Doctor in the House (5 page)

When I heard I had passed the anatomy examination I felt like a man who had received an unexpected legacy. I had cut down my work preparing for the test by refusing to study at all topics that had been asked in the past few papers, in the belief that examiners, like lightning, never strike twice in the same place. I scraped into the pass list in company with Tony Benskin, John Bottle, Sprogget, Evans, and Harris. Grimsdyke also succeeded, and confessed himself amazed how near he must have come on previous occasions to the disaster of getting through.

I was elated: now I was released from the dull tyranny of the study of the dead in the dissecting room to the investigation of the dying in the hospital wards. I could start to perform like a real doctor; I could buy myself a stethoscope.

I strolled into a surgical instrument-maker’s in Devonshire Street to select one, like a boy buying his first pipe. With the grave and critical air of a consultant cardiologist, I chose an impressive instrument with thick rubber tubes, a chest-piece as big as a jam-pot cover, and a few gadgets I could twiddle while delivering my professional opinions.

The choice was an important one, because in hospital a stethoscope is as undisputable a sign of seniority as long trousers in a prep school. It was not thought good taste to exhibit the instrument too blatantly, but a discreet length of tubing poking out of the coat, like a well-set pocket handkerchief, explained to your colleagues you had quitted the anatomy rooms forever. With a bit of luck you might even be taken by the public for a real doctor. To the layman the stethoscope is the doctor’s magic wand; if he sees a man with one round his neck he assumes he is a physician as readily as he takes a fellow in a clerical collar for a parson. These are a pair of conditioned reflexes that have from time to time been used for extracting small sums of money from well-meaning citizens by sufficiently respectable-looking confidence tricksters.

The next morning I walked proudly through the gates of St Swithin’s itself instead of going into the narrow door of the medical school. My first call was the students’ lobby, to find which consultant I was appointed to.

Teaching of the clinical subjects – medicine, surgery, gynaecology, and midwifery – is carried on by a watered-down continuation of the old apprenticeship system. The year is divided into three-monthly terms, each of which the student spends attached to a different consultant. The doctor is the Chief, who usually takes on six or seven pupils known collectively as his firm, and dignified in the physician’s wards with the title of medical clerks.

Each of the clerks is given four or five beds to look after. He is obliged to examine the patients admitted to them, write their notes, and scrape up an account of the case on the consultant’s weekly list. Teaching is done at the bedside either by the Chief himself, his junior consultant, the registrar, or the houseman, and the students are expected to educate themselves in the intervals by nosing round the ward for instructive signs and symptoms and doing the unending medical odd jobs.

I began clinical work on a medical firm under the instruction of Dr Malcolm Maxworth, MD, FRCP. Dr Maxworth was one of the hospital’s oldest physicians and had charge of male and female wards – Patience and Virtue. As he appeared only once a week the new students had to start by attending a small class given by the houseman on examination of the patient. We had at the time no more idea of the correct method for this than water-divining, and a Boy Scout with a first-aid certificate would have been more use in the wards than any of us.

The wards of St Swithin’s, which were contained in two large red-brick blocks, were dull, hostile galleries made up of a succession of irritating corners in which the nurses’ dusters flapped forever in defiance. They were repeatedly being redecorated in an attempt to give them an air of modernity and cheerfulness, but the original design of the corridor-like rooms made fresh paint as ineffective as make-up on a crone. There was always a plan on foot to pull them down and rebuild, but the execution of this seemed to meet with baffling postponements. Meanwhile the staff took pride that they trod the same boards in the exercise of their art as their professional forebears, and the nurses spent a great deal of time they should have given to the patients sweeping the floors.

I walked across the court and up the dark stone stairs to Virtue ward. Tony Benskin, Grimsdyke, and Evans were already standing outside the heavy glass doors, dangling their stethoscopes and trying not to appear a little in awe of their surroundings, like Oxford freshmen or new prisoners at Dartmoor. We greeted each other in low, church tones.

The houseman came jumping down the stairs three at a time. We stiffened ourselves, like sentries coming to attention. He shot straight past and through the ward door, without appearing to notice us. A moment later his head popped out again.

‘Are you relatives waiting to see someone?’ he asked. He caught sight of our proud stethoscopes. ‘Oh, you’re the new clerks, I suppose. Damn it! I’m far too busy to show you anything.’

