DOCTOR IN THE HOUSE

by Richard Gordon

  I walked down the stairs feeling as if I had just finished an eight-round fight. I reached desperately for my packet of cigarettes. The other candidates jostled round, chattering like children just out of school. In the square outside the first person I recognized was Grimsdyke.

  'How did you get on?' I asked.

  'So-so,' he replied. 'However, I am not worried. They never read the papers, anyway. I'm perfectly certain of that. Haven't you heard how they mark the tripos at Cambridge, my dear old boy? The night before the results come out the old don totters back from hall and chucks the lot down his staircase. The ones that stick on the top flight are given firsts, most of them end up on the landing and get seconds, thirds go to the lower flight, and any reaching the ground floor are failed. This system has been working admirably for years without arousing any comment. I heard all about it from a senior wrangler.'

  Benskin's broad figure appeared among the crowd in the doorway. He was grinning widely and waved cheerily at us.

  'You look pretty pleased with yourself,' I said.

  'I am, old boy. To-day I tried out Benskin's infallible system for passing exams, and it worked beautifully. What number are you?'

  'Three hundred and six.'

  'I'm a hundred and ten. All I had to do was walk into the room labelled "Two to Three Hundred," wander round a bit while people got settled, and tell the invigilator chap they hadn't given me a place. He apologized at first, then he looked at my card and turfed me out pretty sharply to find the right room. I was pretty humble, of course, and murmured a lot of stuff about my nerves-however, in my wandering round the desks I'd taken damn good care to read all the questions. Now, if you look up the regulations you'll see candidates are admitted up to twenty minutes after the start of the examination, so I had plenty of time to dodge down to the lavatory and look it all up before presenting myself, breathless and distraught, at the correct room. Pretty smart, eh?'

  'I hope they can't read your writing,' I said bitterly.

  ***

  The oral examination was held a week after the papers. I got a white card, like an invitation to a cocktail party, requesting my presence at the examination building by eleven-thirty. I got up late, shaved with a new blade, and carefully brushed my suit. Should I wear a hospital tie? It was a tricky point. Examiners were well known for harbouring an allergy towards certain hospitals, and although my neckwear might convince them I was not from St. Mary's, for instance, or Guy's, my interrogators were quite as likely to be opposed to men from St. Swithin's.

  I put on a quiet nondescript tie and a white stiff collar. The dressing-up was important, for the candidate was expected to look like a doctor even if he gave no indication of ever becoming one; one fellow who had once unhappily appeared in his usual outfit of sports coat and flannels was turned over to a porter by the outraged examiner with instructions to 'Show this gentleman to the nearest golf-course.'

  It is the physical contact with the examiners that makes oral examinations so unpopular with the students. The written answers have a certain remoteness about them, and mistakes and omissions, like those of life, can be made without the threat of immediate punishment. But the viva is judgment day. A false answer, an inadequate account of oneself, and the god's brow threatens like an imminent thunderstorm. If the candidate loses his nerve in front of this terrible displeasure he is finished: confusion breeds confusion and he will come to the end of his interrogation struggling like a cow in a bog. This sort of mental attitude had already led to the disgrace of Harris, who had been reduced to a state just short of speechlessness by a terrible succession of _faux pas._ The examiner finally decided to try the poor fellow with something simple and handed him a breast-bone that had been partly worn away with the life-long pressure of an enlarged artery underneath. 'Now, my boy,' said the examiner. 'What do you think caused that hollow?' All he wanted for a reply was the single word 'Pressure,' but Harris looked at the specimen in blank silence. With a sigh, the kindly examiner removed his pince-nez and indicated the two indentations they left on each side of his nose. 'Well,' he continued helpfully, 'what do you think caused that?' Something clicked in Harris's panicky brain. The depressed nasal bridge…a picture flashed up that he had seen so often in the opening pages of his surgery book. 'Congenital syphilis, sir,' he replied without hesitation.

