Hill I became (given my strong tenor voice and training) a member of the ‘We can sing dirty songs louder than anyone else’ club. I had never known how many dirty rugby songs existed. I had never expected them to be so explicit. I had never expected to enjoy male company quite so much. So Saturdays became a (mostly pleasurable) ritual. I began to become practiced at drinking quite a lot of beer on rugby nights, and was known to be able to still play a mean game of darts after seven pints of bitter. Ah, the things you could do then that you can’t do now (and would never want to, of course).
Rugby, of course, had never been my passion. As people and team functioning improved, my skills did not seem to grow as fast. By third year clinical, I had been relegated to the fifth team, and was no longer a star winger. First I became a break away, and later ended up in the front row of the scrum as a prop. After we had played a team of London Police one Saturday, and I had gained deep scratches up and down my rather soft cheeks from the unshaven brute of an opposite prop, I thought my loyalties on Saturdays probably lay more in spending time with Jan. I made a good decision to become ‘not available’ and hung up my exceedingly muddy boots. I have retained one rugby jersey in the King’s colours. For some reason it brings back fond memories (and snippets from a rude song list), and I have had to fight tooth and nail to stop the slightly damaged piece of clothing from ending up in the bin.