I soon felt I was doing well. I fumbled an answer about the course of the appendicular artery, and I made a slight error over the muscular structure of the intestinal wall, but if my own critical standards equalled those of the Royal College of Surgeons I thought that this time I should be through.
“You are familiar with Poupart’s ligament?” asked the Professor, as we got on to hernias.
“Of course, sir.”
“Ah! But where is Poupart’s junction?”
For a second I felt panic. This was an anatomical feature I’d never heard of.
“It’s the next station to Clapham Junction,” he said with a chuckle. “Truly, Doctor. Have a look at the signal box the next time you go to Brighton. And which hospital do you come from, Doctor?” He leaned back in his chair, looking at me benignly.
“St Swithin’s, sir,” I said, smiling back.
“Of course, you know how to tell the difference between a Guy’s man and a St Swithin’s man, don’t you, Doctor?”
“No, sir?” I realized with added excitement that the oral period must be almost over; at last I seemed to have got a toe on the surgical ladder.
“They say a Guy’s man always examines his patients with a hand in his pocket,” the Professor continued, laughing.
I laughed, too.
“And they say a St Swithin’s man always examines his patients with both hands in his pockets,” he went on, laughing heartily.
I threw back my head and roared.
A bell tinkled in the distance. “By the way,” said the Professor. “What’s the dose of morphine?”
7
“It was a pity about your Primary,” said Dr Farquarson.
We were sitting together in his consulting-room, which like those of all best British doctors had the air of a Victorian gentleman’s study and exhibited nothing much more clinical than a bust of Edward Jenner. I had just arrived at Hampden Cross, a pleasant place on the edge of London’s saucer, which had once flourished as the last stop for stage coaches but had long ago been overtaken by their destination. Away from the new by-pass it had the cheerfully inconvenient air of any other busy little English town, with the pedestrians and the traffic struggling for possession of the High Street. But there was fortunately an area of quiet grass and gardens near the Abbey, where Dr Farquarson’s surgery was contained in a narrow Georgian house. I was relieved to find such agreeable surroundings, as I was likely to spend the rest of my life in them.
“All these higher examinations are a bit of a gamble, I’d say, if that’s any consolation,” Dr Farquarson went on. “I remember when I took the Edinburgh Membership the clinical hinged on whether you could just feel the tip of the patient’s spleen or not. Even the examiners disagreed over it. One failed all the candidates who said they could, and the other failed all the ones who said they couldn’t. I happened to be in the unlucky bunch.” He scraped out his pipe with the old scalpel he kept on his desk for the purpose. “Still, it’s better to have studied and lost than never to have learnt anything at all. There’s a lot to be said for the old Indian habit of putting ‘FRCS (Failed)’ after your name. And now I suppose you’re waiting for me to give you weighty advice on the ways and means of general practice?”
I looked at him expectantly. I was now reconciled to making my career as a GP rather than a consultant surgeon, and I was determined to be a good one. The modern doctor unfortunately comes from his medical school with haughty views on general practice. For six years he is taught by specialists, who maintain at hospital lectures and hospital dinners that the GP is the backbone of British medicine, but never hesitate to dissect the backbone whenever given the chance. The residents of both Harley Street and the house surgeons’ quarters are understandably tempted to show their superiority over cases sent single-handed into hospital with the wrong diagnosis, and we thus came to look upon our teachers as infallible and general practice, like the Church, as fit only for the fools of the medical family.
“Looking back over my long years of experience,” Dr Farquarson went on, “I would say… What would I say? That I can’t think of anything in the slightest way useful to a young man with reasonably active intelligence. You’ll know most of the ropes from your father. Patients are much the same all the world over, whether you see ‘em being ill at the Government’s expense in hospital or being ill in their bedrooms at their own.”
“I hope you’ll be forbearing for my first few weeks,” I said.
