Chapter LXXXI

by William Somerset Maugham

　　At the beginning of the winter session Philip became an out-patients'clerk. There were three assistant-physicians who took out-patients, twodays a week each, and Philip put his name down for Dr. Tyrell. He waspopular with the students, and there was some competition to be his clerk.Dr. Tyrell was a tall, thin man of thirty-five, with a very small head,red hair cut short, and prominent blue eyes: his face was bright scarlet.He talked well in a pleasant voice, was fond of a little joke, and treatedthe world lightly. He was a successful man, with a large consultingpractice and a knighthood in prospect. From commerce with students andpoor people he had the patronising air, and from dealing always with thesick he had the healthy man's jovial condescension, which some consultantsachieve as the professional manner. He made the patient feel like a boyconfronted by a jolly schoolmaster; his illness was an absurd piece ofnaughtiness which amused rather than irritated.The student was supposed to attend in the out-patients' room every day,see cases, and pick up what information he could; but on the days on whichhe clerked his duties were a little more definite. At that time theout-patients' department at St. Luke's consisted of three rooms, leadinginto one another, and a large, dark waiting-room with massive pillars ofmasonry and long benches. Here the patients waited after having been giventheir `letters' at mid-day; and the long rows of them, bottles andgallipots in hand, some tattered and dirty, others decent enough, sittingin the dimness, men and women of all ages, children, gave one animpression which was weird and horrible. They suggested the grim drawingsof Daumier. All the rooms were painted alike, in salmon-colour with a highdado of maroon; and there was in them an odour of disinfectants, minglingas the afternoon wore on with the crude stench of humanity. The first roomwas the largest and in the middle of it were a table and an office chairfor the physician; on each side of this were two smaller tables, a littlelower: at one of these sat the house-physician and at the other the clerkwho took the `book' for the day. This was a large volume in which werewritten down the name, age, sex, profession, of the patient and thediagnosis of his disease.At half past one the house-physician came in, rang the bell, and told theporter to send in the old patients. There were always a good many ofthese, and it was necessary to get through as many of them as possiblebefore Dr. Tyrell came at two. The H.P. with whom Philip came in contactwas a dapper little man, excessively conscious of his importance: hetreated the clerks with condescension and patently resented thefamiliarity of older students who had been his contemporaries and did notuse him with the respect he felt his present position demanded. He setabout the cases. A clerk helped him. The patients streamed in. The mencame first. Chronic bronchitis, "a nasty 'acking cough," was what theychiefly suffered from; one went to the H.P. and the other to the clerk,handing in their letters: if they were going on well the words Rep 14were written on them, and they went to the dispensary with their bottlesor gallipots in order to have medicine given them for fourteen days more.Some old stagers held back so that they might be seen by the physicianhimself, but they seldom succeeded in this; and only three or four, whosecondition seemed to demand his attention, were kept.Dr. Tyrell came in with quick movements and a breezy manner. He remindedone slightly of a clown leaping into the arena of a circus with the cry:Here we are again. His air seemed to indicate: What's all this nonsenseabout being ill? I'll soon put that right. He took his seat, asked ifthere were any old patients for him to see, rapidly passed them in review,looking at them with shrewd eyes as he discussed their symptoms, crackeda joke (at which all the clerks laughed heartily) with the H.P., wholaughed heartily too but with an air as if he thought it was ratherimpudent for the clerks to laugh, remarked that it was a fine day or a hotone, and rang the bell for the porter to show in the new patients.They came in one by one and walked up to the table at which sat Dr.Tyrell. They were old men and young men and middle-aged men, mostly of thelabouring class, dock labourers, draymen, factory hands, barmen; but some,neatly dressed, were of a station which was obviously superior,shop-assistants, clerks, and the like. Dr. Tyrell looked at these withsuspicion. Sometimes they put on shabby clothes in order to pretend theywere poor; but he had a keen eye to prevent what he regarded as fraud andsometimes refused to see people who, he thought, could well pay formedical attendance. Women were the worst offenders and they managed thething more clumsily. They would wear a cloak and a skirt which were almostin rags, and neglect to take the rings off their fingers."If you can afford to wear jewellery you can afford a doctor. A hospitalis a charitable institution," said Dr. Tyrell.He handed back the letter and called for the next case."But I've got my letter.""I don't care a hang about your letter; you get out. You've got nobusiness to come and steal the time which is wanted by the really poor."The patient retired sulkily, with an angry scowl."She'll probably write a letter to the papers on the gross mismanagementof the London hospitals," said Dr. Tyrell, with a smile, as he took thenext paper and gave the patient one of his shrewd glances.Most of them were under the impression that the hospital was aninstitution of the state, for which they paid out of the rates, and tookthe attendance they received as a right they could claim. They imaginedthe physician who gave them his time was heavily paid.Dr. Tyrell gave each of his clerks a case to examine. The clerk took thepatient into one of the inner rooms; they were smaller, and each had