handsome, so devoted, and so amazingly clever. His learning was beyond
the common grasp, and the depths of his knowledge unfathomable. When
a friend came in at night to smoke a pipe she would sit silent and
open-mouthed, lost in admiration of her husband’s dazzling intellect.
How glibly he would talk of metabolism and blood-pressure; how
marvellously he endowed common things with mystic significance when he
discoursed upon the value in calories of a pound of steak, or upon the
vitamines that enrich the common bean, or even the more common cabbage.
It seemed to her that behind the tiny world she knew there was a
mysterious universe with which her well-beloved was as familiar as was
she with the contents of her larder.
She was supremely happy and content, while her husband bestowed upon
her all the affection of which he was capable. He was naturally vain,
but her idolatry made him vainer. She considered him wonderful, and he
was beginning to think her estimate had some truth in it. She was so
proud of him that she rather wearied her friends by the tale of his
achievements. She pressed him to allow her to have his diploma and his
more florid certificates framed and hung up in the consulting room, but
he had said with chilling superiority that such things “were not done,”
so that she could only console herself by adoring the modesty of men of
genius.
One day this happy, ever-busy lady was seized with appendicitis.
She had had attacks in her youth, but they had passed away. This
attack, although not severe, was graver, and her husband determined,
quite wisely, that an operation was necessary. He proposed to ask a
well-known surgeon in a neighbouring city to undertake this measure.
He told his wife, of course, of his intention, but she would have none
of it. “No,” she said, “she would not be operated on by stuffy old Mr.
Heron.[3] He was no good. She could not bear him even to touch her. If
an operation was necessary no one should do it but her husband. He was
so clever, such a surgeon, and so up-to-date. Old Heron was a fossil
and behind the times. No! Her clever Jimmy should do it and no one
else. She could trust no one else. In his wonderful hands she would be
safe, and would be running about again in the garden in no time. What
was the use of a fine surgeon if his own wife was denied his precious
help!”
The husband made no attempt to resist her wish. He contemplated the
ordeal with dread, but was so influenced by her fervid flattery that he
concealed from her the fact that the prospect made him faint of heart
and that he had even asked himself: “Can I go through with it?”
He told me afterwards that his miserable vanity decided him. He
could not admit that he lacked either courage or competence. He saw,
moreover, the prospect of making an impression. The town people would
say: “Here is a surgeon so sure of himself that he carries out a grave
operation on his own wife without a tremor.” Then, again, his assistant
would be his fellow-practitioner in the town. How impressed he would be
by the operator’s skill, by his coolness, by the display of the latest
type of instrument, and generally by his very advanced methods. It was
true that it was the first major operation he had ever undertaken, but
he no longer hesitated. He must not imperil his wife’s faith in him
nor fail to realize her conception of his powers. As he said to me more
than once, it was his vanity that decided him.
He read up the details of the operation in every available manual he
possessed. It seemed to be a simple procedure. Undoubtedly in nine
cases out of ten it is a simple measure. His small experience, as an
onlooker, had been limited to the nine cases. He had never met with the
tenth. He hardly believed in it. The operation as he had watched it at
the hospital seemed so simple, but he forgot that the work of expert
hands does generally appear simple.
The elaborate preparations for the operation—made with anxious
fussiness and much clinking of steel—were duly completed. The lady
was brought into the room appointed for the operation and placed on
the table. She looked very young. Her hair, parted at the back, was
arranged in two long plaits, one on either side of her face, as if
she were a schoolgirl. She had insisted on a pink bow at the end of
each plait, pleading that they were cheerful. She smiled as she saw
her husband standing in the room looking very gaunt and solemn in
his operating dress—a garb of linen that made him appear half-monk,
half-mechanic. She held her hand towards him, but he said he could
not take it as his own hand was sterilized. Her smile vanished for a
moment at the rebuke, but came back again as she said: “Now don’t look
so serious, Jimmy; I am not the least afraid. I know that with you I
am safe and that you will make me well, but be sure you are by my side
when I awake, for I want to see you as I open my eyes. Wonderful boy!”
