the good surgeon is born, not made. he is a complex product in any case, and often something of a prodigy. his qualities cannot be expressed by diplomas nor appraised by university degrees. it may be possible to ascertain what he knows, but no examination can elicit what he can do. he must know the human body as a forester knows his wood; must know it even better than he, must know the roots and branches of every tree, the source and wanderings of every rivulet, the banks of every alley, the flowers of every glade. as a surgeon, moreover, he must be learned in the moods and troubles of the wood, must know of the wild winds that may rend it, of the savage things that lurk in its secret haunts, of the strangling creepers that may throttle its sturdiest growth, of the rot and mould that may make dust of its very heart. as an operator, moreover, he must be a deft handicraftsman and a master of touch.
he may have all these acquirements and yet184 be found wanting; just as a man may succeed when shooting at a target, but fail when faced by a charging lion. he may be a clever manipulator and yet be mentally clumsy. he may even be brilliant, but heaven help the poor soul who has to be operated upon by a brilliant surgeon. brilliancy is out of place in surgery. it is pleasing in the juggler who plays with knives in the air, but it causes anxiety in an operating theatre.
the surgeon’s hands must be delicate, but they must also be strong. he needs a lace-maker’s fingers and a seaman’s grip. he must have courage, be quick to think and prompt to act, be sure of himself and captain of the venture he commands. the surgeon has often to fight for another’s life. i conceive of him then not as a massive hercules wrestling ponderously with death for the body of alcestis, but as a nimble man in doublet and hose who, over a prostrate form, fights death with a rapier.
these reflections were the outcome of an incident which had set me thinking of the equipment of a surgeon and of what is needed to fit him for his work. the episode concerned a young medical man who had started practice in a humble country town. his student career had been185 meritorious and indeed distinguished. he had obtained an entrance scholarship at his medical school, had collected many laudatory certificates, had been awarded a gold medal and had become a fellow of the royal college of surgeons. his inclination was towards surgery. he considered surgery to be his métier. although circumstances had condemned him to the drab life of a family doctor in a little town, he persisted that he was, first and foremost, a surgeon, and, indeed, on his door-plate had inverted the usual wording and had described himself as “surgeon and physician.” in his hospital days he had assisted at many operations, but his opportunities of acting as a principal had been few and insignificant. in a small practice in a small town surgical opportunities are rare. there was in the place a cottage hospital with six beds, but it was mostly occupied by medical cases, by patients with rheumatism or pneumonia, by patients who had to submit to the surgical indignity of being poulticed and of being treated by mere physic. cases worthy of a fellow of the royal college of surgeons were very few, and even these seldom soared in interest above an abscess or a broken leg.
just before the young doctor settled down to186 practise he married. it was a very happy union. the bride was the daughter of a neighbouring farmer. she had spent her life in the country, was more familiar with the ways of fowls and ducks than with the ways of the world, while a sunbonnet became her better than a paris toque. she was as pretty as the milkmaid of a pastoral picture with her pink-and-white complexion, her laughing eyes and her rippled hair.
her chief charm was her radiant delight in the mere joy of living. the small world in which she moved was to her always in the sun, and the sun was that of summer. there was no town so pretty as her little town, and no house so perfect as “the doctor’s” in the high street. “the doctor’s” was a georgian house with windows of many panes, with a fanlight like a surprised eyebrow over the entry and a self-conscious brass knocker on the door. the house was close to the pavement, from which it was separated by a line of white posts connected by loops of chain. passers-by could look over the low green wooden blinds into the dining-room and see the table covered with worn magazines, for the room was intended to imitate a harley street waiting-room. they could see also the bright things on the sideboard, the wedding-present biscuit box,187 the gong hanging from two cow horns and the cup won at some hospital sports. to the young wife there never was such a house, nor such furniture, nor such ornaments, nor, as she went about with a duster from room to room, could there be a greater joy than that of keeping everything polished and bright.
her most supreme adoration, however, was for her husband. he was so 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 affection188 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, and189 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.190 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, 191 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 192 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; looked193 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 an?sthetist 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 his194 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 an?sthetist. both were motionless. they said nothing. indeed, there was nothing to say.195 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.
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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 when197 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 an?sthetist 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.”