acouch in it covered with black horse-hair: he asked his patient a varietyof questions, examined his lungs, his heart, and his liver, made notes offact on the hospital letter, formed in his own mind some idea of thediagnosis, and then waited for Dr. Tyrell to come in. This he did,followed by a small crowd of students, when he had finished the men, andthe clerk read out what he had learned. The physician asked him one or twoquestions, and examined the patient himself. If there was anythinginteresting to hear students applied their stethoscope: you would see aman with two or three to the chest, and two perhaps to his back, whileothers waited impatiently to listen. The patient stood among them a littleembarrassed, but not altogether displeased to find himself the centre ofattention: he listened confusedly while Dr. Tyrell discoursed glibly onthe case. Two or three students listened again to recognise the murmur orthe crepitation which the physician described, and then the man was toldto put on his clothes.When the various cases had been examined Dr. Tyrell went back into thelarge room and sat down again at his desk. He asked any student whohappened to be standing near him what he would prescribe for a patient hehad just seen. The student mentioned one or two drugs."Would you?" said Dr. Tyrell. "Well, that's original at all events. Idon't think we'll be rash."This always made the students laugh, and with a twinkle of amusement athis own bright humour the physician prescribed some other drug than thatwhich the student had suggested. When there were two cases of exactly thesame sort and the student proposed the treatment which the physician hadordered for the first, Dr. Tyrell exercised considerable ingenuity inthinking of something else. Sometimes, knowing that in the dispensary theywere worked off their legs and preferred to give the medicines which theyhad all ready, the good hospital mixtures which had been found by theexperience of years to answer their purpose so well, he amused himself bywriting an elaborate prescription."We'll give the dispenser something to do. If we go on prescribing mist:alb: he'll lose his cunning."The students laughed, and the doctor gave them a circular glance ofenjoyment in his joke. Then he touched the bell and, when the porter pokedhis head in, said:"Old women, please."He leaned back in his chair, chatting with the H.P. while the porterherded along the old patients. They came in, strings of anaemic girls,with large fringes and pallid lips, who could not digest their bad,insufficient food; old ladies, fat and thin, aged prematurely by frequentconfinements, with winter coughs; women with this, that, and the other,the matter with them. Dr. Tyrell and his house-physician got through themquickly. Time was getting on, and the air in the small room was growingmore sickly. The physician looked at his watch."Are there many new women today?" he asked."A good few, I think," said the H.P."We'd better have them in. You can go on with the old ones."They entered. With the men the most common ailments were due to theexcessive use of alcohol, but with the women they were due to defectivenourishment. By about six o'clock they were finished. Philip, exhausted bystanding all the time, by the bad air, and by the attention he had given,strolled over with his fellow-clerks to the Medical School to have tea. Hefound the work of absorbing interest. There was humanity there in therough, the materials the artist worked on; and Philip felt a curiousthrill when it occurred to him that he was in the position of the artistand the patients were like clay in his hands. He remembered with an amusedshrug of the shoulders his life in Paris, absorbed in colour, tone,values, Heaven knows what, with the aim of producing beautiful things: thedirectness of contact with men and women gave a thrill of power which hehad never known. He found an endless excitement in looking at their facesand hearing them speak; they came in each with his peculiarity, someshuffling uncouthly, some with a little trip, others with heavy, slowtread, some shyly. Often you could guess their trades by the look of them.You learnt in what way to put your questions so that they should beunderstood, you discovered on what subjects nearly all lied, and by whatinquiries you could extort the truth notwithstanding. You saw thedifferent way people took the same things. The diagnosis of dangerousillness would be accepted by one with a laugh and a joke, by another withdumb despair. Philip found that he was less shy with these people than hehad ever been with others; he felt not exactly sympathy, for sympathysuggests condescension; but he felt at home with them. He found that hewas able to put them at their ease, and, when he had been given a case tofind out what he could about it, it seemed to him that the patientdelivered himself into his hands with a peculiar confidence."Perhaps," he thought to himself, with a smile, "perhaps I'm cut out to bea doctor. It would be rather a lark if I'd hit upon the one thing I'm fitfor."It seemed to Philip that he alone of the clerks saw the dramatic interestof those afternoons. To the others men and women were only cases, good ifthey were complicated, tiresome if obvious; they heard murmurs and wereastonished at abnormal livers; an unexpected sound in the lungs gave themsomething to talk about. But to Philip there was much more. He found aninterest in just looking at them, in the shape of their heads and theirhands, in the look of their eyes and the length of their noses. You saw inthat room human nature taken by surprise, and often the mask of custom wastorn off rudely, showing you the soul all raw. Sometimes you saw anuntaught stoicism which was profoundly moving. Once Philip saw a man,rough and illiterate, told his case was hopeless; and, self-controlledhimself, he wondered at the splendid instinct which forced the fellow tokeep a stiff upper-lip before