Just Sign Here: Tales from a life in Surgery

By Bob Greatorex

If you think surgery is only about the drama of an operating theatre, then you should read this book. A delightful collection of anecdotal stories that will take the reader on a journey from boyhood aspiration through surgical training and on to consultant surgical practice that spanned the millennium. All is laid bare as the author describes his joy, anger, frustration, and sadness of life in the clinical environment and beyond.

It embraces a period of transition when clinicians were transformed from self-regulating professionals into paid employees controlled by political diktats from Brussels and Westminster. It is an entertaining account of a period of momentous change and advances in the world of surgical healthcare. A penetratingly candid page turner that will make you laugh, cry and huff with indignation.

• Language: English
• Publisher: Austin Macauley Publishers
• Release date: Jun 23, 2023
• ISBN: 9781398461635

Bob Greatorex

Bob Greatorex is a retired surgeon and a keen student of Admiral Horatio Nelson. He has lectured extensively about Nelson’s life and career for over three decades. Nelson’s Cat and the Agamemnon Eyepatch is the first of a series of books aimed at introducing primary school children to the famous sailor and his many seafaring endeavours. He has previously published a biographical series of short stories titled Just Sign Here, recording his life as a surgeon.

Book preview

About the Author

Bob Greatorex is a retired surgeon who trained as both a dental and general surgeon. He spent forty years working in the NHS and alongside clinical work, became an experienced teacher, trainer and examiner in the UK and internationally. Elected to the Council of the Royal College of Surgeons of England, he was seconded onto national committees within the Department of Health. Away from the clinical coalface, he worked for the Care Quality Commission and the Centre for Workforce Intelligence. He is a champion of equality and diversity within the profession and is an enthusiastic supporter of Women in Surgery.

Dedication

For Jemima Alice

My anchor, compass and advocate.

Copyright Information ©

Bob Greatorex 2023

The right of Bob Greatorex to be identified as author of this work has been asserted by the author in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publishers.

Any person who commits any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

All of the events in this memoir are true to the best of the author’s memory. The views expressed in this memoir are solely those of the author.

A CIP catalogue record for this title is available from the British Library.

ISBN 9781398461628 (Paperback)

ISBN 9781398461635 (ePub e-book)

www.austinmacauley.com

First Published 2023

Austin Macauley Publishers Ltd®

1 Canada Square

Canary Wharf

London

E14 5AA

Acknowledgement

To my wife Carol for her enthusiasm, encouragement and skill in correcting my grammar. Thank you is an insufficient word to express my gratitude.

To my many surgical colleagues and all the patients who placed their trust in me. Without them none of the events described would have taken place.

To the endlessly patient staff of Austin Macauley who guided me through the unfamiliar world of publication. Thank you for bringing this work to fruition.

Introduction

Forty years is a long time to spend using a knife to expose, excise and repair human organs. The self-belief required is almost pathological in itself. The doubts that surface from time to time can be crippling if there is not a deeply rooted belief that you are trying to help fellow beings. Success, especially against the odds, can be overwhelmingly joyful. In contrast, failure, when unexpected, is both immeasurably sad and a trigger for introspective examination. Years of training and experienced brought in to question by the fickle nature of disease, a body’s response and human fallibility. I was fortunate that my failures were few, and never forgotten, but the balance of emotions was overwhelmingly positive.

I started life as a dentist and ended as a general surgeon. How does that happen? This collection of anecdotal tales will give the reader some insight. My career in the NHS was split into three parts. The first was spent training and working as a dental surgeon, the second as a general surgical trainee in a major teaching hospital, and the third as a consultant surgeon in a district general hospital. It embraced elective and emergency services, teaching undergraduates and training young surgeons. With experience came the role of examiner of both undergraduates and postgraduates students and finally, with seniority, it involved responsibilities in the sphere of medical politics—election to the Council of the Royal College of Surgeons and secondment to Department of Health committees. In every environment, there was laughter, tears, joy, sadness and infuriating frustration in equal measure.

