Doctor at Large

2

For the next few weeks I read with equal anxiety the opinions that the Professor expressed in his case-notes on my diagnoses and those that Mr Justice Hopcroft expressed in court on the characters of his convicted criminals. Bingham now smirked every time he spoke to me, and had become intolerable. He was a bad case of the seasonal disease that struck the medical school known as 'Diplomatosis', which was characterized by delusions of grandeur and loss of memory for recent events. He had thrown away his ignominious short student's jacket, and appeared everywhere in a long white coat which he reluctantly removed only for meals; his stethoscope, which he had never carried secretly, now sprouted from his head as proudly as the horns of a rutting deer; he hurried round the hospital with jerky, urgent strides, which implied that consultations of the gravest aspect waited round every corner; he addressed patients, relatives, and junior probationers like a Victorian practitioner breaking bad news; and the responsibilities of qualification left him too preoccupied to recognize the faces of fellow-students who had been less fortunate with the examiners.

I thought Bingham's most irritating performance was in the lift. As well as the wide lifts for stretchers, St Swithin's provided for the staff a small creaking cage that usually had a worn notice on the gate saying OUT OF ORDER, which was traditionally forbidden the students. Bingham now used this lift even to descend between adjoining floors; he was particularly careful to summon it when walking along the corridor with a crowd of students, and would wait for them to arrive breathless upstairs. 'Jolly convenient, the old lift,' he said to me one morning. 'Can't understand how we used to manage without it.'

I was not left much time to brood on him, for either the drivers and pedestrians of London were becoming more careless or I was becoming less efficient: the patients in the casualty-room never thinned until supper-time, and I often had to go without my lunch as well.

'I say, old chap,' be began late one evening, as the benches were at last clearing. 'How about buzzing up to the ward and having a quiz round some cases? There's an absolutely top-hole pyelonephrosis and a retroperitoneal abscess side by side-bet you half a dollar you can't spot which is which.'

'No thanks,' I said. 'As a matter of fact, I'm fed up at looking at suffering humanity for a bit. I'm going out for a pint.'

'Forgive me for saying so, old man, but it's hardly the way to get through the Fellowship, is it?'

'I don't care a monkey's damn for the bloody Fellowship at the moment. My feet hurt, I've got a headache, I want my supper, and I'm thirsty.'

'Yes, cas. is a bit of a bind. I'll be glad to get out of it next month and start proper surgery in the wards.'

I looked him in the eye. 'I will remind you that the post of senior house surgeon will go to only one of us.'

He smirked 'Of course, old man. I was sort of forgetting for a minute. Best man win, and all that, eh?'

'Exactly, Bingham.'

Another fortnight went by, and I began to hope that the Hopcroft affair might be forgotten by a busy man carrying the responsibilities of a surgical Chair. Then one afternoon the Professor appeared in casualty. He stood before my desk, looking at me with the same stare of scientific interest and holding in his hand a patient's treatment card.

'Did you write this?' he asked.

I looked at it. It was directed to the Surgical Registrar, a genial young specialist with whom I had played rugger and drunk beer, and who disliked Bingham almost as much as he did the Fellowship examiners. The card asked for his opinion on a suspected orthopaedic case, but in the stress of casualty I had scribbled only three words

_Please X-ray. Fracture?_

Now I remembered with alarm that the Registrar had the afternoon off to visit the Royal Society of Medicine, and the Professor was taking over his work.

'Yes, sir,' I admitted.

'Have,' he snapped. 'Isn't.'

He turned on his heel and disappeared.

Bingham said eagerly a few days later, 'The Prof. was talking about you this morning, old man.'

'Oh, yes?'

'I'd nipped into the theatre to have a dekko at him doing an adrenalectomy, and he asked if I knew what school you went to. I told him I couldn't say off-hand. Then he made a most surprising remark, old chap-he thought it was probably one of those progressive ones, where the kids learn all about self-expression and bash the teachers over the head with rulers but are never taught to read or write. I suppose you didn't really go to a place like that, did you?'

