Starting a surgical career
It is not hard to recall at this stage, some 60 years later, the sheer joy and exhilaration which Sadie and I experienced after struggling for several years to conquer the Primary exam.
Rochford Hospital, courtesy of John Fisher, was agreeable to me starting work as a Senior House Officer attached to the Surgical Department. First, however, we would take one week of holidays in Devon and Cornwall.
Spring had well and truly arrived in England by this time, the first week of June. It was a glorious week, a week that could only belong to England. Crisp mornings, warm clear days without a breath of wind.
We chose to have a leisurely drive through the West Country: London to Somerset, then on to Devon and Cornwall. The whole week was magic, made more so by our buoyant mood with the primary now behind and everything to look forward to. The weather matched our mood and every day of that week was perfect.
We sampled the cider in Somerset, spent a day exploring the Roman town of Bath and met up with the Pickerings on Woolacombe Beach on the North Devon coast.
We travelled to Land’s End, camping all the way in our little Thames van with the tent over the back. Sometimes we slept in the tent, at other times on a mattress in the rear of the van. We had a cooker and mostly made our own meals. It was a holiday to remember.
Back at Rochford I was still in a state of exhilaration and felt ready to take on the world. It had been a tough six months with some highs but mostly lows. All that now in the past.
With John Fisher’s help and influence I was now appointed a Senior House Officer on the surgical team at Rochford Hospital, part of the Southend Group of Hospitals, sharing common consultants. My registrar was one Ross Shiel, an Australian with gold plate credentials, one week younger than me.
Ross was a Queensland graduate and Rhodes Scholar. He had played for the Wallabies as a fly-half against South Africa in Sydney in 1956. He went on to join Balliol College at Oxford for his Rhodes Scholarship where I understand he decided on a career in the embryo specialty of transplant surgery. However, Ross had no surgical experience and so chose to come to Rochford where there was ample opportunity for him to cut his teeth in quick time. At the time, Ross was courting one Mary-Lou Kent Hughes, a medical graduate, who, probably by design, had followed Ross to England and Balliol College.
Mary Lou’s father was Sir Wilfred Kent Hughes from a Melbourne upper class family. He too had been to Oxford as a Rhodes Scholar, had represented Australia as a hurdler in the 1920 Olympics at Antwerp and been decorated with a Military Cross in WWI whilst with the 3rd Light Horse Brigade. In the 1950s, he became a minister in the Menzies Government. (On a lighter note, he had made a friend of Douglas Jardine whilst he was at Oxford and so tried to defend his friend who was captain of the English team and a major instigator of the Bodyline Series in 1933 in Australia.) Mary Lou was a lovely girl whom we all liked at Rochford, and she had all the boxes ticked for the advancement of Ross Shiel.
Ross and Mary Lou duly married at Balliol College – a fashionable wedding, to which Sadie and I were invited. There we were privileged to meet Mary Lou’s father, Sir Wilfred Kent Hughes, federal politician.
Yes, we liked Ross, and had many happy occasions with him. He was very little more experienced than was I even though he was one leg further up the ladder as a surgical registrar. Of course, there was the frequent request to me:
‘Ross could you do the Saturday take for me, I have to go up to London to play with Harlequins?’
‘No worries Ross, that will be fine.’
One case still sits in my long memory, more than 60 years ago. An adolescent with possible torsion of the testis. I rang Ross up in London for his opinion:
‘Should I explore it?’
‘Oh, probably not,’ was the reply.
On the Monday post-take ward round we came to the case.
‘You should have explored that testis Johnson, the first eight hours is the best opportunity you’ll get to save the testis,’ said the responsible consultant.
‘Yes Sir, I’m sorry,’ I said, expecting Ross, who was also on the ward round, to complete the saga. Not a word was forthcoming and I said nothing more. Disappointing, I thought at the time.
Well, Ross went on to get his FRCS that year, then to a prestigious appointment at Boston to learn transplant surgery, following which he was appointed Professor of Transplant Surgery at the young age of 34 at Sydney Hospital. This appointment in March 1967 was said to ‘provide political clout within the Sydney University group’.[1] Ross went on to have a very distinguished career and was awarded an AO and numerous other accolades from his surgical peers and internationally.
Our time at Rochford was a happy one. I was learning my craft with good teachers. It was a mixed job and included a lot of orthopaedics which I enjoyed. A fellow SHO was one, Evangel Vayanos, but he was far more experienced than me. A Greek, he had graduated from Lyon in France and swore fluently and frequently in the French language. Volatile, as one might expect, but a conscientious and careful surgeon. He was delegated to show me simple operations such as haemorrhoids. Evangel later became a prominent orthopaedic surgeon in Athens and married a girl by mutual arrangement between the two families.
