Mentored by a Madman Page 2

  He concluded the reading with an extract from ‘Twilights Last Gleamings’, a story he had written together with his childhood friend Kells Elvins, in which the first mention of Doctor Benway appears:

  Dr. Benway, ships doctor, drunkenly added two inches to a four-inch incision with one stroke of his scalpel.

  ‘Perhaps the appendix is already out doctor?’ The nurse said. Appearing dubiously over his shoulder, ‘I saw a little scar.’

  ‘The appendix already out!’

  ‘I’m taking the appendix out!’

  ‘What do you think I’m doing here?!’

  ‘Perhaps the appendix is on the left side doctor that happens sometimes you know!’

  ‘Stop breathing down my neck I’m coming to that.’

  ‘Don’t you think I know where an appendix is?’

  ‘I studied appendectomy in 1904 at Harvard.’

  Burroughs’ performance was animated, polished and wickedly humorous despite the fact he had been smoking dope all day and drinking red wine and vodka since late afternoon. He had travelled sideways into myth and backwards into history to reveal contemporary phantoms. He released an atom-deep sensation of otherworldliness on a Liverpool scene.

  On the same day Burroughs arrived in Liverpool for the first and only time, I was successfully appointed to the post of Consultant Neurologist to the National Hospital for Nervous Diseases, Queen Square and University College Hospital in London. I had toed the line, avoided making powerful enemies and had endeavoured to develop a dignified uniformity with my fellow man. Despite my retiring and solitary nature, a flair for clinical research had carried me home. I also had a wife and two small children that helped to falsely reassure the interview panel that I was unlikely to be a deviant or subversive. I was relieved not to have lost out to opponents that I considered less deserving, yet the burden of responsibility that came with this new office filled me with fear. I had now joined the Establishment and would find it much harder to challenge authority.

  William Burroughs had been my dark angel and cultural guru since our intersection at medical school and Liverpool was the eternal city of my childhood that I could never leave behind. The events of October 5, 1982, were a concatenation and became an expression of a deeper intuitive order.

  As I had gone through my training I had learned to treat the person not the disease. William Osler’s words ‘Ask not what disease the person has but rather what person the disease has’ had become my modus operandi. I had come to understand the importance of the nuanced explanation, the calm gesture and the reassuring smile. I had observed my patients’ varied responses to their treatment and grasped the mystery of the therapeutic process.

  I tried as best I could to enter into my patients’ mode of thought. I avoided at all costs saying to them, ‘I understand how you feel’. Many of my decisions were now based on informed guesses, hunches and imaginings; exploratory acts motivated by a passion to do good and quite independent of scientific knowledge. Unconscious wisdom, know-how and rules of thumb all played a part in my doctoring. I looked at the wider picture and when I felt it appropriate I self-experimented to obtain answers. I did my best to relieve suffering and preserve health but most of all I wanted to find new cures.

  From now on, William Burroughs would be my guiding lamp. He was Dr Henry Jekyll warning me about hubris, the power of imagery and the dangers of regulation. I needed to verify, refute and establish the validity of everything I did in relation to the sour smell of nervous disease. Every effect had its cause and there was no such thing as a coincidence. There was no turning back. I was hooked on unreality.

  2

  – Doctor Benway –

  An encyclopaedic knowledge of redundant ports and a passion for grasses and trees contrived to launch me on a career in medicine. My schoolboy geography did not revolve around mountain ranges or capitals but focused on entrepôts like Manaus where rare flowers waited in boxes to be dispatched to Liverpool. I liked to focus on those spaces on maps marked terra incognita and small mysterious islands like Terceira in the Azores. My history reading glossed over battles, treaties, and the lives of England’s monarchs but focused on the lives of the great naval explorers like Álvaro Cabral and Amerigo Vespucci. These adventurers who had made journeys into the unknown became my honorary ancestors.

  A year after I had passed my GCE O-level examinations I was asked to attend for interview at the London Hospital Medical College in Whitechapel. The train journey from Leeds took me past arable land alive with fluttering peewits, cooling towers and northern ings littered with the feathers of mutilated swans. At the Kings Cross depôt I entered the zigzag of underground corridors and stairs that led me to the Tube.

