Richard Gordon: DOCTOR IN THE HOUSE

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.'

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 after the watery lectures of his colleagues had evaporated.

His round was held every Tuesday morning at ten o'clock, and had the same effect on the ward as an admiral's inspection of a small warship.

The preparations for his visit began about five in the morning. The night nurses started the long business of sprucing up the ward to its best pitch of speckless sterility, and when Sister and her day staff arrived at seven the energy given to preparing the long room so that nothing in the slightest way offensive should fall on the great man's eye was increased tenfold. Every article in it was scrubbed and polished thoroughly-the floor, the medicine cupboards, the windows, the instruments, the patients' faces. The bedside lockers, which usually carried a friendly jumble of newspapers, soap, jam, football coupons, and barley-water, were stripped clean and their contents buried out of sight. Even the flowers looked sterile.

The tension and activity in the ward rose together, like the temperature and pulse in a fever. At nine the senior house-surgeon, in a fresh white jacket, looked in for a worried, whispered conversation with, Sister too be certain everything commanded on the Chief's last visit had been done. He didn't glance at the patients. That morning they were part ward furniture, or at most instruments by which the medical staff could demonstrate their abilities to Sir Lancelot.

There was one point, however, on which the patients could not be argued away from their humanity. At nine-fifteen bedpans were issued all round. The acquisition of one of these at such an hour (seven and five were the official times for their use) was usually a business comparable with catching the eye of a waiter in a busy restaurant. At nine-fifteen on Tuesdays, however, they were forced upon the patients. The nurses tripped briskly out of the sluice-room, each carrying a couple under a cloth. This was because Sister thought a request for one of these articles while Sir Lancelot was in the ward unreasonable to the highest degree-indeed, almost indecent.

The bedpans were whipped away a quarter of an hour before the Chief was due. There followed an energetic final ten minutes occupied by a process known as 'tidying' the patients. They could obviously not be allowed to disturb the general symmetry of the scene by lolling about in bed anyhow, like a squad of soldiers falling in with their hands in their pockets. They had to be fitted in to the ward neatly and unobtrusively. The technique was simple. A pair of nurses descended on the patient. First he was shot into the sitting position, and retained there by one nurse while the other smoothed and squared up his pillows (the open ends of the pillowcases always to face away from the door). He was then dropped gently on his back, so as not to ruffle the smooth surface unnecessarily with his head. The bedclothes were seized at the top by the two young women and pulled taut between them like a tug-of-war; they next applied the tension upwards from the patient's feet, which brought the top edge of the bedclothes level with the patient's nostrils. In one quick motion, without releasing the tension to which the blankets were submitted, they tucked them in firmly all round. This made it impossible for the occupant of the bed to perform any muscular movement whatever, except very shallow breathing.