Sunday, September 27, 2015
Making of a Child Psychiatrist(24): Med School (2)
The next few days were full of expeditions to get to know the immediate vicinity to King’s, built between The Strand and the Thames Embankment (just a short walk down Surrey Street). Just across the road was India House, and there was public access to the basement restaurant and some of the hottest and cheapest curries I had eaten. Of course my mother had produced a great, if somewhat stylised, curry for numerous parties and occasions but somehow the ‘real thing’ came as a burning surprise immediately and two days later. Further to the west was Leicester Square, to the north of that Covent Garden, and in between all the London theatres that somehow we did not consider (and perhaps could not have afforded) in those early years. Walking east towards Fleet Street took me past Australia House and I have always wondered whether the repeated image of sun and surf and the promise of a £10 emigration somehow took up space in my mind. You either had to go round India House or Australia House to get to Aldwych to find Kingsway where, in Sardinian Arcade, there was a musty cramped little shop selling University memorabilia. Of course I needed a royal blue and red diagonally striped tie (which I still have) and, of course, a long cloth scarf in the same colours lengthwise (sadly long gone). They were worn with considerable pride. It was important to belong, to tell the world where I belonged. The shop also showed off an array of wooden plaques in the shape of a shield with the college insignia. I wanted one. I coveted one, but could not afford one at the time, and had to wait many years before getting one sent by post. It somehow remains a way of showing my heritage, and has sat on the wall in most of the offices in which I have sat. I have an identity: I was, and am still, a King’s man.
We had a list of prescribed textbooks for the main subjects (Anatomy, Physiology, Biochemistry, Pharmacology), and this necessitated repeated lengthy and fascinating visits to Foyle’s multistorey bookshop in Charing Cross Road. Having been a librarian at school, I was fascinated by the rows and rows of books from all round the world. Others were fascinated by the coffee shop; I never needed that. I was just happy with books, and happy to stay for hours, even though there was always an underlying purpose to each visit. There were other bookshops close by, and some of them antiquarian, but somehow they never had the fascination of Foyle’s. Perhaps not surprisingly (given my first day’s experience), I went a bit overboard in buying anatomy textbooks. I bought a copy of ‘Gray's Anatomy: descriptive and applied’, and a recommended guide for anatomical dissection – a brilliantly simple set of flip charts. Sadly I cannot remember the author’s name but, being a very visual person, I am eternally grateful for the ring back guides that were light enough to carry into the dissection room to assist. Somewhere along the line, I also acquired, and have retained, a copy of the very detailed and beautiful ‘CIBA Collection of Medical Illustrations’ by Frank Netter. These days, of course, it is easy to go onto the Internet, and find diagrams, photographs and MRI sequential scans of the whole body. But nothing compares with poring over a book, and turning time and again to a particular page until the whole thing is embedded in memory. Of course, exquisitely detailed anatomical drawings go back to the days of Leonardo da Vinci, and I am not sure anatomy has changed that much over the years. The new generation prefer the Internet; I prefer to hold a book, without the interruptions of email and other pop-ups.
We needed instruments, and almost furtively entered the recommended shop, whose name I now sadly do not recall. I do, however, have a visual memory of climbing some stairs in an elderly and slightly musty building. They were professional, never asking if any of us was a descendant of Burke or Hare, and responded quickly to our list of forceps, scalpels with spare blades, a probe, tweezers and surgical scissors, and a small boringly khaki canvas roll in which to carry them.
Dissection began on about Day 3, and we had directions as to how to proceed as well as an ever-present demonstrator to guide our thinking and hands. We began with the forearm of the upper limb, and no-one seemed awfully keen to make the first incision. I can still remember the discomfort of that first time; but then if you could not manage such an act on a long dead person, however could you manage on a live one when it might be a matter of life or death. So over the weeks we took turns uncovering the layers of skin, tracing muscles and the arteries and veins that had provided the blood flow to them, and eventually being able to lay out (and describe) the anatomy to please the demonstrator. This was real; it was important, and it left us all with a sense of wonder for the human body. I am sure that smell of formalin permeated not only my lungs, but also my clothes and perhaps my soul. If people moved away from you on the underground, there was always a thought that, perhaps, they knew what I had been up to.
Other topics had exercises in the lab, building from the very simple to the complex, but all providing a sense of how the body works. To this day I have my first Physiology exercise book, with its still schoolboy writing and the date of the first experiment (12th October 1962. Experiment 1 – Blood A: ‘Erythrocyte Count in Blood’). The reporting detail is like nothing I ever did at school; it was careful, precise and thorough. I wanted to do this; it was my future craft, and I was taking it seriously.
We built on examination of the various types of cell, quite literally counting them in squares under a microscope, to measuring heamoglobin levels. By the 27th October we were using an electric stimulator to get frog muscle to contract, and then practicing on each other’s palms. This was to become a way of life; practice on a partner and then they practice on you. On that day, I was working with ‘C. Lines Esq.’, my old friend Chris. Week by week we moved on, examining respiration and lung volumes and then the composition of exhaled air. We learned to use equipment like pipettes, microscopes and oscilloscopes. The experiments were always demonstrated first (see one), and then each of us would take a turn on our own specimens or on ourselves (do one). It was meaningful, grounding, and I gradually gained a sense of the pathway at the end of which I would be a doctor.
By February of 1963 we were doing group experiments which were randomized and controlled. For instance determining the effects of exercise, nicotine or pituitrin on renal output after taking on board a uniform water load. This was a feature providing a reality; we had to take small experimental amounts of all sorts of drugs through that first year to measure changes. When you have such an experience, you have a respect for medications that you cannot gain by reading a formulary and prescribing for some unsuspecting third party.
A weird thing happened one morning on my way to the refectory. I was passing a notice board close to the main entrance, and the word ‘Australia’ sprang out to hold my attention. I stopped, and looked closely. The ‘Inter-University Australia Committee’ (based at Oxford) was requesting applications from students interested in spending a summer holiday in Australia. A requirement was that the student had to have employment for three months, and had to arrange their own accommodation. But flights and transfers would be totally free - no obligation. After my initial disbelief, I read the notice again and again, checking details and dates and timing of applications. Then I wrote it all down. My parents and my sister had been in Adelaide, Australia, since March of 1962, and would be there for the full three-year posting. This might be a way of getting to see them. It might also be a way of getting Jan to myself for three months.
That night I rang Jan excitedly and discussed the possibilities. Then separately and later together, we discussed the ups and downs. She would be missing a whole summer season of contributing to her parents’ hotel. I would miss three months of working to supplement my grant. We discussed the whole thing with Reg and Bobbie, Jan’s parents, and I wrote an air-letter to Australia seeking a response as soon as possible. With agreement we put in our applications, not really believing our good luck, and with that faint sense of wondering about ‘the catch’.