  I was shown to a tiny waiting-room furnished with hard chairs, a wooden table, and windows that wouldn't open, like the condemned cell. There were six candidates from other hospitals waiting to go in with me, all of them in their best clothes. They illustrated the types fairly commonly seen in viva waiting-rooms. There was the Nonchalant, lolling back on the rear legs of his chair with his feet on the table, showing the bright yellow socks under his blue trouser-legs. He was reading the sporting page of the Express with undeceptive thoroughness. Next to him, a man of the Frankly Worried class sat on the edge of his chair tearing little bits off his invitation card and jumping irritatingly every time the door opened. There was the Crammer, fondling the pages of his battered text-book in a desperate farewell embrace, and his opposite, the Old Stager, who treated the whole thing with the familiarity of a photographer at a wedding. He had obviously failed the examination so often he looked upon the viva simply as another engagement to be fitted into his day. He stood looking out of the window and yawning, only cheering up when he saw the porter, with whom he was now on the same warm terms as an undergraduate and his college servant.

  'How are you getting on this time, sir?' the porter asked him cheerily.

  'Not so dusty, William, not so dusty at all. The second question in the paper was the same one they asked four years ago. What are they like in there?'

  'Pretty mild, this morning, sir. I'm just taking them their coffee.'

  'Excellent! Put plenty of sugar in it. A low bloodsugar is conducive to bad temper.'

  'I will, sir. Best of luck.'

  'Thank you, William.'

  The other occupant of the room was a woman. A trim little piece, I noticed, probably from the Royal Free. She sat pertly on her chair with her hands folded on her lap. Women students-the attractive ones, not those who are feminine only through inescapable anatomical arrangements-are under a disadvantage in oral examinations. The male examiners are so afraid of being prejudiced favourably by their sex they usually adopt towards them an undeserved sternness. But this girl had given care to her preparations for the examination. Her suit was neat but not smart; her hair tidy but not striking; she wore enough make-up to look attractive, and she was obviously practising, with some effort, a look of admiring submission to the male sex. I felt sure she would get through.

  I sat alone in the corner and fingered my tie. They always made the candidates arrive too early, and the coffee would delay them further. There was nothing to do except wait patiently and think about something well removed from the unpleasant quarter of an hour ahead, such as rugby or the lady student's legs. Suddenly the door was flung open and a wild-eyed youth strode in.

  'It's not too bad!' he exclaimed breathlessly to the nonchalant fellow. The two apparently came from the same hospital.

  'I had Sir Rollo Doggert and Stanley Smith,' he said with a touch of pride. This brought a nod of appreciation from all of us, as they were known as two of the toughest examiners in London.

  'Doggert started off by asking me the signs and symptoms of pink disease,' he continued. 'Luckily I knew that as I had happened to look it up last night…'

  'Pink disease!' cried the worried man. 'My God, I forgot about that!'

  'So I saw at once the way to handle him was to talk man-to-man, you know-none of this servile business, he much prefers to be stood up to. I reeled off pink disease and he said very good, my lad, very good.'

  'Did he ask you anything else?' his friend said anxiously.

  'Oh yes. He said, supposing I was out golfing with a diabetic who collapsed at the third tee, what would I do? Well, I said…'

  The visitor gave a description of this examination in
detail, like the man who comes out of the dentist's surgery and insists on telling the occupants of the waiting-room his experiences on the excuse that none of the frightful things that can happen really hurt.

  The raconteur was stopped short by the porter. He marshalled us into line outside the heavy door of the examination room. There was a faint ting of a bell inside. The door opened and he admitted us one at a time, directing each to a different table.

  16

  You go to table four,' the porter told me.

  The room was the one we had written the papers in, but it was now empty except for a double row of baize-covered tables separated by screens. At each of these sat two examiners and a student who carried on a low earnest conversation with them, like a confessional.

