Tuesday, 30 March 2021
Tuesday, 23 March 2021
Ashford and Orthopedics.
Ashford & Orthopedics.
It was eight o'clock by the time the operating list was completed and I was exhausted by then. As the afternoon progressed, Dr.Bailey became increasingly grumpy and my arms became weaker and shakier. Dr Bailey continued to mumble complaints regarding the assistance, the delays, the blunt instruments, and me.As I walked into the apartment at 9pm Irene greeted me with a hug and said.
"You must be exhausted, I heard you leave this morning, it must have been about half past six."
He kissed her.
"What a day, you wouldn't believe it."
"What's your boss like?"
"He's a miserable little hypomanic Scot. Can't bear to sit around for a minute. In between cases he runs around mopping up the chalky, white casting material from the floor with a bucket and mop, because he can't wait for the operating room porter to do it. Threw an instrument, a sort of chisel called an osteome, across the operating room at the wall yelling 'get rid of these blunt instruments, no wonder patients get shocked'. And he told me that I'd be responsible for a patient being crippled for life because my arms quivered a little while I was holding and stabilizing a very fat leg with compound fractures while he was hamming and screwing away. I didn't take too much notice of him. He's famous for being a real prima donna!"
"You must be hungry," she said.
"I'm starving," I said. "and, oh yes, my boss threw a dried up ham sandwich across the room at lunch time because it was 'dried up and inedible."
Thursdays were to follow that pattern for as long as I was on that service. The rest of the time was spent on following and caring for the post operative patients, and covering the emergency room patients. I enjoyed that and whenever problems arose I could call on the senior resident or the consultant on call.
Doug Brian James Rhys- Jones, turned out to be a helpful colleague and a good friend. Apart from the fact that he never allowed me to forget the circumstances of our first meeting and never hesitated after a drink or two to regale our friends with the story of (lapsing into a mock Irish accent), 'of himself (me) naively checking for reflexes in a poor old sod , who was hit by a train and who's brain was sitting on the gurney beside him'. 'Doug' as he was called was married and had a little girl about a year older than my daughter. Our families became friends and together we would visit some of those historic sites from the White Cliffs of Dover to the 'Cinque Portes', those five ports from which the British Fleet sailed forth to conquer the world.
My duties included covering the emergency department on the weekdays and a one in three night and weekend call roster. The exception to this was Thursdays, when Dr. Bailey operated starting at seven in the morning and carrying on until the orthopedic surgical list was completed. It was an exceptionally long day, because Dr.Bailey had all the major orthopedic cases from the regional seaport hospitals that he would normally have done on Friday transferred to Ashford Hospital and added on to his Thursday list. There was a method in his madness because this freed up Friday to be at his private consulting rooms in London's Harley Street, that ultimate sanctum of medical practice for the rich and famous. No doubt it greatly enhanced Dr. Bailey's income, but I continued to dread Thursdays for years after I had left Ashford. There were only three junior house interns who rotated call, and two senior residents one in general surgery and one in orthopedics, who could be consulted when the complexities of the cases were beyond the junior physicians. Beyond that various specialists were available for emergency calls. Most of them didn't take kindly to being called needlessly and sometimes their opinion of a needless call differed from that of the junior house staff.
Doug had advised me to get to the operating room at least a quarter of an hour early.
"Bailey is a good surgeon, but a bit of a prima donna. You know, he throws instruments around the operating room and yells at people when he gets upset. He's a fast, non-stop worker, with a long operating list, who really gets agitated when anything slows him down. So be all ready, gowned up and ready to go before seven, and you'll make a good impression. And make sure to have a decent breakfast, God knows when you'll eat again!"
Sure enough, at precisely five minutes to seven, Bailey burst into the changing room, immediately started changing from his street clothes into his operating room greens. I was already changed and was sitting in an armchair reading the previous weeks British Medical Journal. I stood up and introduced myself. This was the first time I was meeting him, because as related earlier he had missed our interview and we had only spoken on the phone.
