HEARTBEAT: If we do not find anything pleasant, at least we shall find something new. (Voltaire)
Needless to say, one cannot simply draw a line at midnight on December 31st and consign the old year to history and await a bright, new dawn. It doesn't happen like that. For me, it seems like a hundred years ago, it signalled the end of my surgical internship and my transference to the medical side of the hospital as houseman to Prof T.B. Counihan, an erudite, accomplished clinician; who, as well as being professor of medicine, was also one of Ireland's first trained cardiologists.
Life became very different, gone were the long hours in theatre, and the weary, worried nights in intensive care. Instead, there were larger patient volumes, lengthy outpatient clinics, long ward rounds and exposure to all those medical conditions that did not call for the scalpel.
It was immediately obvious to me that physicians were different. They inhabited a more celestial plane than the earthbound prosaic surgeons and carried their superiority wrapped like a toga woven of encompassing knowledge around their grave personae.
If I had gone straight into a medical, as opposed to a surgical, job; I might have been impressed. They did not appear as other men, and I suppose that was intentional. Movement was sedate and deliberate and conclusions were reached after profound deliberation. Did they take themselves seriously?
Oliver Wendell Holmes wrote that: "The face of a physician like that of a diplomat, should be impenetrable." In other words, don't let on you haven't a clue. Hippocrates wrote: "A physician who is a lover of wisdom is the equal of a god." The ones I knew all loved wisdom.
My rough surgical edges were rounded in this scholarly ambience and a forced and profoundly unnatural gravitas was assumed. Things were seldom done at the speed of light and the gift of bi-location was no longer required. Joking apart, it was a fascinating time, with continuous and intense teaching mingled with your routine ward work. The standard set was very high and our professor did not suffer fools gladly. He had the gravitas surely, but it did not fully mask the twinkle in the eye and the underlying compassion.
On ward rounds one day a gentleman from overseas had been admitted to a ward that usually we did not have beds in and was the lair of the formidable Sister Dolors, known to generations who passed through the Mater. The suspicion formed in the professorial mind that the diagnosis might be of one of the varieties of leprosy and he so informed us.
From my position on the lowest rung of the ladder, I gave my opinion that this would not mightily impress the good Sister. The professor conceded the point and informed us that we would refer to the condition by its other appellation of Hansen's disease. We did so and the good nun looked puzzled and said nothing.
At rounds the next day, the patient was gone and, before the arrival of the professor, I asked the good Sister where he had gone.
"Did ye lot think I came down in the last shower?" was the reply. "He's gone to the infectious diseases unit in Cherry Orchard hospital." Rightly, I did not wish to pass the glad tidings to the professor who, in fact, appeared outwardly unperturbed. The good sisters owned the hospital and there were times to swallow hard and look the other way.
The professor was a cardiologist principally and so I saw the investigation, diagnosis and medical treatment of heart disease at first hand. Given my career proclivities, this was an added bonus. I took part now on the medical side, in the conferences with the cardiac surgical team, which discussed the patients listed for surgery, and analysed the outcomes of those so treated. Lessons learned in those early days greatly benefited generations of patients yet to come.
The second consequence of my move from surgery to medicine was that my immunity from casualty duty was rescinded. Accordingly, the blurred transition from old to new year 1962-63 found me in the A&E department, confronted by what seemed to me to be an endless stream of revellers who had come to grief in some manner or other, usually fuelled by alcohol.
My firm recollection of that Hogmanay was that the tall dark stranger who provided the "first footing" was a warder from Mountjoy who was escorting a prisoner who had swallowed a bed spring. The patient was then given a cotton wool sandwich in the fanciful hope that this would coat any sharp ends and make perforation of the bowel less likely. In the course of my surgical training, this gentleman ate most of his bed and provided us with surgical problems of increasing difficulty.
By morning on New Year's Day, there were two patients on trolleys and we were not at all happy about that. Little did I dream of what lay ahead and, had the ghost of Christmas Future told me, I would have found it unbelievable. Next week, if I am strong enough, I will try to look forward dispassionately at the year to come and hopefully see some light in the darkness of our health service.
I will finish with a medieval proverb (the original in Latin), a comfort in my new status as a house physician: All idiots, priests, Jews, actors, monks, barbers and old women, think they are physicians.
Maurice Neligan is a cardiac surgeon.