HEART BEAT Maurice Neligan When I started to write about my residence year as a student, and all that it involved, I began to understand how fundamental it was to our collective future careers.
My memory does not enlighten me as to whether we thought so at the time. There is a dichotomy between the everyday experiences and the meaning of it all. Reason tells me, the latter did not trouble us unduly at the time.
This was our initial point of patient contact and we began, for the first time, to experience the intricacies of the doctor-patient relationship. We found that there were faults on both sides of this line, particularly in an implicit assumption that the medical participant is a good listener.
Not all medical people are, and this became obvious to us as students. Sympathy and understanding were not universal traits among the profession, nor indeed among ourselves.
Entering fully into the life, this became obvious in our daily contact with patients. We did of course do more than just draw blood. We took case histories and conducted physical examinations, what was called clerking the patient. We attended outpatients and the accident and emergency department. ER it was not.
Everything was new, everything was interesting, and our knowledge base was gradually and ever so slowly expanding.
Most of us encountered death for the first time, either abruptly in A&E or more slowly, but just as finally in the wards. We learned the obvious differences between those slipping away quietly in old age, and the bitter loss of husband or wife in mid-life, and the heartbreak of the death of a child. Thomas Mann noted that "A man's dying is more the survivors' affair than his own."
We learned the very hard lesson that a doctor could not function properly if a certain detachment from the tragedy of others was not maintained. This is often interpreted as callousness or indifference on the part of the doctor. It seldom is. It is the necessary carapace, constructed to keep one functioning dispassionately in order to help the next in line.
We learned the wide spectrum of grief reactions, and to try to understand them, even when the whole focus was on real or perceived failure by our profession.
This was not an easy part of our education, not to be learned from books, and before the advent of counselling, and organised chaplaincy services. We were amateurs and, as usual, we learned from our nursing colleagues and above all from the good Sisters.
These nursing Sisters were a race apart, and their decline in numbers leaves a gap, impossible to fill adequately.For everyone else in the profession, the caring is part of your life, for the Sisters it was their entire calling.
I would not like anybody to think that we spent our time contemplating mortality, but it did impinge upon our lives.
I well remember a young intern who refused to certify a young man as dead. He maintained that he was only asleep; he had to be led away while a colleague saw to the formalities.
People do die inappropriately, and we, who would have to face this repeatedly, were building our own self-defence mechanisms in order to avoid the contagion of grief. This is all very heavy and gloomy and, of course, it was not always all doom. Patients did survive occasionally and, in the words of Meyer Perelstein, "If your time hasn't come, not even a doctor can kill you."
I well remember being allotted my first patient to treat. The consultant who headed our team at the time,told me to examine a patient in an outpatient cubicle, to arrive at a diagnosis, to read up the treatment and to write a prescription. If he agreed with it all, he would sign the prescription. I quickly established that the patient was a guest of the State, across the road in Mountjoy, and was suffering from an infestation with a tapeworm.
I read up on the treatment and duly presented the scrip to the chief for signature. He looked mildly surprised and suggested I discuss this with the hospital pharmacist. This I did, and this kindly man asked me if I was intent on purging a horse.
I indignantly replied that the treatment regime had been taken directly from the bible of therapeutics He asked me to produce the book and when I did so, he filled the prescription remarking that he was glad he was not the patient. I returned to the outpatient department and delivered medication and instructions to the patient. It transpired that he was due for release two days later and intended travelling to England the following day. I assured him that this would not be a problem.
Five days later on entering the outpatients again, I was hailed by a skeleton, sitting on one of the benches. It was my patient, two stone lighter, with sunken cheeks and hollowed eyes. He had missed his boat and required a letter to explain same. As he put it succinctly: "Jaysus, doctor, if I had any loose teeth, I would have lost them." However, we got the tapeworm.
Dr Maurice Neligan is a cardiac surgeon