Graft vs. Host
When I arrived in the summer of 1980, there was no guide book to Whitechapel. Nonetheless, you were steered constantly in directions seemingly beyond your control. Climbing up and out of the underground station, there was no option but to make your way through the bewildering bazaar of cheap food, even cheaper clothes and plastic household goods, presided over by Bengali stall holders whose purple, Betel-stained teeth competed with the diamond gnashers of other longer-standing traders, geezers called Bernard and Alf, who could have doubled up as henchmen for the Kray twins.
Arriving in a strange city at night you expect to feel unsettled but it was barely afternoon. My anxiety on this first day of induction into the medical school at Whitechapel was compounded by my being over an hour early. The stall-holders, disposed to transmit rather than receive, appeared to ignore me when I inquired about a cafe. Eventually, one of them indicated with a slight jerk of the head a pub just fifty yards away. It was the kind of place where, without being told, you just knew something bad had once happened. Inside the ‘Blind Beggar’ you were struck immediately by the vaguely sickening feeling you get when slowing to walk past a car accident where only the crumpled vehicles remain. The laconic barman, judging me to be a tourist, ushered me to the backroom where bullet holes in the wall (preserved from prying fingers by a sheet of Perspex) were still evident from the Kray’s settling of a gangland score.
Something bad had happened, albeit twenty years earlier. But when I stepped out back onto the High Street, the same feeling followed me. Bad things, I was soon to learn, happened regularly in Whitechapel. When they did, the victims were ferried to the London Hospital to be patched up or pronounced dead; or, like the Elephant Man, put on display for the education of the medical students and staff.
Whitechapel’s lowly position on the Monopoly board was not unwarranted. More down-at-heel than raffish, it felt neglected, with rows of boarded-up buildings that had been condemned; corrugated-iron barricades and rusting barbed wire. I went for what was intended to be a short walk but was soon lost in its Dickensian labyrinth. Hurriedly, retracing my steps to the underground I began to panic. The medical school was nowhere to be found. I stopped a passer-by to ask directions and steeled myself for the inevitably complicated instructions. But she said nothing and merely pointed across the street. There it was: the London Hospital, so tall and imposing that you would have had to pull back further than was possible to take it all in. It towered above everything – brooding, grey and gothic.
The traffic clogged the arterial road. Cars reluctantly made way for a procession of ambulances, travelling not at speed; no faster than their horse-and-cart predecessors from the century before, we were later told, at eleven miles per hour. Oftentimes it took so long to ferry the injured that rather than send an ambulance the A&E doctors might as well have sent a hearse.
More than a hospital, the colossus was a place of safety, a hub, giving shape to the lives of the grimy population – emaciated by poor diets, horrific dentition and skin as grey as the buildings. If they died and left their bodies to the medical school, dissection revealed lungs blackened not necessarily by tobacco smoke but by the car fumes that had clad the buildings ever since the 1950s and hovered around the London Hospital like a permanent black cloud.
And yet, the squalor of the surroundings was more than compensated for by the affection shown towards the hospital and reverence shown to us; not mere medical students but golden youth who had teleported in from the shires and Home Counties to minister to the sick of Whitechapel; except that I was from Luton, a town only marginally more attractive than Whitechapel. Nonetheless, I was the first of my family to receive a tertiary education. And I climbed the steps of The London Hospital with a burgeoning sense that a bastion of British society, the kind of citadel from which my Jamaican parents and their peers had long felt excluded, was about to be breached.
‘There’s at least one schizophrenic on every double decker bus.’ Dr Conville could have put it more plainly and said something like: ‘one per cent of the population is schizophrenic.’ But that was not his way. ‘Does that mean there’s at least one schizophrenic amongst us?’ asked Conville. He was a provocateur; and it was not surprising when he followed up with the question: ‘And why are young black men six times more likely to be diagnosed with schizophrenia?’
