A Hard Day at the Orifice: Reminiscences of an Obstetrician and Gynaecologist

By Dr. John M. Miller

This very personal account provides unique insights into the training and life of a dedicated Obstetrician and Gynaecologist. There are also fascinating accounts relating the history of the profession. Dr. Miller underwent extensive training both in Australia and overseas prestigious institutions.

In addition to delivering well in excess of fifteen thousand babies in his private practice, in his long career he was responsible for numerous thousands more in his roles as medical superintendent of the then largest maternity hospital in the state and specialist consultant in charge of units in large teaching hospitals.He was also a specialist surgeon.

The book is eminently readable and although there are descriptions of obstetric procedures and surgical operations it is certainly not a medical text.

His credo; – to be a good doctor one needs knowledge, proficiency in his craft, compassion and humility. Otherwise he will be merely skilled.



“While Dr. Miller’s reminiscences are bound to interest his peers and medical colleagues, they are written with a great deal of wit, verve and charm, and make fascinating reading for the layman.
The author’s lightness of touch makes the memoir accessible and easy to read, and while he deals with many topical issues ( I found the recollection of his experience in delivering one of the first Thalidomide babies deeply moving ), these moments are balanced by Dr. Miller’s obvious pride in his profession, and his delight in sharing many amusing anecdotes along the way.
No reader can close the final page without the feeling an enormous debt of gratitude to those who have have worked so tirelessly in this field to ensure our own or our loved ones’ safety during pregnancy and childbirth."
—Annette Gilbert, The Raven’s Parlour Bookstore

• Language: English
• Publisher: Xlibris AU
• Release date: Mar 16, 2020
• ISBN: 9781796009729

Dr. John M. Miller

Dr. Miller was indeed fortunate in many ways. His parents were what could be regarded as middle class and were brought up in poverty in the great depression. However, they both excelled scholastically. His father was a decorated soldier in World War II and was promoted to the rank of Major in the intelligence unit of the Australian army. Dr. Miller won a scholarship paying fees to attend Prince Alfred College, and thanks to further scholarships throughout was able to complete private education at P.A.C. to Leaving Honours. At P.A.C. he represented the college in Intercollegiate tennis and Australian Rules football. On leaving he won the prize for best all round student. A vocational guidance test indicated that he was suited to medicine which delighted him. University education was provided thanks to a bursary. During University he played professional A.F.L football until injured! Whilst in residence at the obstetric hospital he discovered a passion for the specialty. He went on to gain the necessary qualifications, –Fellowship of the Royal College of Obstetricians an Gynaecologists, Fellowship of the Royal Australian College of O.& G. and Fellowship of the Edinburgh Royal College of Surgeons. His wife was a Ballerina and for many years has had a large ballet school. He has three children and two step daughters, one of whom was a ballerina who danced internationally. His two sons are both doctors, one is a gynaecological cancer surgeon specialist, the other has more I.T. degrees than a thermometer and has his own melanoma clinic.

Book preview

Copyright © 2020 by Dr. John M. Miller.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

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Rev. date: 06/17/2020

Xlibris

1-800-455-039

www.Xlibris.com.au

804430

To

Vivienne

My rock and my muse

My Remarks, I trust, are true in the whole, though I do not pretend to say that they are perfectly void of mistakes or that a more nice observer might not make many additions, since mistakes of this kind are inexhaustible.

—Gilbert White

Be assured of this most excellent Crito that to use words in an improper sense is not only a bad thing in itself, but it generates a bad habit in the soul.

—Plato

On Biographies:

Others who have not got the advantages of dual personalities remain dull and uninteresting.

—L. O. S. Poidevin in The Lucky Doctor

Contents

Introduction

Murky Beginnings

Medical School

Resident Medical Officer (RMO), Royal Adelaide Hospital

RMO, the Adelaide Children’s Hospital

RMO, the Queen Victoria Hospital

Registrar, the Queen Elizabeth Hospital

The High Seas, P&O Strathaird

The Liverpool Royal Infirmary

Mill Road Maternity Hospital

Catherine Street Women’s Hospital

The Queen’s Home

Private Practice

University Lecturer Hong Kong

More Private Practice

Greenhill Chambers

More Work

Litigation

The Ethics Committee

Extracurricular

The Great Powerlifting Contest

Religion

Separation

Of Sex, Love, and Marriage

Private Practice Finito

Life after Life, Retirement

Acknowledgements

Introduction

Medicine, and obstetrics in particular, must be the most rewarding of all professions.

