F. Mendelsohn
Throughout each year of the medical course, hopes and aspirations are mainly concentrated on "the changes with the year to come", but when the time arrives pre- vious illusions are shattered — only to be replaced, somehow with complete faith, by a new set for next year. In this way time passes by, and it seems the final reward is never quite realized.
The story starts at secondary school, when the "glorious, exciting medical student" image somehow implants in an innocent young mind — not unlike an aggressive, vigorous little spermatozoon taking over a placid undetermined ovum embedded in the warm security of school, and from then on rushing it into a complex series of events from which there is little escape. I don't know how an ovum feels about it, but the fertilized student mind is full of eagerness. Fed by ever perpetuated rumours they enter a period of joy which borders on euphoria and concludes after that incredibly long Christmas vacation.
Bubbling with curiosity, somewhat over- playing the role of casual university student, you arrive on Monday morning, Week one, First term. Welcomed by some new, anony- mous and at the time dramatic, suave know- ledgeables you are shown around some of the "shop" as you have now learned to call it. The wooden stairways, clinging vines, and ramshackle laboratories look interesting, academic — quite unlike your tremulous companions, who are not exactly the elite you expected to join (no doubt they shared similar thoughts).
Then the Caf., Arts Tarts, Pie Queue — all of which are religiously attended be-
cause of the belief that here is the true centre of university life. "Intellectual ex- change". "Develop the full individual". Alas
— those earnest looking discussion groups chatter vapid nonsensical rhubarb. Already your first illusion is crumbling.
So you retreat into work — not that the fear of failing has let you stray far from it — only to be disappointed here. "This isn't Medicine!" you declare angrily; it's second year matric. (or perhaps third or fourth in some cases). What with laws of Motion, Arrhenius, electronics, phloem and xylem, the more medical flavour of zoology may seem attractive. And when at last you wield a scalpel it is only to dissect away the cartilage from the semicircular canals of the dogfish.
But it's only six more months to go and it does sound good — "studying medicine at the university". Perhaps that feeble- minded lady in the corner shop has heard about your vocation and now asks your advice about her husband's fibrositis. This must be one of the few cases of reassurance in reverse — despite your dreadful ignor- ance there gleams some hope of authority one day.
Uncertain which two of your group is going to pass, there starts an indiscriminate rush for knowledge, and everything, relevant or not, uttered by a lecturer is carefully taken down. In fact some people in our first year began to quote from their notes the diversionary stories and jokes — how horrified the lecturers must have been when their attempts at humour were furiously taken down amidst a stony silence of sullen concentration.
PAGE THIRTY-TWO SPECULUM 196 b
The nightmare of annual examinations is passed and full of new hopes, but ex- hausted, you collapse into the Christmas vac.
Next March you walk proudly past the 'Anatomy Students Only" notice as if it were the thousandth time, and pull on a white coat freshly starched and laundered (now an important status symbol that you don at all rags, flour fights or other campus rumpus). Full of composure you swing open the dissecting room doors; Anatomy
is not for you. But within the hour the Impossible task of finding the cutaneous nerves of the anterior chest wall has so absorbed you that you have begun to adjust.
For those that have seen "Doctor in the House" (an important vocational motivating force, no doubt), the first Anatomy lecture restores hope — for here, in real life, is all the tradition and atmosphere of medical teaching, just like the film. As the markings On the clavicle are delineated you flounder, for even if it is a clavicle and not a first rib, it is so delightfully smooth that the markings do not exist. Now you realize you have been had — the nice clean set of bones, that looked so much better than the
"horrible knobbly ones" flogged off to the Year mug, are not worth a cracker. But still they have some value — at parties, or in the caf.; what could be better than a duffle coat pocket full of femora, humeri and vertebrae, or how could you fail to Impress, when boarding a tram nonchalantly carrying a skull by a forefinger inserted through the foramen magnum.
Physiology seems a friendly place, but somehow you feel that the endless variety of things that can be done with a frog's gastrocnemius and a revolving drum of smoked paper begins to lose its interest.
Most took delight in the smoky benzol burners and missed the whole point of the day's experiment.
