A la recherche du temps perdu

I have just been clearing out – old textbooks, cuttings from Update and BMJ from the days before information could be stored electronically, even some old lecture notes (did I once know all that?).

Since I don’t recall my days as a clinical student with fondness, I was surprised while leafing through dog-eared volumes to experience a degree of nostalgia, though not strongly enough to put many books back on the shelf. However, a few escaped the cull.

I couldn’t bring myself to throw away my first Oxford Handbook of Clinical Medicine. The first edition came out just in time for my house-jobs, and it kept me sane and my patients safe. Well, safer. In those days the recto pages of Oxford handbooks were blank, for you to make your own notes. Invaluable for recording the sort of clinical gems which evidence-based medicine cannot reach. They were useful too for noting that consultant A wanted all patients admitted with diagnosis B to be put on drug C, whereas consultant D would tear you off a strip if he saw C on a patient’s drug chart.

Looking at my annotations took me back to Treliske Hospital in the middle of a summer night. GPs calling from remote villages with long Cornish names. Sick patients admitted from holiday cottages proud to be on some ‘very special pills’ from a professor in the Midlands who has instructed them they ‘must never stop them’, but unable to remember what the pills were. The lack of space in the admissions unit. The lack of beds in the hospital. Trying to grab a few minutes of rest curled up on two chairs. The helicopter from RNAS Culdrose bringing in a Bulgarian seaman winched off a Russian ship in the Bay of Biscay. They hadn’t winched off his medical history and it took some time before a Russian speaker was tracked down in Falmouth.  Vivid memories of an important six months.

I slipped two other books back on the shelf. Both are slim. One I kept because it is both dated and dateless. Dated because of the black and white photographs. The headless torso of a  man in a long white coat buttoned across a middle-aged corporation and revealing only his tie demonstrates the muscle groups on a discretely photographed colleague, supplemented by diagrams of the brachial plexus (did I ever know that?) and the lateral cutaneous nerve of the thigh (why do I remember that?). Dateless because it is a guide to neuroanatomy, and neuroanatomy does not change. Do they still hand out Aids to the examination of the peripheral nervous system (Her Majesty’s Stationery Office, £1.75) on Day One of the anatomy course? Do they still have anatomy courses?

The second book is also a neurology aide memoire, and it was a chance finding. I was in a New York bookshop, flicking through books on how to get into medical school, how to survive once you got there, how to pass finals and how to survive once you had done so, and reflecting on what wimps American medical students must be, when a title caught my eye. Clinical Neuroanatomy made ridiculously simple. What a promise! And it was written by a professor from a medical school in Miami. If they could understand it in Florida, perhaps I could! I snapped it up and could have made a tidy income importing copies for resale to my fellow students because Blackwell’s bookshop didn’t stock it. Sir Basil Blackwell would have set his face adamantly against dumbing down. But they stock it now. The cover is unchanged and though it’s in its 3rd edition the evolution seems to be not anatomical but technological – it is now interactive, whatever that means. On Amazon it has five star reviews from UK medical students.

In years to come will doctors who are now at the start of their careers look back fondly on www.gpnotebook.co.uk and treasure the URL of Map of Medicine? It seems unlikely. Does it matter? Perhaps. As you grow older, you lose touch with your younger self, and while you don’t want to know how they treated SLE in 1982 and may prefer not to recall what you got up to at the post-finals party, a textbook can retrieve long-buried memories. And give you back a part of yourself.

Judith Harvey

Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.

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