HEART BEAT Maurice Neligan The resident year as a medical student in the Mater in the late 1950s was an interesting one. Resident was a misnomer, as apart from one month during the year we did not actually live in the hospital.
The rest of the time you made your way to the hospital for the start of the day's work. Hospitals rise early and most clinical units were at work by 8 a.m. This fact of life, however, only became a reality for us after graduation, and thankfully did not extend to our student days.
More latitude was allowed us then, basically because we were useless appendages of the system, bottom feeders and expected to be grateful for any scraps of knowledge incidentally acquired. We did, however, have limited duties - we took the bloods. We were the phlebotomists.
Anybody now acquainted with hospital life and accustomed to having their blood taken for tests, by accomplished business-like women, deadly efficient in all they do, will know what a real phlebotomist is.
We were not like that. For starters, we were not trained as such and we learned from watching each other. This is not the best way to learn, but it was all that was available to us. As in every facet of life, there are quick learners and slow learners, there are those who are adept with their hands, and some less so, some even clumsy. It did not seem to concern the powers that be, and we were left with the problems of extracting given amounts of blood from particular patients, making sure it was placed in the appropriate containers and delivered to the laboratory. On the face of it, this seems reasonably simple. It was not so at the time.
It was your first duty of the day. You presented yourself in your then clean white coat on your ward as early as possible in the morning and your intern (another form of medical low-life) would present you with a list of patients from whom blood was to be taken, and the various blood tests required.
On the surgical side of the hospital, this was usually not too bad. On the medical side, where the lordly physicians were investigating all sorts of abstruse conditions, this could be a monumental job. It would not have been at all unusual to have a list of 20 to 30 victims - I mean patients - requiring your attention. I am not talking leeches here, nor cupping and bleeding, as in days of yore, merely taking enough blood for diagnostic purposes.
The next step was the execution of the task. The instruments we had available to us at that time bore no relation to those available today. Everything we used, excepting the swabs, had to be sterilised after each patient, and re-used. The syringes were of glass in varying sizes, and the accidental breakage of same was almost a capital offence. In some hospitals the students had to pay for replacements and the very least you could expect was an unpleasant interview with the dragon (i.e., Sister) who ran the ward. The needles (of steel) were of varying length, thickness and sharpness. Come early and you got the pick, come later and you would be guaranteed some bad friends amongst the patients.
You then set forth, with your little tray, to inject some misery into the patients' lives. This, of course, was not the intention but sadly often the result. We usually started in the male wards, having been told that it is easier to get blood from men. It is, but I suppose you don't have to be a medical student to appreciate that - just take a look around in daily life. In the strictly anatomical sense, this was because the distribution of body fat made the veins of the man more apparent on the surface.
You approached your victim with an air of nonchalance, applied a tourniquet on the arm and instructed the patient to clench their fist several times. This brought the veins in the forearm and elbow into relief. It was then a simple matter to slip the needle into the vein, withdraw the plunger on the syringe, extract the blood, fill and label your little bottles and dispatch the lot to the laboratory.
That was the theory, and it worked, provided the needle was not blocked, and was actually located within a vein, and that the plunger of the syringe was not too tight or too loose. It worked if your patient had any visible veins, that had not been previously destroyed by hordes of vampire students, and if they were not so unlucky as to have any visible veins at all.
Then it was bad for us, and it must have been frightful for the patients. Failure to acquire the blood was simply not an option, and sometimes a more adept student blood diviner would be called upon by his fellows to locate more deeply hidden streams. Curses, maledictions and prayers filled the ward as we stuck grimly to our task, leaving bruises on arms and hands to mark our passage.
The moral for any patient out there is "never be in a doctor's first 100 of anything, if you can possibly avoid it". Quite what observance of that precept would do for medical pioneering, I am unsure, but we and most of the patients survived.
Dr Maurice Neligan is a cardiac surgeon