I worked in a multicultural environment within teams composed of a variety of specialties, both medical and paramedical. I experienced the best and worst of human nature, was regularly humbled by the fortitude of those I cared for and enjoyed the comradeship of some truly outstanding clinicians. I also witnessed a sea change in attitudes within and towards the medical profession. Some of the events related may bring gasps of astonishment, if not opprobrium, but should perhaps be viewed not with the critical benefit of hindsight but with an understanding of the times in which they occurred. I do not defend any of the less acceptable behaviours I witnessed, but neither do I condemn them from elevated moral high ground that any passage of time may create. The events were of their time and the social history that both preceded and followed these events should perhaps temper attitudes towards the sepia snapshots portrayed.

Before sharing some of the more memorable events that encompassed my kaleidoscopic career, it seems appropriate to clarify the narrative. The events described in this book have been anonymised, but all took place during my passage from schoolboy through undergraduate and postgraduate training to consultant status. Some of these episodes were shared experiences and I was not the lead performer, so I cannot claim sole ownership. However, they were all part of my journey. Memory can sometimes lead one to embellish the telling of stories and I admit to the occasional use of embroidery. I make no apology. I share these in the hope they will entertain the reader as well as document the changes in medicine and society during the years that I was privileged to work as a surgeon in the NHS. I hope they interest and inform many, and offend few. To the latter, I offer my apologies, it was never my intention.

Part 1

In Front of Every Silver Lining

1964–1977

You cannot go back and change the beginning but you can start again from where you are and change the ending.

C S Lewis

Foundations, Fuses and Fruit

What triggers the desire to become a surgeon? There was no epiphany for me, just a steady evolution from a child’s interest in nature, to the science of biology and a fascination with tools. Flickering black and white images on a television exposed me to the humour of films such a ‘Doctor in the House’, the fictional drama of ‘Emergency Ward Ten’ and the wonder of ‘Your Life in Their Hands’. All must have laid subconscious fragments of the foundations that underpinned my future path. The decision to focus on General surgery was eventually triggered by an individual event, but the preceding journey took a tortuous path.

My interest in human biology and the treatment of ailments was kindled by the Boy Scout movement, an inspirational biology teacher and, surprisingly, a dentist. At the age of six, I went to live on the edge of the Essex countryside with my grandmother who, in an instant, enrolled me into the local Scout Cub pack as a way of keeping an errant East London Artful Dodger from under her feet. As a city boy I found the countryside enthralling and wanted to learn about trees, birds, frogs, newts and sticklebacks. Along the way to progression in the Scout movement I acquired a sleeve full of badges, including one called First Aid and a second called Ambulance. A slow fuse had been lit and some deeply buried motivation began to gently glow. I think another unspoken impetus came from my maternal uncle after whom I was named. He left school on his eighteenth birthday, in 1940, to join the RAF. He flew throughout WWII only to lose his life two weeks before the war in Europe ended. He had been offered a place to study medicine before joining up and was my family hero. I grew up with a photo of him in uniform, including his DFC, on my grandmothers’ mantelpiece. That photo graces my home to this day.

My father was an engineer who could manufacture anything from timber or metal and, when we got together at weekends, I became his apprentice. Tools fascinated me and sharing them with my father was a special treat. What’s this for? How do you use this? Is there a tool for fixing that? My grandmother was a doughty Victorian lady who brought up six children alone having been widowed before the days of the NHS, Social Service and child allowances. She taught me the difference between ‘Need’ and ‘Want’. I can still hear her reciting You need a roof, clothes and food, after that it is all want. She recalled the days of healthcare, or lack thereof, before the NHS and thought the latter was an institution made in heaven. Medical and Dental care ‘free at the point of delivery’ was a life changing development for a majority of her generation. She was edentulous before I was born and as dental care was, in my childhood, a fully inclusive part of the NHS I was duly added to the local dentist’s list. My dentist was a kind man and never once frightened me. When I discovered a cupboard full of tools and sophisticated looking instruments in his surgery, he kindly indulged my fascination. By the time I gained admission to the local grammar school, the latent desire for biological knowledge was like ripe fruit on the bough and my Biology teacher, Mr C, wasted no time in harvesting the crop. I had unwittingly found a mentor and flourished under his guidance. My compass had started to point in a particular direction.

