Nearly everyone choosing a medical career now makes this momentous decision as a young teenager. Two sets of exams must be aced, and extracurricular activities buffed to have any chance of gaining what remains, despite the palpably low morale of doctors, a highly competitive profession. At fourteen, I was hoping to keep my place in the school’s first XI cricket team, a little preoccupied about whether a missing front tooth lost playing rugby might hamper future prospects with girls and, being considered a relatively thick pupil at a very competitively academic direct grant school, what O Levels might cause me the least humiliation.

The exams went better than expected especially in arts subjects and my A Levels picked themselves: Geography, History, Economics (a new subject said to be easy) and my banker, Maths because up until then no revision had been required.

I surfed in the slipstream of corporate excellence and although some were surprised by my A Level results, I wasn’t. Along with many others, I was encouraged to apply to Cambridge which meant an additional exam taken during an extra school term. The daunting prospect of another exam was mitigated by the possibility of gaining more representative sporting honours. The offered place produced disbelief in masters who had taught me during my early years and huge vicarious excitement by the PE staff who anticipated sporting Blues.

Life’s pristine lawn was laid out and I had another bonus. Despite the teeth, I had a girlfriend who was going to Oxford and so like me had nine months free before university. She suggested we go to South Africa together because her father remained there after the parental divorce. He was a budding politician in the newly formed Progressive Party and high up in the mining industry favoured by Marilyn Monroe. As the plane crossed the Equator, she announced that her first and true love was meeting us at the airport. Despite this unexpected setback her family were incredibly kind and generous especially when I was arrested for stealing the day’s takings from a famous Jo’burg off-licence chain. The police were surprised that a scruffy student was accompanied by the most senior legal advisor to the richest man in the world at that time.

Shortly after this, an initially dismissed doubt entered my head but it was unrelenting and within a few weeks, I was certain. Despite no family history of disease or medicine, I was going to be a doctor. I knew that with no science O Levels let alone A’s I couldn’t change my degree at Cambridge. My decision to decline the place caused some consternation except from my mother who quietly stated that she always knew I was going to study Medicine.

I returned to the UK and only then realised the how risky my decision had been. The option to study science A Levels at a local technical college was turned down due to the missing chemistry O Level. I wondered whether experiencing medical life might help me decide if it really was my calling. A portering job at the local district hospital was available because a longstanding employee had tipped a patient out of a wheelchair. I worked there for nearly two years and just when I was thinking of going on bended knee to reactivate my Cambridge offer, fate intervened. Before social media, gossip travelled around hospitals more slowly. When I was approached by a senior and highly esteemed surgeon at the hospital, he not only knew my name but also my ambition to study medicine. He suggested I might apply to his old medical school which still provided an atavistic preliminary year originally intended for nineteenth century gentlemen who at school had studied Classics but no Natural Sciences. This First MB course is no longer offered. I applied and, thanks to the large South African member of the interview panel with a cauliflower ear, was offered a place. Returning to my portering job I was surprised that most people already knew. The revered surgeon was delighted and invited me to come back in six years to be his house surgeon, an invitation that was accepted and enjoyed by both parties. A truly wonderful man.

I wasn’t the most diligent medical student and learning biochemical pathways did not come easily. However, the most extraordinary metamorphosis happened after qualification. The academic knowledge of medical school was helpful but clinical medicine was all about experience and application, putting theory into practice, more akin to a trade apprenticeship. I found that the histories, test results and diagnoses of every patient were easy to recall. The registrars soon stopped betting whether I was bluffing or not when, without notes, I reeled off everything about the patient. I have subsequently realised that all of us can remember things that matter. Patients who declare that they are too stupid to understand their options - “so you decide doc” - can often take an engine apart, or recall every football team, or recite poetry.

From day one, I regularly received ‘golden nuggets’ from my fantastic consultant mentors, which starkly contrasts with the soul-destroying nature of a current foundation doctor’s roles. I learned that patients prefer to be seen by ‘their’ doctor or consultant, not whoever is on that shift and available. Continuity is also vital for formative medics. Receiving feedback on decisions and watching patients improve or not, is essential. Presenting patients to familiar seniors builds confidence and allows mentors to judge progress. I presented and received feedback on more than 1000 patients in my first year. Talking to current F1s they rarely have this opportunity.

My favourite nugget was delivered in a late running clinic by the surgeon who had directed me to his old medical school. He reminded me that although he sometimes felt a bit flat towards the end of a repetitive clinic, to the patient it wasn’t merely the most important thing they were doing that day but might be the most important fifteen minutes in their life. I did my best to remember this but probably failed sometimes.

After this fantastic year, despite what are now considered very long hours, I was hooked and wanted to be a hospital doctor. Although I enjoyed the day-case minor list during my surgical six months, becoming a physician was my aim. To achieve this, I would require another exam, Membership of the Royal College of Physicians (MRCP) which could be taken a few years after full registration. An 18-month Senior House Officer rotation at a distant hospital expanded my experience and I then returned to be the medical registrar under my previous boss and fortunately passed MRCP. Having celebrated this, another unheralded ambition hit me. My boss was a renowned gastroenterologist and we had discussed a possible career in the same speciality. When I announced that I wanted to be a cardiologist he wished me luck because the career pole was “greasy and studded with razor blades”, adding that an absence of multiple medical school prizes might make it difficult.

Determination is sometimes more important than talent. I became a cardiology research registrar. I published many papers including some based on my PhD research (a doctorate was almost mandatory to gain a consultant cardiology post). Ironically the doctorate had a significant biochemical component which I found easy because the science had direct clinical relevance. Luckily, I also came second in the British Cardiac Society’s Young Investigator award (young but by now 36), which is probably why I gained the now defunct level of Senior Registrar at St Bartholomew’s. I appreciate that competition for training posts in the UK is currently very tough but during the two years I was applying for this penultimate step to eventually becoming a consultant, only seven such posts were advertised in the whole UK.

Just after my fortieth birthday I commenced my consultant post at Royal Papworth and the Norfolk and Norwich hospitals. Over my time there, I helped develop cardiac services and although I trained in both the heart’s electrics and plumbing, the latter was my special interest. To improve local services, especially the immediate treatment of heart attacks by unblocking the offending artery as soon as possible, in 2007 I helped raise the £I.5 million NHS financial shortfall by rowing the Atlantic. Having seen the dire consequences of heart attacks before unblocking the culprit artery became the gold standard, it is no wonder that seeing gravely sick patients turn from grey to pink and leave hospital undamaged remained an addictive gratification until my retirement. The team buzz of salvaging patients was as, if not more, potent, than snatching victory from defeat on the sporting fields of my youth.

In retirement I wrote a book about memorable patients. After publication, I received an email from a patient who I had treated for a heart attack in 2008. He was a retired GP and wanted to give me an update. He had nursed his wife until she died a few years before but had been kept active by housing Ukrainian refugees and undertaking charity work. He will be 100 years old later this year and it’s patients like this that remind me why I would do it all again.


Liam Hughes is the author of Bodily Fluids: Five Decades of Blood, Phlegm and Bile on the Hospital Frontline is published by Eye Books (2026)

More information here: https://www.eye-books.com/products/bodily-fluids

Read our review of Bodily Fluids here: Blood, Bile, Pus: Bodily Fluids By Liam Hughes