Mr Graham Meikle
I’m flattered to be included as ‘East Lothian’s last genuine general surgeon’ which I’m proud of, and like to think is true!
It is perhaps ironic that I ended up as such – when I embarked on my training as an aspiring surgeon in the early 1960s, after a brief spell as Locum Registrar in Orthopaedics with Professor J I P James, I intended to pursue their specialty, but was advised by ‘JIP’ to first go and work for while in General Surgery. This I did, I enjoyed it and managed to get up the ‘ladder’, albeit slowly, and ended up as Senior Registrar for nearly four years in wards 13/14, RIE, where […], the main interests were peripheral vascular surgery and renal transplantation, so I ended my training as a reasonably competent vascular surgeon.
But after my appointment as Consultant Surgeon at Leith and Roodlands Hospitals, it rapidly became apparent to me that for every patient in these hospitals needing a vascular operation, there were dozens more with major and minor injuries, or the visceral, urological and many other surgical problems which in that area were handled by the general surgeons, so I changed tack in my work, became a ‘jobbing’ general surgeon, and never had any regrets. (Perhaps not 100% true – in later years I then much enjoyed performing simple ‘plastic surgical’ operations, and regretted not having a real expertise – I felt I could have been very satisfied with a career in Plastic Surgery – if I had, I doubtless would have been a lot wealthier also!).
I was lucky that it was an era where a surgeon could change his interests and repertoire of surgical operations freely – ‘Accredited Training Programmes’ and ‘Specialist Registration’ were things for the future; one only has to recall the career of Sir Walter Mercer, a competent general surgeon, quite prepared to perform cardiac surgical procedures, and subsequently ending up as Professor of Orthopaedics!
The success of the Surgical Unit and the Casualty Department at Roodlands was undoubtedly due to the efforts of Mr James McLean Ross. He was appointed as single-handed Consultant to open the Unit, in what I believe was part of the old Fever Hospital, in 1950. I know that he had support and encouragement initially from Mr Paterson Brown, Consultant in Wards 15/16 RIE, who would visit the new Unit to see outpatients and to perform operations. This travelling of a Royal Infirmary Consultant to a rural hospital was not unique – I believe some surgeons did the same at Bangour Hospital, and I recall that, as late as 1966 when I was Senior Registrar with Mr Eric Farquharson in Wards 11/12 RIE, he had an arrangement where he went down to Berwick Infirmary once a month, on Wednesday: on one visit he would see out-patients, and on the next monthly visit would do an operating list, leaving the post-operative care entirely to the nurses and local General Practitioners.
Jim Ross worked for 22 years at Roodlands as single Consultant, from 1950 to 1972, when I joined him part-time with four sessions. When the Unit opened his junior staff were one Registrar and one House Surgeon. By 1972 the team had increased to Registrar, one Senior House Officer, and three House Surgeons. When he took his annual holidays, a locum had to be found and appointed; otherwise he was on call seven days and nights a week, although he had an informal arrangement with friendly surgeons at the RIE, such as Mr ‘Jim’ Jeffreys, to stand in for him for the odd night off.
In the early 1970s, he made arrangement with the South East Regional Hospital Board to get some limited support from the Surgical Senior Registrars in the RIE, on an ad hoc basis, and this is how I started my involvement at Roodlands. This modest assistance was long overdue, considering that by this time a surgical unit in the RIE had three Consultants (or two and a Senior Lecturer) and a Senior Registrar (Professorial units + a Lecturer) to man the same number of beds, around forty, as Jim Ross was working with, on his own, at Roodlands! (In addition he had the use of Ward Three, East Fortune Hospital for convalescent surgical patients or elderly folk awaiting admission to geriatric beds.) Effectively this meant Roodlands surgical Unit functioned with 58 beds (42 at Roodlands in Wards 1 and 2, + Ward 3, 16 beds). Of course this meant a ‘Bed Occupancy Rate’ of a pretty low figure, for a lot of the time. When I was Consultant there I never bothered to note what it was even! This sounds very inefficient, but if we had ever reached 100% full beds, there would not have been enough nurses and junior staff to look after them. A particular bonus was that the junior staff never had to have any reservations about admitting difficult diagnosis cases for observation, and we never had to hurry patients out, after surgery, if their wounds were not completely healed, or their support system at home was fragile. I even recall a night when a car full of pleasant Americans was involved in a road accident on the Gladsmuir straight, and brought to Roodlands. The House Surgeon treated their various cuts and bruises, and then telephoned me, as it was very late, they had no transport, and the local hotels were long closed. I gave him my usual instructions when in doubt ‘…put them in warm beds and I’ll see them in the morning…’
Next morning I saw them on my ward round. They were extremely grateful for a comfortable night and a good Mrs Paton breakfast. The Ward Sister arranged a hire car for them to continue on their holiday, and they came to my office before leaving to ask for the bill. They were flabbergasted at not being requested to pay anything, pressed a large donation into my hand for the hospital patients’ fund, and went away singing the praises of the NHS. It may have been inefficient, but it was humane, and made a small contribution to Scots/American rapport!
