Hektoen International

A Journal of Medical Humanities

Unequal encounter: An initiation

Hugh Tunstall-Pedoe
Dundee, Scotland

In October 1961, I started at Guy’s Hospital Medical School in London for three years of clinical training. I was at the very bottom of the clinical hierarchy and put straight onto a surgical ward as a first-year ward clerk responsible for clerking admissions, junior to the third-year senior dressers on the same service, some of whom lorded it over us. I had been shaken on my first day, holding open a door for two pinstriped gentlemen, to have them sweep past as if I was invisible.

Woe betide the ward clerk who did not know his patients. Two weeks after starting, the student gauleiter allocated me a young woman with a renal cyst. The senior registrar said that I was to present her case next Saturday morning to a very distinguished visitor, Sir Clement Price Thomas, who had operated on King George VI for his lung cancer, and who had had surgical instruments named after him. He was also well known for failing FRCS candidates. So watch out! I took my history, studied Hutchison’s Clinical Methods, and tried to reassure the patient.

Front seats in the steeply shelving demonstration room were occupied by pinstriped consultants, and the back seats by senior medical students, also in formal dark suits. I began my history. The patient had been cutting out a dress on the kitchen table when she was hit with such a violent and sudden pain in her right loin that she had thrown the dressmaking scissors across the room. (“Good boy!” from the front row.) “She has never smoked, and she does not drink very much.” “Oh,” said Price Thomas, “No. That is not so good. I am not satisfied with that. What do you mean? Tea? Water? What are you talking about? Be specific, man!” I cannot remember if the digging in the ribs I was getting was mental or physical also.

I collected myself, “Well, sir, she drinks port on festive occasions.” The room dissolved into laughter and applause, and the students in the back rows thunderously drummed their feet on the wooden decking beneath them to show their support.

“Show me how you examine the abdomen.” Hutchison insisted on an essential piece of equipment. I looked round with anxiety. The patient and nurse attendant were expecting my approach. I opened the door to the anteroom. “Hey, where are you going?” called Price Thomas, amid titters from the audience. “To get a chair,” I replied, disappearing and emerging a moment later with my trophy, to a round of applause.

Thereupon, mindful of my instructions, I placed the chair up against the patient’s couch and sat down, leaving Price Thomas standing…

Pandemonium ensued, laughter and applause mixing with the thunder of drumming feet. Dignity—my own, the patient’s, and the distinguished visitor’s—demanded that I continue regardless, but I could see that this rumored Welsh ogre had a twinkle in his eye and was having the time of his life.

He held up his hand for silence, as if blessing the audience, questioned me, and teased me gently about my unorthodox technique. I had examined the abdomen—with my chair—from both sides of the bed. He replaced me in the chair to do his own examination, dismissed me while he discussed the X-ray findings, recalling me later with “Where’s my young friend?” for further questioning before thanking me, and leading the applause as the tribal drums welcomed my return to the back of the room.

It was an unexpected initiation, at times rather puerile. But after that Saturday I discovered that I had lost my invisibility, receiving conspiratorial smiles and nods in the corridor.

And I no longer believed in ogres.

Reprinted with permission, and with some rewording, from the BMJ (British Medical Journal) 1998, volume 316, issue 7135, March 21, p. 920.

HUGH TUNSTALL-PEDOE is emeritus professor of cardiovascular epidemiology in the University of Dundee, Dundee, Scotland, UK.

Winter 2024



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