Richard Gordon: DOCTOR IN THE HOUSE

The department was run chiefly by the hospital porters. These were an invaluable body of men, without whom the work of the hospital would immediately have come to a standstill. They were experts at such common tasks beyond the ability of the doctors as directing patients to the correct department, holding down drunks, putting on strait jackets, dealing tactfully with the police, getting rid of unwanted relatives, and finding cups of tea at impossible hours. They stood, in their red and blue livery, inspecting with experienced Cockney shrewdness the humanity that daily passed in large numbers under their noses.

As soon as a patient entered the building he came up against a porter-a fat one sitting on a stool behind a high desk, like a sergeant in the charge-room of a police station.

'What's up, chum?' the porter demanded.

The patient would begin to mumble out his leading symptoms, but he would be cut short with 'Surgical, you,' or 'Throat department,' or the name of the appropriate clinic. The porters were the best diagnosticians in the hospital. They unerringly divided the cases into medical and surgical so that the patients arrived in front of the correct specialist. If a porter had made a mistake and consigned, for instance, a case of bronchitis to the surgical side, the complications that would have arisen and the disaster that might have overtaken the patient were beyond speculation.

After passing the porter the patient visited the counter to collect his case notes. St. Swithin's kept faithful records of its visitors, and several residents of the district had been neatly represented by a green folder containing the obstetrical notes of his birth, an account of the removal of his tonsils, the surgical description of the repair of his hernias, a record of his mounting blood pressure, and details of the postmortem following the final complaint that carried him off. Clutching his folder in one hand, he took his place at the end of the queue seated outside the door of his clinic. The queue shifted up the wooden seat as each patient was called inside by the stern-faced nurse at the door: the movement was slow and spasmodic, like the stirrings of a sleepy snake.

For the first half-hour the patient amused himself by reading carefully through his folder of confidential notes, comparing in his mind what the doctors had written about him with what they told him to his face. After a while this became boring, so he read the morning paper. When he had exhausted the paper, he passed the remainder of the time in clinical discussion with his neighbours. This was the most attractive part of the visit, and a pleasure he had been storing up for himself.

Discussion of one's illness with neighbours on the bench was done with pride: the patients wore their symptoms like a row of campaign medals.

'Wot you in for, cock?' he began to the man next to him.

''Art trouble,' was the reply, delivered with gloomy zest.

'Anyfink else?'

'That's enough, ain't it?' replied the neighbour sharply. "Ow about you?'

'The doctor says I am a walking pathological museum.' The patient rolled the syllables off his tongue deliberately.

'Go on!'

'I've got diabetes mellitus, 'emeroids, normocytic anaemia, chronic bronchitis and emphysema, 'ammer toe, cholecystitis, and an over-active thyroid.'

'That's a packet, all right,' his neighbour admitted grudgingly.

'And I 'eard 'im say I've got a positive Wasserman, too!' he added in triumph.

''Ave you 'ad any operations?' inquired a thin woman on the other side of him in a voice rich with misery.

'Not to date, touch wood, I 'aven't.'

The woman gave a loud sigh.

'I wish as I could say the same,' she remarked, shaking her head sadly.

''Ow many 'ave you 'ad, missus?' asked the patient, anxious over his own record.

'Fifteen,' she told him, in tones of exquisite martyrdom.

'Coo! I'm glad I 'aven't got your complaint.'

'That's the trouble. They don't know wot's wrong with me. The last time they took out my colon. The doctor said it was the worst they'd ever 'ad in the 'ospital. Took them four and a 'arf hours, it did. Then they 'ad to leave some of it behind. I'm lucky to be 'ere now, if you ask me.'

'Must have been a bad do,' the patient said, respectful of such exuberant pathology.

'Bad do! I was left to die four times!'

'Oo's your doctor, missus?'

'Mr. Cambridge. Wot a lovely man! 'E's got such soft 'ands.'

I soon discovered another peculiarity of out-patient work. In the wards the patients are all ill: in outpatients' they are nearly all healthy. Men and women with organic disease formed a small fraction of the hundreds who came past the fat porter at the door every day. Most of them complained of vague aches and pains that they had been trotting up to the surgeries of their own doctors for several months, and they, poor men, had got rid of them temporarily by handing them a note to St. Swithin's. This was an example of an established medical practice known as snag-shifting, which went on just as actively in St. Swithin's itself.

The most usual condition in out-patients' was headache, which was slightly more common than troubles of the poor feet, giddy spells, the rheumatics, and insomnia ('Not a wink for forty years, doctor'). Most of the symptoms were manifestly incompatible with life if they had existed, but every patient had to be investigated in case something sinister lay beneath. This provided an excellent opportunity for snag-shifting. A persistent patient with headaches could, with a few strokes of the pen, be transferred to the eye department. It simply needed the houseman to scribble 'Headaches. Any eye signs?' on the notes and the patient moved to another queue outside another doctor's door. After the eye department had found nothing and were tired of the fellow appearing in front of them week after week they sent him to the throat clinic. The throat surgeons usually operated on all their patients and would probably remove his tonsils or the inside of his sinuses; when he continued to attend with his headaches afterwards, they would pack him off to the general surgeons with the suggestion his complaint was the result of sepsis lurking in his gall-bladder, kidney, or some other organ comfortably outside their province. The surgeons might operate or not, according to the length of their waiting-list at the time; whatever happened, after a few more visits to out-patients' he would find himself having all his teeth out in the dental section, who packed him off afterwards to the physiotherapy department in case the headaches-which continued-were due to disfunction of the neck muscles. From the physiotherapy department the patient went as a last resort to the psychiatrists, and as they were then unable to transfer him to anyone he probably continued to visit them and talk about his headaches once a week for the remainder of his life.

While I was working in out-patients' the hospital authorities installed a bar for tea and buns in the hall to break the tedium of the long wait. The regular patients were delighted, and showed their appreciation by spending as many of their afternoons as they could enjoying a medical tea-party with their fellow sufferers.

'Times have changed,' one of the old porters said gloomily, looking at the girl distributing cups of tea from the new counter. 'None of this 'ere nonsense in the old days. Mollycoddling, I call it.'

He wistfully described the routine of forty years ago. The patients had to be inside the building and seated at the benches by eight o'clock every morning. Then the doors were locked and anyone coming late had no alternative than to wait until the next day. The consultant arrived at nine, and strode to his room accompanied by a senior porter. When the doctor had settled himself in his chair the porter went to the door and shouted: 'Nah then! All them with coughs, stand up!' A handful of patients came to their feet and shuffled into the room. When they had been seen the porter returned and commanded: 'Stomach pains, diarrhoea, and flatulence!' The possessors of these alimentary disorders filed before the doctor while the porter marshalled the chronic cases who had come simply for a new bottle of medicine. The patients found the system convenient, and it was abolished only when the senior physician left for Harley Street after a remarkably heavy morning treating chest symptoms and found a stall outside the hospital from which was being sold 'Genuine St. Swithin's Cough Mixture.' This was bought off the patients for twopence and retailed to the public by the stallkeeper at sixpence a bottle.