DOCTOR IN THE HOUSE

by Richard Gordon

  DOCTOR IN THE HOUSE

  Richard Gordon

  Richard Gordon

  DOCTOR IN THE HOUSE

  First published in 1952

  'A parcel of lazy, idle fellars, that are always smoking and drinking, and lounging…a parcel of young cutters and carvers of live people's bodies, that disgraces the lodgings.' _Bob Sawyer's landlady in_ PICKWICK PAPERS

  To Jo

  Note

  St. Swithin's Hospital does not exist; neither do its staff, students, nor patients.

  1

  The large and completely unused set of surgical instruments that my father kept in his consulting-room held for the old gentleman the melancholy fascination of a hopefully gathered layette to an ageing childless wife. For twenty years he had not troubled to exercise the self-deception that he might one day come to use them. They lay in the slots of their metal trays, fitting in with each other like the pieces of a Chinese puzzle. There was a sharp-toothed circular trephine for boring holes in the skull; bone forceps like a pair of shiny pliers; a broad hacksaw for amputations; scissors with long, sharp blades; probes, trocars, and bistouries; and a row of scalpels as impotent as a line of ceremonial swords.

  The instruments were in a heavy black wooden box with his name in copperplate script on its tarnished metal label. He had stowed it away some years ago at the bottom of a tall cupboard in the corner, where it had become silted over with old medical journals, out-of-date diaries, and bright advertisements from the big drug firms that he had slung in there from time to time with the vague belief that he might want to refer to them one day. Occasionally, rummaging his way through the dusty papers, he would uncover the box and light up in himself a momentary glow of frustration: he had once been convinced he was going to be a great surgeon, and the instruments were an expensive gift from his admiring mother the day he qualified as a doctor.

  My grandparents were, unhappily, the only ones to share his confidence in his professional destination. The first step in becoming a surgeon of even mediocre ability is the acquisition of the Fellowship of the Royal College, an examination he sat regularly twice a year for six years before he faced up to the truth that his ability was not a powerful enough propellant for his ambition. His history after that was the not disagreeable one of a good many other unsuccessful young surgeons: he married and went into general practice, in the provinces.

  When he saw the brass plate being screwed on to his new doorpost he recognized it as the coffin-lid of his surgical aspirations. For a few months he was bitter at his abandonment of specialization, but his resentment was rapidly smoothed down by the heavy planes of domesticity, busy practice, and the momentous trivia of provincial social life. He became a prosperous, and even fairly efficient, general practitioner, and reflected on his dead ambitions only when he came across his case of instruments or thought seriously about the education of his son.

  Like most doctors' children, I had from my earliest schooldays come to look upon a medical qualification like a hereditary title. Graduation seemed a future occurrence over which I had no control; indeed, neither my parents nor myself contemplated my earning a living by any other means. My father sometimes wondered timidly if I might fulfil his own surgical hopes, but experience had made him guarded in predicting his son's postgraduate attainments. I had certainly not demonstrated in adolescence any aptitude for my already settled career. Up to the age of six I had a habit of pulling to pieces birds and small mammals ingeniously trapped in the garden, and this was thought by my parents indicative of a natural inclination towards the biological sciences. The practice of medicine was to me no more than a succession of mysterious people coming twice a day through the front door, and the faint tang of antiseptic which had been in my nostrils as long as I could remember, like the scent of the sea to a fisherman's son.

  Once my father stood me up on his leather examination couch, on which the most respected bodies in the district had lain in their forbidding nakedness, and showed me the framed photograph that hung above it. It was the rugby team at his old hospital, the year he had managed to scrape into the side owing to a fortunate attack of diphtheria in the regular wing threequarter.

  'Which one's you, daddy?' I asked, running my forefinger along the double row of solemn young men in shorts.

  He indicated a thin fellow at the end of the back row.

  'Good old St. Swithin's!' he muttered sadly. 'You'll be there one day, my lad. And mind you get in the first fifteen like your father did.'

