HEART BEAT: 'Faith and knowledge lean largely upon each other in the practice of medicine" - Pere Mere Latham. The faith, more than the knowledge in my brief exposure to general practice. While waiting to commence my surgical life, I had some time to pass. Idleness was not an option owing to the necessity of eating and maintaining myself.
Accordingly, I had to find something to do. I spent a fortnight as locum A&E officer in St Vincent's, then located at the corner of St Stephen's Green. The department was housed in a lane off Leeson Street and this lane also provided access to the side door of Hartigan's pub, our medical haunt, when not actually ministering to the sick.
It really was off the beaten track and lacked the activity of the more strategically placed hospitals like Jervis Street and the Mater. In today's world, all of these would be regarded as havens of peace and tranquillity.
This was the quietest job I ever had. Almost nothing happened on a daily basis. The unit was run by an elderly Sister who was averse to having it dirtied in any way, especially by troublesome patients. Those kind of patients belonged elsewhere and reputedly she had dispatched those of whom she disapproved of on various grounds (usually over indulgence in alcohol, and usually students) to other, as she deemed, less salubrious hospitals in the neighbourhood.
She stressed to me that it was a great honour to work in St Vincent's and obviously wondered how standards had slipped so much as to allow me in the door. St Vincent's was "nice".
You didn't get paid any more, you didn't learn any more, you worked less, but it was kind of genteel and everybody knew their place. I am not sure that is the case today, but my good friends on the staff certainly think it is.
The good Sister reputedly haunted the unit after her demise, but there is no record of her having made the move to Elm Park. Perhaps they are too busy now to notice!
The days in those Elysian Fields being quickly over, I found myself as a locum GP in a very busy west Dublin practice. Nothing in my medical career thus far had prepared me for independent existence outside the cocoon of hospital life.
That was about to change. The practice had a public and private component, the former based on a relatively new health centre and the latter based on the home surgery.
It was the first time that the public/private divide actually impinged on me. From the private patient you actually had to collect fees. How did you go about that? I quickly discovered that there were those designated private who were extremely reluctant to pay their doctor, no matter what the service or whatever the hour.
I became used to put downs like "I only pay the real doctor", or "I'll settle this when Dr X is back."
Sir William Osler, one of the greatest of physicians and medical writers, wrote: "it must be confessed that the practice of medicine on our fellow creatures is often a testy and choleric business". Right on Sir William! I was also reminded of the African proverb: "In the midst of your illness you will promise a goat. On recovery, a chicken will seem sufficient."
On my first morning I arrived at the centre, bright and early, carrying my shiny new Gladstone bag with its assortment of essential drugs. It later proved to have as much relevance as an udder on a bull. I was so early in fact that I had to wait until a man appeared to open the building. He ignored me as did the rest of the arriving staff. Indeed for a time I felt invisible.
There were no patients in sight, it being a mite early for them. Eventually, a bored secretary asked me for my medical card and, on learning that I was in fact the locum doctor, made no effort to hide her incredulity.
She quickly shared this sentiment with one and all, and the general, mercifully unspoken attitude in my presence, was "this child is still wet behind the ears". They were right of course and I quickly moved to confirm their belief.
On entering the surgery, I noted it to be sparsely furnished. There was a desk and a chair behind same. There was no examination couch or even a second chair. My inquiries were fruitless, so I expropriated a chair from the waiting room and awaited my first patient. She was a large elderly lady. "Where's Dr X?" she demanded rather than questioned.
I explained. "I'd better come back then" she replied. I tried again and it transpired that she had only come to have a prescription for her cough bottle renewed.
I said that was no problem, but that first I would have to examine her chest. She didn't actually call me a pervert, but she certainly intimated it, while finally exposing about one square inch of skin to the stethoscope. It was a losing battle and I made out the prescription.
No sooner had she departed when the door burst open and a large redhaired nurse burst into the room. She grabbed my newly acquired patient's chair and withered me with a look.
"For Christ's sake, do you want them here all day?" she demanded. I had no adequate response. When I later incredulously recounted this episode to a colleague, he immediately trumped it: "In our place," he said, "there were no chairs in the waiting room either."
A feeling that things were going to be very different for the next few weeks settled upon me and this indeed proved to be the case.
Maurice Neligan is a cardiac surgeon.