DOCTOR AT LARGE

by Richard Gordon

  'All right by us. It'll save the police surgeon getting out of bed. And who is your doctor?'

  'Doctor-' Mike Kelly drew himself to add dignity to his words-'John Harcourt Bottle, Master of Arts at the University of Cambridge, Licentiate of the Royal College of Physicians of London, member of the Royal College of Surgeons-'

  'All right, all right. Where's he to be found?'

  'Ring the Resident Medical Staff Quarters at St Swithin's Hospital. Ask for', continued Mike, deflating slightly, 'the Assistant Junior Resident Anaesthetist.'

  John Bottle, who had been continuing the party with the other residents in his room on the top floor of the Staff Quarters, expressed himself indignant over the telephone that the police should have submitted a member of the medical profession to such shame. He spoke at some length, giving the sergeant his opinion on his conduct, demanding an immediate apology, hinting at substantial compensation, and threatening to write to his M.P. He then declared that he would summon a taxi and appear immediately to put this regrettable matter to rights. The result of his intervention was not one doctor being charged with being drunk and disorderly in Bow Street that night, but two.

  This was too much, even for St Swithin's, whose staff and governors showed remarkable tolerance towards purple paint on the statues, cart-horses in the quadrangle, and cami-knickers flying from the flag-staff on the morning of the Lord Mayor's visit. To avoid disproportionate damage to their careers the Staff Committee sent Kelly and Bottle on unpaid leave for the rest of their appointment, leaving two gaps on the resident staff until the next batch of students qualified in three months' time. As Mike Kelly had brought himself to his confused state by sympathizing with Grimsdyke at the dinner, he suggested his misfortune might at least be turned to the gain of his friends. Grimsdyke and I hurried to St Swithin's to see Mr Cambridge, and introduced ourselves as the charming young gentlemen who had been so appreciative of his teaching the night before. The next day I had become his temporary senior house surgeon and Grimsdyke was assistant junior resident to the hospital's anaesthetics department.

  'I'm only a ruddy stuffist,' Grimsdyke complained. 'But by George! we're lucky to get paid work at all in our present state. It's hard luck on old Mike, though.'

  I too was sorry for our former classmates, but I was overwhelmingly delighted to be back in St Swithin's. The disappointment of my earlier departure was wiped out. I was at last a senior house surgeon, if not an official one; there were hopes of resuscitating my moribund surgical career; and it would be a delicious affront to Bingham.

  I returned to the Staff Quarters, the tall, cold, sooty building between the hospital laundry and the mortuary that had been used as the ear, nose, and throat wards until condemned by the Governors as unfit for the housing of patients. Mike Kelly's room was next to the one allotted Bingham, who was hurrying down the corridor in his white coat as I struggled in with my luggage.

  He pulled up short. We had not met since the incident in the lift. He seemed uncertain what to say. He looked more boyish, more untidy, more pimply than ever, and his stethoscope seemed to have increased in size until it entwined his neck like a rubbery vine.

  'Hello, Bingham,' I said.

  He swallowed. 'Hello, old chap. Heard you were coming back.'

  'Look here,' I said, dropping my suitcase and holding out my hand. 'I'm sorry about that business of the bananas' in the lift. It was damn bad manners on my part, but I was a bit upset at the time. About not getting the job, you know. Not that I'm saying you didn't deserve the promotion. But we've got to live next door to each other for a bit, so can't we forget the whole thing?'

  'Of course, old chap,' Bingham said awkwardly., There was a short silence. 'I'm-er, sorry if I hogged all the cases in cas., and all that.'

  'You deserved them, too.'

  We shook. 'If you want any tips about the work, old chap,' Bingham went on, 'I can put you right. Only if you ask, of course,' he added quickly. 'The Prof.'s been jolly decent, and letting me try quite a bit off my own bat. I've done a couple of hernias and some piles already, and there's a nice excision of warts on the list for me tomorrow. Must buzz off now, old chap, there's a query tib. and fib. just come into cas. See you at supper.'

  I went to my room feeling like the head girl at St Agatha's making it up with the lacrosse skipper.

