Epsom and a new baby
Towards the end of completing my job at Croydon in mid-1963, we began to look around for a surgical registrar’s job. By contrast with Australian jobs which ran by calendar years, English appointments came up at any time and were advertised in the journals. An important prerequisite for us was suitable, reasonably comfortable accommodation, as a baby was due. Eventually, we settled for a job at Epsom General Hospital.
The accommodation was adequate and within walking distance of the hospital. In hindsight, you’d have to say the surgical consultants weren’t outstanding; D.O.Davies, better known as ‘Doddy’, and a Mr Callum. The former had served in the British Army in the second world war, whilst the latter had been a missionary doctor in Africa. It’s not a rarity for missionary surgeons to be gung-ho, taking on some procedures for which they are untrained and ill-equipped – leaving God to pick up the bits.
Aneuryn Bevan’s National Health Service, introduced into Britain under the Atlee government in July, 1948, gave both these surgeons a huge career boost. Both would have had the required surgical qualifications but could not have envisaged employment for life with a comfortable income in the salubrious surrounds of the Surrey countryside. Nor would they ever have to battle to build private practices in competition with surgeons possibly better skilled and more personable.
I had not as yet passed the final exam and we wanted somewhere close to London to do courses and comfortable quarters for the birth of our first baby. Epsom fitted the bill.
The English Fellowship at that time was an examination in all aspects of surgery, as it was prior to sub-specialisation. It included orthopaedics, urology, plastic surgery, neurosurgery (basic) and even thoracic surgery. For the last named I attended a course over two weekends at the Royal Northern Hospital on the North Circular Road near Holloway. The Royal Northern Hospital was incorporated into the Royal Free Hospital and University College hospital and was subsequently demolished in the mid-1990s and is now the Royal Northern Gardens.
The Royal Northern’s main claim to fame was that it was home to Hamilton Bailey, probably the most famous surgeon in my era as a medical student, as he was the author of Short Practice of Surgery, together with McNeill Love. The latter had the ‘pleasure’ of examining me for the final exam at The Royal College of Surgeons at Lincoln Inn’s Fields in 1964 and his signature appears on the certificate.
Hamilton Bailey’s claim to fame rests on several counts. As well as writing a number of text books, all of which were widely acclaimed, he was never elected to the Council or the Court of Examiners of the Royal College of Surgeons because the surgical establishment could never accept that someone outside their body should have acquired a world-wide reputation as a teacher and author.
An episode in Hamilton Bailey’s life has stuck with me. He sent his son to be educated at Mill Hill School in London and during the London Blitz the school was evacuated to the seaside at Cumbria. At the end of term break the boys returned by train to their parents in London. During the journey on July 29, 1943, Bailey’s adolescent son was horsing around with his friends when he had the misfortune to lean out of the carriage window and was promptly decapitated by a train passing in the opposite direction.
It is recorded that the details of this accident were conveyed to Bailey in the operating theatre at Potters Bar, thirteen miles north of London, where he was in the midst of a gall bladder operation. He received the news with icy calm, completed the operation and called for the next case. Worse was to follow, as the patient whose gall bladder he had removed was given an incompatible blood transfusion and died a few days later[1].
In 1951, Bailey was admitted to a psychiatric hospital with manic depression. He died in 1961 at Malaga, Spain, where he had retired. The cause of death was a mismanaged bowel obstruction, Bailey himself instructing the young Spanish surgeon as to what particular procedure he was to perform on the famous man. Regrettably, his own instructions were directly responsible for his rapid demise. Bailey had directed his surgeon to do a primary anastomosis on his perforated large bowel rather than bring it out as a temporary colostomy and then do a secondary anastomosis later, when it was safe to do so.
Trevor Pickering and I continued to join forces for study weekends and, in the autumn of 1963, we decided to attend the orthopaedic course run by Graham Apley over three alternate weekends at the Rowley Bristow Hospital at Pyrford, Surrey, a hospital established by the Church of England in 1907 for poor and crippled children by the Waifs and Strays Society. The conditions suffered by these children requiring long term stays included tuberculer bone disease, rickets, the effects of poliomyelitis, and other bone diseases and deformities. Over the years it developed into a hospital and special school and later became a centre of excellence for the practice and teaching of orthopaedic surgery until its closure in 1990. The course was run on alternate weekends because it was for registrars preparing for the second part FRCS, and registrars all worked every second weekend in the NHS.
The lecture room at Pyrford was set up with a stage and examination couch, above which was a large mirror so that the audience could see the patient and the physical signs being demonstrated. A large number of patients were available for the display of pathological conditions and for us to examine in turn.
