Pride comes…

BMJ 2004; 328 doi: (Published 19 February 2004) Cite this as: BMJ 2004;328:460
  1. Hugh Tunstall-Pedoe, director
  1. Cardiovascular Epidemiology Unit, University of Dundee

    To supplement both my income and my experience, I, like many junior hospital doctors in London in the late 1960s, did odd surgeries for general practitioners at weekends and some emergency home visits then and at night. The latter were telephoned through to my home in Dulwich. Single visits were poor value, as you got considerably less than the general practitioner was reimbursed, but you might get a run of visits, telephoning in after each one. They meant driving all over south London, from the inner slums and housing estates to the leafy suburbs and beyond, to Kent. Travelling under the aegis of a doctor's medical bag was then relatively safe, although it provoked attempted theft later. I felt really threatened only once, when approached aggressively by two policemen in a patrol car when I had stopped in a deserted shopping street at 3 am to use a public telephone. Thinking they were definitely on to a criminal, they were reluctant to change their minds.

    This particular summons was to a young man with a stiff neck, seen inconclusively both by an emergency doctor and in an accident and emergency department. He was allegedly deteriorating. The caller was querying meningitis. I set out to Docklands. The address was in a largely deserted and boarded up, soon to be demolished, row of ancient tenement buildings, erected in the previous century by a charitable trust. They were dank, dark, and silent except for the drip and trickle of overflow pipes leaking from a great height. With some difficulty I located the right building, entered, mounted a decrepit stone staircase in appalling light, and found the flat I needed. I was greeted effusively and with great deference by an Asian immigrant concerned about his son.

    The young man was lying in the shadow of a single low-powered bulb, in a bed with no sheets. He did indeed have a stiff neck. Rhythmically it went into involuntary spasm, pulling his head backwards on to his pillow—spasmodic retrocollis, an extrapyramidal syndrome. He had chronic schizophrenia and was receiving depot injections at a clinic to control it. I explained to the father that, although distressing, the spasms were not a serious threat to his son and that they were caused by his medication. This would need adjusting by those managing it, whom he should contact for advice when he could.

    I left the tenement flat a transiently heroic figure—one up on two other doctors in my diagnosis, explanation, and management, and with the flowery and elaborate compliments and thanks of the father ringing in my ears. Missing the top step off the darkened passage, I skidded and crashed all the way down the first flight of stairs, my precious status symbol, the medical bag, thumping and bumping alongside to join me in a heap at the bottom. Shaken, and suitably chastened, I picked myself up and made a bruised withdrawal towards the dimly visible exit—enriched by a few shillings and by an unforgettable experience.

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