Never work with children or animals

As soon as I finished my psychiatry attachment, my girlfriend and I got married. Obviously, Woolwich Town Hall first thing on a cold December morning would not be anyone’s idea of a nice day for a white wedding, but, like my grandfather’s funeral shortly before, we constructed a bespoke occasion that was congruent with the relationship we had, and still have.

My mother-in-law was a former professional tailor who made wedding dresses for other family members, and she was disappointed that there was no dress to be made. In fact, almost all of the elements associated with a traditional British wedding were eliminated. No wedding vows, just the minimum wording required by law. We invited only immediate family and a handful of close friends. No speeches and no wedding reception. Steve Hammond did the wedding photos. Several of those invited could not make it. My brother-in-law and his wife were in Nigeria. My paternal grandfather had died and, at the last minute, my maternal grandmother was admitted to Lewisham Hospital with her umpteenth cardiac crisis.  So, like the Last Supper, there were thirteen of us at the wedding.

photograph of a family group

After the ceremony, we were ushered out through a side door and found ourselves facing the verruca clinic that my wife had attended as a child. We visited my grandmother in hospital, where we drank champagne and ate wedding cake, and then we went on to a meal at a restaurant in Eltham. Steve designated himself Best Man, and made a spontaneous speech. Cigars were smoked.

Two days later, we went to see Elvis Costello and the Attractions at the Dominion in Tottenham Court Road. This was an outstanding gig, one of the best I have ever attended. Costello was in his first glorious incarnation, still young, angry and high-energy. The band unexpectedly played a great version of one of my favourite songs, Nick Lowe’s What’s So Funny About Peace, Love and Understanding. The support acts were exceptional as well. John Cooper Clarke is now officially a national treasure, but we had never heard of him before. He stood under a spotlight looking like Bob Dylan circa 1965, firing off poems that are now on the GCSE English Literature curriculum. According to his autobiography, he took a substantial hit of heroin before the show. It did not seem to affect his performance. The other support act was Richard Hell and the Voidoids featuring Robert Quine, who was up there with Ollie Halsall in the highest echelon of second generation innovator electric guitarists. The reviews in the music papers were effusive. The gig was at the core of the coolest things that were happening in mainstream rock at the end of 1978.

After the gig, we had a couple of nights in Paris. European culture had yet to have its full impact on British life and neither of us had ever been to France before. Paris at Christmas time was thrillingly foreign. We were introduced to the joys of fresh croissants and good coffee for breakfast. We were fascinated by the Metro’s Art Nouveau architecture, pre-War rolling stock and the strict hierarchy of qualifying conditions for use of the disabled seats, headed by “Mutilés de Guerre”. The walls were covered in adverts for treatments for nits and haemorrhoids, both of which were completely unmentionable on the British public transport system of the time. There was an overwhelming aroma of garlic. We have never noticed it during our subsequent trips on the Paris Metro, presumably because we now reek of garlic as well and cannot detect it.  The food was, of course, uniformly excellent. We had been led to believe that Parisians would be aloof or rude, but we deployed our flawed O-level French and everyone was very friendly. We walked up the Eiffel Tower because we had a limited  budget and I deemed the lift to be an extravagance. We queued up to see the Mona Lisa at the Louvre. We were not beguiled by the Gioconda smile, possibly because it is difficult to be beguiled whilst being jostled. We walked for miles and miles. On returning home, we spent Christmas with my parents, sharing a bedroom in their house for the first time. The thing about being married was that, whilst our lifestyle was exactly the same as before, the rest of the world treated us differently. I was 22 and my wife was 23, and I felt as if we were playing at being grown-ups.

Returning to medical school after Christmas, Obstetrics and Gynaecology was a bit of an anti-climax. We were meant to deliver twelve babies each, but I am not certain that I reached that number. I certainly delivered a few. I do remember delivering a child with the umbilical cord  wrapped twice around her neck. I was hugely relieved that both mother and child were fine and that they had not suffered because of my inexperience. Mrs RT Varma was a flamboyant academic gynaecologist and memorably excellent teacher. She certainly made an impression, but I found it difficult to muster much enthusiasm for a specialty that was, at the end of the day, a form of surgery.

Paediatrics was altogether more engaging. General practice, paediatrics and psychiatry were the three specialties at medical school that seemed to look at patients in a way that was interested in more than just the details of the disease. They concerned themselves with what happened outside of the consulting room, and from my point of view, that made them more satisfying than the dominant, narrowly focussed, hospital specialties. I was attached to Professor June Lloyd’s clinical team for a while. I had to write up a “long case” for her to mark, essentially an essay based around the clinical details of a child-patient who I had seen, with reference to the relevant science.

The child was about 4 years of age, and when he was admitted via A&E, he was absolutely prostrated. His poor parents were beside themselves, explaining that he had seemed slightly off colour before lunch, had a nap in the afternoon and then could not be woken for his tea. Unbeknownst to them, he had developed diabetes, and he was now in a state of severe diabetic ketoacidosis, a life-threatening metabolic emergency. He was pale, sunken-eyed and quite obviously serious unwell. The paediatric registrar had great difficulty in getting a cannula into his collapsed veins in order to rehydrate him, but eventually succeeded. I stayed at the child’s bedside until the early hours, by which time his biochemistry was improving and he was beginning to show spontaneous movements. I wearily dragged myself out of bed in the morning and returned to the ward to see how he was doing. He was energetically bouncing around the children’s ward’s play area with another little boy, looking the picture of good health, as if the entire ordeal had just been a good night’s sleep.

