Doctor in the House

9

In order to teach the students midwifery St. Swithin's supervised the reproductive activities of the few thousand people who lived in the overcrowded area surrounding the hospital. In return, they co-operated by refusing to water down the demands of Nature with the less pressing requests of the Family Planning Association.

The midwifery course is of more value to the student than a piece of instruction on delivering babies. It takes him out of the hospital, where everything is clean and convenient and rolled up on sterile trollies, to the environment he will be working in when he goes into practice-a place of dirty floors, bed-bugs, no hot water, and lights in the most inconvenient places; somewhere without nurses but with bands of inquisitive children and morbid relatives; a world of broken stairs, unfindable addresses, and cups of tea in the kitchen afterwards.

It was fortunate that I was plunged into the practice of midwifery shortly after my unfruitful love life, for it is a subject which usually produces a sharp reactionary attack of misogyny in its students. Tony Benskin, Grimsdyke, and myself started 'on the district' together. We had to live in the hospital while we were midwifery clerks, in rooms the size of isolation cubicles on the top floor of the resident doctors' quarters. My predecessor, a tall, fair-haired, romantic-looking man called Lamont had been so moved by his experiences he was on the point of beaking off his engagement.

'The frightful women!' he said heatedly, as he tried to cram a pile of text-books into his case. 'I can't understand that anyone would ever want to sleep with them. That someone obviously has done so in the near past is quite beyond me.'

'How many babies have you had?' I asked.

'Forty-nine. That includes a couple of Caesars. I'd have made a half-century if I hadn't missed a B.B.A.'

'B.B.A.?'

'Born before arrival. Terrible disgrace for the midder clerk, of course. I reckoned I'd have time for my lunch first, and when I got there the blasted thing was in the bed. However, mother and child did well, so I suppose no real harm was done. Don't try and open the window, it's stuck. I'm going out to get drunk. Best of luck.'

Picking up his bag he left, the latest penitent for the sin of Adam.

I sat on the bed, feeling depressed. It was an unusually raw afternoon in November and the sky hung over the roof-tops in an unbroken dirty grey sheet. There was no fire in the room and the pipes emitted flatulent noises but no heat. The only decoration was a large black-and-white map of the district on which some former student had helpfully added the pubs in red ink. I looked out of the window and saw a few flakes of snow-ominous, like the first spots of a smallpox rash. I wished women would go away and bud, like the flowers.

The three of us reported to the senior resident obstetrical officer, a worried-looking young man whom we found in the ante-natal clinic. This clinic was part of the St. Swithin's service. Every Thursday afternoon the mothers came and sat on the benches outside the clinic door, looking like rows of over-ripe poppy-heads. The obstetrical officer was absently running his hands over an abdomen like the dome of St. Paul's to find which way up the baby was.

'You the new clerks?' he asked, without interest.

We each nodded modestly.

'Well, make sure you're always within call. When you go out on a case a midwife will be sent separately by the local maternity service, so you've got nothing to worry about. Don't forget to carry two pennies in your pocket.

'To 'phone, of course,' he said when I asked why. 'If you get into trouble dash for the nearest box and call me, and I'll come out in a police car. Don't wait till it's too late, either.'

He dismissed us and bent over to listen to the foetal heart rate with a stethoscope shaped like a small flower-vase.

Our next call was on the Extern Sister, who controlled all the midwifery students. I found her a most interesting woman. She was so ugly she could never have had much expectation of fulfilling her normal biological function; now she had been overtaken by the sad menopause and was left no chance of doing so at all. As she had not been offered the opportunity of bearing children she had thrown herself into midwifery like a novice into religion. She knew more about it than the obstetrical officer. She could talk only about mothers and babies and thought of everyone solely as a reproductive element. In her room was a gold medal she had won in her examinations, which she proudly displayed in a small glass-covered frame between two prints of Peter Scott's ducks. She talked of the anatomy involved in the birth of a baby as other women described their favourite shopping street. She had, however, the unfortunate trick of awarding the parts of the birth canal to the listener.

'When your cervix is fully dilated,' she told us gravely, 'you must decide whether to apply your forceps to your baby. You must feel to see if your head or your breech is presenting.'

'Supposing it's your shoulder or your left ear?' asked Benskin.

'Then you put your hand in your uterus and rotate your child,' she replied without hesitation.

She gave us a rough idea of delivering babies and demonstrated the two instrument bags we had to take on our cases. They were long leather affairs, like the luggage of a dressy cricketer, containing sufficient material to restore the biggest disaster it was likely a student could pull down on himself. There were bottles of antiseptic, ether and chloroform, needles and catgut in tins of Lysol, a pair of obstetrical forceps, a peculiar folding canvas arrangement for holding up the mother's legs, enamel bowls, rubber gloves, and a number of unidentifiable packages.

