Doctor in the House (6 page)

I began to see how the ward was managed by Sister, whom I avoided like a pile of radium. Every bodily occurrence that could be measured – the pulse, the amount of urine, the quantity of vomit, the number of baths – was carefully entered against the patient’s name in the treatment book, which reduced the twenty or so humans in the ward to a daily row of figures in her aggressive handwriting.

There were two functions of the physiology which Sister thought proceeded wholly in her interest. One was temperature. The temperature charts shone neatly from the foot of the beds, and each showed a precise horizontal zigzag of different amplitude. Sister wrote the dots and dashes on them herself every morning and evening. The temperatures were taken by the junior nurses, who used four or five thermometers. In spite of inaccuracies due to a different instrument being used daily on each patient and the varying impatience of the nurse to whip the glass spicule away, the figures were looked upon as indispensable. Any errors occurring through mercurial or human failings were not of great importance, however, because Sister always substituted figures of her own if the ones returned by the patient did not fit with her notion of what the temperature in the case ought to be.

The other particular concern of the Sister was the patients’ bowels. A nurse was sent round the ward every evening with a special book to ask how many times each inmate had performed during the past twenty-four hours. ‘How many for the book?’ she would enquire with charming coyness. The patients caught the spirit of the thing, and those returning fair scores to the nurse did so with a proud ring in their voices but anyone making a duck confessed with shame and cowered under the bedclothes.

The number of occasions was written in a separate square at the foot of the temperature chart. A nought was regarded by Sister as unpleasant, and more than two blank days she took as a personal insult. Treatment was simple. One nought was allowed to pass without punishment, but two automatically meant cascara, three castor oil, and four the supreme penalty of an enema.

We rapidly became accustomed to our position of inferiority to everyone on the ward staff. Like all apprentices, the students were used as cheap labour by their superiors. We did all the medical chores – urine-testing, gruel meals in patients with duodenal ulcers, blood samples, and a few simple investigations. For the first few weeks everything seemed easy. It was only at the end of the three-month appointment that there crept up on me an uneasy certainty that I did not yet even know enough to realize how ignorant I was.

The impact of surgery on the student is likely to be more dramatic than the first gentle touch of medicine. Although surgeons have now abandoned such playful habits as hurling a freshly amputated leg at a newcomer in the theatre, the warm, humid atmosphere, the sight of blood spilt with apparent carelessness, and the first view of human intestines laid out like a string of new sausages sometimes induces in a student a fit of the vapours – a misfortune which draws from his unaffected companions the meagre sympathy afforded a seasick midshipman.

Nevertheless, I started the surgical course with a feeling of superiority over my predecessors of ten or fifteen years ago. As I went to the pictures fairly regularly I was already as familiar with the inside of an operating theatre as with my father’s consulting room. From a seat in the local cinema not only myself but most other people in the country had achieved a thorough and painless knowledge of what went on behind the doors marked ‘Sterile.’ I was ready for it all: the crisp white gowns; the cool, unhurried efficiency; the tense concentrated silence broken only by the click of instruments, a curt word of command from the surgeon, or a snapped-out demand for a fresh ligature by the theatre sister. I prepared myself to face the solemnity of an operation, with the attention of everyone in the room focused on the unconscious patient like the strong beam of the operating spotlight.

I was attached to Sir Lancelot Spratt for my surgical teaching. My official title was Sir Lancelot’s dresser, which meant not that I had to help him into his white operating trousers in the surgeons’ changing-room, but that I was supposed to be responsible for the daily dressings of three or four patients in the ward. The name had a pleasing dignity about it and suggested the student really did something useful in the hospital instead, as it was always impressed on him by the nurses and houseman, of getting in everyone’s way like a playful kitten.

The appointment of Sir Lancelot’s firm was something of an honour, as he was the Senior Surgeon of the hospital and one of its best-known figures. He was a tall, bony, red-faced man with a bald head round which a ring of white fluffy hair hung like clouds at a mountain top. He was always perfectly shaved and manicured and wore suits cut with considerably more skill than many of his own incisions. He was on the point of retiring from the surgical battlefield on which he had won and lost (with equal profit) so many spectacular actions, and he was always referred to by his colleagues in after-dinner speeches and the like as ‘a surgeon of the grand old school.’ In private they gave him the less charming but equivalent epithet of ‘that bloody old butcher.’ His students were fortunate in witnessing operations in his theatre of an extent and originality never seen elsewhere. Nothing was too big for him to cut out, and no viscus, once he had formed an impression it was exercising some indefinite malign influence on the patient, would remain for longer than a week
in
situ
.

Sir Lancelot represented a generation of colourful, energetic surgeons that, like fulminating cases of scarlet fever, are rarely seen in hospital wards today. He inherited the professional aggression of Liston, Paget, Percival Pott, and Moynihan, for he was trained in the days when the surgeon’s slickness was the only hope of the patient’s recovery, the days before complicated anaesthetics, penicillin, blood-transfusion, and the other paraphernalia of modern surgery had watered down the operator’s skill and threatened to submerge him completely.

