Looking back, my strategy to get into medical school was naive. I would probably have done better if I had engaged the skills that underpinned my flair for cheating at cards.
Second time around I applied to five medical schools whose prospectuses seemed to convey liberal social attitudes. This included two London medical schools, both of which invited me to interview. I got a haircut and bought my first suit in preparation for an interview at the Royal Free. It was a complete debacle. The interviewers seemed to think that I was someone else. When they found the correct set of papers, they implied that they could not understand why I had been invited to interview. Most of the time was taken up with their explanation that the course was grossly over-subscribed. It was no surprise to receive yet another rejection letter. I felt that I had presented a watered-down version of myself and I resolved never to humiliate myself again.
My interview at St George’s a few months later was only slightly less disappointing. I was no longer prepared to compromise, so my hair hung long. I wore a dark blue jumper and corduroy jeans. Asked what paper I read, I said Workers Press (I was still in the Workers Revolutionary Party at the time). The interviewers asked what other paper I read. I told them The Daily Telegraph, explaining that everything published in it had a strong right wing bias and that this consistency made it easier to interpret than more centrist organs such as the Guardian. Plus I could complete the crossword most days. The interviewers appeared to enjoy this, and it all seemed to be going rather well. I was horribly let down at the end when I was told that all the places had already been allocated for that year. I would be placed on a waiting list and if sufficient candidates failed to make their required grades, then I might be offered an unconditional place. It seemed to me that I was not being taken seriously, which I felt was a consequence of belonging to the wrong class. I had never heard of anyone getting a medical school place at Clearing, so my only way forward was to resit A-levels to seriously improve my grades and make a third attempt. Giving up was not an option that I considered.
In the spring, I took four weeks unpaid leave from my job as a hospital porter to prepare for re-takes. I had not looked at a textbook since the year before. Although I only had a short time to up my game, something in me had changed. I adopted a much more systematic approach. I realised I could not study effectively for more than eight hours a day, and that the prospect of going to the pub in the evening would help motivate me. I identified what was essential to learn and what could be skimmed. I abandoned my notes and worked exclusively from textbooks. Under the influence of Ben, the academic-turned-hospital-porter, I read the books for fun and made no effort to memorise anything. My new-found self-discipline and efficiency was assisted by the cloudless skies of the 1975 spring (which were interrupted by snow in June). I gain a deep suntan.
I re-sat my A-levels with pupils from the year below me. On the morning of the first paper, Biology, I arrived at the sixth-form common room in good time. Three lads who I knew were playing draw poker. Someone commented about how relaxed I seemed. It was true. Having discovered systematic study, I was confident. I was calm enough to come up with an opportunistic practical joke. A teacher called us to the examination hall and everyone left. Alone, I lingered and fixed the pack of cards left on the table. If there were four players, I would be able to deal myself four aces.
After the examination was over, we drifted back to the common room and I positioned myself close to the card table. Just as I had expected, I was invited to join the resumed poker game. I said that I had never played before, and I got them to write down the rank order of hands on a piece of paper.
I offered to deal and I cut the cards elaborately, returning the cards I had fixed earlier to the top of the pack. During the betting, I changed my superfluous card and ostentatiously consulted my crib sheet before betting. After months of daily poker, it was not difficult to draw their money onto the table. The stakes were high, and a small audience gathered. At the show, I presented my four aces. There was a satisfying gasp of amazement. None of them had ever seen anyone hold four aces before, other than in cowboy films, and this was supposedly the first poker hand I had ever been dealt. At this point, I told them that I could not take their money because I had cheated.
They could not understand how I had done it, because they had watched my hands as I dealt and had seen nothing untoward. I refused to tell, but promised I would confirm the method if they could work it out. This provided me hours of pleasure over the months that followed. They kept trying, but they failed. The trick has had different meanings for me at different times in my life. For a long time, like a South London Machiavelli, I saw it as an example of a general rule that advantage can be secured by anticipating simple and predictable behaviours. Now, I think that it signifies how much I had changed since leaving school. I had always liked practical jokes, but this involved planning and patience as well as an understanding of how other people think. I would never have come up with it a year earlier. Working in the lodge had instilled a wiliness that has persisted down the years. It is not my nicest characteristic, but I must acknowledge that it is part of me.
I duly improved my grades to ABB. I wrote a second letter to every medical school except Oxbridge, setting out my new grades. To my surprise, the University of Liverpool wrote back saying that an application to attend the following year would be regarded favourably. Although medical school still seemed a remote destination, I finally seemed to be making some progress towards it.