He scratched his curly head. He was a pleasant-looking fellow, about three years older than ourselves.

‘Look,’ he went on cheerfully. ‘Get a sheet of instructions from Sister Virtue and see how you get on examining a few patients. I’ve got a lumbar puncture and a couple of aspirations to do, but I’ll give you a hand when I can.’

He disappeared again. The small glow of self-importance over our promotion was dimmed. Glancing nervously at one another we went through the doors into the ward.

The houseman had already disappeared behind some screens round a bed at the far end. One or two nurses were busy attending to the patients. The four of us stood by the door for ten minutes. No one took the slightest notice.

From a small door on one side of the ward the Sister appeared. She immediately bore down on our quartet.

‘Get out!’ she hissed savagely.

I had never seen a sister close to before. This unexpected proximity had the effect of being in a rowing-boat under the bows of the
Queen Mary
.

Sister Virtue was a fine body of a woman. She was about six feet tall, her figure was as burly as a policeman’s, and she advanced on her adversaries with two belligerent breasts. Even her broad bottom as she passed looked as formidable as the stern of a battleship. Her dress was speckless blue and her apron as crisp as a piece of paper. She had a face like the side of a quarry and wore a fine grey moustache.

My immediate impulse was to turn and run screaming down the stairs. Indeed, all of us jumped back anxiously, as if afraid she might bite. But we stood our ground.

‘We’re the new clerks,’ I mumbled in a dry voice.

She looked at us as if we were four unpleasant objects some patient had just brought up.

‘I won’t have any nonsense here,’ she said abruptly. ‘None at all.’

We nodded our heads briskly, indicating that nonsense of any sort was not contemplated.

‘You’re not to come in the ward after twelve o’clock, in the afternoons, or after six in the evening. Understand?’

Her eyes cauterized each of us in turn.

‘And you’re not to interfere with the nurses.’

Grimsdyke raised an eyebrow.

‘Don’t be cheeky!’ she snapped.

She turned quickly to her desk and came back with some foolscap sheets of typewritten notes.

‘Take these,’ she commanded.

We selected a sheet each. They were headed ‘Instructions on Case-Taking for Students.’

‘You may look at patients number five, eight, twelve, and twenty,’ Sister Virtue went on sternly. ‘You will replace the bedclothes neatly. You will always ask the staff nurse for a chaperon before examining any female patient below the head and neck. Kindly remember that I do not like students in my ward at all, but we are forced to put up with you.’

Her welcome finished, she spun round and sailed off to give a probationer hell for not dusting the window-ledges the correct way.

We silently crept through the doors and leant against the wall of the corridor outside to read the instruction papers. Grimsdyke was the only one to speak.

‘I wonder if she goes to lunch on a broomstick?’ he said.

I turned my thoughts to the typewritten paper. ‘A careful history must be taken before the patient is examined,’ I read. There followed a list of things to ask. It started off easily enough – ‘Name. Address. Age. Marital state. Occupation. For how long? Does he like it?’ It continued with a detailed interrogation on the efficiency with which the patient performed every noticeable physiological function from coughing to coitus.

I turned the page over. The other side was headed ‘Examination.’ I read halfway down, but I was burning to try my luck on a real patient. I stuffed the paper in my pocket, like a child tossing aside the instructions for working a new complicated toy. I carefully put my nose inside the door and was relieved to find Sister had returned to her lair. I thought she was probably digesting someone.

Timidly I walked down the rows of beds to patient number twelve.

‘Look where you’re going!’ a female voice said angrily in my ear.

I spun round. Behind me was a cross-looking nurse. She was young and not bad looking, and she wore the bows and blue belt of a qualified staff-nurse.

‘Can’t you see that floor has just been polished?’ she demanded.

‘I’m sorry,’ I mumbled. She tossed her head and stalked off with a swish of starched apron.

Number twelve was a stout young blonde browning at the roots – a frequent condition in female wards. She was sitting up in bed in a green woollen jacket reading a book by Peter Cheyney.

‘Good morning,’ I said humbly, expecting she as well would attack me.

She immediately slipped a piece of paper in her book, set it down on her bedside locker, threw off her bed-jacket, and dropped the top of her nightdress off her shoulders to reveal a large and not unpleasant bosom. Then she smiled.

‘Good morning,’ she said. She was obviously used to the routine.

