Memoirs of an Oxford medical student 1967-70

Osler House, Woodstock Rd

More than 50 years after graduating from Oxford University Medical School, I found a boxful of letters and diaries which I had written during my clinical course. To a naive 20-year-old from a rather sheltered home background, whose first degree at Leeds University had involved more work than play, life in Oxford was a revelation – intellectually, socially and emotionally. My memory for the past is fairly patchy and though I clearly recall some of the people, places and events described, I have forgotten many others which were obviously significant at the time. I was known by my maiden name, Jenny Collins.

The course was mainly based at the old Radcliffe Infirmary in Woodstock Rd. For some attachments we visited the Churchill Hospital, where I would later become a junior doctor and eventually a consultant, Cowley Road Hospital, and the Nuffield Orthopaedic Centre. The Radcliffe Infirmary was closed in 2007 and its site is now occupied by university offices. The hub of student life was Osler House (not to be confused with the present clubhouse of the same name on the John Radcliffe site) an 18th century listed building in the hospital grounds. Downstairs was a lounge, bar and kitchen. Morning coffee and afternoon tea were provided free. Upstairs were bedrooms for use when on call. There was an attractive garden with a croquet lawn. Each student also had an attachment to an Oxford college – mine was Somerville – but being postgraduate did not live in. My first few months were spent lodging in Summertown with the mother of a family friend, the widow of a bishop and a keen supporter of Moral Rearmament. After I had moved into my own flat, my former landlady continued to invite me for dinner on Sunday evenings.

Our intake contained only 18 or 20 students. Being divided into even smaller groups for clinical attachments, we got a great deal of individual attention from our teachers. For me, as one of the few women in a male-dominated environment, this was often of a kind which would not be tolerated nowadays. As well as clerking patients we were given considerable responsibility for practical procedures such as taking blood, putting up drips, lumbar punctures, delivering babies, and assisting with surgical operations.

There were periods of intense activity – on take for medicine and surgery, night deliveries in obstetrics, preparing for exams. But otherwise the pace of work was fairly leisurely and allowed time for a vibrant social life. Lunches, dinners, parties and outings were frequent and usually involved vast quantities of food and drink. I sang in the hospital choir and in my final year played a good fairy in the students’ pantomime, Tingewick. I must have done a certain amount of studying but most of my free time seems to have been spent entertaining friends for supper or afternoon tea, making my own dresses, listening to pop music, or walking around Oxford which was then a peaceful place with few cars. Several of my friends did have cars, and when they were driving north would give me lifts home at weekends. It was a privileged and mostly hugely enjoyable life which, I imagine, was far more relaxed and informal than for clinical students today.

Much of what I wrote is too trivial, personal or libellous to publish, but maybe I will adapt some extracts for a series of blog posts, a memoir of a novel. Meanwhile I’d be pleased to hear from anyone who remembers those times.

On the other side of the (medical) fence

Since retiring from medical practice I’ve exchanged the role of doctor for those of patient and of patient’s wife, and being on the other side of the fence has been an interesting experience. Between the two of us, my husband and I have needed to see a good many different healthcare professionals from various specialties in recent years. Most of them were excellent, but a few were unsatisfactory and this was usually because of their poor “communication skills”.

Following the retirement of the family doctor we had known and trusted for a long time, I saw a GP whose failings included a rude manner, ordering me to take a long-term prescription for a new drug without any discussion of its efficacy and side-effects, and – as I discovered later – referring me to a hospital clinic without telling me. After that I changed to a different practice and am very happy with my doctor there, but my experience with the previous one distressed me for a long time, illustrating the importance of a good therapeutic relationship not only for improving patients’ emotional well-being, but for influencing their compliance with treatment and the outcome of their disease.

I don’t remember having any guidance about how to relate to patients when I was at medical school in the 1960s, nor during my junior doctor posts. Senior role models varied greatly in their approach, ranging from the caring and compassionate to the arrogant and disrespectful. In the later years of my career this aspect of clinical practice began to be taken more seriously, led by specialties such as general practice, oncology and palliative care. Communication skills training is now included in the education of doctors, nurses and other healthcare professionals, though its long-term impact must be difficult to measure, and depend on the student’s personality. The skills may come naturally to those who have chosen their career for humanitarian reasons. Those who are mainly interested in the scientific and technical side, or whose prime objective is making money, may pay little attention to such “soft” subjects in the curriculum.

