• emergency department management
• emergency departments

I qualified in London in 1968. Being the first doctor in my family, I had little idea of medical career structure. My first post was as House Surgeon in a small hospital in North London. We worked a one in two rota. Two medical staff lived in each night, a House Surgeon and a House Physician. There were Senior House Officers (SHOs) who could go home at night and Registrars whose work was mainly in larger units nearby.

During my first night on duty, being called to attend Casualty was a bit of a surprise. I can remember one airway problem which I was expected to handle by myself, luckily with the help of nursing colleagues. Fifty years on, I still remember the difficulty of clearing undigested food from the pharynx.

We dealt with limb fractures not requiring hospital admission, even displaced Colles’ fractures. I think one House Officer gave the general anaesthetic while the other tried to reduce the fracture and apply a forearm plaster. We had to take the X-rays too, developing the films in tanks of reagent.

By day there was an older doctor in Casualty, not a consultant. He tried to give some guidance to his very green colleagues. I was summoned to look at a rather chunky forearm cast, which had just been removed from one of my patients. I asked if something was wrong with it. ’Everything', he replied, sadly. I realised that there were many skills that were probably not quite as simple as they looked.

My ambition was to serve overseas for a while. After house jobs I completed training posts in Paediatrics and Obstetrics, then a course in Tropical Medicine with the Army. I was sponsored by the UK Government in preparation for work overseas. The aspects of clinical work from …