failings were not of great importance, however, because Sister always substituted figures of her own if the ones returned by the patient did not fit with her notion of what the temperature in the case ought to be.
The other particular concern of the Sister was the patient's bowels. A nurse was sent round the ward every evening with a special book to ask how many times each inmate had performed during the past twenty-four hours. 'How many for the book?' she would enquire with charming coyness. The patients caught the spirit of the thing, and those returning fair scores to the nurse did so with a proud ring in their voices but anyone making a duck confessed with shame and cowered under the bedclothes.
The number of occasions was written in a separate square at the foot of the temperature chart. A nought was regarded by Sister as unpleasant, and more than two blank days she took as a personal insult. Treatment was simple. One nought was allowed to pass without punishment, but two automatically meant cascara, three castor oil, and four the supreme penalty of an enema.
We rapidly became accustomed to our position of inferiority to everyone on the ward staff. Like all apprentices, the students were used as cheap labour by their superiors. We did all the medical chores-urine-testing, gruel meals in patients with duodenal ulcers, blood samples, and a few simple investigations. For the first few weeks everything seemed easy. It was only at the end of the three-month appointment that there crept up on me an uneasy certainty that I did not yet even know enough to realize how ignorant I was.
6
The impact of surgery on the student is likely to be more dramatic than the first gentle touch of medicine. Although surgeons have now abandoned such playful habits as hurling a freshly amputated leg at a newcomer in the theatre, the warm, humid atmosphere, the sight of blood spilt with apparent carelessness, and the first view of human intestines laid out like a string of new sausages sometimes induces in a student a fit of the vapours-a misfortune which draws from his unaffected companions the meagre sympathy afforded a seasick midshipman.
Nevertheless, I started the surgical course with a feeling of superiority over my predecessors of ten or fifteen years ago. As I went to the pictures fairly regularly I was already as familiar with the inside of an operating theatre as with my father's consulting room.
From a seat in the local cinema not only myself but most other people in the country had achieved a thorough and painless knowledge of what went on behind the doors marked 'Sterile.' I was ready for it all: the crisp white gowns; the cool, unhurried efficiency; the tense concentrated silence broken only by the click of instruments, a curt word of command from the surgeon, or a snapped-out demand for a fresh ligature by the theatre sister. I prepared myself to face the solemnity of an operation, with the attention of everyone in the room focused on the unconscious patient like the strong beam of the operating spotlight.
I was attached to Sir Lancelot Spratt for my surgical teaching. My official title was Sir Lancelot's dresser, which meant not that I had to help him into his white operating trousers in the surgeons' changing-room, but that I was supposed to be responsible for the daily dressings of three or four patients in the ward. The name had a pleasing dignity about it and suggested the student really did something useful in the hospital instead, as it was always impressed on him by the nurses and houseman, of getting in everyone's way like a playful kitten.
The appointment of Sir Lancelot's firm was something of an honour, as he was the Senior Surgeon of the hospital and one of its best-known figures. He was a tall, bony, red-faced man with a bald head round which a ring of white fluffy hair hung like clouds at a mountain top. He was always perfectly shaved and manicured and wore suits cut with considerably more skill than many of his own incisions. He was on the point of retiring from the surgical battlefield on which he had won and lost (with equal profit) so many spectacular actions, and he was always referred to by his colleagues in after-dinner speeches and the like as 'a surgeon of the grand old school.' In private they gave him the less charming but equivalent epithet of 'that bloody old butcher.' His students were fortunate in witnessing operations in his theatre of an extent and originality never seen elsewhere. Nothing was too big for him to cut out, and no viscus, once he had formed an impression it was exercising some indefinite malign influence on the patient, would remain for longer than a week _in situ._
Sir Lancelot represented a generation of colourful, energetic surgeons that, like fulminating cases of scarlet fever, are rarely seen in hospital wards to-day. He inherited the professional aggression of Liston, Paget, Percival Pott, and Moynihan, for he was trained in the days when the surgeon's slickness was the only hope of the patient's recovery, the days before complicated anaesthetics, penicillin, blood-transfusion, and the other paraphernalia of modern surgery had watered down the operator's skill and threatened to submerge him completely.