One September morning, I returned to the porters’ lodge after changing an oxygen cylinder on a ward. The head porter, Bert, told me that my mother had phoned to say that I had to call her urgently. I made the call from the phone on the wall, just across from the men who were playing cards. My mother tremulously said that she had had a call from St George’s and I was to phone them straight back. She was excited. I spoke to a friendly woman in the St George’s registry who said that my name had come to the top of their waiting list. If I was still interested, I could start medical school in October. I accepted the place immediately and asked whether they had received my letter about improved A levels. They had not. They had offered me a place on the basis of my cocky interview.
I put the phone back in its holder. I was somewhat stunned to have suddenly stumbled through an open door. I turned to the card school and I said “I’ve got a place at medical school” No one reacted. I raised my voice. “I’m going to be a doctor!”. Bert looked up from his cards. After a long doleful stare, he spoke. “Nah,” he said “you won’t leave here. You’re one of us”. A few days later, Brian Matthews, my physics teacher, said something altogether more challenging. “Just don’t forget where you’ve come from. Don’t assimilate. Change it.”
Two weeks later, I arrived at King’s College, London, and started my pre-clinical course. After such a long haul to secure a place, I expected that the other students would be really clever. A few were definitely a lot brighter than me. Several seemed a bit thick. Mostly, after my intense education in worldliness, these school leavers seemed naive. Some of them came from similar backgrounds to mine, but many were privately educated, mostly in the public school system. Irrespective of my dislocation and chippiness, I made close and enduring friendships at medical school, but I was in a state of culture shock for much of the first year. My physics teacher’s words have resonated down the years but I regret to report that medicine has changed me a lot more than I have changed it.
I have had an interesting and successful career as a clinician and, more recently, as an academic, despite having secured a place at medical school only through sheer cussed persistence. I had the good fortune to be interviewed by someone who thought that “a cocky but bright Marxist with a sense of humour might be an interesting student” (or so he later told me). I did not grow up in deprivation, and my academic performance was far from perfect. Nonetheless, I was right to believe that a major factor in my difficult route to medical school was membership of the wrong social class, which was not mitigated by attending a grammar school. I was ignorant of the rules and the key points of reference in medical culture. Those who acted as gatekeepers did not see the requisite reflection of themselves in me. This is how class privilege is politely but firmly maintained in British society. These barriers are not impenetrable, but they are strong. I was still coming up against them ten years later when I worked in Oxford (although, whilst I was there, I realised that I made a mistake in thinking Oxford was too elitist to take me as an undergraduate. It was definitely elitist, but they might well have taken me for exactly the same reasons that St George’s did).
Medicine has not become more accessible to pupils from state schools. I think that it has gone backwards in the course of my career. Although hardly any public school pupils become doctors these days, an awful lot of medical students are privately educated and have ponies or private skiing lessons. It is good that there are a lot more women in the profession now, and medical schools are far more ethnically diverse than they were then. However, we do not have a medical school selection process that favours awkward left-wing academic late-developers or any other type of non-conformist. State-school students have to display private education signifiers to gain entry. I think that is bad for the profession, and for patients.
One morning, around the time of my late 1975 encounter with the Sex Pistols, I bumped into Ben in Blackheath Village, old-fashioned tightly-rolled umbrella hooked over his forearm. We had not seen each other for months. When I went back to work after my re-sits, Ben had lost his job. The hospital had discovered that he had lied about his date of birth. He was well past retirement age. We embraced and he insisted that I come to his flat for coffee. “Come and meet my daughter!” he said. As we went through the front door, I walked into a different world. Ben called out in Hungarian. His wife, who always seemed so dour around the hospital, was full of smiles and welcomed me as an old friend. She was cooking and there were rich spicy aromas.
Coffee was made and I went into the living room, where I was introduced to their daughter. She was very friendly and turned out to be a student at the London School of Economics. She said that Ben had often spoken of me. He had talked about her to me too, but he had not mentioned that she was clever, vivacious and beautiful. We all sat and laughed for more than an hour. Ben was taking his driving test for the umpteenth time. He refused to take lessons and insisted he could pass by reading about driving rather than practicing. So he kept failing, because he had never mastered the clutch. For all of his sharp intelligence, he was fundamentally an unworldly pre-War academic. The coffee and the company were good. In my head, I was trying to think of a form of words to suggest to Ben’s daughter that we might meet up again. I lacked the necessary social skills to do this without embarrassing myself in front of her parents, and the moment passed. I left with an invitation to drop by anytime. It was the last time I saw Ben, but his influence endures.