Doctor, doctor

Iain McGilchrist

Jonathan Gathorne-Hardy describes the practice of a woman doctor working alone in an inner-city wasteland:

The receptionist was replacing a lavatory seat when we arrived. The other had been torn off. So that I could be shown round, a cupboard was unlocked and inside it was a small metal wall safe. Inside that, row upon row of keys. It was like visiting a gaol ... It was an old house, all the doors were toughened against fire and break-in. The glass in all the downstairs windows was unbreakable. ‘You can’t break it but you can heat it and bend it. We came one morning and the windows were buckled – so. Another time they picked the putty out of the windows and the glass fell in’ ... We went upstairs. The windows here had metal grilles. The whole of the back was encircled by a high stone wall, along the top of which were dense coils of barbed wire. A sizeable wedge of new masonry showed where there’d been a recent collapse – or a break-in. ‘They drove a lorry at it. Partly after drugs, partly vandalism ... We put that non-dry paint on the drainpipes so that when they put their hands on it, they get their hands all wet and slip. That kept them off for a while.’

The patients vandalise the surgeries, flood the lavatories, soak the prescription pads in brake fluid so that they can substitute the names of narcotics, and sell their drugs on the black market. Here among the wrecked cars and the rubbish, the prams are padlocked to iron bars while mothers – those few that can be bribed to come – attend an ante-natal clinic in a small damp room with paper peeling in a large curl down the edge of one wall. The doctor herself, when out on her rounds, a lonely figure on a night call, may – like others of her colleagues – be assaulted, or even killed, for the contents of her black bag.

One of the sixty or so GPs interviewed by Gathorne-Hardy remembers practice in the East End of Glasgow in the Twenties:

At night, walking through the slums of the Gorbals, it was scaring because it was the time of the razor-slashing gangs. They’d slash from ear to mouth. I was never attacked, never. You had your little black bag in your hand and it would take you anywhere.

My father, who worked in the slums of both Glasgow and Dublin twenty years later, remembers the same thing: the chain-wielding gangs escorting him to the seventh floor of a tenement building, while a ‘guard’ was placed on his car outside. But doctors make few visits anywhere now. Perhaps it is only in the relatively civilised conditions of the African bush that a doctor is still safe. There the patients, referred, as one GP recalls, by ‘about sixty witch-doctors’, regularly travel as much as a hundred and fifty miles over impossible mountain paths, on an old donkey or in a wheelbarrow, to receive pills which they then distribute to their friends in the hope that they are aphrodisiacs.

Until not long ago you could become a doctor, as indeed you could become almost anything, on the say-so of the Archbishop of Canterbury. Now that this humane custom has fallen into disuse, doctors have to spend years studying the intriguing arcana of science. But the work has always been hard, and it is still scarcely what one would call technical. Until the Second World War, it was largely a matter of comforting and consoling, so few were the diseases that could be treated by drugs. Now it is still largely a matter of comforting and consoling, but for the opposite reason: so much acute disease has, at least for the moment, been banished. It must have been rewarding to be a doctor in that brief period between about 1940 and 1960, and to go around actually curing people, but this extraordinary state of affairs will probably not recur. Many of the doctors who remember it still have a quite different attitude to prescribing from that of their wary younger colleagues.

Nowadays people take fewer organic diseases, and more social and psychological conditions, to their doctors. Those organic conditions they do bring are usually chronic, and harder to treat. They bring them earlier than they used to, which makes diagnosis more difficult. They expect more immediate and more dramatic solutions. The doctors – the general practitioners, that is – have insufficient diagnostic facilities, insufficient staff, insufficient time, insufficient training. They prefer prescribing to listening. Many of the rewarding and stimulating aspects of general practice – home deliveries, minor surgery – have been removed to experts. The doctors, left with only intractable social and psychological problems, chronic diseases and dispiriting trivia to treat, are themselves the victims of stress, tending to alcoholism and suicide. These are their problems as the doctors themselves voice them.

It is impossible not to be struck by such reminiscences: delivering babies on straw, washing your instruments in chamber pots; leaning out of the pony and trap to chat to labourers in the field; calling at the farm and being offered endless cups of tea – requiring frequent stops behind the hedges; surgeries in a converted stable (three on weekdays, two on Saturdays, one on Sunday), with two consultations going on in the same room; patients strapped to the kitchen table in case the anaesthetic wore off – rough, but, if nothing else, more memorable than hushed consultations in airless health centres just off the High Street. The patients were another race, too: miners sitting on their ‘hunkers’ in the waiting-room, rather than sit on the unfamiliar chairs; poor families of Glasgow sleeping in relays, eight in the bed and 16 on their feet; a coffin on the table with the remains of breakfast around it. One doctor remembers an old couple in a Medieval farmhouse who never washed at all:

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