Ann Y Coxon

Am I the only one still working ?

The problem with looking back is the perspective into a past that was so different, a present where you no longer fit in, and a future that is therefore unrecognisable.

I remember at Guy’s being taught compassionate, person centred, clinical medicine at a very high standard. Reflecting such borrowed feathers I was spontaneously offered teaching jobs at Johns Hopkins and Cleveland in the US so the brand was seen as valuable.

Today the explicit requirement of a Doctor is to be protocol driven, to work in teams that never see the same patient twice, and yet somehow adequately manage multisystem disease in the demented, language compromised frail humanity in front of you.

Patients love it that I can remember issues of drug allergy, previous investigations and minor illness they had forgotten because as a Guy’s graduate I was told the totality of a patients care is my responsibility.

Where I despair of patient care, I marvel at changing treatment options. A patient with TTR cardiac amyloid is back to playing golf on Vutrisiran, (cost £500,000 per annum, free on the HELIOS trial), hoping to be included in CRISPR trails where after one infusion with no side effects, he will have the same effect with no need for further treatment. Sickle cell anaemia, spinal muscular atrophy are no longer death sentences because of the same technology. But in  a world where starvation kills relentlessly, the cost of over £1 million for one life is questioned.

Because of cost, the rivalry of State v Private systems of care do not reveal that neither are adequate. Waiting lists in the State system have a mortality, and Insurance systems never seem to be able to pay for the treatment you need because of some small print, because they run on a profit motive.  There remains a serious problem in the delivery of care, which becomes a lottery.

It is sad to end a career of more than 60 years of active medical practice with recognition of an ideal not achieved, and a standard of careful practice learned from dedicated teachers that is now mocked by the NHS as a sign of arrogance. The banner has been passed to a new generation no longer interested in the values we thought important. But the intellectual momentum to discover the processes causing  illness reveals awesome progress inconceivable in the hallowed halls of Guy’s Hospital  1962.

 

News from Mike "Paggers" Pagliero

It is lovely that I will meet some of you again in September and though my blog of ten years ago. (see year of 1962 blog), covered my career story to that point there was life beyond that, which may or may not be of interest. I have always recommended Medicine as a career to the younger members of my family as it opens so many doors. Little did I know that such an option would present itself in my fifties!

My mortgage condemned me to have to work right up to 65 when suddenly I was challenged by the Regional Management with their efforts to revise the distribution of services and my unit was to be transferred to Plymouth. I was 52 and not warm to the idea of relocating with my children at local schools, being organist at my Parish church, membership of the local golf club and so I said “not on your nelly!”

However, I realised that the change was inevitable and I would have to lump it! At the time I was Chairman of the NACT and with that background I felt I had a good chance to get the S.W. Postgraduate Deans job when another olive branch appeared in that Guy’s had been asked to take over the training at the King Fahd Memorial hospital in Jeddah. I would be joined by Max Rendall, Senior lecturer from the Guy’s Surgical Department, the Guy’s Chief of Obstetrics,  a Paediatrician from G.O.S and a St Thomas’ Physician. A mouthwatering tax-feee salary was the inevitable decider and although I abandoned my family seemingly for a year, Anne actually joined me for nine months and each of of the children had a never to be forgotten holiday.

It was an interesting year particularly as my religion was against their law. It was educational but sad knowing of mass beheadings on Fridays and the bullying of the Mutawa (religious police) and the exclusion of women. As for the job it was a non starter – many Saudis lack a work ethic and it was  intriguing to find that emergencies always appeared in A&E during prayer time! I was not appointed to do surgery but did two oesophagectomies which were the only times such procedures had survived! However, they would not have, had I not stayed up all night, given the drugs, changed the drips etc etc etc. I then appreciated and missed the wonderful teamwork that I had enjoyed at the RD&E,

We could worship in the safety of the Consulate and, being a DIY situation, that too was interesting. The Bishop of Cyprus appeared on one occasion and that was a breath of fresh air! We avoided the city to a large extent but had to go shopping where alcohol was banned but grape juice, sugar and yeast were on adjacent shelves! Weekends were spent on an almost secluded beach (prying eyes in the distance avidly observed our bikini-clad ladies!) swimming and sailing Sunfish or Lasers. There was a golf course with ‘Browns’ (oiled sand) rather than ‘Greens.’