"Sorry we didn't manage to meet when you came over for your interview," Bailey said. He was a small man, with straight, well pomaded hair that was parted in the middle and brushed flat against his head. Reminded me of George Raft a Hollywood actor who played gangster roles.
"Is everything ready to go? I don't want to be sitting around for ten minutes waiting for the anesthetist."
i nodded that it was and said that I didn't know if the anesthetic was being started yet.
"Well get in there and tell O'Hare that I'll be ready to start in five minutes. He's slow and I don't want to waste time standing there waiting."
I pushed my way through the scrub room and into the operating room, to where O'Hare was starting an intravenous on the morning's first patient. He was a middle aged, middle sized Irishman, who gave me a friendly grin and said:
"Ah, his majesty sent you in to warn me he'll be ready in five minutes and doesn't want to be kept waiting. Well you can tell him we'll be ready in three! You must be the new orthopedic intern from Dublin. Welcome on board. I can use another sane Irishman around here to give me a bit of support."
I admitted that I was.
"He gets a bit temperamental at times, but don't take him too seriously, it blows over quickly."
I went back into the scrub-room where Dr Bailey was busily scrubbing up, stationed myself at the next sink, turned on the water with the knee-controlled tap and lifted a soft little scrubbing-brush out of a stainless steel container. I squeezed another lever with my elbow that measured out a volume of antiseptic soap and began the mandatory three minute scrub. I was glad that the noise of the running water made conversation unnecessary.
The torture that was orthopedic assisting required a little skill and great patience and often long periods of holding a shattered limb in perfect alignment while the orthopedic surgeon hammered, chiseled, manipulated and screwed plates to hold the bones in apposition in the hope that they would heal in functional position. When the limbs were attached to two hundred and fifty pound people, as they often were, and the procedure took three to four hours, as they often did, it made for a long hard day. These days there must be all sorts of gadgetry to support and align limbs and other body parts. In those days it was just another job for the poor intern.
We wound up the third case by two pm, by which time I was starving and wished that I
had taken Doug's advice to have a good breakfast.
"Let's get a bite of lunch before the next case," said Bailey, who hadn't spoken to all morning. Me pall morning, other than occasional instructions, and on one occasion a barked command to "hold the bloody limb steady, if this fellow ends up a cripple it'll be your fault!"
The limb in question was obese, heavy and difficult to hold absolutely motionless, and my arms were already exhausted and shakey from keeping the limb aligned for so long..
"I'm holding this limb as still as I can.". It took some time to learn to answer him in kind. For all the current whining about bullying, there's nothing like a little gentle bullying early on to teach a person to cope with bullying.
We walked into the little sitting room off the operating room, where the doctors sat between cases and dictated their notes while awaiting the next patient. It was two o'0clock by the time we finally succeeded in moving into the room for lunch.
"We still have five more cases to do, I don't want to waste much time in here." Dr. Bailey grunted.
"No sir," I said, reaching for a sandwich and wondering if I should have said 'yes sir'.
Dr. Bailey also reached out and picked up a sandwich. He looked at it disdainfully, observed the delicately cut dried-out triangular portions, that were now curling up at the edges and flung it across the room.
"Disgusting !" was his single worded comment.
"Well, they have been sitting out there since twelve o'clock," the nurse said. "I'll order some fresh ones up from the cafeteria. I suspected that the fresh sandwiches were not going to be for me so I ate several of the dried-out sandwiches while Bailey awaited a plate of fresh sandwiches. O'Hare, the anesthesiologist, just munched on his dried out sandwich and gave me an exaggerated wink.
Our lists almost always went on until seven or eight at night on Thursdays.
I didn't have many discussions with Baily, who I grew to respect for his energy and skills and his preoccupation with doing the carpentry called orthopedic surgery perfectly despite lacking in social skills. Just before I moved off his service we had a discussion in the lunch /dictation room.
The discussion turned to work and tax.
