and masked, leant reflectively on a sort of towel rail used for counting the swabs, and another strode in with a fresh cylinder of oxygen on his shoulder. The only indication that there was a patient present at all was a pair of feet in thick, coarse-knitted bed-socks that stuck pathetically from one end of the audience.
As soon as Sir Lancelot spoke, the group round the table opened as if he were Aladdin at the mouth of his cave. I walked unhappily into the centre. My companions closed tightly behind me, and I found myself wedged against the table opposite Sir Lancelot with a man who played in the second row of the hospital forwards immediately behind me. Escape was therefore out of the question, on physical as well as moral grounds.
The operation was on the point of starting. The patient was still invisible, as the body was covered with sterile towels except for a clean-shaved strip of lower abdomen on the right-hand side of which the operating light was focused diagnostically. I couldn't even see if it was a young man or a woman.
Having forced me into a ringside seat, Sir Lancelot then appeared to dismiss me from his mind. He paused to adjust the cuff of the rubber glove that stretched over his bony hand. Stubbins and Crate were waiting with gauze dabs, and the theatre sister was threading needles with catgut as unconcernedly as if she was going to darn her stockings.
'Stubbins,' said Sir Lancelot chattily, making a three-inch incision over the appendix, 'remind me to look into Fortnum's on my way home, there's a good lad. My missus'll give me hell if I forget her dried ginger again. I suppose it was all right for me to start?' he asked the anaesthetist.
The
I was surprised. Dried ginger in an operating theatre?
Shopping lists disturbing the sanctity of surgery? And the _Daily Telegraph?_
'I've got a damn funny story to tell you lads,' went on Sir Lancelot affably, deepening his incision. 'Make you all laugh. Happened to me last week. An old lady turned up in my rooms in Harley Street…Sister!' he exclaimed in a tone of sudden annoyance, 'do you expect me to operate with a jam-spreader? This knife's a disgrace.'
He threw it on the floor. Without looking at him she handed him another.
'That's better,' Sir Lancelot growled. Then, in his previous tone, as though he were two people making conversation, he went on: 'Where was I? Oh yes, the old lady. Well, she said she'd come to see me on the advice of Lord-Lord Someoneorother, I can't remember these damn titles-whom I'd operated on last year. She said she was convinced she'd got gallstones.
'Now look here, Stubbins, can't you and Crate keep out of each other's way? Your job is to use that gauze swab sensibly, not wave it around like a Salvation Army banner. How the devil do you think I can operate properly if everything's wallowing in blood? Why am I always cursed with assistants who have a couple of left hands? And I want a clip, Sister. Hurry up, woman, I can't wait all night!'
Sir Lancelot had cut through the abdominal wall while he was talking, like a child impatient to see inside a Christmas parcel.
'Well,' he went on, all affability again, seemingly conducting the operation with the concentration of a gossipy woman knitting a pair of socks, 'I said to this old lady, 'Gallstones, eh? Now, my dear, what makes you think you've got gallstones?' And I've never seen anyone look so embarrassed in my life!'
He returned to the operation.
'What's this structure, gentlemen?'
A reply came from under a student's mask on the edge of the crowd.
'Quite correct, whoever you are,' said Sir Lancelot, but without any congratulation in his voice. 'Glad to see you fellers remember a little fundamental anatomy from your two years in the rooms…so I wondered what was up. After all, patients don't get embarrassed over gallstones. It's only piles and things like that, and even then it's never the old ladies who are coy but the tough young men. Remember that bit of advice, gentlemen…Come on, Stubbins, wake up! You're as useless as an udder on a bull.'
He produced the appendix from the wound like a bird pulling a worm from the ground, and laid it and the attached intestine on a little square of gauze.
'Then the old lady said to me, 'As a matter of fact, Sir Lancelot, I've been passing them all month…', Don't lean on the patient, Stubbins! If I'm not tired you shouldn't be, and I can give you forty or fifty years, my lad.