  My job as a senior house surgeon in St Swithin's was looking after the day-to-day needs of the patients in the wards, assisting in the operating theatre, and acting as a clinical valet to Mr Cambridge. This was my most difficult duty, because Mr Cambridge, though an excellent surgeon who had plucked more stomachs than anyone else in the hemisphere, was alarmingly absent-minded. His professional memory was excellent: he never forgot a stomach. Socially, he couldn't remember the day of the week, whether he had come out in his overcoat, what he was supposed to be doing in the afternoon, and if he had already had lunch. As a young surgeon he had arrived at St Swithin's from his lodgings one winter's morning, to operate as usual, and was aware as he scrubbed up of a strange loneliness about the place. Not only was the surgeon's room silent, but peeping into the theatre itself he found it deserted, with the table under a dust-sheet. At first he thought he was in the wrong operating block, but there was his name on his locker, as plain as ever. Next, he wondered if it might be Sunday; but he was certain it was Wednesday, because he paid his landlady every Tuesday and he remembered that he had forgotten to give her the cheque yesterday. It then occurred to him that he had noticed a strangeness about the streets while driving to the hospital. Was there a sudden general strike, perhaps, sweeping up the doctors and nurses as it hurricaned upon them? He padded down the corridor in his operating clothes, white rubber boots, and surgical mask, to seek information. At the ward door he stopped short. It was most extraordinary. There appeared to be some sort of riot inside, with nurses and patients dancing round the beds. Clearly, revolution had broken out in St Swithin's. 'Why, hello, Mr Cambridge!' called the Sister from the door. 'Merry Christmas!'

  My first morning on duty I waited in the quadrangle for Mr Cambridge's arrival, according to hospital tradition standing beneath the statue to its famous former surgeon, Sir Benjamin Bone.

  'The Chief's getting late,' I said to the Registrar, a tall, thin, serious, but pleasant young man called Hatrick, who already had his F.R.C.S.

  'There's nothing much you can do about it,' he said gloomily. 'The last time the old boy didn't turn up I found he'd gone on an American lecture tour.

  We were due to begin operating at nine, but it was almost half-past when Mr Cambridge came cheerily through the main gates on foot.

  'Ah, good morning, my dear Mr Er-er, and my dear Mr Ah-ah,' he greeted us. He could never remember the names of his assistants, and I was thankful that he had managed to recall mine twelve hours after the reunion dinner. 'Sorry I'm late. Got my notes?' I handed him three or four envelopes, addressed in his own barely legible handwriting. Whenever he thought of anything he ought to remember the next day, he wrote it on a card and immediately posted it to himself at St Swithin's. 'Let's see, we operate this morning, don't we?' he continued, as we marched towards the surgical block. 'There's a most interesting gastrocolic fistula I'd like you to inspect Mr Er-And of course you too, Mr Ah-'

  There followed one of the most painful mornings since I qualified. As a medical student I had occasionally been ordered to scrub-up, dress in a sterile gown, and join the surgeon's assistants, but once at the operating table I only played dummy in the surgical quartet. Occasionally I would be given a retractor and told, 'Hang on to that, boy!' but usually I was edged away as the surgeon became more interested in the operation and spent most of the time watching nothing more illuminating than the buckle on the back of his braces. But as a house surgeon I was a necessary member of the surgical team, responsible for cutting the stitches, clipping off the bleeding points, and fixing the dressings. Conscious of this, I pulled on my rubber gloves with unusual determination, and split them from thumb to cuff.

>   'Nurse!' The sister's voice rang across the theatre. 'Another pair of gloves for Mr Gordon!'

  A small nurse, muffled in her theatre clothes, darted across the floor and drew a white glove packet from the sterile drum with a pair of long forceps.

  'Thank you,' I mumbled. I was now so flustered that I forgot to powder my damp hands with the small gauze bag of talc, and could hardly force them inside the rubber at all. I seemed to have two fingers jammed in the thumb space, while the end of the glove danced about like seaweed in a strong tide.

  'A case of multipollices, isn't it?' murmured the small nurse.

  This increased my agitation, and I pulled the glove in two.

  'Nurse!' cried the theatre Sister, more loudly. 'Another pair of gloves for Mr Gordon.'