The operation was commenced. The young doctor told me that as he cut
with his knife into that beautiful white skin and saw the blood well up
behind it a lump rose in his throat and he felt that he must give up
the venture. His vanity, however, urged him on. His doctor friend was
watching him. He must impress him with his coolness and his mastery of
the position. He talked of casual things to show that he was quite at
ease, but his utterances were artificial and forced.
For a time all went well. He was showing off, he felt, with some
effect. But when the depths of the wound were reached a condition
of things was found which puzzled him. Structures were confused and
matted together, and so obscured as to be unrecognizable. He had read
of nothing like this in his books. It was the tenth case. He became
uneasy and, indeed, alarmed, as one who had lost his way. He ceased to
chatter. He tried to retain his attitude of coolness and command. He
must be bold, he kept saying to himself. He made blind efforts to find
his course, became wild and finally reckless. Then a terrible thing
happened. There was a tear—something gave way—something gushed forth.
His heart seemed to stop. He thought he should faint. A cold sweat
broke out upon his brow. He ceased to speak. His trembling fingers
groped aimlessly in the depths of the wound. His friend asked: “What
has happened?” He replied with a sickly fury: “Shut up!”
He then tried to repair the damage he had done; took up instrument
after instrument and dropped them again until the patient’s body was
covered with soiled and discarded forceps, knives and clamps. He
wiped the sweat from his brow with his hand and left a wide streak of
blood across his forehead. His knees shook and he stamped to try to
stop them. He cursed the doctor who was helping him, crying out: “For
God’s sake do this,” or “For God’s sake don’t do that”; sighed like a
suffocating man; looked vacantly round the room as if for help; looked
appealingly to his wife’s masked face for some sign of her tender
comfort, but she was more than dumb. Frenzied with despair, he told
the nurse to send for Mr. Heron. It was a hopeless mission, since that
surgeon—even if at home—could not arrive for hours.
He tried again and again to close the awful rent, but he was now nearly
dropping with terror and exhaustion. Then the anæsthetist said in a
whisper: “How much longer will you be? Her pulse is failing. She cannot
stand much more.” He felt that he must finish or die. He finished in a
way. He closed the wound, and then sank on a stool with his face buried
in his blood-stained hands, while the nurse and the doctor applied the
necessary dressing.
The patient was carried back to her bedroom, but he dared not follow.
The doctor who had helped him crept away without speaking a word. He
was left alone in this dreadful room with its hideous reminders of what
he had done. He wandered about, looked aimlessly out of the window, but
saw nothing, picked up his wife’s handkerchief which was lying on the
table, crunched it in his hand, and then dropped it on the floor as the
red horror of it all flooded his brain. What had he done to her? She!
She of all women in the world!
He caught a sight of himself in the glass. His face was smeared with
blood. He looked inhuman and unrecognizable. It was not himself he saw:
it was a murderer with the brand of Cain upon his brow. He looked again
at her handkerchief on the ground. It was the last thing her hand had
closed upon. It was a piece of her lying amid this scene of unspeakable
horror. It was like some ghastly item of evidence in a murder story. He
could not touch it. He could not look at it. He covered it with a towel.
In a while he washed his hands and face, put on his coat and walked
into the bedroom. The blind was down; the place was almost dark; the
atmosphere was laden with the smell of ether. He could see the form
of his wife on the bed, but she was so still and seemed so thin. The
coverlet appeared so flat, except where the points of her feet raised
a little ridge. Her face was as white as marble. Although the room
was very silent, he could not hear her breathe. On one side of the
bed stood the nurse, and on the other side the anæsthetist. Both were
motionless. They said nothing. Indeed, there was nothing to say. They
did not even look up when he came in. He touched his wife’s hand, but
it was cold and he could feel no pulse.
In about two hours Heron, the surgeon, arrived. The young doctor saw
him in an adjacent bedroom, gave him an incoherent, spasmodic account
of the operation, laid emphasis on unsurmountable difficulties, gabbled
something about an accident, tried to excuse himself, maintained that
the fault was not his, but that circumstances were against him.