He ranged across the lecture hall, tall and imperious. The tangy sarcasm of his voice, you suspected, had not lessened in all the years of lecturing. His intellect was obviously wasted on medical students; but, God help him, he enjoyed teaching. He had a talent for it. Conville reached inside the breast-pocket of his white overcoat and extracted a silver telescopic aerial. It must once have been attached to a transistor radio. Now it was a pointer: one that appeared to have a life of its own, veering from side to side. It was unmistakably directed at me.
Dr Conville seemed faintly irritated by my silence. Given my complexion, surely I must have a view on the matter, surely! His laser gaze drilled through to the back of my head. ‘Why do you . . . ’ He left a gap for me to declare my name. ‘Why do you have a greater chance of being diagnosed as schizophrenic than any other medical student in this room, mmh?’ He was as patient as a priest awaiting the details of confession. There was not a murmur from the class; but then, it was only our second day at medical school. There were no ties that bound us other than fear of personal exposure. My only recourse was to pretend it wasn’t happening to me. I was no different from the others: I wouldn’t even leap to my own defence. When it was clear that no matter how long he paused no answer would be forthcoming, Conville turned away from me and addressed the whole room: ‘Because black people are schooled in paranoia.’
Dr Conville scowled at the back row from where, now that the tension had lessened, one or two titters emerged. The higher incidence wasn’t specific to black people, of course, but to all migrants. In fact the Norwegian population of Milwaukee, he intoned, exceeded all groups in percentage of schizophrenics – a fact which produced another flurry of tittering. When the room had sufficiently calmed again, he came to the point that we were to take away from this, our first lecture: ‘Think pathology!’ Conville collapsed the aerial, slipped it back into his pocket, before continuing: ‘You’re walking down the high street, just outside, and you see a Bengali woman with a hacking cough, honking onto the pavement. Observe the colour of the sputum. Is there blood in it? Tuberculosis? There’s a sixty-year-old fellow whose route to the off-license takes him past the entrance of this hallowed institution every day. You’ve probably seen him already. Bent over like an arthritic jockey. He has a mirror in his hand so that he can see where’s he’s going. On the few occasions when he painstakingly straightens up it’s apparent that half his nose is missing. That’s tertiary syphilis, isn’t it? Isn’t it? Do not squander your time here. There is much to learn over the coming years. Keep your eyes peeled and think pathology. Always be thinking pathology’.
Selective perception is such that once you started to look, invariably, you saw pathology everywhere. You couldn’t look at a pretty girl now without wondering about the slight stain to her teeth. Had she been given tetracycline as a child? And Conville was sadly right about the black schizophrenics, at least in the East End: they were everywhere. Though, the sight of other students examining the phlegm on the pavement – a practice which seemed almost medieval – made me ponder the wisdom of ‘thinking pathology’.
It might have been that Conville was playing some dark joke on us. But then you couldn’t legislate for the idiosyncrasies of any particular lecturer: all wore their idiosyncrasies as a badge of honour. There were myriad cynics. The worst of all was the pathologist assigned to teach us medical ethics. You judged immediately that it was a reluctant commission when he began: ‘Medical Ethics? Medical Ethics? If you’re gonna screw around with the patients, don’t get caught.’
I grant that it might have been as a result of my own selective perception that I began to see contemptuous medics everywhere I looked. As a treat, at the end of our first week, we were allowed onto the wards, to trail a consultant and his team, arranged in an inverted V behind him as if we were part of a peerless thespian’s enormous cloak, as he began a ward-round. When a patient queried why an investigative laparoscopy had ended in an emergency laparotomy, the consultant sneered: ‘Well, you wanted the operation, didn’t you?’
Up until medical school I had associated the practice of humiliation with the ill-educated, ignorant English people who dressed up their antipathy towards my Jamaican father and his friends with a kind of surly, faux politeness: it couldn’t be helped. It was a shock to see scorn as the default position of learned medical practitioners. Medical school served up a daily diet of humiliation: it was built into the very fabric of the institution and rarely questioned. The consultant regularly humiliated the senior registrar; the senior registrar turned his ire on the registrar; the registrar held the senior house officer in contempt; and the house officer was the last in the line, the dog to be kicked, because there was no one else left. It could be argued that the lecturers with their withering comments were preparing us for the lives ahead of us. But to see grown men and women scorned and infantilised by their superiors was disturbing. I felt their embarrassment was heightened by our being witness to it, just as my father was doubly discomfited by any assault to his dignity that took place in the presence of his child.