The essay I wrote covered the pathology and biochemistry of sudden-onset type 1 diabetes in an infant, the management of the condition in the short, medium and long term and the likely impact on the family and on his education. It covered the whole range of ramifications for a child whose long-term health now depended on insulin and good control of his blood sugar. June Lloyd declared it excellent and told me I should consider becoming a paediatrician. However, for me, the case illustrated the whole problem of working with sick children. They get seriously ill really quickly and they recover equally quickly. The worry that doctors experience over any sick patient is greatly heightened when the patient is a child. Although this is offset by a heightened euphoria when they recover, bad outcomes are hard to cope with. It was far too intense for comfort.

With a different paediatric team, I saw a child who had sub-acute sclerosing panencephalitis. This is a complication of measles. It develops months after the acute infection has settled. The child’s brain becomes inflamed, scar tissue forms and behavioural development goes into reverse. Skills and intellectual abilities are progressively lost. In most cases, severe neurological deficits arise and eventually the child dies. The boy who I saw was in a dense coma and showed return of primitive neurological reflexes, both of which are signs of profound brain injury. He was dying. His parents found this impossible to accept and, like many parents under similar circumstances, they constantly looked for signs that might indicate the beginning of a recovery. Sometimes, they reported that he had spoken to them. The whole scenario was unbearably tragic. I have thought of that boy regularly over the years, particularly as I watched the exposure of Andrew Wakefield’s research fraud unfold, alongside his enduring impact on global vaccine hesitancy.

June Lloyd was an extraordinary woman. She had taken up post as Professor of Paediatrics at St George’s just a couple of years earlier, having moving from Great Ormond Street Children’s Hospital. Her scientific work was concerned with disorders of lipid metabolism, but in her clinical work she had an acute awareness of her patients’ social circumstances. She was a small red-haired woman who was a little daunting, mainly because of her obvious intellect and a somewhat brusque manner. She had a reputation for fieriness, but I never saw that; women who could hold their own in the grossly sexist medical culture of the time tended to be perceived as difficult. I thought that she was quite shy, and she was quietly kindly. She certainly had a sense of humour. She was the only one of our professors that invited every batch of students to their home. We went in groups to her house in Islington for a home-made curry. There were stools and folding chairs to sit on, so that we could eat our dinner on our laps. Brian sat on a deck chair which promptly collapsed. To his absolute mortification, the plate of curry in his hands flew over his head and spread itself up the wall behind him. Professor Lloyd seemed unperturbed.

June Lloyd had a pivotal role in the establishment of the Royal College of Paediatrics and Child Health. This is recognised in her depiction within their coat of arms, where she can be seen on the left, red haired and holding a double helix of DNA.


Coat of Arms of the Royal College of Paediatrics and Child Health

I liked and respected June Lloyd, and, if I had not already decided to become a psychiatrist, I might have seriously considered her advice to pursue a career in paediatrics. She received quite a few honours and she was eventually made Baroness Lloyd of Highbury. Sadly, at around the same time that she was ennobled, she suffered a severe stroke. As a consequence, she never made her maiden speech in the House of Lords.

June Lloyd was not the only paediatrician that taught me. I spent an enjoyable three weeks on the south coast attached to Bud Robinson’s team. Bud was a wise but colourful paediatrician who continually cadged hand-rolled cigarettes from me. I was also taught by Oliver Brooke, an aloof and rather cold neonatologist. Much later, in the mid-1980s, he was arrested. He was found to have a large quantity of child pornography stashed in his office. After conviction, he was briefly imprisoned. The leniency of his sentence was justified by the judge on the grounds that Professor Brooke was otherwise of good character. It was hard to know what that meant under the circumstances, given his terrible betrayal of trust and his collusion with child abuse. It was utterly shocking and, of course, it led to front page headlines in the national press. This all came to light many years after I had qualified; by then I was a senior registrar in psychiatry in Oxford. Nevertheless, I felt vicariously tainted, and I imagine that hundreds of other people who had come across him as patients, parents, students or colleagues must have felt the same. It was a horrible dark coda to my student experience of paediatrics.

Meantime, outside of the walls of the hospital, the winter of discontent gathered momentum through the early months of 1979. Although journalists and politicians suggest that the main problem of the time was that the power of trade union barons had become uncontainable, it looked differently to me. For several years, trade unions had been struggling to get their members’ incomes to keep up with galloping inflation, which was driven by international oil prices, not wage costs. From this point of view, the period was not dissimilar to the present day.

Following the 1973 war in the Middle East, the oil-producing Arab nations pushed  oil prices high, causing inflation to rise to exceptionally high levels. This was compounded in 1976 when the Labour Government took a huge loan from the International Monetary Fund to stop a run on the pound, the so-called Sterling Crisis. Under the influence of the IMF, the Government made spending cuts and tried to hold public sector wage rises down; in this way the Labour Government piloted part of  programme of the Thatcher Government that followed, although it is rarely acknowledged. The result was multiple public sector strikes. Rubbish piled high in Leicester  Square. In March, the Labour Government of James Callaghan lost a vote of no confidence by a single vote, precipitating a general election. By that time, the IMF loan had been repaid because it had not been needed after all; oil prices had dropped and the economic situation had stabilised without it. The incoming Conservative Government had found a rationale for the destruction of the trade unions and the destitution of working class communities in the industrial North, but none of it was necessary. It was the increasing flow of North Sea oil that ended toxic levels of inflation.

On 4th May 1979, Margaret Thatcher became prime minister. I now remember rather ruefully that I took consolation in the fact that a woman had been elected prime minister. 4th May was a true watershed. At the national level, it marked the end of the post-war collectivist consensus and the beginning of the era of unapologetic individualism and greed. At a personal level, it marked the beginning of a decade of discomfort caused by visceral anger over a Government that seemed to me to be wrong about absolutely everything.