'You must check your bags before you go to your mother,' Sister said.

We chalked our room-numbers on the board in the hall and went out for a drink in the King George. The snow was falling thickly, swirling round the lamp-posts and clinging to the hospital walls, giving the old building a more sinister appearance than ever.

'What a night to start stork-chasing!' Grimsdyke exclaimed.

'What happens when we get out there?' I asked.

'Getting nervous, old boy?'

'I am a bit. I haven't seen a baby born before. I might faint or something.'

'There's nothing to worry about,' Benskin told me cheerfully. 'I was talking to one of the chaps we're relieving. The midwife always gets there first and tells you what to do under her breath. They're a good crowd. They let the patient think you're the doctor, which is good for the morale of both of you.'

We went back to the hospital for dinner. Afterwards Benskin asked the duty porter if everything was still quiet.

'Not a thing, sir,' he replied. 'It's a bad sign, all right. After it's been as quiet as this for a bit they start popping out like rabbits from their warrens.'

We sat in Grimsdyke's room and played poker for matches for a couple of hours. It was difficult to concentrate on the game. Every time the 'phone bell rang in the distance we jumped up nervously together. Grimsdyke suggested bed at ten, predicting we would be roused as soon as we dropped off to sleep. We cut for who should be on first call: I lost.

It was four when the porter woke me up. He cheerily pulled off the bedclothes and handed me a slip of paper with an address scribbled on it in pencil.

'You'd better hurry, sir,' he said. 'They sounded proper worried over the 'phone.'

I rolled out of bed and dressed with the enthusiasm of a prisoner on his execution morning. The night outside was as thick and white as a rice pudding. After a glance through the curtains I pulled a green-and-yellow hooped rugby jersey over my shirt and a dirty cricket sweater over that. I tucked the ends of my trousers into football stockings, wrapped a long woollen scarf round my neck and hid the lot under a duffle coat. I looked as if I was going to take the middle watch on an Arctic fishing vessel.

The reason for this conscientious protection against the weather was the form of transport allotted to the students to reach their cases. It was obviously impossible to provide such inconsequential people with a car and we were nearly all too poor to own one ourselves. On the other hand, if the students had been forced to walk to their patients the race would have gone to the storks. A compromise had therefore been effected some ten years ago and the young obstetricians had the loan of the midwifery bicycle.

This vehicle had unfortunately not worn well in the service of the obstetrical department. It had originally been equipped with such necessaries as brakes, mudguards, lights, and rubber blocks on the pedals, but, as human beings sadly lose their hair, teeth, and firm subcutaneous fat in the degeneration of age, the machine had similarly been reduced to its bare comfortless bones. The saddle had the trick of slipping unexpectedly and throwing the rider either backwards or forwards, it was impossible to anticipate. The only way to stop the machine was by falling off. It was the most dangerous complication of midwifery in the practice of the hospital.

I searched for the address on the map. It was on the other side of the district, a short, narrow, coy street hiding between a brewery and a goods yard. It seemed as remote as Peru.

I waddled down to the out-patient hall to collect the instrument bags. The place was cold and deserted; the porter who had called me was yawning in the corner over the telephone, and the two night nurses huddled in their cloaks round their tiny electric fire, sewing their way through a stack of gauze dressings. They took no notice of the globular figure coming down the stairs an insignificant midwifery clerk wasn't worth dropping a stitch for. For the houseman, or, if they were lucky, one of the registrars come to open an emergency appendix-to them they would give a cup of coffee and a flutter of the eyelids. But what good were the junior students?

The bicycle was kept in a small shed in the hospital courtyard, and had for its stablemate the long trolley used for moving unlucky patients to the mortuary. I saw that the first problem of the case was balancing myself and my equipment on the machine. As well as the two leather bags I had a couple of drums the size of biscuit barrels containing the sterilized dressings. There was a piece of thick string attached to the bicycle, which I felt was probably part of its structure, but I removed it and suspended the two drums round my neck like a yoke. Carefully mounting the machine, I clung to the bags and the handlebars with both hands and pedalled uncertainly towards the front gate. The snowflakes fell upon me eagerly, like a crowd of mosquitoes, leaping for my face, the back of my neck, and my ankles.

The few yards across the courtyard were far enough to indicate the back tyre was flat and the direction of the front wheel had no constant relationship to the way the handlebars were pointing. I crunched to a stop by the closed iron gates and waited for the porter to leave his cosy cabin and let me out.

'You all right, sir?' he asked with anxiety.

'Fine,' I said, 'I love it like this. It makes me feel like a real doctor.'

'Well,' he said dubiously, 'good luck, sir.'