The surgeon’s examination of the patient was very brief. He went into
the room alone. As he came out he closed the door after him. The
husband, numb with terror, was awaiting him in the lobby. The surgeon
put his hand on the wretched man’s shoulder, shook his head and,
without uttering a single word, made his way down the stairs. He nearly
stumbled over a couple of shrinking, white-faced maids who had crept up
the stairs in the hope of hearing something of their young mistress.
As he passed one said: “Is she better, doctor?” but he merely shook his
head, and without a word walked out into the sunny street where some
children were dancing to a barrel-organ.
The husband told me that he could not remember what he did during these
portentous hours after the operation. He could not stay in the bedroom.
He wandered about the house. He went into his consulting room and
pulled out some half-dozen works on surgery with the idea of gaining
some comfort or guidance; but he never saw a word on the printed page.
He went into the dispensary and looked over the rows of bottles on the
shelves to see if he could find anything, any drug, any elixir that
would help. He crammed all sorts of medicines into his pocket and took
them upstairs, but, as he entered the room, he forgot all about them,
and when he found them in his coat a week later he wondered how they
had got there. He remembered a pallid maid coming up to him and saying:
“Lunch is ready, sir.” He thought her mad.
He told me that among the horrors that haunted him during these hours
of waiting not the least were the flippant and callous thoughts that
would force themselves into his mind with fiendish brutality. There
was, for example, a scent bottle on his wife’s table—a present from
her aunt. He found himself wondering why her aunt had given it to her
and when, what she had paid for it, and what the aunt would say when
she heard her niece was dead. Worse than that, he began composing in
his mind an obituary notice for the newspapers. How should he word it?
Should he say “beloved wife,” or “dearly loved wife,” and should he add
all his medical qualifications? It was terrible. Terrible, too, was his
constant longing to tell his wife of the trouble he was in and to be
comforted by her.
Shortly after the surgeon left the anæsthetist noticed some momentary
gleam of consciousness in the patient. The husband hurried in. The
end had come. His wife’s face was turned towards the window. The
nurse lifted the blind a little so that the light fell full upon her.
She opened her eyes and at once recognized her husband. She tried
to move her hand towards him, but it fell listless on the sheet. A
smile—radiant, grateful, adoring—illumined her face, and as he bent
over her he heard her whisper: “Wonderful boy.”
XI
BREAKING THE NEWS
Among the more painful experiences which haunt a doctor’s memory are
the occasions on which it has been necessary to tell a patient that
his malady is fatal and that no measure of cure lies in the hands of
man. Rarely indeed has such an announcement to be bluntly made. In the
face of misfortune it is merciless to blot out hope. That meagre hope,
although it may be but a will-o’-the-wisp, is still a glimmer of light
in the gathering gloom. Very often the evil tidings can be conveyed by
the lips of a sympathetic friend. Very often the message can be worded
in so illusive a manner as to plant merely a germ of doubt in the mind;
which germ may slowly and almost painlessly grow into a realization
of the truth. I remember being present when Sir William Jenner was
enumerating to a friend the qualities he considered to be essential in
a medical man. “He needs,” said the shrewd physician, “three things.
He must be honest, he must be dogmatic and he must be kind.” In
imparting his dread message the doctor needs all these qualities, but
more especially the last—he must be kind. His kindness will be the more
convincing if he can, for the moment, imagine himself in the patient’s
place and the patient in his.
The mind associates the pronouncing of a verdict and a sentence of
death with a court of justice, a solemn judge in his robes, the
ministers of the law, the dock, a pallid and almost breathless
audience. Such a spectacle, with its elaborate dignity, is impressive
enough, but it is hardly less moving when the scene is changed to a
plain room, hushed almost to silence and occupied by two persons only,
the one who speaks and the one who listens—the latter with bowed head
and with knotted hands clenched between his knees.
The manner in which ill-news is received depends upon its gravity,
upon the degree to which the announcement is unexpected and upon the
emotional bearing of the recipient. There may be an intense outburst of
feeling. There may be none. The most pitiable cases are those in which
the sentence is received in silence, or when from the trembling lips
there merely escapes the words, “It has come.”