I have digressed, I realise, from the assistance of Surgical Senior Registrar, from the RIE, at Roodlands. My own involvement in 1970 started when James Ross approached me and asked me to ‘cover’ for him at the odd weekends off, and to perform operation lists and do outpatient ‘cliniques’ when he was occupied at the Royal College of Surgeons as Examiner in the FRCS Diploma Examinations. I was flattered, and enjoyed the responsibility and independence of working at Roodlands. I had been a Senior Registrar for four years, had applied for many Consultant posts in England and Scotland, unsuccessfully, and have to admit I was somewhat ill-placed in an academic professorial Unit. Mr Ross was much liked and respected by his RIE surgical colleagues, and my own Consultants were quite happy with the arrangement, provided I did my own duties in wards 13/14, and for the next two years I was regularly at Roodlands, until my appointment as Consultant placed me there formally, in 1972.
While he worked as the only surgeon, James McLean Ross adopted a practical and straightforward work routine; operating sessions all day Tuesdays and Thursdays; outpatient clinics Monday, Wednesday and Friday mornings, with brisk ward rounds on arrival at the hospital each morning. In the afternoons following his outpatients, he would dictate his letters to the GPs and his meticulous operation notes; these would be typed up by his secretary the next day, and on his desk the same afternoon for signature and posting. This meant that the referring family doctor of the patient seen, say, on a Monday, would have James McLean Ross’s letter probably by the Wednesday or Thursday. I doubt if e-mail and computerisation has improved on this in current hospital practice!
When I was appointed, I worked seven sessions at Leith Hospital, and four at Roodlands, relieving Mr Ross of one day’s operating, one outpatient clinic, leaving one session to cover the Unit for emergencies six days a fortnight, Thursdays and alternate Friday-Sunday weekends. James McLean Ross also passed over to me the job of Consultant in charge of the Casualty Department, a responsibility I also took on at Leith
Over the next eight years my work pattern at Roodlands remained unchanged; I continued at Leith Hospital until 1977, at which time the Surgical Unit there was being run down and prior to closure, so I moved to the Eastern General Hospital and worked there until 1980.
In 1980 Mr McLean Ross retired, and I moved full-time to Roodlands to replace him, being joined, part-time by Mr J M T G ‘Mike’ Griffiths, and we worked together until I retired in 1991.
I was sorry to do so, but the status of the Surgical Unit was being drastically downgraded: the Casualty Department was closed, Ward 1 changed to a geriatric ward, and Ward 2 reduced to a ‘Day Unit’ for minor elective surgery only. The Lothian Health Board, very reasonably, offered me a new contract at the EGH, but I was by then 58, planned to retire at the age of 60 anyway, so I felt this was the moment to hang up my scalpel; and have no regrets. I have now enjoyed ten years of happy retirement!
Another pleasure I remember of my time at Roodlands was that there [were] minimal demands made on a Consultant for committee work and administrative meetings and paperwork, leaving one free to do what one was best at – see outpatients, look after my ward patients, operating, and support and train my junior doctors.
I attended for some time, the monthly meetings of the Medical Committee (? proper title) at the Astley Ainslie Hospital; there were odd meetings of the Division of Surgery; otherwise most ‘administrative’ discussion and decisions were handled over lunch in the Roodlands dining room on Friday! Mr McLean Ross established a very sensible system – Mr David Bonsor, the Treasurer, and Mr Ronnie (? surname), part-time administrator, came to Roodlands on that day, and any Consultants available – Dr Bob Littlewood, Dr Roger Kellett, Dr Norman Speirs, myself – would join them for a good lunch prepared by Mrs Paton, the hospital cook (another loyal and valuable servant of Roodlands, providing patients and staff with excellent plain but well cooked meals from her modest kitchen).