Other good friends included Paddy and John Beck from South Africa. John was very tall and very clumsy. One corner of the ward was called ‘Beck’s corner’ by the consultants and it was there that his less successful operations convalesced over a protracted period. The Becks went home to South Africa and we sadly lost contact as Paddy was a good friend to Sadie.
The Friday morning orthopaedic ward round traditionally ended in the Marlborough Head in the High Street where the two orthopaedic consultants shouted pints all round. Very civilised, we all thought.
One occasion sits in my mind. Norman Abel was the orthopaedic registrar and I was his junior SHO (Senior House Officer). The orthopods in the Southend Group were very senior and very competent, particularly John Shelswell who had trained at the Royal National Orthopaedic Hospital at Stanmore, Middlesex. On this occasion, Norm and I were assisting the junior of the two consultants, Tony Ratliffe, to insert a Küntscher Nail into a fractured shaft of femur. (Coincidently this operation was to become the first operation I was to perform in my fledgling private practice in 1968. I remember the patient’s name today. As a workers compensation case [WCA], it was a good start to my earning life.) All was proceeding well and Tony was hammering the K-nail through the fracture and into the distal end of the shaft, when suddenly the nail became jammed in the medulla of the distal fragment. The medullary cavity was too narrow to allow the nail to pass. Well, Tony called for the extraction device which was a sort of reverse hammer designed to extract the nail. It was firmly stuck and refused to budge. Tony’s hammering became ever more vigorous and the inevitable happened – the extractor broke in two! At this stage, the operation degenerated into a farce – with lots of bad language and a touch of panic. Tony eventually avoided the drama of the operating theatre for an academic career.
Meanwhile, what to do? We all scratched our heads. The K-nail was half in and half out, refusing to budge. Well, all he could do, we decided, was to sterilize a hack saw blade and cut off the protruding end of the nail as it entered the greater trochanter. Tony was very agitated and sweaty but the situation resolved.
The next day on the ward round we came to Tony’s patient and the drama of the previous day was related. ‘Oh, that happens sometimes’, said John Shelswell calmly, ‘All you needed to do was put a longitudinal cut in the femoral shaft at the place it was jammed, and that would have relieved the pressure allowing it to slide down.’ I looked at Norm and he looked at me!
Even as a junior I got on well with Shelswell. The following year when I was working at the Croydon Casualty Department I applied for the orthopaedic registrar job with Shelswell and Ratliffe at Southend – a top job. I learned later that Shelswell went to the interviews for the job to make sure I was appointed – alas, I had decided a grand continental tour was more important and did not turn up for the interview and so was not appointed. Had I taken that job, my career may well have followed a very different path in orthopaedics.
I did not lose sight of the fact that there was the second part of the exam to pass and we were fortunate that the junior of the orthopaedic surgeons, Tony Ratliffe, was very keen on teaching. Every Friday evening he would have four or five of us around to his home and run mock exams. If he was not an examiner for the college at the time, he certainly became one later.
We had house surgeons down from Barts at that time, one of whom, Gary, was on the tubby side and he purchased an MG TC which he drove at very high speed on the A40 between London and Southend. Sadly, the inevitable happened and Gary managed to roll his MG end on end at high speed along the A40, killing himself in the process. He finished up in our Rochford mortuary.
In the second half of 1961, I realised that I would have to spend six months in an approved casualty department before I became eligible to sit the final examination. The sooner I had this out of the way the better. Before my brother-in-law John left for Australia he organised for his orthopaedic friend from Sydney who was working at Oxford, Tommy Taylor, to try to arrange a casualty job for me. Tommy had a friend who was the consultant orthopaedic surgeon responsible for the Croydon General Hospital Casualty Department, McMillan by name, and he fortuitously organised for me to be appointed registrar in charge of the day to day running of that casualty service. Tom was later to become the first professor of orthopaedic surgery appointed in Australia based, coincidently, at the Sydney Hospital with Ross Shiel.
So, sometime towards the end of 1962 we uprooted ourselves from Rochford, loaded all our worldly possessions into our little Thames Van, and transported ourselves to a flat inside the Croydon Hospital. I was upgraded to a middle grade registrar with a very welcome, although very modest, increase in salary from the NHS.
[1] Assoc. Prof John Mahoney, Nephrologist, Renal Society of Australia Journal, July 2009, Vol 5 No. 2. The political clout referred to would be the fact that Ross’s father-in-law at that stage was a Minister in the Menzies government
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RG Johnson 