'So now we come to the interesting part of the story. She showed me a little box, like those things you send out pieces of wedding cake in…Sister! What in the name of God are you threading your needles with? This isn't catgut, it's rope. What's that, woman?' He leant the red ear that stuck out below his cap towards her. 'Speak up, don't mutter to yourself. I'm not being rude, damn you! I'm never rude in the theatre. All right, tell your Matron, but give us a decent ligature. That's more like it. Swab, man, swab. Stubbins, did I ever tell you about the Matron when, she was a junior theatre nurse? She had a terrible crush on a fellow house-surgeon of mine-chap called Bungo Ross, used to drink like a fish and a devil for the women. Became a respected G.P. in Bognor or somewhere. Died last year. I wrote a damn good obituary for him in the _British Medical Journal._ I'm tying off the appendicular artery, gentlemen. See? What's that, Stubbins? Oh, the old lady. Cherry stones.'
He tossed the appendix into a small enamel bowl held for him by Stubbins.
'Looks a bit blue this end, George,' he said in the direction of the anaesthetist. 'All right, I suppose?' The anaesthetist was at the time in the corner of the theatre talking earnestly to one of the nurses who had been serving out the instruments. Theatre kit is unfair to nurses; it makes them look like white bundles. But one could tell from the rough shape of this one, from the little black-stockinged ankles below her gown and the two wide eyes above her mask, that the parcel would be worth the unwrapping. The anaesthetist jumped back to his trolley and began to twiddle the knobs on it. Sister, who was already in a wild temper, injected the nurse with a glance like a syringeful of strychnine.
'Forceps, Sister!' bellowed Sir Lancelot. She handed him a pair which he looked at closely, snapping them together in front of his mask. For some reason they displeased him, so he threw them over the heads of the crowd at the opposite wall. This caused no surprise to anyone, and seemed to be one of his usual habits. She calmly handed him another pair.
'Swabs correct, Sister, before I close? Good. Terribly important that, gentlemen. Once you've left a swab inside a patient you're finished for life. Courts, damages, newspapers, and all that sort of thing. It's the only disaster in surgery the blasted public thinks it knows anything about. Cut their throats when they're under the anaesthetic, yes, but leave anything inside and you're in the _News of the World_ in no time. Shove in the skin stitches, Stubbins. What's the next case? Tea? Excellent. Operating always makes me thirsty.'
7
During the following three months I learnt a little about surgery and a lot about surgeons. I learnt more than I wanted about Sir Lancelot. In the theatre he was God. Everything in the routine for operating sessions was arranged to suit his convenience. A white linen suit, freshly starched, was carefully warmed by the junior nurse before being laid out in his changing-room in the morning. A Thermos pitcher of iced water labelled 'Sir Lancelot Spratt ONLY' was set on a silver tray nearby. He had his own masks, his own scrubbing brush, and his own soap. When he crossed the theatre floor from the scrub-up basins to the table the onlookers scattered before him like unarmed infantry in front of a tank. If anyone got in his way he simply kicked them out of it. He rarely asked for an instrument but expected the Sister to guess which one to place in his waiting hand. If she made a mistake, he calmly dropped the wrong instrument on to the floor. Should she do no better at her second attempt he repeated his little trick. Once he silently reduced a whole trayful of instruments to an unsterile heap at his feet, and the Sister had hysterics.
Sir Lancelot had a personality like an avalanche and a downright bedside manner that suited equally well a duchess's bedroom or the hospital out-patient department. He radiated confidence like a lighthouse through a storm. His suggestions on the removal of his patients' organs never met with their objection. The more he did to them, the greater the complications that resulted from his interference, the larger the number of supplementary operations he had to perform to retrieve his errors, the more they thanked him: there was never one but died grateful.
His teaching in the ward, like his surgery in the theatre, was full-blooded. He had a long string of aphorisms and surgical anecdotes, none of which was original or strictly accurate, but they stuck in the minds of his students long
