In 1974 Dalrymple began his first paid employment “in a small hospital in a town in the Midlands…” On pages 3-11 of Fool or Physician: the Memoirs of a Sceptical Doctor, he explains his decision to pursue an unconventional medical career:
Once qualified, I remembered the advice proffered by a senior consultant to a group of us at the outset of our clinical studies. He was teaching us how to examine patients; he had just discovered that he had cancer of the bowel, which he took to be a sentence of death. His life was at an end, he said, and now he realised that he had devoted it to a worthless ambition, namely to become a consultant in a teaching hospital. To achieve this he had led a deformed life for many years: he had been endlessly on duty at night, ruining his family life; he had toadied for years to men whom he detested; he had failed to develop other interests; and he had played silly academic games by doing research which he knew from its inception to be futile, since it was undertaken from a desire for promotion rather than from love of knowledge. Worst of all, he had lived his entire adult life in a single institution, knowing nothing of the world beyond. And now it was too late, he was dying.
‘I know you don’t like me,’ he said, which was no more than the truth, for he had been an irascible and intimidating teacher. ‘But I want to give you a piece of advice. You won’t take it, I know, but I’ll give it you all the same. On no account pursue a career only for power or prestige. To live an interesting life, that is the main thing. You don’t appreciate it yet, but this is the only life you have, so make the most of it. Don’t do what I’ve done. The world is much bigger than any hospital.’
His words, I think, fell largely on deaf ears… I, on the other hand, was receptive to his embittered message, because it coincided so exactly with my own feelings. Whenever I had been on duty in the hospital over the weekend I felt a sense of physical release, as though from prison, when I left the building. I knew it was a poor omen for a conventional medical career.
My first paid employment was in a small hospital in a town in the Midlands…
….
The consultant with whom I spent most time was a woman in her mid-fifties, a spinster for whom her patients were her family, her recreation, her whole life. Her devotion to them was absolute. On her ward rounds she examined each with minute care, read their notes from start to finish, and ordered long batteries of tests in case she had missed something, even when the diagnosis had been made weeks before. Though she was clearly a woman of the greatest kindness, her ward rounds were a terrible ordeal for all concerned – patients, doctors, nurses – lasting eight or ten hours. By the end of them one wished to scream, to kick the walls, to smash plates. And the worst of these ordeals was that they benefited no-one. I do not recall a single patient whose life was saved, whose diagnosis was made, whose prognosis was improved, by this minute sifting of details.
Though she was a very clever woman who, had she been a man, would have achieved far greater distinction within the profession, she nevertheless displayed an ignorance of what went on in her own hospital which was at once naive and utterly invincible.
In one of the geriatric wards there were two old-time nurses, who had returned to nursing. They were splendid creatures, ample of girth, one of them in crisp green uniform, the other in fine blue and white stripes. Each vast bosom was kept in order by a stiffly-starched apron of dazzling whiteness: one would get snow-blindness looking at it for too long.
These two nurses had a no-nonsense attitude to their calling. They didn’t hold with new-fangled ideas, like science. They believed that when a patient was destined to die no power on earth – certainly not hospitals, conceited doctors, or nurses – could intervene. The geriatric ward was their domain. Visited rarely by a doctor, and then only to withhold antibiotics from a stroke patient who had contracted pneumonia, these nurses had an elemental view of their calling: to keep the ward clean, the bowels moving, and to suppress by sedatives any human noise in competition with the television…
Occasionally, however, the two nurses were called upon to exercise less custodial and more therapeutic skills. When other wards in the hospital ran short of staff they were seconded to them. And it was here that the trouble began. One of their duties was to keep fluid balance charts – the quantity of fluid a patient took in each day compared with the quantity he lost by all routes in the same period. These charts were as tablets from Sinai to the meticulous woman consultant, whom the two nurses hated as only female nurses can hate female doctors.
