It’s often difficult for patients to tell who’s who in hospital or to tell the difference between a young -looking house physician and a mature medical student.
When I started on the wards as a clinical medical student, I had already qualified as a dental surgeon and had a bit more gravitas than my friends. I always introduced myself quickly as being a student.
This excerpt from my memoir ‘Woman in a White Coat’ describes my first day on the wards.
Listen to me reading this chapter or read it for yourself
Chapter 14 Mrs Roberts pp 191-195
We stood outside the Bristow female medical ward, stethoscopes hanging nonchalantly out of our pockets, about to start our clinical attachments to the medical, surgical and obstetric firms.
Through the leaded windows in the double doors, we could see Sister’s desk, and the nurses in their blue and white striped dresses busying themselves about the patients. We hesitated, uncertain whether to go in or wait for our senior registrar.
Dr Evans, a tall red-haired man, strode up.
‘Well, what are you all standing about for, like a load of twits? You’ve been taught how to take a medical history and carry out a full physical examination. Get inside and collect your notes. We’ll meet in Sister’s office in three quarters of an hour.’
He handed each of us a buff-coloured folder. My patient was Mrs Mary Roberts.
Sister looked up.
‘One of my nurses will take you to your patients. I don’t want you students making a nuisance of yourselves. No coming in before eight in the morning, lunchtimes or during patients’ visiting hours.’
A nurse led me to a side room and deposited me by the bedside of the most enormous woman I had ever seen.
‘Our Mary’s quite a character. You may need some help when you come to examine her,’ she told me.
‘Good morning, Mrs Roberts,’ I said. ‘I’m your new student, Abby Waterman.’
‘Don’t be nervous, girl. I won’t bite you,’ Mrs Roberts wheezed. ‘Call me Mary. No-one calls me Mrs Roberts here.’
I pulled up a chair, sat down by her bed, and looked through the thick sheaf of notes. She’d been in and out of hospital many times.
The first two fingers of Mary’s podgy right hand were stained brown.
‘You may well look, dearie. They say it’s because of the ciggies that I’m like this.’
She coughed wetly, and spat into the sputum cup by her bed.
‘I’ve given them up loads of times, but they settle my nerves, they do.’
I wrote out a summary of Mary’s long medical history, and drew the curtains ready to examine her. The male students had to get a nurse to chaperone them if their patient was in a side room. Being a woman, that didn’t apply to me.
With a lot of struggling on my part, and heavy breathing on hers, I managed to wrestle her nightdress off. I stared with horror at her enormous breasts. The apex of the heart is under the left breast, but each breast looked as if it weighed several pounds. How on earth would I get a stethoscope underneath? When we were shown how to listen to the heart, we’d had a slim, elderly man to practise on.
Mary smiled at me.
‘They usually get a nurse to help, dear.’
I hurried out, but all the nurses looked busy. Finally, I saw a nurse with a red belt, a staff nurse.
‘Of course,’ she said. ‘Just give me five minutes to finish up, and I’ll send someone over.’
I told Mary to cover herself, and meanwhile looked at her swollen hands and feet. When I pressed the flesh of her ankles, my fingers left a dent which didn’t fill again for some time. She was having trouble catching her breath and her neck veins were engorged.
‘Superficial examination suggests the diagnosis of right-sided heart failure,’ I wrote.
A junior nurse bustled in, her starched apron crackling against her dress.
‘I’ve been sent over to give you a hand.’
She tried not to grin as she lifted a huge left breast with both hands, while I struggled to get the bell of my stethoscope underneath. The skin was red and sore from being constantly warm and damp. There was a strong smell of caked talcum powder.
By the time I’d completed my examination of Mary’s cardiovascular, respiratory and nervous systems, I was exhausted. The notes said she weighed seventeen stone, but it felt as if she weighed a ton.
‘I don’t really get on with the stuff they’re giving me,’ she said. ‘The heart pills make me feel sick, and I have to have a wee every few minutes because of the water tablets. But you should have seen me when I came in. More like a barrage balloon, I was.’
A deep rumbling laugh turned into a coughing fit. When she’d got her breath back, she said:
‘What wouldn’t I give for a tub of jellied eels? The hospital food is all mush.’
Tubby Isaacs Jellied Eel stall stood at the corner of Goulston Street and Aldgate. The red-faced, cheerful stallholder in his signature straw boater, white coat and black bow tie, used to call after me on my way home from St Margaret’s.
‘Lovely jellied eels, miss. Cockles and mussels, Alive Oh,’ he’d shout, knowing I would make a face. Eels and shellfish are forbidden to Jews.
I felt sick at the thought of those grey slices of eel on his stall. I couldn’t imagine anyone wanting to eat the disgusting things, even if they weren’t Jewish.
Over the next few weeks, I watched Mary’s vast bulk shrink, as the digoxin and diuretic pills began to work. One day, as I was checking her over, she started to cry.
‘They’re going to put me in the geriatric ward at St Mildred’s,’ she sobbed. ‘They say I can’t manage on my own. I live on the fourth floor, and there’s no lift. I can’t get my breath, even to go as far as the lavatory.’
‘Couldn’t you stay with one of your children?’
‘I haven’t heard from any of my kids in years. None of them’s ever been to see me in hospital. Two of the boys are inside, and I wouldn’t want to live with any of the others, even if they offered, which they wouldn’t.’
On my way home from Aldgate East station that night, I went up to Tubby Isaacs stall. I cringed at the sight of those mounds of cockles and whelks and other seafood I didn’t want to identify. To one side there was an enamel bowl full of clear jelly containing slices of jellied eel.
‘I’ll have a tub of jellied eels,’ I said, breathing through my mouth.
I hid the tub behind my books, away from my mother’s prying eyes, and thought about Mary in a geriatric ward. If she was lucky, it would be clean and cheerful, like the one at St Margaret’s, but that was only for short-term admissions. I’d visited a miserable urine-smelling long-stay ward, when my great aunt had her stroke. It was ghastly.
When I arrived next morning, Mary was dressed and waiting for the ambulance to take her to St Mildred’s. Her eyes were red and swollen. She clutched my hand.
‘I never thought it would come to this.’
‘This should cheer you up a bit,’ I said, and handed her the tub from Tubby Isaacs. Jellied Eels, Established 1919.
A smile lit up her face.
‘You’re a lovely girl, you know,’ she said. ‘You’ll go far, mark my words. You’ve got a heart of gold, you have, and there’s not many of them around.’