Doctors’ memories from a different era

Dr David Perel; Registrar in Pathology at RBH, 1968-73

Amongst the volunteers at the Museum, stories are often triggered by the appearance of an object for registration in the collection such as a piece of equipment from a pathology laboratory.

A mention of the introduction of auto-analysers in pathology across the 1960s to 70s prompted David to talk about the frustrations of the job of manually testing for serum amylase as a pathology registrar at the Royal Brisbane Hospital. Incidentally, these positions were salaried without any overtime payments then, and there was only one registrar on call. Amylase estimation had to be timed to exactly 30 minutes which meant, if interrupted, he had to restart the test. The common request for a serum amylase for a presentation of an acute abdomen, could easily be quickly followed by an unrelated urgent request for a crossmatch of blood for an emergency transfusion. Even with the rapid papain method used this took 15-20 minutes and David estimated that he personally did about 2,000 crossmatches in his more than four years as a registrar. The irritation of having to repeat serum amylase tests happened on many occasions.

Sometimes the crossmatching was fraught. He recalled a time of an urgent demand for several bags of blood to cover an operation for oesophageal varices and having attempted the 20 bags of the appropriate group in the RBH blood-bank he still had not found one to match the patient. This meant ringing the boss, who never welcomed a call in the middle of the night, to scour Brisbane for the blood. They found three out of 50. The on-call pathologist had no assistance in doing the work for this request.

Another complication was the accompanying request for a full blood count and electrolytes with the amylase. At the time these were manually done as individual tests, however usually the results were unremarkable, and the on-call pathologist knew that, for safety, the appendix would be removed and a request for bacteriology would come later to substantiate the diagnosis of mesenteric adenitis. A rough estimate at the time suggested only about 5% of appendectomies resulted in a convincingly inflamed appendix and abscesses were unusual.