St. Bernard's: The Romance of a Medical Student

“Yes, all very fine, and make the welkin ring with cries for your slippers and your grog when tired and heated with the chase. After a very few months of that sort of work, the fit would cool down; and the next thing that the world would see of you, you would be dining with your father at the Fishmongers’ banquet, eating your turtle and drinking your très sec like the rest of the ‘domine diriges.’”

“I believe he has gone off with some girl,” said ugly little beetle-browed Mills, the clinical clerk; “or somebody’s wife more likely still.”

“Well, you may comfort yourself, Mills, that that indiscretion will never happen to you. I could believe it of a cash-box, but there isn’t a woman living who would elope with you – married or single. You will never create that scandal.”

At this moment a knock was heard at the door, and a nurse put her head into the room and, addressing one of the house surgeons, told him the patient Green, in Isabella ward, had consented to undergo the operation which he had suggested, and then added: “Sister says she thinks he is dying fast, and are you going to operate?”

“Going to operate! Rather think I was. Don’t you know, Nurse, this is my first capital operation? Do you think I am going to lose the chance?”

“Then, sir, Sister told me to ask you if I had better let the chaplain know?”

“Chaplain be hanged!” he cried. “Certainly not! It would only depress the poor devil. No! no! Plenty of brandy! Keep him up! Cheer him all you can; tell him it is only a trifling, every-day sort of affair, and he will be well in a jiffy. You may send for his wife.”

“Oh, sir, she has been waiting about the hospital all day.”

“All right, then! Now, gentlemen, to business. You shall see me do something pretty. Bishop says I may do it all myself as soon as the ether is given. Is Bishop in the wards?”

“No, I saw him in the pathologist’s room with Crowe an hour ago, and he said he should be here but part of the day. I’ll tell him, shall I?” asked a dresser.

“Do!”

The bell rang for the operation, to assemble the students, some of whom said “It was a beastly shame to torture a poor wretch who hadn’t a chance of getting over it.”

“Ah, you won’t talk like that when you are house surgeon (H.S. they always termed it) yourself. You will be glad to operate on your own father if you can’t get anybody else. Besides, what are hospitals for, if not to qualify us for our work? If people don’t want us to learn all we can from them, why don’t they stay at home and die? The parish doctor won’t disturb their latter moments with operations.”

And so, while the case was being discussed by the novelty-hunting lads, and the grim tools of the surgeons were being selected and placed on a pretty little table by the side of the couch in the theatre, and covered with a white napkin; – while the nurses were assembling who had to assist, and the surgeon refreshing his memory by a last peep at the text-book directing the steps of the operation; – while the poor patient, who, after much worrying, had at last consented to undergo what he was told was a trifling affair that would be certain to cure him – an agonised young woman, with a baby at her breast, was pacing up and down the courtyard of the “cathedral of surgery,” as the Sunday papers called it, feeling that her poor husband was fast leaving her and his little home, and much doubting if she should have given that young doctor her consent to cut and hack the sinking frame of the father of her babe. But what was she to do? Had not five well speaking, kind-looking gentlemen told her that very morning it was the only chance of saving him? Did not the pretty nurse and the ladylike sister urge her to do just whatever the doctor in charge of the case advised? There was only her own heart, her sad misgivings, standing between her and the operation that they said was to give her Jimmy back to health. She had yielded; it was to be done. She had seen him, and kissed him; but her heart told her she would see him and hear his voice no more in life.

A kind porter in the place let her sit down in his room and await the result. Before nightfall, she was a widow. The announcement was made to her by one of the dressers, who coupled his bad news with a request from the authorities for leave to make a post-mortem examination. For James Green had yet something to contribute to science and St. Bernard’s; he had given his life; had presented a rising young surgeon with his first opportunity for a great and interesting operation. He had still something more to bestow – his dead body. It was considered a grievous oversight, and a wrong to the institution, if a patient who had died there failed to make his or her appearance on the post-mortem table at four o’clock the next day, not only that it might be seen and demonstrated by skilled pathologists just where and how the operation had gone wrong, but for the sake of all the beautiful and instructive things that might be shown in brain, or heart, or lungs. For statistical purposes, for treatises being written, for papers for learned societies on all and every of the ailments of humanity, it was ill fortune to let a sectio cadaveris slip, as one never knew what one might be losing. They had an euphemistic way of asking the relatives’ permission for what they termed a “P.M.”

