Within a week I discovered that medicine in the country is wholly different from medicine practised anywhere else. In the first place, most of the patients suffer from diseases totally unknown to medical science. At St Swithin’s I examined my patients confident that their condition could be found somewhere between the green morocco covers of French’s
Index of Diagnosis
; but in the country I puzzled over the significance of symptoms like horseshoes pressing on the head, larks in the stomach, and ferrets running up and down the spine at night. Even Dr Farquharson’s former diagnoses were obscured by the patient’s helpfully remembering the name, it taking me some time to recognize, for instance, that the woman complaining her child had been attacked by the infant tiger meant that he was suffering from impetigo.
Secondly, the visit of the medical attendant in most households provided less relief for the sufferer than entertainment for the rest of the family. The cry of ‘Coo! It’s the Doctor!’ brought children running from their corners as powerfully as the smell of baking cakes. Arriving in the sickroom, I found it difficult to place the fingertips together and demand with dignity, ‘And how about the bowels?’ when half a dozen small boys and girls were staring at me as though I were the hanging scene in a Punch-and-Judy show. When I insisted on having them shooed away they continued the enjoyment by taking turns to peer round the door, and my careful assessment of the pitch of a percussion note was often ruined by the awestruck whisper passing down the corridor, ‘He’s punching poor mummy all over the chest.’
In houses where there were no children, the patients reflected the more leisurely life of the country by using their attack of gastritis or summer flu to give the doctor a résumé of their life story and their opinions on their relatives. A brisk ‘Good morning! And what can I do for you?’ as I approached the bedside generally brought a contemplative folding of hands across the abdomen, a faraway look, a deep sigh, and the reply, ‘Well, Doctor, in the 1914–18 war I was standing in a trench at Vimy…’ or, ‘I haven’t been the same, Doctor, since that night me ’usband joined the Buffaloes…’
When I mentioned these discoveries to Farquharson after supper one evening, he said, ‘Oh, folk need to unburden themselves a bit. They don’t like boring their friends, and their relatives won’t listen to ’em any more. They’re scared of the parson, so the doctor’s the only one left they can pour their hearts out to.’ He began to scrape out the bowl of his pipe with a scalpel he kept on the mantelpiece. ‘I’ve got old-fashioned ideas, but that seems to me part of the doctor’s job. That’s something they never took into account when they got up this Health Service. Bloody silly, isn’t it? Ask any GP, and he’ll tell you half his job is sympathizing with people, and that’s ten times as difficult as treating ’em. Did you use the thermometer?’
‘I couldn’t – there’s only one in the surgery, and it’s broken.’
‘It’s broken all right. If I can’t tell when a patient’s feverish, I’m not much of a doctor. But shove it under their tongue, lad, and you’ve shut ’em up as long as you like. Or you can stick your stethoscope in your ears – it’s not much good for anything else round here, because half of ’em think they’ll drop dead if they take their vests off. Or you can take their pulse and scowl at ’em while you wonder what the devil’s the matter.
That
shuts ’em up good and proper. You don’t even need a watch. I couldn’t afford a watch when I qualified, so I used to stare at my cupped hand instead, and nobody found out for eighteen months.
‘As for the audience, always give ’em something to do. The public loves to see the vomit coming up or the baby coming down, but they love it even better playing the nurse. Get them to boil water – pots of it. When there aren’t any saucepans left you can always start them tearing up the best sheets for bandages.’ He lit his pipe, and went on reflectively, ‘Never start off by asking a patient, “What are you complaining of?” They’ll say, “I’ll have you know I’m not the complaining type, not like some I could mention,’ and start some rigmarole about their sister-in-law who’s been living with them since Christmas. Don’t try “What’s wrong with you?” because they like scoring one over the doctor and they’ll reply, “I thought that was what you were here to find out.” That starts the consultation on the wrong foot. And never ask, “What brought you here?” because ten to one they’ll tell you the tram or the ambulance. Always listen to a patient’s story, however long it is and however much you want your dinner. Usually they’ve come about something quite different, and they’re too embarrassed or too scared to bring it out. And always give ’em a bottle of medicine, even if you and the whole Pharmaceutical Society know it’s useless – even a straw’s a comfort to a drowning man. Never tell them they’re an “interesting case.” Patients have got enough sense to know the only interesting cases are the ones we don’t know anything about.