  I pulled on the third pair intact, though there was a small empty space like the teat of a baby's bottle at the end of each finger. I anxiously made towards the table, pushing aside a surgical trolley in my way.

  'That trolley is unsterile,' declared the theatre Sister, louder than ever. 'Nurse! A complete change of clothes for Mr Gordon!'

  When I reached the patient the operation was almost over. Mr Cambridge merely murmured, 'Hello, Mr Er -ah-Will you take the second retractor from Mr Ah-er-?' I determined to do my best and recover from the bad start, but I cut the stitches the wrong length, let the retractors slip, jammed my fingers in the handles of artery clips, and dropped several small instruments on the floor. Mr Cambridge seemed to take no notice. I decided that he was not only the politest surgeon in the hospital, but one of the cleverest in allowing for the assistance of fumbling house surgeons when planning his operating technique.

  My only consolation that morning was watching Grimsdyke out of the corner of my eye. He was having a worse time than I was. When I had asked him at breakfast how he felt about giving anaesthetics he had replied lightly, 'Doing dopes? There's nothing to it. It's all done by machines these days-none of the old rag-and-bottle business any more. Just like driving a car. You twiddle a knob here, twiddle a knob there, and you're away.'

  'Possibly-but supposing you make the mixture too rich?

  'Too much choke, you mean? He started to laugh, but said, 'Sorry, old lad. Didn't mean it at breakfast. Anyway, it's perfectly simple to a chap with a mechanical mind like myself.'

  'I suppose you've read up all the stages of anaesthesia, and so on?'

  'Old lad, as far as I'm concerned there are only three stages of anaesthesia awake, asleep, and dead.'

  It was now clear that Grimsdyke knew nothing about the administration of anaesthesia whatever. He was sitting at the head of the table beside a large chromium-plated trolley thick with dials, and though only his eye and forehead were showing I had never seen him looking so worried since one of the pretty girls in the X-ray Department thought she was in the family way. Every now and then he hopefully turned a coloured tap, or buried under the sterile towels to look up Macintosh's _Essentials of Anaesthesia,_ which he had propped against the unconscious patient's nose. Grimsdyke had come to the theatre confident that he would be expected only to assist the consultant anaesthetist, a cheerful fat man with the best stock of rude stories in London: but the consultant had the habit of returning to the surgeon's room and solving _The Times_ crossword as soon as the patient was on the table, leaving his assistant at the controls.

  Unlike most of the surgeons at St Swithin's, Mr Cambridge was considerate and polite to his anaesthetist. He made no remark about the grunts coming from beneath Grimsdyke's fingers, and an unexpected paroxysm of coughing from the patient left him unperturbed. Towards the end of the operation I was alarmed to feel something stir beneath the sterile towels. I glanced at Grimsdyke, but he had now given up the struggle and was leaning on the trolley with his eyes shut. To my horror the patient's arm came slowly into the air. 'Mr Anaesthetist,' said Mr Cambridge quietly, 'if the patient can keep awake during the operation, don't you think you might, too?'

  When operating on other people's stomachs Mr Cambridge disregarded his own. As gastrectomy followed gastrectomy my fumbling became worse and I began to long for the release of lunch. After the fourth case the theatre Sister announced firmly as she handed me the dressing, 'We are stopping for an hour now, sir. It's two o'clock.'

  'Two o'clock? Already? How the morning flies, Sister.'

  'And there is a detective to see you.'

  'Ah, yes. Which one this time?'

  'Sergeant Flannagan.'

  'Flannagan? Can't say I recall the name. What's he like?'

  'Big and red-faced, sir,' said Hatrick.

  'I know him very well. I'll be out directly. Just clean up the incision, will you Mr Ah-er-'

  Mr Cambridge was well known to the Metropolitan Police because he was continually losing his car. As soon as he felt his feet as a surgeon he had bought the customary Bentley, but he either forgot where he had parked it, wondered if he had come out in it at all, or threw open the garage doors in the morning and found it wasn't there.