'Thank you.'

The porter turned the key in the lock and pulled one of the gates open against the resisting snow.

'Your back light isn't working, sir,' he shouted.

I called back I thought it didn't matter and pedalled away into the thick night feeling like Captain Oates. I had gone about twenty yards when the chain came off.

After replacing the chain I managed to wobble along the main road leading away from the hospital in the direction of the brewery. The buildings looked as hostile as polar ice-cliffs. Everything appeared so different from the kindly daytime, which gave life to the cold, dead streets with the brisk circulation of traffic. Fortunately my thorough knowledge of the local public houses provided a few finger-posts, and I might have done tolerably well as a flying angel of mercy if the front wheel hadn't dropped off.

I fell into the snow in the gutter and wished I had gone in for the law. As I got to my feet I reflected that the piece of string might have been something important to do with the attachment of the front wheel; but now the lesion was inoperable. Picking up my luggage, I left the machine to be covered by the snow like a dead husky and trudged on. By now I was fighting mad. I told myself I would damn well deliver that baby. If it dared to precipitate itself into the world ungraciously without waiting for me I decided I would strangle it.

I turned off the main road towards the brewery, but after a few hundred yards I had to admit I was lost. Even the pubs were unfamiliar. I now offered no resistance to my environment and submissively felt the moisture seeping through my shoes. I leant against a sheltering doorpost, preparing to meet death in as gentlemanly a way as possible.

At that moment a police car, forced like myself into the snow, stopped in front of me. The driver swung his light on my load and on myself, and had no alternative than to decide I was a suspicious character. He asked for my identity card.

'Quick!' I said dramatically. 'I am going to a woman in childbirth.'

'Swithin's?' asked the policeman.

'Yes. It may be too late. I am the doctor.'

'Hop in the back!'

There is nothing that delights policemen more than being thrown into a midwifery case. There is a chance they might have to assist in the performance, which means a picture in the evening papers and congratulatory beer in the local. The constable who walked into St. Swithin's one afternoon with an infant born on the lower deck of a trolley bus looked as pleased as if he were the father.

The warm police car took me to the address, and the crew abandoned me with reluctance. It was a tall, dead-looking tenement for ever saturated with the smells of brewing and shunting. I banged on the knocker and waited.

A thin female child of about five opened the door.

'I'm the doctor,' I announced.

The arrival of the obstetrician in such a briskly multiplying area caused no more stir than the visit of the milkman.

'Upstairs, mate,' she said and scuttled away into the darkness like a rat.

The house breathed the sweet stench of bed-bugs; inside it was dark, wet, and rotting. I fumbled my way to the stairs and creaked upwards. On the second floor a door opened a foot, a face peered through, and as the shaft of light caught me it was slammed shut. It was on the fifth and top floor that the accouchement seemed to be taking place, as there was noise and light coming from under one of the doors. I pushed it open and lumbered in.

'Don't worry!' I said. 'I have come.'

I took a look round the room. It wasn't small, but a lot was going on in it. In the centre, three or four children were fighting on the pockmarked linoleum for possession of their plaything, a piece of boxwood with a nail through it. A fat woman was unconcernedly making a cup of tea on a gas-ring in one corner, and in the other a girl of about seventeen with long yellow hair was reading last Sunday's _News of the World._ A cat, sympathetic to the excited atmosphere, leapt hysterically among the children. Behind the door was a bed beside which was grandma-who always appears on these occasions, irrespective of the social standing of the participants. Grandma was giving encouragement tempered with warning to the mother, a thin, pale, fragile woman on the bed, and it was obvious that the affair had advanced alarmingly. A tightly-packed fire roared in the grate and above the mantelpiece Field-Marshal Montgomery, of all people, looked at the scene quizzically.

'Her time is near, doctor,' said grandma with satisfaction.

'You have no need to worry any longer, missus,' I said brightly.

I dropped the kit on the floor and removed my duffle coat, which wept dirty streams on to the lino. The first step was to get elbow room and clear out the non-playing members of the team.

'Who are you?' I asked the woman making tea.

'From next door,' she replied. 'I thought she'd like a cup of tea, poor thing.'

'I want some hot water,' I said sternly. 'Lots of hot water. Fill basins with it. Or anything you like. Now you all go off and make me some hot water. Take the children as well. Isn't it past their bedtime?'

'They sleep in 'ere, doctor,' said grandma.

'Oh. Well-they can give you a hand. And take the cat with you. Come on-all of you. Lots of water, now.'

They left unwillingly, in disappointment. They liked their entertainment to be fundamental.

'Now, mother,' I started, when we were alone. A thought struck me-hard, in the pit of the stomach. The midwife-the cool, practised, confident midwife. Where was she? To-night-this memorable night to the two of us in the room-what had happened to her? Snowbound, of course. I felt like an actor who had forgotten his lines and finds the prompter has gone out for a drink.

'Mother,' I said earnestly. 'How many children have you?'

'Five, doctor,' she groaned.

Well, that was something. At least one of us knew a bit about it.

She began a frightening increase in activity.

'I think it's coming, doctor!' she gasped, between pains. I grasped her hand vigorously.

'You'll be right as rain in a minute,' I said, as confidently as possible. 'Leave it to me.'

'I feel sick,' she cried miserably.

'So do I,' I said.

I wondered what on earth I was going to do.

There was, however, one standby that I had thoughtfully taken the trouble to carry. I turned into the corner furthest away from the mother and looked as if I was waiting confidently for the precise time to intervene. Out of my hip pocket I drew a small but valuable volume in a limp red cover-_The Student's Friend in Obstetrical Difficulties._ It was written by a hard-headed obstetrician on the staff of a Scottish hospital who was under no illusions about what the students would find difficult. It started off with 'The Normal Delivery.' The text was written without argument, directly, in short numbered paragraphs, like a cookery book. I glanced at the first page.

'Sterility,' it said. 'The student must try to achieve sterile surroundings for the delivery, and scrub-up himself as for a surgical operation. Newspapers may be used if sterile towels are unobtainable, as they are often bacteria-free.'

Newspaper, that was it! There was a pile of them in the corner, and I scattered the sheets over the floor and the bed. This was a common practice in the district, and if he knew how many babies were born yearly straight on to the _Daily Herald_ Mr. Percy Cudlip would be most surprised.

There was a knock on the door, and grandma passed through an enamel bowl of boiling water.

'Is it come yet, doctor?' she asked.

'Almost,' I told her. 'I shall need lots more water.'

I put the bowl down on the table, took some soap and a brush from the bag, and started scrubbing.

'Oh, doctor, doctor…!' cried the mother.

'Don't get alarmed,' I said airily.

'It's coming, doctor!'

I scrubbed furiously. The mother groaned. Grandma shouted through the door she had more hot water. I shouted back at her to keep out. The cat, which had not been removed as ordered, jumped in the middle of the newspaper and started tearing at it with its claws.

Suddenly I became aware of a new note in the mother's cries-a higher, wailing, muffled squeal. I dropped the soap and tore back the bedclothes.

The baby was washed and tucked up in one of the drawers from the wardrobe, which did a turn of duty as a cot about once a year. The mother was delighted and said she had never had such a comfortable delivery. The spectators were readmitted, and cooed over the infant. There were cups of tea all round. I had the best one, with sugar in it. I felt the name of the medical profession never stood higher.

'Do you do a lot of babies, doctor?' asked the mother.

'Hundreds,' I said. 'Every day.'

'What's your name, doctor, if you don't mind?' she said.

I told her.

'I'll call 'im after you. I always call them after the doctor or the nurse, according.'

I beamed and bowed graciously. I was genuinely proud of the child. It was my first baby, born through my own skill and care. I had already forgotten in the flattering atmosphere that my single manoeuvre in effecting the delivery was pulling back the eiderdown.

Packing the instruments up, I climbed into my soggy duffle coat and, all smiles, withdrew. At the front door I found to my contentment that the snow had stopped and the roads shone attractively in the lamplight. I began to whistle as I walked away. At that moment the midwife turned the corner on her bicycle.

'Sorry, old chap,' she said, as she drew up. 'I was snowed under. Have you been in?'

'In! It's all over.'

'Did you have any trouble?' she asked dubiously.

'Trouble!' I said with contempt. 'Not a bit of it! It went splendidly.'

'I suppose you remembered to remove the afterbirth?'

'Of course.'

'Well, I might as well go home then. How much did it weigh?'.

'Nine pounds on the kitchen scales.'

'You students are terrible liars.'

I walked back to the hospital over the slush as if it were a thick pile carpet. The time was getting on. A hot bath, I thought, then a good breakfast…and a day's work already behind me. I glowed in anticipation as I suddenly became aware that I was extremely hungry.

At the hospital gate the porter jumped up from his seat.

''Urry up, sir,' he said, 'and you'll just make it.'

'What's all this?' I asked with alarm.

'Another case, sir. Been waiting two hours. The other gentlemen are out already.'

'But what about my breakfast?'

'Sorry, sir. Not allowed to go to meals if there's a case. Orders of the Dean.'

'Oh, hell!' I said. I took the grubby slip of paper bearing another address. 'So this is midwifery,' I added gloomily.

'That's right, sir,' said the porter cheerfully. 'It gets 'em all down in the end.'