A couple of hours before the consultant’s ward round, the two nurses would sit down together to make up the charts which they had failed completely to keep since the last ward round. Knowing nothing of physiology, they put down on the charts the first figures that came into their heads, and then sailed majestically round the ward clipping a chart to the end of each bed.
During the interminable ward round that followed, the consultant would pore over the charts, trying to unravel their physiological mysteries. For example, a patient would be shown as having drunk twenty litres less over a week than he urinated, though he demonstrated as yet none of the signs of dehydration. Or he would be shown as having drunk twenty litres more than he urinated. She took the charts to the office, where we sat round a table trying – for hours at a time – to reconcile them with any known laws of physiology or pathology. It never once occurred to her that they were entirely bogus, works of cheap fiction. She was too devoted to her patients, too conscientious herself, to imagine such a thing of others. Everyone else in the room went mad alternately with boredom and suppressed laughter. Eventually she came up with a rare diagnosis, the nearest that she could somehow reconcile with the figures before her, and order[ed] a battery of expensive and time-consuming laboratory tests to confirm or refute it. No-one ever dared tell her about the two nurses, who laughed most of all; and thus a stream of patients was subjected to all kinds of unnecessary tests, and the resources of the health service frittered away, because of the child-like innocence of this clever woman.
She died not long afterwards, of secondaries from a primary cancer that had been removed some years before. Her aged mother, with whom she had lived all her life, survived her. When I learnt of her death I was seized by melancholy. A good and talented woman (she had studied under some of the most famous medical scientists of her day, and had had their good opinion), she had not, I suspected, known much personal happiness. At best she had made an accommodation with life. Her death would have been greeted with secret relief by all those who had still to endure her ward rounds; and a week later, it would have been entirely forgotten that she ever existed.
….
My time in that hospital was neither happy nor productive. Doctors are often accused of treating their patients as physiological objects rather than as ‘whole human beings,’ but the reverse is just as true: patients often treat doctors as mere curative devices. Whenever I tried in the wards to talk to the patients about some aspect of their lives other than illness they always brought the subject back to their constipation, or this pain that shoots from my left knee, doctor, twists round my waist and up into my right eye. Prolonged contact with the patients usually provoked a string of new, unfathomable complaints and left me with a feeling of impotent rage. So when I had a moment to spare I spent it not with the patients, as I had once idealistically thought I should, but in a corner, reading Russian novels.
My greatest excitement came with the death of one of my patients. He was a rich old colonel, dying slowly of an insidious disease. He and I had got along famously…he was one of the few patients who preferred not to catalogue almost lovingly the minute fluctuations of every symptom. On one occasion he had a heart attack while I was in the room and hi
s heart stopped beating. His case notes had yet to be marked N.T.B.R. – not to be resuscitated – and I managed to bring him back to life.
Some time later I heard from a nurse that he was so grateful to me for his temporary reprieve from oblivion that he had decided, having no close relations, to leave his money to me… However, when the colonel died (shortly after my departure from the hospital, I hasten to add), I did not hear from his solicitors.
I decided that if the greatest excitement I could expect from working in a British hospital was the off-chance of a legacy, I had better seek employment elsewhere. I learnt that a hospital in Bulawayo, in what was still then Rhodesia, sought house officers. By a strange chance, the hospital was recognised by the General Medical Council for registration purposes. (Every doctor, after graduation, must work a year under supervision in an approved hospital.) I received an offer from Bulawayo, and all the people who thought they ought to advise me warned me that to accept it was the end of my career, if not worse. It was tantamount to professional suicide, they said; I should never get another job when I returned to Britain; the regime had a terrible reputation for brutality; besides which, it was illegal for a Briton to give aid and comfort to the white rebels of Africa.
I did not find these arguments compelling. I could not conceive that my presence would bring aid and comfort to anyone (not even patients, let alone whole regimes); and as for my career in Britain, supposing I had one, I gave it no further thought.
Copyright 1987 Anthony Daniels. Reprinted with permission.
