HEART BEAT: As a society, we are judged by how we look after our disadvantaged, our sick and our elderly. I think that any fair-minded person would concede that based on such criteria, we are not doing well, writes Maurice Neligan.
It should not be beyond the realms of possibility to change our communal attitude, and for us to take a wider and more compassionate view of society as a whole. It can only be done by the people as an entity, not prepared to tolerate any longer, the neglect of our most vulnerable. Maybe I dream, but I hope not, as I feel that intrinsically we are a fair and decent people.
I had been writing about my experiences as a student in the Coombe Hospital, some 40 years ago, and subsequently a colleague reminded me that amongst the things we were taught, was that there was a place for the operation known as symphysiotomy. This was described in one of our text books at the time, by Alex Bourne, Consulting Gynaecologist to St. Mary's Hospital, London and Consulting Obstetric Surgeon, Queen Charlotte's Hospital London, etc. etc. This book published in 1959, a Synopsis of Obstetrics and Gynaecology 12th. Edition; discusses the advantages and disadvantages and effectiveness of this operation as opposed to the alternative of Caesarean section. Having listened to and read the distressing stories of some of the women who underwent the procedure, it would seem however that at the time I was a student, it was a legitimate and accepted procedure. The suggestion that it was performed for Catholic ideological reasons seems extremely far fetched. Medicine moves slowly on, and the procedures of the past may seem ridiculous and indeed barbarous to us now, but we should not judge yesterday by the standards of today.
In the controversies that surround our medical service today I would like to make one further observation. There is a feeling that we must increase taxes in order to increase social services. This may indeed be so, but it is a moot point. However particularly in the health service I suggest that huge savings could be made by prudence and economy, and above all by rationalisation. How much of the various treatments available are needed and where? How many doctors, nurses and other front
line staff are required and where should they be based? Does every hospital need to cover every specialty? Have we any conception of the economies of scale and the concentration of expertise? Above all have we the will to divert funds from a bloated non-productive bureaucracy to the front lines of patient care. I am talking about the health service, but throughout all areas of Government there is prodigious waste as every sentient citizen knows. As I have said before, we are not a low tax economy, our income taxes may be on the low side but our stealth taxes are not. For example we do not have a free hospital service, nor free third level education. We only think we do. As an exercise in making yourself depressed, just take out a pen and jot down all the additional taxation frills. I think you will find the end result horrifying!
Now I will return to the time when reality was far away. Inexorably however it was approaching steadily. "Gaudeamus igitur,Juvenes dum sumus"; no longer covered the illusion that student days would last for ever. Needless to say we did not believe that they would, and so most fervently did our parents wish for our departure from the nest and payroll. In the meantime however, about a year free of serious obstacles remained between us and the final medical exam. So we had reached the final rung of the medical school ladder. We still lived drank and socialised, but we could not escape the knowledge that the day of reckoning was coming closer. About the only plus at the time was that we could now say truthfully at the dances that 'I'm a final medical student', most of the ladies still seemed sceptical, but in truth our minds were elsewhere. We felt as if we were isolated from the world and suspended from normal life as we tried to absorb multitudes of facts about various conditions and diseases. Causes, treatments and prognoses were absorbed and varying amounts of knowledge acquired about hosts of illnesses. It was rather like being incarcerated and isolated from the world, almost fancifully like the prisoner in Wilde's Ballad of Reading Gaol;
"I never saw a man who looked
With such a wistful eye
Upon that little patch of blue
Which prisoners call the sky,
And at every wandering cloud that trailed
It's ravelled fleeces by,
We felt sorry for ourselves, but nobody else did, we were understood only by fellow sufferers, and inhabited a closed world, We studied as individual hermits or in little groups, depending on personalities and always in the certain knowledge that the rest of the class knew more than you.
In truth of course it was not all that bad, and there were lighter moments. In my small way I shall endeavour to describe that time, as it might help people to understand where their doctors come from and how they qualified.
Dr Maurice Neligan is a cardiac surgeon.