Dr. Bailey "I'm just filling out my tax returns."
Me. "oh yes."
Dr Bailey. "It gets worse every year."
He drove an e type Jaguar, had a boat and a big house in London. . I felt really sorry for him.
I said, "I wish I had those problems."
He smiled only slightly malevolently and said "you will lad, you will."
Dammit, he was right!
Tuesday, 16 March 2021
The Non Interview. Ashford 1.
The Non Interview.
During the first part of my internship as a pathology intern due to being out of sync with the academic year (see previous episodes of that era), I was scanning the medical journals looking for suitable positions to complete my hospital residency and obtain full licensure. I found what I was looking for in Ashford, Kent and was required to to come from Dublin for an interview. The post was for an Emergency Room/ Orthopedics intern and the head of orthopedics wanted to interview me before offering me the job. The hospital offered to pay my expenses to make the journey at the cheapest possible rate. The salary was to be twelve pounds a month, very little, even in those days. It was virtually slave labour and the only thing that made it possible for me to exist at that income level was that a furnished apartment came with the job. The interview involved taking an overnight boat from Dublin to Liverpool and then traveling by train to Ashford. I had taken the Dublin - Liverpool lap before on several occasions as a student, but this was the first time I was able to afford a cabin. Well, it was more of a cell than a cabin, a little boxy room with a bed, a porthole and a wash-hand basin, but I thought it the essence of luxury. I dumped my case in the cabin and went up on to the deck to watch the boat steam out of the harbour as the setting sun dipped down towards the horizon, throwing out a shimmering silver carpet straight at me. I turned up my collar to protect me against the cold November wind. The damp cold penetrated my reverie and made me seek the warmth and comfort of the lounge, where I ordered a beer and lit up a cigarette. I watched the animated antics and listened to the cheerful chatter of the drinking groups for a while, then got up and went to my cabin, got into bed and slept like a baby until I was awakened a few hours later by the boat docking in Liverpool.
The train to Ashford in Kent left at about seven in the morning. I'd had time to have a cup of tea and a cheese roll before boarding the train. As the train puffed its way across the scenic Kentish countryside I stood by the window looking out at field upon field of rusting Spitfires.
An older man standing beside me said, "Hard to believe all that rusting metal and a bunch of eighteen year old kids flying them won the bloody war for us and now you can buy one for a hundred pounds!"
I arrived in Ashford and took a taxi from the station to the hospital and made my way to the administrators office. Mr Singleton was a tall lean man who walked with a limp assisted by a cane. He had been a world War 2 fighter pilot who was shot down in 1944 and spent the remainder of the war in a prison camp. Although he must have been in his fifties now, his deportment and accent betrayed him as an officer and a gentleman.
"Ah, Smith, nice to make your acquaintance," he said, grasping my hand in a firm handshake. "Weren't you supposed to come tomorrow ?"
"I don't think so, sir,"I said anxiously. "I'm sure it was today."
Mr. Singleton perched his reading glasses on his nose and studied his appointment book.
"'Yes, you're quite right, it was to be today. Pity, Mr Bailey (the orthopedic surgeon who was to be my boss) is operating in Dover today. I thought you were coming tomorrow for some reason. ( I suspected that Mr. Singleton had told the surgeon the wrong day,) Anyway, I'll phone him later, perhaps we can conduct the interview over the phone,"he said hopefully. "Otherwise you'll just have to stay over another day,"
I hoped that wouldn't happen. I was going to be away two nights as it was, and I had to be back to work the following day.
"It's just about lunch - time," said Mr. Singleton. "Let me take you over to the cafeteria for a bite to eat. I'm sure you must be hungry after your long trip."
"That would be nice," I said.
We walked out of the office, turning left down a long corridor towards the end of which was the hospital cafeteria. As we walked and then stood in line Singleton gave me a brief history of the hospital and its sister hospital in nearby Willsborough. We took our loaded trays to a table close by.
"Are you from around here, sir?"
