Down Memory Lane February

DOWN MEMORY LANE - Why General Practice?

Dr Ian Nisbet

I have wanted to be a GP since the age of four. In the 1940s, when my two uncles were single-handed dispensing GPs in Halifax and Stainland in Yorkshire, I was  fascinated by the smell of Vitamin B in the dispensary, the consulting rooms in the house and the conversations over the meal table which demonstrated the two doctors' profound devotion to their patients. Their wives were the sole receptionists and only they would answer the telephone which was mounted on the wall at eye level. The box was mahogany and the fittings were all brass. There was a crank handle to contact the operator. The brass mouthpiece was permanently fixed to the box and the brass earpiece was removed from the box to take the call.

My aunts would put out my uncles' clothes every day, matching the shirts, suits, cufflinks and shoes to save the doctor being troubled by mundane matters. Assisted by the maid, the cleaner and the gardener (the chauffeur had been dismissed when the NHS started in 1948 and the doctors' incomes, although lower, became regular. The remaining staff gradually disappeared over the next few years), the wives would run their enormous houses with military precision. The houses, which were quite similar, had long tiled corridors, ideal for pushing my Dinky lorries and buses around and I must have travelled miles on my knees; the aunts were horrified by how black my knees became!

The two GPs would take me out on their visits around the towns and the Yorkshire Moors. They had Rover cars which improved as new models became available, leading up to the Rover 90, 100 and 110, great luxury. I was always made most welcome by the patients, who plied me with lemonade and cakes, a great treat when many groceries were still on ration, and fired me up with enthusiasm to be a GP.  Only later did I learn of the enormous stress the doctors were under, with a 24/7 commitment to their patients and many night visits of which I, as a child, was unaware. Many treatments were as yet uninvented, sulphonamides were quite new and Penicillin was in its infancy. The uncles would often have to watch patients die, with nothing except compassion to offer them. Crisis and Lysis were still very much in vogue. Uncle David used to have a couple of “coping strategies”. In Winter, when he could cope no longer with the stress, he would drive to Scotch Corner on the A1 and sit there for an hour or two. In the Summer, he would drive to the seaside, hire a small motor boat and drive it out to sea until he ran out of petrol. Then, he would sit there and wait to be rescued! I could never understand the boat scenario at the time but I was often reminded of it after I had moved to Feltwell and frequently became overwhelmed by the day and night workload.

I only have one unhappy memory of those times. One of the aunts laid the table with thin, round cork mats to protect the surface. My enquiring mind made me wonder whether or not the mat could be folded in two. Of course, I tried it and it broke. My father, who was of a Victorian disposition with regard to my upbringing, was singularly displeased and I remember the episode well.

The single-minded ambition to be a GP made all my school decisions about which subjects to take very easy. I went to Birkenhead School, something of an academic pressure cooker with seven day a week commitments, and went to The London Hospital to study Medicine, starting a couple of months before my 18th birthday. I qualified when I was just over 22 years old and started my “House jobs” at The London Hospital (Orthopaedics) followed by General Medicine and a senior house officer position in Obstetrics and Gynaecology at the old Redhill General Hospital.

The house jobs were extremely hard work. Basically, at Redhill, I was on call 24 hours a day, seven days a week with only half a day off each month, all for £78 per month. It was absolutely exhausting and I felt nauseous with tiredness a lot of the time. I had my own room on the ward, with a bed in it. I remember being grateful if I managed to have more than an hour's uninterrupted sleep. The experience gained was phenomenal. Today's young hospital doctors, with their 48 hours per week in shifts, must have great problems gaining the sort of experience which has stood me in such good stead. Abiding memories from those days involve glass syringes. There were no disposable plastic syringes. The glass plunger was ground to make it rough, so that it would have friction with the barrel of the syringe. We would put some vaseline on it to make it watertight. Often, while pulling on the barrel to extract the blood from a vein, the whole thing would go loose, the plunger would fall out of the barrel and the floor would be covered in blood. Angry patient and embarrassed doctor.

I have previously written about boiling patients' urine as part of the testing procedure – warm it gently over the Bunsen burner, go too far and an air bubble will form in the test tube, explode and blow the entire contents of the test tube over the bench.

I have vivid memories from my Gynaecology job. A middle-aged Canadian lady ended up on my ward. She had uterine fibroids and had been bleeding profusely before collapsing. She was admitted with a Haemoglobin of about 20% (it should be at least 85%) and was in imminent danger of death. Normally, we would transfuse her with blood, get her stable and perform an hysterectomy. The problem was – she was a Jehovah's Witness and refused point blank to have a transfusion. I told her she would almost certainly die without treatment and she said “OK, if that is God's will”. I rang her husband in Canada and he said the same! Thoroughly rattled, I rang the Medical Protection Society who told me that I should leave her alone, having asked her to sign a disclaimer form. She signed and I waited for her to die. However, the bleeding stopped, her Haemoglobin started to rise and, against all the odds, she survived. We must draw our own conclusions.

I bought a house in Copthorne and started in general practice in Pound Hill, Crawley, when I was just over 24 years old.