XIII
THE SURGEON TALKS
"Men die of the diseases which they have studied most," remarked thesurgeon, snipping off the end of a cigar with all his professionalneatness and finish. "It's as if the morbid condition was an evilcreature which, when it found itself closely hunted, flew at the throatof its pursuer. If you worry the microbes too much they may worry you.I've seen cases of it, and not necessarily in microbic diseases either.There was, of course, the well-known instance of Liston and theaneurism; and a dozen others that I could mention. You couldn't have aclearer case than that of poor old Walker of St. Christopher's. Notheard of it? Well, of course, it was a little before your time, but Iwonder that it should have been forgotten. You youngsters are so busy inkeeping up to the day that you lose a good deal that is interesting ofyesterday.
"Walker was one of the best men in Europe on nervous disease. You musthave read his little book on sclerosis of the posterior columns. It's asinteresting as a novel, and epoch-making in its way. He worked like ahorse, did Walker--huge consulting practice--hours a day in the clinicalwards--constant original investigations. And then he enjoyed himselfalso. '_De mortuis_,' of course, but still it's an open secret among allwho knew him. If he died at forty-five, he crammed eighty years into it.The marvel was that he could have held on so long at the pace at whichhe was going. But he took it beautifully when it came.
"I was his clinical assistant at the time. Walker was lecturing onlocomotor ataxia to a wardful of youngsters. He was explaining that oneof the early signs of the complaint was that the patient could not puthis heels together with his eyes shut without staggering. As he spoke,he suited the action to the word. I don't suppose the boys noticedanything. I did, and so did he, though he finished his lecture without asign.
"When it was over he came into my room and lit a cigarette.
"'Just run over my reflexes, Smith,' said he.
"There was hardly a trace of them left, I tapped away at his knee-tendonand might as well have tried to get a jerk out of that sofa-cushion. Hestood, with his eyes shut again, and he swayed like a bush in the wind.
"'So,' said he, 'it was not intercostal neuralgia after all.'
"Then I knew that he had had the lightning pains, and that the case wascomplete. There was nothing to say, so I sat looking at him while hepuffed and puffed at the cigarette. Here he was, a man in the prime oflife, one of the handsomest men in London, with money, fame, socialsuccess, everything at his feet, and now, without a moment's warning, hewas told that inevitable death lay before him, a death accompanied bymore refined and lingering tortures than if he were bound upon a RedIndian stake. He sat in the middle of the blue cigarette cloud with hiseyes cast down, and the slightest little tightening of his lips. Then herose with a motion of his arms, as one who throws off old thoughts andenters upon a new course.
"'Better put this thing straight at once,' said he. 'I must make somefresh arrangements. May I use your paper and envelopes?'
"He settled himself at my desk and he wrote half a dozen letters. It isnot a breach of confidence to say that they were not addressed to hisprofessional brothers. Walker was a single man, which means that he wasnot restricted to a single woman. When he had finished, he walked out ofthat little room of mine, leaving every hope and ambition of his lifebehind him. And he might have had another year of ignorance and peace ifit had not been for the chance illustration in his lecture.
"It took five years to kill him, and he stood it well. If he had everbeen a little irregular he atoned for it in that long martyrdom. He keptan admirable record of his own symptoms, and worked out the eye changesmore fully than has ever been done. When the ptosis got very bad hewould hold his eyelid up with one hand while he wrote. Then, when hecould not co-ordinate his muscles to write, he dictated to his nurse. Sodied, in the odour of science, James Walker, aet. 45.
"Poor old Walker was very fond of experimental surgery, and he brokeground in several directions. Between ourselves, there may have beensome more ground-breaking afterwards, but he did his best for his cases.You know M'Namara, don't you? He always wears his hair long. He lets itbe understood that it comes from his artistic strain, but it is reallyto conceal the loss of one of his ears. Walker cut the other one off,but you must not tell Mac I said so.
"It was like this. Walker had a fad about the portio dura--the motor tothe face, you know--and he thought paralysis of it came from adisturbance of the blood supply. Something else which counterbalancedthat disturbance might, he thought, set it right again. We had a veryobstinate case of Bell's paralysis in the wards, and had tried it withevery conceivable thing, blistering, tonics, nerve-stretching,galvanism, needles, but all without result. Walker got it into his headthat removal of the ear would increase the blood supply to the part, andhe very soon gained the consent of the patient to the operation.