No favour can surpass the privilege of assisting a newborn baby into the world and sharing the joy and wonder of birth with the new parents. Nevertheless, one in four women in our society will never know the revelation of pregnancy and childbirth, many of their own volition. Procreation must be close to the meaning of life.

I have seen those innocents whom I have delivered go on to become geniuses, savants, pillars of society, worthwhile everyday citizens, possessors of low intellects, and yes, even murderers, lawyers, and politicians. The philosophical point? The accoucheur can only do so much then it’s up to the individual.

Although, on reflection, today’s long-suffering obstetricians are sued if the child performs poorly in kindergarten, has zits or prominent ears, or turns out to be a substance-using layabout.

Gynaecology, the other branch of my speciality, provided a nice balance of diagnostic medicine and procedural surgery.

Medicine is worthwhile; to me, everything else is stamp collecting. Before too many feathers are ruffled, I hasten to add that I am an avid philatelist.

Two of the most important decisions in life are choice of employment and marriage partner.

It’s true. Find a job you love doing, and you’ll never work another day in your life. Arbeit does indeed macht frei despite the abomination of this sign on the gates of jolly old Auschwitz.

There shouldn’t be a difference between vocation and vacation. Don’t be a square peg in a round hole. That criticism certainly didn’t apply to me, pun intended. Don’t be dissuaded if there are setbacks. The old adage of 1 per cent inspiration and 99 per cent perspiration holds true for most pursuits. It’s no good being on the ball for one day and on the bench the other six.

And as to marriage, mutual respect and common goals are paramount. Show your love every day if you want it to last.

Because of my zeal for obstetrics, I have introduced a little of its history, which to me is fascinating. After all, we all underwent that journey through what could have been the valley of death. Historical recollection, of necessity, involves an element of plagiarism. Academics label this ‘research’.

Although medicine was an all-consuming passion, there were many others. If you haven’t got more than one blade to your forceps, you would be pretty useless, dull, and boring.

This autobiography will convey the truth—but as usual, not the whole truth, for that serves no good purpose. As Dickens midwife Sairey Gamp said, ‘We never knows wot’s hidden in each other’s hearts.’ But it will be light on downright lies. Implicit in any autobiography is the premise that the innermost secrets of past sins of individuals cannot be revealed on the written page for fear of irretrievably destroying relationships.

It started off as things to tell my grandchildren but deteriorated into things I shouldn’t have. Inevitably, children and grandchildren judge and analyse their parents and grandparents. After all, people who don’t ask questions don’t get answers. Very occasionally, they are pleased with their findings and love us in spite of everything.

It is rated M—for mature audiences. It contains coarse language, adult themes, sexual references, some nudity, but very little violence apart from sport, where of course it is quite acceptable.

To pen a clerihew (which, like testicles, is a short, paired couplet of unequal lengths)

The art of biography

Is different from biology.

Biology is about bods

Biography concerns sods.

Murky Beginnings

As far as we know everyone had problems in childhood.

—psychiatrist, The Oprah Winfrey Show

(And during teens, young adulthood, middle

age, and senility, I would add!)

The earliest real memories, the ones that stick, are not those that you have been told about which are generated in family folklore. They are the painful experiences suffered, either physical or mental. Child psychologists are coy on the subject. And all Dr Spock can contribute is ‘I really learned it all from mothers.’ However, Stephen King the author lends me de facto support. He recounts his earliest memory, which happened when he was about two and a half years old. To cut a short story shorter, he dropped a cinder block on one bare foot, ‘mashing all five toes’. It was the worst pain he ever suffered.

