The phone rang. I had overslept. It was 9:30 am. It was the dermatology secretary.
“I have Dr MacDonald on the phone,” she told me.
“Where are you?” he demanded.
“I’m at home,” I replied.
“Why are you at home?” he barked.
“We’ve had a baby.”
“Is everything okay?”
“Yes, Sarah and the baby are fine”.
‘Then get dressed and come to work immediately.’
I knew it was a research clinic that morning, normally with three doctors — one consultant, one senior registrar and me. There would be six patients at the most. I knew that I was not needed, and that they would cope without me. Nevertheless, I dressed quickly, leaving home without breakfast.
When I arrived at work, the other members of the department looked at me with worried expressions.
“He’s in there,” someone whispered.
I knocked on the door.
“Come in.”
He didn’t invite me to sit down. How could I be so unprofessional? What was I thinking? How dare I behave like this? He would not stand for it! There would be consequences. I started crying, I couldn’t stop myself. My emotions were scrambled. I began to sob loudly.
I left his office, and tried to hold myself together. The senior registrar put her arms around me. I started crying again.
“I hate that fucking bastard!” I said.
“So do I,” she said, nervously fingering her pearls.
In those days, the senior consultant opinion was crucial for the career advancement of the trainees. It was not uncommon for consultants to phone each other before the interviews. This was the old boy network. The opposite was also possible, where the senior consultant tried to knobble the chances of a candidate who has let him down, offended him or disappointed in some way, as in my case.
I had applied for a senior registrar post in Cardiff. Dr MacDonald was one of my referees. He was sure to go out of his way to try to stop me from reaching my goal. My second referee was my first boss from High Wycombe, the one who had warned me that this man was a bully. We discussed tactics and he offered to phone the Professor of Dermatology in Cardiff to put in a good word. This was using the old boy network to resist the old boy network. He would make a point of explaining that he had advised me not to accept the registrar job at Barts because of the reputation of the senior consultant. In other words, he was taking responsibility for the fact that things went wrong, although it was certainly not his fault.
Dermatology in Cardiff was a hierarchy with a charismatic professor at its head, under which worked a large team. There were Master’s degree and PhD candidates and post-doctorate researchers too. My CV was now strong for research with a respectable number of publications, some in good journals. I explained at interview that I was now keen to do a research degree, preferably a medical doctorate; if appointed, would I be supported in this goal? I was appointed, and yes, I would be supported with this ambition.
FEMALE, EARLY FIFTIES, RED EARS
A woman in her early 50s with bright red, very tender, slightly floppy, swollen ears. It had come on suddenly over the previous six weeks. She lived in Essex, commuting into London for a well-paid secretarial post in a stock-broker’s office. I call in the consultant, but am sure I knew what it is. We both agreed, it is the rare immune-mediated condition which attacks cartilage, relapsing polychondritis.
“Yes, it can be treated,” I explain. “However, it will require strong drugs to suppress your immune system, starting with oral steroids.”
“Is that safe?” she asks. “My nan took steroid tablets for her kidney disease and ended up with a moon-face.”
We discuss it in more detail. I explain that the steroid dosage should not be too high, and we will also start her on a steroid-sparing drug. As things improve, we will then tail off the steroids and keep her on the steroid-sparing drug. She will need some time off work. She smiles, liking this suggestion.
“What about the floppy ears?” she asks. “I feel like a spaniel.”
“Let’s wait and see,” I said. “Hopefully they will regain their normal stiffness with time.” However, it was hard to predict; I had never seen a case of relapsing polychondritis before. The tenderness and pain in her ears would respond rapidly to treatment, and she would soon be sleeping better. But the floppy ears might stay floppy.
Alex Anstey 