“That’s when you’ll get most of your work, of course. They’ll all want to have a look at you. Even now they’re gossiping over their teacups wondering what you’re like.” He stretched his long thin legs under the desk. “I’m converting the little room next door as a surgery for you. I’m sorry I can’t put you up in the house,” he apologized. “My flat upstairs is hardly big enough for all the junk I’ve accumulated over the years. And anyway you wouldn’t want to room with such a senile specimen as me, would you? The other flat is of course occupied by our estimable Miss Wildewinde.” This was the receptionist who had admitted me, a middle-aged woman of the type seen so often in England in charge of dogs, horses, or other people’s children. “Miss Wildewinde is a lady of intimidating efficiency, as you will shortly find out. She also dwells lengthily on McBurney’s professional and personal attributes, which occasionally makes life like marriage to an over-fresh widow. Anyway, living away from the shop means you’ll escape a lot of night calls. And this Crypt Hotel place will probably look after you all right.”
My illusions about general practice were lost within a week. My first discovery was that diseases affecting the population of Hampden Cross seemed to have no connexion with the ones we were taught in St Swithin’s. Many of my patients suffered from easily identifiable troubles of those overstrained systems The Tubes, The Nerves and The Wind, but many others seemed only to exemplify mankind’s fruitless struggle against Nature. There were old women who complained of being too fat and young women who complained of being too thin, people who found they couldn’t sleep and people who found they couldn’t stay awake, girls who wanted less hair on their legs and men who wanted more on their heads, couples anxious for children who couldn’t have any and couples who had too many and didn’t know how to stop. The rest simply wanted a certificate. I signed several dozen every day, entitling the holders to anything from more milk to less work, and from getting the youngest off an afternoon’s school to getting the eldest off his National Service.
“The poor doctor’s signature,” observed Dr Farquarson when I mentioned this to him, “is the Open Sesame to the Welfare State. Folk can’t exist these days in a civilized community without it. Did you know there’s a dozen separate Acts of Parliament that call for it? I’ve counted ‘em myself.”
“Well, I hope I’m not doing down the national Exchequer,” I said anxiously. I knew the penalties for careless certification from a chilly little notice issued by the General Medical Council. Mistakenly entitling an applicant for a bottle of orange juice to a free pair of surgical boots might land me in the local Assizes. “I also seem to be prescribing about twice as many bottles of medicine as are therapeutically necessary.”
“Don’t worry, lad. A citizen’s bodily contentment for half a pint of coloured water is cheap at the price for any Government. Anyway, once the public’s got the idea in their heads that something does them good you’ll never get it out – whether it’s medicine, milk drinks, or meat extracts, which as you know consist of eighty per cent flavouring with no food value whatever and twenty per cent salt to save them from the putrefaction they so richly deserve.”
Dr Farquarson started filling his insanitary-looking pipe.
“The trouble with this generation is that its environment’s outstripping its intelligence. Look at the village idiot – a hundred years ago he sat contentedly on his bench outside the village inn. Someone occasionally gave him a little beer, and someone occasionally gave him a little hoeing. He never got in his own way or anyone else’s. Bu
t what happens today? He’s got to cope with pedestrian crossings, income-tax, football pools, national insurance, welfare workers, and God knows what. As he can’t, he either plagues his doctor as a neurotic or they put him inside. Another fifty years and anyone without a working knowledge of nuclear physics will be certified as mentally defective. Oh, it’ll be a happy day when there’s more of us inside than out. But at the moment the job of general practice is separating the idiots from the ill.”
“I hope I’ve done so today,” I told him, noticing his eyebrows quivering. “I think I spotted an early tubercule and an early schizophrenia. I packed them off with notes to the appropriate hospitals.”
“You were right, of course. The tuberculous one would sooner or later infect the family, and the mad one would sooner or later smash up the china. Though I try to keep people out of hospitals as long as possible, myself. They’re abnormal institutions. It’s often better for both sides if patients are nursed by their own relatives. A man ought to be given a chance to be born at home, and he certainly ought to have a chance to die there. The family gathers round, you know, and it’s only right he should feel the event is something of an occasion.”
“Sterility…” I murmured.
