HEART BEAT Maurice NeliganIncrease the remit of the National Treatment Purchase Fund, give a ritual kick to the consultants: the omens are not good. It is ironic that the first problem arises in the children's hospital where, yet again, children awaiting heart surgery have to be sent home because of a lack of intensive care nurses.
Nothing new there, Minister - this has been a problem for years, with no solution forthcoming from your Department. How about looking at nursing provision with some urgency, given that 70 per cent of graduate nurses leave the profession within 18 months of qualification? Can the country afford this? However, you will need more than one week and, in fairness, you can only be judged by tangible results and not condemned by your inherited problems.
That is a little bit of today and, as usual, I find myself flitting between past and present but "time is a brisk wind for each hour it brings something new" (Paracelsus, on Hippocrates).
Meanwhile, back to medical school, and we were approaching the final year. Having hurdled all obstacles thus far, just a few furlongs separated us from the final fence. At that time, the final medical exam required medicine, surgery and obstetrics/gynaecology to be taken in one sequence over a three-week period in June. We had been exposed to medicine and surgery from our earliest clinical days, but we had yet to encounter obstetrics and gynaecology. So, now we became the lowest form of student life in one of Dublin's famous maternity hospitals.
We were spoiled for choice, because our capital boasts three of the finest maternity hospitals in the world, whose reputations stand firmly on their record of service and achievement. This not only to our own people but to populations worldwide, whose doctors and nurses they trained. The current impasse between the consultants, the Medical Defence Union (MDU) and the Government over professional indemnity in no way reflects the excellence of Irish obstetrics and its practitioners. It reflects, rather, the litigious nature of our society - and, in medical matters, our record is the worst in the world. It simply cannot continue and I would rate it along with the lack of beds as a major factor in the deterioration of our medical service. In the realm of obstetrics, we had better produce a race who like Topsy in Uncle Tom's Cabin "never had no father, nor mother, nor nothin'. I was raised by a speculator, with lots of others." Mind you, Topsy would thus have fitted in well in this country but, in reality, there are some things even the Government can't privatise.
Most of my classmates opted for the National Maternity Hospital (Holles St) - partly due to its location near UCD, and also because it then contained our professor. A minority, including myself, chose the Coombe Hospital for no particular reason that I can recall. The Rotunda was then the preserve of students from Trinity and the College of Surgeons - and God only knows what queer goings-on us good Catholic children might encounter there.
We were in residence for six weeks and, in that time, had to perform 12 deliveries. Don't worry ladies and don't reach for the lawyers just yet, we had our hands held every inch of the way - and, believe me, the midwives were every bit as ferocious as the ward sisters in the general hospitals. I am talking about the old Coombe Hospital here, not the modern structure in Dolphin's Barn. The old Coombe is now sadly only represented by the original portico. To say that it was old-fashioned and needed replacement was an understatement, but its foundation stone had been laid in 1770 as a general hospital. In 1826, a maternity service was added - founded by Margaret Boyle - and, in 1829, it became the Coombe Lying-in Hospital. In 1839, a gynaecology ward opened. In 1960, this august institution acquired me as a medical student. I am sure there are other significant dates.
It was a new world in which we were dealing with normality rather than sickness. The standards were strict and nothing was spared to ensure the welfare of both mother and child. We learned the stages of pregnancy, the occasional pathology and the management of labour and birth. We learned about ante-natal and post-natal care, and we finally understood the preoccupation with the location of the foetal head. This was probably as well put by Pliny the Elder circa 75 AD: "It is contrary to nature for children to come into the world with feet first." Accordingly, we became fleetingly aware of breech presentations, Caesarian sections, ectopic pregnancies, etc. We marvelled at the survival of little premature babies and at the advances in their care. I little knew that, in later years, I would perform cardiac surgery on them, a prospect unthinkable at the time.
I made my 12 carefully supervised deliveries, but sadly I am not aware of any little Maurice named after my interventions.
Husbands in those days were real men and there was none of this rubbish about sharing the experience. Fathers simply didn't do childbirth. Many waited anxiously in nearby hostelries before visiting the recent mother who, after her recent labour, could be forgiven for looking at them with a slightly jaundiced eye.
More to come about this time - and the preparations for final medical exams which, to this day, can give me nightmares.
Dr Maurice Neligan is a cardiac surgeon.