My pain occurred in midwinter on the dirt floor of my grandmother’s dark and dingy kitchen. Nana was generous to a fault even though she was church-mouse poor. Nevertheless, she rarely babysat. The kitchen was mostly bare apart from an old wood stove emanating warmth from an alcove in the wall. Atop, a large saucepan bubbled with boiling water. I sat nearby, having my baby bath and basking in affection. The fire glowed and crackled in the open stove as it was fed. Nana decided that my bath needed topping up. Unfortunately she slipped in the process. The saucepan was partly emptied on my back. It was probably only a few splashes, because I don’t have any scars. I reckon I howled and howled. The memory remains indelible.

Also at around the age of three, another lasting recollection transpired. This was more gruesome. It was Christmas. How do I know that? Because the occasion involved the execution of a chicken. Chicken was a delicacy and only appeared on the family menu once a year on very special occasions, namely Christmas. Chicken was not available in shops. Its availability therefore involved murder. The foul(!) deed took place on our pocket-handkerchief back lawn. The implements, a wood block and the family axe with the loose head. Probably as usual after several bungled attempts, the head was cut off. I can remember blood spouting from the severed neck arteries whilst the body ran aimlessly around the lawn. This was observed by the head lying on the side, as the eyes clouded over and the beak opened and closed.

‘Chooky’s thirsty. Chooky wants a drink,’ I said. This I distinctly remember.

This grisly scene cannot be erased. Freudian sequelae remain. I am unable to wring pigeons’ necks or knock things on the head. Inflicting pain on animals horrifies me. But humans could take their chances with impunity. There were no problems with surgery and incising living flesh to expose pathological anatomy, no problems with lancing boils. ‘Where there is pus, let it out,’ ‘The local anaesthetic will be more painful than the procedure,’ ‘It will be over before you know it,’ I reassured the patients.

I performed countless circumcisions on babies, mostly without anaesthetic. I used the old-fashioned bone forceps method. This required skill and (misplaced?) courage. The foreskin was put on the stretch with mosquito forceps. The amount to be excised was gauged by feeling the extent of the glans underneath and marking the distal skin with the thumbnail. The bone forceps, an ugly pincer instrument with concave jaws to protect the glans, was then applied. This was the moment of truth. The ceremonial heating of the scalpel blade over a spirit lamp followed. The foreskin was then removed with a deft slice of the glowing blade, hopefully cauterising any potential bleeders in the process.

A neat dressing dabbed with tinct benz co., a.k.a. friar’s balsam, as a haemostatic, and Bob’s—or Dick’s—your (circumcised) uncle.

I don’t remember my own circumcision. Do you? I should. I have a scar on the old boy, the one-eyed trouser snake, dating from my ‘little operation’. This mishap should not occur using today’s Plastibell technique which protects the glans. It hasn’t inhibited me in any way, but I have often felt like entering the fact on my passport and other official documents under the heading Distinctive Markings. However, on reflection, circumcision may have been more traumatic than I remember, because I didn’t walk for another ten months.

Circumcision during much of my obstetric career was almost routine on our population. ‘Ye shall circumcise the flesh of your foreskin; and it shall be a token of the covenant betwixt me and you’ (Genesis 17:11). Many would prefer some sort of legal document to seal the deal as an alternative to the ‘unkindest cut of all’.

I could make an excellent case either way, either yea or nay, for or against circumcision

‘Why do an essentially needless mutilating operation with potential significant complications?’ the antagonists argue.

‘The incidence of Sexually Transmitted Diseases is much lower. Cancer of the penis is unknown in circumcised males. Their partners in later life are less prone to cervical cancer. It’s a terribly traumatic and embarrassing operation if needed later in life for medical conditions such as phimosis,’ the protagonists counter. Phimosis, or constriction and nonretractability of the foreskin, affected Louis XVI. This led to difficulties with sexual intercourse and, supposedly, Marie Antoinette’s infertility.

Spurious arguments also exist. ‘Circumcised males make better lovers.’ The glans is less sensitive, and they can therefore more easily prolong the act to the enduring satisfaction of their partner. ‘Bollocks,’ say the others. ‘It’s all in the head’ (again, no pun intended). And ‘sex to the insensitive circumcised male can be compared to a colour-blind person viewing Renoir’. What have I missed all these years? Not much, I suspect.