'As a matter of fact I did. We never learnt to read, write, do arithmetic, play cricket, or swap marbles, but at least we were brought up not to go around kissing the backsides of people we wanted to get jobs from.'

Bingham stiffened. 'I might say that's an extremely offensive remark, old chap.'

'I might say that I meant it to be. Old chap.'

My ambition to be a surgeon now burned low. But it was not extinguished until the week before my casualty job was to end.

Bingham and I lived on the top floor of the Resident Medical Staff Quarters at St Swithin's, a tall, gloomy building containing a couple of dozen bleak bed-sitters and a dining-room enlivened by a battered piano and a picture of Sir William Osler gazing at us chidingly down his sad moustaches. On the table was a collecting-box in which anyone talking shop at supper had to drop half a crown; this was labelled FUND FOR THE BLIND, and underneath in smaller letters _And What a Blind!_ Every six months, when half the house surgeons left, this box was broached. As the Professor's retiring house surgeon had also passed his Fellowship, found a new job, and become engaged on the same day, he asked me to take his night duty for him. I was delighted, because it showed I was capable of accepting higher surgical responsibilities. Also, it made Bingham furious.

There was usually a trickle of emergency cases entering St Swithin's during the night, but that evening I was disappointed to find that the admission-room inside the gate was quiet. About midnight I went to sleep, leaving Hamilton Bailey's _Emergency Surgery_ beside my bed and my trousers hopefully receptive on the chair. I dreamed that I was in casualty, operating with a soup spoon on Bingham's double hernias without an anaesthetic, and I woke with a start to the porter's knock.

'What is it?' In a second I was scrambling out of bed, switching on the light, and jumping into my shoes. 'What's the time?'

''Arf past three.. Case of intermittent abdominal pain. Getting worse over last three days. Mostly subumbilical.'

'Really? Does the patient look very ill?'

'Nah. Came in a taxi.'

I immediately felt sorry: it looked as though I would not have the chance of assisting at an emergency operation. The porter stood picking his teeth while I pulled a sweater over my pyjamas. 'Gall-stone colic I reckon it is,' he said.

I made my way downstairs, through the cold, empty, black halls of the out-patients' department. It was a bitter night outside, with sleet falling heavily and freezing immediately on the pavement. There was no one in sight except a porter sweeping in the distance in the thin light of a lonely bulb. I suddenly felt that I was the only doctor in the world.

I found the patient sitting under a blanket on an examination couch. He was a thin, neat-looking man in a blue suit and a white collar, with a small moustache, carefully-brushed hair, and horn-rimmed spectacles. He looked worried, but unfortunately not like an immediate candidate for the operating table.

'Well now, what's the matter?' I began, as briskly as possible.

'I'm extremely sorry to have troubled you, Doctor. Extremely sorry indeed.' He spoke quietly, with a faint Cockney accent. 'I have took you away from your no doubt well-earned repose. I apologize, Doctor, and ask your forgiveness for that which I have done.'

'That's quite all right. It's what I'm here for.'

'I said to myself as I came in, "The doctor is now, no doubt, reclining in the arms of Morpheus. He is sleeping the sleep of-"'

'What's the matter with you, please?' I interrupted.

He suddenly clutched his abdomen with both hands and groaned.

'Abdominal pain?' I said, flicking the pages of my surgical text-book through my mind. 'Colicky, no doubt? Any relation to food?'

He relaxed, looked round, and whispered, 'Are we alone, Doctor?'

'Alone? I assure you, professional confidences will not be divulged.'

'You're the Professor's house surgeon, ain't you, Doctor?' I nodded. 'Well, Doctor, it's like this here. The Professor operated on me six months ago-partial gastrectomy, up in Faith Ward. All was well, Doctor, until three days ago. Then I began to have pains.' He groaned as another spasm caught him. 'Something shocking, Doctor. Tonight, after a bite of supper, I coughed and found something hard in my throat.' He glanced over his shoulder again and whispered, 'It was a nut, Doctor.'