Cockroaches and Crutches

My biology teacher at school, Mr C, was not only an inspiring teacher but also a gentle and forgiving man. This most generous of characteristics manifested itself in an episode involving cockroaches. It was part of the Biology curriculum to dissect a cockroach. These singularly primeval looking creatures were kept in a large glass tank that sat on top of a radiator in the Biology laboratory. This maintained the ambient temperature at a level that paradoxically kept the cockroaches healthy until their execution. On the day of their demise, a student was charged with removing the tank to an outside yard, to cool down. The colder the tank the less frisky the cockroaches became and the easier they were to handle. Needless to say, on the occasion that I was charged with this responsibility I forgot; until the last moment. Minutes before execution was due I realised my error, rushed into the laboratory and lifted the tank outside. Before the temperature inside the tank had a chance to adequately drop, Mr C retrieved the container and called us forward to select a specimen to place in a chloroform jar. It was a mixed gender school and the boys allowed the girls to go first. As the lid to the tank was removed the still overheated and very active cockroaches made a break for freedom. They exploded into the classroom like a cloud of locusts. The screams of the girls were heard throughout the school and all attempts to retrieve the insects were thwarted by their impressive ability to find a bolthole via the smallest of cracks in skirting and floor boards. As they scuttled around the floor the girls took refuge on stools whilst the boys took great delight in turning retrieval into a competition as to who could catch the most—dead or alive. Very few were retrieved and as cockroaches kept re-appearing from month to month the school eventually had to enlist the services of a pest control company. I am certain that Mr C was fully aware of the underlying cause of this episode, and who was responsible, but he never attributed blame. I think he carried the responsibility himself and protected his grateful student with this amazingly benevolent act. This early exposure to cockroaches was to prove an advantage some years later in a surgical setting.

When it came time to select my ‘A’ level subjects, Biology was top of the list and, with guidance from Mr C, Chemistry and Physics completed my curriculum. My fascination with biology and tools meant application to Dental school had long been predetermined and when applications were followed by interviews, and offers of places, the East London in the boy surfaced and I accepted a place at a London Dental school based in the eastern part of the capital. I was thrilled on several levels. Firstly I was going to be the first member of my family to attend university, secondly I was being given the opportunity to follow my dream of becoming a dentist and finally, the cherry on the cake, was rugby. I’d been sports mad since primary school days, mostly football, and tennis. My secondary school was a rugby-playing establishment and I had played in the first team for two years. The Medical and Dental School that awaited me had a rugby team with a fine reputation and I had plans to trial for the team. Then fate intervened.

Later in my career I worked for a bluff Yorkshire surgeon with a wickedly dry sense of humour. Whenever things were not going well for a patient his optimistic nature would reveal itself with the oft repeated and somewhat perverse phrase—Eee lad, in front of every silver lining there’s a ruddy great black cloud! Just when I was about to enter the world of higher education an enormous black thundercloud appeared. I was involved in a road accident whence an unaccompanied learner driver knocked me off my motorbike. The result was an x-ray of my right leg that could have found a place as an example of Cubist abstract art. There followed twelve months of surgery, plaster casts and crutches at the end of which I was instructed, in no uncertain terms, that my rugby playing days were over. Indeed, any sort of contact sport was out of bounds. I clearly recall the Consultant surgeon’s earnest tone as he lectured me—If you injure the leg again you will lose it. I spent some weeks behaving like a proverbial stroppy teenager, moaning about my misfortune rather than being grateful that my leg had been saved. Thus it was that, aged eighteen, I hobbled into the world of higher education on a pair of old-fashioned wooden crutches.