"Well, we did it at night. Walker, of course, felt that it was somethingof an experiment, and did not wish too much talk about it unless itproved successful. There were half a dozen of us there, M'Namara and Iamong the rest. The room was a small one, and in the centre was thenarrow table, with a mackintosh over the pillow, and a blanket whichextended almost to the floor on either side. Two candles, on aside-table near the pillow, supplied all the light. In came the patient,with one side of his face as smooth as a baby's, and the other all in aquiver with fright. He lay down, and the chloroform towel was placedover his face, while Walker threaded his needles in the candle light.The chloroformist stood at the head of the table, and M'Namara wasstationed at the side to control the patient. The rest of us stood by toassist.
"Well, the man was about half over when he fell into one of thoseconvulsive flurries which come with the semi-unconscious stage. Hekicked and plunged and struck out with both hands. Over with a crashwent the little table which held the candles, and in an instant we wereleft in total darkness. You can think what a rush and a scurry therewas, one to pick up the table, one to find the matches, and some torestrain the patient, who was still dashing himself about. He was helddown by two dressers, the chloroform was pushed, and by the time thecandles were relit, his incoherent, half-smothered shoutings had changedto a stertorous snore. His head was turned on the pillow and the towelwas still kept over his face while the operation was carried through.Then the towel was withdrawn, and you can conceive our amazement when welooked upon the face of M'Namara.
"How did it happen? Why, simply enough. As the candles went over, thechloroformist had stopped for an instant and had tried to catch them.The patient, just as the light went out, had rolled off and under thetable. Poor M'Namara, clinging frantically to him, had been draggedacross it, and the chloroformist, feeling him there, had naturallyclapped the towel across his mouth and nose. The others had secured him,and the more he roared and kicked the more they drenched him withchloroform. Walker was very nice about it, and made the most handsomeapologies. He offered to do a plastic on the spot, and make as good anear as he could, but M'Namara had had enough of it. As to the patient,we found him sleeping placidly under the table, with the ends of theblanket screening him on both sides. Walker sent M'Namara round his earnext day in a jar of methylated spirit, but Mac's wife was very angryabout it, and it led to a good deal of ill-feeling. Some people saythat the more one has to do with human nature, and the closer one isbrought in contact with it, the less one thinks of it. I don't believethat those who know most would uphold that view. My own experience isdead against it. I was brought up in the miserable-mortal-clay school oftheology, and yet here I am, after thirty years of intimate acquaintancewith humanity, filled with respect for it. The evil lies commonly uponthe surface. The deeper strata are good. A hundred times I have seenfolk condemned to death as suddenly as poor Walker was. Sometimes it wasto blindness or to mutilations which are worse than death. Men andwomen, they almost all took it beautifully, and some with such lovelyunselfishness, and with such complete absorption in the thought of howtheir fate would affect others, that the man about town, or thefrivolously-dressed wo
man had seemed to change into an angel before myeyes. I have seen death-beds, too, of all ages and of all creeds andwant of creeds. I never saw any of them shrink, save only one poor,imaginative young fellow, who had spent his blameless life in thestrictest of sects. Of course, an exhausted frame is incapable of fear,as any one can vouch who is told, in the midst of his seasickness, thatthe ship is going to the bottom. That is why I rate courage in the faceof mutilation to be higher than courage when a wasting illness is finingaway into death.
"Now, I'll take a case which I had in my own practice last Wednesday. Alady came in to consult me--the wife of a well-known sporting baronet.The husband had come with her, but remained, at her request, in thewaiting-room. I need not go into details, but it proved to be apeculiarly malignant case of cancer. 'I knew it,' said she. 'How longhave I to live?' 'I fear that it may exhaust your strength in a fewmonths,' I answered. 'Poor old Jack!' said she. 'I'll tell him that itis not dangerous.' 'Why should you deceive him?' I asked. 'Well, he'svery uneasy about it, and he is quaking now in the waiting-room. He hastwo old friends to dinner to-night, and I haven't the heart to spoil hisevening. To-morrow will be time enough for him to learn the truth.' Outshe walked, the brave little woman, and a moment later her husband, withhis big, red face shining with joy came plunging into my room to shakeme by the hand. No, I respected her wish and I did not undeceive him. Idare bet that evening was one of the brightest, and the next morning thedarkest, of his life.