  I was now in an after world of perpetual solitude, another level down, above the tombs with nothing to worry about. The Underground train doors closed shut and we careered through endless echoing darkness, drawing in air before finally breaking cover in the Whitechapel cutting. I felt like a diminutive package in a canister being sucked through an airless system of pipes.

  I alighted on Platform 4, climbed the wide flight of stairs and walked across the overhead bridge that linked the station’s islands to the booking office. Rows of market stalls with the bluster of Jewish costermongers greeted me on the Whitechapel Road. ‘Blame it on the Bossa Nova’ (the dance of love) by Eydie Gormé, was blasting out from Paul’s for Music. Across the road emblazoned on a large yellow brick building below a huge clock with its round stone bezel and ashen face were the words ‘The London Hospital’. In the anaemic sunlight I stared up at the attic where Joseph Merrick, ‘The Elephant Man’, had first found peace.

  I climbed the stairs to the hospital, walked through its imposing colonnade and past the forecourt full of parked Daimlers and ambulances. At the lodge in the front wing, the dapper head porter pointed me in the direction of a short flight of stairs that led to the Board Room. A middle-aged woman dressed in a prim blouse told me to take a seat outside the door. I rehearsed again the extracts I had memorised from the College prospectus. The London Infirmary, later to become The London Hospital, had been founded by six businessmen in the Feathers Tavern in 1740, primarily for the relief of all sick merchant seamen. It had later become the first voluntary hospital to offer a teaching course of lectures as well as an apprenticeship. According to my mother, who had thoroughly researched the hospital’s credentials, diseases of the poor and exotic maladies common in lascars were its particular forte.

  After a short delay I was ushered in by the secretary and asked to sit on a hard backed chair without arms. I explained to my ten genial inquisitors that for the last three years I had kept diaries of garden birds and had learned the importance of accurate observation and precise recording through contact with learned men in the Leeds Naturalist’s Club. As the interview was drawing to an end, I raised one or two chuckles from the committee when I told them that ‘The London’ was my first choice because of its proximity to the docks. The chairman, Dr John Ellis, then stood up and thanked me for attending. As I left the room I could see two of the committee members smiling conspiratorially.

  In less than a minute I was back out on the Whitechapel Road under a clay white sky. I slipped down the stairs of the Underground as if it was a ship’s ladder. On the way back to Kings Cross, I started to enjoy the contingencies between the train stopping and the doors opening. The noise of a passing car on the other line recalled Atlantic breakers. The slamming of the doors sounded like a giant wave of surf rolling down the platform. I was in deep and a long way from shore.

  Two weeks later my parents received a short note informing them I had been offered a place on the proviso that I didn’t flunk my A-levels. None of the doctors and surgeons on the panel had asked me if there were doctors in the family, whether I played rugby for the school first team, or if I could recall whether stethoscopes and nurses had featured in my childhood play routines. My destiny had been sealed in less than half an hour but for now I could keep my distance and r
eturn to the neutrality and beauty of nature. I kept returning to the Liverpool Landing Stage to look out at that exotic grey horizon. The Manaus riverboats haunted my dreams.

  I arrived back in Whitechapel eighteen months later on October 4, 1965 to begin my apprenticeship. My year was composed of a mix of public school and grammar school entrants from all over the United Kingdom but only seven out of the eighty were women and there were no black students. In his welcome address, the Dean informed us that we were here to study medicine and that from now on our lives would be dedicated to the prevention, cure or alleviation of human disease. Medicine was a calling, not a business. He hoped that we would all live up to the high traditions of our chosen profession and represent ‘The London’ with honour and trustworthiness. Homo sum, humani nihil a me alienum puto – ‘I am a human being, I consider nothing that is human foreign to me’ was the hospital’s motto.

