UNDERGRADUATE PAGE

Innocents in Wards

By PAUL WELLINGS (University College Hospital) j t t UNIOR Clinical Course ? " He repeated our question, and then said, "Yes, sir, go out of my door, turn right, then take the first turning on the right, and you'll see the medical school facing you." Somehow it was all a little different. During the past three years I had grown accustomed to less prosaic - directions. In Cambridge, once one had walked down the " Chimney " one passed into an oasis of academic quiet where traffic ceased to be heard. The idea of a busy street interposed between Hall, now transmuted into, a refectory, and one's staircase, deflated to a bed-sitter proof against the most accomplished of cat-swingers, took a little time to get used to. However, all was not completely unfamiliar. The person who had just issued these directions might not wear a top-hat and call himself the Head Porter, but he had all the latter's traits. Instead he wore a more militant uniform and called himself the Beadle. This title brought back nostalgic memories of processing Vice-Chancellors ; memories heightened by the discovery that the Beadle possessed the retentive memory for faces which is a !dittressing feature of all his kind.

The first discovery I made On gaining the medical school was that coming up to hospital meant another return to the Freshman stage. This was the fourth time that I had undergone this defla- tionary ordeal, and it fitted in nicely with the Introductory Address. "Perhaps the greatest thing to remember in medicine is that one is always learning something new." Occasional relegation to the bottom rung may be excellent therapy for acutely swollen heads, but to a person who likes set ways this up-and-down motion is rather upsetting, Was I never going to gain a stable position in society ? Once more I had to master elaborate schemes of precedence and discover how this fresh seat of learning was organised. At prep. school nobody cared very much about precedence ; there were big boys and little boys, and they were soiled out by the only convention known to savage society, namely, strength of arm. At public school things became more complex, and .care had to be exercised in such matters as how many jacket- buttons one did or did not do up, or which way one walked round certain playing-fields. Later at Cambridge the stresses of etiquette lessened, and the only complicated piece of conventional hocus- pocus I came across in my own college was about which of the three Boat HOuSe changing-rooms I might use.

Hospital is. a return to the intricacies of school life with all the penalties for non-observance of _ the nicer points. Once upon a time it had been fatal to confuse a house captain, umbrella and two buttons undone, with the more potent dignity vested in the person with an umbrella and no jacket-buttons fastened. The latter was a school prefect, and consequently a much more dangerous beast. Now the danger lay- in confusing. the various species of nurse. To aid in their identification the hospital had instituted a system not unlike that used by the London Transport Executive to Illustrate their Underground Railways. Thus a nurse of almost sister rank, and therefore somebody to whom it paid to f■e nice, wore a belt coloured like the Central Line. Less important, but nevertheless State-registered, nurses wore the homely blue of the Piccadilly Line ; furthermore, one made a firm mental note to cultivate blue belts against the day that they assumed the scarlet of near-sisterhood. Mere physiotherapists could be identified by their belts of Inner Circle green. Unfortunately, the colour scheme had not been extended to the medical students themselves ; consequently it was difficult to distinguish female medicos from lady-housemen. In this case a careful glance to determine the presence or not of patina on their stethoscopes helped considerably.

During the dear, dead days when morbid anatomy and the only slightly less moribund subject of physiology had filled my curriculum the idea of interviewing and examining patients had been something that resuscitated flagging spirits when their edge was blunted against the solidarity of "Henry Gray's immortal treatise." In those days,

however, one only visualised patients as helpless creatures peeping over the tops of carefully folded sheets and behaving in a deferential manner to oneself ; .who, armed with shiny stethoscope, springy patellar hammer and a clean, short set of finger-nails, was about to demonstrate that the spirits of Harvey and Hunter still walked

the wards. The reverse was in point of fact true, and had it not been for the forethought of the teaching staff in providing an

acclimatisation course for the neophytes, I fancy that the Casualty Department would have been cluttered with mary cases of severely shocked students.

My first case had not been immured in a teaching hospital for six weeks without learning a thing or two, and his knowledge of

his own complaint was encyclopaedic. He had all the physical

signs and symptoms belonging to his particular disease, and was insistent that I should hear them all and appreciate them individually.

His account was.intedarded with technical malapropisms (anorexia

of the big toe I will treasure for a long time) and besprinkled with many of the abbreviations uSed in hospitals—all of them quite unknown to me. We had been warned against such as he, but

although we had started practical pharmacy we had not yet met the nostrum specific for verbal diarrhoea. Ward etiquette and euphemisms that failed to ruffle the patient's calm were child's play,

but how to keep a patient to the point and get him to tell you his story from the beginning without letting, him introduce local colour, his relations and his views on medical students was some-

thing that still had to be learnt. In fact, we created havoc in the ward during our first week. An urgent appeal was made by the

sister that we should cease to use the dates of departure of patients from the hospipl and sprightly " What's-the-matter-with-yous " as opening conversational gambits, since these particular enquiries were sufficiently tactless to distress many of the habitués. Pharmacy provided a. congenial change from the inquisitorial sessions needed to work tip a convincing bedside manner. Noisome

messes had long attracted me, and I had always found that one of

the main attractions of " Macbeth" was the Uninhibited culinary composition displayed by the Three Weird Sisters. Later in my career, when I discovered that the pharmacopoeia had been enriched by. unorthodox persons as ex-pirates,. these incongruities com- pensated for the fact that picturesque medicaments such as oils of puppy-dogs and crab's eyes had long ago ceased to be 'official, and, despite the present-day conservatism in the choice of drugs, I felt that mistura diabolica had potentialities when. I read its recipe.

The age-old rivalry between physicians and surgeons, I found, provided a fertile source of amusement. Since the inception Of anaesthesia and antiseptics, and the consequent growth of surgery as a 'separate branch of medicine, physicians have tried to. impress upon surgeons that their art is still an integral part of medicine and not a thing apart. Their success has been slight, and surgeons regard themselves as the doyens of the medical warld and refuse to stand second to the physicians. This is seen in the stories that each tell about the other, and the collection of these stories can enliven any dull ward round. Being completely new to the game and slightly pro-physician anyway, I thoroughly enjoyed the storY of the two surgeons, one of whom enquired, "What did you operate on X for ? " "A. hundred guineas," was the reply.. "No, no! said the first, "-I meant what had he not ? " ".A hundrediguineas.