Twice a week during the three-month pathology course we had classes in forensic medicine. This was a subject that fascinated me, because I was a conscientious reader of detective stories and took delight in the realization that I too now knew how to distinguish human blood from animal's, compare bullet wounds, and differentiate murder from suicide. The lecturer was a portly, genial man whose picture appeared fairly regularly in the Sunday papers inspecting the scene of all the more attractive crimes. We learnt from him the favourite ways of committing suicide, abortion, homicide, and rape: the lecture on the last subject, which was illustrated with lantern slides, was the only one I can remember when I couldn't find a seat.
After the pathology course we began a round of the special departments, spending a few weeks in each. I was sent to learn a little about eyes and then to the throat surgeons, where I learned how to look into ears, up noses, and down throats. The E.N.T. clinic was busy from early morning until long after the others had finished at night, for the London atmosphere silted up patients' sinuses and roughened their lungs. 'That stuff's really irrespirable,' said the surgeon, flinging his arm in the direction of the window. 'Thank God I live in the country.' He was a big, brusque, overworked man who had nevertheless extracted a fortune from the respiratory damage caused by London air. He was supposed to be the fastest remover of tonsils and adenoids in the country, which he did every Thursday afternoon in out-patients', passing the anaesthetized children through his hands with the efficiency of a Chicago pig-killer.
After the throat department I was glad to sink into the restful atmosphere of the skin clinic. This was run by two very old and very gentlemanly specialists who conversed with each other, the students, the nurses, and the patients in whispers. They were both formally dressed in expensive suits, and each arrived at the hospital with a Rolls and a chauffeur. I had not expected such opulence and satisfied tranquillity from dermatologists, but on reflection it struck me that diseases of the skin were the most agreeable of all to specialize in. They are quiet, undramatic affairs which never get you up in the middle of the night nor interrupt your meals. The patients never die, but on the other hand they never seem to get better. A private patient, once diagnosed, is therefore a regular source of income to his doctor for the rest of his long life.
***
I still lived in the flat in Bayswater with Benskin and Bottle. Archie Broom and Mike Kelly had qualified and left, and we had been joined by Sprogget and Evans.
One evening after supper Bottle leant back in his chair and said, 'What shall we do to-night? Could you take a flick, anyone?'
'There's nothing on much,' said Tony in a bored voice. 'We might pop out for a pint a bit later.'
'I've got a novel to finish,' Evans said. 'It's got to go back to the library by the sixteenth. What's the date to-day, John?
Bottle picked up the calendar from the mantelpiece. 'The fourteenth,' he said. He frowned. 'I say, do you chaps realize it is exactly five weeks to-day to our finals??
'What!' Benskin jumped up in his chair. 'It can't be. They're not till the end of October.'
'Well, this is the middle of September.'
'Good God!' said Sprogget nervously. 'We shall have to start doing some work.'
Bottle put the calendar back.
'I'm afraid you're right. I've hardly looked at a book since we came out of the anatomy rooms. We've had a bloody good holiday, and now we've got to pay for it.'
Benskin, who believed in making his unpleasant decisions swiftly, immediately picked up a copy of Price's _Practice of Medicine_ from the bookshelf and wiped the dust off the cover with his sleeve.
'At least that settles our evening for us,' he said. 'From now on it's a case of burning the old, midnight oil. Good Heavens! Is there all this on tuberculosis?'
Our evenings afterwards were swiftly blown away in a gale of industry. We collected up our dusty books from the floor, the chairs, and the back of the cupboards, and left them in heaps, open, on the table. As soon as we returned from our work in the hospital we started reading. We ate bread and cheese when we felt like it and took caffeine and benzedrine tablets to keep awake. We worked past midnight, sometimes until four in the morning, cramming three years' study into thirty-five nights.
