At the start of the course, most of the medical students either lived in University Halls of Residence or, like me, with their parents. Over time, people drifted into shared flats clustered around the course of the Northern tube line through South West London. I had had enough of living at home, but I knew that I did not want to live in a flat share either.
I like to have space and I have never relished communal living. So my girlfriend and I decided to get a flat together. She had left a job with Social Services and was working in a benefits office in Lewisham, processing sickness benefit claims. I was in receipt of a student grant from the Inner London Education Authority. We were on a low income and our choice of accommodation was limited. With some difficulty we managed to find a place that was more or less equidistant between her workplace and St George’s Hospital, Tooting.
At that time, Herne Hill was a somewhat run down suburb. It is close to Brixton and there is a large open space, Brockwell Park, with an art deco open air swimming pool, one of London’s Lidos. Our accommodation was part of a double-fronted Edwardian terraced house close to the park. We had a large bedroom and a small sitting room on the first floor, with a kitchen/diner up a further flight of stairs. Another couple had the other two rooms on the first floor, and we shared a bathroom and toilet. Heating was provided by ancient gas fires, and the hot water came from Ascot geysers, devices which lit with an alarming thump when the hot water tap was turned on. Sometimes, ignition was delayed and then flame would shoot out of the Ascot as it lit.
The landlord was Tadeusz, known as Teddy, and he occupied the ground floor. We shared his front door. Teddy had escaped to the UK as a mechanic in the Polish Air Force when Germany invaded, and he now worked as a maintenance man at the RAF club in Piccadilly. There was a large Polish community in South West London, and Teddy and his friends spent a lot of time shouting at each other in Polish in his kitchen. He had a large bird loft in his back garden. He raced pigeons until most of them were killed in a lorry crash on the motorway on their way to a start in Birmingham. Aviation was something of a theme in the flat in Herne Hill. Concorde, the supersonic airliner, passed overhead several times a day on its approach to Heathrow. It was a beautiful delta-winged aircraft but it was incredibly noisy. Even with the windows closed, it drowned out the television as it passed overhead.
Teddy was a single man. He liked us. He called my girlfriend “Princess” and he often sought my medical opinion about his insulin-dependent diabetes. It was futile to protest ignorance. This is generally true. When a doctor declines to give informal medical advice, people assume that you are choosing not to say something sinister, and they press you. I learned to offer Teddy anodyne guidance such as “Make sure you maintain your fluid intake” (generally good advice unless you have renal failure).
Teddy did not like the other couple at all, and he developed an increasingly complex theory that the woman (who was about our age) had been seduced away from her parents by the man (who was about ten years older) and that he was using her as a sexual plaything. He predicted that she would soon be cast aside, a tainted woman who would languish in the shame of the episode for the rest of her days. There was no evidence to support this theory. They seemed unremarkable and inoffensive to us, but for the fact that they appeared to own only one record, Rumours by Fleetwood Mac, which they constantly played at high volume. The woman eventually left and we gathered that the record had been hers. Teddy took her disappearance as support for his theory, and he told me that he had told the man that if he did not leave within a week, he would torch the house. This was slightly alarming, because the house was something of a death trap at the best of times. Teddy did all of the maintenance himself and, quite apart from the Ascot geysers, we had good cause to worry about the gas plumbing. The first time that we lit the gas fire in the kitchen, an 18 inch column of flame ignited from the leaky gas tap and the fire could not be turned off. Teddy fixed the problem by using a piece of string as a washer. We suspected that he was not CORGI registered.
Our cooking repertoire was limited when we moved in together, but it rapidly grew. We shopped at Brixton market, which was a joy for the adventurous student of cookery. It opened up a whole multicultural cuisine. We bought a good knife made of mild steel and a proper pepper mill, both of which we still possess and use daily. The knife is now a wobbly stiletto due to decades of sharpening. There were vegetables that were entirely new to us, such as sweet potato, okra and chillies, there were wig shops and, in a railway arch, there was Desmond’s Hip City record shop with its wonky “Blue Beat Centre” sign. The market throbbed with reggae. There was a supermarket called Continental Stores where we could purchase a pound of bacon scraps very cheaply. We diced the scraps and made a pasta sauce, and it was often the only meat we ate all week, quasi-vegetarians from economic necessity rather than conviction.
One of my conceits is that I am fiercely independent minded, but the evidence tends to suggest otherwise. If anything, I appear to have been unusually impressionable as a medical student. A number of the people who taught me have had an enduring influence, not through what they taught me but through the way that they thought. Tony Dornhorst was the first person I ever encountered who could be described, without hyperbole, as brilliant. He was the foundation Professor of Medicine at St George’s. He liked teaching, and his emphasis on careful history-taking and observation followed by rigorous hypothesis formation and testing made him my role model for the clinician-as-scientist. It is often said that the traditional model of British medical training was an apprenticeship model, but I think that, when it worked well, it was closer to the Oxbridge tutorial system. Student numbers were low, and students could enjoy a one-to-one relationship with their teachers. This went a long way to make up for the rather plodding nature of the actual course curriculum, with its emphasis on fact-accumulation and its neglect of understanding.