'You mean you'd been eating nuts?'

'No, no, Doctor. I mean a metal nut. Then five minutes later I produced a screw. And after that two more nuts and a bit of spring. I've been bringing up bits of old iron all night, Doctor. So I thought I'd better come along here.'

'But dash it, man! That's almost impossible. Are you sure?'

'Look, Doctor,' he said proudly. From his pocket he pulled a screwed-up piece of the _Evening News,_ which held several bright nuts and bolts and a small coiled spring. We looked at them solemnly. Our eyes lifted and met. I licked my lips.

'They could have come from a surgical retractor,' I murmured.

He nodded. 'That's what I thought, Doctor,' he went on in a low voice. 'I know, see. Used to be in the R.A.M.C. Come to think of it, after my operation I heard a sort of rumour something might be missing.'

'Let me have a look at your stomach,' I said.

There was a gastrectomy scar, about six months old.

'Umm,' I said. I scratched my head. I looked up and down the room. There was no one in sight. Even Bingham would have been welcome.

'This might be serious,' I suggested.

'That's why I came in, Doctor,' he continued calmly. 'Mind, I'm not one of them people that makes trouble with law courts and that. But if anything happened…Well, I've got a lot of relatives, Doctor.'

'Quite,' I covered him with the blanket and began to walk round the couch slowly. The hospital rules were clear: all serious cases at night were to be referred immediately to a consultant. And if the Professor had somehow managed to leave a spring-loaded retractor inside an abdomen, he certainly would want to know of it before anyone else.

'I think we'll hang on for a bit,' I said. 'By eight o'clock I can get your notes from the registry and organize proper X-rays-'

He grabbed his stomach violently. 'Something else, Doctor,' he cried. 'Coming up!'

The Professor had a Wimbledon number, and after ringing a long time the telephone was answered by a cross female voice.

'Yes?'

'Could I speak to the Professor, please?'

'Who's there?'

'St Swithin's.'

'Oh dear, oh dear! Don't you ever leave the poor man in peace? Ar-thur!'

When the Professor reached the telephone, which seemed to be several minutes' walk from his bed, I began, 'I'm terribly sorry to bother you, sir. This is the house surgeon-'

'Rogers?'

'Er-no, not Rogers, sir. Gordon.'

I heard him draw his breath. 'Where's Rogers?'

'He's out for the night, sir.' I felt this was truthful, as I had seen him carried to bed. I steadfastly gave the Professor a brief clinical history of the case.

'It's perfectly possible, I suppose,' he admitted. I could tell that he was worried. 'I can't remember the case offhand, but six months ago I certainly had a new theatre sister…You're sure it's bits of a retractor?'

'Oh, definitely, sir.'

There was a pause.

'Very well,' he decided grudgingly. 'I'll drive in. The Lord only knows how I'll manage it this weather. Admit him to Faith, and get the theatre ready for an emergency laparotomy.'

'Yes, sir.'

'And-er, Gordon.'

'Sir?'

'It was quite right of you to phone me.'

'Thank you, sir!' I said in delight.

But he had already rung off.

I spent the next half hour organizing the operation. I woke the theatre sister and her staff, brought the night sisters and porters from their suppers, and ordered the night nurses on Faith Ward to prepare a bed with hot-water bottles and electric blankets. Then I went back to the patient, who was now lying quietly on the couch

'Don't worry, old man,' I said heartily, slapping him on the shoulder. 'Everything's under control.' I glanced at my watch. 'The Professor will be here any moment, and he'll fix you up in no time.'

'Thank you, Doctor,' he said, with a sigh of gratitude. He took my hand touchingly. 'I'm real pleased with the way you've looked after me, Doctor.'

'Oh, it's nothing. Just part of the service.'

'No, honest I am, Doctor. Real pleased. Mind you, I've got a soft spot for doctors. Especially young doctors trying to get on in the world like you.'

'That's very kind of you.'