A study published in the Medical Journal of Australia found that most men interviewed gave an accurate report on their circumcision status. However a number had no idea and said that they were circumcised when they were not, and vice versa. Perhaps the ones who wrongly claimed that they were circed were afraid that they might be forced to if found to have the foreskin intact. Likewise in an earlier study which compared the prevalence of carcinoma of the cervix in the partners of circumcised versus uncircumcised males, a significant number of married women were clueless as to whether their husbands were circumcised or no, or gave the wrong answer on a follow-up short-arms inspection.

Results published in the Medical Journal of Australia showed ‘significant association between the state of being uncircumcised and four major sexually transmitted diseases, herpes genitalis, candidiasis, gonorrhoea and syphilis’. Smegma can accumulate under the foreskin. Rashes and dermatoses can result. The authors recommended that attention should be directed towards improvement of personal hygiene among uncircumcised men. Urinary tract infections are much more common in uncircumcised babies. The inner foreskin is lined by a cells which are prone to infection and lowered resistance to HIV and human papilloma virus, the virus which contributes to cancer of the cervix in women.

Circumcision prior to puberty is protective against HIV and also cancer of the penis. There is an eightfold increase in protection against AIDS. Heterosexual men having unprotected sex with an HIV-positive partner have significant protection against contracting the disease if circumcised. Authorities are therefore actively undertaking a programme of circumcision in Africa as a preventive measure.

The benefits of the procedure need to be balanced against the inherent risks. There is a technical complication rate of approximately 2 per cent in performing the operation. The main complications are those of anaesthesia (if employed), haemorrhage, and genital disfigurement. As far as urinary tract infections are concerned, over 100 babies would need to be circed for prevention of a single case. HIV implications are to be considered in the context of the low incidence of sexual transmission in our population. Therefore, the official line by the august medical colleges in Australia is that there is insufficient evidence to support universal circumcision of the newborn.

The reason for the backlash against circumcision in the late fifties and early sixties has been largely forgotten. The real impetus for the anti-circumcision movement was much more legitimate. Even so, in the late 1980s, circumcision was still the most common surgical procedure performed in the United States.

I was, at the time of the about-turn, a resident medical officer at the children’s hospital. There was an epidemic, almost a pandemic, of golden staph, Staphylococcus aureus. In particular, infections with the lethal phage type 80/81. This was a particularly virulent strain, resistant then and now to antibiotic therapy. Babies were dying. Interviewing and trying unsuccessfully to console distraught bereaved parents took an enormous emotional toll, and it occurred relatively frequently.

It then came to light that circumcised babies were more prone to infection. The raw circumcision wound served as a focus for bacteria. This was in the days before rooming-in of newborns. The babies were all lumped together in communal nurseries and only taken out for feeds and visitors. Cross infection was inevitable. Most of the staff, medical and nursing, were carriers. The circumstances carried shades of Semmelweis.

Hungarian born Ignaz Semmelweis (1818–1865) worked as an obstetrician in a maternity hospital in Vienna. He discovered the cause of childbed fever. The hospital was divided into two sections. The maternal mortality rate in the section of the hospital staffed by doctors was 18 per cent, and less than 1 per cent in the area which was staffed by midwives. The patients dreaded being transferred from the midwives and saw it as a death sentence. Semmelweis observed the obstetricians going straight from performing autopsies on mothers who had died from puerperal fever to the delivery room without changing their dirty, bloodstained white coats. He concluded that they were carrying some sort of microorganisms which caused infection.

Semmelweis suggested the simple expedients of changing and washing the hands in chlorinated limewater with a subsequent dramatic reduction in maternal mortality. He was sacked for this heresy by the conservative older brigade. He became depressed and later died in a mental asylum.

Circumcised babies thus were more likely to develop staphylococcal infections. There could be skin problems, boils, carbuncles, or pustules. More serious and feared was osteomyelitis. This deep-seated recalcitrant infection of the bone was painful in the extreme, disfiguring, and caused sinuses which could discharge pus and spicules of bone for years. Staph pneumonia, if contracted, could be fatal.

Nevertheless later, when staphylococcal infections were less prevalent, like Onassis I supported circumcision. Onassis apparently had barstools on his yacht made from the foreskin of whales.