Nearly all the lectures were delivered by Apley himself. He was meticulous in the preparation of the contents of each lecture with the end result that they were given with great clarity, an air of spontaneity, and with the flair of a professional actor.
Memorable phrases and jokes were orchestrated into the substance of the lecture and held the attention of the audience. After delivery, a lecture would be reviewed, improved and rememorised for the next occasion.
It was the slickest course by far that any of us ever attended and stood us in very good stead for the orthopaedics we would encounter in the final exam.
Graham Apley died in 1996 but the course was encapsulated in his text book, A Method of Orthopaedics. The Rowley Bristow Hospital has also gone but those who attended the course remember it and Graham Apley with great affection.
Trevor stayed with us at Epsom for each of these weekends as we lived reasonably close to Pyrford. Sadie would recognise us coming up the road from the bus stop each evening by the swinging of our unfashionable but matching Fletcher Jones calf length overcoats.
There was plenty of surgical experience to be had at Epsom Hospital but the clinical staff were not teachers by vocation. I was on good terms with one surgical consultant, ‘Doddy’ Davies, and as a special treat he took Sadie and me, together with his wife, up to London to see Spanish dancers and have dinner afterwards. It was a very enjoyable evening especially when Doddy produced cigars at the end of the dinner and they were enjoyed by him and the two ladies but declined by me!
Setting out from Central London to return to Epsom, Doddy lost his way. Normally, one would consult a map but not Doddy. He got out of his car and consulted the stars. Were any to be seen in the sky above London? I doubt it. Nevertheless, we eventually found our way home to Dorking Road.
The biggest event by far in that year was the birth of our firstborn, Anne, on November 21, 1963. Her arrival celebrations were dampened a little by the assassination of President Kennedy the following day but it was a happy occasion nevertheless and one which added a huge dimension to our lives.
Everything went smoothly and justified one of our rare phone calls to families back in Australia. There was joy all round.
Of course, we had to add all the accoutrements of babying like prams, cots, potties, nappies and so forth but it was all exciting and enjoyable and made us feel like a proper family.
I had harboured ambitions to have my final exam under my belt before being distracted by a family, all before turning 30, but we felt secure enough in the fact that eventually I would pass, so jumped the gun.
At the end of 1963, I went up to London to sit for the final exam at the College of Surgeons at Lincolns Inn Fields, knowing full well that it was premature and that I was not adequately prepared. My compatriots had told me that sitting the exam was as good as doing a short course and that I would know what to expect next time. Well, what they said was true, and I was accustomed to failing, so this time it did not worry me.
Trevor and I continued to work together and, by May of 1964, I felt my chances were good so sat again. The oral exam held at The Royal College was awesome; the format followed was identical to that of the previous 100 years and one felt a part of history and tradition. The feeling was amplified by the famous names among the examiners on the day who subsequently signed my certificate, including Lord Russell Brock, Baron Brock of Wimbledon, the doyen of British heart surgery and a pioneer of modern open-heart surgery; C. Naunton Morgan, a famous colorectal surgeon of the day; McNeill Love, author of the popular text book from the Royal Northern Hospital; David Trevor, George MacNab, Hugh Eastcott, Guy Blackburn, George Quist and several other famous surgeons of the era.
The candidates were directed to examine a number of patients and report their findings, whereupon they were further questioned on the diagnosis and asked to recommend treatment.
Other parts of the examination included pathology, with specimens preserved in formalin pots forming the basis of discussion, this part of the examination being identical to that held 100 years earlier and forming the subject of a famous painting hanging in the portals of the college.
After sitting many exams, one gets to feel, as the oral exam progresses, whether or not one is on top of the examiners. Little things, like the examiners showing disinterest or asking personal questions, indicate that one has their confidence. If they suddenly both sit up and look for further detail, it is a bad sign. On that day, I was on a roll. Nothing was difficult, nothing troubled me; it all fell together. A vascular question, then a new discipline I had checked out the week before and knew as much about it as the examiner. What luck! In fact, it was all going so well that I was enjoying myself.
In those days, the exam covered everything in surgery – orthopaedics, urology, plastic surgery, basic neurosurgery but no eyes or ENT.
The format of delivering the result of the exam to the candidates must be unique to the College of Surgeons, albeit archaic.
At the end of the day’s gruelling test the exhausted candidates congregate on the steps in front of the college waiting for the examiners to deliberate. Finally, the examination proctor appears on the top step, dressed in the appropriate livery of the day complete with white gloves and gown, and holds up his clipboard and announces, ‘The following candidates have been successful today and will those gentlemen whose number I call please enter the college behind me to meet the examiners.’ No names are mentioned.