  His love for his old hospital, like one's affection for the youthful homestead, increased steadily with the length of time he had been shot of it. As a medical student, he had felt a surge of allegiance to the place only for an hour or so a week on the football field; now it represented a glowing period in his life when he was single, irresponsible, and bouncing with ambition. I grew into the impression that St. Swithin's combined the medical efficiency of the Mayo Clinic with the teaching of Hippocrates and the recreational facilities of the Wembley Stadium. For most of my schooldays the place was an ill-defined but agreeable and definite destination, like Heaven, and it was not until I found myself on the point of going there that I troubled to crystallize my thoughts about it.

  St. Swithin's was, in fact, an undistinguished general hospital which spread its grey, insanitary-looking walls across a grimy section of North London. It was not even one of the oldest hospitals in the Metropolis, and as age is esteemed in England as the first of the virtues, this alone imbued the staff and students with a faint sense of inferiority. St. Swithin's did not possess the proud antiquity of St. Bartholomew's, which for several centuries looked on to the crisp green of Smithfield and the sweet waters of the Fleet tumbling unconfinedly into the Thames; nor was it as ancient as St. Thomas's over the River, which was already old when Shakespeare came to the Globe. Its origins were obscure, but there was a tradition that it was founded to deal with the outbreak of syphilis that rolled over Europe after the discovery of America, whence it had been imported by Columbus's sailors (so setting a persistent maritime habit). St. Swithin's had, however, been in existence sufficiently long for Londoners to accept it as one of the settled institutions of their city that seemed completely reliable, like Westminster Bridge or St. Paul's. It now attended only to the pale inhabitants of the streets crammed against its walls, to whom it had been for three or four generations simply 'The Hospital,' a place you went into and either got better or died according to your luck.

  I had not seen St. Swithin's until the morning I was interviewed by the Dean of the Medical School. The Dean had replied to my father's explanatory letter with the assurance that the school was always glad to see the sons of former Swithin's men, but he added that he was nevertheless obliged by the Governors to inspect each candidate and allot places solely on the strength of the aptitude they showed for the practice of medicine. As the course of study was fixed by law for a time not less than six years, this struck me as a task comparable in difficulty with determining the sex of day-old chicks. For a week I was coached earnestly by my father on every question the Dean could possibly ask; then I put on my best suit and went up to London.

  St. Swithin's was heavily disappointing. It was like the time I was taken to the Zoo to see my first elephant: it was distinctive enough, but not nearly so large, clean, and dignified as I had imagined.

  I walked gingerly inside the forecourt, which was separated from the main road by a long line of heavy iron railings and a gatehouse. The court contained a few plane trees and a patch of pale grass in the centre, and a pair of large black statues representing St. Swithin's most renowned sons. On the right of the gate as you went in was Lord Larrymore, the famous Victorian physician who maintained for some years that he had almost di
scovered the cause of tuberculosis but was cruelly forestalled by Robert Koch in Germany. On the left you saw Sir Benjamin Bone, Larrymore's celebrated surgical contemporary, who was nearly appointed to the Queen's household but was dropped at the last minute because Her Majesty objected to the expensive, but distracting, aroma of cigars and brandy exuded all day from his person.

  When St. Swithin's began to find its feet as a teaching hospital at the beginning of the century the staff were as aware of their lack of presentable antecedents as a newly rich family. These two gentlemen had therefore undergone a process of medical canonization and were invested with professional abilities and intellectual qualities certainly not indicated by their true histories. Shortly after they had been elected to the staff a quarrel broke out between them, and for thirty years afterwards they refused to speak to each other. Communication was necessary on professional matters, and this was conducted by short notes in the third person carried from one to the other by a hospital porter specially employed for the purpose. In the later part of his life Sir Benjamin refused to utter the name of his colleague at all, and gave no indication that he was conscious of the other's existence until he saw one New Year's Day that Larrymore had been given a barony and immediately died of apoplexy.