When I worked in Liverpool, the anti-circumcision movement was at its height. The only practitioner who could be coerced into the performing circumcisions was a Jewish rabbi. He toured the north of England performing the rite and making a fortune. He charged £16, discounted to £8 for the babies of ‘medical colleagues’. His technique involved making a dorsal slit in the foreskin, which then hung down, leaving the penis with the appearance of a frill-necked lizard.

Boys who have been circumcised as babies are now rearing their ugly heads. They are apparently threatening litigation against their parents and the surgeon involved. It is argued that parents did not have the legal power to give proxy consent for nontherapeutic procedures. ‘Long-tail’ liability gives the child the right to sue on reaching majority. A paradox even more threatening to the medical fraternity is that in our society the law states that the applicable standard of care is determined by the court rather than by accepted professional practice at the time.

Professor Bates contributed an erudite article to the Journal of Law and Medicine on the present state of play regarding the real risk of possible litigation for the unkindest cut of all. Emotive graphic descriptions of circumcision from another source are quoted. It is said to involve ‘scraping, tearing apart, and destroying the normal erogenous tissues of the child’s sex organ’. Amputation of the foreskin was likened to ‘ripping off a fingernail from its quick’. Not in my experience.

Lord Templeman, discussing ritual circumcision in a contentious decision of the House of Lords in R v. Brown, said, ‘Surgery involves intentional violence resulting in actual or sometimes serious bodily harm but surgery is a lawful activity.’ Exceptions to the general prohibition on assaults causing bodily harm do include medical treatment. But there are legal opinions similar to another exhaustive article in the Journal of Law and Medicine, which summarised ‘Enforced non-therapeutic genital cutting of unconsenting minors is overdue for recognition by the legal community as sexual mutilation. As we enter the 21st century, appropriate legal action must be taken to safeguard the physical genital integrity of male children.’ I would submit that any doctor or parent consenting to routine circumcision at present is laying himself or herself open to future action. No doubt, the vast majority of such lawsuits, if they do arise, will prove to be vexatious and based on imagined rather than real injury.

I had first-hand experience of a staph infection during my first year residency at the Royal Adelaide Hospital. We worked like dogs but revelled in it for the experience gained. It seemed that all we did was to work and sleep;-particularly when rostered on Casualty. We were chronically tired and run down and susceptible to anything going around. There was, however, the occasional residents’ party.

I had developed a large boil over my tibia, the lower leg, an area notorious for slow healing. My better judgement overruled by booze at one such orgy, I agreed to let a mate lance it after freezing. Don’t let anyone ever kid you that this is an effective anaesthetic. It hurt like hell. The laudable pus expelled and a dressing applied, I returned to the party where I unsuccessfully tried to seduce a lesbian nurse. I also abused S., an England fast bowler. The visiting test team were impromptu guests that night.

The knowledge that I could be a carrier of staph was sad in later years, when I had my own young family. I was, rightly or wrongly, afraid of intimate physical contact for fear of transmitting infection. I rarely nursed our babies, to the detriment of both sides. In that context, it is of interest that recent research has now indicated that there may be an association between staphylococcal infections and SIDS, i.e. sudden infant death syndrome, otherwise known as cot death.

Medical School

On my first day at uni, having been failed again by my well-known unerring sense of direction, I was unable to find the introductory lecture theatre. I happened to chance upon a mate from the Holdfast Tennis Club. He knew his way around and offered to escort me. We entered through the back door of the lecture theatre, and he pointed out my seat. He ascended the podium and delivered the lecture. I felt quite at home.

There were about 120 hopefuls who started in our year. This included only a handful of females. The first modern woman doctor was a Dr James Barry. She qualified in Edinburgh in 1812. She followed a career in the army and was elevated to the post of inspector general of hospitals. At one stage, she fought a duel. Her deception was only discovered at her death aged seventy. The charwoman who laid her out discovered that she was a woman. The presence of striae gravidarum suggested that she may in fact have been parous, although stretch marks can, of course, have different aetiologies to pregnancy.

This bias against women in the nineteenth century also surfaced in the Edinburgh University. Englishwoman Sophia Blake was denied entrance to the university because ‘the brains of women were not capable of holding the knowledge required’. Despite satisfactorily completing the medical course syllabus, she and six other females were not permitted to graduate. Only now, 150 years later, have they been recognised and granted the posthumous degree of M.B.ChB.—i.e. bachelor of medicine and bachelor of chirurgie (French feminine noun meaning ‘surgery’).