It would be wrong to suggest that our second year student is not fascinated by the new realms of knowledge opening out before him, but with the panic of the previous year left behind, a new phenom- enon appears. Namely, "the word of a good turn tonight", how someone chundered dramatically last night, or whisked away some steamy bird in a way that commands
°Illy respect and admiration from all.
SP ECULUM 1964
Yes, sex and booze have made their ugly appearance and parties, balls, sherry gatherings, the Med dinner and Medleys all cater for this requirement. The scathing indictment of "conchy" or "pounder" is flung around indiscriminately, and must be too much to take, since it is pretty success- ful in getting new recruits. Even those too sick from last time must smile nauseatingly and return to the "fun".
You are still overplaying the role of carefree, gay medical students and casual clothes, pipes and counter lunches flourish.
This period of conditioning in fact sets a way of life and thought that tones the rest of your days. Although not in the Handbook, it is as much a part of the syllabus as Anatomy.
Rumours about the short, difficult third year have prepared you and, although you haven't changed inside there is a consider- able dampening influence now.
The prospect of starting clinical work is most appealing and is enhanced by appetis- ing glimpses at a few demonstration sessions. Even the scruffiest appear in immaculate suits, white shirts and ties for these half-day sessions; here starts the concept of the well-dressed but internally rebellious individual that lasts through the clinical years. To avoid "being picked", the old uniform of jumper, open-necked shirt and cords quickly replaces this sartorial saunter.
The first experience with living mammal- ian tissue in physiol. prac. sorts out the prospective surgeons; most see their first pair of Spencer Wells — "They're not scissors, are they?"
On arrival at the teaching hospitals you may be impressed by the short white coats and may not realize they convey a strict hierarchy, with suits at each end of the scale and a graduated coat length with various addenda — "tubes", "hammers", and "lights".
It is great fun at the first few clinics until a dreadful expose of your ignorance puts you back in your place. The traditional mode of clinical teaching, whereby the clinician roasts the most likely-looking student is quite unlike the preclinical days, where you imagine yourself and lecturer or tutor as roughly equal, sharing a common
PAGE THIRTY-THREE
interest in a particular discipline like "fellow learned students worth listening to".
As your skin thickens, these occasions become an unperturbing part of the day, but soon you appreciate the marked class consciousness of the big hospitals. It is with some dismay that you discover that the most junior nurse considers you an ignorant peasant; she is apparently unaware of your three years with physiol., anatomy and biochem., but it makes no difference when one trembles with a sphygmomanometer cuff and bungles the most minor clinical procedures.
It may seem worthwhile when someone in Outpatients calls you "Doctor" for the first time, but this temporary inflation is burst when the clinician scorns your history taking technique and destroys your patient's respect for you at the same time.
Now you feel that the course has really started; pathology deals with some tangibles and patients are at last a reality.
Learn to tremble when the great clinical gods enter the room, and to give the appearance of rapt attention as you dream of the last Vac. at Surfer's (for that, surely, is an important part of the course, too!).
Now you discover that Medicine is not science alone, but also an art: "clinical experience" is the final word and if your previous years of training scream "Rubbish!"
you should stay silent.
At this stage visits to theatre rapidly dispel previous notions of T.V. type
surgeons, gripping dramas, parents and spouses weeping outside the glass doors, even gun battles and psychiatric emergen- cies. In fact, an obsessive-compulsive army of assistant personnel, arranged in an elaborate pecking order, terminates with wide-eyed students at the bottom.
"Path and Bugs" over, fifth year brings full time clinics. But it is not all you imagined it to be, for when you reach the
"Women's" you discover that the crew has not changed much at all since pre-med days; maybe there are a few more wrinkles and people get less sleep, but otherwise they are about the same.
There are, however, some real changes:
casual dances and "conning" have some- how been lost, and whilst most settle down with wives and girl friends — engaged or not — the others retreat from exactly those things that have captivated their colleagues.
You are slowly hemmed in (sometimes literally) by blisses with strings attached.
The fleeting encounter is now a relative rarity.
I cannot peak personally about finals, but it does seem that the big goal is within reach. Indeed, with this stimulus some remarkable bursts of enthusiasm have been known to occur in the most unlikely people.
What do the residents say about the new life once the golden hurdle is passed? "It differs from finals only in that there's more bloody responsibility".
PAGE THIRTY-FOUR SPECULUM 1964