Teaching enabled the doctors to escape, albeit temporarily, the adversarial climate of the hospital wards and surgical theatres, but some vestige of the trauma remained and leaked out in the Tourette’s-like verbal explosions and excoriating barbs that inexplicably punctuated a lecture or tutorial: these guys just couldn’t help it. The wisest course of action might have been to go along with it, to grin and bear it – or as Jamaicans say ‘to play fool to catch wise’. But I was governed by a seriousness that had been generations in the making. My Jamaican migrant parents had made sacrifices, scrimped and saved and sent me to an expensive private school so that I would not be exposed to the daily degradations they endured – or so I thought. We all carry psychological baggage. My fellow students had, wisely, merely packed an overnight case; but I seemed to tow along a trunkful of confusion that, until entrance to medical school, had remained unopened and unexplored.
At heart I knew in that first week that I’d made a profound mistake. Medicine was a wrong turn. But unhappiness was not enough of an alibi; I couldn’t leave because of my colour and class: too much had been invested in me. It was a truth I had acknowledged on our first day, when the dean in his welcoming address had posed a question: ‘Which of you has a parent who is a doctor?’ One or two hands shot up immediately; then others emboldened raised their arms cautiously, and still others more sheepishly. By the final count the hands had it: more than half the year were the sons and daughters of doctors. But there was no censure from the dean; rather he sought to congratulate them and us, for we were all privileged. We had chosen our profession wisely, he said, because ‘the sick will always be with us’.
Taking part in one of the many social clubs might offer some relief from the nerve-jangling intensity of medical school. The rugby club should have been a natural fit but the wisdom of joining that club had to be considered alongside the inevitable high jinks initiation ritual that accompanied admission: a candidate was required to drop his trousers and allow a rolled-up newspaper to be shoved up his rectum. If his enthusiasm cooled at this point then it would have dipped below freezing by the next stage when the newspaper ‘torch’ was lit and he was forced to run a gauntlet, reaching the end, hopefully, before the flame reached his gluteus maximus.
The rugger buggers were a marginal improvement on earnest liberals amongst whom my colour granted me a special pass. Welcomed to cheese-and-wine dinner parties where a fondue kit might be unveiled for the first time, the guests cooed on your arrival and offered sympathy for the plight of your poor fellow black brethren consigned to Brixton which was ‘little short of being trapped in a Stalinist gulag,’ didn’t you agree?
Ultimately, I took solace in extra-curricular reading. I had only read three or four works of literature prior to medical school; and only those books fit for the purpose of passing the O Level required for the grand scheme of getting me into medicine. I’d certainly never heard of Anton Chekhov – but over the course of the next few gruelling years the sentiment expressed by Chekhov that ‘medicine [was] his lawful wife, and literature his mistress’ began to chime with me.
The dizzying excitement of literature was a relief after the intensity of concentration needed to absorb and commit to memory the thumping thousand-page Gray’s Anatomy (the medic’s bible), piles of other text books, a new precise, scientific language and thousands of Latin words and phrases. Most lecturers made no apology for cramming essential knowledge into us like geese being force fed corn; OK, their livers were so distended they couldn’t move but then they were destined to end up as pâté.
Luckily, there was a handful of women who believed in a more holistic approach to a discipline that they argued was as much an art as a science: Annie Burgess presented her embryology classes with the panache of a Busby Berkley musical – ‘the spermatozoa is in the wings; the ovum on stage, draw back the curtains and let the drama begin’. The surgeon Rita Auden (niece of the famous poet), required you to come to theatre with a poem to recite to offset the necessary tedium of surgery; and at the start of obstetrics, Wendy Savage bid us put away our gynaecology text books and handed out copies of Germain Greer’s The Female Eunuch and Erica Yong’s Fear of Flying, so that we might better understand women and female reproduction.
