A comment on the career of Frank Parsons
by Es Will
‘He often joked that (an operation in mid Atlantic) was the last he undertook before becoming a physician’1
Introduction
The dramatic predicament of Goethe’s Dr Faustus, taking a wager with Beelzebub that risked his eternal soul for the experience of self-gratification, is more pertinent than ever in modern society and the professions. The potential gains and losses may be less dramatic in a secular culture, but the temptation can be of the same quality. Any means to achieve one’s ideals, and avoid the cost, may be worth considering in a lacklustre life.
In professional memoir we tend to focus on the positive, by fashioning the heroic contributions of our predecessors, while their inevitable personal sacrifices are typically ignored. We like to exaggerate incipiently Faustian scenarios. That may assuage our group amour propre in the abstract but conceals the inevitable human cost of the struggles that really link us to them, the frustrations of human life on earth. It mirrors the lively controversies of modern academic historians.2,3 There is solace, of course, in both the heroic and anti-heroic. In the event, the trace of personal sacrifice occasionally surfaces in a careful reading of the public record.
The record
The 1989 journal article by Dr Frank Parsons (FMP) published posthumously in the BMJ is a remarkable valedictory.4 On the one hand it directly expresses attitudes to his achievements. For example, he is aware of being first to categorise the need to match dialysis treatment frequency to urea generation rate but admits no early awareness of a dialysis disequilibrium he even describes.5-8 On the other, it inadvertently crowns his struggle to establish conventional medical credentials in the thicket of his career pathway (vide infra). The enthusiasm for a challenge and the talent for improvisation that characterised his contribution to 1950s UK kidney replacement were replicated uncannily in the unorthodox predicament that he voluntarily entered, in terms of formal recognition in the profession. It appears that he was determined not to be a victim of local hospital and UK conventions, but to sustain a self-conceived status.
The context
After WWII demob in 1949 he found himself in the Leeds General Infirmary (LGI) in his mid-thirties as a trainee surgeon (BSc, part 1 FRCS qualified).9 Although the charismatic soon-to-be-professor of urology, Leslie Pyrah, seemed mainly interested in renal calculi, the need for the surgical replacement of a removed bladder led him to research ureterosigmoid diversion and its subsequent biochemical abnormalities. The biochemistry was explored with FMP, who was fortunate to employ a flame photometer in biochemical measurement, and they published in 1952. His self-taught education in electrolytes is described as leading to an awareness of renal failure, the literature of renal replacement and even an ambition to dialyse. The need to establish a departmental professorial infrastructure, at least, had been satisfied by the appointment of FMP from registrar to Urology Research Fellow, something which he celebrated as personal contact with the local great and good. He did not have a higher degree. When subsequently the opportunity arose for an exchange BTA (Been To America – a near rite of passage then for ambitious UK medical graduates) he went off to academics in the USA. Although cancer was the major interest of his first host it was the second, shorter attachment that informed the rest of his professional contribution. The rotating drum artificial kidney at the Brigham Hospital in Boston was largely worked out and employed already to relieve uraemia. He can be said to have grabbed it. He also describes direct contact with treated kidney failure scenarios, which must have given him encouragement and a practical perspective.
On return to the UK the ambition to reproduce his US experience at the LGI was irresistible, in providing a substrate for his entrepreneurship. He and Pyrah must have seen this as a suitable profit from the trip and an appropriate US-informed opportunity for a Research Fellow.10-12 In career terms it was highly unorthodox but Pyrah’s influential social skills and the availability of LGI trust funds meant a project could be established, regardless of the staffing and formal implications. Frank had thereafter to live with that successful opportunism. Pyrah cobbled together an MRC grant, which rather awkwardly accommodated both dialysis and chemical stone research.13
The personal dissonance
From the start the formal status elements were controversial. With Pyrah as Director (despite a recognised limitation as a research supervisor) there was concern that FMP should not subsequently, and automatically, assume that position. Such reservations were not aired around Dr Hodgkinson, on the other limb of the grant. FMP was named Assistant, not Deputy, Director. While salary was another obvious concern, the MRC rejected as unconventional the suggestion of an LGI title for FMP of Research Consultant or Consultant in Research. The alternative of SHMO was not accepted by the protagonists. With hindsight, a progression from Research Fellow would sooner or later have become appropriate, yet FMP was not even a fully qualified urological surgeon. The pressure to find an acceptable credential was to continue throughout his career. To be named a Consultant seems always to have been crucially important to him, just as a clinical Chair can come to preoccupy any ambitious medical professional.