Tony Dornhorst was a loner with an iconoclastic streak who seemed to know a huge amount about everything. I was impressed by the way that his intellectual firepower was intensely focused on every patient he saw. No problem was too banal to escape his full attention. It is true that his manner could lack warmth and that he was not above quietly mocking patients. I remember a man who insisted that his belching could not be due to swallowing air, which led Professor Dornhorst to teasingly enquire exactly what it might be that was fermenting in his stomach. The unfortunate man really did not understand the point. Dornhorst was at the end of his career, but I chose more than one placement with him. I was acting up as his (non-prescribing) locum house officer when he retired in the spring of 1980.
Tony Dornhorst was based at the Bolingbroke Hospital on Wandsworth Common, away from the cut and thrust of the new St George’s campus in Tooting. The Bolingbroke was a Victorian voluntary hospital that had started to very slowly wind down, because it was too small to support a modern Accident and Emergency Unit. It finally closed in 2007, and it is now an academy-school. The hospital retained some features from a previous age. There was no longer any paediatric provision at the hospital, and the former children’s ward had been partitioned into office space. On the walls there were magnificent Victorian ceramic tiles depicting scenes from nursery rhymes. The entrance hall was dark wood, brass fittings and Victorian tiles, with a porters office containing a small telephone switchboard. With no A&E, on-call was quiet, and the junior doctors would go around the corner to the local pub in the evening. There was a dedicated phone on the bar for calls for the doctors. As the medical staff walked towards the hospital front door, the porter would call “Off to the chapel, gentlemen? We’ll send a message if you are needed”. In 1980, this seemed jarringly anachronistic, like something out of a black and white film starring Dirk Bogarde.
Professor Tom Pilkington was as flamboyant as Tony Dornhorst was austere, a pioneer of metabolic medicine who established a scientific approach to the treatment of obesity. Tom was an incredibly warm man whose clinical practice and teaching were rolled together into a form of extended performance art. His ward rounds stretched long into the evening, but few complained. Tom loved gossip and laughter. He was probably not the easiest colleague, because he was stubborn and subversive, but he was extremely supportive to students and junior doctors. Right up until I finally left St George’s in 1985, he would stop me in the corridor, address me by name, and showed a genuine interest in what I was doing. His wife, Pam, was a psychiatrist and he was sympathetic to my career choice. Tom liked to shock. He arrived in clinic one day carrying a copy of High Times, a magazine for connoisseurs of cannabis. He threw it at me and asked what I thought of it. I said I could not really see the point of reading about cannabis; I think I made the “it’s like dancing about architecture” joke. Another time he came in and said that should he become in any way peculiar, we were to intervene, because he had just injected himself with naloxone, an opioid antagonist, in pursuit of a lab experiment.
When I was a student, Brian Robinson was a Reader in Medicine, but he was later appointed Professor of Cardiovascular Medicine. He was younger than Tom Pilkington and Tony Dornhorst, around my parents’ age. He was a gentle, reserved man who gave amazing lectures about the physiology of cardiac and respiratory signs, explaining how, for example, various heart sounds heard through a stethoscope related to underlying cardiac activity, normal and abnormal. He had written a book on the same subject which was an unassuming masterpiece in its clarity. It was a model of what a medical text could be, and it had some influence on my writing style twenty five years later. He had many scientific achievements, but to me the other really important thing about him was that he was openly gay. Although homosexual acts had been partly decriminalised in England by a 1967 Act of Parliament, the persecution of gay men escalated in the 1970s. This was captured by the bitter sarcasm of Tom Robinson’s song Glad To Be Gay. It was not an easy time to be a gay doctor. Brian Robinson was an activist, and I remember spotting him in a TV report of a gay rights demonstration. His stance was one of dignified insistence on being who he really was. He was generally liked and well-respected, with an enviable reputation for integrity. He showed that it was possible to be an activist without compromising your professional role.
These men who I have thought of regularly throughout my career had a number things in common. They all had a strong commitment to the NHS. None was involved in private practice. None of them were deferential to status. They applied intellectual rigour to clinical practice as well as to medical science. They all followed their own path and did not mind shaking things up: in fact, they all sought to do exactly that, each in their own way. They helped to form within me a model of what medicine can and should be. Although I recognise the contradictions implicit in that model, I am still strongly attached to it. To me, more than anything else, rationality and fighting for social justice are intrinsic to medicine. Of course, many doctors disagree with these propositions. I believe that, in doing so, they are betraying medicine’s core mission.
Other senior doctors at St George’s had an enduring impact on me, but I felt the influence of Professors Dornhorst, Pilkington and Robinson at the very beginning of my long clinical career. It is not a co-incidence that they were White and male. Hospital medicine was overwhelmingly male at the time and it was my generation that saw things start to change. About 10% of my year-group were of South Asian heritage. There was no one with Black ethnicity. About 40% were women. Small beginnings.