Sir Lancelot had made a fortune, chiefly from the distressing complaints of old gentlemen, and was charging two hundred guineas for an appendicectomy while Aneurin Bevan was still thumping a local tub in Ebbw Vale. His real success started in the ’twenties, when he earned his knighthood by performing a small but essential operation on a cabinet minister that allowed him to take his seat in the House with greater ease. The minister was delighted, and recommended him in every drawing-room of importance in London. Just at that time Sir Lancelot got it into his head that rheumatism could be cured by the removal from the body of all organs not strictly necessary for the continuance of life. As most people over the age of fifty have rheumatism and it is impossible to make it much better or much worse with any form of treatment his practice increased tenfold overnight.

The rheumatism rage lasted long enough for him to buy a house in Harley Street, a country home on the Thames, a cottage in Sussex, a small sailing yacht, and a new Rolls, in which he was still wafted round between the four of them and the hospital. By then he was ready to operate on anything – he was, he told his dressers with pride, one of the last of the general surgeons. He claimed to be capable of removing a stomach or a pair of tonsils with equal success, or to be able to cut off a leg or a lung.

Every Tuesday and Thursday afternoon he operated in his own theatre on the top floor. The list for the session was pinned up outside like a music-hall bill – the best cases were always at the top for Sir Lancelot to operate on himself, and the programme degenerated into a string of such minor surgical chores as the repair of hernias and the removal of varicose veins, to be done by his assistants when he had gone off to his club for a glass of sherry before dinner.

On the first Tuesday after my appointment to the firm I walked up the stairs to the theatre – students were not allowed to use the hospital lift – and went into the dressers’ changing-room. A row of jackets and ties hung under a notice in letters three inches high: DO NOT LEAVE ANYTHING IN YOUR POCKETS. Everyone entering the theatre had to wear sterile clothing, which was packed away in three metal bins opened by foot pedals. Using a pair of long sterile forceps I took an oblong cap from one, a mask from another, and a rolled white gown from the third. Unfortunately there was no indication of the size of these coverings, and the gown fell round my feet like a bridal dress while the cap perched on my head like a cherry on a dish of ice-cream. I pushed open the theatre door and stepped inside reverently, like a tourist entering a cathedral. Standing by the door, my hands clasped tightly behind me, all I wanted was completely to escape notice. I felt that even my breathing, which sounded in my ears like the bellows of a church organ, would disturb the sterile, noiseless efficiency of the place. I was also a little uncertain of my reactions to cut flesh and wanted to keep as far away from the scene of activity as possible.

‘You, boy!’

Sir Lancelot’s head popped above the caps of his attendants. All I could see of him was a single brown, bushy strip that separated the top of his mask and the edge of his cap, through which there glared two unfriendly eyes like a hungry tiger inspecting a native through the undergrowth.

‘Come over here,’ he shouted. ‘How often have I got to tell you young fellers you can’t learn surgery from the door-post?’

The operating table was in the centre of the bare, tiled room, directly under the wide lamp that hung like a huge inverted saucer from the ceiling. It was completely invisible, as about twenty figures in white gowns were packed round it like tube passengers in the rush hour. These were mostly students. The operating team was made up of Sir Lancelot himself, who was a head higher than anyone else in the room; his theatre Sister, masked and with all her hair carefully tucked into a sterile white turban, standing on a little platform beside him; his senior houseman, Mr Stubbins, and his registrar, Mr Crate, assisting him from the opposite side; and his anaesthetist, sitting on a small metal piano stool beside a chromium-plated barrow of apparatus at the head of the table, reading the
Daily Telegraph
. On the outskirts of this scrum two nurses in sterile clothes dashed round anxiously, dishing out hot sterilized instruments from small metal bowls like waiters serving spaghetti. A theatre porter, also gowned and masked, leant reflectively on a sort of towel rail used for counting the swabs, and another strode in with a fresh cylinder of oxygen on his shoulder. The only indication that there was a patient present at all was a pair of feet in thick, coarse-knitted bed-socks that stuck pathetically from one end of the audience.

As soon as Sir Lancelot spoke the group round the table opened, as if he were Aladdin at the mouth of his cave. I walked unhappily into the centre. My companions closed tightly behind me, and I found myself wedged against the table opposite Sir Lancelot with a man who played in the second row of the hospital forwards immediately behind me. Escape was therefore out of the question, on physical as well as moral grounds.

The operation was on the point of starting. The patient was still invisible, as the body was covered with sterile towels except for a clean-shaved strip of lower abdomen on the right-hand side of which the operating light was focused diagnostically. I couldn’t even see if it was a young man or a woman.

Having forced me into a ringside seat, Sir Lancelot then appeared to dismiss me from his mind. He paused to adjust the cuff of the rubber glove that stretched over his bony hand. Stubbins and Crate were waiting with gauze dabs, and the theatre sister was threading needles with catgut as unconcernedly as if she was going to darn her stockings.