Overall it was an experience I relished but was pleased when it was over. It also meant that I could actually retire at 54 which had not been on my agenda. I sought a menial job in minor surgery at Exmouth Hospital but which clashed with my former General surgery colleagues as the DOH had introduced the principle of GP fundholders who could  purchase from providers. I was therefore the ‘enemy’! The RD&E refused to provide me an anaesthetist! Fortunately I had an anaesthetic chum from Taunton join me. Amazingly, the game changed a couple of years later and Hospitals had to achieve ‘targets’ and my former colleagues wanted me to ‘up my game’ and reduce their waiting lists! I was their friend again! A strange world we live in!

I only worked a couple of sessions a week which allowed me to be available to ‘International Medical Rescue’. That was a fantastic opportunity to travel the world Club Class with some time off to enjoy the venue. All the patients were nursed to fitness before their return so there was nothing to do for them. However, I was ‘identified’ and without the tannoy saying “Is there a doctor on board’ I found myself treating the ‘normal’ passengers for their sunburn and asthma and even the broken leg of an old lady who tripped on the way to the loo! Money for old rope but the downer was the rather disturbed sleep pattern with all the time zones traversed!  However, I  earned oodles of air miles!

Still not ready for retirement I applied to become an Appeals Tribunal Judge and with my Thoracic leaning found myself hearing claims from the lovely Welsh miners against the parsimonious Department of Work and Pensions. It was a privilege to support these hard working fellows'claims that had resulted from their unpleasant and dangerous jobs. I love those miners and I will mention one tale – an aged ex miner presented himself in an All Blacks Rugby Jersey. It was unnecessary to examine him as I had chest X-rays, scans and RFTs; however I had the option and asked to see him in the side room merely to ask him why he was wearing such a shirt to which he replied in his lovely deep Welsh dialect “I support two teams.”. “Which are they” said I? “Wales” said he.“OK” said I “and who is the other one” to which he replied  with a wicked smile “Anybody playing against England!!” Lovely guys – we owe so much to them!

Many wonder why I didn’t opt for retirement especially as minor surgery would be considered a little mundane after my experiences with Cardiac and Oesophageal surgery but the simple fact is I just liked being a doctor. Helping folk and earning their thanks and respect is lovely though maybe it was feeding my arrogance! As Chairman of the National Clinical Tutors one of my interests was the lack of training in teaching our juniors and subjects such as breaking bad news. I believe it is better now. I did get training, en passant, from a lovely Welsh surgeon in Bath who said “Never deny that anyone has cancer because they know!!” Instead he would always tell them they had a tumour which was ‘on the turn’. Without any deceit he had left them with ‘hope.’ One other lesson came from a gypsy who would knock on doors and offer to tell fortunes. He admitted that prior to calling he would go round the back of the houses and note the toys and clothes on the washing line to get a picture of the family which he would recount to the surprise of the occupant who was than prey to anything he might predict. He was not a villain and I had no hesitation in taking a leaf out of his book (and he did in fact write one!) If a patient came in I might, in a preliminary chat, learn for example that he kept bees. Immediately at the head of notes would be inscribed ‘Bee-keeper’ so that a year later I could astonish him with my memory!! Patient interaction was the pinnacle of all my jobs and even spread into the realms of the appellants in the tribunals I used to judge and was a far greater challenge than the routine of surgery.

I look forward to our reunion in the Borough now no longer smelling of ‘Hops’ and in its market minus the din of dropped boxes of fruit and revving lorries, the laughter of night porters and the merriment of a few students taking advantage of the rearranged opening hours of the local pubs! No longer can one acquire “Hamburger steak, Spaghetti and chips in” the Cathedral Caff. with Southern railway trains rumbling above the ceiling drowning the drunken post rugby conversation or the market by the station where one could buy fruit with a ‘sell by’ date’ within hours of its expiry. It is a ‘coming home’ for me having lived there as a student and a junior doctor over a twelve year period, lived in the renowned Trinity Church square, acquiring horse manure from the Met. Police stables in the Elephant for our tiny garden! Where I married my lovely Guy’s Nurse, had two of my children and christened one in the Guy’s chapel and within just a couple of miles my Father and Mother grew up, married in St Phillips church which is no more having been pulverised by Adolph Hitler and where even now hosts my Daughter who is a language teacher in the St Saviours and Olaves Girl’s Cathedral school just down the road from Guy’s where my Mother matriculated one hundred years ago.

The Borough  …...”Who could pass by a sight so touching in its Majesty!”

PS One of the problems of the oesophagus is that it is "shared" by the General, the Thoracic and the ENT surgeons, and in 1977, with my dear friend Hugo Matthews from East Birmingham we created the British Oesophageal Group, (affectionately termed "BOG"), to have annual meetings combining each of the specialties. It survives, 45 years later.