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!