  'This time I'm certain it's been stolen,' he explained to the policeman in the surgeon's room, as Hatrick, Grimsdyke, and I began tucking in to our cold congealed mutton stew. 'I came in by tube this morning, and I didn't have it out yesterday I don't think so, anyway. But the day before, Sergeant Um-um, I distinctly remember I had it parked outside my rooms in Harley Street. When I came out I'm absolutely certain it was gone.'

  The sergeant coughed. 'But why didn't you inform the police at the time, sir?'

  'Well, you see, when I saw it had gone I was certain I hadn't brought it with me. You follow?'

  'Quite,' said the sergeant.

  Mr Cambridge disappeared after lunch to remove stomachs in another part of London, leaving Hatrick and myself to finish the list. As the consultant anaesthetist accompanied the surgeon, Hatrick pointedly told Grimsdyke that he would do the remaining minor operations under local. Grimsdyke took this as a slight, murmured something about, 'Any bloody fool with a sharp knife can be a surgeon,' and left the operating theatre in a huff. As the students had drifted away with the loss of their main attraction, and a milder staff nurse was substituted for the theatre Sister, the pair of us operated peacefully until nightfall. After the morning's exhibition I was then certain that I would never become a surgeon; but under Hatrick's gentle tuition I began to gain confidence.

  'Always steady the blade of the scissors with your finger when you cut,' he murmured as I fumbled round the incision. 'Tuck them into the palm of your hand when you're not using them. Take the artery forceps with the tips of your fingers, so, then you won't get stuck. Tie a surgical knot like this, and you'll only have to use one hand. Never worry about cutaneous bleeding-it always stops. And use the handle of your scapel if in doubt-it does less damage.'

  When we returned to the surgeon's room as the last case was wheeled away, we found Sergeant Flannagan waiting.

  'Mr Cambridge has left the hospital,' I told him. 'Is there any message?'

  'Yes. There is. We've found his car.'

  'Oh, really? And where was it in the end?'

  'Locked in his ruddy garage at home.'

  14

  Mr Cambridge had charge of two wards at St Swithin's-Fortitude for men and Constancy for women-where my, duties, though less exciting than in the operating theatre, were of more value to the hospital. Mr Cambridge himself skipped round the beds every Tuesday morning, his bedside manner consisting largely of poking a patient hard in the tummy and saying cheerfully, 'You'll be much better with it out.' Hatrick tidied up all the surgical odd jobs, and I was left in charge of the more domestic side of hospitalization. The patients were less concerned with the feats of surgery performed upon them under anaesthesia than the discovery that they were unable to sleep, their bowels wouldn't work, the fish for supper was cold, and there was a draught all day from the window opposite, all faults that I was expected to rectify. As I was obliged to make my rounds twice daily the patients saw far more of me than the other members of the surgical firm, and so
metimes embarrassed me by imagining that I was the brilliant young doctor in charge. 'Which surgeon are you under?' I overheard one of them being asked in the X-ray- Department downstairs.

  'Dr Gordon.'

  'I mean, who's the head surgeon in your ward?'

  'Why, Dr Gordon,' said the patient in amazement. 'You know-the young feller.'

  'Is there any other doctor?'

  The patient thought for a time. 'There's another youngish chap called Hatrick what Dr Gordon gets to help him sometimes-'

  'Yes, yes, yes! But who else?'

  The patient tried to remember. 'No one else except an old man Dr Gordon asks in every so often out of the kindness of his heart. But he's past it, I reckon,' he added confidentially

  As the Professor's wards were immediately below mine in the surgical block, I saw a good deal of Bingham. We treated each other with aggressive politeness: Bingham markedly avoided the lift when we went downstairs together, and I pointedly asked his advice, as the senior surgeon by six months, about my difficult cases. Whenever our professional interests conflicted, we drenched each other in courtesy.

  'Hello, old chap,' he said, coming to the duty operating theatre one evening. 'Just finished a case?'

  'Well, er, no. Actually, I was just going to scrub up for a stitch abscess from the ward. But if you want the theatre first-'

  'Not a bit, old chap, not a bit,' he said quickly. 'We are on duty tonight, I admit, and we do have priority in the theatre and all that, but I wouldn't dream of standing in your way. It's only a F.B. in the pop. foss.; and that can wait.'