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Title: Doctors Off Duty
Author: Arthur Gask
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Language: English
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DOCTORS OFF DUTY



By Arthur Gask



Published in the Chronicle (Adelaide, SA : 1895 1954), Thursday 7 November 1940.





An important medical congress had been opened that morning in a big northern city, and, after dinner that night, a little party of medical men were smoking and talking in the library of a palatial mansion which was giving them hospitality for the duration of the congress. Their host, a wealthy manufacturer, had arranged with the organising committee of the congress to put up a round score of the visiting members, and, his house and grounds being among the show places of the district, he had been allotted some of the chairmen of the various sections. He was now thrilled at entertaining such distinguished members of the profession under his roof.

"And I suppose," he laughed, "I should be quite safe tonight if I were to be suddenly attacked with any kind of disease. I mean there must be a specialist here for almost everything."

"Certainly there is, Sir Herbert," laughed back a merry-looking little man who, for all his diminutive size, was one of the best known authorities upon nervous diseases in the Western Hemisphere, "and among the lot of us I am sure we should be able to manage your decease somehow. With all the new drugs which have come out lately we should have a splendid chance."

"And people have the idea," went on Sir Herbert jokingly, "that in no calling in the world are there so many really good and really bad men as among you doctors."

"Exactly!" commented the nerve specialist, but now speaking quite seriously. "The very nature of our work, with all its opportunities, brings out both the best and worst in us." He nodded. "But I like to think that, considering our number, there are very few black sheep among us. Occasional money-grabbers, of course, who trade with their eyes for ever upon the till and who put in every extra visit they can and operate wherever they guess there's a bit of cash." He nodded again. "Still, those are the exceptions and the majority of us are quite decent men."

"In a district near where I am," growled an old and grizzled general practitioner, the panel and lodge patients of whose practice ran into many thousands, "there's a fellow who boasts he takes out an appendix almost every morning before breakfast." He shrugged his shoulders. "I don't know where he finds them. I often see a hundred patients a day, and it's an event when I send a patient into hospital for an appendicectomy. And it's the same with tonsils. I don't agree with this wholesale taking of them out."

"But perhaps you're a wee bit old fashioned, Dr. Gregson," smiled a bright-faced young surgeon, prominent among the ear, nose and throat men in the West of England. "You general practitioners are not ready enough to appreciate the beautiful new instruments and appliances which are being turned out for us by the manufacturers."

"I, certainly, am slow there," said the old G.P. frowningly. He nodded significantly. "But my patients live just as long without them and they probably suffer a great deal less."

"I'm quite sure they do, Dr. Gregson," smiled a great Harley street consulting physician. He went on banteringly. "All these young surgeons think of is cutting you about. They're crazed to open you somewhere. It's your blood they want."

Another physician chimed in in the same vein. "Quite right, sir, there is a false glamor about surgery, and so many in our profession want to make it the hallmark of cleverness if they can cut you open and you don't die on the operating table. They'd like the public to think so, too."

"Yes," nodded a second general practitioner darkly, "and I know several men who can do a good operation and yet who are rotten doctors, for all that. With many minor ailments they are perfect duds and can't treat even an ordinary indigestion properly." He smiled. "It's we common G.P.'s who are the salt of the profession, and no man becomes a great surgeon—I don't mean a good operator, for that doesn't necessarily mean a good surgeon—unless he has first graduated from among us."

"But why," asked their host, looking rather puzzled, "does a good operator not always mean a good surgeon?"

"Well, he may only have operated because he has made a faulty diagnosis," replied the G.P. "Suppose you go to him with a hard swelling in a gland and he tells you you've got a growth there and cuts the whole gland out. Then he finds the swelling is only a hardened abscess and all he need have done to put you right was to have lanced it. Now, although he may have done a perfect operation you wouldn't call him a good surgeon, would you?" He shook his head. "No, a good surgeon must be a good physician, first."

A famous surgeon who could command almost any fee for his operations took up the tale. "You are quite right, Dr. Hensley," he said. He shrugged his shoulders deprecatingly. "I know that what little success I have had I owe entirely to the foundation the five gruelling years I spent as an assistant up North gave me. My employer had a huge practice among the poorest classes and my work made a good physician of me." He smiled a grim smile. "A shilling for a consultation, including a bottle of medicine, and, as with Dr. Gregson here, our visiting list ran into hundreds a day."

"But what could you do to them," asked his interested host, "when you were attending to so many?"

