Extracts and Tasters published SUES Forum October 2021
Man is distinguished from all other creatures by the faculty of laughter
Joseph Addison, 1712
This collection draws on over forty years of of observations and experience as a consultant physician and the rich variety of characters colleagues and personalities that I have been privileged to encounter.
Medical interations reflect the extraordinary range of individual quirks, foibles and mannerisms of professionals and their patients. Most of us receiving medical advice prefer our clinicians to be capable and proficient, yet able to deliver services with a smile. In medical practice, the emotional pendulum can oscillate rapidly between the deadly serious, the deeply moving and the poignant, at times swinging into the irresistibly funny or the frankly comic. Humour comes with plenty of scope for misunderstandings, but for many is a welcome, sometimes inspirational tool for psychological survival, capable of lightening the load and lifting the mood in life’s darker moments.
Meet the Author
Born in Sheffield, I qualified at St Mary’s Hospital, Imperial College London and held posts in London, Dublin and the Nuffield Department of Medicine, University of Oxford, then consultant physician and later clinical director of Medicine at Aintree University Hospital. Transitioning towards retirement, I acquired an MA History [Chester] and a PGCert Psychology [Liverpool]. I am a Fellow of the Royal College of Physicians, London, where I interview for the oral history collection.
The author in the Chester Storyhouse ‘Reading Chair’
Early Promise
Aged seventeen and faced with the A-level Zoology practical examination, I sensed the presence of the bespectacled, tweed-suited examiner observing my dissection performance. With a twitch of an eyebrow, he whispered, “did you use an axe?” Rising anxiety only partially allayed by the faintest hint of his suppressed smile. The exercise required demonstrating dexterity with scalpel, surgical scissors and forceps, to display the anatomy of the branchial arches (gills) of a rough-skinned lesser-spotted dogfish. An ugly brute of a specimen, preserved in acrid, sneeze provoking formaldehyde - my least favourite part of the curriculum.
Primitive members of the shark family, dogfish are common in British waters but less valuable and nothing like as tasty as haddock or cod. Often sold in fish and chip shops as the euphemistic, more palatable-sounding rockfish, or more optimistically as ‘rock salmon’.
Royal Marines can do anything
Doreen looked up from her hospital bed with a confident and knowing smile, sitting up to reassure the ward-round team not to worry, as her former Royal Marine brother ‘could do anything’. An ex-wartime Wren she had an unshakeable belief in the capabilities of Her Majesty’s marines.
Short-term memory patchy, with legs refusing to coordinate as once they did, she was slowly and shakily, rehabilitating from pneumonia. The physiotherapy assessment did not sound promising, ‘not safe on stairs and borderline for independent living’. Her discharge was cancelled and replaced by a home visit to assess safety in her more familiar environment.
The front door swung open to reveal a rope terminating in a noose, swaying ominously in the hallway. The senior therapist, pulse rising and mind racing, struggled to make sense of the scene as warning signals from the Caring for the Carers course flashed through her brain. Where was the brother? Stressed relatives do funny things – but surely not?
The former commando and colour sergeant, now eighty-five, retained a sturdy physique and emerged onto the landing wearing an HMS Ark Royal heritage polo shirt. Expertly and nonchalantly, he demonstrated his home-made hoist, rigged with a leather sling, tailored for Doreen’s sizeable torso. Patiently explaining that, as she was “not too good on her legs”, he used a ship’s block and tackle to haul her upstairs.
Baffled alarm melted into smiles of relief as Doreen beamed, looked at her brother admiringly and announced how happy she was to be home.
Passing through at Park House
Father Gerard O’Keefe had felt increasingly unwell through a busy weekend of masses, baptisms and a long-awaited wedding, that neither he nor the bride wanted to rearrange.
By Monday the irritating dry cough, annoyingly amplified by the microphone clipped to his vestments, had loosened, resulting in sticky green sputum discolouring his newly laundered white handkerchief. Feeling hot and shivery, he was now sweating profusely.
A call from the lab reported a high white cell count, and a look at the chest X-ray revealed an unmistakeable area of bronchopneumonia in the left lung.
