Confessions of a Doctor. Stanley Feldman
artery bypass surgery still has a part to play.
THE CHILDREN’S HOSPITAL
David Levi, a senior surgeon at the Westminster Children’s Hospital, lived for surgery. He taught anatomy at St Mary’s Medical School where his Saturday morning anatomy demonstrations were a ‘tour de force’, attracting a large audience. He was ambidextrous: his particular trick was to use both his hands, each holding a piece of chalk, to draw the two sides of the vertebral column at the same time. This feat was always rewarded with a round of applause. He was an old-fashioned general surgeon, and he would follow an operation to remove a child’s tonsils with a prostatectomy on an octogenarian, and then an operation on a baby with pyloric stenosis.
He claimed he was a lucky surgeon but in fact he owed much of his success to a detailed knowledge of anatomy. As he operated he would mumble to himself: ‘I am far too busy to have complications.’ Indeed, the complications were very few and far between. Before a list of several operations he would arrive in the changing room with the command to the nursing staff to ‘send for the first two patients’. He would then proceed to remove his suit jacket which had the shirt cuffs attached to the inside of the jacket sleeves. Once down to his trousers and short-sleeved shirt (he never removed his collar and tie), he would don a plastic apron and he was ready to operate.
In his private practice, Levi was often assisted by the patient’s general practitioner, which allowed the GP to charge the patient an ‘attendance fee’. These doctors were mostly unused to surgical procedures and the principles of sterility. As a result, he would keep them as far away from the field of surgery as possible, constantly muttering to himself, ‘This is difficult, very difficult’, before producing the offending appendix or bowel from the impossibly small wound.
He worked at all hours and on all occasions. Many years after I became a consultant I used to work with Levi from time-to-time in his private practice. Once, he invited me to his son’s wedding and as I was congratulating him as he received his guests at the reception, he whispered to me: ‘Appendix; John and Liz’s hospital; 6.30’. Not even a special occasion could prevent him performing an operation.
He also seemed to have a special instinct that allowed him to know the precise moment I was getting into bed at night, for it was then that the telephone would ring with a call to help at an operation. On one such occasion I found myself confronted with a reluctant, elderly French patient who was unable to pass urine. Unfortunately he spoke no English, and my French was very basic. As I approached him with a syringe full of intravenous anaesthetic, miming my intention to inject its content so as to put him to sleep, he leapt out of bed trailing his catheter, shouting, ‘No pi pi’. After a short, breathless chase around his bed he was cornered and subdued. It was only after the intervention of an interpreter that we were able to proceed with the operation. There was no question of informed consent!
I have often had cause to regret my inability to communicate freely with foreign patients. There was one occasion when, having anaesthetised a French patient I went to visit her in the recovery room. She appeared to be in some discomfort and I enquired in my best French, ‘Madame, avez vous le douleur’. My accent obviously confounded her, for a puzzled expression appeared on her face, slowly to be replaced by a look of comprehension, and she replied, ‘Non monsieur, pas des dollars, seulement sterling’.
THE GORDON HOSPITAL
Eric Crook operated at the Westminster Hospital annexe at the Gordon Hospital in the Vauxhall Bridge Road. He was a typical old-school ‘gentleman surgeon’ and certainly the politest surgeon I ever met. If I arrived late he would wave aside an apology and instead insist he was at fault for being early. His anaesthetist was of a different type and he had the habit of starting the day by telling a risqué joke which Eric would appear to find funny but which I could sense was actually causing him a great deal of embarrassment.
Once, when he was performing an operation while teaching the assembled medical students, Eric pointed out that the blueish colour of the tissue in the wound around an anal fistula was typical of tuberculosis inflammation. A few minutes later, when the anaesthetist replaced the oxygen cylinder, which had run out, with a full one, the patient’s tuberculosis inflammation miraculously disappeared. Eric was totally nonplussed by the suddenness of the cure.
Perhaps the best-known surgeon who operated at the Gordon Hospital was Lawrence Abel, a great friend of Dixon Wright. Both were superb technical surgeons but both were surgically arrogant and lacking in any bedside manner. Their treatment of patients and junior staff would not be acceptable today, although there are few surgeons who can match their dexterity. They were good surgeons but indifferent doctors.
Lawrence Abel would often see his patients for the first time in the anaesthetic room, the diagnosis and decision to operate having been made by the registrar. There the patient, a little groggy from the effect of the premedication, would see the famous surgeon who would be holding his life in his hands. Unfortunately, more often than not his surgeon would be wearing a white operating shirt top but no trousers; instead he usually had on boxer shorts covered with pictures of bees, bearing the words, ‘I am a busy bee’. But once the patient was on the operating table Abel displayed a masterly surgical ability. I never heard a patient complain about his somewhat unusual attire and his bizarre manner, but in those days it was very rare for any patient ever to complain about his surgeon, who was generally regarded as a god.
On one occasion, when Abel was operating upon a private patient who had cancer of the colon, the patient’s private GP, who had come to observe the procedure (and collect an assistant’s fee), remarked casually that he suspected the patient also had gallstones. Abel put his hand up under the patient’s ribcage and after a couple of deft snips with the scissors produced the gall bladder which he threw to the GP with the remark, ‘You can see for yourself if you were right’.
Abel was a difficult surgeon to work with; he had little concept of timekeeping and would often keep the theatre staff waiting for hours before he appeared, offering no apology or excuse. He insisted that such were his skills that his patients did not need any intravenous infusions or blood during the operation and, being a god-like creature, he usually had his way. This often led to the anaesthetist having to resuscitate a dehydrated, shocked victim by starting a blood transfusion the moment he left the operating theatre – not always an easy thing to do.
OBSTETRICS
Our obstetric department was one of the best in London and the private wing was popular and fashionable. There were three excellent consultant obstetricians including Sir Arthur Bell, a past president of the College of Gynaecologists and Obstetricians. Sir Arthur was a canny and enthusiastic accoucheur who, when encouraging a mother to ‘push’, would become totally involved in the birthing process. His face would go scarlet and the veins on his neck and face would bulge until one was fearful he might have a stroke. It was touch and go as to who would give birth first. Off duty, he was a great horse-racing man but his staff soon learned not to rely on his ‘tips from the horse’s mouth’.
The obstetrician idol of the ‘smart set’ was Roger de Vere, labelled ‘Divine de Vere’ by a Sunday newspaper. Always suave and smiling, he was an amusing colleague, never lost for a witty riposte. He encouraged his anaesthetist, J B Wyman, to introduce the technique of epidural anaesthesia to alleviate the pain of labour. For many years epidural labours were limited to about two or three practices in London. The other obstetrician who encouraged their use was J B O’Sullivan. His anaesthetist was the very able Andrew Doughty. When they successfully delivered a male heir to a Middle Eastern potentate, the proud father gave his almost-new Rolls Royce to the obstetrician as a token of his gratitude. The anaesthetist, who had administered the epidural and attended the patient assiduously, received a cheque for £20.
De Vere was not a great enthusiast of the various new fashions in maternity practice. He had lived through the Grantley Dick Reed era of natural childbirth and saw little merit in birthing pools. On one occasion when a mother-to-be expressed an interest in the le Vosier method of birthing he pointed out that it meant the patient lying in a bath of water