The most vivid displays of feeling that occur to my mind have been
exhibited by mothers when the fate of a child is concerned. If her
child be threatened a mother may become a tigress. I remember one
such instance. I was quietly interviewing a patient in my consulting
room when the door suddenly flew open and there burst in—as if blown
in by a gust of wind—a gasping, wild-eyed woman with a little girl
tucked up under her arm like a puppy. Without a word of introduction
she exclaimed in a hoarse whisper, “He wants to take her foot off.”
This sudden, unexplained lady was a total stranger to me. She had no
appointment. I knew nothing of her. She might have dropped from the
clouds. However, the elements of violence, confusion and terror that
she introduced into my placid room were so explosive and disturbing
that I begged my patient to excuse me and conducted, or rather
impelled, the distraught lady into another room. Incidentally I may
remark that she was young and very pretty; but she was evidently
quite oblivious of her looks, her complexion, her dress or her many
attractions. I had before noticed that when a good-looking woman is
unconscious of being good-looking there is a crisis in progress.
The story, which was told me in gasps and at white heat, was as follow.
The child was a little girl of about three, almost as pretty as her
mother. She was the only child and had developed tuberculous disease
in one foot. The mother had taken the little thing to a young surgeon
who appears to have let fall some rash remark as to taking the foot
off. This was enough for the mother. She would not listen to another
syllable. She, whom I came to know later as one of the sweetest and
gentlest of women, changed at the moment to a wild animal—a tigress.
Without a word she snatched up the baby and bolted from the house,
leaving the child’s sock and shoe on the consulting-room floor. She had
been given my name as a possible person to consult and had dashed off
to my house, carrying the child through the streets with its bare foot
and leg dangling in the air. On being admitted she asked which was my
room. It was pointed out to her, and without more ado she flung herself
in as I have described. The child, I may say, was beaming with delight.
This dashing in and out of other people’s houses and being carried
through the streets without a sock or a shoe on her foot struck her as
a delicious and exciting game.
The mother’s fury against my surgical colleague was almost
inexpressible. If the poor man had suggested cutting off the child’s
head he could not have done worse. “How dare he!” she gasped. “How
dare he talk of cutting off her foot! If he had proposed to cut off
my foot I should not have minded. It would be nothing. But to cut
off her little foot, this beautiful little foot, is a horror beyond
words, and then look at the child, how sweet and wonderful she is!
What wickedness!” It was a marvellous display of one of the primitive
emotions of mankind, a picture, in human guise, of a tigress defending
her cub. By a happy good fortune, after many months and after not a few
minor operations, the foot got well so that the glare in the eyes of
the tigress died away and she remembered again that she was a pretty
woman.
It is well known that the abrupt reception of ill-tidings may have a
disastrous effect upon the hearer. The medical man is aware that, if he
would avoid shock, the announcement of unpleasant facts or of unhappy
news must be made slowly and with a tactful caution. In this method of
procedure I learnt my lesson very early and in a way that impressed my
memory.
I was a house-surgeon and it was Christmas time. In my day each
house-surgeon was on what was called “full duty” for one entire week
in the month. During these seven days all accident cases came into
his surgeon’s wards. He was said to be “taking in.” On this particular
Christmas week I was “taking in.” Two of my brother house-surgeons had
obtained short leave for Christmas and I had undertaken their duties.
It was a busy time; so busy indeed that I had not been to bed for two
nights. On the eve of the third night I was waiting for my dressers in
the main corridor at the foot of the stair. I was leaning against the
wall and, for the first and the last time in my life, I fell asleep
standing up. The nap was short, for I was soon awakened, “rudely
awakened” as novelists would put it.
I found myself clutched by a heated and panting woman who, as she
clung to me, said in a hollow voice, “Where have they took him?” The
question needed some amplification. I inquired who “he” was. She
replied, “The bad accident case just took in.” Now the term “accident”
implies, in hospital language, a man ridden over in the street, or
fallen from a scaffold, or broken up by a railway collision. I told
her I had admitted no such case of accident. In fact the docks and the
great works were closed, and men and women were celebrating the birth
of Christ by eating too much, by getting drunk and by street rioting,
which acts involved only minor casualties. She was, however, convinced
he was “took in.” He was her husband. She gave me his name, but that
conveyed nothing, as it was the dresser’s business to take names. With
a happy inspiration I asked, “What is he?” “A butler,” she replied.