strangers. But was it possible for him to bebrave when he was by himself, face to face with his soul, or would he thensurrender to despair? Sometimes there was tragedy. Once a young womanbrought her sister to be examined, a girl of eighteen, with delicatefeatures and large blue eyes, fair hair that sparkled with gold when a rayof autumn sunshine touched it for a moment, and a skin of amazing beauty.The students' eyes went to her with little smiles. They did not often seea pretty girl in these dingy rooms. The elder woman gave the familyhistory, father and mother had died of phthisis, a brother and a sister,these two were the only ones left. The girl had been coughing lately andlosing weight. She took off her blouse and the skin of her neck was likemilk. Dr. Tyrell examined her quietly, with his usual rapid method; hetold two or three of his clerks to apply their stethoscopes to a place heindicated with his finger; and then she was allowed to dress. The sisterwas standing a little apart and she spoke to him in a low voice, so thatthe girl should not hear. Her voice trembled with fear."She hasn't got it, doctor, has she?""I'm afraid there's no doubt about it.""She was the last one. When she goes I shan't have anybody."She began to cry, while the doctor looked at her gravely; he thought shetoo had the type; she would not make old bones either. The girl turnedround and saw her sister's tears. She understood what they meant. Thecolour fled from her lovely face and tears fell down her cheeks. The twostood for a minute or two, crying silently, and then the older, forgettingthe indifferent crowd that watched them, went up to her, took her in herarms, and rocked her gently to and fro as if she were a baby.When they were gone a student asked:"How long d'you think she'll last, sir?"Dr. Tyrell shrugged his shoulders."Her brother and sister died within three months of the first symptoms.She'll do the same. If they were rich one might do something. You can'ttell these people to go to St. Moritz. Nothing can be done for them."Once a man who was strong and in all the power of his manhood came becausea persistent aching troubled him and his club-doctor did not seem to dohim any good; and the verdict for him too was death, not the inevitabledeath that horrified and yet was tolerable because science was helplessbefore it, but the death which was inevitable because the man was a littlewheel in the great machine of a complex civilisation, and had as littlepower of changing the circumstances as an automaton. Complete rest was hisonly chance. The physician did not ask impossibilities."You ought to get some very much lighter job.""There ain't no light jobs in my business.""Well, if you go on like this you'll kill yourself. You're very ill.""D'you mean to say I'm going to die?""I shouldn't like to say that, but you're certainly unfit for hard work.""If I don't work who's to keep the wife and the kids?"Dr. Tyrell shrugged his shoulders. The dilemma had been presented to hima hundred times. Time was pressing and there were many patients to beseen."Well, I'll give you some medicine and you can come back in a week andtell me how you're getting on."The man took his letter with the useless prescription written upon it andwalked out. The doctor might say what he liked. He did not feel so badthat he could not go on working. He had a good job and he could not affordto throw it away."I give him a year," said Dr. Tyrell.Sometimes there was comedy. Now and then came a flash of cockney humour,now and then some old lady, a character such as Charles Dickens might havedrawn, would amuse them by her garrulous oddities. Once a woman came whowas a member of the ballet at a famous music-hall. She looked fifty, butgave her age as twenty-eight. She was outrageously painted and ogled thestudents impudently with large black eyes; her smiles were grosslyalluring. She had abundant self-confidence and treated Dr. Tyrell, vastlyamused, with the easy familiarity with which she might have used anintoxicated admirer. She had chronic bronchitis, and told him it hinderedher in the exercise of her profession."I don't know why I should 'ave such a thing, upon my word I don't. I'venever 'ad a day's illness in my life. You've only got to look at me toknow that."She rolled her eyes round the young men, with a long sweep of her paintedeyelashes, and flashed her yellow teeth at them. She spoke with a cockneyaccent, but with an affectation of refinement which made every word afeast of fun."It's what they call a winter cough," answered Dr. Tyrell gravely. "Agreat many middle-aged women have it.""Well, I never! That is a nice thing to say to a lady. No one ever calledme middle-aged before."She opened her eyes very wide and cocked her head on one side, looking athim with indescribable archness."That is the disadvantage of our profession," said he. "It forces ussometimes to be ungallant."She took the prescription and gave him one last, luscious smile."You will come and see me dance, dearie, won't you?""I will indeed."He rang the bell for the next case."I am glad you gentlemen were here to protect me."But on the whole the impression was neither of tragedy nor of comedy.There was no describing it. It was manifold and various; there were tearsand laughter, happiness and woe; it was tedious and interesting andindifferent; it was as you saw it: it was tumultuous and passionate; itwas grave; it was sad and comic; it was trivial; it was simple andcomplex; joy was there and despair; the love of mothers for theirchildren, and of men for women; lust trailed itself through the rooms withleaden feet, punishing the guilty and the innocent, helpless wives andwretched children; drink seized men and women and cost its inevitableprice; death sighed in these rooms; and the beginning of life, fillingsome poor girl with terror and shame, was diagnosed there. There wasneither good nor bad there. There were just facts. It was life.