“D’ye ken what’s wrang wi’ Christmas in hospitals nowadays?” A complex question, coming from an operating-theatre orderly who has been around even longer than I have: a cheery, gossipy man who regularly buttonholes me in the lower surgical corridor. “Tell ye whit it is . . . Nowadays, naebody’s pissed.”
To describe the past is not to glorify it. “D’ye mind the time Santa could hardly stand? Mind you, a drink in every ward . . .” I remember it well. And I remember struggling – cold sober – to put up a drip on a very sick patient with hardly any veins. One of my fellow housemen – cheerful, voluble and glowing with morning drink – looked into the ward, took over, slid the thing effortlessly in, wished both me and the patient a happy Christmas and floated away on a cloud of agreeable fumes, leaving me to tidy up.
It wasn’t just the drink. Thirty years ago, our ever-changing National Health Service still embodied vast chunks of previous cultures now extinct. Then there were ghosts in the machine, shades of a pre-1948 heritage, perpetuated rather than remembered. It was another country. They did things differently there.
In our great teaching hospitals – in the shabby lower surgical corridor of one of which the above conversation took place – there were remnants of Victorian charity. Consultants who in earlier days would have accepted hospital duties as strictly honorary – a status in the treatment of the poor that enhanced their capacity gainfully to treat the rich – had been succeeded by others who still somehow thought of themselves as honoured.
Their senior nursing colleagues, the ward sisters, then mainly a coven of determined spinsters who considered themselves married to their wards, were transformed, Cinderella-like, into hostesses for a day. And their Christmas hospitality for their senior medical colleagues ensured that most of the latter’s aspiring juniors would turn up, too.
This was not without its discomforts. Consultants who had successfully avoided each other all year faced special difficulties. In my first medical ward a large jolly clubman, bred from the purple of Edinburgh medicine, had arrived early, claimed his mince pie and warm brown sherry, and was presiding over a cheerful little party of juniors when his distinctly less inspiring contemporary, now nominally in charge of the unit, arrived.
The social temperature dropped precipitously. The jolly clubman braced himself, got to his feet, warmly shook his loathed colleague’s hand and roared, “A merry Christmas to you, Bertie”.
His fellow consultant, already guilty of the solecism of wearing a white coat on Christmas Day, limply returned his handshake. “And a happy Christmas to you too, Dr Marks.”
Bertie gulped down his warm brown sherry and fled. Marks settled comfortably once more into his armchair. “He was a pathetic wee student,” he mused aloud. “And now he’s a pathetic wee consultant in charge.”
At the entrance to the ward a large, faded notice reminded the patients of their status. Smoking was strictly controlled, drinking was forbidden and “able-bodied patients might be required at the discretion of the ward sister to undertake such domestic duties as were appropriate”. Though these rules were no longer enforced, there was no suggestion that they were relaxed for Christmas.
Alongside the bombazine ghost of charity past strode another, more cheerful figure. Medical life in the NHS in the sixties and early seventies still bore the stamp of its postwar founding members and even that of their predecessors, the Edwardian and Georgian junior staff whose languidly posed group photographs still adorned the corridor leading to the medical residency toilets.
We had inherited odd, precious fragments of regimental and club life. We had a mess – still so called – of our own. We had a butler, a dissolute but devoted man whose long-gone prime had been spent in the service of the officers of rather a good cavalry regiment. He and others indulged us. We were somehow junior officers, with duties, privileges and liberties. We worked hard – 120 hours a week on call was routine – played hard, and were forgiven much.
At Christmas that mattered a lot. Since most of us lived in and half of us were on duty anyway, Christmas in the mess took on the charm of making the most of it, an atmosphere that might have been recognised by subalterns on the NorthWest Frontier a hundred years ago. Lapses, if not expected, were permitted. The regiment was a family. Loyalty was a given, forgiveness available. Serious lapses might count against you.
A few years afterwards, one of my contemporaries was found late on Christmas afternoon crawling along the corridors of a famous London teaching hospital. Even in a famous London teaching hospital, that was going too far. On senior advice his career plans turned from surgery to general practice.
Now, for better or worse, these ghosts are gone. This year Christmas in hospital will be one of four days – two of them a weekend, two statutory days – a holiday in name only, in most respects more like one of four dull Sundays in row. Patients will be cared for, with operating theatres taking emergencies and labs providing essential information grudgingly. Medical staff will be sober, and very thin on the ground. Santa, if he appears, will certainly be fully capable of walking round the hospital, and probably on double time, too.
Better or worse? I’m not sure. Duller and safer, certainly. The presiding ghosts of Christmas present are risk management, health and safety at work, junior hospital doctors’ hours and – of course – policy guidelines on alcohol in the workplace. But you might still glimpse, at about five past midnight on Christmas morning, strolling along our shabby lower surgical corridor, a gallant, tipsy young doctor- subaltern, and on his arm the ghost of Florence Nightingale, her cheeks ever so slightly flushed.