  On my third day, I lined up in embarrassment with Lampard, Lashman, Lawford, Lewin and Lupini by the side of the last dead body on the row of cadavers. A smell of rancid sickliness tinged with the pungency of fixative turned our stomachs. Our corpse was a man called Wolynski, portly, with a gargantuan head and sparse body hair. His name tag stated that he had died of natural causes nine months earlier. I imagined he must have been a Polish seaman who had collapsed in a boarding house down by the river. He was a stunning figurine waiting to be vandalised. My first cut into his swollen arm revealed a morass of deathly beigeness devoid of the glistening red, white and blue of living flesh. Soon Wolynski became little more than a giant rat.

  I had been forced to accept that a career collecting rare flowers in an imaginary homeland was now no more than an adolescent dream and my focus transferred to the anatomy of the human body. I applied ribald mnemonics to the tributaries of the carotid artery and reduced the brachial plexus to roots, trunks and branches. Our surgical demonstrator Andrew Paris took us to the museum where we pored over pots of pickled organs under the watchful eye of Merrick’s skeleton. Paris told us we were embarking on an adventure that may take us to places beyond our mind’s eye.

  I shut myself away in my room to memorise Henry Gray’s descriptions and recite the name of each ridge and groove of my second-hand bone collection. I wrote home to reassure my anxious parents that I was adjusting to leaving home and enjoying medical school. Fortunately, my mother had not got wind of the fact that a doctor’s son from Wales had shot himself in the first week of term, reducing our number to seventy-nine. But my letters did not really tell the truth. London was a different country and a faceless monster that both excited and frightened me. I desperately missed those kindly flat vowels and people who talked to me at bus stops. I missed the passion and romance of little Northern towns like St Helens, Widnes, Wigan and Oldham and the intergalactic highway of Liverpool. I had closed down and curled inwards. Study had become a pathetic solace and a remedy for homesickness.

  When our picking was finally complete, Wolynski’s frozen remains were removed from the dissection room and buried. His ‘cutting open’ had been our rite of passage. A rumour that passed from one generation of students to the next was that at the end of each term the mauled cadavers were transported on a dead body train from the hospital to Whitechapel Station and then to a place of rest near the necropolis of Brick Lane. I was not invited to Wolynski’s funeral but I was grateful for his sacrifice and have never forgotten him. He had helped me to acquire the carapace of insensitivity required to become a doctor.

  Once I had negotiated the 2nd MB examinations in physiology, anatomy, human biochemistry and clinical pharmacology and become a clinical dresser on Sister Paulin’s Ward, I relaxed my studying a little. I found conversing with the sick distressing and nerve-racking. I lacked confidence and felt inept, particularly when I had to present cases on teaching rounds. Some of the patients’ stories were harrowing and I marvelled at their bravery in the face of serious illness. The gentleness and solicitude of many of the student nurses embarrassed me. In their mauve and white checked dresses with puffed sleeves, separate white buttoned collars and starched aprons they glided like seraphim between the bays. Changing colostomy bags and lifting dead weights took love and selflessness.

  It was around this time that I started Harlem shuffling with a cool yé-yé crowd at Le Kilt, Birdland and Le Bataclan in Soho. I was all dressed up with a pair of grey striped hipster flares, Ravel shoes and a skin-tight ribbed crew neck sweater worn over a blue crepe shirt. The chic French au pairs wore very short kilts, tight Shetlands and plenty of black pencil. I was out on a limb, an ‘in crowd’ modernist leading a double life. I was navigating between alternate worlds.

  Some Sunday afternoons I would walk from Stepney Way across Commercial Road through a wasteland of bloodshed and beer down to Limehouse and Poplar past the now deserted West India Docks. I was drawn towards the river, the dock road and the Isle of Dogs. I wished to be at home and away simultaneously. It seemed as if I was always in another place, dancing and mourning.

  After these break-outs I returned to my textbooks with renewed commitment. If study had gone well that week, I would go out again in the evening for a half pint in The Grave Maurice. On the other side of its beguiling velvet curtain there were diamond geezers with flashy broads bathed in subdued light. I loved the affectionate way the Cockneys talked to me, their rhyming slang, their unaffected cosmopolitanism, and above all, their sense of community. In these casual encounters I was acutely aware of my provinciality and slow-wittedness.

