Doctor at Large

Richard Gordon DOCTOR AT LARGE

First Published in 1955 All characters, institutions, and incidents are fictitious 1

Qualifying as a doctor is an experience as exciting for a young man as first falling in love, and for a while produces much the same addling effects.

Before my own new diploma had uncurled from its cardboard wrapper I was prancing through the streets hoping every pretty girl in sight would be seized with a fit of fainting, and longing at each crossroads for a serious accident. I scattered prescriptions like snowflakes, and squandered my now precious opinion on relatives, friends, and even people not looking very well who happened to sit opposite me in railway trains. I frequently started conversations with, 'Speaking as a medical man-' and an appeal for a doctor in a theatre would have brought me from my seat like a kangaroo.

After six years as a suppressed medical student this sudden importance was intoxicating, and was refreshed every morning with thick envelopes pouring through a letter-box which had previously breakfasted only on slim bills and orange packets from the football pools. The drug manufacturers pressed me with free samples, diaries the size of hymn-books, and sufficient blotters to soak up the Serpentine; shops in Wigmore Street offered to sell me clinical equipment from brass door-plates to X-ray machines; societies opposed to vivisection, smoking, meat-eating, blood sports, socialism, and birth control jostled on the breakfast table for my support; the bank, that a week ago echoed my footsteps like a police court begged to advance me money, safeguard my valuables, and execute my will; even the British Medical Association officially recognized my existence by sending a free sixteen-page booklet on _Ethics and Members of the Medical Profession,_ advising me henceforward to live a pure and moral life and not associate with unqualified midwives.

Unfortunately, both young doctors and young lovers soon descend from their rosy clouds on to the spiky realities of life. At the age of twenty-four I had to look for my first job, like a prospective office boy out of school. The quest was a serious one, for today even those students whose most thoughtful work in the lecture-room is carving their names on the benches are determined to become specialists. There seems no point in being anything else, when it is common knowledge in medical schools that general practitioners under the National Health Service are all seedy men signing forms in insanitary surgeries until they drop dead at forty through overwork.

Long before qualifying I had decided to become a surgeon. I had rather fancied myself cutting up the dogfish, frogs, and rabbits in the first-year zoology class, and thought the principle was probably the same further up the evolutionary tree; once I had passed my finals the only problem seemed to be finding the smoothest channel for pouring my surgical energies upon the public. My own hospital, St Swithin's, did not foster its sons beyond inviting them to the annual reunion dinner, at two guineas a head exclusive of wines; but I remembered that outside the medical school office hung a secretive notice in faded copper-plate behind speckled glass saying _Newly Qualified Men Should Consult the Secretary, Who Will Advise Them on Their Careers._ Few graduates obeyed the invitation, for the office was established in the students' eyes as a magistrate's court, which could give summary punishment for minor offences and refer promising cases to the more powerful majesty of the Dean next door. The secretary himself was a shrivelled old man with pince-nez on a thick black ribbon, who must have been the last person in London to wear elastic-sided boots, and he sat surrounded by piles of dusty official papers growing slowly from the floor like stalagmites. He suggested that I become a medical officer in the Regular Army. This advice was depressing, because I knew that he was an old-fashioned man who suggested the Army only to graduates he thought unfit to attend ordinary human beings.

Although I had won no distinctions, scholarships, or prizes at St Swithin's I boldly asked the secretary to enter me for one of the house surgeon's jobs, for these were well known among the students to be distributed in the same sporting spirit that enlivened the rest of the medical school. They were awarded by the hospital consultants sitting in committee, and represented their last chance of getting their own back on students they disliked. Youths who had sat on the front bench at lectures and asked intelligent questions to which they already knew the answers were turned down; so were earnest young men in open necks and sandals who passed round the _New Statesman_ and held intense little meetings in corners of the common room on _The Conscience of the Doctor in a Capitalist Society._ Another advantage to an applicant like myself was the consultants' habit of always voting against the favourites of colleagues they disliked. A surgeon with the overwhelming personality of Sir Lancelot Spratt had condemned several dozen promising physicians to start their careers in provincial hospitals because the Professor of Medicine had once refused to let him park his Rolls in the shade of the medical laboratory.

'I fear you are letting your recent qualification unbalance you somewhat,' the secretary told me. 'There are over eighty-three thousand practitioners on the British Register. So you have added less than one eighty-third thousandth to the medical strength of the country. If not the Army, how about the Colonial Service?'

But St Swithin's showed extravagant confidence in its educational ability, and the next afternoon I was appointed junior Casualty House Surgeon to the Professor of Surgery.

'They won't allow you to go cutting up real live people for a bit,' said my landlady with satisfaction, while I was excitedly doing my packing. 'They used to let the learners do the poor people who couldn't afford to pay, but the Government's gone and stopped all that with the National Health Service.'

'I am perfectly entitled to go cutting up whoever I like now I'm qualified,' I told her with dignity. 'Naturally, one starts in a small way, like in everything else. Bumps,' ganglions, and cysts, you know-you work your way up through varicose veins and hernias, but after your first appendix it's more or less plain sailing.'

She sniffed. 'I certainly wouldn't want you to go cutting up anyone belonging to me.'_

'I must ask you to remember, please, that I happen to be a doctor now, not a medical student.'

'Well, there's twelve and six to pay, Doctor, for the breakages.'

The casualty job was admittedly one of the lowliest in the hospital, coming ahead in academic status only to an obscure appointment known as 'Skins and V.D'. It was performed in the casualty-room, which was really nothing more than a dressing-station in the battle between London's drivers and pedestrians, and its clinical responsibilities could have been undertaken by any confident member of St John Ambulance Brigade. These thoughts did not occur to me as I crossed the hospital quadrangle the next day to start work. The subaltern joining his first regiment sees only his promotion to colonel, the new clerk plans his managerial reorganization, and even the freshly-ordained clergyman probably spares a thought for the suitability of his calves for gaiters. At the time, the end of my career was clearer to me than the beginning. I saw myself already rising through the profession to become a consultant surgeon at St Swithin's itself, collecting on the way honours, fellowships, and degrees like a magnet in a box of iron filings.

'I say!' someone called across the courtyard, as I strode in my new stiff white coat towards the casualty entrance. 'I say, old man! Half a jiff!'

I turned, and recognized the first obstacle in my professional path. It was Bingham, the other Junior Casualty House Surgeon. He was a pale youth with thick spectacles and bushy hair, who still looked seventeen and always had boils. As a student he was never a frontbench squatter, but he had once won the Dean's Prize in applied anatomy and thereafter always walked through the students' quarters with the Lancet sticking from his pocket like a flag and a couple of large books under his arm. Every lunch hour he carried these books to the library, where he ate his cheese sandwiches and removed from the reference volumes dust which he transferred during the afternoon to the instructive abdomens of patients in the wards. Every Saturday when, the library closed he moved to the surgical pathology museum, where patients' organs were stored away in thick glass jars on shelves like left luggage, and carried his books round the galleries instead. Bingham seemed to absorb a good deal of knowledge from the armpit.