The basic principles should be obvious, simply involving courtesy, common sense and genuine concern for the patient. Giving a polite and friendly greeting. Meeting in a clean and tidy consulting room free of interruptions. Listening to the patient’s story with genuine interest and empathy. Taking account of the patient’s knowledge and preferences when discussing management of the problem.

Conducting the interview becomes more difficult in the case of a serious condition. The medical literature contains many studies about techniques of “breaking bad news”, usually in relation to a cancer diagnosis, and I won’t attempt to detail them all here. Key points include giving truthful information without destroying hope. And avoiding dogmatic statements about prognosis, because the outcome in individual cases can vary so much from the average. Negative predictions can be self-fulfilling as well as disheartening, whereas except in the most dire situations there is always some help to be offered, and some scope for improvement. Another point highlighted by our recent experiences is that illness can be just as stressful for relatives as for patients themselves.

Free speech?

“This may be offensive to your reader” warns Microsoft Word when it finds bitch in the text of my forthcoming novel. Considering that I was using the term to describe a female dog I find this quite amusing, but it makes me think about other less trivial ways that the use of language is becoming curtailed. One of my characters expresses racist views before being admonished by his wife, and I understand that a similar incident in one of Sally Rooney’s books led a journalist to accuse the author herself of racism. JK Rowling was “cancelled” for a comment that some interpreted as transphobic – fortunately my novel contains nothing about gender identity issues. It seems more acceptable to portray violence towards people and animals in fiction than to risk upsetting “woke” sensibilities.

Free speech is also limited in real life. Here in New Zealand, doctors who express valid concerns about the safety of Covid vaccination are being disciplined by the medical authorities. The rare but well authenticated cases of serious illness or death attributable to this vaccine are seldom reported in the media, and campaign materials designed to get everyone vaccinated make no mention of potential risks. I regard the vaccine as the lesser of two evils so have had my own two shots, but I respect the rights of those who have researched the pros and cons of this intervention and decided not to accept it.

Book review “Cured: the life-changing science of spontaneous healing” by Jeffrey Rediger

Cases of the phenomenon variously called “spontaneous healing” or “spontaneous remission” or “remarkable recovery” are sometimes reported in the medical literature, usually in relation to advanced cancer. They are probably not quite so rare as followup statistics suggest, either because sceptical doctors presume that the original diagnosis was wrong, or because the patients concerned have stopped attending hospital clinics. Jeffrey Rediger, a physician and psychiatrist who is on the faculty of Harvard Medical School, has spent fifteen years studying this topic by interviewing patients and visiting healing centres. In his book, case histories are interwoven with summaries of the latest research into the body’s defences against disease.

The library copy of Cured on which I based this review is subtitled “the life-changing science of spontaneous healing” by Jeffrey Rediger but the version on the Amazon page, presumably more recent, has “the power of our immune system and the mind-body connection” by Jeff Rediger. Although I don’t know why the subtitle was changed (or the author’s name shortened) it strikes me that the term “spontaneous” could be misleading. Most unexpected, apparently miraculous, recoveries from a disease that had been considered incurable do not happen out of the blue, but after the patients concerned have taken active steps to reclaim their health.

Early chapters focus mainly on physical aspects, with detailed discussion about how to optimise nutrition, and support the functioning of the immune and nervous systems. The later ones have a more obvious “mind-body” emphasis with topics such as the placebo response, faith healing and prayer, the power of love, and what he calls “healing your identity”.