"All that was necessary," replied the surgeon. "As with my employer, I became most expert in making a lightning diagnosis. Some, I could see with one glance, had nothing much the matter with them, and two minutes was all they got." He nodded. "Others may have taken up half an hour." He turned to the old general practitioner. "That's the way you handle them, too, is it not, Dr. Gregson?"

Dr. Gregson nodded. "And I've been so long at the game that I can tell with one look at them whether they're heart, lung or kidney cases." His old shrewd eyes glinted. "Ay, and also whether I'll be getting my money paid."

There were smiles all round, and then their host, addressing them all, generally, remarked, "And, of course, being brought in contact with so many people, you must have had many very interesting experiences."

"We have," replied an old doctor, Dr. Smith, who was not far off eighty and who had given up active practice for some years, but who in his time had been noted for his successes in difficult cases of midwifery. "And it is only natural," he went on, "for the life of a medical man is one great adventure from start to finish, from beginning to end. We are present at all the crises of our patients' lives, their births, their deaths, and all the sicknesses and accidents in between. No, we can't help seeing and hearing a lot."

"Then tell us one of your adventures, Master," called out a young doctor. "We all know everything you say is worth listening to."

The others joined in with the request, and the old man was flattered. "Well," he said slowly. "I'll give you a little bit of romance, and the moral it points is the absolute trust which most people have in their medical man. I mean a confidence which they take to themselves as a matter of course. They are sure that if he knows any secret about them he will not give them away. There is no need for them to exact any promise."

He spoke fervently. "Gad, in this particular instance I held a woman's secret for nearly fifty years, and yet, ignoring there was any secret to hide and that I knew all about it, during all that time she lived a happy, smiling, and confident life! She was certain I should never give her away."

A rustle of interest stirred round the room, and the old man went on. "What happened was this. When I was quite young, indeed, only just qualified, I went to look after the practice of a man who had been ordered away for a long voyage, and who would not be returning to work for a year."

"I had not been there long when a young woman came in to book me"—he smiled—"for the forthcoming interesting event so natural with members of her sex. She had left things rather late, and there were only a few weeks to go. She was very pretty, and I guessed at once there was tragedy about the business, because she said she was a stranger to the town and all upon her own. She asked me to engage the nurse and not get an expensive one. She told me she was twenty-two, but I was sure she was younger than that. She said she was Mrs. Brown.

"In due time, after some little anxiety for me, as the case was by no means an easy one, the baby was born in the house where the girl had apartments. She was a little daughter, and when delivered was not pretty to look at, as there was a big naevus covering the whole of one side of the face and the entire nose as well." He turned to his host. "I mean, Sir Herbert, she had one of those port wine stain birthmarks which are so disfiguring for anyone when they grow up, and particularly so for a girl. This one was so big that it would have been impossible to do anything for it." He frowned. "There was also a deformity of one foot. The child was not breathing when she was born.

"I made a lightning decision as to what I should do, and all my life long I have never regretted what it was. The mother was in a bad way and needed all the attention I could give her. The child was, so obviously to me, born out of wedlock, and if she lived, unsightly as she would grow up, would have to face both the pity as well as the scorn of the world. So"—he paused a few moments—"if she had come from heaven I let her return there straightaway. I made no attempt to start the breathing." He looked round the room. "Now does anyone here say I did wrong?"

A silence followed, and, no one taking up the challenge, he went on—"The mother soon got well, and in a fortnight passed out of my life, as I thought, for ever. I never expected to hear or see anything more of her. But I was greatly mistaken, for a little over two years later I met her again.

"I had gone up North and set up in practice in a district where it was destined I should remain for the rest of my professional life. A couple of months or so after I arrived I was invited to a dance and there, to my amazement, was introduced to my one-time patient, the pretty Mrs. Brown. Her name was now given me as Miss So-and-So, but, of course, I recognised her at once, realising at the same moment that she had recognised me, too. Still, only just a quick intake of breath, a levelling of the beautifully arched eyebrows and a lightning look of dismay in the soft grey eyes, and that was all the evidence of recognition she showed. I thought her prettier than ever, for now the sadness upon her face had passed. She quite fascinated me. We had several dances together, and I took her into supper, but our conversation was just the ordinary conventional one, and there was not the slightest allusion to our having met before.

