It was the tradition of St. Swithin's that the Chief should be greeted in the courtyard and lead his firm to the ward. Surgeons were met in front of the statue of Sir Benjamin Bone and physicians before that of Lord Larrymore. This form of reception resulted in everyone becoming cold in winter, hot in summer, and wet all the year round, and as it had apparently been going on for three or four hundred years this seemed an excellent reason for refusing to alter, it.
We gathered for our first ward-round under the cold eye of Sir Benjamin. The differences that divided the firm, which were emphasised on Tuesday mornings, had already become obvious. The students stood in a little subdued group behind the statue. We wore our suits, with stethoscopes coiling out of our pockets and foolscap notebooks under our arms. We chatted quietly between ourselves, but would not have contemplated exchanging words with the two house-surgeons, who stood apart murmuring to each other with expressions of intense seriousness on their faces.
The third section of the party consisted only of Crate, the registrar. He was allowed to wear a long white coat like the Chief, but as he had no companion to talk to and was unable to converse with his housemen or students at such a solemn moment he had to content himself with looking at the sky in a reflective and earnest way, as if he were turning over in his mind the niceties of surgery or trying to forecast the weather.
At ten the Rolls drew into the courtyard and stopped opposite our group. Crate opened the door and wished Sir Lancelot good morning. The car was driven to its parking-place by the chauffeur and the Chief disappeared with his registrar towards the staff common room to leave his hat and put on his white coat. When they reappeared the rest of the party followed them to the wards.
Once Sir Lancelot burst through the ward door more people arranged themselves in his wake. Indeed, it was impossible for a man of his importance to walk about St. Swithin's at all without a procession immediately forming up behind him.
First, of course, was Sir Lancelot, the therapeutic thunderbolt. A pace behind came the registrar, and behind him the two house-surgeons, the senior one leading. After the two housemen was Sister, her long cap trailing behind her like a wind-stocking on an aerodrome. She was followed by her senior staff nurse, who carried a trayful of highly-polished instruments with which the patients could be tapped, scratched, and tickled in the aid of making a diagnosis. Sir Lancelot never used any of them and probably did not know how to, but they were produced every Tuesday nevertheless, like a ceremonial mace. Behind the staff nurse was a junior nurse bearing a thick board covered with a pad of paper, to which a pencil was attached with a piece of string. The board was marked sternly 'SIR LANCELOT SPRATT'S DRAWING PAPER.' On this he would sometimes sketch points of anatomy-not often, about once every six months, but the board had to be flashed to his hand if he asked for it. In the rear of the junior nurse, in the winter months a probationer carried a hot-water bottle in a small red blanket for Sir Lancelot to warm his hands before applying them to exposed flesh.
At the end of the party, behind even the hot-water battle, were the students: an un-uniformed, disorderly bunch of stragglers.
The Chief spent two hours examining the candidates for the afternoon's operating list, with whom he illustrated to us the principles of surgery. Sometimes he passed all morning on one case, if the patient contained a lump of sufficient interest to him; on other Tuesdays he would whip round the whole ward, diagnosing like a machine-gun. Sitting was forbidden, and towards lunchtime the students shifted heavily from one foot to the other. Sir Lancelot thought any young man incapable of standing on his own feet for a couple of hours as another disagreeable product of modern life, like socialism.
On our first ward round we were pushed easily into place by the precision with which the rest of the troupe fell in. Sir Lancelot strode across the ward, drew up sharply, and looked over the patients in the two rows of beds, sniffing the air like a dog picking up a scent. He thundered over to the bedside of a small, nervous man in the corner. The firm immediately rearranged itself, like a smart platoon at drill. The Chief towered on the right of the patient's head; Sister stood opposite, her nurses squeezed behind her; the students surrounded the foot and sides of the bed like a screen; and the registrar and housemen stood beyond them, at a distance indicating that they were no longer in need of any instruction in surgery.
Sir Lancelot pulled back the bedclothes like a conjurer revealing a successful trick.
'You just lie still, old fellow,' he boomed cheerfully at the patient. 'Don't you take any notice of what I'm going to say to these young doctors. You won't understand a word of what we're talking about, anyway. Take his pyjamas off, Sister. Now you, my boy,' he continued, gripping me tightly by the arm as I was nearest, 'take a look at that abdomen.'
I stretched out a hand to feel the patient gingerly in the region of the umbilicus. I noticed his skin was covered with goose-pimples and twitched here and there nervously.
'Take your dirty little hand away!' said Sir Lancelot savagely, flicking it off the surface of the abdomen like a fly. He paused solemnly, and continued in a heavy tone, wagging his finger: 'The first rule of surgery, gentlemen-eyes first and most, hands next and least, tongue not at all. Look first and don't chatter. An excellent rule for you to remember all your lives. Now look, boy, look.'
I gazed at the abdomen for a whole minute but it appeared no different from any that might be seen on Brighton beach. When I thought I had inspected it long enough to satisfy the Chief, who rose uncomfortably above me, I diffidently stretched out my arm and prodded about with my finger in search of a lump.
_'Doucemong, doucemong,'_ Sir Lancelot began again.
'Gently, boy-you're not making bread. Remember'-his finger came up again warningly-'a successful surgeon must have the eye of a hawk, the heart of a lion, and the hand of a lady.'
'And the commercial morals of a Levantine usurer,' murmured Grimsdyke under his breath.
With a glow of relief, I finally discovered the lump. It was about the size of an orange and tucked under the edge of the ribs. We lined up and felt it one after the other, while Sir Lancelot looked on closely and corrected anyone going about it the wrong way. Then he pulled a red grease-pencil from the top pocket of his coat and handed it to me.
'Where are we going to make the incision?' he asked. By now the patient was forgotten; it was the lump we were after. Sir Lancelot had an upsetting habit of treating the owners of lumps as if they were already rendered unconscious by the anesthetic.
I drew a modest line over the lesion.
'Keyhole surgery!' said Sir Lancelot with contempt. 'Damnable! Give me the pencil!' He snatched it away. 'This, gentlemen, will be our incision.'
He drew a broad, decisive, red sweep from the patient's ribs to below his umbilicus.
'We will open the patient like that. Then we can have a good look inside. It's no good rummaging round an abdomen if you can't get your hand in comfortably. What do we do then? Right-take a better look at the lump we've been feeling. Do you think it's going to be easy to remove?' he asked me, gripping my arm again.
'No, sir.'
'Correct-it's going to be most difficult. And dangerous. There are at least a dozen ways in which we can make a slight error-even though we are experienced surgeons-and kill the patient like that!' He snapped his fingers frighteningly.
'Now!' He tapped the abdomen with his pencil as if knocking for admission. 'When we have cut through the skin what is the next structure we shall meet? Come on, you fellers. You've, done your anatomy more recently than I have…what's that? Yes, subcutaneous fat. Then, gentlemen, we first encounter the surgeon's worst enemy.' He glared at us all in turn. 'What?' he demanded in general. There was no reply. 'Blood!' he thundered.