‘Stubbins,’ said Sir Lancelot chattily, making a three-inch incision over the appendix, ‘remind me to look into Fortnum’s on my way home, there’s a good lad. My missus’ll give me hell if I forget her dried ginger again. I suppose it was all right for me to start?’ he asked the anaesthetist.

The
Daily Telegraph
rustled slightly in assent.

I was surprised. Dried ginger in an operating theatre? Shopping lists disturbing the sanctity of surgery? And the
Daily Telegraph
?

‘I’ve got a damn funny story to tell you lads,’ went on Sir Lancelot affably, deepening his incision. ‘Make you all laugh. Happened to me last week. An old lady turned up in my rooms in Harley Street…Sister!’ he exclaimed in a tone of sudden annoyance, ‘do you expect me to operate with a jam-spreader? This knife’s a disgrace.’

He threw it on the floor. Without looking at him she handed him another.

‘That’s better,’ Sir Lancelot growled. Then, in his previous tone, as though he were two people making conversation, he went on: ‘Where was I? Oh yes, the old lady. Well, she said she’d come to see me on the advice of Lord – Lord Someoneorother, I can’t remember these damn titles – whom I’d operated on last year. She said she was convinced she’d got gallstones.

‘Now look here, Stubbins, can’t you and Crate keep out of each other’s way? Your job is to use that gauze swab sensibly, not wave it around like a Salvation Army banner. How the devil do you think I can operate properly if everything’s wallowing in blood? Why am I always cursed with assistants who have a couple of left hands? And I want a clip, Sister. Hurry up, woman, I can’t wait all night!’

Sir Lancelot had cut through the abdominal wall while he was talking, like a child impatient to see inside a Christmas parcel.

‘Well,’ he went on, all affability again, seemingly conducting the operation with the concentration of a gossipy woman knitting a pair of socks, ‘I said to this old lady, “Gallstones, eh? Now, my dear, what makes you think you’ve got gallstones?” And I’ve never seen anyone look so embarrassed in my life!’

He returned to the operation.

‘What’s this structure, gentlemen?’

A reply came from under a student’s mask on the edge of the crowd.

‘Quite correct, whoever you are,’ said Sir Lancelot, but without any congratulation in his voice. ‘Glad to see you fellers remember a little fundamental anatomy from your two years in the rooms…so I wondered what was up. After all, patients don’t get embarrassed over gallstones. It’s only piles and things like that, and even then it’s never the old ladies who are coy but the tough young men. Remember that bit of advice, gentlemen… Come on, Stubbins, wake up! You’re as useless as an udder on a bull.’

He produced the appendix from the wound like a bird pulling a worm from the ground, and laid it and the attached intestine on a little square of gauze.

‘Then the old lady said to me, “As a matter of fact, Sir Lancelot, I’ve been passing them all month…” Don’t lean on the patient, Stubbins! If I’m not tired you shouldn’t be, and I can give you forty or fifty years, my lad.

‘So now we come to the interesting part of the story. She showed me a little box, like those things you send out pieces of wedding cake in… Sister! What in the name of God are you threading your needles with? This isn’t catgut, it’s rope. What’s that, woman?’ He leant the red ear that stuck out below his cap towards her. ‘Speak up, don’t mutter to yourself. I’m not being rude, damn you! I’m never rude in the theatre. All right, tell your Matron, but give us a decent ligature. That’s more like it. Swab, man, swab. Stubbins, did I ever tell you about the Matron when she was a junior theatre nurse? She had a terrible crush on a fellow house-surgeon of mine – chap called Bungo Ross, used to drink like a fish and a devil for the women. Became a respected GP in Bognor or somewhere. Died last year. I wrote a damn good obituary for him in the
British Medical Journal
. I’m tying off the appendicular artery, gentlemen. See? What’s that, Stubbins? Oh, the old lady. Cherry stones.’

He tossed the appendix into a small enamel bowl held for him by Stubbins.

‘Looks a bit blue this end, George,’ he said in the direction of the anaesthetist. ‘All right, I suppose?’ The anaesthetist was at the time in the corner of the theatre talking earnestly to one of the nurses who had been serving out the instruments. Theatre kit is unfair to nurses; it makes them look like white bundles. But one could tell from the rough shape of this one, from the little black-stockinged ankles below her gown and the two wide eyes above her mask, that the parcel would be worth the unwrapping. The anaesthetist jumped back to his trolley and began to twiddle the knobs on it. Sister, who was already in a wild temper, injected the nurse with a glance like a syringeful of strychnine.

‘Forceps, Sister!’ bellowed Sir Lancelot. She handed him a pair which he looked at closely, snapping them together in front of his mask. For some reason they displeased him, so he threw them over the heads of the crowd at the opposite wall. This caused no surprise to anyone, and seemed to be one of his usual habits. She calmly handed him another pair.