One of the first women to graduate in 1899 was Elsie Inglis. Later, in 1914 when war broke out, she applied to the Royal Medical Corps. Edinburgh Castle refused, admonishing her with ‘My good lady, go home and sit still.’ However, she persisted and convinced the Women’s Suffrage Society to fund and organise field hospitals run by women.

Opposition to women in medicine continued to flourish until the late nineteenth century. Revolting male students rioted in protest at Surgeons’ Hall. Their reasons? Anatomy lecturers would not be able to impart lewd mnemonics, and lectures on venereal disease were not thought proper for a mixed audience.

There were a few ex-servicemen in our year and a smattering of students from Western Australia, which did not have a medical school of its own at that stage. I don’t remember the content of the introductory lecture but recall sitting next to a student—we were seated in alphabetical order—who later became the victim of a horrible tragedy.

The initiation ceremony, popular at that time but since banned, was held in the refectory adjacent to the River Torrens. It was a real shambles, crowded and noisy with drunken med students everywhere. Older students belted out bawdy medical songs to the tune of Lili Marlene:

Night upon the Torrens

We were doing med.

The students all were up (who?)

The nurses all in bed.

The final year students forced the first years to perform all manner of unspeakable, embarrassing, and humiliating acts. A buxom female student was perched atop the piano and made to sing with her skirt up around her neck.

With all the semi-inebriated panache which I could muster, I pretended to be a second year. As a nonvictim, I was quite enjoying the spectacle when word got around that something had happened at the river. We stumbled out into the darkness and down the river bank. There we were greeted by a grim, eerie sight. Several cars were drawn up on the riverbank with their headlights beaming out and playing on the stygian murky river.

Some of the sixth years had dragged my neighbour from the lecture to the river. Despite his terrified screams and protestations that he could not swim, they had heaved him in fully clothed. He sank like a stone and had been underwater for a half hour by the time I arrived. This was before the days of CPR and external cardiac massage and mouth-to-mouth. Most of the sixth years were running around like chooks with their heads cut off. A resounding memory was of one student, Bob K., who was repeating first year. He had organised a line of students along the riverbank. They were stripped down to their underwear. On Bob’s command they were diving into the river, trolling the bottom and trying to retrieve the body. This they did shortly after I arrived. By then he was lifeless.

There was a coroner’s inquiry and court case. The students responsible were banned from sitting their final examinations and had to present at a later date. They no doubt felt ghastly about the whole sorry business.

The episode gave me a lot of insight into Bob’s character. He became a stalwart friend and a member of our exclusive clique. Don’t ask me how the rat pack arose or what attracted the members to one another. There was no common bond or thread attaching us. Judge for yourself.

Bob’s father was a Lutheran minister. As such, Bob was always impecunious. He did it hard. Bob arose at an ungodly hour and worked in the market before attending lectures. He eventually sealed the record at twelve for number of years taken to complete the medical course. This record will stand in perpetuity. The current system of running assessments does not allow for students to repeat more than one year.

He was having his third try at first year when we started. By the time I was a registrar at the Queen Elizabeth hospital, Bob was still doing his obstetric residency as a final year student.

Bob became known to the examiners, and I think that this introduced an element of bias. Unbeknown to anyone but yourselves until now, when he was one of my students at the Queen Elizabeth hospital, I suggested to him his paper for his obstetric project. He chose one of the prof’s favourite topics, the management of breech presentation. He drew liberally on the prof’s own contributions to the literature. When later I raided the filing cabinet in the prof’s office, I found that he had only been awarded a B!

Bob was a talented sportsman. He could easily have played league football, and he captained our year football team. One time at the dinner held following the completion of the annual interyear football tournament, after receiving the trophy, he collapsed as the result of indulgence superimposed on bleeding into a corked thigh.

We played a lot of tennis on the courts at the QEH during his residency. I thought the standard quite high and that we put on quite a show. On one such occasion a female consultant bailed me up and complained, ‘I just saw that horrible B. fellow playing tennis with someone.’ Bob would be dressed by either Pro or Joe in a borrowed suit in order to look presentable for the vivas. Pro also gave him serious coaching. But he lacked subtlety.