Now a butler is one of the rarest varieties of mankind ever to be seen
in Whitechapel, and it did so happen that I had, a few hours before,
admitted an undoubted butler. I told her so, with the effusion of one
eager to give useful information. She said, “What is the matter with
him?” I replied cheerily, “He has cut his throat.”
The effect of this unwise readiness on my part was astonishing. The
poor woman, letting go of my coat, collapsed vertically to the floor.
She seemed to shut up within herself like a telescope. She just went
down like a dress dropping from a peg. When she was as small a heap as
was possible in a human being she rolled over on to her head on the
ground. A more sudden collapse I have never seen. Had I been fully
awake it would never have happened. We placed her on a couch and soon
restored her to consciousness.
Her story was simple. She and her husband had met. The two being “full
of supper and distempering draughts” (as Brabantio would say) had had
a savage quarrel. At the end he banged out of the house, exclaiming,
“I will put an end to this.” She had bawled after him, “I hope to God
you will.” He had wandered to Whitechapel and, creeping into a stable,
had cut his throat there and then. The friend who hastened to inform
the wife told her, with a tactfulness I so grievously lacked, that her
husband had met with an accident and had been taken to the hospital.
This lesson I never forgot and in the future based my method of
announcing disaster upon that adopted by the butler’s discreet friend.
Although a digression from the present subject I am reminded of the
confusion that occasionally took place in the identity of cases. All
patients in the hospital who are seriously ill, whether they have been
long in the wards or have been only just admitted, are placed on “the
dangerous list” and have their names posted at the gate so that their
relatives might be admitted at any time of the day or night.
A man very gravely injured had been taken into the accident ward. He
was insensible and his condition such that he was at once put on the
dangerous list, or, in the language of the time, was “gated.” During
the course of the evening a youngish woman, dressed obviously in her
best, bustled into the ward with an air of importance and with a
handkerchief to her lips. She demanded to see the man who had been
brought in seriously injured. She was directed by the sister to a
bed behind a screen where lay the man, still insensible and with his
head and much of his face enveloped in bandages. The woman at once
dropped on her knees by the bedside and, throwing her arms about the
neck of the unconscious man, wept with extreme profusion and with such
demonstrations of grief as are observed at an Oriental funeral. When
she had exhausted herself she rose to her feet and, staring at the
man on the bed, exclaimed suddenly, “This is not Jim. This is not my
husband. Where is he?”
Now, in the next bed to the one with the screen, and in full view
of it, was a staring man sitting bolt upright. He had been admitted
with an injury to the knee. This was Jim. He was almost overcome by
amazement. He had seen his wife, dressed in her best, enter the ward,
clap her hand to her forehead, fall on her knees and throw her arms
round the neck of a total stranger and proceed to smother him with
kisses. Jim’s name had been “gated” by mistake.
When she came to the bedside of her real husband she was annoyed and
hurt, so hurt, indeed, that she dealt with him rudely. She had worked
herself up for a really moving theatrical display in the wards, had
rehearsed what she should say as she rode along in the omnibus and
considered herself rather a heroine or, at least, a lady of intense
and beautiful feeling which she had now a chance of showing off. All
this was wasted and thrown away. An injured knee, caused by falling
over a bucket, was not a subject for fine emotional treatment. She was
disgusted with Jim. He had taken her in. “Bah!” she exclaimed. “Come
in with water on the knee! You might as well have come in with water
on the brain! You are a fraud, you are! What do you mean by dragging
me all the way here for nothing? You ought to be ashamed of yourself.”
With this reproof she sailed out of the room with great dignity—a
deeply injured woman.
To return to the original topic. In all my experience the most curious
manner in which a painful announcement was received was manifested
under the following circumstances. A gentleman brought his daughter to
see me—a charming girl of eighteen. He was a widower and she was his
only child. A swelling had appeared in the upper part of her arm and
was increasing ominously. It became evident on examination that the
growth was of the kind known as a sarcoma and that the only measure to
save life was an amputation of the limb at the shoulder joint, after,
of course, the needful confirmatory exploration had been made.