Heart Beat: At least the past was real. It actually happened and provided you with your experience of life and, for us, of medicine.
There were pathways which, if followed, led to attainable goals. There was discipline and authority for its enforcement. The system worked, even if creaking sometimes, and delivered excellent care by the standards of the time. Certainly it was perceived by the junior doctors then as being too authoritarian and not sufficiently self-questioning. Be that as it may, it certainly worked, eg no patients on trolleys, no waiting lists. Such limited administration as then existed was cost conscious and responsible.
A religious source of whatever denomination provided much of the dynamism and who will say that this was not for the good. Science and medicine have advanced but, in my humble opinion, care and compassion have regressed. The good old days, as I am well aware, were not really all that good, but they sure seem so in contrast with the shambles of today.
Work then occupied nearly all your time. Whatever leisure space was allowed to you was often encroached upon by study. Deep analysis of the systems in place would have been a very low priority. The price of the pint, the football and the dress dance would have rated much higher priority. But as you endured, you noticed and you learned and became progressively more informed about the delivery of healthcare. Nowadays people with little or no such knowledge make the important decisions.
The delivery of healthcare is primarily the business of doctors. Anybody who thinks otherwise is wishfully practising self delusion. It is not some cosy partnership of happy families. Somebody decides what is important and makes it happen. It is not done by committee and consensus, valuable and indeed necessary as that may be. The prime movers in the delivery of healthcare at all levels must be doctors. Pretending otherwise leads to the shameful chaos we witness today.
Part of the vacuous nonsense we have had to endure in recent years, emanating from ministers and the Department of Health, concerns the use of expensive facilities around the clock. The realists know the hospitals can only staff and afford such facilities during ordinary business hours, if even then. The proponents of this nonsense must never have been in a working hospital at night. I have.
As the working day gradually drew to a close, operating theatre, outpatients, diagnostic departments became silent. Night nurses in lesser numbers supplanted their daytime colleagues and received the reports of the day's problems. Apart from casualty, intensive and coronary care units, only a skeleton staff was available or on call.
For the interns, however, this comfortable diurnal rhythm did not pertain. After the evening meal, if you were lucky enough to obtain such, myriad tasks remained. Admission and examination of new patients was generally impractical during visiting hours and thus usually started around 8.30pm. Calls came to casualty, intensive care wards, assistance might be required in theatre for surgical emergencies; the requirements on one little body seemed endless. The organisation of anaesthetists, lab and X-ray work for emergencies was also your responsibility.
If you were lucky, you might make it back to the residence by 11pm or 11.30pm and nobody ever retired for the night without first checking the activity in the common room. Such interaction preserved our sanity. Conclusions were drawn about the antecedents, peculiarities even paternity of nuns, consultants and patients. Harrowing war stories were the order of the day with us heroic interns fighting disease, ignorance and all round malevolence. Maybe poker, to accompany supper, and then finally off to bed.
Optimistically you wrote a call time on the board before retiring, as if such a ritual would guarantee you being left undisturbed until the appointed hour. It was seldom so, the knock on the door summoning you once again to the perpetual battlefield. You felt, in William Blake's words, "born to endless night". Two, three, four o'clock in the morning as you often ran through a sleeping hospital to try to deal with whatever lay in store. Sometimes the problem was small, to reset an infusion, to examine a patient who had fallen, and a return to your warm bed a distinct possibility. Many times you realised that the hour in bed was all that you were going to get and that the new day started here.
Go on folks, tell us doctors about the hospital at night. Pardon us if we seem less than impressed.
Dr Maurice Neligan is a cardiac surgeon