'As a matter of fact, Doctor,' he said more cheerfully, 'I'd like to meet you again when all this is over. Socially, you know.'

'Perhaps we will,' I said with an indulgent smile. 'Who knows?'

'I'd like you to come and stay with me for a week-end. I've got quite a nice little place in the country. Down by the river. It's an old castle I picked up cheap. There's a bit of shooting and fishing if you care for it. Private golf links, of course. So bring your clubs along, Doctor, if you play.'

'I don't think I quite-'

'Tell you what I'll do. 'I'll send the Rolls for you on the Friday afternoon. The chauffeur can pick you up here. You can't miss it, it's solid gold all the way through, even the piston-rings. Just looking at me now, Doctor,' he said proudly, 'you wouldn't think I owned the Bank of England, would you?'

I met Bingham in the lift.

'Hello, old chap.' He grinned. 'Sorry you didn't get the senior H.S. job and all that.'

'Yes, I'm sorry, too.'

'You had hard cheese rather, old chap, didn't you? About that loony, I mean. You ought to have had him X-rayed before calling the Prof. Or asked "patient's occupation" as your first question. I'd have done.'

'I suppose I ought.'

'Now you're going to look for a job in the provinces, aren't you? There's some jolly good hospitals outside London, so they tell me. Not up to St Swithin's standards, of course, but you might do pretty well in time. Do you want me to say good-bye to the Prof. for you? I don't suppose you'll want to see him again, will you-after that.'

'It happens I've just been to him. For my testimonial.'

'Any time I can be of help to you, old chap, just let me know.'

'Thanks.'

We reached the ground floor, and I got out.

'I'm going to the basement,' Bingham explained. 'Going to have a dekko at some slides in the lab. Now I'm senior H.S. I thought I'd better run over my path. and bact.' I slammed the gates. 'Don't expect I'll see you before you go, old chap. Got to give a talk to the new cas. H.S.-they don't seem to know a thing, you know, these chaps who've just qualified. Toodle pip!'

He pressed the button. The lift moved six inches and stopped. Bingham pressed all the other buttons in turn. Nothing happened. He rattled the gate. It wouldn't open.

'I say, old chap,' he called after me anxiously, 'I'm stuck in the lift.'

'So I see, Bingham.'

'Absolutely bally well stuck.' He gave a nervous laugh and rattled the lattice again. Several nurses, porters, and patients had gathered round to watch. Passengers were often stuck in the St Swithin's lift, which provided a regular diversion to the otherwise monotonous aspect of the corridors.

'I say, old chap.' His voice wavered. 'Get me out, will you?'

'But I don't think I know how.' Some of the nurses began to titter. 'Do you mean I ought to send for the fire brigade, or something?'

'No, dash it, old man. This is beyond a joke.' He rattled the gate loudly, terrified that his dignity was slipping away from him. 'Be a sport, old chap,' he implored. 'Get some help. You can't leave a pal like this, can you?'

'Oh, all right,' I said testily. I supposed even Bingham had human rights. 'Wait a minute.'

'Thanks, old chap. I knew you'd do the decent.'

As I strolled away as slowly as possible to fetch a porter, I noticed a loaded food trolley moving down the corridor with the patients' lunch. An idea struck me. When I returned to the lift I was pleased to see the crowd had doubled and Bingham was rattling the bars again.

'Ah, there you are, old chap!' he said with relief. 'You've been pretty nippy, I must-here! What's the idea?'

I slowly peeled half a bunch of bananas and poked them one after another through the bars. This simple pantomime delighted the audience, which had now been joined by a party of convalescents from the children's wards and blocked the corridor. Bingham himself became mildly maniacal.

'I won't forget this!' he spat at me. 'I won't bally well forget it! You wait and see!'

I left him still in the lift and walked straight out of the hospital, for the first time in my qualified career feeling reasonably contented.

On the bus I opened the Professor's testimonial. It was short:

_To Whom It May Concern

Dr Gordon has been my Casualty House Surgeon for the past three months, in which time he has performed his duties entirely to his satisfaction._