“You don’t object to a slight examination, do you, just to find out the real cause of death, so as to make the death certificate all right?”

Who could object? Few understood what it all meant, fewer thought they had any power to object; so the cases were rare where the ruse failed.

There is a widespread feeling amongst the people against post-mortem examinations. There is a vague apprehension that portions of their deceased friend’s anatomy may appear “in spirits in a vial,” in some museum or other. When the remains of the relative come back from the hospital, it is unpleasant to feel doubts as to their integrity. Visions of important portions of their internal economy lying perdu in back gardens of students’ lodgings, the prey of the too inquisitive cat or investigating terrier, are not altogether baseless. Hundreds of back gardens in London doubtless do contain such material, as we have frequent proof. Many thousands of museum shelves are loaded with preparations of such departed friends. It is doubtless, in the abstract, absurd to object to these common practices; but when it comes home to a mother to ask how she would like her dead child’s remains disposed of, it is perfectly natural, and not at all absurd, to suppose that with her whole heart, she would earnestly demand that they should be reverently interred in Christian ground, and be as little mutilated as possible.

The Jews are very reluctant to allow post-mortem examinations on their relatives; and, when such a thing is unavoidable, as by coroner’s order, an official from the synagogue is present to see that nothing is abstracted. It has often happened that the friends have discovered that portions of the corpse have been withheld or lost; and, as such detention of human remains is forbidden by law, the authorities have had to compensate the relatives by handsome sums towards the funeral expenses. Nevertheless, one shilling will still purchase a healthy, adult human brain to dissect quietly at home; and the emptiness of the dead person’s head is not always a cause of surprise. A judicious porter in the P.M. room has often found the cranial cavity a good receptacle for the liver, thus balancing matters comfortably.

CHAPTER XXVI.

SISTER AGNES REVOLTS

The world’s male chivalry has perished out,But women are knights-errant to the last;And if Cervantes had been Shakespeare too,He had made his Don a Donna.– Elizabeth B. Browning.