  I stood before table four. I didn't recognize the examiners. One was a burly, elderly man like a retired prize-fighter who smoked a pipe and was writing busily with a pencil in a notebook; the other was invisible, as he was occupied in reading the morning's Times._

  'Good morning, sir,' I said.

  Neither of them took any notice. After a minute the burly fellow looked up from his writing and silently indicated the chair in front of him. I sat down. He growled.

  'I beg your pardon, sir?' I said politely.

  'I said you're number 306?' he said testily. 'That's correct, I suppose?'

  'Yes, sir.'

  'Well, why didn't you say so? How would you treat a case of tetanus?'

  My heart leapt hopefully. This was something I knew, as there had recently been a case in St. Swithin's.

  I started off confidently, reeling out the lines of treatment and feeling much better.

  The examiner suddenly cut me short.

  'All right, all right,' he said impatiently, 'you seem to know that. A girl of twenty comes to you complaining of gaining weight. What do you do?'

  This was the sort of question I disliked. There were so many things one could do my thoughts jostled into each other like a rugger scrum and became confused and unidentifiable.

  I-I would ask if she was pregnant,' I said.

  'Good God, man! Do you go about asking all the girls you know if they're pregnant? What hospital d'you come from?'

  'St. Swithin's, sir,' I said, as though admitting an illegitimate parentage.

  'I should have thought so! Now try again.'

  I rallied my thoughts and stumbled through the answer. The examiner sat looking past me at the opposite wall, acknowledging my presence only by grunting at intervals.

  The bell rang and I moved into the adjoining chair, facing _The Times._ The newspaper rustled and was set down, revealing a mild, youngish-looking man in large spectacles with a perpetual look of faint surprise on his face. He looked at me as if he was surprised to see me there, and every answer I made was received with the same expression. I found this most disheartening.

  The examiner pushed across the green baize a small sealed glass pot from a pathology museum, in which a piece of meat like the remains of a Sunday joint floated in spirit.

  'What's that?' he asked.

  I picked up the bottle and examined it carefully. By now I knew the technique for pathological specimens of this kind. The first thing to do was turn them upside down, as their identity was often to be found on a label on the bottom. If one was still flummoxed one might sneeze or let it drop from nervous fingers to smash on the floor.

  I upturned it and was disappointed to find the label had prudently been removed. Unfortunately there was so much sediment in the jar that it behaved like one of those little globes containing an Eiffel Tower that on reversal cover the model with a thick snowstorm. I could therefore not even see the specimen when I turned it back again.

  'Liver,' I tried.

  'What!' exclaimed the surprised man. The other examiner, who had returned to his writing, slammed down his pencil in disgust and glared at me.

  'I mean lung,' I corrected.

  'That's better. What's wrong with it?'

  I could get no help from the specimen, which was still tossing in swirling white particles, so I took another guess.

  'Pneumonia. Stage of white hepatization.'

  The surprised man nodded. 'How do you test diphtheria serum?' he demanded.

  'You inject it into a guinea-pig, sir.'

  'Yes, but you've got to have an animal of a standard weight, haven't you?'

  'Oh yes…a hundred kilogrammes.'

  The two men collapsed into roars of laughter.

  'It would be as big as a policeman, you fool!' shouted the first examiner.

  'Oh, I'm so sorry,' I stammered miserably. 'I mean a hundred milligrammes.'

  The laughter was renewed. Ors or two of the examiners at nearby tables looked up with interest. The other candidates felt like prisoners in the condemned block when they hear the bolt go in the execution shed.

  'You could hardly see it then, boy,' said the surprised man, wiping his eyes. 'The creature weighs a hundred grammes. However, we will leave the subject. How would you treat a case of simple sore throat?'

  'I would give a course of sulphonamide, sir.'

  'Yes, that's right.'

  'I disagree with you, Charles,' the other interrupted forcibly. 'It's like taking a hammer at a nut. I have an excellent gargle I have been prescribing for years which does very well.'