"Well, actually I'm from London but when war broke out in 39, I joined the RAF and was posted to Biggin Hill, not far from here, one of the biggest RAF bases in the south of England. In fact, we were the first group to shoot down a thousand enemy aircraft." He stopped and seemed lost in thought for a few moments, smiled and then went on.
" You could stand on the front steps of this hospital and watch the dog fights of the Spitfires and Messerschmitts Bf 109s overhead. Although everything was supposed to be top secret, everyone knew about it and we had a celebration party the likes of which you just couldn’t imagine. We felt we had played a big part in winning the war in the air. All the bigwigs from London came down to celebrate." He couldn’t hide the pride he felt for a moment, and then went on.
"Soon after that I was shot down over enemy territory, but that's another story. Anyway, I don't know why I'm boring you with all this ancient history. We'll take a walk around the hospital and grounds after lunch and after that we'll give Mr. Bailey a call."
Mr Singleton walked me around the hundred bed hospital and then around the attractive grounds.
"All these trees," he smiled , "grow the most glorious Victoria plums, so you'll never go hungry. At least not in the summer." He laughed, while I quite seriously registered a limitless supply of plums as a definite asset. Plum jam, plumb tarts, plumb cobbler, plumb crisp, plumb cobbler and even fresh plumbs.
Then he continued,
"Right across this orchard here is the backyard of one of the two houses that belong to the hospital and are allocated to the house-staff. They front on to Western Rd. I'll show you the one you'll live in."
I noted with reassurance that Singleton was talking as though I already had the job. It was one of those occasional bright sunny cold dry days that allowed us to walk across the orchard among the bare trees without getting our feet soaked. We walked into the backyard of a good - sized two story nicely kept house.
"You'll have the upstairs flat, the pediatrics intern, Dr. Bonita and her family have the downstairs flat. When you get to know her, she'll probably invite you and your family for the best curry you've ever tasted. She usually does that for the new staff. She's been here longest."
They entered through the backdoor and went up several stairs to a bright roomy second story that was sparsely but adequately furnished. The living room at the front of the house was large and well-lit and had a fireplace and sitting area at one end and a dining area at the other. There was a long corridor, at the end of which was the bedroom. I noted with satisfaction that there was plenty of room for a crib. Just before the bedroom, a door to the right opened into the kitchen.
"I hope you'll like it," said Mr. Singleton. It's not too bad."
"Yes, it's very nice," said I.
I was absolutely ecstatic. Irene would be so happy. After four months living in an awful rented house, with no hot water this was like a palace. Even though I hadn't had my interview yet, the way things were going it looked as though I would be getting the job.
"Let's go back to my office now and see if we can get hold of Bailey. Perhaps it will be sufficient to hold the interview over the phone."
He got hold of Mr Bailey and I could imagine the conversation just from hearing one side of it.
"Yes, yes, fine" Singleton responded to what I conjectured must have been an inquiry as to whether I looked alright. The one sided responses seemed to be the reply to questions regarding my suitability.
"He'd like to have a word with you," Mr Singleton said, extending the telephone to me .
I stood up and took it.
"Hello Smith here."
"I'm here operating at Hythe General Hospital today, so I'm quite a distance away. I'm afraid there was some confusion about the day. I gather that Singleton has given you all the details about the job?"
Singleton had pointed out that as the Orthopedic Intern I would also be the Emergency Room physician on the days when Bailey was not operating. I would also be looking after his pre and post operative patients.
"Good, and he informs me that your documentation is all in order."
"Well then I don't think we really need to drag you all the way to Hythe for an interview. That would require that you spend an extra night and I'm sure you're anxious to get home as soon as possible at this time of the year."
He disregarded that I had traveled a night and a day for this interview.
"And you'll manage to get here in time to take call around New Year's day? We're a bit short of house staff."
( I have already described that in another post).
"Yes sir," I replied obsequiously.
Then I got my things together for my trip home. It was a very satisfactory non interview!
