I had somehow got through the surgical pre-registration six months not quite killing anyone, even the aforementioned Mr X, as far as I know. I didn’t shine as a medical house officer either, in the second six months at the Hereford County Hospital, but I didn’t want to. I was just grateful to have been so thoroughly ‘blooded’ that nothing was likely to throw me again. All I wanted was that I and my patients should survive and I wouldn’t have to face the coroner or my consultant. My terror was much greater in relation to them than the slightly unreal idea of a patient dying as a result of my ineptitude, but I guess that was a form of denial that had allowed me to continue working in the previous job.

My second six months, with an acute medical team, was a good deal more civilised. It took place in the other hospital in Hereford, the County, about a mile away from the General. There were several more doctors and specific casualty SHOs during the day, though we were still on call at night. We were nominally responsible for emergencies out of hours in the children’s ENT and paediatric wards, though thank goodness these were very rare and we were always backed up immediately, both there and with any minors in casualty, by the paediatric team. It was almost certainly safer to be a child than an adult!

There were also good things about it all. I remember that some of the patients and things that happened to them were at the time very funny, but not really in a repeatable way. The laughter was lavatorial, infantile, inappropriate and magnificently politically incorrect. Laughing into hiccuping hysterics, hopefully out of the patient’s hearing, was a marvellous release from tension and the only stress-buster available most of the time.

I remember a patient who asked when meeting me the morning after a night admission, “But where’s the night doctor?” In fact, a lot of them asked this and were absolutely incredulous at the hours we worked. I remember this particular nameless lady because when I said how much I loved the lily of the valley flowers on her locker, she described where they grew in her garden and promised me some when they finished flowering. Sure enough, a few weeks later, long after her discharge, I had a big parcel of roots. I don’t remember what I did with them and I’m sure in my hectic life I didn’t write and thank her. I lived in a very small single room in the hospital residency and of course, had no garden, but you don’t forget a gesture like that. Wherever I have lived since I have bought and planted lily of the valley roots and thought of her.

Later on, when I became a lecturer in the Academic Department at the University Hospital of Wales, I remembered those first days as a junior house officer and used to tell my students to imagine the day they would start on the wards for real. “You’ll find yourself standing by a bed with a collapsed, unconscious patient,” I would tell them. “There’s a team of people around the bed. You’ll look around to see who is going to take control and you’ll suddenly realise that they are all looking at you.” The students would turn slightly green and become very thoughtful.

Another good thing about Hereford was that the drunks rarely caused violent problems, unlike most town drunks. The local cider seemed, for habitues, to induce a deep slumber, usually in the fields or on the grass verges of roads. The tougher men might wake and stagger into casualty with an almighty hangover, or the less tough be brought in after being run over by tractors, but there were not so many argumentative drunks on beer. The aggressive potential of pigs, drunk or sober, was another matter; we got a lot of nasty pig injuries. All sorts of wild and bloody accidents happen in the country, not surprisingly considering the murderously sci-fi nature of most farm machinery.

Roger joined me in Hereford for this second six months. He was doing the surgical job I had just finished. There was virtually no concession to married house officers in those days; you were not expected to be married and my room was tiny, with a single bed. After a lot of badgering, a second bed was put into a little flat opposite the General Hospital and Roger and I were allowed, as a special concession, to live there instead of in the tiny residency or apart. Another couple, both Sri Lankan, lived in the flat downstairs. There was no telephone in the building and the porters absolutely hated it because in the evenings and nights they had to come over, let themselves in, come to the bedroom and shout to wake us up. Not much fun for us either. 

Is it any surprise that when I became a committee member and then Chairman of the Trades Union, the Junior Hospital Doctors’ Association, I spent a lot of my time shouting at administrators about junior doctor facilities?

The range of crises on the medical wards were fewer, or maybe more predictable. I do remember on one occasion diagnosing a rather rare heart condition and the astonishment of the registrar. “I’m not a total idiot, you know!” I said, a bit miffed. His expression said it all and I reverted to my usual submissive quietness. Heart conditions were what I had failed the first time around in my finals and I had overlearned them to the point of moderate expertise.

In the second term of pre-reg work we had fewer on-call shifts, though ‘less’ is a relative term. I was more likely to get my night off a week, as there were more of us around and we only covered the Casualty Department out of hours. There was even the very occasional trip into Hereford, to the pub of an evening or, in the day, to the Coroner’s Office. Nothing to do with my faults you understand; we had a lot of geriatric patients who succumbed from natural causes.

I remember one real character. He was a Mr Smith, the head of a huge clan of local gypsies. He came in regularly with terrible chest infections and would be in an oxygen tent for a few days. You knew when he began to feel better because he would try to light up a fag in the tent. It was everyone’s duty to look out for this and dive across beds and lockers to prevent the ward from being blown up. 

I spent some time talking to his elderly wife, who took a bit of a shine to me. She told me one day how to cure a child’s bedwetting. “You try the juice from dandelion stalks first,” she said, “and if that don’t work, take a mouse, skin it, boil it up and take out the bones. Sew them into a bundle in the skin.” You were then supposed to put the little bundle under the child’s pillow. “Never fails!” she ended emphatically. I never tried it as a Child Psychiatrist, though it ought to be a useful remedy. I guess a sensitive child would never sleep in the bed again on finding the gruesome thing, so it would be a sort of cure.

Mr Smith died one night and I was called over first thing. As I crossed the yard towards the ward, the whole clan, led by this matriarch, was just coming out. Seeing me, they changed direction and marched as one towards me. I had a moment of seriously wondering whether there was an old gypsy custom that involved massacring the responsible medical officer and if I should take flight. Fortunately, they only wanted to thank me, and all of them shook me by the hand and passed on. Phew!

Another slightly alarming incident occurred on one of my rare trips out of the hospital. I turned at a loud shout and saw a large group of youngsters on motorbikes chasing me. Before I could panic, I saw that the front guy was waving his hand in the air and grinning from ear to ear. He had come off his bike some weeks earlier and badly injured his hand. He just wanted to show me what a “lovely job,” [his words] I had done on amputating the tip of one hopelessly crushed finger. 

This takes me to the end of that incredibly tough year in Hereford. I can think of no better way to finish this account than with a tribute to the many kindnesses that we junior doctors exchanged under these incredibly hard conditions. This story is from those first 6 months—and it illustrates what helped most of us to survive.

On my very first evening at work in the County hospital, there had been a ‘patient collapsed’ urgent call from the ward. I had got up, trying to conceal my panic. The outgoing doctor stretched casually. “My last night here,” he said. “Nothing on telly. Do you mind if I come up too?” Tactful man! I had assured him that I had no objection to him amusing himself in this way and watched in admiration as he tipped the bed head down, checked the vital signs, prescribed, then allowed me to take over when the crisis was past, with no loss of face. 

Six months later on my own last night, crisis over and replacement doctors in place. I was having a last evening in the residency with the new young man. A radiographer rang to say there was something really strange on an X-ray, like nothing she had seen before. Recognising the fear in his eyes, I pushed aside my plate and said, “Mm, that sounds interesting. Mind if I come along too?” and we went together. My experience told me that I wouldn’t have a clue what was on the X-ray, but I would know something much more important—whether we should disturb the second on-call or wait till morning.