Between 1733 and 1980, St George’s Hospital and its medical school were located at Hyde Park Corner, one of the best sites in Belgravia. The building was grand but neglected. In 1980, just before I sat medical school finals, we were allocated our pre-registration house jobs. I was not looking forward to working as a surgeon, but I took consolation when I found that I was to work at Hyde Park Corner, where I would have a room in the junior doctors’ accommodation at 1, Knightsbridge, SW1.
Unfortunately, before I could take up post, a bit of masonry fell off of the eighteenth-century façade and injured a passer-by. The long-planned closure of the building was brought forward and my post was relocated to Tooting, South West London, where I had a room in a tower block overlooking Lambeth cemetery. The building at Hyde Park Corner is now the Lanesborough Hotel, the most expensive hotel in London. Their cheapest room costs more than £1,000/night. The accommodation tower block in Tooting has also been turned into a hotel, the Pelican, where you can occupy my old on-call room for £55/night.
A shortage of doctors during the Second World War laid bare the need to modernise medical education. Planning for change started in the 1940s but the parts of the plan that involved rationalising London medical schools were realised very slowly. It was my generation of medical students, born ten years after the end of the War, that finally started to experience their impact. The Fountain and the Grove, nineteenth century hospitals adjacent to each other in Tooting, were slowly demolished to make way for a massive purpose-built St George’s Hospital and Medical School. A Dorian Gray process of neglect, demolition and construction carried on throughout my ten years as a student and junior doctor at St George’s. My admission interview was not held in the fading grandeur of the building at Hyde Park Corner. It was held in an over-heated temporary hut on a building site, ten minutes’ walk from Tooting Broadway underground station.
There were just under 50 of us in the intake of 1975, but the following year’s intake was larger, and expansion continued year-on-year. St George’s now admits almost 300 medical students each year. We were the last group that studied basic medical sciences at other University of London colleges. In my case, this was King’s College in the Strand.
I spent a lot of time on tube trains in the 1970s. One evening, I sat facing open sliding doors at a station when a man wearing a three-piece suit and carrying a brief case rushed on to the platform. Realising that the train was about to leave, he trotted towards the doors with his briefcase stretched in front of him, hoping to obstruct them as they closed. Jamming sliding doors with the ferule of an umbrella was a common ploy that would cause the guard to open them again, allowing the passenger to avoid a wait until the next train arrived. The sliding doors closed around the man’s wrist, with his briefcase in the carriage and most of the rest of him on the platform. I looked at him and he returned a rather blank expression while, contrary to expectation, the doors did not move.
There was a subtle change in his expression as he contemplated the possibility that the train would move away without the doors opening. This meant that he could either free himself by letting go of his briefcase, in which case he would never see it again, or he could hang on, with the risk that he would be dragged along the platform and slammed against the wall as the train entered the tunnel. After several uncomfortable seconds, the door started to open. With a look of relief, he stepped forward. The guard must have tried to clear the doors without bothering to look down the platform, because they only opened by about 18 inches and then closed again, this time firmly clamping the man’s head. After another, even more awkward, stuck moment, the doors finally fully opened, and the passenger flopped down onto the seat opposite me with his briefcase on his lap. After a short pause, he took a newspaper from his briefcase and pretended to read it as if nothing had happened.
These tiny but perfect comic vignettes are one of the few pleasures of regular travel on public transport in London. This one stands as an allegory for my years at medical school, awkwardly trying to find a place in a profession that was nothing like I expected it to be.
As I grew up, my mother often repeated Polonius’s words to Laertes:
“To thine own self be true,
And it must follow, as the night the day,
Thou canst not then be false to any man.”
I internalised this as a temperamental objection to compromise. It complicated the task of adjusting to a peer group, some of who had a very different background to my own. Many had attended elite public schools, often as boarders. At first sight, we seemed to have few shared attitudes and values, although it turned out to be rather more complicated than that. Like all medical students of the time, I was expected to learn a huge amount about the biological sciences in the first two years, unleavened by much in the way of theory or reflection to make it interesting. My favourite subject was biochemistry, because I loved the elegance of the interlocking metabolic cycles, which made the task of memorising them much less burdensome. There was no such relief from the tedium of rote-learning the fine detail of human anatomy. Alongside the intense internalisation of facts, we had to become doctors, a task that I soon realised was more ontological than educational in nature.
I felt uncomfortable with doctors and their culture quite frequently as a medical student, but I only rarely flirted with the thought that I might have made the wrong career choice. I developed a strong attachment to an abstracted concept of what medicine should be, and I judged my teachers harshly when they fell short. I did not feel hostility to expensively educated students, notwithstanding my tendency to (half-) jokingly tell them that they were the class enemy. As far as I was concerned, they were exotic and I was curious about them. Five years together as a small group is a lot of shared experience and, of course, we soon converged and formed a tight-knitted kinship group. I continued to see myself as being on the outside looking in, but I had felt like that at school, in the porters’ lodge, and in the Workers Revolutionary Party. Incongruously, I still feel like that. The only place where I have felt completely free of that feeling is playing in bands. I admired the social skills of the privately educated students, which were, in general, much more polished than mine. Just like the battered tube train passenger coping with his embarrassment by pretending to read his newspaper, I found comfort in the familiar. I stuck with a stance of gauche argumentativeness, exploiting my rhetorical skills to cover my inability to chat amiably.
