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After physiology finals at Oxford, I went on to begin my clinical training at the Middlesex Hospital. The Radcliffe Infirmary could accommodate only a dozen or so medical students, and it was felt that one could see a wider range of patients in a London hospital. The Middlesex Hospital—despite its name—was not in Middlesex, but in central London, equidistant from Oxford Circus, Regent's Park and Soho. It was one of the great London hospitals (figure 1), with a very high reputation, even though it lacked the antiquity of ‘Barts’—St Bartholomew's—a hospital dating back to the twelfth century and refounded 400 years later by Henry VIII. My older brother, David, had been a medical student at Barts; my eldest brother, Marcus, at the Middlesex, a newcomer founded in 1745 but housed, in my day, in a modern building from the late 1920s.
I qualified in 1958, did a 6-month house job on the medical unit at the Middlesex, and then another 6 months on the neurological unit, where my chiefs were Drs Michael Kremer and Roger Gilliatt (figures 2–4), a brilliant but almost comically incongruous pair. Kremer was always genial, affable, suave. He had an odd, slightly twisted smile, whether from an habitually ironical view of the world or the residue of an old Bell's palsy, I was never sure. He seemed to have all the time in the world for his housemen and his patients.
Gilliatt was much more forbidding: sharp, impatient, edgy, irritable, with—it sometimes seemed to me—a sort of suppressed fury that might explode at any …
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↵i Valentine Logue, their neurosurgical colleague on the ward above, used to ask junior physicians if they saw anything ‘wrong’ about his face—and only then would we realise that there was something odd about his eyes: one of his pupils was much larger than the other. We speculated endlessly as to why this was so, but Logue never enlightened us.
ii Kremer wrote:
I was asked to see a puzzling patient on the cardiology ward. He had atrial fibrillation and had thrown off a large embolus giving him a left hemiplegia, and I was asked to see him because he constantly fell out of bed at night, for which the cardiologists could find no reason.
When I asked him what happened at night he said quite openly that when he woke up in the night he always found that there was a dead, cold, hairy leg in bed with him, which he could not understand but could not tolerate and he, therefore, with his good arm and leg pushed it out of bed and naturally, of course, the rest of him followed.
He was such an excellent example of this complete loss of awareness of his hemiplegic limb but, interestingly enough, I could not get him to tell me whether his own leg on that side was in bed with him because he was so caught up with the unpleasant foreign leg that was there.
I quoted this passage of Kremer's letter when I had occasion to describe a similar case (“The Man Who Fell Out of Bed”) in The Man Who Mistook his Wife for a Hat.