Professor Cox, who was dean of the faculty, interviewed Bob just prior to the final exams in Bob’s penultimate year. Professor Cox advised him that if he undertook a public health job on graduation and would not therefore be dealing with an unsuspecting public, he would pass. Bob’s answer, ‘What, and be one of those flunkies?’ ensured many happy returns for another year.

Bob eventually became a highly respected, capable, and loved country general practitioner.

Pro, short for Professor, was tall and bespectacled with a studious air and was highly intelligent. He had previously completed a science degree and acted as a demonstrator in the zoology laboratory for us in first year. Pro was a man of the world. He had numerous ‘witty’ observations such as ‘That guy would drink urine strained through an Afghan’s loincloth’ or ‘He would do the clock if somebody would hold the hands’. Joe was also a mature-aged student. He had been in the US Army during the Second World War and married an Australian girl. He spoke with an attractive Rhode Island drawl which made John sound like Jaarn. He was being educated under the GI scheme. The US government always supplied him with the very best of equipment throughout the course—microscopes, skeleton, stethoscopes, ophthalmoscopes, auroscopes, and a plethora of textbooks, of which we were sometimes beneficiaries. Joe made a habit of wearing his Purple Heart ribbon to the exam vivas. He was the sort of guy who, when you were standing unsuspecting at the urinal, would unbalance you with a push from behind. He thought it hilarious when urine soaked the front of your trousers. I suppose it was if you weren’t the victim.

The other members of our rat pack were Pop, Dunc and Keith.

I think Pop was short for ‘Eddie Cantor pop eyes’. .He was always full of fun. Pop’s father had a very large old Packard. In fact, an eighteen-gallon keg of beer could fit in the back seat, a bonus come time for our year picnics. At one of these picnics on the beach at Seaford, one of the students fainted during a game of cricket. We thought ourselves particularly clever to diagnose paroxysmal tachycardia and revive him with carotid artery pressure and by pressing on his eyeballs.

Dunc had my admiration. He was the only student I knew who had the nerve to read several novels during SWOTVAC just before the exams. The rest of us had our heads buried in text books. He too was always full of witticisms, some of them obscure to all but Dunc himself. With his Scottish ancestry, he could be quite dour at times. Many’s the time that I was the only one who caught his meaning.

Dunc was responsible for a brainchild mnemonic which I have since passed on to countless medical students. It relates to the complications of diabetes mellitus. The magic word is KANGIROO, spelt with an I not an A. Those complications are ketosis, atheroma, neuropathy, gangrene, infection, renal, ocular, and obstetric. The basis for any brilliant exam answer.

Keith was a near-scratch golfer who boasted a remarkable butso. Blond and handsome, if the term had been invented, he would have been referred to as a chick magnet. He later set up in general practice at McLaren Vale. I would take my instruments to the local hospital on a Sunday morning. After the operating session, we would have a barbecue with magnificent wines from the local vineyards and play tennis on his lawn court. Keith had my admiration in that he later knuckled down and obtained a Royal College of Surgeons specialist degree.

Our group won the coveted university beer drinking (swilling) championship when we were in second year. The attraction was not the glory but rather the free beer. This was about the only general university activity that medical students took any part in. Because the medical school and hospital were physically distant from the refectory and quadrangle, we were not interested in the union activities and pseudo politics that a lot of the other so-called faculties indulged in.

Two other students joined our circle when we were in obstetrics residence. They were John J., whose father was a knight of the realm. He was dux of final year and, like his père, became a urologist. Peter B., also extremely intelligent, became a general practitioner.

But by and large we were a separate entity who socialised together. In this, as far as I know, we were a unique group in our year.

I found first year a breeze, no doubt because of the advantage of the extra two years in leaving honours. The subjects, in retrospect, could easily have been compressed and integrated into subsequent years. They included botany (learning about plant phyla, of all things), zoology (the different species and genera, and dissecting frogs and the like), histology (peering down microscopes), biology and medical physics. I can’t even remember what else.

I managed to come third in the