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BMJ No 7123 Volume 315 The muses Saturday 20/27 December Christmas 1997 issue La salle de garde: bastion of the French lunch hour for junior doctors Bernard D Prendergast The Parisian teaching hospitals are guardians of a number of proud traditions, including (predictably) catering arrangements for internes, or junior doctors, at lunchtime. La salle de garde, originally conceived in the mid-19th century to provide a convivial, mess-like facility for all doctors resident in the hospital, now functions as the junior doctors' dining room, where central funds finance a simple, sustaining midday meal. Originally a bachelors' preserve, each salle retained a refined ambience (albeit male oriented), being finely decorated in the style of la belle &ecute;poque (around 1900). Nowadays, despite the advent of sexual equality, the prevailing atmosphere is somewhat akin to that of a rugby club late on a Saturday night. Artistic frescos have been replaced by lurid, semipornographic murals, which are updated regularly by students at the Ecole des Beaux Arts in Paris to depict current members in various states of undress. Nevertheless, despite the passage of time, certain original rituals remain. Daily rituals Internes arrive from half past 12 onwards, and after ceremonially greeting everyone present with a tap on the shoulder take their place at table in a strictly appointed order. Proceedings are overseen by the elected interne économe, whose duties include the preservation of tradition and maintenance of house rules. Lunch is not served until he (the honour is nearly always given to a man, usually a surgeon, most commonly an orthopaedic surgeon) is seated at high table at one o'clock sharp, and house rules apply until his coffee is served, usually a good hour later. His decisions are final: nobody may leave without his permission, even to answer bleeps, which sound remarkably infrequently (lunchtime is sacred in France). Communication with kitchen staff is also through his table. Offences are punishable by a forfeit determined by the spin of a wheel high on the wall behind him and range from singing a drinking song to buying a round of red wine for everyone. On more ribald occasions offenders may be asked to partially strip or to kiss their neighbour. Dismissal or (more commonly) dousing with a bucketful of cold water or kitchen leftovers is the punishment for failing to comply. White coats are mandatory, although external badges of office and protruding medical paraphernalia are frowned on. Medical discussion is forbidden, but conversation buzzes (reassuringly), interspecialty referrals being made in code. The suitability of topics under discussion is judged by the head cook. The term of address is always the familiar tu, not the more formal vous, and medical hierarchy is abolished. Tables are covered with aging discarded hospital sheets - which function as tableclothes, hand towels, and serviettes - and are bestrewn with bottled beer, mineral water, and the occasional pitcher of earthy red wine. Vast platters of wholesome food pass from table to table in strict order. Typically, a salad based hors d'oeuvres is followed by meat in a cream sauce (perhaps steak, though more usually chicken or minced beef) and a large cheeseboard (served before dessert, naturally), with bowls of fresh fruit and yoghurt to finish. At the weekly amelioré, organised by the économe, subscriptions augment the quality and quantity of food, are given as gratuities to the kitchen staff, and occasionally pay for entertainment - a musician, comedian, or stripper. Performances are usually risquÍe, accompanied by noisy interjections, audience participation, and a cacophony of appreciative plate banging (clapping is forbidden). At two o'clock, after the économe> leaves, everyone dons their bleeps and enters the world of the hospital again, mentally and physically refreshed for an afternoon's work. Other rituals Twice each year, in May and November, the rotation of jobs is celebrated with a raucous all night party, le tonus. Partners are forbidden, and the evening takes the form of a prolonged dinner with copious quantities of red wine and an accompaniment of drinking songs and games traditional to the salle de garde. Dinner is followed by more songs and jokes, medical sketches with a broadly medical or sexual theme, or both, and a series of speeches by senior members ridiculing the économe and senior hospital staff. Unsurprisingly, proceedings often get out of hand, culminating in food fights and mischief around the hospital complex. Another highlight in the calendar is l'enterrement (literally burial), held to mark the promotion of a member to chef de clinique (senior registrar or experienced specialist registrar). During an extended tonus humorous speeches of tribute (and otherwise) are made about the new incumbent, recalling misdemeanours and narrow escapes during his (or her) four to five years as an interne. Departure to another life is symbolised by a drunken funeral procession (complete with coffin containing the promoted interne) through the hospital at around 3 am in full view of patients - scenes difficult to imagine elsewhere. A sad (yet familiar) footnote: the future of the salle de garde is under threat from hospital managers, who consider it an unaffordable luxury. The pictures are taken from pp 78 and 79 of La Salle de Garde ou Le Plaisir des Dieux, Tome 2 by Patrick Balloul, which was first published in 1994 in Paris by Publications Patrick Balloul (ISBN 2-9508738-0-4). Institut National de la Santé et de la Récherche Médicale, Unite de Récherches sur la Biologie et la Pathophysiologie du Systéme Cardiovasculaire, Hôpital Lariboisière, 75010 Paris Bernard D Prendergast, Medical Research Council French exchange fellow Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline