Doctor at Large (2 page)

I shortly became aware that Bingham always had far more cases waiting on the benches outside minor ops. than I did. As we took alternate patients coming through the casualty door I envied his luck, until I discovered that he had the habit of stopping people he saw in the street with promising boils, warts, moles, or cysts, handing them his card, and telling them to come to the casualty room of St Swithin’s at midday and ask specifically for himself. This brought him a brisk practice of taxi drivers, railway porters, bus conductors, tea-shop waitresses, news-vendors, and road-menders, and he not only removed the lump and others found by a more searching examination than was possible in public, but usually pulled out their ingrowing toenails and extracted their bad teeth as well.

This unsporting approach to surgery so annoyed me that one morning when Bingham was out of the casualty room I felt justified in harvesting some of his crop myself. I was halfway through removing under local anaesthetic an interesting sebaceous cyst on the nose of an Underground ticket collector, when Bingham burst into the theatre.

‘I say!’ he started, his white coat flapping furiously. ‘That cyst’s bally well mine!’

I looked at him over my mask. ‘Oh, is it?’ I said in surprise. ‘I thought you’d gone to lunch.’

‘Lunch! Have you ever known me go to lunch during minor ops.? Of course I wasn’t at lunch, you chump. I was having a dekko at a p-m – jolly interesting ruptured kidney – and having a chat about it with the Prof., if you must know.’

‘Well, there’s plenty more,’ I said, picking up the cyst in a pair of forceps. ‘I’ll be finished in five minutes.’

‘That isn’t the bally point,’ he went on crossly. ‘The fact is, old chap, I particularly wanted to do that cyst. I’ve been looking forward to it all morning. And I might add it’s pretty unethical to pinch another chap’s patients, old chap.’

‘It’s also pretty unethical for a chap to go round the streets of London touting for custom.’

He blushed. For a few seconds he said nothing. ‘I don’t think I like your tone, old chap,’ he muttered.

‘And I don’t ruddy well care if you don’t.’

The patient, now alarmed that his medical advisers were about to come to blows over his body, reminded them of their obligations with a noise through the sterile towels like the neigh of a dying horse.

‘I’ll report you to the Prof.,’ Bingham hissed, and swept out.

He revenged himself immediately by directing all the ‘old chronics’ to my desk. These patients were a human sludge in the machinery of St Swithin’s, of which it could never rid itself. They appeared regularly with notes as large as the score of a symphony, on which the words ‘Rep. Mist.’ were scrawled in the writing of twenty successive house surgeons. These abbreviations entitled them to another bottle of medicine, the original purpose of which was generally forgotten and the original prescriber probably dead.

The old chronics that morning seemed unending as they shifted slowly up the benches towards me. By two o’clock there were still a dozen left; I hadn’t had my lunch, and I was in a bad temper. Then I noticed a patient queue-jumping.

He was a shifty-looking, elderly man dressed in a shabby black coat and striped trousers. He had sneaked down the room and sat himself on the edge of the foremost bench. He held the finger of one hand in a bloodstained handkerchief and he still wore his black Homburg hat. I knew his type well: we often saw head clerks and managers from surrounding offices who carried their self-importance on to the equalizing benches of the casualty room, and we were encouraged by the Professor to stop it.

‘One minute, missus,’ I told a fat woman with some obscure but ancient condition of the feet. ‘Now look here, daddy,’ I began sharply, crossing to the interloper. ‘What’s the meaning of this?’

He looked up at me in alarm.

‘Yes, I saw you,’ I went on sternly. ‘Thought you were being clever, didn’t you? Sneaking up the side like that. You ought to be ashamed of yourself. You won’t bleed to death with that little cut, and there’s plenty of people in the room more seriously injured than you. Where’s your treatment card, anyway?’

‘Card? I – I’m very sorry, but – what card?’

‘Can’t you read, daddy?’ I asked in despair. ‘There’s a notice the size of Marble Arch inside the door. It says all patients must ask the clerk for a treatment card. So hop off and get one.’

‘I’m sorry, I didn’t think–’

‘Run along, daddy,’ I said waving him away. I returned to the lady’s feet, feeling in a better temper already. Medical pomposity is an invigorating draught to a young doctor.

Within a few minutes the man had returned with his card. Now he started hovering round the back of my chair. For a while I pretended to ignore him, then I turned round and demanded angrily, ‘What the devil’s the matter with you now, daddy? Why can’t you go to the end of the queue like everyone else?’

‘Yes, but you see, I
am
in rather a hurry–’

‘So is everybody else. So am I, if it comes to that. Now get back to the last bench.’

‘Perhaps I should explain–’

‘I’m not in the slightest interested. If you don’t jump to it I’ll get you shifted by one of the policemen.’

His mouth opened in horror. I congratulated myself – I had judged my man shrewdly. A fellow of his type would be frightened by such an indignity.

‘Really, I must say, Doctor, it’s a most–’

‘Now stop arguing. You can’t chuck your weight around as usual in here. And for God’s sake, daddy,
take your blasted hat off
!
’

‘What on earth’s going on here?’

I spun round, and found the Professor looking down at me. I had hardly spoken to him before, because he was far too occupied with the higher problems of academic surgery to worry about the poultices and fingerstalls of the casualty room. He was a chilly, scientific man with a gravelly voice and a long nose and chin like Mr Punch. He had only once been known to laugh, the day Sir Lancelot Spratt arrived at the hospital in a brand new plum-coloured Rolls and was rammed by an ambulance in the courtyard in front of all his students.

‘This patient, sir–’ I began.

‘Are you in some sort of trouble, Charles?’ the Professor asked.

‘Yes, I am. This young man here has been behaving extremely rudely.’

The Professor looked at me as if I were one of the rats in his laboratory developing an interesting disease.

‘Perhaps I had better introduce my friend, Mr Justice Hopcroft,’ he said slowly. ‘He unfortunately happened to cut his hand while we were lunching at my club. I have been collecting some instruments to suture it.’

I stared at him in silence. I felt the casualty room was revolving round me at high speed.

‘What did you say your name was? It’s slipped my mind since making the appointment.’

‘Gordon, sir,’ I croaked.

‘Gordon, eh?’ The Professor grunted and nodded his head several times, shaking it well into his memory.

‘What name?’ demanded Mr Justice Hopcroft, staring hard into my face.

I repeated it.

He grunted too. ‘Gordon. Yes, Gordon. I’ll remember that.’

As they disappeared into minor ops. it not only seemed likely that I wouldn’t retain my job, but that my first brush with the law would land me in Dartmoor for life.

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,’ he 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 retro peritoneal 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 offhand. 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 round 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 bedsitters and a dining-room enlivened by a battered piano and 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. ‘Gallstone 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 horned-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 textbook 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 RAMC. 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 what 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 weekend. 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.