"Later, I was told that she and her people had not long come to live in the town, and that she had there met and become engaged to a very nice young fellow. It was to be an excellent match for her, as the boy was very well-off. I became friendly with her family, and when the marriage took place was present as an esteemed guest.

"None of her people were then patients of mine, neither were any of her husband's. So I was very astonished when one day, less than a year later, her husband called upon me and asked me to attend his wife in a few months' time. I went to see her professionally, and, in the course of our conversation, she remarked with a smile, "I thought I would prefer you to anyone else as you would understand me."

The old doctor slapped his hands together. "And that was the only remark with any suggestion of reference to my earlier association with her she ever made. Just think of it! For nearly fifty years I was an intimate friend of the family, as well as being their medical attendant, and yet—she never asked me to keep silent about what I knew. It never entered into her mind that I should betray her secret. She never so much as said. 'I can trust you, can't I? You'll never mention about that Mrs. Brown?' No"—his old eyes glowed with pride—"she took it for granted she could rely upon my honor, without making any appeal to me."

He went on. "Besides this first child of her happy married life, I brought four more into the world for her, and lovely children they all were. Then, as the years rolled on, I was the first to set eyes upon the little ones of her two daughters, and when a much loved and greatly respected old lady was carried to her last resting place, shortly before I gave up practice"—his voice was reverent and solemn—"her secret was buried with her." He spoke huskily. "That is my little story, gentlemen."

"A very interesting one, Dr. Smith," commented his host, "and you told it very nicely, too."

"Well, as I say," said the old doctor, "the only moral I wanted to point was the unquestioning reliance the ordinary men and women place upon their medical men, and, I believe, deservedly so."

Another doctor spoke up. "Now I'll tell you a little story and it's a humorous one. It points no moral and, if it be true, rather reflects upon us as a profession." He laughed. "We need a little taking-down sometimes." He drew the eyes of his audience upon him and began.

"Two well-to-do elderly ladies lived in a small country town, and the younger of them fancied she was not in good health, and always upon the verge of a complete breakdown. In consequence, she was a reliable source of income to the local medico, who put in an almost daily visit, with a becomingly solemn face. The patient didn't get any better, which was not to be wondered at, when you realise she had nothing the matter with her. Still, the elder sister began to get worried, and one day told the doctor she thought a specialist from London ought to be brought down.

"The doctor considered, and then, remembering an old fellow-student of his who had risen to eminence, and with whom he thought he would like to have a yarn, suggested, well, we'll call him, Sir Pompey Flapdoddle. The sister was quite agreeable, and so Sir Pompey was communicated with, and he came down.

"Now, this elder lady was most anxious to know from what disease her sister was really suffering, and, accordingly, made arrangements to listen in to what the two doctors would say when they came to discuss the case after the examination in the bedroom had taken place. So she kept out of the way when the great man arrived, and secreted herself behind a screen in the room into which they would be shown afterwards, to talk things over. Sherry and biscuits had been provided.

"The examination over, the two medicos duly came in. The door was shut carefully, and the sister prepared to listen hard. The old friends at once began to talk animatedly together. They spoke of their hospital days and the happy times they had had; of their old fellow-students and what had become of them; how White had worked up a big practice in Liverpool, how Black had died of fever on the West Coast of Africa; how Green had married a rich wife, and now did nothing but play golf. Then they exchanged a few stories which made the listener behind the screen hold her breath in horror, while the narrators themselves were muffling their laughter so that it should not be heard outside. And all the time not a word had been said about the patient. She had not been referred to in any way.

"Presently the listener heard the pushing back of chairs and the great consultant say, 'Well, old chap, it's been very nice to have a chat with you, and many thanks for having me down.'

"'Not at all, my dear fellow,' said the local medico. 'I shall always be only pleased to do anything I can.'

"'Then, good-bye, my boy,' went on the consultant, 'and good luck to you,' and they both walked towards the door.

"'Here, one moment!' exclaimed the other, 'You've not given me your opinion of the patient. What do you think of her?'

"'Think of her?' laughed the consultant, 'why, I think she's the ugliest old woman I ever saw.'

"'Ha, ha!' laughed back the local man, 'but you wouldn't say that if you had seen her sister. She's even uglier still.'"

When the general laughter which the story had evoked had died down, the famous surgeon stirred in his chair, and began slowly. "But, harking back to operations which the few unscrupulous men among us perform when they know perfectly well they are not necessary, although it's in the nature of a confession, I'll tell you what I once did." He looked upon everyone with a grim smile, and lowered his voice impressively. "For the first and only time in my life I myself performed an operation which, when I did it, I was absolutely convinced was wholly unnecessary."