It could have been that the title of consultant was particularly relevant to presence in the LGI. The honorary-consultant body, the Faculty, had been highly influential in institutional policy and decision-making. There was also, unusually, a bespoke consultant’s dining room, which survived beyond the change in hospital status of 1948. Such perks seem not to have been critical to Frank, who was not satisfied with LGI-derived titles like Consultant in Clinical Renal Medicine or Consultant in Clinical Renal Physiology, with which to express his position in the serially renamed renal research activities. Even Renal Unit Director (1982), after the LGI appointment of a trained consultant nephrologist, did not somehow assuage his hankering to be called a Consultant Physician.14 Although he was formally assisted always by a qualified physician from the academic Department of Medicine, it is unsurprising that his kidney work took him in a physicianly direction.15 That was reflected not only by his 1961 higher degree of MD (‘with distinction’) but also an honorary membership, and then fellowship, of the Edinburgh College of Physicians. Even then, he was keen to project in his article and journal affiliations that LGI had made him some sort of ‘Consultant Physician’. This sequence is conveyed in the BMJ paper with a mixture of modesty (‘mere ….’) and immodesty (‘I had started a new discipline in the United Kingdom’).4
The solution
In practice, he infiltrated his more than fifty publications with a progressive migration of claimed affiliations after 1970, dropping the ‘E’ or ‘Ed’ of the FRCPE to assert FRCP (which suggested the London qualification) and offering ‘Consultant Physician’.16 The evidence that this was conscious is that the FRCPE reappeared in a multi-author paper that included a prominent Edinburgh graduate.17 The fact that those authors accepted the clear, associated ‘Consultant Physician’ claim is moot.
Frank retired in 1983, nearly thirty years after the start of his major contribution. He had continued in active collaborative research in renal transplantation and other metabolic interests from LGI facilities. He became a persistent anecdotalist, which he mentions specifically as additional to his recollections in the BMJ paper.4 His contribution to the clinical mainstream had been short-lived, although he was a ready witness to early kidney replacement in the UK. His struggle with conventional credentials seems likely to have made him a rather nostalgic figure. That may explain his unique capacity to solicit advocacy during and after his lifetime, although the early lobbying of his mentor suggests that was fully expressed at the start of his UK dialysis adventure.13,18 Likewise, the reported early, uncorroborated, negative comments of the MRC about dialysis have the ring of synopsis and his grandiosity. They are often complemented by the still photograph of his awkwardly demonstrating the monster machine to senior colleagues. Unfortunately, once his patron retired he was professionally high and dry, an LGI icon left with an unconventional place in the profession but nursing a consciousness of status. As if to emphasise the professional gradients, it has been noted that the next stage of UK dialysis expansion was all in professorial academic units, prior to the NHS regional programme of maintenance haemodialysis after 1966.
The last throw
The incipient pathos was ultimately relieved in a way that we can assume he never knew, since he died before the BMJ article was published. In the 1989 credits he returned himself to FRCP, Consultant in Renal Medicine, abbreviating the LGI title he had not used for years in print.4 However, a BMJ editor, qualifying his recent death, titled him erroneously ‘Consultant Renal Physician’. He achieved then, posthumously, the very credential that he had pursued for years through the covert claims in journal affiliations. The error suggests that he had achieved that plausible status in the medical publishing community, at least.
His unconventional decisions in mid-life were only partially accommodated to his satisfaction by the UK professional establishment. It was only in death that there was a mitigation of his essentially Faustian wager, the opportunity to express his entrepreneurship in the challenge of UK haemodialysis for acute renal failure at the risk of losing career recognition in the form he came to long for and publicly express. His repeated joke was profoundly prescient.1
(A shortened version of this article was published in the Hektoen International, Journal of Medical Humanities. see reference 19.)
References
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Last Updated on April 2, 2024 by John Feehally