“Ah, sterility! In the old days there were plenty of prostatic old gentlemen going about with their catheters tucked in their hat-brims. If you’re going to be infected, it might as well be your own bugs. In hospital you’ll get someone else’s, and penicillin-resistant ones they’ll be, too. Still, I’m boring you. Remarkable how senility makes a man ramble, isn’t it?”
I thought practice with Dr Farquarson looked like being stimulating.
My enthusiasm for my new life was dimmed only by crossing the peeling portals of the Crypt Hotel. The hotel stood on the other side of the Abbey, and was a typical English boarding-house of the type I had slept in so many nights since first becoming a medical student. There were yellowing net curtains sagging across the front windows, an austere card askew in the transom announcing VACANCIES, a hall containing chessboard lino worn red down the middle, and a picture of shaggy cattle standing uncomfortably with their feet in a Highland pool. There were notices desiring punctuality over meals and settling accounts, and a landlady whose manner suggested that she was summing up the chances of your murdering the lot of them in their beds. But the place had seemed clean enough and the customary smell of cooking rising up the staircase smelt savoury, so I had decided to stay.
I had been given a room the shape of a cheese-dish tucked under the roof, which was filled with a polished brass bedstead and was as awkward to undress in as a telephone box. There was a bathroom next door with plumbing apparently designed by Emmett, and a threadbare sitting-room downstairs containing a curly marble fireplace, a set of The British Campaign in France and Flanders, and a picture of a fat female albino peeping through a waterfall entitled “Psyche In Her Bath Glen Gurrick Distilleries Ltd”. This room was filled nightly with the “commercials”, red-faced men in blue suits who I felt were welcome for ensuring both variety of company and maintenance of the catering standards. The hotel’s regulars were composed of faded old ladies and retired schoolteachers. Then there was Mr Tuppy.
Mr Tuppy was the hotel’s funny man. I first met him at dinner the day of my arrival, when he entered the dining-room with the self-assurance of Danny Kaye taking the stage at the Palladium and demanded in general “Is there a doctor in the house?” This simple remark sent everyone into roars of laughter. Sitting at the table next to mine, he tucked his napkin under his chin and continued to make funny remarks about doctors while I tried to concentrate solemnly on the Lancet. When he shortly struck up a conversation he expressed overwhelming surprise that I happened to be of the medical profession, but by this time I was clearly established as his straight man.
“Knew a feller who went to the doctor’s once,” he told everyone over his steak pie. “Had a throat complaint. Couldn’t talk above a whisper. Our professional friend here will know all about it, eh, won’t you, Doctor? Anyway, this feller – went to the doctor, see. Door opened by a beautiful blonde – all right, Mrs Knottage, you won’t have to leave the room – where was I? Oh, yes. Door opened by smashing blonde. Feller says in a hoarse whisper, ‘Is the doctor at home?’ Blonde whispers back, ‘No, he isn’t – come on in.’”
The old ladies roared loud enough to shake the medicine bottles on their tables, while I tried to raise as good-natured a grin as possible.
“Reminds me of another one,” Mr Tuppy breezed along, helping himself to more potatoes. “Chap goes to a psychiatrist – our professional friend here knows what a psychiatrist is, eh? Feller who goes to the Windmill and looks at the audience. Well, chap goes to psychiatrist, see. Says, ‘Nothing’s wrong with me, doctor – only these red beetles and blue lizards crawling all over me.’ ‘All right,’ says the psychiatrist. ‘But don’t keep brushing them all over me.’”
Collapse of everyone, including Mrs Knottage. I later unwisely tried to combat Mr Tuppy by telling a joke about doctors myself, but no one seemed to think it at all funny. I made an even bigger mistake in offering some mild chaff to Joan, our anaemic waitress. She accepted from Mr Tuppy a run of innuendo which would have had the proprietors of any teashop telephone the police, but to me she said frozenly she was not that sort at all, thank you, which lowered me even further in the estimation of my fellow-guests. Mr Tuppy also had an annoying habit of appearing for breakfast rubbing his hands and declaring “Hail shining morn, don’t say it’s kippers again,” and of raising the special glass of brown ale to his lips every lunch and supper with the expression “Lovely grub – you can feel it doing you good!” I shortly developed the habit of sitting with clenched fists waiting for these remarks, and it became clear that I should suffer permanent psychological damage unless I shortly made a change of accommodation.