He paused for a moment to let his words sink in, noting with some amusement the astounded looks upon the faces of his audience.

He went on—"Yes, it's an extraordinary story, and brings home the almost inconceivable things which may happen to any of us. I was just over thirty then, and struggling to get a footing as a surgeon in London, and with no private means behind me. You will all understand what that meant, keeping up appearances and half-starving to do it. I had taken my 'master of surgery,' and by great good luck been appointed an assistant surgeon at St. Bengers. Of course, that helped me a bit, but private patients were coming in very slowly, and there were many days when I sat in my expensive consulting room in Wimpole street and didn't see a soul."

"At that time my main standby was Sir Benjamin Luke—dear old Ben—the greatest surgeon of his day. He was very kind to me, and I often picked up a few guineas from patients he sent me. In fact, but for him I am sure I should have had to go back to an assistantship with some general practitioner, as all the money I had saved had been spent in trying to establish myself where I was. I particularly mention that to make you all realise under what obligations to him I was at that time.

"Well, one morning he rang me up. He was going away that same afternoon for a month's holiday, and he was sending me a man called Martin, who would be coming straight away, and whose appendix he wanted me to remove as speedily as possible. It was not, however, an acute case, but one of long-standing inflammation, and the patient was a slippery one to handle. For months and months he, Sir Benjamin, had been urging him to have it out, but the man had been shilly-shallying and unable to make up his mind. Now things had come to such a pass that to delay any longer would be really dangerous.

"Still, bad as his condition is," went on Sir Benjamin over the phone, "you'll have to bounce him into it. When you've examined him you must give him no time to think, but take him on the hop and rush him into hospital immediately. Operate today as a matter of extreme urgency. That's the only way you'll get him before it comes to an actual perforation. Oh, and remember, he's unreliable in everything he says. To put it plainly, he's a dreadful liar. He may say he has no symptoms at all, or he may describe ones quite different from those he really has. He's inclined to be very secretive, too, and likes to make a mystery of everything. So, if he's in the mood he may not mention me at all, and say nothing about my having told him to come to you. If he doesn't choose to tell you that, you act as if you knew nothing, and just deal with him as a new patient who has been recommended to you, you don't know by whom. You understand the position. Take no notice of anything he says, insist that an immediate operation is a matter of extreme urgency, and don't give him the opportunity to change his mind. Rush him into hospital I say."

The surgeon went on—"I kept close to my consulting room all that day, but it was not until towards the end of the afternoon, and just when I was disappointedly thinking the man was not going to turn up that he arrived. As I have already told you, patients were not very plentiful with me, and, in consequence, my nurse came into me with some natural excitement. 'A new patient, doctor,' she said. 'A Mr. Martin, and he wants to know if you can see him without an appointment. I told him I thought I could put him in in a few minutes if he waited.'

"So I kept him waiting a quarter of an hour, prepared, however, to rush out at any moment if I heard any movement in the hall which suggested he had got tired of waiting. Ah, you smile! But that's a custom well-known to the profession and I dare venture we've many of us done it in our time. To go on. When, at length I had him shown in, I thought him at once, as Sir Benjamin had intimated to me, a secretive and uncommunicative man, as he did not mention who had recommended me to him and, moreover made no reference to any abdominal symptoms. His only complaint was that for a long time he had been suffering from severe frontal headaches which quite incapacitated him while they lasted. He had lately begun to fear he must have a tumor on the brain.

"I paid little attention to what he told me about his head and, apparently to his great surprise, made him strip, and started to examine his abdomen. Then, to my amazement, I could not find the very slightest trace of anything wrong. I pushed and pummelled, but there was absolutely no tenderness, and the abdomen was that of a normal healthy man.

"I was in a dreadful quandary! What was I to do? How could I possibly make out the instant operation was imperative? Yet, was I to pit my judgment against that of a great surgeon like Sir Benjamin, than whom no one had a more profound knowledge of the diseases of the abdomen? Should I send this man away, telling him he had nothing the matter with him which a holiday and some mild sedative might put right, when all along for many months the renowned Sir Benjamin Luke had been insisting he was seriously ill and in grave danger? Then, another consideration, was I to run the risk of offending my best friend, the one man who had helped me whenever he could? It was a dreadful position for me to be in."