  By Monday morning the two halves of London that never added up to a whole were forgotten, as I assisted in theatre, delivered babies at Mile End and navigated the long frightening corridors of the Claybury asylum. My neurology and psychiatry teachers galvanised me and in spare moments I went to the College library to read up on motor neurone disease and brain tumours. In Enoch and Trethowan’s Uncommon Psychiatric Syndromes I learned that Cotard’s was a delusional disorder in which the sufferer believed he was a walking corpse and that De Clérembault’s was a disabling, obsessive, unrequited love.

  The teaching autopsy too was an eagerly anticipated ritual. Our medical firm (Bomford and Ellis) would troop across the road from the hospital to the mortuary where a clinician would present the history and physical signs of the deceased and then the morbid anatomists, under the watchful eye of Professor ‘Doe’ (Doniach) would reveal the macroscopic pathological findings. Henry Urich, perched on a ledge next to the cadaver, would lead the discussion on the neurological cases in his intense Eastern European accent as we hung spellbound on his every word. Urich used a large knife to skilfully cut open the brain on what looked like a large breadboard. The naked-eye appearance of the coronally sliced hemispheres and the transverse cuts of the brain stem allowed him to suspect diagnoses such as Parkinson’s disease. With the help of a large pair of toothless forceps he magically exposed other pathologies, such as water on the brain, neoplasms, obscure degenerations and catastrophic haemorrhage. These demonstrations taught me the great level of uncertainty relating to the cause of death in so many autopsies, the common occurrence of more than one pathology in the elderly and most importantly of all, the need for humility in medicine. Urich also reminded us that there were more secrets waiting to be revealed when the fixed brain was examined under the light microscope.

  This new knowledge I was acquiring as a medical student re-ignited my interest in the world of living creatures but also inspired a new fascination with dead matter. Human life in its development and decay, with its ever-varied patterns of disease, presented me with new dilemmas of the highest interest. There seemed to be a great deal of advantage of coming in at the end of the story when all the facts were in. Pathology gave me security.

  But just when I started to feel I was getting to grips with my training, a disturbing sense of disaffection reared up. Most of my peers now seemed self-satisfied and narrow-minded. Carrying out a vaginal examination in theatre on an anaesthetised woman with fibroids without her prior consent, see
med even then like an assault. Being told by the registrar to go and see ‘the gastric cancer in the big end’ seemed crude and inhumane. On electives to other hospitals, such as my short time at the overcrowded South Ockenden Institute for Mental Defectives, I felt that care was too often casual and matter-of-fact and that most of the severely handicapped patients had been stripped of their dignity. I didn’t blame the nurses as much as a system that lacked a will for change. Then I was ordered by Sister Gloucester to get my shoulder-length hair cut before she would let me back on her ward. My reluctance to comply was a feeble and selfish expression of growing rebellion. I became increasingly sensitive to judgmental condescension. Received Pronunciation was expected and my Northern English accent was scorned and imitated by some of my peers and teachers.

  It was the front cover of the Beatles’ Sergeant Pepper’s Lonely Hearts Club Band that first brought William Burroughs into view. Amidst the rows of famous faces he was on the second row next to Marilyn Monroe and above Oscar Wilde. I didn’t recognise him so I looked him up.

  I learned that Burroughs was in his own words a ‘queer’, who after ‘accidentally’ shooting his common law wife, Joan Vollmer, in Mexico City had fled to Colombia in search of a telepathic truth drug called yagé. His lurid descriptions of heroin-laced depravity, sodomy and infanticide in Naked Lunch had been described by a Boston judge as ‘a revolting miasma of unrelieved perversion’. A connection with Paul McCartney and Barry Miles at the Indica bookshop had got him on the cover. He seemed to have come out of nowhere.

  The conformity of medicine was suffocating me. There seemed more interesting things to do than playing bridge in the Students Union, going to ‘hops’ on Wednesday evenings or singing Zulu warrior after a rugby game at Hale End. The medical establishment was still dominated by old school ties and funny handshakes. Subjects that seemed important to me, like the management of drug addiction or the rudiments of forensic medicine, did not appear anywhere on the medical student curriculum. I began to harbour reservations whether unconditionally helping the sick was going to be sufficiently fulfilling for the next fifty years.