Each of us developed a favourite attitude for concentration. I found I could learn best sitting on a hard chair with my elbows on the table; Benskin was apparently able to absorb knowledge comfortably only if he removed his collar, tie, shoes, belt, and socks and stuck his large pink feet on the mantelpiece. Bottle preferred to take his text-book and sit alone in the lavatory, and Sprogget would pace nervously up and down the narrow hallway repeating under his breath the signs and symptoms of innumerable diseases and giggling grotesquely when he couldn't remember them. Only Evans passed the pre-examination stage in tranquillity. His mind was so efficient he found it necessary to do no more than loll in an armchair and read gently through his text-books as though they were the Sunday papers.
For an hour or so we would work without speaking, filling the room with tobacco smoke. But it was a thin, taut silence, like the skin of an inflated balloon. Benskin was usually the first to break it.
'What the hell's the dose of digitalis?' he asked angrily one night.
'Six grains eight-hourly for three doses, followed by three grains three times a day for two days, and half that dose four times daily for two days,' I replied brightly.
'I'm sure that's not right,' he said. 'It's somewhere round two grains a day.'
'Of course it's right!' I barked at him. 'I've only just learnt it.'
'Richard's right,' said Evans quietly from his chair.
'All right, all right! Don't fly off about it. I haven't got as far as digitalis yet, anyway.'
Sprogget's head appeared at the door.
'Is a presystolic murmur at the apex diagnostic of mitral stenosis?' he asked anxiously.
'Yes,' Evans said.
'Oh damn! I didn't think it was.' He looked as if he was going to burst into tears. 'I'm bound to fail, I know I am!' he exclaimed.
'You'll be all right,' Benskin told him gruffly. 'It's nervous types like me who'll come down. Do you get cyanosis in pneumonia?'
We took one night a week off: on Saturday we all went out and got drunk. The rest of the time we were irritable with each other, uncommunicative, and jumpy. Benskin's usual sunny good humour seemed to have left him for ever. He scowled at his companions, complained about everything in the flat, and developed the symptoms of a gastric ulcer.
The grim period of study and Benskin's bad temper were relieved by only one incident before the examination. One Sunday night the famous helmet disappeared from the King George. No one knew who had taken it and no one had seen it go: it had simply vanished from its hook some time during the evening. The theft made Benskin furious, particularly as he had reasons to suspect the students from Bart's, whom St. Swithin's had, beaten soundly earlier on in the year in the inter-hospitals' rugby cup. The next night he took himself off to Smithfield and climbed over the venerable walls of that ancient institution. He didn't find the helmet, but he put his foot through a window and was asked to leave by a porter. His foray came to the ears of the Dean of St. Swithin's, who called him to his office, abused him soundly for ten minutes, and fined him three guineas. The Dean could not appreciate at all Benskin's plea that the loss of the helmet justified such strong action. Whether this had any connection with an event that occurred shortly afterwards and established itself for ever in the hospital tradition with the title of the Dean's Tea Party was never known. Benskin was suspected, and there was a rumour that he had been spotted coming out of a small printer's in the City: but there was never any proof.
A few days after his interview with Benskin the Dean entered his office to find his personal secretary rummaging through his desk.
'Hello!' he said. 'Lost something?'
'Not exactly, sir,' she said, giving him a worried look. 'I was just wondering why I hadn't seen the invita
tions?'
'Invitations? What invitations?'
'To your At Home to-morrow,' she replied simply. 'The 'phone's been ringing all morning. The Deans of all the other hospitals in London have been through to say that the notice is a little short but they will be glad to come for cocktails in the library. There have been some people from the Medical Research Council, too, and a professor from Birmingham.' She looked at a pencilled list in her hand. 'About thirty have accepted so far, and there looks like a good many more have arrived by the second post.'
The Dean hurled his hat on the floor.
'It's an outrage!' he shouted in fury. 'It's a disgrace! It's a…! By God, these bloody students! By God, I'll punish them for this! You just wait and see!' He poked a quivering finger at her so forcefully she leapt back with a little squeal.
'You mean-it's a hoax?' she asked timidly.