  The two doctors now stared in placid, set annoyance at each other across the court, and were disturbed only by an occasional painting-up from the students and the indiscriminate droppings of the London pigeons. What they originally quarrelled about had long ago been forgotten, but it was probably too trivial to be of interest.

  My attention wandered from replicas of St. Swithin's staff to their living counterparts. The personnel of the hospital seemed to be in a state of constant transition across the courtyard. The consultant physicians and surgeons could easily be picked out, for they always moved from one spot to another in public as if they were in a desperate hurry. This gave the impression that their services were urgently needed in many places at once, and was good for their professional reputations. The junior practitioners had quickly picked up the habit from their superiors. The housemen strode importantly across the courtyard, their' short white coats flying behind them, their stethoscopes trailing from their necks, wearing the look of grave preoccupation seen only in the faces of very fresh doctors. This drab, hurrying band of physicians was sprinkled with nurses in long mauve dresses and starched white caps that turned up at the back like the tails of white doves. They tripped smartly from one block to another and to the Nurses' Home in the rear. Of the people in the court they were the only ones genuinely in a hurry, for they had so little time to themselves they devoured their lives with a perpetual rush to get on and go off duty.

  The bulk of the pedestrians in the courtyard was made up of almost equally important-looking and hasty people whom I was unable to identify. Apart from the doctors and nurses, a hospital has to employ men and women from a good many other occupations to run it. There must be chefs to prepare the food and dieticians to tell them what to cook; girls to work the X-ray machines and wardmaids to scrub the floors; physiotherapists to prevent the patients' muscles melting away in bed, and occupational therapists to stop their minds being similarly affected by showing them how to make mats, rugs, stuffed horses, and other unexciting articles while they are imprisoned in the wards. There must be liftmen and laundrymaids, porters and padres, stokers and statisticians; and as all these people must be paid and controlled there has to be a large number of clerks, typists, and secretaries to do so. The staff at St. Swithin's had come to outnumber the patients by four to one and now seemed to be expanding naturally, like a water-lily covering a small pond.

  There were patients, too, in the courtyard. A couple of them lay on each side of the statues in their beds, tucked up firmly in red blankets and sucking convalescence from the dirty London air. A few more hobbled about on their sticks, tossed helplessly in the strong cross-currents of hospital activity; one or two fortunate ones had found quiet alcoves and stayed there, like trout backing under the bank of a rocky stream. And, as I watched, there passed through the whole lot a cheery-looking man jauntily propelling a six-foot barrow with a stiff canvas cover towards a small door in one corner labelled 'Mortuary.'

  I asked for the office of the Dean, Dr. Lionel Loftus, F.R.C.P. A porter showed me into a small bare waiting-room decorated only by framed black-and-white pictures of past deans, which ran along the walls like a row of dirty tiles. As there were no chairs I sat on the edge of the dark polished table and swung my legs. The surroundings, and a week of my father's coaching, had made me depressed and nervous. My mind was filled with the awkward questions that Dr. Loftus was even then contemplating asking me, and I found to my surprise I could give no satisfactory replies to any of them. I wondered what I should say if he simply asked me why I wanted to be a doctor. The answer was, I suppose, that neither my parents nor myself had the originality to think of anything else, but this didn't seem a suggestion likely to help me into the medical school.

  This disheartening introspection was interrupted by the waiting-room door opening. An old man stood on the threshold, looking at me silently. He wore a heavy black jacket buttoned high in the chest, narrow trousers, and a two-inch collar. In his hand he held a pair of gold-rimmed pince-nez, which were attached to his right lapel by a thick black silk ribbon. He was so thin, so old, so pale, and so slow he could have taken his place in the nearby post-mortem room without attracting attention.

  He clipped his glasses on to his nose with a slow, shaky movement and inspected me more carefully. I leapt to my feet and faced him.

  'Gordon?' croaked the old man from the doorway. 'Mr. Richard Gordon?'