This last aspect may be of crucial importance. It builds on the work of early researchers such as Lawrence Le Shan, whose book Cancer as a Turning Point influenced my own choice of psycho-oncology as a career, and echoes the message of more recent books such as Remarkable Recovery by Caryle Hirshberg and Marc Barasch. Many of the patients described in these books made a decision, consciously or not, to take control of their lives and “rewrite their stories”. This often involved leaving a toxic relationship or an unsatisfying job, reviving an undeveloped talent or ambition, and most importantly making “deep mental and spiritual changes”. An essential feature was being true to themselves rather than conforming to outside expectations, and following their own path. This might require courage and faith, and the discipline to “burn their boats” to prevent a lapse back to the previous way of life. Some became whole-heartedly committed to particular healing practices. These were very varied, ranging from a strict ketogenic diet to daily immersion in yoga or meditation, suggesting that faith in the chosen modality whatever it may be is the crucial factor in its effectiveness.

This psychological picture does not fit every case. Regression from cancer following an acute infection with high fever is well documented, and must have a biological basis rather than a psycho-spiritual one. Some cases of remarkable recovery do appear spontaneous, because no explanation at all can be found.

Dr Rediger provides plenty of information and guidance for those seeking to prevent disease, or to maximise their chances of recovery from an existing condition, and the case histories are inspiring. He rightly avoids recommending particular approaches, and he acknowledges that there are no guarantees. Plenty of patients “do all the right things” and still succumb to their disease; spontaneous healing remains to some extent a mystery. This is a valuable book, though perhaps rather too long and detailed to be easily digested by someone dealing with a serious illness. Future editions could be made more accessible by adding an index, and summaries at the end of each chapter.

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Jennifer Barraclough, originally from England and now living in New Zealand, is a retired doctor and a writer of medical and fiction books. A list can be found on her author pages: https://www.amazon.com/Jennifer-Barraclough/e/B001HPXGZI (US) and https://www.amazon.co.uk/Jennifer-Barraclough/e/B001HPXGZI (UK).

Recovering from wrist fracture: six months on

Six months have passed since I broke my wrist. Having heard from various sources that recovery from this type of fracture should be largely complete by six months, I decided to write what will probably be my last update on the subject, and hope it may be useful for other people dealing with this common injury.

Six months is of course a ballpark figure based on an average of many cases. Healing is a gradual process and its rate varies greatly between individuals. My own recovery is not complete, but there has been a lot of progress. As well as all personal care and household tasks, I can now easily manage the main activities that are important to me: typing on the computer, driving the car and walking the dog. The exception is playing the piano, which continues to hurt. My wrist still looks misshapen and probably always will, but I hope the residual swelling will eventually subside.

At my recent outpatient review with Xray, the consultant orthopaedic surgeon said that the bones were “solidly healed” but that the alignment between radius and ulna was not quite right and therefore certain wrist movements are restricted. He offered an operation to correct the displacement but, considering that this would require another six weeks in plaster with consequent limitation of activity and loss of fitness, I decided not to accept it at present. Surgery can be reconsidered at a later stage, but I hope that my condition will continue to improve on its own.

Finding “silver linings” in an illness is not always easy. I hope this experience has made me more patient, more tolerant of others’ limitations and not in so much of a hurry myself. It has led indirectly to several positive changes: a new choir, a new GP, and attending Pilates and “Silver Swans” ballet classes each week to improve my strength and balance.

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Jennifer Barraclough, originally from England and now living in New Zealand, is a retired doctor and a writer of medical and fiction books. A list can be found on her author pages: https://www.amazon.com/Jennifer-Barraclough/e/B001HPXGZI (US) and https://www.amazon.co.uk/Jennifer-Barraclough/e/B001HPXGZI (UK).

Recovering from wrist fracture: ten weeks on

Recovery demands a lot of patience, but there have been several positive changes since my last post five weeks ago. I hope writing these updates will help me to appreciate the progress made, and be useful to readers recovering from similar fractures.

My cast was removed about six weeks after the injury. I was anxious about seeing my wrist again, knowing that the two attempts to reset the displaced bones had been only partly successful and the final position would not be perfect. It did indeed look crooked and thickened compared to the other side, and still does, though I hope some of the swelling will go down in time. It was a relief to have the cast replaced by a removable lightweight splint.