'Of course it's a hoax! It's these damn hooligans we've been giving the best years of our lives trying to educate! Send me the School Secretary! And the Professor of Medicine! Get me the Head Porter! Ring up all those people and tell them the thing's a damnable practical joke!'
'What, all of them'
'Of course, woman! You don't think I'm going to be made a fool of by my own students, do you? Get on to them at once!'
At that moment the 'phone rang again. She picked it up.
'Hello…' she said. 'Yes, he's here now. Certainly. One moment please.'
She turned to the Dean. 'The Lord Mayor's Secretary,' she exclaimed. 'He says the Lord Mayor would be delighted.'
The Dean fell into his armchair like a knocked-out boxer.
'Very well,' he groaned. 'Very well, I know when I'm beaten. Get me those catering people, whats-is-names, instead.'
The party was a great success. Although the Dean entered the library black with anger he found himself in the middle of so many of his distinguished contemporaries that he mellowed rapidly. Didn't the leading heart specialist in the country grip him by the arm and tell him how much he appreciated his latest paper? Didn't the Lord Mayor himself hint of a donation towards the new library, and, more important, ask for an appointment in Harley Street? Besides, he had quickly seen to it that the expenses would be borne by the Governors. He said a genial good-bye to his last guests as they climbed into their cars in the courtyard. Suddenly he saw Benskin, with his hands in his pockets, grinning at him from the shadow of Lord Larrymore's statue. The Dean's face twisted malignantly.
'Do you know anything about this, damn you?' he demanded.
'Me, sir?' Benskin asked innocently. 'Not at all, sir. I think it may have been someone from Bart's.'
15
To a medical student the final examinations are something like death: an unpleasant inevitability to be faced sooner or later, one's state after which is determined by the care spent in preparing for the event.
The examinations of the United Hospitals Committee are held twice a year in a large dingy building near Harley Street. It shares a hidden Marylebone square with two pubs, a sooty caged garden, an antique shop, and the offices of a society for retrieving fallen women. During most of the year the square is a quiet and unsought thoroughfare, its traffic made up by patrons of the pubs, reclaimed women, and an unhappy-looking man in sandals who since 1931 has passed through at nine each morning carrying a red banner saying 'REPENT FOR YE DIE TOMORROW.' Every six months this orderly quiet is broken up like a road under a pneumatic drill. Three or four hundred students arrive from every hospital in London and from every medical school in the United Kingdom. Any country that accepts a British qualification is represented. There are brown, bespectacled Indians, invariably swotting until the last minute from Sir Leatherby Tidy's fat and invaluable _Synopsis of Medicine;_ jet-black gentlemen from West Africa standing in nervous groups and testing their new fountain-pens; fat, coffee-coloured Egyptians discussing earnestly in their own language fine points of erudite medicine; hearty Australians, New Zealanders, and South Africans showing no more, anxiety than if they were waiting for a pub to open; the whole diluted thoroughly by a mob of pale, fairly indifferent, untidy-looking British students conversing in accents from the Welsh valleys to Stirlingshire.
An examination is nothing more than an investigation of a man's knowledge, conducted in a way that the authorities have found to be the most fair and convenient to both sides. But the medical student cannot see it in this light. Examinations touch off his fighting spirit; they are a straight contest between himself and the examiners, conducted on well-established rules for both, and he goes at them like a prize-fighter.
There is rarely any frank cheating in medical examinations, but the candidates spend almost as much time over the technical details of the contest as they do learning general medicine from their text-books. We found the papers set for the past ten years in the hospital library, and the five of us carefully went through the questions.
'It's no good wasting time on pneumonia, infant diarrhoea, or appendicitis,' Benskin said. 'They were asked last time. I shouldn't think it's worth learning about T.B. either, it's come up twice in the past three years.'
We all agreed that it was unnecessary to equip ourselves with any knowledge of the most frequent serious illnesses we would come across in practice.
'I tell you what we ought to look up,' said Evans. 'Torulosis.'