  'Yes, sir. That is correct, sir,' I replied with great respect.

  'So you have come for entrance to St. Swithin's?' the old man asked slowly.

  'Yes, sir, I have.'

  He nodded, but without enthusiasm.

  'Your father is a Swithin's man, I believe?'

  'Oh yes, sir.'

  'I am not the Dean,' he explained. 'I am the medical school Secretary. I was Secretary here long before you were born, my boy. Before your father, probably. I remember well enough when the Dean himself came up to be admitted.' He removed his glasses and pointed them at me. 'I've seen thousands of students pass through the school. Some of 'em have turned out good, and some of 'em bad-it's just like your own children.'

  I nodded heartily, as I was anxious to please everyone.

  'Now, young feller,' he went on more briskly, 'I've got some questions to ask you.'

  I folded my hands submissively and braced myself mentally.

  'Have you been to a public school?' he asked.

  'Yes.'

  'Do you play rugby football or association?'

  'Rugby.'

  'Do you think you can afford to pay the fees?'

  'Yes.'

  He grunted, and without a word withdrew. Left alone, I diverted my apprehensive mind by running my eye carefully over the line of black-and-white deans studying each one in turn. After ten minutes or so the old man returned and led me in to see the living holder of the office.

  Dr. Loftus was a short, fat, genial man with wispy white hair like pulled-out cotton wool. He was sitting at an old-fashioned roll-topped desk that was stacked untidily with folders, copies of medical journals, letters, and reference books. On top of these he had thrown a Homburg hat, a pair of yellow gloves, and his stethoscope. He was obviously in a hurry.

  'Sorry to keep you waiting, old man,' he said cheerily, 'I was held up at a post-mortem. Have a seat.'

  I sat down on a hard leather chair beside the desk.

  'Now,' the Dean began. 'Have you been to a public school?'

  'Yes.'

  'Your people can afford the fees and that sort of thing?'

  'I believe so.'

  'You play rugby, I suppose?'

  'Yes, sir.'

  The Dean began to look interested.

  'What position?' he asked.

  'Wing three-
quarter.'

  He drew a pad of paper towards him and pencilled fifteen dots on it in rugby formation.

  'Threequarter…' he murmured to himself. 'How old are you?' he asked sharply.

  'Almost eighteen, sir.'

  'Umm. First fifteen at school?'

  'Oh yes, sir.'

  The Dean traced lines through his dots, crossed other out, and rustled through a sheaf of typewritten papers beside him. He jerked back in his chair and inspected me closely all over.

  'You're rather thin, aren't you,' he announced. 'I suppose you've got the speed?'

  'I've got cups for the hundred,' I told him eagerly.

  'Well, you may shape well. Lucky you're a three. The hospital's full of forwards,' he added in disgust.

  He frowned at his paper pad for a few seconds. His face suddenly lightened, and I saw he had come to a decision: my hands gripped the arms of the chair as I waited to receive it. Rising, he shook me briskly by the hand and told me he had pleasure in admitting me to St. Swithin's.

  I wondered for some time afterwards how he had been able to discover from these questions that I had the attributes of a successful doctor, but I later found out that even this brief interview was superfluous, as the Dean always took the advice of his old secretary and told applicants this man disliked the look of that there were no vacancies.

  2

  The medical school of St. Swithin's hospital was an offshoot of the main buildings and had its own entrance on the main road. It was a tall, gloomy structure that held three floors of laboratories, an anatomical dissection room, a lecture theatre that was clothed in perpetual dusk, and the smelliest lavatories in the district.

  The school had been built by the richest brewer in London, who was happily knocked over by a hansom outside the hospital gates one slippery winter's morning in 1875. He was restored to health and normal locomotion in the wards, and to show his gratitude he purchased his peerage the following year by founding the school. The place was now far too old, dark, and small for the requirements of the students, but as the hospital could see little prospect of the accident being repeated it was impossible to tear it down.