-/-

Car Parking and Compost

After a year in plaster casts, my right leg was skin and bone, with very little muscle in evidence. Sport requiring any sort of physical effort seemed impossible when even climbing stairs was a challenge, and tiddlywinks held little appeal. I finally decided to do something constructive and started visiting the hospital gymnasium to regain some muscle strength by doing gentle weight training. It was a dark, rainy November evening when a silver lining appeared in the shape of half a dozen boisterous students who burst into the gymnasium and started heaving weights around. I was incapable of matching their efforts so kept myself apart, not wishing to have my feeble performance unfavourably compared. During a break in the testosterone and sweat laden mayhem, one of the group joined me on a bench. Hi, aren’t you the guy who nearly lost his leg? he asked. I had no inkling that my circumstances had been a topic of conversation in the college. I didn’t really want to rehearse the events of the past year, so quickly changed the direction of conversation. Yes, trying to get a little muscle back, didn’t know the college had a weight lifting team. His reply was a eureka moment. Oh we’re not weight lifters, were oarsmen trying to up our strength. Rowing. A non-contact sport! My mind was thrown into overdrive as I computed the opportunity. Oh, wow. I’ve never rowed. Is it possible to join the rowing club and learn? I asked tentatively. Sure, we’re always looking for more crew members. It was a life changing moment.

When I’d entered the hallowed portals of a London Hospital Dental School the Beatles were top of the pops, Carnaby Street was alive with mini-skirts and the space race dominated our imaginations. The oral contraceptive had created a seismic change in social mores towards sex, and television continued to bring front line medical care into our sitting rooms in ever-increasing detail. It was only twenty years since the end of WWII and many ‘Old Soldiers’ were still relating the tales, and maintaining the behaviour patterns, of yesteryear but societal attitudes were changing on all fronts and the 1960s were in full swing. Unfortunately for me the only thing that had been swinging was my right leg as I negotiated my way around college on crutches. However, my passion for rugby found an outlet as a supporter of the Hospital Rugby team. The Inter Hospitals Rugby Cup is the oldest rugby cup competition in the world. It started in 1875, as a competition between London Hospital teams, and predated the Calcutta cup, between England and Scotland, by four years. Participation in the Inter Hospitals Cup was accompanied by fanatical support from the undergraduate populations of the respective teaching hospitals. Unable to participate on the field I threw myself into the parallel off field shenanigans. If the hospital team reached the final, then it became open house in terms of opportunistic pranks against the opposing team’s hospital. This occurred twice during my time at college, in 1965 and 1968, and on both occasions we won both the on field game and the preceding ‘Strop’ as it was known.

It was in the dastardly area of Machiavellian pre-match activities that I played a part in my first year. I couldn’t run, but I could weald a paintbrush. My college’s first move was to place an ancient Austin, minus its wheels and painted in our Hospital colours, across the entrance of our opposition’s Consultants’ Car Park. Said car then spent several days, despite a lack of wheels, moving back and forth between the two hospitals Consultants car park entrances under the cover of darkness, whilst miraculously changing its colours from one team’s to the others with each swing of the pendulum. Eventually the two medical school Secretaries combined to issue a polite request that further nocturnal chameleon motor activity should cease. With its many layers of paint, the old Austin jalopy finally disappeared into the local scrap yard and the pages of rugby cup history.

Appetite undiminished, it was then decided that it would be an appropriate gesture to deposit a tea chest¹ full of horse manure, from the local brewery’s stables², in the entrance to the cloister of our opposition’s college. The trick was to deliver the crate undetected and upturned with its top removed—any attempt to lift and move the chest would result in an elephantine mound of horse dung escaping onto the paving. Having acquired a tea chest, filled it with horse manure and transported it in the back of an old van, a waiting game ensued. Parked close to the target the delivery crew waited for an opportunity to deposit the package. An opening appeared when the Porters lodge was briefly unoccupied and a small team of unshaven undergraduates, disguised as workmen with boiler suits and flat caps, delivered the chest. It rapidly became apparent that an unfamiliar aroma was filling the entrance to the cloister and drew attention to the chest in short order. Porters were summoned and the intended evacuation of the chest unfolded as planned. I played a small part in this escapade but contributed in good measure to the celebrations in our College bar that evening.