Sunday, 7 March 2021
Paradiso to the Butler Arms.
The Butler Arms Hotel Saga.
In those days people took pride in how they looked. Mark Twain wrote "Clothes make the Man" and long before Shakespeare wrote "The apparel oft proclaims the man." (Hamlet written about 1600). When people traveled they looked clean and 'spruced up'. Artificially frayed, grubby looking finery hadn't been invented yet and if it had peopled would have collapsed with laughter.
So, all dressed up in our 'best' (we knew that Billy's mother wanted to make sure we would 'fit in' with their fine guests, we set out on our journey to Waterville at the very southern tip of the island. Now in the age of super highways the drive takes only three and a half hours. Then it was an eight hour train journey on a narrow gauge railway. I was astounded when I first came to Canada and saw the size and magnificence railroad system and traveled on the Canadian Pacific Railway's supertrain 'The Canadian'. Little did we know at that time we would travel from coast to coast on that train and down the west coast of the United States to Los Angeles within a couple of years.
We packed up all our requirements, including my drum kit, stuffed them into the car of the only friend I knew who had a vehicle big enough to accommodate them and would dump us off at the railway station. We puffed and chugged so far down to the southern tip of Ireland that if we went a few miles further we'd have been in the Atlantic Ocean.
Billy H was right there on the station platform to welcome us as we got in. Right away we like him. He was about thirty and warm and welcoming and related more like a friend than a potential employer. He helped us collect our luggage, including the drum kit and load them into the hotel van.
"I'll settle you into your living space and give you time to settle in. I have to get to bed early." he said wearily. "I have to be up really early in the morning to play golf with one of the guests." Billy sounded as though this was more of an obligation than a pleasure. Waterville was a golfing, fishing and sailing paradise, so getting up at six am to play golf probably was more work than pleasure. "I'll pick you up about nine o'clock and we will go and see mother."
We were engaged at the time so, in the interests of propriety the management made sure to locate us as far apart as possible. I was at one end of the hotel, Irene at the other. The rooms were very nice and we were invited to use the dining rooms gratis just not at peak hours. We took a walk around the hotel and the surrounding area, impressed by its grandeur.
The recollection of the meeting with Mother seems to have become cloudy over the years, after all it was sixty something years ago. I will attempt to relate it to you as I remember it, without undue embellishment, although as I re-read it it seems a little fantastic, even to me! I therefore will not guarantee its accuracy. This is how it appeared to me.
We met Billy as arranged a little before nine. "Mother likes people to be on time."
We were as they say, nicely 'turned out' and Billy led us into an oak paneled ante- room and went off to do whatever it was that he had to do, assuring us that he would pick us up in a while." it's a really nice day so when you're finished if your like to take a stroll around the gardens I'll catch up with you."
He deposited us in a large ante room. There were double oak doors at one end of the room and after about five minutes one of the doors opened A middle aged woman approached us.
"Hello, Mrs H will see you now. Just walk straight on in."
We walked into a long narrow poorly lit room and at the far end of the room sat Queen Victoria on her throne! Oh no, it was only Mrs H. at her big dark mahogany desk. She seemed very very old to two twenty years old people. We stood before her desk.
" Good morning," said we.
"Good morning," she responded, all the while giving us a good look over.
"You may sit down.". We sat. "And you're a medical student?"
"Yes," said I. "Trinity College.
"And what school did you go to?"
"St. Andrews College." I answered.
"I had a grandson go there." she said casually. "And you?" she asked Irene.
" I went to Wesley College, Dublin."
" These are our expectations. We will expect you to play for two or three hours about three or four times a week. Billy will let you know well in advance. You will be free to enjoy the facilities of the hotel including the dining room other than at peak hours. Be respectful of the guests at all times, we get some very important guests here. Other than that you may mingle freely. You will be on the payroll as of today. That's all. You may go now."
That was it. We had the job. No questions about our musical skills or experience. No desire to hear us play. We looked okay and could communicate satisfactorily. Now Billy was in charge.
