Richard Gordon: DOCTOR AT LARGE

I turned, and recognized the first obstacle in my professional path. It was Bingham, the other Junior Casualty House Surgeon. He was a pale youth with thick spectacles and bushy hair, who still looked seventeen and always had boils. As a student he was never a frontbench squatter, but he had once won the Dean's Prize in applied anatomy and thereafter always walked through the students' quarters with the Lancet sticking from his pocket like a flag and a couple of large books under his arm. Every lunch hour he carried these books to the library, where he ate his cheese sandwiches and removed from the reference volumes dust which he transferred during the afternoon to the instructive abdomens of patients in the wards. Every Saturday when, the library closed he moved to the surgical pathology museum, where patients' organs were stored away in thick glass jars on shelves like left luggage, and carried his books round the galleries instead. Bingham seemed to absorb a good deal of knowledge from the armpit.

'I'm jolly pleased you got the other cas, job, old chap,' he said, grabbing my sleeve. 'I wondered who it'd go to. Could have been deuced tricky. Suppose they'd given it to some awful stinker. See what I mean? But we'll get along top-hole together, won't we?'

'Yes, we're pretty well bound to, I suppose.'

'I say,' he went on enthusiastically. 'This is a lark, isn't it?'

'What's a lark?'

'Being qualified and all that. I mean, now we can get on with things properly. I've got a couple of septic fingers, a lipoma, and four circs. lined up for minor ops. already.' He rubbed his hands, as if contemplating a good dinner. 'The Prof. stuck his nose in and said I was pretty quick off the mark. By the way, old chap, he asked why you weren't there.'

'But why should I have been there?' I asked in surprise. 'The job only starts today, surely?'

'Yes, but from midnight last night or something, old chap. Technical point. Didn't you know? The last H.S. has cleared off, anyway. I told the Prof. you were really quite a reliable sort of fellow, and even if you were a bit prone to nip off for long week-ends you'd be back in a few days. I said I'd willingly cope with the extra work in the meantime.'

I looked at Bingham coldly. 'And what, may I ask, did the Professor say to all that?'

'Nothing, old chap. He just sort of snorted and went off.'

'I see.'

This was a bad start. Before I could seriously begin my career I would have to win promotion to senior house surgeon and work in the wards themselves under the Professor of Surgery. The appointment would be made after we had finished three months' work in casualty-and only one of us could be chosen. The reject would be turned out in his medical infancy to wail on some other hospital's doorstep.

'I say, old chap,' Bingham continued as we walked along. 'You simply must nip up to the ward after supper and have a dekko at some wizard pancreatic cysts. There's a wonderful perf. up there too-pretty sick, you know, but I think he'll last till we've had a squint at him.' Bingham had the true surgeon's mentality, for it never occurred to him that interesting signs and symptoms were attached to human beings. 'There's a kid with a smashing ductus, too. Murmur as loud as a bus. Could hardly take my bally stethoscope away.'

'I thought casualty house surgeons weren't supposed to go into the wards?'

'No really, old chap, but I told the Prof. I was working for Fellowship already and he said I could nose, round as much as I liked. I expect it'll be all right for you to come too, as long as you're with me.'

I began to hate Bingham before we first crossed the threshold of our common work-place.

The casualty-room at St Swithin's was not likely to fire in any young man the inspiration to be a second Louis Pasteur or Astley Cooper. It was a long, tiled, semi-basement place, lit by small windows high in the walls, smelling strongly of carbolic and always crowded, like a public lavatory at a busy crossroads. As St Swithin's had to find money to buy all the latest antibiotics and isotopes, it saw no point in spending it on a department where the therapeutic technique had hardly changed since its patients were brought on shutters from beneath the wheels of hansom cabs. Everything in casualty was old: there were old horsehair examination couches, sagging screens of old sacking, dull old instruments, battered old dressing drums, and steamy old sterilizers. Even the porter was past retiring age, and all the nurses seemed to be old ladies.

As we entered, the rows of old wooden benches were already filled with people-one-quarter men, and a quarter each women, children, and policemen. There were policemen everywhere, as thick as tom-cats in a fish market. They stood in the corners holding their helmets, they hid behind the screens with open notebooks, they drank pints of free tea solemnly round the sterilizer, they peered across stretchers and requested eternal 'particulars.' Policemen are inseparable from casualty surgery, and it was well known at St Swithin's that anyone falling over in the district and not getting up damn quickly was immediately seized by the police and enthusiastically borne into the casualty-room.

I sat down at an old desk in one end of the room, which held a large brass ink-pot and a pile of different coloured forms. My job was simple. I handed one of these forms to any patient who I felt 'was beyond my own professional ability and thankfully disposed of him for ever into some inner department of the hospital. As my only post-graduate guidance from St Swithin's was a leaflet on what to do in case of fire and another describing the most fruitful way of asking relatives for a post-mortem, I was at first worried about matching the correct form to the case. Fortunately, the old porter had long ago accepted the responsibility of running casualty himself, and tactfully brought me the right document to sign after selecting it with the infallible diagnostic instinct of a St Swithin's employee.

The casualty-room never emptied before evening, and for a week I was too busy even to notice Bingham. We met professionally only once a day, at the noon interlude in the clinical rough-and-tumble known as 'minor ops'. This was for surgery too lowly for the main operating theatres, and was performed by Bingham and myself in an undignified theatre made by a partitioned corner of the casualty-room, containing a galvanized-iron operating table, an Edwardian dental-chair decorated with gilt _fleurs de lys,_ and a small anaesthetic apparatus on which some former house surgeon had written _Property of the Gas, Fight, and Choke Company._ Although we made our incisions with scapels that would have been hurled to the floor in the main theatre, and probably had been, it was minor ops. that made the casualty job tolerable: as newly-qualified prospective surgeons, both of us had the same enthusiasm for the knife as the Committee of Public Safety for the guillotine.

I shortly became aware that Bingham always had far more cases waiting on the benches outside minor ops. than I did. As we took alternate patients coming through the casualty-door I envied his luck, until I discovered that he had the habit of stopping people he saw in the street with promising boils, warts, moles, or cysts, handing them his card, and telling them to come to the casualty-room of St Swithin's at midday and ask specifically for himself. This brought him a brisk practice of taxi drivers, railway porters, bus conductors, tea-shop waitresses, newsvendors, and roadmenders, and he not only removed the lump and others found by a more searching examination than was possible in public, but usually pulled out their ingrowing toe-nails and extracted their bad teeth as well.

This unsporting approach to surgery so annoyed me that one morning when Bingham was out of the casualty-room I felt justified in harvesting some of his crop myself. I was half-way through removing under local anaesthetic an interesting sebaceous cyst on the nose of an Underground ticket collector, when Bingham burst into the theatre.