I started to write plays and put them on in pub theatres. One day the dean heard about them and summoned me to his office for a few prophetic words of caution: ‘In my experience, students who write plays do not go on to become doctors.’
Soon I began to have monthly audiences with the dean where I voiced my unhappiness. I wanted a year out from the course. I tried to explain that my parents were the first stage rocket and I was the second stage; I was meant to go further than them but inexplicably I had run out of fuel. Medicine was not inspiring; it was grim and distressing. If medical school was the host then I was a graft that would not take. I’d been bluffing all along. Surely, the dean understood. I thought my discomfort philosophical; the dean could only conceive of it in medical terms. Perhaps there was some underlying pathology at play. If I consented to see a psychiatrist and he/she arrived at diagnosis then I might be ‘signed off’ for a month or so. ‘But wait for a while,’ he added, ‘things might get better.’
I wavered and miraculously the dean appeared to be right, especially after I stumbled across a fantastic book called A Fortunate Man, a photo-journal of a country GP in the Forest of Dean. The book was so titled because the subject, Dr Sassall, was so obviously fortunate. He was intellectually stimulated by his work, handsomely paid, lived in an idyllic cottage and was loved by his patients. He mended broken legs, sat with the elderly as they lay dying, offered indispensable words of wisdom to young and old, and helped mothers give birth. Reading A Fortunate Man had a profound effect on me: it induced a kind of euphoria and restored my faith in medicine. No sooner had I finished the book than I rushed to the library to find out more about Dr Sassall. It was easier than I thought. His name had appeared a few months back in the BMJ. It was a shock to discover his obituary, and especially the wording that hinted at suicide.
Soon after, like a relapsed addict, I returned for another audience with the dean but he merely repeated the terms of any deferral from the course. The shame of what I had agreed to only hit me in the waiting room of the Maudsley Hospital the next day when I saw my fellow patients (a bus-load of Conville’s schizophrenics), the majority unfortunately black, with crumbs around their lips, shuffling along and ululating, drugged up to their eyeballs with anti-psychotics.
I could not proceed with the appointment but, equally, I could not go back to the dean. It was the exam period. We all withdrew into our rooms to study but I did not fully re-emerge. Instead of studying I surrendered to the repetitive comfort of Tai Chi and my bedroom carpet, already thin, was worn down until it was threadbare.
I started skipping the odd lecture or revision tutorial. Before long, I had absented myself without leave on so many occasions that passing finals became less and less likely. In any event, to pass an exam you needed, at the very least, to turn up. I did not.
The exams came and went, as did the chance to re-take; and still I did not return. A new term started but I had reached the tipping point of not going in at all. Months passed, maybe even a year. When I did summon the courage to go back to the London Hospital it was with the fractured nervousness of a lover returning to a doomed affair.
The season – it was the beginning of autumn – seemed to allow for a return. I booked another appointment with the dean. When I walked through the door into his office, another man was sitting in his seat. The replacement dean did not look up but continued to pour over my notes. Eventually, he let the notes fall shut and looked up with an unnervingly steely glint. He was affronted, he said, by my attitude ‘personally affronted.’ I gathered he was also ‘affronted’ by the latitude shown towards me previously. He reminded me of a schoolboy who had just learned a new word and was determined to use it in every sentence. There was a long list of people to get through on whose behalf he was ‘affronted’. And it was with some relief that he concluded that he was ‘ashamed’ of me as I was someone who clearly had ‘so little regard for this venerable institution.’
I found myself apologising and agreeing with the dean. He brightened. I thanked him for his support and mumbled something about being on a life support machine that should perhaps be turned off. The dean chortled. He stood up, held out his hand, escorted me to the door and wished me good luck in whatever I decided to do in the future.
Outside, I lingered in the courtyard one last time leaning on one of the large oak trees. As I walked on leaves began to fall; and I reflected that, though it was kind of sad, there was inevitability about the fall; and at least the leaves were at peace.
Photo courtesy of Colin Grant