8
When I began to look for other lodgings seriously I had been in Hampden Cross almost three months, By then the shadow of the Abbey was falling noticeably earlier across our doorstep, the draughts in the surgery were finding their old corners, the mornings had the evasive chill prodromal of autumn, and the evenings stepped softly up the streets in mist. My resignation to an existence spent handling the small change of medicine had already turned into enthusiasm, and our partnership began to stride along successfully. To the patients, Dr Farquarson was the wise, conservative physician, though possibly rather outdated; I was the young, dashing doctor, though possibly rather dangerous. Life was busy, but it seemed uncomplicated. Until the morning I was called to see Mrs Tadwich.
The address given by Miss Wildewinde turned out to be a flat over a sweetshop near the main street. I now always followed Dr Farquarson’s advice of trying to make the diagnosis before ringing the doorbell, and I stood on the mat deciding from the careless hang of the curtains and the grubby air of the paintwork that I was about to be confronted with an ageing widow with progressive myosis and rheumatoid arthritis. I felt an involuntary spasm of pity and prepared to do my best for her. Then the door was opened by a plump blonde in a pink negligeé.
“Er – Mrs Tadwich?”
“That’s right.”
“I’m the doctor.”
She gave a bright smile. “Come on in, do. I wasn’t expecting you so early in the morning,” she explained, deftly flicking a pair of drying nylons from a string in the untidy sitting-room.
“I usually see my new patients first.”
I followed her through the door beyond, and found myself in the bedroom.
“Do you live here alone?” I asked.
“Oh, yes. Mr Tadwich left,” she explained amiably. “There’s a divorce pending. Would you like me on the bed?”
I began to feel alarmed. This was a situation never experienced in the ordered routine of hospital. At St Swithin’s we were strictly forbidden to examine any female patient lower than the clavicles without a nurse as a bedside chaperone, and I saw my career ending prematurely in the bleak chambers of
the General Medical Council in London. But I decided that it would look foolish if I simply grabbed my bag and hurried out. Besides, I was under an equal moral obligation to examine her, and if I didn’t I might land just as ignominiously before the local Executive Committee to have my pay stopped like a naughty schoolboy’s pocket-money.
“What’s the trouble?” I asked, hoping that it was some complaint wholly free of ethical dangers, like sinusitis or nits.
“It’s my heart, Doctor.”
My spirits fell lower. But there is fortunately one refuge for the nervous young practitioner – the cold professional manner. This is a psychological defence mechanism, which explains why so many newly qualified men appear brusque and unintelligible to their equally terrified patients. Assuming an air that went out with broughams and Gladstone bags in Harley Street, I gripped my lapels and declared, “The heart, madam? And what are the symptoms?”
“Oh, no symptoms.” She lay back on the pillow, more at home in the situation than I was. “Just the palpitations sometimes, you know. I’ve got a problem heart.”
“Indeed?”
“Leastways, that’s what the specialist said. There’s a funny quiver you can feel in the middle of my chest, just here.”
“No other manifestations of the condition, I presume?”
“Oh, no. They said in hospital it doesn’t mean any harm. Don’t you want to examine me?” She slipped off her nightdress down to the waist.
“An idiopathic condition, eh?” I said steadily. “Umm. Nothing to cause any alarm, then. And now,” I announced with dignity, “Let me palpate this vibration in the cardiac area.” I laid the flat of my hand sharply between her breasts, as though swatting a mosquito. Sticking strictly to clinical terms, I admitted loftily “I certainly feel a distinct thrill.”
“Go on with you, Doctor,” she said, giving me a wink and a poke in the ribs. “We’re all human, aren’t we? How about coming round one evening for a drink?”
Doctor in Love Page 5