Early in 1981, while working in the Coronary Care Unit of the Royal Infirmary in Edinburgh, I was interviewed for the two-year medical registrar post at Milesmark Hospital in Dunfermline. The interview was held at Lynebank Hospital, an institution for patients with ‘mental handicap’, as it was then called. It was also the site of various administrative offices for the West Fife region. I was keen to get a job that would allow me to stay in Edinburgh while I studied for the MRCP*. In the candidates’ holding pen I came across the medallist from my year who had graduated MB ChB with honours. We were not close friends. From this discovery I assumed that my chances of being appointed were now poor to nil. He emerged from his session with the interview committee looking his usual confident self.
The committee were seated at a long table, their backs to three windows that looked out onto the grounds of the hospital. The candidate sat facing them. Hoping to impress my interlocutors, I had listed, at the end of my CV, the number of lumbar punctures I had performed as a house officer in neurology and the equally numerous temporary pacemakers I had inserted in my current post. When his turn came to question me, Dr Desmond Noel Scott Malone (formerly of the Royal Canadian Air Force) flicked through the pages of my application and alighted upon all this information. “What are the memoirs of Malcolm Muggeridge all about then?” he asked, in a stinging tone. Muggeridge had recently published a lengthy, over-detailed and self-regarding autobiography.
At this delicate point of potential humiliation, one of the resident patients chose to wander past outside and look into the interview room. He paused at each window in turn to pull a face and stick out his tongue at the occupants. I was the only one in the room who could see him. “Well?” asked Dr Malone, growing impatient. Distracted, I made some stumbling excuse about trying to quantify my experience for the panel and assumed the interview was now definitely a goner. At this point I did not know that Doctors Lawson, Malone and Fraser put a bit more weight on what one might call social skills than pure academic brilliance. To my astonishment and delight, they called me back in after their deliberations to offer me the job. Apart from any other benefits, it meant I had secured gainful employment for the next two years.
The advantage of the commute between Edinburgh and Dunfermline was that you were travelling against the heavier traffic. In the morning, most of it was moving south across the Forth Bridge from Fife into Edinburgh while you made your way north on the quieter carriageway. The reverse applied on the way home. On mornings when a haar** affected Edinburgh, one often emerged from the advection fog into beautiful sunshine halfway across the bridge.
Two additional middle-graders, a senior house officer and another registrar, rotated through Milesmark from Edinburgh posts, creating a one-in-three resident on-call rota. It soon dawned on me that with annual and study leave to be taken by each one of us, huge blocks of one-in-two on-call lay ahead. During these times, every second night and every second weekend had to be spent in the hospital. At one point, I did three continuous months of one-in-two, only getting home to Edinburgh for a weekend off once a fortnight. Not being a natural swot, I found this level of commitment combined with studying quite testing.
Inevitably, life shrank down to the hospital and its immediate environs. Socialising was largely restricted to our fellow inmates, much to the detriment of relationships with friends and family at home. It did, however, breed an intense camaraderie. Should a staff night out occur, we would simply stay over in the hospital residence. I remember the entire junior staff establishment turning out for a cardiac arrest in the early hours after the off-duty cohort had returned from a night of curling at the Green Hotel in Kinross. It was a successful resuscitation despite that.
The medical experience on offer was excellent and represented the best possible preparation for the clinical parts of the ‘Membership’ exam. We saw a full range of general admissions, including coronary care and poisonings, and we triaged patients who would go on to regional specialist units in Edinburgh. The outpatient clinics were immensely varied.
Having already cracked temporary pacemakers, I was soon a dab hand at gastric washouts. Unfortunately, the local surgical service was not on-site. The surgeons were based at the old Dunfermline and West Fife Hospital in the town. We medical registrars were expected to go there on request to offer physicianly advice. Conversely, when I performed my first-ever suprapubic catheter insertion, I had to follow instructions over the phone from a consultant surgeon who was scrubbed-up in theatre at the time. After I passed the MRCP, I ran into him when I was at the West Fife on a consultation. “I understand that congratulations are in order, Allan,” he offered, lugubriously. Pleased that he’d noticed, I thanked him. “Well, now you’ll find out everybody’s got one,” he said.
We ventilated major poisoning cases without the luxury of an attending anaesthetist. Our equipment was a cape ventilator with huge knobs on it that looked like something Dan Dare might use. The patient got whatever minute-volume you set on it whether they liked it or not. A nurse who had taken a massive barbiturate overdose required longer term respiratory support and a change of endotracheal tube was called for. My consultant confirmed with me that I was happy to go ahead with this, then went home. When I extubated her she went into laryngeal spasm and I couldn’t re-intubate her. Having ascertained that we had some suxamethonium, I administered it for the only time in my career – and to my colossal relief the vocal cords parted like magic. It was less ‘see one, do one, teach one’ than ‘do one’.