  'Oh, I don't know,' said the surprised fellow warmly. 'One must make use of these drugs. I've always had excellent results with sulphonamides.'

  'Did you read that paper by McHugh in the _Clinical Record_ last winter?' demanded the first examiner, banging the table again.

  'Certainly I read it, George. And the correspondence which followed. Nevertheless, I feel it is still open to doubt-'

  'I really cannot agree with you-'

  They continued arguing briskly, and were still doing so when a second tinkle of the bell allowed me to slide out and rush miserably into the street.

  ***

  The days after the viva were black ones. It was like having a severe accident. For the first few hours I was numbed, unable to realize what had hit me. Then I began to wonder if I would ever make a recovery and win through. One or two of my friends heartened me by describing equally depressing experiences that had overtaken them previously and still allowed them to pass. I began to hope. Little shreds of success collected together and weaved themselves into a triumphal garland. After all, I thought, I got the bottle right, and I knew about tetanus…then I forgot about it in my anxiety over the last section of the examination, the clinical.

  The clinical is probably the most chancy of the three parts. The student may be allotted a straightforward case with sounds in the chest that come through his stethoscope like the noise of an iron foundry; or he may get something devilish tricky.

  The cases for clinical examinations were collected from the out-patient departments of hospitals all over London, and were in the class referred to by physicians informally as 'old chronics.' They have their lesions healed as far as possible; now they walked round in fairly good health but with a collection of clicks, whistles, or rumbles inside them set up by the irreversible process of their diseases. These are just the sort of things examiners like presenting to students. A case of vague ill-health or an indefinite lump are too arguable, but a good hearty slapping in the chest gives a right to fail a man forthrightly if he misses it.

  For this service the patients were given seven-and-six and free tea and buns. But most of them would happily have performed with a strictly amateur status and provided their own sandwiches. The six-monthly visits to the examination were their principal outings of the year. They attended their own hospitals monthly to show off the signs they proudly possessed to a single doctor and discuss their ailment with fellow-patients on the benches outside, but in the exam they were inspected by hundreds of doctors-or as good as-and chatted to the йlite of fellow sufferers. It is much the same as winning an international rugby cap.

  I arrived at the examination building in plenty of time
, to find out what I could of the cases from men who had already been examined. I knew Benskin had been in early and looked for him in the hall to ask what there was upstairs.

  'There's an asthma in a red scarf, old boy,' he said helpfully. 'And an old man with emphysema just behind the door as you go in-if you get him be sure to examine his abdomen, he's got a couple of hernias thrown in.'

  I made a mental note of it.

  'Then there's a little girl with a patent ductus-you can't miss her, she's the only child in the room. Oh, and a woman with burnt-out tabes. He'll ask you what treatment you'd give her, and he expects the answer "None".'

  I nodded, thanked him, and made my way to the examination room.

  My first impression of the clinical examination was of a doctor's surgery gone into mass-production. Patients were scattered across the room on couches, beds, and wheel-chairs, the men divided from the women by screens across the centre. They were in all stages of undress and examination. Circulating busily between them were a dozen or so nurses, examiners in white coats, and unhappy students dangling their stethoscopes behind them like the tails of whipped puppies.

  I was directed to a pleasant, tubby little examiner.

  'Hello, my lad,' he began genially. 'Where are you from? Swithin's, eh? When are you chaps going to win the rugger cup? Go and amuse yourself with that nice young lady in the corner and I'll be back in twenty minutes.'

  She was indeed a nice young lady. A redhead with a figure out of Esquire._

  'Good morning,' I said with a professional smile. 'Good morning,' she returned brightly.

  'Would you mind telling me your name?' I asked politely.

  'Certainly. Molly Ditton, I'm unmarried, aged twenty-two, and my work is shorthand-typing, which I have been doing for four years. I live in Ilford and have never been abroad.'

  My heart glowed: she knew the form.

  'How long have you been coming up here?' I asked. 'You seem to know all the answers.'