After admission to Park House, his temperature continued to rise. At four in the morning, drenched in sweat, he experienced a bed-shaking rigor when the thermometer exceeded 40°C. The delirium peaked in the dead still of the graveyard shift, as a heavy-lidded night nurse sipped tea in the ward kitchen, hoping to stave off an overwhelming urge to close her eyes. Her reverie roused by a voice reverberating through the sleepy silence of the corridor; “Call the Archbishop and tell him I’m dead.”
At eight o’clock the ward bustled with activity as the night shift handed over to the day nurses, breakfast was served and those fasting prepared for theatre. The intravenous antibiotics had worked their magic and Father Gerard’s temperature had fallen almost to normal, even better his mind was clear. Sitting up in bed with tea and buttery toast, as the nurses jokingly teased about the nightmare, he retorted. “Quick, ring the Arch and tell him O’Keefe is back.”
Lexical gremlins invade medical letters
Unintended humour has long featured in consultant letters to general practitioners. An ill-fated, short-lived managerial exercise, outsourcing dictation from NHS hospitals to faraway typing pools in South Asia, produced a spectacular increase in lexical creativity.
We have identified the Euston Station Tube problem (eustachian tube)
There is a suspicious noodle in the left breast (nodule)
Her persistent horse voice requires laryngoscopy (hoarse)
The patient will be listed for a boloney amputation (below knee)
The polyp looks eminently respectable (resectable)
A fragment of stork remained after uterine polyp resection (stalk)
The helicopter by lorry test proved positive (Helicobacter pylori)
Some super flea bites in the left leg (superficial phlebitis)
Letters from Mental Health
seem especially prone to linguistic misunderstandings
The patient has two teenage children but no other abnormalities.
His paranoia is quite well controlled. The chip on his left shoulder balances the chip on the right.
This patient has been depressed ever since seeing us in 1991.
Murmuration of masks
17th Century Plague Doctor | Wellcome Collection London
Earlier generations would have been bemused by the outsized notice displayed on the anti-Covid Perspex shielding reception: ‘This Trust has a zero-tolerance policy towards verbal or other abuse of hospital staff.’ The message hammered home by a graphic, offering offenders the choice of NHS or Police. Its starkness contrasted by a cheery uplifting poster from Rosie Regan of St Julie’s Primary School, featuring a rainbow above ‘We Love our NHS’.
A murmuring hum of hushed voices emanated from behind the masks of the assembled patients. All looked orderly behind their masks, as they waited to be summoned into clinics for Haematology, Chest Medicine and Oncology. The most popular face coverings were blue surgical paper masks, then the solid black or whites, amidst which were some colourful fabrics printed in geometrics or nature themes. Some contained football logos and an occasional entrepreneurial message: Helta Skelta Taxis, and Clare Hair Care. A smattering sported more elaborate masks, some with air filtration devices, over which the extra-vigilant had positioned visors.
Only one was not wearing a mask, its absence explained to the staff as a medical exemption because of panic attacks. Some were far from perfectly positioned with exposed noses, while others slipped them on and off when talking. A teenager, compulsively eager to avert dehydration, lifted hers every few minutes, sipping from a litre bottle of sparkling water. Others made adjustments to accommodate lattes or cappuccinos, from polystyrene containers. One young woman, with a palm-tree-themed, satin designer mask, Doc Marten boots, pink leggings and a vivid mini beach-dress – displaying her impressive tattoos – announced her arrival from a holiday sunspot.
Heads turned and conversation ceased, as the phlebotomist, pressed a buzzer then flashed number sixty-six onto the screen. A man briskly stepped forward, but dejectedly returned to his seat after the ‘phlebo’ examined his ticket, turned it the right way up and pointed to number ninety-nine.
Where’s the doctor?
As doctors were absorbed into the armed forces in World War II, medical staffing in large
mental health hospitals, already precariously thin, became stretched to skeletal levels.
Case record entry September 1939
The patient appears to be sinking slowly
Case record entry May 1945
Still afloat
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