Then follows a calling of the numbers in sequence, perhaps some 30 to 40 per cent being successful on each occasion. On one notorious day, the proctor announced with some mirth in his tone, ‘Gentleman, I regret to tell you that no candidates have been successful on this occasion. I wish you good evening!’
Well, the proctor carried many careers in his hands, and upon his announcement many hearts leapt with joy or fell with despair.
After his announcement on this occasion, those of us lucky enough to hear our number leapt up the steps and entered the Council Room, were given a glass of sherry and shook hands with those eminent members of the English College. We then phoned our news, returned gleefully home and awaited an invitation to the award ceremony at the college.
FRCS – magic in those letters and with them comes the power to open doors to endless opportunities! So we thought. For my part, I imagined I would be able to step up to the next level as a senior registrar and have opportunities for better jobs at better hospitals and with better consultants.
Things for us in England were on the up and up after being on the down and down for our first year. In the second half of 1964, we relaxed a bit, went to Lords and The Oval, not far from us at Epsom. We went to the Epsom Derby where Anne said her first words as the Queen strolled down the straight, ‘Dad, Dad’. We did a lot of sight-seeing around southern England and generally enjoyed a more relaxed life.
One of my bosses, Doddy, was particularly pleased with my success and implied that it was because of his good tutelage that I had passed. I refrained from putting him straight. Doddy did very little major surgery and I remember catching him in the Epsom hospital library looking up Robb’s Operative Surgery where it set out the steps in doing a gastrectomy, which I knew we had on the list for the following day.
When he fronted in theatre, Doddy was clearly nervous and passed loud flatus during the whole procedure, even leaning sideways to gain better egress. The theatre sister and I looked at each other but said nothing. We left this to the consultant anaesthetist who laughingly remarked, ‘Well, at least we know you’re not obstructed Doddy!’
Doddy was eccentric – but eccentrics appeared to be so common in England as to be almost the norm. It was customary for the house surgeon and registrar (myself) to write in the patients’ notes and for the consultant to peruse them but Doddy never read what we wrote, instead writing in the case notes himself in his spidery, small handwriting. Was it a legal thing or did it help him in later outpatient care? I never knew and never asked. He also collected stamps enthusiastically, confining himself to a particular province of India. One of our house surgeons was lucky enough to have come from that province and as a result got along famously with Doddy. That same house surgeon came to dinner at our flat with his Indian wife and presented Anne with a panda bear. The black bear and dark face peering into her cot engendered a terrified response. When we suggested at dinner that they may go to the north of England for their next job the wife replied, ‘Oh no, we wouldn’t go up north, there are too many black people up there!’
On reflection, I think I learnt more from the wily old theatre sister than from any of my consultants that year. Her name eludes me after all these years, but she knew how to go about every operation and handed me the right tools for the right job every time. She remained unmarried and, as I remember, had a great fondness for whisky and a great sense of humour. She was the scrub sister on the day of Doddy’s gastrectomy.
One of my very good friends at Epsom was the medical registrar, Henry Garfunkel. He was Jewish, a competent doctor and was engaged at the time. We asked he and his fiance to dinner and Henry politely told Sadie what they could eat and how to cook it.
The dinner was a great success and they subsequently asked us to their wedding. Henry’s father was a Rabbi in London and it was to be the Jewish wedding of the year with all the cultural trappings and tradition, canopy, dancing, the lot. Even the BBC Symphony Orchestra was to be in attendance. Unfortunately, we declined as Sadie said her outfits were not good enough.
As the end of 1964 approached, there was more job hunting. We decided to stay another year in the UK in order to consolidate my surgery in a more senior position. Trevor Pickering also passed his FRCS in that May, 1964, but he had been away from Adelaide for almost seven years and so elected to accept an appointment as Senior Surgical registrar at the new Queen Elizabeth Hospital at Woodville, SA. Having been away from Australia for more than five years he and his family were able to return to Australia as ‘ten-pound Poms’.
I applied for a number of senior registrar posts, one at Birmingham, another at Bristol and elsewhere. On each occasion, I was pipped by someone more senior and with more experience at better hospitals. In the end, I settled for a year at Southlands Hospital, Shoreham-by-Sea, Sussex. This job had attractions – good accommodation, quality consultants (two of whom were New Zealanders) and was in a pleasant part of the country on the Sussex coast. It was, however, still a middle grade registrar job.
At this stage, we were seriously contemplating staying in England permanently but, in the end, the pull of ageing parents and family in Australia won the day.
[1] Adrian Marston, Hamilton Bailey, A Surgeon’s Life, Greenwich Medical Media, 1999, pp. 92-3.
RG Johnson 