I see a physiotherapist once a week, and carry out the prescribed exercises four times per day. I can’t manage the full range of movements but measurements have shown a slight improvement at each clinic visit. Gently massaging the skin with herbal or homeopathic creams, and essential oils, is comforting. I no longer feel any need to take analgesics, but the ulnar side of the wrist is still stiff and tender, and I understand this can be a persistent problem which might require surgery later on.

As regards daily activities the the most significant advances include being able to drive the car and cut my own nails, though I still can’t use a knife and fork. My general vitality, which was impaired for weeks after the injury, has recovered now and I hope to get back to creative writing soon.

On the negative side, the Dexa scan carried out as part of the follow-up showed reduced bone density. This was disappointing because I take plenty of outdoor exercise and eat the right foods. Before considering medication I shall try extra vitamins and sunbathing, and be more careful about avoiding falls.

All the aftercare is free of charge under New Zealand’s generous Accident Compensation scheme.

Recovering from wrist fracture: five weeks on

Five weeks have passed since I fell on a rock and fractured my wrist, as described in my previous post Trauma on Cheltenham Beach. Progress has been frustratingly slow, but there are definite improvements. I no longer take painkillers. I have a synthetic cast which is lighter and more comfortable than the plaster one. I can walk the dog using a harness, and fasten my own watch and wash my own hair. I still can’t cut my nails, drive the car, make beds, cope with tight screw tops or plastic packaging. I type and play the piano with one hand.

Colles fractures are common. While I am out walking people often ask me what is wrong with my arm, and a surprising number of them have gone on to tell me that they or someone in their family have had a broken wrist themselves. From talking to them I have learned that the outcome can vary a great deal. One woman, who had the same operation that I would probably have had but for the Covid lockdown, reported an excellent result and showed me the barely visible scar. Another had a similar operation which appeared to have worked well until she experienced a return of pain, found to be due to displacement of one of the screws used to secure the metal plate, and is awaiting further treatment. A third, whose fracture was treated conservatively several years ago, has persistent pain and weakness in her wrist. A couple of others, however, have recovered well after conservative treatment. The only man in my little sample, whose injury was very recent, is scheduled for surgery this week.

Clearly the prognosis for each individual depends on details of the fracture and the general health of the patient. There will be many months to wait before I know what it will be like for me.

Trauma on Cheltenham beach

One of the loveliest walks on Auckland’s north shore, only possible at low tide, goes around the headland between Cheltenham and Narrow Neck beaches. Three weeks ago I set out on this walk but slipped over backwards on a wet rock and automatically put out my hand to break my fall. A sharp pain, accompanied by faintness and nausea, told me I had broken my wrist. A kind passerby helped me walk to the road, and a kind friend drove me to an emergency clinic where Xray confirmed a displaced Colles fracture of the radius and fractured tip of the ulna. Over to the public hospital, and a long wait to have the fracture reduced under local anaesthetic. Home at midnight with swollen fingers peeping out from a pink plaster cast.

Having had previous injuries that recovered quite easily, I wasn’t prepared for the long haul ahead. For the first fortnight I was constantly in pain, and struggled with basic self-care. It was a great help to have my husband taking over household tasks, and relatives and friends providing meals. I expected the worst would soon be over, but met with a setback. A followup Xray at the outpatient clinic showed that the bones had slipped back out of place and a further attempt at reduction, this time without local anaesthetic, was unsuccessful.

Surgery was proposed. I packed my bags and spent an anxious few days awaiting the call to come into the hospital, after starving from midnight. But apparently, discussion within the orthopaedic team had reached the conclusion that the likely benefit of the operation was too marginal to justify the risks (and New Zealand had just gone back into another Covid lockdown, limiting hospital services). I’ll find out more at my next appointment this week, but from what I gather so far the recovery will be a slow process and I’m likely to be left with some permanent deformity and weakness. Things could be far worse, I know, and I hope to be able to return to my former activities of dog-walking, cathedral choir, swimming and driving before too long. Meanwhile I can still go for walks, and enjoy the glorious summer weather. And in theory I have plenty of time to work on my next novel, though typing with one hand is cumbersome and inspiration lacking.

