HEART BEAT: Last week, I described my initiation into the world of the operating theatre. Little did I know at the time that it would prove the locus of my future professional life.
At this stage in our training, the fascination of medicine was taking hold. There was more to come in other core branches of the profession: obstetrics, paediatrics, pathology, forensic medicine and so on.
The sheer volume of knowledge to be absorbed for your future career, not to mention the more immediate problem of examinations, was daunting. At the time, in our resident student year, medicine and surgery were our principal pre-occupations, but we also had parallel lectures on such riveting subjects as social and preventive medicine, and in microbiology.
There was nothing in these subjects that held student interest in comparison to the daily happenings in the hospitals, but we realised that they were part of the foundations, and while they were not there to be enjoyed, they had to be endured. Microbiology and pathology were, in fact, closely integrated with our teaching, and both were vital to the understanding of the spectrum of illness that we encountered daily.
We tried hard and diligently, but our haloes slipped occasionally and the odd lecture was skipped, particularly on fine, sunny days. I remember well a large section of our class being released unexpectedly into the sunshine from a dismal lecture on medical statistics. A student in one of the middle rows of the tiered lecture hall was quietly reading the newspaper when a friend in the row below quietly lit the lower edge of the paper, and the lecture hall was enveloped in smoke, flames and curses. Guilty and innocent alike were ejected into the sunshine with dire threats of retribution at exam time.
I also remember, with mixed feelings, that on presenting myself in the out-patient department one morning, the staff nurse who normally would not deign to notice students, said to me: "I thought you were on holidays." "No," I assured her. Sometime later, an intern made a similar remark. Finally, the consultant came in and said: "I am delighted to see Mr Neligan, you are honouring us with your presence." There was laughter from all, except yours truly.
Similar remarks continued throughout the morning, until finally a fellow student told me to look at the social and personal columns of the morning newspapers.
It was then the custom for senior consultants leaving on holiday to notify these columns of their absence. This custom persisted until they realised that with literacy on the increase, many burglars could now read. In any case, at the end of the usual list of holiday arrangements, there I was. "Maurice C Neligan, clinical clerk and surgical dresser, will be out of town for a short period." Indeed, I had some nice classmates.
Those subjected to our medical humour didn't always see the funny side and the humorist was often landed in trouble with the powers that be.
A colleague, now a highly respected GP, provided two such light moments. He was dealing with a very overweight lady who was complaining of vague abdominal pain. Persistent questioning failed to pinpoint a definite location, as it seemed to move all over the abdomen. Exasperated, he hazarded a diagnosis. "I think, Mrs So and So, that you are suffering from a wandering fart." Instant outrage and severe reprimands were visited on our classmate.
Undaunted, our intrepid hero struck again, this time dealing with a man complaining of altered bowel habit. Had he passed blood? Negative. Had he had diarrhoea? Negative. Was he constipated? Well, sort of. "What do you mean by that?" asked my colleague. "Well," said the patient, "the motions are small and hard and kind of diamond shaped." Quick as a flash, our budding doctor arrived at the solution: "I suggest, sir, that you cut six inches off your string vest."
It may surprise you to know that we were an irreverent shower, but such events helped to preserve sanity, in situations where humour was rare. Now, I am going to be politically incorrect. We learned that while doctors could be bad, patients could be 10 times worse. We learned the difficult, dangerous and inexact art of distinguishing the hypochondriac from the genuinely ill.
We learned also how to deal with the difficult patients. You would tell these patients that everything they were telling you was very important, so important you wanted them to go home and write it all down exactly as it happened and bring it back next week. When they had completed the task, you would say: "Thank you very much, I will have to read these 20 pages very carefully, come back next week for your prescription." You don't have to be a rocket scientist to figure out the rest.
Look suspiciously at your doctor the next time you visit to see if there is a glint in his or her eye. If not, maybe choose another doctor.
• Dr Maurice Neligan is a cardiac surgeon