Christopher Frank, MD, FCFP, CCFP
Queen’s University, Kingston, Canada
|The Glasgow Royal Infirmary|
We know famous hospitals for the care they provide,for eminent physicians who have worked in them, or for their architectural heritage. Hospitals are rarely famous for their patients. The Glasgow Royal Infirmary dates back to the eighteenth century and is best known as the place where Sir Joseph Lister studied antiseptics. In addition to its long and notable history, it stands out in my mind as a unique institution because of the patients who come to its doors.
A few months ago, my hospital in Canada put up glass barriers at our nursing stations to keep staff discussions confidential. Seeing the partitions triggered memories of 1987, when I was a Canadian elective student in the Casualty Accident and Emergency at the Glasgow Royal. While I was on placement there, similar glass barricades went up, but for a much more malign reason. Drug addicts had been progressively more aggressive with the triage staff, so glass walls had to be erected to shield the nurses. Hospital maintenance staff then added to the renovations; a small roof was added to the top to deter irate patients from climbing up and spitting down onto the horrified staff members. Like the addicts, many of the patients I met at the Glasgow Royal were living in difficult circumstances. However, most of them displayed the resilience and humour that the City is known for, and the hospital seemed emblematic of the spirit of the entire city.
The Glasgow Royal Infirmary was originally built in 1794, with additions added throughout the nineteenth and early twentieth centuries. The building was a labyrinth, and I remember getting lost trying to get to the cafeteria and library on several occasions. There was a large modern part built a few years before my arrival, but most of it seemed very old to my colonial eyes. In the 1980s, new hospitals in the NHS (National Health Service) seemed to be designed to look dated at time of completion. It looked to me like the NHS was on the verge of collapse, and I learned a lot about how patients (and staff) are affected by basic things like cleanliness of corridors, poor lighting, coarseness of toilet paper (noted by most people to be similar to grease-proof paper), and the quality of the meals.
Current online reviews of the staff and visitors’ cafeteria at the Royal describe the food as “dodgy.” I remember food that was much cheaper than in my home hospital in Canada. Happily for me, the menu usually included desserts that were familiar from my Scottish-Canadian childhood, but would never have appeared in the offerings at a Canadian hospital (when was the last time you saw apple crumble with custard on top in your North American cafeteria?).
The neighborhood around the hospital was quite poor on three sides and relatively affluent to the west. The older parts of the Royal looked out onto the Necropolis, a large cemetery now listed as a destination on Trip Advisor, but looking and feeling as foreboding as its name back in the 80s. It did not look remotely enticing when viewed from the dimmer parts of the GRI, and most of the staff warned me about venturing in except in full daylight. There was a long list of additional “no-go” spots in the vicinity and many of the local denizens hanging around these forbidden spots eventually seemed to show up in the Casualty A & E.
Compared with the hospitals in the university town in southwestern Ontario where I was studying, the Royal cared for truly Dickensian characters. We saw people hit by bricks thrown through bus windows at 7:45 a.m. (who would do that, and why would a person who might consider throwing a brick be up so early in the morning?); several people who had been assaulted with hammers (thankfully not a weapon used with any regularity in Canada); and the occasional wounded victim of a straight razor, the old-school Glasgow street fighting weapon. One of the “hard men” brought in to be stitched up after a razor fight (“Ye’ should’ve seen the other fella’”) fainted when given his tetanus “jag”!
Glasgow is famous throughout Scotland for its tough and pugnacious citizens but also for the Glaswegian wit. Many of the patient encounters had a Billy Connelly feel to them, with frequent use of “swearie words” and much ribaldry. My favourite patient was the fellow who came in to be stitched up after being mauled by his dog. The man repeatedly muttered “I don’t understand it, I wiz jes’ sitting there and the dug went wild,” when his wife picked him up she said to us, “I told the stupid bastard that this would happen if he kept kickin’ the dug.” Another fellow came in having just chopped off his last fully intact finger with a power tool. He moaned repeatedly, “Oh, what wull ma’ wife dae when she hear o’ this?” The effects of generational poverty were more evident than in any other place I have worked. However, my recollection is more of wit and resilience rather than despair.
I was frequently amused when ten minutes into an interview the patient would turn to me and tell me, “You’re no fi’ Glesca, are ye?” Although hard to transcribe into the written word, English usage in Glasgow is famous. The local “Patter” requires translation for North American English speakers. Classic examples heard daily included; ‘Big Man’ as a title for anyone the speaker did not know (including the senior registrar and other doctors), ‘gallus’ (arrogant, as in “That English doctor’s right gallus, the bas”); ‘chibbed’ (stabbed, “The big polis brought me tae the Royal effer I wuz chibbed at the Saurrie Heid” (the Saracen’s Head—a well-known pub)). When I returned home to Canada, I could always use an example of Glasgow Patter picked up at the Royal to amuse my Scottish-born parents or confuse my friends.
Echoing the Scottish independence referendum, I recall a mini-referendum going on in the Casualty A & E over whether to kill the senior registrar or let him live. He was an old-school Englishman, lording it over more junior Scottish residents. All the “auld” resentments between the two nations were lived out each shift, with black (and somewhat caustic) Scots humour winning out. I wondered for some time afterwards what happened to the senior registrar—whether he ever finished his position and left the Royal or if he got “malkied” (slashed with a razor) or “got a doing” (beaten up) by one of his patients or by a member of the junior staff.
The film Trainspotting made Scottish drug addicts famous (even if they were Edinburgh addicts) and characters similar to Spud and Sick Boy loom large in my memory of the hospital. The ever-higher barricades, the escalating antics of the addicts, and the frustrations and very real fears of the staff reflected the bleak spirit of the age. The addicts were certainly the bottom dwellers of the lowest part of society and were viewed disparagingly by many of the other patients. Despite their pernicious reputation, I often appreciated the dry, and usually black, humour shown by many of the addicts. It is easy to forget how hospitals were affected by the fear of HIV, before effective treatment became available. At the Royal, the HIV and the intravenous drug crisis of the eighties produced innovative forms of hooliganism in the A & E ward. Despite all the challenges faced by the hospital in the present economy and political landscape, I cannot imagine the patients could be living in situations as impoverished and harsh as at the time of my visit.
My rotation at the Glasgow Royal Infirmary was one of the highlights of my medical training. Scots love stories, and the place provided me with a plethora of tales to bring back to “America.” I imagine a clinical clerk’s experience there today would be quite different from mine. I am sure that there is still plenty of violence and penury but many of the people raised in the heyday of traditional Glasgow culture are “deid,” and, like in most places, replaced by a less unique society. A better writer than I could capture the elegiac feeling that physicians experience part way through our careers, when a distinct group of patients we cared for as young docs die off and are replaced by people with experiences closer to our own. In North America, the stoic farmer or smart aleck urban wise-guy are less common in my practice, replaced by a more homogeneous group of patients.
I would love to go back and visit the Royal, and maybe wander around the Necropolis (at night!) while I am at it. It would be great to chat with a visiting student too. For them, the downtrodden in the A & E are likely as funny, exasperating, and memorable as they were to me.
Christopher Frank, MD, FCFP, CCFP, is a family physician with additional training in care of the elderly and works as an associate professor in the Department of Medicine, Queen’s University. Despite living most of his life in Canada, he is still a proud Scot. His focus is on geriatric rehabilitations and palliative care and he enjoys exposing medical trainees to the humanities whenever possible.