The last job of a weekend on-call was to record the week’s poisonings. In those pre-computer times, this involved yellow punch cards with holes running around the periphery. Each case was recorded on one of these cards. The holes corresponded to various data such as age and sex, the substance taken and any treatment given. Using a hand punch, you cut a V-shaped notch into the relevant hole. Later, to sort the data for publication, you made a neat bundle of all the cards, then pushed a knitting needle through the hole relating to the parameter you wanted to select. If you shook the cards, any positives with the notched-out holes would then fall off the needle onto the desk. We had many poisoning admissions every week, but I always put the hated card-punching chore off until the very last moment on Sunday night.
The registrars’ on-call accommodation was a ‘cottage’ next to the car park. The previous incumbent had been an Indian doctor. His family were feeling the Scottish cold terribly and he had stuffed the gaps around the windows with cotton wool to try to keep the heat in – a sight that somehow added to the gloom of the place. Overnight, a telephonist was on duty at reception. One of them, an attractive lady with a cockney accent, had a side-line in making charming alarm calls to various other local workers – policemen and the like. She was always cheerfully apologetic when she called you in the middle of the night. “I’m sorry love, cardiac arrest, Ward 2,” she would coo gently. You then had to leap out of bed and run across the car park hoping the house officer had started resuscitation.
In-house entertainment was confined to table tennis and a TV, but while on-call there was rarely much time for sitting about. The news events I remember during my incumbency at Milesmark were Ian Botham’s Ashes series, the Falklands War and an NHS pay dispute. Regarding the latter, the management asked if the medical staff on-call would mind delivering the meals to the wards in the morning if they, the managers, cooked them. We all agreed that this seemed a humane thing to do. After a torrid night of alarums and excursions on the wards, I got called out of a deep sleep about 7am to do my duty as delivery man. Feeling tired and grumpy and with little sense of solidarity, I trudged off to get the small electric vehicle that towed the meal trolleys. It was then I discovered that the porters had hidden it in the farthest corner of the grounds. I finally found it and got it hitched up to the trolleys outside the kitchens. On the way back to the wards, I had to drive past the picket line which consisted of many people I knew and liked. They pelted me with empty fag packets and the like, while shouting “scab!” and “blackleg!” at me. What a laugh.
One other significant event was meteorological. The winter of 1981-82 was incredibly cold. It set in before Christmas with heavy snow and by early January temperatures were below zero all day. Occasional slight thaws had resulted in meltwater freezing onto the stone walls like glass and icicles hung from the gutters of the buildings. I had taken to sleeping in my old-fashioned heavy, cotton-striped, pyjamas, which I wore over a T-shirt. I was still cold.
In the early hours of 10th January 1982, I received one of the charming estuarine-accentuated phone calls. I threw my white coat on over my pyjamas, stuck my bare feet in my shoes and set off running across the car park which was very icy. We soldiered away for an hour or so attempting to retrieve a patient from the jaws of death. Afterwards, I went over the learning points with the house officer then wrote up my account in the notes. Wrapping myself tightly in my white coat and feeling very tired I set off on the return journey to the cottage. It was a dazzling moonlit night. The car park had been cleared, but the surrounding grass had about six inches of lying snow. The light sparkled on a crust of large ice crystals that had formed on top of the snow over the days since it had fallen. How pretty, I thought, and experimented with breaking through the crust to the powdery stuff beneath. How lovely the Moon and stars look tonight, I mused. Quite suddenly I became aware of a numbness in my nose and ears and had the distinct feeling that icy fingers were reaching through my clothes into the flesh beneath. I began to wonder how cold it actually was – and hurried on to the cottage and its relative warmth. The indoor temperature induced a dull pain in the tip of my nose, ears, fingers and toes.
In the morning I switched on the radio as usual to listen to the news. I learned that the lowest ever UK temperature of -27.2°C had been recorded overnight in Braemar. They added that the lowest temperature ever recorded in the Scottish Lowlands had occurred in Dunfermline where it had reached -26°C. If I’d stayed out much longer, I might have developed proper frostbite, an interesting and possibly unique hazard of hospital medical practice.
*Membership of the Royal College of Physicians, a postgraduate qualification for those wishing to practice general medicine.
** Sea or advection fog caused by the cooling of warm, saturated air.