There were about 150 pre-clinical students in our year group at King’s College, and I was not the only one grappling with the challenges of accelerated social mobility. Grammar school apologists rarely mention that the necessary corollary of selective education is a second tier for the majority. For my generation, this was the secondary moderns, which catered for working class children who had failed the eleven plus. There was one woman at King’s who had attended a secondary modern school. She dropped out of medicine at the end of the first year. I did not know her well enough to know why she left, but it upset me. Most people in my position embraced the transition with more equanimity than I did. I almost had a romantic relationship with another state school medical student, but it stalled. Some years later, she said that I had seemed determined to remain in a world of whippets and boiled cabbage, whereas she had wanted to walk away from all that.
Many of my new friends were charming but they often seemed insecure under the surface. I took to describing boarding school as “the buy-your-child-a-personality-problem scheme”. This was unkind, but it was not entirely inaccurate. I only once encountered raw snobbery, from a latter-day Flashman with a ridiculously affected accent who attempted to mock me in order to amuse his friends. He failed and he did not try to do it twice. I have not forgotten his name. True to stereotype, he now plies his trade as a senior surgeon in expensively-suited private practice in London.
Early in our first term at King’s, the St George’s students were invited to meet the Dean of the medical school for a “get-to-know-you” evening at doctors’ mess at 1, Knightsbridge. The bar had magnificent views over Hyde Park, and the Dean “got to know” us by providing copious free beer, organising beer races and persuading the unwary to drink yards of ale.
Looking back, this was wildly irresponsible. A group of teenagers was plied with liquor to the point of drunkenness by the head of the institution that was supposed to be educating them. However, it was entirely congruent with the values of organised medicine at that time. There was a strong alcohol culture, and it persisted into the 1980s. Doctors were an occupational group with a very high rate of alcohol dependence. Not only was drinking accepted, it was encouraged. Large hospitals had bars that kept pub opening hours, and a couple of pints at lunchtime before returning to clinics or operating theatres in the afternoon was accepted practice.
St George’s had a Spider Naevi Club. Spider Naevi are skin lesions that are associated with cirrhosis of the liver. Members had to wear their Spider tie on a Thursday. If they were caught without it, they had to buy drinks for any members that challenged them. The junior doctors mess had a small self-service bar, so that hard-worked on-call doctors could have a few beers during breaks. Pharmaceutical companies served food and wine at lunchtime meetings as the incentive for doctors to listen to presentations about new drugs. In the 21st century, by contrast, alcohol is as taboo as tobacco. It would be incorrect to suggest that most doctors spent the 1970s rolling around drunk, but there were horror stories about intoxicated surgeons having loud rows with theatre nurses as to whether they were fit to operate. Although I spent a lot of my meagre grant money on beer, I never liked drinking at lunchtime. It invariably made me fall asleep in the afternoon, no matter what I was supposed to be doing.
The Dean’s “get-to-know-you” piss-up was one of a number of events early in the pre-clinical course that facilitated acculturation. Another was our introduction to the dissection room, which was a large tiled space in the old part of King’s College, with high windows and frosted-glass paned doors. We were told that we could smoke in there, although the reason for this was obscure. As a hospital porter, I had had regular contact with death. Most of the other students had never seen a dead person until they were confronted by this room full of stainless steel tables, each one bearing a naked cadaver. There was a strong smell of formaldehyde, a preservative that allowed groups of students to slowly dissect a body over three terms.
On this first visit, the mood was sombre and several students looked very pale. The Professor of Anatomy emphasised that these were people, not objects, that they had left their bodies to medical science and that they should be respected. The statement was an effort to avoid macabre pranks and it was more or less complied with. We were, I think, respectful of the cadavers, but we became indifferent to the increasingly disfigured presence of twenty former people, each of whom had lived, loved and been loved. I recall eating sandwiches in the dissection room. We were developing the psychological distancing that is characteristic of doctors the world over.
We were slower to accept cruelty to animals. Physiology practical sessions involved experiments on unconscious laboratory animals, some of whom sometimes started to come round. We protested that the entire programme was inhumane and that the resultant carnage was unnecessary, but it came to nothing. I wrote to my girlfriend in York that the course should be renamed Statistics and Frog Torture.
For their pre-clinical course, St George’s students mostly attended either King’s College or University College London. UCL was the obvious choice for someone like me, with my background of socialism and atheism. It was founded as a temple of rationality, the first secular university in England and the first to admit women. In some kind of cosmic joke, I was allocated to King’s, an institution that was established by two arch-reactionaries, George IV and the Duke of Wellington, who disliked each other, but disliked the godless doctrines of Jeremy Bentham in Gower Street even more. The King’s College chapel was magnificently over-the-top. It was designed by Sir Gilbert Scott, who also designed the Albert Memorial and the frontage of St Pancras Railway Station. KCL offered a supplementary theological course, the Associateship of King’s College (AKC) to all students. Lectures for AKC were scheduled between 9 and 10 am daily, and all other academic activity started at 10 am to ensure that students could attend if they wished. I was tempted, but rejected the option in favour of sleeping-in, so I enjoyed two years of getting up late while punk rock raged nearby in the semi-dereliction of Covent Garden.