We selected a sheet each. They were headed 'Instructions on Case-Taking for Students.'
'You may look at patients number five, eight, twelve, and twenty,' Sister Virtue went on sternly. 'You will replace the bedclothes neatly. You will always ask the staff nurse for a chaperon before examining any female patient below the head and neck. Kindly remember that I do not like students in my ward at all, but we are forced to put up with you.'
Her welcome finished, she spun round and sailed off to give a probationer hell for not dusting the window- ledges the correct way.
We silently crept through the doors and leant against the wall of the corridor outside to read the instruction papers. Grimsdyke was the only one to speak.
'I wonder if she goes to lunch on a broomstick?' he said.
I turned my thoughts to the typewritten paper. 'A careful history must be taken before the patient is examined,' I read. There followed a list of things to ask. It started off easily enough-'Name. Address. Age. Marital state. Occupation. For how long? Does he like it?' It continued with a detailed interrogation on the efficiency with which the patient performed every noticeable physiological function from coughing to coitus.
I turned the page over. The other side was headed 'Examination.' I read half-way down, but I was burning to try my luck on a real patient. I stuffed the paper in my pocket, like a child tossing aside the instructions for working a new complicated toy. I carefully put my nose inside the door and was relieved to find Sister had returned to her lair. I thought she was probably digesting someone.
Timidly I walked down the rows of beds to patient number twelve.
'Look where you're going!' a female voice said angrily in my ear.
I spun round. Behind me was a cross-looking nurse. She was young and not bad-looking, and she wore the bows and blue belt of a qualified staff nurse.
'Can't you see that floor has just been polished?' she demanded.
'I'm sorry,' I mumbled. She tossed her head and stalked off with a swish of starched apron.
Number twelve was a stout young blonde browning at the roots-a frequent condition in female wards. She was sitting up in bed in a green woollen jacket reading a book by Peter Cheyney.
'Good morning,' I said humbly, expecting she as well would attack me.
She immediately slipped a piece of paper in her book, set it down on her bedside locker, threw off her bedjacket, and dropped the top of her nightdress off her shoulders to reveal a large and not unpleasant bosom. Then she smiled.
'Good morning,' she said. She was obviously used to the routine.
I felt a little at a loss. I had never been in such circumstances before, anywhere.
'Er-do you mind if I examine you?' I asked diffidently.
'Go ahead,' she said invitingly, giving me a bigger smile.
'Thanks awfully.'
The experience was so unusual I couldn't think of anything to say. I groped for remembrance of the instructions, but the sheets in my mind's eye were as blank as the patient's counterpane. I felt like an after-dinner speaker who had risen to his feet and found he'd forgotten his notes. Then an idea rescued me unexpectedly-I would take her pulse. Seizing one wrist, I felt for the throbbing radial artery while I gazed with unseeing concentration at the face of my wrist-watch. I felt I had held her arm for five minutes or more, wondering what to do next. And all the time her gently heaving breasts kept tugging at my eyes. They fascinated me, not with any sexual appeal but alarmingly, as if they were a couple of dangerous snakes. I noticed they had fine drops of sweat on them near the nipples.
A thought exploded in my mind.
'I must fetch a nurse!' I exclaimed. I dropped her wrist as if she had smallpox. 'A chaperone, you know.'
She giggled.
'Oh, go on with you!' she said playfully.
I backed away quickly. A nurse undecorated with belts or bows was dusting a locker on the other side of the ward. She looked hearteningly junior.
'I wonder if you would kindly chaperone me with a patient for a few minutes?' I asked urgently.
'No!' she said. She paused in her dusting to glance at me. I must have looked so miserable a little pity glowed in her heart. 'Ask the junior probationer,' she suggested brusquely. 'It's her job. She's in the sluice-room cleaning the bedpans.'
I thanked her humbly and went to look for my help-meet. She was a worried-looking girl of about eighteen who was busy polishing a pile of metal bedpans as if they were the family silver.
'Will you please be my chaperone?' I asked meekly. She pushed a lock of straw-coloured hair out of her eyes wearily.
'I suppose so,' she said. 'If I have to.'
We went back into the ward together and gathered some screens round the stout blonde's bed. The probationer stood opposite me with a look of contempt on her face for my inexpert manipulations while I examined the blonde's tongue, her eyes, and her teeth. I stuck my stethoscope warily here and there on her chest, though the noises were as uninformative to my ears as the sound of sea on a distant shore.
Taking the earpieces out I said 'Good!' as if I had completed my diagnosis.
'Aren't you going to examine my tummy?' asked the blonde with disappointment. 'All the doctors examine my tummy. It's my tummy what's wrong.'
'To-morrow,' I said firmly. 'I have to go and operate.'
How could I tell her in front of the nurse I had not yet learned as far as the tummy?
Inspection, palpation, percussion, auscultation-the unalterable, ever-applicable tetrad. They were drummed into us like drill to recruits. Whatever part of the patient you examine, whatever disease you suspect, the four motions must be gone through in that order. You look first, then feel; when you have felt, you may tap, but not before; and last of all comes the stethoscope.
I began to learn how to look at a patient so that even the fingernails might shine with a dozen diagnoses. They taught us to feel lumps, livers, and spleens; how to percuss correctly and to understand the evasive murmurs transmitted through a stethoscope. Diagnosis is simple observation and applied logic-detection, in fact. A matter of searching for clues, igniting a suspicion and knowing where to look for proof. Conan Doyle modelled Sherlock Holmes on a physician, and the reverse holds perfectly well.
Dr. Maxworth took his firm round the ward every Wednesday morning. He was a thin, desiccated little man who had never been known to appear in public dressed in anything but black coat and striped trousers. He was not really interested in students at all. For most of the round he forgot we were crowding in his footsteps, and would suddenly recall our presence by throwing a few half-audible scraps of instruction over his shoulder, He was a specialist in neurology, the diseases of the nervous system. This is the purest and most academic branch of medicine and requires for its practice a mind capable of playing three games of chess simultaneously while filling in a couple of stiff crossword puzzles between the moves. As almost all the nervous diseases we saw in the ward appeared to be fatal, it seemed to me a pretty barren speciality. But Maxworth drew exquisite pleasure from it. He was not primarily concerned with treating his patients and making them better, but if he scored a diagnosis before the proof of the post-mortem he was delighted. He was, his houseman said, a fairly typical physician.
I began to see how the ward was managed by Sister, whom I avoided like a pile of radium. Every bodily occurrence that could be measured-the pulse, the amount of urine, the quantity of vomit, the number of baths-was carefully entered against the patient's name in the treatment book, which reduced the twenty or so humans in the ward to a daily row of figures in her aggressive handwriting.
There were two functions of the physiology which Sister thought proceeded wholly in her interest. One was temperature. The temperature charts shone neatly from the foot of the beds, and each showed a precise horizontal zigzag of different amplitude.' Sister wrote the dots and dashes on them herself every morning and evening. The temperatures were taken by the junior nurses, who used four or five thermometers. In spite of inaccuracies due to a different instrument being used daily on each patient and the varying impatience of the nurse to whip the glass spicule away, the figures were looked upon as indispensable. Any errors occurring through mercurial or human