Some years later I visited the same hospital to attend a conference. It had a splendid rose bed and I found myself recalling this adventure with a smile. I couldn’t help wondering if the rose beds had benefitted from our delivery of compost. Perhaps some good had come from our mischief!

-/-

---

¹ A washing machine sized wooden crate lined with tin foil and used, before the days of tea bags, to ship tea leaves around the globe.↩︎

² Horse drawn drays were still in use delivering barrels of beer around the city.↩︎

Field of Colours

The previously mentioned ‘Strop’ always took place on the day of the final at the same location as the match. A separate field was allocated and teams from each hospital met with the intention of acquiring the trophy brought by their opposition. The trophies started under the goal posts at each end of the field and there was no limit to the numbers on each team; it was usually upward of one hundred per team. Our trophy was a purloined mobile London Transport bus stop sign with the College emblem painted over the circular, red London Transport motif. It had a very heavy concrete base a long steel tube and the painted metal sign on top. It was like a flag of battle around which our troops could rally. Beyond avoiding physical injury, no holds were barred. Teams turned up with flour bags and finger cots (single digit rubber sleeves) full of a variety of dyes including Methylene blue, Congo red and Methyl green. Still lacking two serviceable lower limbs I was unfit for battle, but found a role in the manufacture of munitions. For weeks after my fingers carried the evidence of my involvement in finger cot loading. I must have filled over two hundred finger cots and transported them to the battlefield in the back of a fellow student’s ex post office Morris minor van.

The journey to the match took us along the Embankment. We were waiting for the traffic lights to turn green, by Lambeth Bridge, when a car full of opposition students stopped alongside us in the outside lane. They were easily identified by their college scarves trailing from the car windows. We had no such identifiers. I was sitting in the front passenger seat and the opportunity was too good to pass up. Taking a Methylene blue (our college colour) filled finger cot from behind me I lowered my side window and waited for the lights to change. When the green light appeared, the opposition car leapt forward and with consummate skill I lobbed the finger cot over our bonnet scoring a bullseye on their windscreen. It was just too good to be true and sure enough, at that precise moment, a police motorcycle officer passed us in the opposite direction. A flashing blue light rapidly appeared in the rear view mirror and I started to formulate an explanation for my grandmother as to how I had ended up behind bars. Having pulled over and exited the van our opposition students, in a truly chivalrous fashion, came to our rescue.

No harm done officer, we don’t wish to press charges, just inappropriate undergraduate high jinks, followed by a slightly malevolent aside We’ll see you at the Strop! My details were taken and I had to present myself at the local police station the following day. Having received a royal dressing down and a metaphorical slapping of my wrist I felt I had escaped lightly. As a non-combatant I never did meet my saviours on the field of blue, red and green, which was a pity because I would have liked to thank them. However, I did enjoy the spectacle of a couple of hundred students giving an outstanding interpretation of something between American Indian and Scottish warrior face paint. Actually, face paint is an understatement. I think every piece of exposed skin on the field was liberally decorated with a mixture of flour and colorant. Mary Berry would have been impressed. That was the end of my rugby related activities because by 1968, I was totally engaged in the sport of rowing.

-/-

Criminals and Cannabis

Not far from the hospital was a now infamous pub called ‘The Blind Beggar’. It was one of several East London pubs frequented by students. It was also a favourite of the Kray twins, a particularly unpleasant pair of gangsters who dominated the underworld activities on the northern banks of the Thames at this time. I only ever saw them once when they walked through the front bar to a private room at the back of the pub. We all knew to stay well out of their way. The only minor impact they had on me was when the police carried out one of a number of random traffic stops, presumably looking for signs of, or the fruits of, illegal activity. By this time, I was fully active on two legs and had acquired an old Morris Traveller, a van with windows and timber external trim. A sort of motorised greenhouse. It could carry five passengers legally, two in front and three on a rear bench seat. There was also space for two to be carried in the back, but as there were no seats it was probably illegal. I had been to a party in a flat on Clapham common, with six fellow students, and were on our way back to College when we were stopped by a police check on Tower Bridge. I and my front seat passenger had drunk a couple of pints of beer and I felt capable of driving competently¹.

