The first casualty

Heart Beat: After the results of our final medical exams became known, we spent a brief period in some sort of Limbo

Heart Beat: After the results of our final medical exams became known, we spent a brief period in some sort of Limbo. We were waiting to start our first jobs as qualified doctors. For our group getting an appointment was not all that difficult.

Ours was a small medical class, and by the time our overseas classmates had departed, the remainder filled the intern requirements of our teaching hospitals, the Mater and St Vincent's. It was a parting of the ways, because apart from our conferring, we were never together as a group again.

The accepted protocol was that you approached the consultant whom you wished to work for and asked to be considered for the position of House Surgeon or House Physician. If they thought you suitable they would represent you at a meeting of the hospital medical board and shortly thereafter a list of appointees was posted.

We also had to insure ourselves against any havoc we might wreak. There were then basically two organisations providing such medical insurance, both British-based. They were the Medical Defence Union (MDU), and the Medical Protection Society, (MPS). The cost of cover, even to the impecunious newly-qualified, was negligible.

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This was to change drastically over the years and the costs now are in a fair way in to crippling the practice of medicine in many specialities, especially the high-risk ones like obstetrics, neurosurgery, plastic surgery, cardiac surgery etc. Increasing litigation has led to enormous increases in the cost of delivering medical care, forcing doctors and hospitals to practise defensively.

These nightmares lay in the future and for us it was the toss of a coin as to which organisation you joined. For me fortuitously it was the MPS. Fortuitous indeed considering the problems that have arisen for some doctors insured with the MDU for whom major problems have arisen since the introduction unilaterally by the Department of Health of so-called Enterprise Liability. This indeed may be one of the factors precipitating unprecedented industrial action by doctors in the near future.

There was for us, little time between completing our exams and starting work. No trips to the Far East, Australia or the US were contemplated. In fact by the time we had sorted out our problems, we were left with approximately one week for holiday. Does anybody remember the Amethyst Hotel in Achill Island? I have the fondest memory of the week spent there with some classmates before we joined the real world.

Quiet in late June, we spent our time there, swimming, sunbathing, carousing and above all talking to one another, wondering what the future held. The week passed quickly. It was also the first time that we could say truthfully to the girls, "I am a doctor". I don't think that magic phrase greatly altered outcomes.

All too quickly, we headed back to Dublin to begin a new life. I well remember the excitement, the anticipation, and the hopes of being equal to the task.

We did not approach lightly, but seriously and with some foreboding. By this time I knew that my first six months were to be spent as house surgeon to Prof Eoin O'Malley on the surgical professorial team. My second six months were to be spent with Prof Tim Counihan on the medical professorial team. Cardiology and cardiac surgery figured large in both units and the example and encouragement of these outstanding men ultimately led me down my chosen career path.

Shortly before the fateful day, I was approached by one of the previous years interns, who enquired if I and a couple of my fellows would contemplate starting one day early, as the interns en masse wished to spend their last day together at the Irish Derby at the Curragh. This conversation took place in Hartigan's pub and believe it or not I agreed and furthermore had no trouble in recruiting two colleagues to accompany me.

Thus it was that on that Sunday morning, June 30th, I walked across the threshold of the Mater Hospital to begin my medical career. It was an entirely different experience to that of being there as a student. Now with one wave of the wand, you were right in the firing line, expected to initiate the problems of diagnosis and treatment, and to respond to situations not previously experienced.

We were met by some of our predecessors who gave us the briefest possible idea of our duties and then vanished like smoke. Not for us the luxury of orientation days, it was straight in, at the deep end.

The three volunteers were left to decide who would cover the surgical side, the medical side, and A&E (casualty) department. At that time the Mater had almost as many beds as today but we did not guess what lay ahead.

Firstly we had to present ourselves to the good nun Sr M. Rosarii, who was in charge of the residence. Who were we? Why were we a day early? Did we realise we were screwing up the routine?

So much for our altruism. We were told the rules and allotted our monastic cells, bed, inbuilt wardrobe, and multi- purpose sink. We had first choice of rooms, upstairs in the residence, away from the common room and the flight path of returning revellers at night.

There was also an area called the Espiello, where the lady doctors were housed. The many statues in the residence were also put to bed there on party nights. It was a year before it was pointed out to us that the correct appellation of the harem was SPLO (Strictly Private, Ladies Only).

While placing my belongings in the room there came a knock, "Doctor you are wanted in casualty". A new life had begun.

We've only 40 more years to go. Do you think we'll all last the pace?

Dr Maurice Neligan is a cardiac surgeon.