The cult of the hospital consultant has been replaced by a cult of the body.
The head without the brain lolls alarmingly.
As a pathology laboratory junior attending autopsies in the 1930s, a particular concern of mine was to find equivalent make-weights for brains which had been extracted for further examination. Sometimes this meant a scrabble among the rubbish outside in search of a suitable brick-end. Plaster casts would have been less absurd, but in those days of voluntary (charity) hospitals, make do and mend was our watchword.
By today’s standards, my improvisation might be judged a criminal act. I was tampering with cadavers without the consent of relatives, who were never informed that parts of their loved ones had turned to (brick) dust even before burial. But standards were different then. Medicine and its representatives-on-earth were accorded the highest status, whereas nowadays we seem more inclined to worship our bodies, dead or alive. I for one am not convinced that the new cult is any advance on the old.
Seventy years ago, the front entrance to the Coventry and Warwickshire Hospital was ponderous, gloomy and Gothic. Inside the impression was of light airiness and scrupulous cleanliness (we did not have antibiotics but hospital-acquired infection was extremely rare). The pace was brisk, and there was more regimentation than would be acceptable now. Innovation was quietly continuous, prompting an ethos of understated optimism.
The institution was venerated locally. Its consultants were accorded divine status, but no heavenly salary. For their voluntary hospital work, they each received a small honorarium – about enough to run their stately cars.
The aura surrounding consultants was not simply a function of their position at the top of the hierarchy. Their place in the top drawer depended partly on their ability to heal the sick, but was also associated with the universal assumption that all medical practice would contribute in some way to the growing corpus of knowledge and expertise.
Thus the consultant was expected to personify both immediate effectiveness and long-term progress; and we venerated them insofar as they represented these qualities. Seen from this angle, the giant personalities which many of them cultivated were not instances of egomania but their individual responses to the huge expectations which junior staff and patients placed upon them.
The same order of expectation pervaded every hospital procedure, including the autopsy. About 150 post mortems were carried out in a year. At around 60 of these, some part, ranging from a small sample for microscopic examination to a whole organ, to occasionally a bucket full of organs, might be removed for further study. I do not recall any consent forms signed by relatives, but we were confident of our motives for the removal of tissues and organs, which were as follows:
— to confirm diagnosis and keep a record of it
— to exclude or confirm the possibility of dual pathology
— to provide the opportunity to study a sample at leisure, with an eye for secondary involvement and complications
— to provide evidence in cases where compensation was to be assessed
— to preserve rare specimens (colours restored and displayed in crystal clear jars – works of art!) for training and research.
In order to meet these demands, one was expected to acquire a professional attitude. At autopsies, this meant being both respectful (to the memory of the person previously housed in the cadaver) and instrumental (handling dead tissue for diagnostic and research purposes). The consultant pathologist set the tone for the rest of us. I recall one occasion when, at the conclusion of a series of post mortems, the laboratory was a shambles: opened cadavers everywhere, displaced organs all over the place. With an expression of mock bewilderment the consultant pathologist turned and said ‘Good job we get hardened’, before immediately correcting himself: ‘No, no, we never get hardened, but we become accustomed.’
Today, when dissecting dead animals has been cut out of school syllabi on the grounds that it may offend different sensitivities, such professionalism might well be regarded as emotional illiteracy. What, then, accounts for our becoming so unaccustomed to particular medical procedures?
Some welcome the defrocking of consultants as a sign of democratisation: the people will not stand for being pulled apart and pushed around by men in white coats. I am not so sanguine about the hostility towards senior doctors. The urge to bring down the edifice of medical practice seems to me to indicate the extent to which our expectations have been brought down already. Where once we looked up to consultants as the personification of humanity’s ability to rise above nature, now we look upon our bodies as the only sacrament we have.
This is itself a morbid symptom: the idea that matter is all that matters is deathly to the human spirit.
Frederick Cuthbert was in charge of hospital laboratories for 25 years before becoming a priest. Officially retired, he is now an avid reader and writer.
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