The three bench seat passengers had imbibed more liberally and were in a very happy and voluble state of mind. The two stowaways in the boot (I had started to formulate an excuse for their presence) were roaring drunk and had their heads out of the sliding rear windows in response to my threats of castration if they vomited in my car. There were four or five cars ahead of us and, as I edged forward, the backbenchers wound down their windows and started to entertain the police with their idea of relevant information.

The ‘Marples Act’ of 1962 (Ernest Marples the Minister of Transport) made it an offence if a driver’s ability to drive properly was temporarily impaired by alcohol, but there was no legal limit and two pints was considered well within socially accepted norms. It wasn’t until 1967 that Barbara Castle, who had replaced Ernest Marples, introduced the Road Safety Act which established a maximum blood alcohol level of 80mg per 100ml, or a urine level of 107mg per 100ml. Police were thereafter empowered to breathalyse drivers at the roadside.

Officer, Officer, this car has been nicked. He pinched it on Clapham Common.

Shut up you idiots, you’ll get us all arrested, I growled.

It’s true Officer, he nicked it. Not even sure he’s got a licence.

I’ll strangle you lot if you don’t shut up. As we reached the front of the queue the two stowaways in the rear compartment threw up copiously down the sides of the car, removing any possibility that they might go unnoticed. As I wound down my window, to greet the Officer now standing beside the car, the three monkeys behind me broke into a whooping litany of accusations.

Help us please Officer. This driver is out of control. We think he’s drunk. He’s been driving like a maniac and he’s locked us in. Please help us.

Is this your car sir? The officer enquired.

No, we saw him nick it on Clapham Common, came the chant from behind.

Desperately trying to create some semblance of sanity I smiled in what I hoped was a sincere fashion.

Yes Officer, it’s my car. I apologise for my passengers, they’ve overdone the beer and I need to get them home.

Yes sir, I can see that. Could you tell me the registration number of your car please?

Really. Seriously. Of course not. I’m surrounded by drunken idiots, being questioned by the police and I’ve had a couple of pints myself, I thought.

Actually Officer I can’t quite recall it at the moment, I mumbled.

Told you he’d nicked it, chanted the unholy Trinity behind me, accompanied by a descant of vomiting from the boot.

Mm. Could you open the bonnet of your car please sir? It was clear that I was now under serious suspicion of being in cahoots with the Krays. I obediently opened the bonnet and the Officer shone his torch on the contents of the engine compartment. Hell, I knew at least one of my passengers had a stash of cannabis. Had the bugger planted cannabis under the hood?

"What type of battery do you have in this car sir?"

Well, let’s be reasonable. If I can’t remember my registration number, what’s the chance of knowing the type of battery the Officer was now looking at? I dredged the bottom recesses of whatever information I might possess regarding car batteries.

Well, you know Officer, one of those big black ones.

Told you he’d nicked it, accompanied by more heaving through the rear windows. Visions of sharing a cell with the Krays crowded in on me, Out. Out of the car sir. The tone was serious enough to send a cold chill down the back of my neck.

Where have you come from?

Clapham Common.

What were you doing there?

Attending a party.

Where are you going?

The London Hospital.

Oh God! Are you lot medical students? I didn’t think an explanation that some of us were dental students was likely to help our case, so told a teeny white lie.

Yes sir.

Well stop wasting our time and bugger off. And tell those two sticking their heads illegally out of the back windows that if they vomit on my uniform they’ll spend the night in clink. I briefly contemplated pointing out that he had stopped us and that he was wasting our valuable drinking time but decided, on balance, that I would rather not end up in front of a magistrate.

Yes sir, was my considered reply. I somehow managed to start the car, engage first gear and pull away without stalling. We made it back to Whitechapel without a single sighting of the Kray twins or any other reprobates, barring the drunks who had decorated the outside of my car. Safely back at base everybody piled out and I locked up. As we started walking away one of my passengers swayed towards me.

Can you unlock the car again Bob?

What for? I asked irritably.

I’ve left something in the boot.