When it was found that Elsworth had quite disappeared, and nothing more was heard of him, many of the good sisters and kind-hearted nurses were really sorry to have lost him. None more so than Sister Agnes. Sister Agnes was the brightest, cleverest, and most devoted nurse that could be imagined. She never wearied of her work, never grew snappy and huffy, as the best of women will when worn and weary with hard work and watching. She never seemed to need rest; that is to say, she never exhibited in her perfect temper the strain upon her system which her heavy duties entailed. She was not only the intimate personal friend of all the nurses under her, but she made it her business to aid in a thousand ways all her patients and smooth their pillows by the many sweet attentions such a loving woman could bestow. She was the widow of a clergyman who had died two years after his marriage, and having no family she was free to follow a long cherished desire, and so devoted herself and her admirable talents to the sacred office of nursing. She was tall and dark, with charming wavy hair and a healthy, not to say ruddy, complexion, which bespoke more than the usual health of a London woman. Deeply religious, of High Church principles, she was yet entirely free from those prejudices against other forms of belief which often detract from the usefulness of a hospital sister. It was enough for her to know that a patient loved her Master, in whatever outward form that love was expressed, to make Sister Agnes at once a friend. In many a way she contrived to instil even into the hearts of the most indifferent some thought of better things, some hope of a life beyond. Most of her patients left her wards the better for having come into contact with her. Sister Agnes often said she had observed in Elsworth traits that promised a great and useful man, and she was always unwilling to believe that he had gone wrong in any way. For many months past she had found difficulties in her work at St. Bernard’s in consequence of the growing dissatisfaction she felt at the conduct of most of the doctors who attended her patients. It pained her and roused her indignation that needless and dangerous things were constantly done to patients who had no idea of their import, and who would have protested with all their might if the opportunity had been given them. Valuable lives of patients who had become her friends had been sacrificed to the growing taste for novelty in methods and instruments, daily introduced from all parts of the world. What one man had done in Berlin must be imitated here, and what had proved fatal in New York was tried at St. Bernard’s in the hope of better success and the increased reputation of the operator. One man extirpated one organ and one another; one resected this and another that, till poor Sister Agnes began to wonder what, and if any, part of the frame would ultimately claim exemption from the rage for taking it away. And she was expected to do her part in paving the road for all these mutilations. The wiser she grew, and the more she learned of her business, the more she saw that much, if not most, of all this was not for the patient’s good; and no wonder she began to rebel. She was brought principally in contact with Dr. Stanforth, who was the chief physician of the women’s wards. Not alone did she object to his professional methods, but the manner he used in the wards. It was neither useful nor expedient for Dr. Stanforth to regale his class, in the presence of herself and nurses, with his most salacious anecdotes, his coarse allusions and indecent jokes. Some patients no doubt enjoyed them, but these were a minority which should have been made better instead of worse by living in the hospital. To most, however, these things were painful in the extreme. It required better health and stronger nerves than the women generally possessed to cope with Dr. Stanforth and his rollicking lads. The valley of the shadow of death is an ill place for satyric abominations. The sympathetic nerves of the poor sister’s face were too habituated to Dr. Stanforth’s little ways to cause her cheeks to flush at all of their manifestations, but there were times when her indignation would make her turn away with her note-book and inkstand, and remove out of earshot. At such times the funny man would apologise in a way which only made matters worse, and she would often wonder in her own mind how much longer she could or ought to be a party to these improprieties.

CHAPTER XXVII.

“ANOTHER PATIENT, SISTER!”

He was happier using the knife than in trying to save the limb.

– Tennyson.And whom have ye knowen die honestlyWithout help of the Poticary?– Heywood.

Dr. Stanforth was considered a model hospital physician – for the students. They were ever the first in his thoughts; to touch one of them was to touch the apple of his eye. He lived for them (and by them), yet he never allowed any of his patients to suspect anything of the kind. There was nothing he grudged his pupils, and they consequently worshipped him. To serve any of his boys he would sacrifice the feelings of any interesting bit of “clinical material” that came in his way, and he boasted that he turned out more proficient practitioners than any one of his colleagues. His methods were startling even to them, and many were the wrinkles he put them up to. His fame in his speciality – gynæcology, was so great, and his really remarkable abilities so well recognised, that nothing he did, startling though it was to the outside world, diminished the crowds of patients who flocked to his consulting rooms. Of course he had the bonhomie and social tact that are needful in attaching young men to a teacher; he was, in addition, able to prove to them that by attending his practice they were acquiring a practical knowledge of their work which they could obtain in no other way.

Dr. Stanforth held all his patients at the disposal of any pupil of his who desired to do or see something new. “Do what you like, my lad,” he used to say to a favourite assistant. “You are in these wards to learn all you can, and all my beds are at your service. Would you like to do a gastrotomy? You ought to do one or two before you leave; it’s a very pretty operation. I never knew a case survive more than a week; but there’s nothing like trying, and if you pick out a case that must die any way, you are welcome to use any of my cases that we can get to consent: and with Sister Agnes’ help – Sister is capital at getting consent to anything, aren’t you Sister? – it can generally be managed. Yes, you had better do one or two; it will be a fashionable operation before long. Rabbits do very well with it, better than dogs in my hands; but humans don’t take nicely to it at all. Now, don’t scruple to let me know anything you’d like to do. I owe you something good for keeping that pretty Pemphigus going so nicely while I was on my holiday – very good of you, very good indeed – I sha’n’t forget you; bye-bye.”