"It's wonderful how bravely and cheerily a woman can face a crushingblow. It is different with men. A man can stand it without, but itknocks him dazed and silly all the same. But the woman does not lose herwits any more than she does her courage. Now, I had a case only a fewweeks ago which would show you what I mean. A gentleman consulted meabout his wife, a very beautiful woman. She had a small tubercularnodule upon her upper arm, according to him. He was sure that it was ofno importance, but he wanted to know whether Devonshire or the Rivierawould be the better for her. I examined her and found a frightfulsarcoma of the bone, hardly showing upon the surface, but involving theshoulder-blade and clavicle as well as the humerus. A more malignantcase I have never seen. I sent her out of the room and I told him thetruth. What did he do? Why, he walked slowly round that room with hishands behind his back, looking with the greatest interest at thepictures. I can see him now, putting up his gold _pince-nez_ and staringat them with perfectly vacant eyes, which told me that he saw neitherthem nor the wall behind them. 'Amputation of the arm?' he asked atlast. 'And of the collar-bone and shoulder-blade,' said I. 'Quite so.The collar-bone and shoulder-blade,' he repeated, still staring abouthim with those lifeless eyes. It settled him. I don't believe he'll everbe the same man again. But the woman took it as bravely and brightly ascould be, and she has done very well since. The mischief was so greatthat the arm snapped as we drew it from the night-dress. No, I don'tthink that there will be any return, and I have every hope of herrecovery.
"The first patient is a thing which one remembers all one's life. Minewas commonplace, and the details are of no interest. I had a curiousvisitor, however, during the first few months after my plate went up. Itwas an elderly woman, richly dressed, with a wicker-work picnic basketin her hand. This she opened with the tears streaming down her face, andout there waddled the fattest, ugliest and mangiest little pug dog thatI have ever seen. 'I wish you to put him painlessly out of the world,doctor,' she cried. 'Quick, quick, or my resolution may give way.' Sheflung herself down, with hysterical sobs, upon the sofa. The lessexperienced a doctor is, the higher are his notions of professionaldignity, as I need not remind you, my young friend, so I was about torefuse the commission with indignation, when I bethought me that, quiteapart from medicine, we were gentleman and lady, and that she had askedme to do something for her which was evidently of the greatest possibleimportance in her eyes. I led off the poor little doggie, therefore, andwith the help of a saucerful of milk and a few drops of prussic acid hisexit was as speedy and painless as could be desired. 'Is it over?' shecried as I entered. It was really tragic to see how all the love whichshould have gone to husband and children had, in default of them, beencentred upon this uncouth little animal. She left, quite broken down, inher carriage, and it was only after her departure that I saw an envelopesealed with a large red seal, and lying upon the blotting pad of mydesk. Outside, in pencil, was written:--'I have no doubt that you wouldwillingly have done this without a fee, but I insist upon youracceptance of the enclosed.' I opened it with some vague notions of aneccentric millionaire and a fifty pound note, but all I found was apostal order for four and sixpence. The whole incident struck me as sowhimsical that I laughed until I was tired. You'll find there's so muchtragedy in a doctor's life, my boy, that he would not be able to standit if it were not for the strain of comedy which comes every now andthen to leaven it.
"And a doctor has very much to be thankful for also. Don't you everforget it. It is such a pleasure to do a little good that a man shouldpay for the privilege instead of being paid for it. Still, of course, hehas his home to keep up and his wife and children to support. But hispatients are his friends--or they should be so. He goes from house tohouse, and his step and his voice are loved and welcomed in each. Whatcould a man ask for more than that? And besides, he is forced to be agood man. It is impossible for him to be anything else. How can a manspend his whole life in seeing suffering bravely borne and yet remain ahard or a vicious man? It is a noble, generous, kindly profession, andyou youngsters have got to see that it remains so."