What?

I hid my packet of Hash under the spare tyre!

What! You bloody idiot. You could have got us all arrested, I shouted at him.

On reflection the boot, with two vomiting drunks sitting on top of his stash, was as good a place as any, but I never gave him a lift again. I never indulged in, or approved of, the use of recreational drugs but was incongruously prepared to participate in the abuse of alcohol.

-/-

Steady Hand

One of the first clinical skills to be mastered as a dental student was the administration of local anaesthetic. If students were to hone their skills, a term I use loosely at this stage of training, on willing volunteers, it could at least be done painlessly. One of the first techniques taught was how to achieve an ‘inferior dental nerve block’. This nerve supplies sensation to the lower jaw including all the lower teeth. It enters the bony mandible on the inside of the mandibular ramus where the trunk of the nerve can be reached via the oral cavity. The procedure involves inserting a thumb inside the mouth and palpating the front edge of the ramus whilst locating the back edge of the ramus with the index finger outside the mouth. By a process of spatial dead reckoning, the site of the aforementioned nerve can be located midway between finger and thumb. The needle of the syringe full of local anaesthetic is then advanced through the soft tissues of the mouth towards the nerve. This requires a sense of direction and depth for the tip of the needle to arrive at the precise location intended.

Students worked in pairs and I was teamed up with a somewhat anxious young lady who was afforded the privilege of first shot. I was unable to establish which of the student and the elderly male patient was shaking the most, but it was clearly not synchronised. I watched with a mixture of curiosity and disbelief as the tip of the needle was inserted into the mouth, advanced until it exited the patient behind his jaw and was inserted in to the young lady’s finger. Terror must have rendered her insensitive to the needle and I watched with incredulity as she proceeded to inject local anaesthetic into her own digit. The end result was a student with a numb finger and a patient with fully sensitive teeth and two needlepoint holes, one inside and one outside his mouth.

I was desperately keen to demonstrate my knowledge of human structures and clinical technique but lacking a sense of adventure, for understandable reasons, the patient declined a second undergraduate shot. Frustratingly I thereby lost the opportunity to demonstrate my mastery of three-dimensional spatial awareness and a steady hand.

Ecclesiastical Cold

Although you may think that dental studies are strictly limited to pure oral pathologies, you would be incorrect. Many systemic diseases can present themselves with oral manifestations and, as a consequence, dental students had to attend certain clinics usually populated by medical students. One such was the euphemistically entitled ‘Special Clinic’, otherwise known as the ‘Sexually transmitted diseases clinic’. The prime reason for this was the fact that syphilis can present with ulcers in the mouth. It is well illustrated in every textbook that covers the matter, but in over forty years I have never seen a case. However, it was part of the curriculum and therefore attend we did.

The Consultant was a dour gentleman of few words who had served in WWII. I found myself wondering if his choice of career had been triggered by some behind the lines activities during his military career. He gave every appearance of finding our presence an ordeal to be suffered. There were three of us present on this particular day and we were completely disinterested in the endless line of scrotal rashes, urethral discharges and worried well who had strayed, reproductively speaking, and were certain that moral retribution was about to descend on their genitals. Not a single oral chancre, macular-papular rash or gumma (sequential manifestation of primary, secondary and tertiary syphilis) was to be seen. We were close to terminal boredom when the afternoon took a turn for the better—from an undergraduate point of view. A priest in full ecclesiastical apparel was ushered in. Our pique was definitely interested. The poor man was clearly embarrassed, a state not improved by the Consultant’s unsympathetic approach. With no introduction, or eye contact, he continued making notes.

Sit down. What’s the problem? With no reassurance to bolster his confidence the Priest could barely stutter a reply.

Well um, well, I um, I think I um, I think I may have um, caught um, a cold um, in my um, in, in my um penis. In my bored state, I was slow to pick up on the relevant detail. Umpiness? Not sure I’d covered that page in the anatomy books. A fellow student elbowed me in the ribs with a wolfish grin and I realised the extent of my terminally slow wit.

"Mm. When? How long ago? Any other