At what awful cost all this was to the “material” he never troubled to estimate. The scandal at last got too strong for St. Bernard’s, and he was soon promoted “out of the opportunities of his art” – as he complained.

“Sister, let us have another patient!” said Dr. Stanforth, on one occasion, just as one might say, “Hand me another chair,” or “Bring me another book.” It was in the private operating room at St. Bernard’s, screened off from the ward specially set apart for women. The assistant physician of this important department had invented a new apparatus for administering anæsthetics, and it was tried that day for the first time – tried on hospital patients first, of course. It promised materially to assist in bringing the patient under the influence of the anæsthetic with rapidity and comfort. Being a complicated machine, with various ingeniously constructed valves, it was not by any means an easy thing to manage, and the least error might have fatal consequences; it would never do, therefore, to use such a thing out of doors till all its bearings had been taken at the hospital, where any mishap could be adroitly attributed to some other cause. Long before one dare use such a thing on Lady Millefleurs, its capabilities and little eccentricities must be exhibited on the unimportant carcass of Eliza Smith; and so it fell out that day that a little knot of students, interested in giving chloroform or ether, with due address, were assembled to see the working of this pretty bit of mechanism.

Dr. Stanforth was an amiable creature, who lived and worked for, and devoted all his energies to his “boys,” as he called his students; for them he spared his patients neither shame nor pang; for them his beds were occupied by so much “teaching stuff.” He was skilful to cure, but at St. Bernard’s he often forebore to cure too rapidly, lest the “pretty case” might get well before all his boys had had their fill of it. It was far better, he used to say, that a patient should “bide a wee,” if any interest attached to her case, than that any budding obstetrician should leave the hospital imperfectly equipped with all the weapons he required. “Have as many patients as you want, my lad,” he said; “let us get the thing right while we are about it.” “The thing” was the new apparatus, and on its first trial on patient number one, had narrowly escaped sending her to kingdom come by suffocation. She appeared to be “going off lovely,” as funny Mr. Philips said, till Dr. Stanforth, suddenly turning round in the middle of a droll story about his friend “Wales and the actress,” seized the patient’s hand, and declared she was “going” in quite another sense. Artificial respiration was performed, and the woman restored to life and consciousness. It was generous not to subject her to any further experiment that day, and she was sent back to her bed, which she had not left for any benefit likely, under any circumstances, to accrue to herself, while the instrument which had so terribly failed was carefully examined for the cause of the mishap. On taking it to pieces, a mechanical genius amongst the students found that a valve had got fixed, and as it was speedily put to rights, the operator was encouraged by Dr. Stanforth with “Better luck next time my boy. Sister, let us have another patient!” How the sister managed to induce a second woman to undergo a mysterious ordeal, the purport of which she was not permitted to question, and after the experiences of the first victim, which did not appear to the curious ward as having been altogether pleasant, we do not pretend to understand; but hospital sisters who know their business have clever little ways whereby they aid and abet the doctors in their search for wisdom. Sister Agnes had long felt that her conscience was being overstrained at St. Bernard’s. Her work was developing itself as quite other than she had expected when she gave herself up to the life of a nurse. These good women, at any rate, had a lofty ideal, and followed it with no hope of other than its own reward. They were not seeking fame, or money, or any worldly reward; it was no wonder therefore that a noble-minded woman like Sister Agnes should see that unless the great work of her life, for which she had given up all else, were undeviatingly followed, she at any rate had failed in attaining her mission. It was not to help doctors to get knowledge; it was not by trickery and “white lies,” used to induce defenceless sufferers to submit to horrible ordeals, and indescribably painful examinations for no benefit to themselves, but simply to teach their business to young men, that she had devoted herself to work in the wards of a general hospital. And daily the conduct of Dr. Stanforth and his assistants clearly showed that the patient’s benefit was quite a secondary object, and the chief end of his or her residence in the wards of St. Bernard’s was precisely that of an artist’s model visiting a studio. Very good, doubtless, in its way, but not what the main body of hospital subscribers intend; still less what the patients come for, and only partially, surely, what such as she had left the world to aid. In a word, she saw plainly that the whole system of the modern hospital in great cities was a gigantic sham, a cruel fraud on the subscribers, and an atrocious delusion and a snare to the patients themselves.