The famous surgeon sighed heavily. "Gentlemen, I gave in. I stifled my conscience with the feeble excuse that, after all, I was only obeying the orders of one much older and wiser than I. So I told the patient all Sir Benjamin had bidden me. Oh, yes, I frightened him right enough, and, patting myself upon the back for succeeding where Sir Benjamin had failed, made him enter a hospital within the hour, arranging that I would operate at nine o'clock that night.

"Everything seemed to be promising well until I got a 'phone call from a medical man in a town about forty miles from London. He said he was a cousin of this Mr. Martin and, having just heard of the operation, would like to be present. He asked when it was going to take place, and I had to tell him.

"I was aghast! The last thing I wanted was a shrewd G.P.—and most of you G.P.'s are shrewd enough, in all conscience—seeing the healthy appendix I was going to take out. So, plunging even deeper into the mire, without letting this cousin know anything about it and under an excuse of urgency, I advanced the time of the operation an hour, and it was all over and I was well away from the hospital and not to be got at again that night by the time he had arrived in town. I heard next day that, when he had asked to see the offending appendix, he had been most disappointed to learn I had taken it off with me.

"The next morning the patient said he was feeling fine. The wife was by the bedside when I appeared, and she thanked me most gratefully for having made her husband have the operation performed so quickly, thus giving him such a little time to think about it beforehand. I tell you I felt horrible, but tried hard to console myself, as I had done before, that I had only been obeying orders, and had acted exactly as Sir Benjamin would have done had his services been available."

The surgeon paused here to light a cigarette, and then continued. "Now, for the perfectly astounding sequel. That same afternoon I was seated once more in my consulting room, as usual disengaged, when in came my nurse, looking, as she had done the previous day, quite excited. "There's another new patient here, doctor," she said, "of the same name as the one who came yesterday, another Mr. Martin, and he says he's been sent you by Sir Benjamin Luke."

"What!" I exclaimed incredulously, with a cold shiver running up my spine. "Another patient of the name of Martin, and he says he's been sent by Sir Benjamin!"

"Yes, doctor, and he wants to see you as quickly as possible. He says he's in pain and thinks he ought to be operated upon immediately."

"God, I felt sick with horror! What a ghastly mistake! I've operated upon the wrong man!

"I ordered him to be shown in instantly, and at once the urgency of the matter was beyond any possibility of doubt. The man was in a very grave condition, and not a moment must be lost. Indeed, things looked so bad that I wouldn't let him even return home, but drove him straight to the hospital, where the other Martin was. Fortunately, he had had nothing to eat that day, and the moment I could get the anaesthetist round, in not much over an hour, he was being put under the anaesthetic. Heavens, I was only just in time! The abscess would have burst in a matter of only minutes!"

He leant back in his chair and looked round smilingly. "Well, the two Martins were soon convalescent and reclining upon the balcony together, no doubt discussing the coincidence of the similarity of their names and complaints, and the wonderful doctor who was attending to them. He nodded emphatically. "But wasn't it a marvellous thing that, when I was expecting one Martin, two of the same name should appear one after the other. Of course, I know Martin is not a rare name, but it's by no means a common one."

"And did you get a big fee from the first Martin?" asked one of the other doctors banteringly.

The surgeon shook his head smilingly. "No, only a very moderate one, and I sent it as an anonymous donation to my hospital." He laughed. "But the patient expressed his willingness to pay double or treble the amount, as he had benefited so greatly from the operation. You see, from the day I took out his appendix he never had a single one of those headaches which had been his curse for years and years. That was an extraordinary happening, too."

"But not so extraordinary as you perhaps think, doctor," broke in his host immediately, "as I happen to know just such a case in my own family. My poor father, who is dead now, was cured of dreadful headaches in exactly the same way, when he was quite a young man. A surgeon in London, I don't remember his name, took out his appendix, it must be nearly thirty years ago, for precisely the same reason." He laughed merrily. "Why, if you hadn't told us your patient was called Martin, you might be the very doctor who operated upon my father, for ours, too, is a name which might easily have had a double. There are plenty of people about called Hunter." He rose from his chair and made a movement towards the door. "But come on, now. We'll go and join the ladies. They are going to give us some music."

"Whew, but what a narrow escape that was!" murmured the great surgeon under his breath. He swallowed hard. "What a mercy I didn't give the right name! Fancy after all these years meeting the man's son! Gad, as old Smith has just told me, we medical men do see life!"



THE END.