‘You can diagnose half your patients as soon as you step through their front door, with a bit of practice. Brass gongs on the wall and tiger skins on the floor mean high blood pressure. Box of chocolates on the piano and a Pekinese on the mat – that’s obesity. Bills on the dresser and cigarette ash on the parlour carpet look like a duodenal ulcer upstairs. I’ve found aspidistras and antimacassars generally go with constipation. It’s common sense. If you keep your eyes open you won’t need the curate’s legs sticking from under the bed to spot a case of female frustration. And never be squeamish asking about insanity in the relatives. I always start off, “How many in the asylum?” and you’d be surprised at the answers I get, even in the best families. But I’m rambling,’ he said apologetically. ‘You talk for a change. Seen any good cases today?’
‘There was an unusual psychiatric one. A farmer came in complaining that he experienced a strong sexual sensation every time he blew his nose.’
Farquharson stared at his burning tobacco. ‘Well, now, that is interesting. What did you say?’
‘Nothing much. I’m not well up in psychiatry. What would you have done?’
‘I should have told him,’ said Farquharson without hesitation, ‘that some people get all the luck.’
For the first time it occurred to me that Dr Farquharson knew much more medicine than I did.
During my month in the practice I gained six pounds in weight, took on a deep sunburn, and learned more practical physic from Farquharson than I had gained from the whole staff of St Swithin’s. The remaining gaps in my education were completed by the village constable, who was the fattest policeman outside pantomime, and seemed to have the single duty of supervising the nightly closing of the Four Horseshoes from the inside. After a pint or two he would unbutton his tunic and solemnly recount the medico-legal history of the countryside. ‘It was but a year ago, as I recall,’ he would begin with the air of a surgeon discussing a grave case with a colleague, ‘that we had an indecency down at Smith’s farm.’ He frowned as he took some more beer. ‘I can’t remember offhand whether it was a
gross
indecency, or just an ordinary one. But you’d be surprised what goes on round ’ere, Doctor. Why, we gets at least an indecent exposure once a week.’ He continued to describe some of his recent cases in the odd anatomical terms used only by the police force. ‘Mind you, it’s hard work, Doctor,’ he added proudly. ‘You’ve got to be sure of your facts. It was only at the last Assizes there was an ’ell of a row because we had a case concerning a mare, and the barrister got hold of the idea it was one with a gold chain round his neck what we meant.’
A few days before I was due to leave, Grimsdyke paid a visit.
It was clear at once that he had enjoyed a change of fortune. He roared up in a bright sports car, he wore a new tweed coat and a clean waistcoat, his shoes shone, his face was plumper and better shaved, his hair was tidy, and he had a brand new monocle with a fine sparkle to it. He carried a pair of yellow gloves, and a bulldog puppy leapt at his heels. He looked like the young squire after a good day at the races.
Although Farquharson began by asking him how the devil he had got qualified and when was he going to start a decent job of work, Grimsdyke still seemed to imagine himself the favourite nephew. Only when his uncle’s conversation had been reduced to a string of grunts he suggested the pair of us went out to the Four Horseshoes.
‘The market seems to be doing well of late,’ I observed, as we entered the bar.
‘The market? Oh, yes, yes, of course. It’s buoyant. By the way, I believe there’s a few bob I owe you. Care for it now? Don’t mind taking fivers, do you, it’s all I’ve got? Cigarette – I suppose you like these black Russian things? Now let’s have a drink. What can I get you?’
‘A pint of bitter.’
‘Beer? Nonsense! We’ll have champagne! This is an occasion – the beginning of a great medical partnership. You know, Banting and Best, Florey and Fleming, Orth and Pettenkofer, and all that. I’ll explain in a minute. Landlord! Your best vintage!’
The effect was lessened by the landlord of the Four Horseshoes having only a beer licence, so we had some Special Christmas Brew instead.
‘Now what is all this,’ I began firmly, wondering what trouble Grimsdyke was concocting for me and determined to stay clear of it.
‘Have you had a go at the Primary yet?’ he interrupted.
‘Yes. The examiners were very undiscerning.’
‘If you must wear a hair shirt,’ he said chidingly, ‘you deserve to be tickled. Didn’t you find out where they printed the examination papers? Some of these printer chaps’ll do anything for a few quid.’
‘I thought I’d better fail honestly, at least.’
‘Quite right. I’ve been a great believer in professional honesty myself since old Moronic Maurice told me how he got through his surgical finals. At about the eighth shot, I might add. You know those cases they get up for the exam – all the old chronics, the harvest of every outpatient’s department in London. Maurice spent a couple of months nosing around the teaching hospitals until he was pretty confident he’d seen all the old familiar faces. Of course, he sneaked a bloody good look at their notes to see what was wrong. He went into the exam room knowing he’d already examined and diagnosed every case in the place, which he said gave him a wonderful feeling of confidence.’