How difficult a task it would be to convince the world of all this! What an Augean stable for a weak woman to cleanse! Then again nothing annoys the public more than to open the doors of its whited sepulchres. Of course, it was no use to condemn the present system without putting something better in its place. The workhouse infirmary was far better in one sense; there, the object was to help the patient to get well as speedily as possible, and take himself off the books; but there attaches a stigma to the infirmary from which the hospital is free, yet the hospital must be reformed on the model, in some respects, of the infirmaries.

The sister was a clever woman, a woman of ample means, and with great influence; why should not this be her life-work to found a new order of charity? It had been the work of many a noble woman to do greater things than this, and with apparently less foothold; and that night, before she went to rest, she prayed that strength and wisdom might be given to her to carry out the scheme which was taking hold upon her heart. “I shall want half a million of money to make a beginning. What is that? A man dies, and leaves a quarter of a million to a college of anatomy and surgery, to be spent in skeletons and pickled specimens of curious fish and odd deformities. Many a man’s picture gallery has had that spent upon it; it might buy a moderately good ironclad; would make a mile or two of suburban railway, and execute a few hundred yards of submarine tunnel. Somebody will come along who will see with me that humanity and cruelty, whom God hath disjoined eternally, shall not be forced into unholy union. Let me be the Joan of Arc to fight this out.”

But not yet. She must arrange her plan of campaign, collect her forces. So enormous a task must demand an adequate inception, and though she shrank from nothing, she ventured nothing rashly.

CHAPTER XXVIII.

DR. STANFORTH WITH HIS PUPILS

His story would not have been worth one farthing if He had made the hat of him whom he represented one inch narrower.

– Steele.

Natural ferocity makes fewer cruel people than self love.

– La Rochefoucauld.

Dr. Stanforth knew everybody, from “a very exalted personage,” with whom he led the students to believe he was on terms of close intimacy, down to the most insignificant disciple of Galen who had ever been connected with the hospital. He never permitted a patient to baffle him; he always pretended that he knew all about him or her, and had his or her medical history at his fingers’ ends. His days in the out-patients’ rooms were looked forward to by the students with delight. He was so droll; he teased the pert and knowing patients worse than any Old Bailey barrister. “There was no getting over Stanforth,” they declared; “he was too much for the artfullest of ’em.” His bete noir was the over-dressed, robust, viragoish lady patient, who could well afford to pay for medical advice, but wanted it for nothing.

“Put out your tongue, madam.”

The lady complied. Carefully adjusting his gold eye-glasses, he would minutely inspect it.

“Did I understand you to say you were a strict teetotaler?”

“No, sir, I am not exactly that: but it’s little I ever touch except a glass of beer with my dinner.”

“No spirits, madam?”

“Very seldom, sir.”

Dr. Stanforth would take off his glasses, carefully wipe them with his handkerchief, and readjust them.

“Permit me to see your tongue again, madam. Um – ah – h – h.” Then, after looking at the organ closely for some moments, he would ask, incredulously —

“You never take spirits, madam?”

“I said very seldom, doctor – never more than a teaspoonful of brandy in a little water the last thing at night. You know you told I might do that last time I was here.”

“One teaspoonful, madam?” with another scrutiny of the tongue; “only one teaspoonful of brandy?”

“That is all, sir,” said the patient, bridling up and getting restive.

Dr. Stanforth took off his glasses, folded them, and leaning back in his chair, asked in his blandest tones, “Pray, where do you procure your brandy? It must be very strong. I can get none so good!”

The woman would bear no more roasting that day, and having taken her prescription, left the room, the assembled students heartily enjoying her discomfiture.

The way to annoy him and put him on his mettle was for a lady patient to object to an examination in the presence of his very large class of students.