Heart Beat: Arnold Bennet writing in his diary on the 8th of October, 1924, noted: "I saw in a slatternly chemist's shop a section of window given to 'Yeast is life. Vitamins mean health. X-Yeast Tablets - a lightning pick me up, guaranteed (or money back), to aid headaches in five minutes, flatulence etc. in five to 10, stomach trouble in 10 to 15, and 'flu or colds in 24 hours."
He bought some and felt better. We haven't changed that much over the intervening 80 years; indeed from the centuries before that. The credulous are always with us and I suppose in fairness that a lot of these remedies do little harm. I have nothing against them with one important proviso, if you get sick go to the doctor, and forget about the yeast, the needles (acupuncture), aromatherapy, herbal medicines etc. These latter are strictly for when you are well, and have little else to do.
We are now I believe in the age of reason, and in healing that means evidence-based medicine. As we all know that is not infallible. However, it is the best we've got. I do not think that when we are ill ,we are meant to let our brains abdicate entirely. Rational and informed thought processes are required. It is quite difficult sometimes to distinguish the trivial from the serious complaint. That is what the doctors are trained to do. "Man is a dupable animal. Quacks in medicine, quacks in religion, and quacks in politics, know this and act upon that knowledge." (Robert Southey; The Doctor). Strikes me we've got a full house here in our little island. Please don't think this is a rant against alternative medicines or therapies; as far as I am concerned, whatever turns you on is all right by me. My point is that when you are sick, at least obey one of mankind's strongest instincts, self preservation, and seek qualified help.
This is indeed a very interesting topic and one to which I shall return shortly. I think the column will be entitled: "How to avoid the Doctor (if you don't mind dying)".
I had been talking about autumn and the biologically perverse quickening of hospital life. Shortening days outside meant little inside. The work simply increased. Many nights were spent at the bedside in the intensive care, or if you were lucky a curtained cubicle at the end of the unit. The latter was a mixed blessing; a previous colleague awoke to find that the night nurses had gone off duty taking his clothes with them. He was still engaged in pleading with the day staff when the morning ward round arrived. Little sympathy was shown to him or his predicament and the story lives still.
Those nights left an indelible impression. Dimmed lights, hushed conversation, ventilators reflecting the rhythm of patient breathing, the atmosphere of watchfulness, all proclaimed that this was the frontline. When things happened, they happened quickly and it was always impressive to see a well-trained and experienced staff move quickly and calmly in even the most dire emergency. Not indeed that you had much time for admiration, as you were yourself part of the team. These were the early days of cardiac surgery with very many very sick, indeed almost terminal patients being operated upon. Many were as sick as I would ever see again in my surgical lifetime.
Sometimes on operating days word would filter out of the operating theatre that matters were not going well. Bad news travels fast everywhere, but it seems to me especially so in a hospital environment. This was no good news for the intern either. The best we could hope for was an extremely critical patient returning to the intensive care unit and an anxious work filled night ahead. At worst, different protocols took over. The coroner had to be informed and to undertake this task you had to brief yourself thoroughly. I did not know that coroners ate interns for breakfast although I quickly found out. Depending upon the coroner's instructions there was maybe a post mortem to organise. This involved explaining to the relatives just what was entailed, and then organising same with the pathologists. They usually didn't jump for joy at your appearance. Come to think of it, as an intern, few people did.
It happened often also that you were the doctor responsible for telling relatives that things were not going well, often as a prelude to telling them that their loved one had died. This was never easy and to have to ask for a post mortem examination at this time of grief was a major undertaking, let alone describing to them what was involved. The strictures of recent years about full disclosure of the procedures being a paramount concern strikes me yet again how little interface there is between the theoretical and practical arms of my profession. I speak here from sad experience of dealing with shattered relatives, running the gamut of human emotions, from rage to calm understanding. To give a blow-by-blow account of post mortem procedure was never apposite or practical. Relatives were often numb and trying to comprehend their tragedy. It was hard enough for us to try to explain what had happened and try and comfort them as if we understood their grief. It was difficult then and the passage of years made it no easier.
Such events sometimes freed you from night's duties, but they never freed your spirits.
I understand Prof Drumm has said we have enough beds and that we don't have too many administrators. Hold onto your hats folks, this is going to be interesting.
Maurice Neligan is a cardiac surgeon.