‘There’s nothing very honest about that.’
‘But wait a minute. The examiner grabbed him by the sleeve, and to his horror started dragging Moronic Maurice towards the one patient in the place he didn’t recognize. Maurice realized it was the moment for honesty. “Sir,” he said solemnly, “I feel I must inform you that I have already had an opportunity to examine this particular case in the hospital.” “Very truthful of you, my lad,” the old boy said. “Come and have a look at one of these over here instead.” So he got through.’
‘Quite. Now if you’ll explain what new villainy you’re up to–’
‘By the way, I forgot to mention we’re both out of debt to that trio of sabre-toothed tigers Wilson, Willowick, and Wellbeloved.’
‘Both?’
‘I strode in there the other day to fling their filthy lucre in their faces. It was such a pleasant experience I flung a bit more for you, too. Here are the IOUs. We might have a pretty little ceremony burning them in the Piccadilly Bar, don’t you think?’
‘Look here,’ I said in alarm. ‘You’re not doing anything dishonest, are you? I mean, false certificates and abortions and things?’
Grimsdyke looked pained. ‘Have you ever known me try anything underhand outside the examination hall? No, old lad, it’s simple. I’ll let you into the secret. Through family influence, I’ve got myself a good job. Personal doctor to old Lady Howkins – you know, widow of the bloke who grabbed half Johannesburg and has been digging up useful little bits of gold ever since. She lives in a ruddy great house near Gloucester. She’s as mean as a tax collector in the usual way, but she’s pretty lavish with the cash to yours truly–’
‘You mean you’re a sort of clinical gigolo?’
Grimsdyke slapped down his glass in annoyance. ‘Damn it, I pay your bloody debts–’
‘I’m sorry. But you must admit it looks fishy on the face of it. Even you wouldn’t admit you’re a second Lord Horder.’
‘Look, Lady Howkins is ninety-four, and to my mind as crazy as a coot. But fortunately, like my grandmother, she’s crazy about doctors. All I do is recite to her the miracles of modern medicine, some of which I know and some of which I mug up in the
Reader’s Digest
, and she thinks it’s wonderful. She’s fascinated by technical stuff. She knows more about things like isotopes and gastroscopes than I do. And she’s bound to kick the bucket any day now.’
‘And you’ll be out of a job.’
‘Yes, and no. I have it on good authority she’s left me a terrific packet in her will. Think of it, old lad! Thousands of quid in the kitty, tax-free just like the football pools! And that’s where you come in. I thought we might go off for a nose round the Bahamas or somewhere, and set up a little clinic for tired newspaper owners, film stars, and so forth. You’d do the medicine, with your Park Lane touch, and I’d fix the business side – you must admit, even though I may not know an appendix from an adenoid, I’ve a sharp eye for juggling the cash. What do you say?’
‘Say? Damn it, this is a bit startling–’
‘Think it over. Coming to the hospital dinner next month?’
I nodded.
‘We’ll discuss it again then. Don’t think you’re going to use ill-gotten gains, old lad, because they’re not. I dance attendance like any other GP, and call in specialists to the old dear as needed. If it wasn’t for me she might be shared by dozens of Harley Street sharks. Lots of people leave money to their doctors, anyway. Must be damn brave,’ he added reflectively. ‘Have another?’
I shook my head. ‘I’ve got to see some patients. One thing I’ve learned in general practice, if you smell faintly of alcohol just once, the word goes round by next morning that the doctor’s a drunkard.’
‘Have one of these,’ Grimsdyke said, producing a tube of tablets. ‘Chlorophyll removes all unpleasant odours. Fools patients and policemen alike.’
‘Don’t delude yourself. The goats round here eat it all day, and you should have a sniff at them.’
The St Swithin’s reunion dinner was held every year in the Moorish Room of a huge banquet factory off Piccadilly Circus, and was anticipated by most of the guests as eagerly as Christmas in an orphanage. The majority of St Swithin’s graduates were hardworking GPs scattered across the country, who faced ruin by being seen in the local pub or having more than two small ones in the golf club; the reunion dinner was their only chance to shed their inhibitions and splash for a while in the delightful anonymity of London.
I had arranged to meet Grimsdyke in the Piccadilly Bar before the dinner, which was five weeks later. He arrived in a new dinner jacket with a red carnation in the buttonhole, smoking a cigar and looking jubilant.
‘Well, old lad?’ he demanded at once. ‘Have you decided?’
‘I’ve thought the matter over very carefully,’ I told him. ‘I must admit I’m a bit scared of the scheme, but my present system of casual employment is precarious, and I see no future for myself anywhere in England as a surgeon. So I’ll come with you.’
