Anthony Barker was a small man with a long straggly beard, glasses and a bow-tie. He was one of the most flamboyant figures at St George’s in the late 70s and early 80s. A surgeon by training, he was known as Dr Barker, because although he was a surgeon, he also had a MD. In my final year at medical school, he told me that he chose to use the title, by reference to his research doctorate, rather than following the convention of being known as Mr Barker, by reference to his Fellowship of the Royal College of Surgeons, because he considered “Doctor” to be an honourable designation. In my first year, I would have agreed, but as qualification approached, the remark did not resonate with my own feelings. I had become markedly disaffected with hospital medicine and with some of the behaviour that I had witnessed amongst senior doctors.
I have always believed that personal titles should convey something that is meaningful to the uninitiated. No one knows why Dr Who uses the title. He comes from the planet Gallifrey, so it might just be his name. I am certain that the general public has a similarly hazy understanding of what the title ‘doctor’ is supposed to signify when applied to health professionals (it means ‘teacher’). Over the past 20 years, non-medical UK health professions, such as dentists and clinical psychologists, have adopted this ambiguous title. I have come to feel that it is a de facto non-specific signifier of status, albeit a status that carries the implication of learnedness. Abandoning it on attaining postgraduate qualifications as a surgeon might then be understood to signify accomplishments involving skill and dexterity that sit outside of a hierarchy of learning. My general feeling is that it would probably be best if titles of all sorts were abolished, including in my profession. Nonetheless, I have called myself ‘doctor’ for 45 years and, like Dr Who, it just seems to be part of my name. I remain uncomfortable with ‘Professor’, a title I acquired 15 years ago. When speaking out loud, I do not use it as a personal title, because it seems a bit poncy and irrelevant in everyday situations. What would I be trying to convey about myself by using the title? It all leads back to Anthony Barker’s remark. In my view, ‘honourable’ describes specific behaviour. It cannot be assumed that people will behaviour honourably just because they have passed some exams.
Anthony Barker and his wife Maggie ruled A&E. They were Christian radicals, devout in their faith. For decades, they ran the Charles Johnson Memorial Hospital in Nqutu, Zululand.
They developed the hospital on a non-discriminatory basis, in defiance of apartheid, building it from almost nothing to become an institution with a significant international profile. When they returned to the UK in 1975, more or less expelled by the regime, Anthony took a job as the consultant in the A&E department at St. George’s. Posts of this sort had only recently started appearing and Emergency Medicine had yet to emerge as a distinct specialty. Many of the appointees to these new posts were, like the Barkers, returning medical missionaries. Conventional consultant roles were difficult for them to secure and their overseas experience was very broad in scope. This prepared them well for the work of A&E departments. Anthony Barker seemed to be able to turn his hand to almost anything, from microscopy and surgery to carpentry and medical research.
Maggie worked in a more junior medical role in A&E. I found her much the more likeable of the couple. Anthony was a good teacher and he was a clinician with huge energy, but he micromanaged his department and everyone within it. This had knock-on effects throughout the rest of the hospital. Although he was charming and charismatic, he was controlling and sometimes rather overbearing. He really did not like being challenged. Another of his flaws was a noticeable dislike of dealing with people with mental illness. His usual bedside manner was old fashioned: elaborately courteous but somehow rather patronising. In contrast, he tended to be impatient and unsympathetic with the small number of people with severe mental illness who found their way to his department. I never worked out what this was about, but it was a marked departure from his reaction to people whose pain and distress arose from bodily injury. Maggie, on the other hand, had no side. She too was a good teacher, able to turn her hand to all medical tasks with skill, or so it seemed,
The Barkers seemed to spend every waking moment in close proximity to each other. If you saw one of them, the other was likely to be just a few yards away. They did not own a car. They had a tandem bicycle and they were often to be seen out and about on it, travelling at speed on the busy roads of South West London. Anthony sat in the front saddle, steering, Maggie sat behind him, pedalling. They retired in 1985 and eight years later, they died. They were touring the Lake District on their tandem, and they had a confrontation with a truck on a narrow winding road. It was awful that the Barkers died violently and prematurely, but it was fitting that they died as they had lived, together. Their fame was such that they merited obituaries in both the Guardian and the New York Times.
I was pottering around the orthopaedic ward one morning when I had a call from Anthony Barker. He had assessed an eight year-old boy who was complaining of pain in his hip, and he wanted me to admit the child immediately. This was most unusual. In the majority of cases, pain of this sort in a child is due to irritable hip, a benign and self-limiting condition. Much more rarely, hip pain in a child can indicate a serious problem such as Perthes disease, septic arthritis or juvenile onset rheumatoid arthritis (Stills Disease). These conditions are usually associated with other symptoms, but the boy was not unwell, apart from pain. The standard treatment approach with irritable hip, then and now, is to rest the joint and wait and see what happens next. However, Anthony Barker emphasised that Stills Disease should be excluded. The reason for his anxiety about the case arose from the fact that the lad was the son of a senior academic doctor at St George’s. A psychiatrist. Someone who I had never met, but whose name was well known to me. Someone who, to my mind, was likely to be influential in the question of who was selected for the then prestigious training scheme in psychiatry at St George’s.
Anthony Barker sent the child and his father directly to the paediatric ward, without awaiting orthopaedic or paediatric review. This was a little irregular, but in those days cutting corners in this way was considered to be a courtesy to colleagues. I later came to see this kind of short cut as hazardous, as special cases usually turn into bad cases. Dr Barker told me to admit the child and to arrange for a proper orthopaedic surgeon to see him as soon as possible.
I was keen to give the father an appearance of competence. Everything went smoothly to begin with. The child was a nice lad who let me take blood without complaint. His father was relaxed and undemanding. I paged the orthopaedic senior registrar, and assured the father that he would be along soon. Unfortunately, I could not locate the senior registrar, nor any other competent orthopaedic surgeon. The SHOs were not replying either. It turned out that everyone except me was operating. This was no co-incidence, as I hated going to the brutal operating sessions. At that moment, the entire available orthopaedic resource at St George’s was me.
After about an hour, the child’s father asked if I knew how long it was likely to be before a surgeon would appear. It was a reasonable question, but I had no sensible answer. I started to self-pityingly wonder how the senior registrar (who I considered a friend) could let me down like this. I stood by the nurses’ station, waiting for the phone to ring. The wards of the new hospital had a rectangular racetrack structure, with the nurses’ stations at corners. I could see only one arm of the racetrack. After a seeming age, the phone went and it was the senior registrar. “Get your sorry arse down here now!” I hissed. “I’ve got a senior psychiatrist and his son here, they’ve been waiting for hours, I’m applying for psychiatric training and you’re fucking it up! Move it!” I put down the phone, turned around, and the father was standing about two metres from me. He had overheard the lot. I said, rather weakly, “He’s on his way”. The psychiatrist smiled pleasantly and thanked me. It was obvious to me that my psychiatric career had just curled up and died before it had even started.
In the fullness of time, the boy’s condition was confirmed to be benign. In the course of a brief admission, several other faux pas killed any possibility that I might redeem myself. I was taking blood from the boy one morning when I clumsily pulled the plunger out of the end of the syringe. Blood went all over the child, his mother and me, creating an alarmingly grotesque tableau. In due course, the child fell in with a fairly unruly peer group from the rougher end of Tooting and his behaviour steadily became wilder under their influence. His father was unfailing nice to me for decades after this, and eventually tried to get me to work with him as a consultant. I would have been pleased to, but did not. That is a whole different story. Meanwhile, house jobs were coming to close, much to my relief.