I’d like to be able to say that my recent exploration of Stoic philosophy is helping me to cope with all this. A recent article https://classicalwisdom.com/philosophy/stoicism/marcus-aurelius-stoicism-and-pain/ emphasises the basic precept of focusing only on those aspects of an illness or injury that are under personal control – for example making informed choices about treatment, and taking general steps to maintain a healthy lifestyle. There is no point dwelling on the negative aspects, or getting stuck in feelings of resentment, frustration or regret. The aim is to accept the situation and develop a constructive response. Simple basic advice, not so easy to put into practice.

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Jennifer Barraclough, originally from England and now living in New Zealand, is a retired doctor and a writer of medical and fiction books. Details can be found on her author pages: https://www.amazon.com/Jennifer-Barraclough/e/B001HPXGZI (US) and https://www.amazon.co.uk/Jennifer-Barraclough/e/B001HPXGZI (UK).

“Beautiful Vibrations”: Living through medical illness with Bach flower remedies

Dr Edward Bach described his flower remedies as having “beautiful vibrations” capable of promoting positive mental states such as hope, courage and calm. Established as a safe and natural therapy for almost 100 years, they can help to relieve the emotional distress often associated with physical illness. This short practical guide explains how to select and use the remedies as part of a holistic approach to healing. There are sections on common problems such as anxiety and sadness about the medical condition and its treatment, and difficulty in adjusting to changes in lifestyle and relationships. Despite all its negative aspects, serious illness can have “silver linings” and the flower remedies can help to bring these out.

Dr Jennifer Barraclough is a former consultant in psychological medicine with many years’ experience of working with patients and their families especially in cancer care settings. She is also a qualified Bach flower practitioner, life coach, and author of fiction and nonfiction books.

Beautiful Vibrations is available from your local Amazon website:

Amazon US: Kindle, Paperback

Amazon UK: Kindle, Paperback

Amazon AU: Kindle

Letters from the past

Over four years have passed since my mother died. The financial side of her estate has finally been settled, following prolonged correspondence with accountants and lawyers. A personal aspect, namely the letters in two of the box files I discovered in the spare bedroom when clearing her house, remains unresolved. I hope this is the last weekend of the Covid-19 lockdown, which would seem an ideal opportunity to deal with these boxes before my life gets busy again. But I still can’t decide what to do with them.

One box contains a series of letters written to my mother during my childhood in the 1950s and 60s, regarding a situation of which I was only dimly aware. I don’t know whether she intended me to find them after her death, but as she was a very “private person” I suspect not. I did read them, while feeling somewhat guilty about doing so. I think it likely that she intended to destroy them one day, but having become weak and unwell in the last months of her life, either lacked the energy to do so or forgot they were there. I haven’t shown the letters to my husband, but he knows something about their content, and suggests that it could make a good basis for my next novel. This may be true, but writing such a book would seem disloyal however heavily I disguised the plot. I have several options. I could destroy all the letters now. I could go through them again and copy selected extracts into a file on my computer for future reference, then destroy the rest. I could leave them in the box, with a note asking whoever finds them after my death to destroy them unread.

The other box contains the letters I sent home to my mother and grandparents in Yorkshire when I was a medical student in Oxford in the late 1960s. I have only reread some of these, having found the style embarrassingly naive, but some contain descriptions of the course which might perhaps be of interest to a medical historian. I was shocked to find that I remember nothing about most of the people and events described. What a contrast to my husband Brian Barraclough and my friend Jean Hendy-Harris, who can both recall their past lives in great detail and have published memoirs about them. I wonder which of us is the more unusual.

Update December 15 2020: With the fifth anniversary of my mother’s death approaching, it was time to make decision about her letters. I destroyed them all yesterday, not without regret, but felt it was the right thing to do.

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Jennifer Barraclough is a retired doctor, originally from England but now living in New Zealand, who writes medical and fiction books. Her latest one You Yet Shall Die, a novel about family secrets and a long-ago crime set in southern England, is available from Amazon and other online retailers, or can be ordered from bookshops and libraries.