An initiation: Unequal encounter

BMJ 1998; 316 doi: (Published 21 March 1998) Cite this as: BMJ 1998;316:920
  1. Hugh Tunstall-Pedoe, cardiovascular epidemiologist
  1. Dundee

    Just down from Cambridge in October 1961, I was bottom of the clinical hierarchy at Guy's Hospital. Put straight on a surgical ward as ward clerk I was responsible for clerking admissions and was junior to the senior dressers, some of whom lorded it over us. I had been shaken on my first day, holding open a door for two pinstriped gentlemen, to have them sweep past as if I was invisible.

    Woe betide the ward clerk who did not know his patients. Two weeks after starting, the student gauleiter allocated me a young Bermondsey woman with a renal cyst. The senior registrar said that I was to present her case next Saturday morning to a distinguished visitor, Sir Clement Price-Thomas, who had operated on King George VI and who had surgical instruments named after him. He also had a formidable reputation for failing FRCS candidates. So watch out. I took my history, studied Hutchison's Clinical Methods, and tried to reassure the patient.

    Front seats in the steeply shelving room were occupied by pin-striped consultants and the back seats by the senior medical students, also in formal dark suits. I began my history. The patient had been cutting out a dress on the kitchen table when she was hit with such a violent and sudden pain in her right loin that she had thrown the dressmaking scissors across the room. (“Good boy” from the front row.) “She has never smoked and she does not drink very much.” “Oh,” said Price-Thomas, “No. That is not so good. I am not satisfied with that. What do you mean? Tea? Water? What are you talking about? Be specific, man.” I cannot remember if the digging in the ribs I was getting was mental or physical also.

    I collected myself, “Well, sir, she drinks port on festive occasions.” The room dissolved into laughter and applause, and the students in the back rows drummed their feet to show their support.

    “Show me how you examine the abdomen.” Hutchison insisted on an essential piece of equipment. I looked round with anxiety. The patient and nurse attendant were expecting my approach. I opened the door to the anteroom. “Hey, where are you going?” called Price-Thomas, amid titters from the audience. “To get a chair,” I replied, disappearing and emerging a moment later with my trophy, to a round of applause.

    Thereupon, mindful of my instructions, I placed the chair up against the patient's couch and sat down, leaving him standing. Pandemonium ensued, laughter and applause mixing with the thunder of drumming feet. Dignity—my own, the patient's, and the visitor's—demanded that I continue regardless, but I could see that this rumoured Welsh ogre had a twinkle in his eye and was having the time of his life.

    He held up his hand for silence, as if blessing the audience, questioned me, and teased me gently about my unorthodox technique. I had examined the abdomen—with my chair—from both sides of the bed. He replaced me in the chair to do his own examination, dismissed me while he discussed the x ray findings, recalling me later with “Where's my young friend?” for further questioning before thanking me, and leading the applause as the tribal drums welcomed me to the back of the room.

    It was an unexpected initiation, at times rather puerile, and a million miles from Cambridge matters like frog nerve-muscle preparations and the structure of myoglobin. After that Saturday, however, I discovered that I had lost my invisibility, receiving conspiratorial smiles and nods in the corridor. And I no longer believed in ogres.

    We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to.

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