Sir Lancelot had made a fortune, chiefly from the distressing complaints of old gentlemen, and was charging two hundred guineas for an appendicectomy while Aneurin Bevan was still thumping a local tub in Ebbw Vale. His real success started in the 'twenties, when he earned his knighthood by performing a small but essential operation on a cabinet minister that allowed him to take his seat in the House with greater ease. The minister was delighted, and recommended him in every drawing-room of importance in London. Just at that time Sir Lancelot got it into his head that rheumatism could be cured by the removal from the body of all organs not strictly necessary for the continuance of life. As most people over the age of fifty have rheumatism and it is impossible to make it much better or much worse with any form of treatment his practice increased tenfold overnight.
The rheumatism rage lasted long enough for him to buy a house in Harley Street, a country home on the Thames, a cottage in Sussex, a small sailing yacht, and a new Rolls, in which he was still wafted round between the four of them and the hospital. By then he was ready to operate on anything-he was, he told his dressers with pride, one of the last of the general surgeons. He claimed to be capable of removing a stomach or a pair of tonsils with equal success, or to be able to cut off a leg or a lung.
Every Tuesday and Thursday afternoon he operated in his own theatre on the top floor. The list for the session was pinned up outside like a music-hall bill-the best cases were always at the top for Sir Lancelot to operate on himself, and the programme degenerated into a string of such minor surgical chores as the repair of hernias and the removal of varicose veins, to be done by his assistants when he had gone off to his club for a glass of sherry before dinner.
On the first Tuesday after my appointment to the firm I walked up the stairs to the theatre-students were not allowed to use the hospital lift-and went into the dressers' changing-room. A row of jackets and ties hung under a notice in letters three inches high: DO NOT LEAVE ANYTHING IN YOUR POCKETS. Everyone entering the theatre had to wear sterile clothing, which was packed away in three metal bins opened by foot pedals. Using a pair of long sterile forceps I took an oblong cap from one, a mask from another, and a rolled white gown from the third. Unfortunately there was no indication of the size of these coverings, and the gown fell round my feet like a bridal dress while the cap perched on my head like a cherry on a dish of ice-cream. I pushed open the theatre door and stepped inside reverently, like a tourist entering a cathedral. Standing by the door, my hands clasped tightly behind me, all I wanted was completely to escape notice. I felt that even my breathing, which sounded in my ears like the bellows of a church organ, would disturb the sterile, noiseless efficiency of the place. I was also a little uncertain of my reactions to cut flesh and wanted to keep as far away from the scene of activity as possible.
'You, boy!'
Sir Lancelot's head popped above the caps of his attendants. All I could see of him was a single brown, bushy strip that separated the top of his mask and the edge of his cap, through which there glared two unfriendly eyes like a hungry tiger inspecting a native through the undergrowth.
'Come over here,' he shouted. 'How often have I got to tell you young fellers you can't learn surgery from the door-post?'
The operating table was in the centre of the bare, tiled room, directly under the wide lamp that hung like a huge inverted saucer from the ceiling. It was completely invisible, as about twenty figures in white gowns were packed round it like tube passengers in the rush-hour. These were mostly students. The operating team was made up of Sir Lancelot himself, who was a head higher than anyone else in the room; his theatre Sister, masked and with all her hair carefully tucked into a sterile white turban, standing on a little platform beside him; his senior houseman, Mr. Stubbins, and his registrar, Mr. Crate, assisting him from the opposite side; and his anaesthetist, sitting on a small metal piano stool beside a chromium-plated barrow of apparatus at the head of the table, reading the _Daily Telegraph._ On the outskirts of this scrum two nurses in sterile clothes dashed round anxiously, dishing out hot sterilized instruments from small metal bowls like waiters serving spaghetti. A theatre porter, also gowned