I felt a little at a loss. I had never been in such circumstances before, anywhere.

‘Er – do you mind if I examine you?’ I asked diffidently.

‘Go ahead,’ she said invitingly, giving me a bigger smile.

‘Thanks awfully.’

The experience was so unusual I couldn’t think of anything to say. I groped for remembrance of the instructions, but the sheets in my mind’s eye were as blank as the patient’s counterpane. I felt like an after-dinner speaker who had risen to his feet and found he’d forgotten his notes. Then an idea rescued me unexpectedly – I would take her pulse. Seizing one wrist, I felt for the throbbing radial artery while I gazed with unseeing concentration at the face of my wristwatch. I felt I had held her arm for five minutes or more, wondering what to do next. And all the time her gently heaving breasts kept tugging at my eyes. They fascinated me, not with any sexual appeal but alarmingly, as if they were a couple of dangerous snakes. I noticed they had fine drops of sweat on them near the nipples.

A thought exploded in my mind.

‘I must fetch a nurse!’ I exclaimed. I dropped her wrist as if she had smallpox. ‘A chaperone, you know.’

She giggled.

‘Oh, go on with you!’ she said playfully.

I backed away quickly. A nurse undecorated with belts or bows was dusting a locker on the other side of the ward. She looked hearteningly junior.

‘I wonder if you would kindly chaperone me with a patient for a few minutes?’ I asked urgently.

‘No!’ she said. She paused in her dusting to glance at me. I must have looked so miserable a little pity glowed in her heart. ‘Ask the junior probationer,’ she suggested brusquely. ‘It’s her job. She’s in the sluice-room cleaning the bedpans.’

I thanked her humbly and went to look for my helpmeet. She was a worried-looking girl of about eighteen who was busy polishing a pile of metal bedpans as if they were the family silver.

‘Will you please be my chaperone?’ I asked meekly.

She pushed a lock of straw-coloured hair out of her eyes wearily.

‘I suppose so,’ she said. ‘If I have to.’

We went back into the ward together and gathered some screens round the stout blonde’s bed. The probationer stood opposite me with a look of contempt on her face for my inexpert manipulations while I examined the blonde’s tongue, her eyes, and her teeth. I stuck my stethoscope warily here and there on her chest, though the noises were as uninformative to my ears as the sound of sea on a distant shore.

Taking the earpieces out I said ‘Good!’ as if I had completed my diagnosis.

‘Aren’t you going to examine my tummy?’ asked the blonde with disappointment. ‘All the doctors examine my tummy. It’s my tummy what’s wrong.’

‘Tomorrow,’ I said firmly. ‘I have to go and operate.’

How could I tell her in front of the nurse I had not yet learned as far as the tummy?

Inspection, palpation, percussion, auscultation – the unalterable, ever-applicable tetrad. They were drummed into us like drill to recruits. Whatever part of the patient you examine, whatever disease you suspect, the four motions must be gone through in that order. You look first, then feel; when you have felt, you may tap, but not before; and last of all comes the stethoscope.

I began to learn how to look at a patient so that even the fingernails might shine with a dozen diagnoses. They taught us to feel lumps, livers, and spleens; how to percuss correctly and to understand the evasive murmurs transmitted through a stethoscope. Diagnosis is simple observation and applied logic – detection, in fact. A matter of searching for clues, igniting a suspicion and knowing where to look for proof. Conan Doyle modelled Sherlock Holmes on a physician, and the reverse holds perfectly well.

Dr Maxworth took his firm round the ward every Wednesday morning. He was a thin, desiccated little man who had never been known to appear in public dressed in anything but black coat and striped trousers. He was not really interested in students at all. For most of the round he forgot we were crowding in his footsteps, and would suddenly recall our presence by throwing a few half-audible scraps of instruction over his shoulder. He was a specialist in neurology, the diseases of the nervous system. This is the purest and most academic branch of medicine and requires for its practice a mind capable of playing three games of chess simultaneously while filling in a couple of stiff crossword puzzles between the moves. As almost all the nervous diseases we saw in the ward appeared to be fatal, it seemed to me a pretty barren speciality. But Maxworth drew exquisite pleasure from it. He was not primarily concerned with treating his patients and making them better, but if he scored a diagnosis before the proof of the post-mortem he was delighted. He was, his houseman said, a fairly typical physician.