Over the meal we would discuss any hospital problems, and consider any planning necessary; decisions were taken quickly and amicably, nothing was put down on paper, and the Treasurer & Administrator returned to Edinburgh, usually to come up with action (money?!) by the next Friday lunch. I doubt that many of the Consultants in practice today enjoy this sort of simple and effective system.
In the same pattern was the way in which maintenance of hospital fabric and equipment was handled. Mr Kennedy, the hospital engineer, had his office across the drive from mine, and I could drop in on him any time for helpful and rapid action. With his help we made many little improvements to the Operating Theatres – new lights, diathermy, piped gases, new flooring and air-conditioning. I always thought I had the nicest operating theatre in Lothian – it had a huge plate glass window facing south, with a view over a field with contented cows grazing, and the Lammermuir hills on the horizon!
And the hospital had a rolling programme of painting and decorating, so that the wards and facilities were regularly freshly painted and clean. I am not saying that we had unlicensed liberty to do what we wanted, or to spend extravagantly, but things seemed to happen without the complex administrative minefields and acrimony which hospital consultants need to go through nowadays.
Accident and Emergency Service at Roodlands
One of the particularly valuable services available at Roodlands, when it was an ‘acute’ hospital, was the Casualty Department. In it we were able to treat a modest, but almost constant stream of minor injuries to conclusion, and to resuscitate and ‘stabilise’ serious multiple injuries, and head injuries before transfer to specialist units in Edinburgh. And with plenty of back-up beds available in Wards 1 and 2, we could admit straightforward major injured cases, such as fractures of the neck of femur, for definitive treatment by ourselves. And the generous bed capacity allowed us to readily admit patients needing ‘observation’, such as minor head injuries, or those with vague abdominal symptoms.
One has to remember that this was an era when the Scottish Ambulance men were essentially just vehicle drivers, competent to move and handle the injured, but few had even ‘First Aid’ training, and the words ‘Paramedic’ and ‘Medic 1’ were for the future. I do know that, after a bad road accident in the vicinity of Haddington, the ambulance men were extremely grateful to be able to stop at Roodlands with a bad casualty, perhaps shocked or unconscious, rather than continue the journey to the city without surgical or nursing help. Not all the vehicles were staffed by two men, so one man only might have to drive the vehicle and observe the patient. I think I can use the term ‘ambulance men’ without being sexist, because this was before competent and pleasant women were recruited by the ambulance service, as is the norm nowadays!
Inevitably there were a significant number of RTA casualties from crashes, particularly on the notorious stretch of the antiquated A1 from Tranent — Haddington — Dunbar -Cockburnspath in our catchment zone. The most serious occurred in the 1960s when a school bus was in a crash at the Ballencrief Crossroads; some children were killed, and several suffered serious injuries, and were admitted to Roodlands and treated by Mr McLean Ross and his team. The transfer of seriously injured cases to Edinburgh involved an anxious and possibly dramatic journey; the ambulance drivers would ask if we wanted ‘lights and siren’, which meant they would make the journey as fast as possible, blue lights on, and siren wailing. In such situations we would have a very helpful Police escort car speeding in front to clear the way – of course there was no motorway then, we had to wind our way along the old A1, pushing through the traffic in Tranent, Musselburgh, and the eastern city.
I use the word ‘we’, as it was normal practice to send a nurse and a House Surgeon with the patient, and the doctors enjoyed the drama. I only did the run once myself, when we were short staffed and no one else was available, to accompany a young woman, deeply unconscious from a bad head injury, and I cannot say that I relished the experience. The ambulances of the era were sturdy Bedfords, not renowned for their cornering ability or smooth ride when driven fast, and my nurse and I were bumped and thrown about like ping-pong balls, while we struggled to control the intravenous infusion, keep the airway clear, and to monitor pulse and blood pressure. I do know that I was very relieved to reach the Neurosurgery Unit at the WGH in one piece, with a live patient, a live nurse, and a live Consultant, and then to make the return journey to Haddington at a sedate pace!