‘Capital!’
‘The only snag seems to be that this patient of yours might quite easily live to be a hundred, and by that time will certainly have found out that you are simply an unprincipled–’
‘But haven’t you heard, old lad? Haven’t you heard? The old dear snuffed it last week. Frightful pity of course, but who wants to live longer than ninety-four? And look at this–’ He pulled a long letter from his pocket, typed on solicitor’s paper. ‘It came this morning – ten thousand quid! Ten thousand! Think of it! All for yours truly. Don’t bother to read it all now, it’s full of legal stuff. Shove it in your pocket. What an evening we’re going to have! Barman! Champagne – the best in the house!’
We arrived in high spirits at the dinner, and found the Byzantine anteroom full of prosperous-looking middle-aged gentlemen in dinner jackets, all drinking like pirates. The function always followed a strict ritual, and at eight o’clock the Dean himself climbed on a table and announced that dinner was served. This was a signal for the middle-aged gentlemen to cry ‘Limerick! Limerick!’ until the Dean coughed, and obliged tradition by reciting in his lecture-room voice:
‘Ah – There was an old man of Manchuria
Who had the most painful dysuria.
The unfortunate chap
Had not only got clap
But haematoporphynuria.’
This brought the house down.
Grimsdyke and myself, with our old friends Tony Benskin and Taffy Evans, sat round the foot of one table with Mr Hubert Cambridge, who was one of the most popular of St Swithin’s surgeons through being entertainingly eccentric. While the waiter with the chronic sinusitis was serving the chemical soup, Grimsdyke insisted on ordering champagne for all five of us.
‘But my dear boy, can you afford it?’ Mr Cambridge asked. ‘I assure you that pale ale is good enough for me.’
‘Sir,’ Grimsdyke said solemnly, ‘it is a token of our appreciation of your tuition at St Swithin’s. Within an hour the champagne will be carbon dioxide and water – but your teaching will remain with us all our lives.’
‘And the Dean says the standard of our students is dropping!’ he said, rubbing his hands. ‘Tell me, what are the names of your excellent young men?’
After the soup came the mummified turbot, wearing its funeral wreath of shrivelled shrimps; next, the poor arthritic chicken, the devitaminized cabbage, the vulcanized potatoes; then the deliquescent ice and the strange compost on toast. Afterwards, we faced with British composure the stern British discipline which emphasizes that life is not all feasting and gaiety – the speeches. They were always long at the St Swithin’s dinner, because the speakers were in the habit of lecturing for a full hour at a time to their students without fear of interruption. First the Dean told us what jolly good chaps St Swithin’s men were; then the visiting medical Lord told us what a jolly good chap the Dean was; then the Senior Surgeon told us what jolly good chaps everyone was. After that we were released into the Gothic Smoking-Room to sing the old student songs, while the Dean played the piano and the visiting Lord conducted with a loaf of French bread. We sang the unfortunate adventures of The Baker’s Boy Who to the Chandler’s Went, The Honest Woman and the Rogue, The Man Who Went Fishing With Line and Rod, and of the wildly psychopathic evening in Kirriemuir. It was difficult to see anyone in the room ever gripping their lapels and declaring, ‘No starchy foods, no alcohol, and no smoking – the human body’s not a machine, y’know.’ But all of them would be saying it tomorrow morning, sterner than ever.
In the excitement of the evening I had almost forgotten that I was committed to an alarming medico-commercial adventure. I was paying the waiter for a round of drinks when Grimsdyke’s letter fell from my pocket. Concentrating, I began to read it in the light of one of the Tudor wall lanterns.
Grimsdyke had just reached the top note in the St Swithin’s version of ‘She Was Poor But She Was Honest,’ when I drew him carefully to one side.
‘Are you sure you’ve read this letter through?’ I asked.
‘Of course I’ve read it,’ he said crossly. ‘Every word. All that guff about my being a dedicated young physician and all that.’
I nodded. ‘Perhaps you’d better look at the last line again.’
‘Last line? What are you up to, old lad? Some sort of joke?’ He took the letter. ‘It looks absolutely straightforward to me – “In recognition of your devoted service bequeaths to you the sum of ten thousand pounds–”’ His voice trailed off. Like a man uttering his last words while suffering death in the garrotte he finished the sentence: ‘“…for you to donate in its entirety within six months to the hospital performing medical research you consider the most rewarding.”’
The letter fell to the floor.
‘Hard luck, Grim,’ I said sorrowfully. I summoned a waiter. ‘You’d better swallow the rest of that tube of chlorophyll.’