I was at one end of the hotel, Irene at the other. Having said this we were very pleased with our accommodation and we were treated like guests at the hotel, ate in the dining room with the guests and welcomed to participate in any of the hotel activities. Billy was actually a nice guy , and easy to work for. There was a couple of regular scheduled dances and occasionally unscheduled ones. When there was an unscheduled one, Billy would come and politely say, "we thinking of having a bit of a spontaneous hop tomorrow night when we get back from a fishing trip. Would that be alright with with you and Irene?"
He was, in fact, the entertainment manager and despite his laid-back and easy manner worked quite hard at it. He invited us along to various activities he arranged and on more than one occasion I heard him moaning, "Oh I better get home to bed, I have a meeting to play golf with some of our golfing guests." Poor Billy!
Waterville was famous for its golf courses and fishing as well as some of the world's most magnificent rugged scenery. Dingle Bay and the 'Ring of Kerry' boasts some of the most beautiful scenery I've ever seen. Its history tends to be overlooked in the part it played in the connection between the old and New World. (See plaque above).
Many famous people found this area to be a respite from the tumult of twentieth century. Among the most famous was Charlie Chaplin, who returned so frequently that Waterville commissioned a statue of him that they erected on a Beach-side walk that they called, logically enough, Charlie Chaplin Way. J.P.Morgan and Walt Disney were also guests at the Butler Arms. None of them arrived in time to see Irene & Stan, Piano, vocal, drums.
I think I still have a few of our business cards kicking around our memorabilia!
We did run into a few memorable characters. We were sitting out on the patio one sunny day having our mid afternoon tea and scones. The tables were mostly occupied when a large well dressed - in the American style, man and a young East Indian boy inquired if they could join us.
"Certainly," said Irene. They sat down at our table.
"I'm Jack Zuckerman ," he said with a very New York accent of the Brooklyn dialect. "This young man here is the Prince of Baroda, his mother is the Maharani of Baroda. She is over here for a holiday and to buy some Irish thoroughbred horses. I'm their bodyguard." said Jack. "I guess twenty-five years in the New York Police Department qualifies me for the job. He put his hand in his pocket and took out a 'gold' NYPD badge. "This is what they gave me when I retired." he said proudly. He ordered a coffee for himself and a lemonade for the Prince. He was a certainly a larger that life character, reminiscent of a Damon Runyon ("Guys and Dolls") character. He had some good stories to tell and was entertaining company. After they left Kerry they were going to Dublin for a while and Jack asked us if we had any suggestions about what to do to entertain the 'kid' , who was a very nice kid, to keep him amused, while his mother was buying Irish thoroughbred horses. We had a few suggestions and when he asked Irene about her folks and heard she had a little sister about the prince's age, he said " I might just drop in on them". He did. And that's how my wife's baby sister is the only one in the family who spent an afternoon playing with a prince!
When we weren't performing or doing something at the hotel, we would visit the local pub. It was a fun place frequented by locals and tourists alike. The licensing laws in Ireland were very rigid and pubs were not supposed to serve liquor after ten thirty PM. The Irish found many ingenious ways to circumvent that ridiculous rule. The local police officer was a customer as well as a law enforcer and would warn customers when he dropped in at ten fifteen or so, "better order up, ladies and gents, no liquor can be served after ten thirty." Apparently it was legal to finish off whatever drink you had on the bar or at your table. The result when the 'last call' was announced was that the patrons would order two or three drinks and as long as no alcohol was served after ten thirty they were within the bounds of the law. And the local cop, Seamus joined the crew! Finishing off the drinks already on the bar or the table often took another hour or two!
I saw my first mosquito in Kerry. Generally Ireland is too cool for mosquitoes, however although the country is only 486 km long the temperature in the southern tip is warm enough to nurture palm trees and mosquitoes.
The days flew by all too quickly and it was soon going to be time to get back to school. It was one hell of a summer!