'Never heard of it,' Benskin said.
'It's pretty rare. But I see that old Macready Jones is examining this time, and it's his speciality. He has written a lot of stuff about it in the B.M.J. and the Lancet. He might quite easily pop a question in.'
'All right,' I said. 'I'll look it up in the library to-morrow.'
My chances of meeting a case of torulosis after qualification were remote, and I wouldn't have recognized it if I had. But to be well informed about torulosis in the next fortnight might make the difference between passing and failure.
Benskin discovered that Malcolm Maxworth was the St. Swithin's representative on the Examining Committee and thenceforward we attended all his ward rounds, standing at the front and gazing at him like impressionable music enthusiasts at the solo violinist. The slightest hint he was believed to have dropped was passed round, magnified, and acted upon. Meanwhile, we despondently ticked the days off the calendar, swotted up the spot questions, and ran a final breathless sprint down the well-trodden paths of medicine, snatching handfuls of knowledge from the sides where we could.
***
The examination is split into three sections, each one of which must be passed on its own. First there are the written papers, then _viva voce_ examinations, and finally the clinical, when the student is presented with a patient and required to turn in a competent diagnosis in half an hour.
On the morning the examination began the five of us left the Bayswater flat early, took a bus along Oxford Street, and walked towards the examination building in a silent, sickly row. I always found the papers the most disturbing part of the contest. They begin at nine o'clock, an hour when I am never at my best, and the sight of other candidates _en masse_ is most depressing. They all look so intelligent. They wear spectacles and use heavy fountain-pens whose barrels reflect their own mental capacity; once inside they write steadily and sternly, as though they were preparing leaders for the next week's _Lancet;_ and the women students present such an aspect of concentration and industry it seems useless for men to continue the examination at all.
I went with a hundred other students into one of three large, square halls used for the examination. The polished wooden floor was covered with rows of desks set at a distance apart that made one's neighbour's writing completely indecipherable if he had not, as was usually the case, already done so himself. Each desk was furnished with a card stamped with a black examination number, a clean square of pink blotting-paper, and a pen apparently bought second-hand from the Post Office. The place smelt of floor-polish and freshly-sharpened pencils.
A single invigilator sat in his gown and hood on a raised platform to keep an eye
open for flagrant cheating. He was helped by two or three uniformed porters who stood by the doors and looked impassionately down at the poor victims, like the policemen that flank the dock at the Old Bailey. The students scraped into their chairs, shot a hostile glance at the clock, and turned apprehensively to the buff question paper already laid out on each desk.
The first paper was on general medicine. The upper half of the sheet was taken up with instructions in bold print telling the candidate to write on one side of the paper only, answer all the questions, and to refrain from cribbing at peril of being thrown out. I brought my eyes painfully to the four questions beneath. At a glance I saw they were all short and pungent.
_Give an account of the sign, symptoms, and treatment of heart failure_ was the first. 'Hell of a lot in that!' I thought. I read the second and cursed. _Discuss the changes in the treatment of pneumonia since 1930._ I felt the examiners had played a dirty trick by asking the same disease two papers in succession. The next simply demanded _How would you investigate an outbreak of typhoid fever?_ and the last was a request for an essay on worms which I felt I could bluff my way through.
Three hours were allowed for the paper. About halfway, through the anonymous examinees began to differentiate themselves. Some of them strode up for an extra answer book, with an awkward expression of self-consciousness and superiority in their faces. Others rose to their feet, handed in their papers, and left. Whether these people were so brilliant they were able to complete the examination in an hour and a half or whether this was the time required for them to set down unhurriedly their entire knowledge of medicine was never apparent from the nonchalant air with which they left the room. The invigilator tapped his bell half an hour before time; the last question was rushed through, then the porters began tearing papers away from gentlemen dissatisfied with the period allowed for them to express themselves and hoping by an incomplete sentence to give the examiners the impression of frustrated brilliance.
DOCTOR IN THE HOUSE Page 13
