I sat alone in the corner and fingered my tie. They always made the candidates arrive too early, and the coffee would delay them further. There was nothing to do except wait patiently and think about something well removed from the unpleasant quarter of an hour ahead, such as rugby or the lady student’s legs. Suddenly the door was flung open and a wild-eyed youth strode in.
‘It’s not too bad!’ he exclaimed breathlessly to the nonchalant fellow. The two apparently came from the same hospital.
‘I had Sir Rollo Doggert and Stanley Smith,’ he said with a touch of pride. This brought a nod of appreciation from all of us, as they were known as two of the toughest examiners in London.
‘Doggert started off by asking me the signs and symptoms of pink disease,’ he continued. ‘Luckily I knew that as I had happened to look it up last night…’
‘Pink disease!’ cried the worried man. ‘My God, I forgot about that!’
‘So I saw at once the way to handle him was to talk man-to-man, you know – none of this servile business, he much prefers to be stood up to. I reeled off pink disease and he said very good, my lad, very good.’
‘Did he ask you anything else?’ his friend said anxiously.
‘Oh yes. He said, supposing I was out golfing with a diabetic who collapsed at the third tee, what would I do? Well, I said…’
The visitor gave a description of his examination in detail, like the man who comes out of the dentist’s surgery and insists on telling the occupants of the waiting-room his experiences on the excuse that none of the frightful things that can happen really hurt.
The raconteur was stopped short by the porter. He marshalled us into line outside the heavy door of the examination room. There was a faint ting of a bell inside. The door opened and he admitted us one at a time, directing each to a different table.
‘You go to table four,’ the porter told me.
The room was the one we had written the papers in, but it was now empty except for a double row of baize-covered tables separated by screens. At each of these sat two examiners and a student who carried on a low earnest conversation with them, like a confessional.
I stood before table four. I didn’t recognize the examiners. One was a burly, elderly man like a retired prize-fighter who smoked a pipe and was writing busily with a pencil in a notebook; the other was invisible, as he was occupied in reading the morning’s
Times
.
‘Good morning, sir,’ I said.
Neither of them took any notice. After a minute the burly fellow looked up from his writing and silently indicated the chair in front of him. I sat down. He growled.
‘I beg your pardon, sir?’ I said politely.
‘I said, you’re number 306?’ he said testily. ‘That’s correct, I suppose?’
‘Yes, sir.’
‘Well, why didn’t you say so? How would you treat a case of tetanus?’
My heart leapt hopefully. This was something I knew, as there had recently been a case in St Swithin’s. I started off confidently, reeling out the lines of treatment and feeling much better.
The examiner suddenly cut me short.
‘All right, all right,’ he said impatiently, ‘you seem to know that. A girl of twenty comes to you complaining of gaining weight. What do you do?’
This was the sort of question I disliked. There were so many things one could do my thoughts jostled into each other like a rugger scrum and became confused and unidentifiable.
‘I – I would ask if she was pregnant,’ I said.
‘Good God, man! Do you go about asking all the girls you know if they’re pregnant? What hospital d’you come from?’
‘St Swithin’s, sir,’ I said, as though admitting an illegitimate parentage.
‘I should have thought so! Now try again.’
I rallied my thoughts and stumbled through the answer. The examiner sat looking past me at the opposite wall, acknowledging my presence only by grunting at intervals.
The bell rang and I moved into the adjoining chair, facing
The Times
. The newspaper rustled and was set down, revealing a mild, youngish-looking man in large spectacles with a perpetual look of faint surprise on his face. He looked at me as if he was surprised to see me there, and every answer I made was received with the same expression. I found this most disheartening.
The examiner pushed across the green baize a small sealed glass pot from a pathology museum, in which a piece of meat like the remains of a Sunday joint floated in spirit.
‘What’s that?’ he asked.
I picked up the bottle and examined it carefully. By now I knew the technique for pathological specimens of this kind. The first thing to do was turn them upside down, as their identity was often to be found on a label on the bottom. If one was still flummoxed one might sneeze or let it drop from nervous fingers to smash on the floor.
I upturned it and was disappointed to find the label had prudently been removed. Unfortunately there was so much sediment in the jar that it behaved like one of those little globes containing an Eiffel Tower that on reversal cover the model with a thick snowstorm. I could therefore not even see the specimen when I turned it back again.
‘Liver,’ I tried.
‘What!’ exclaimed the surprised man. The other examiner, who had returned to his writing, slammed down his pencil in disgust and glared at me.
‘I mean lung,’ I corrected.
‘That’s better. What’s wrong with it?’
I could get no help from the specimen, which was still tossing in swirling white particles, so I took another guess.
‘Pneumonia. Stage of white hepatization.’
The surprised man nodded. ‘How do you test diphtheria serum?’ he demanded.
‘You inject it into a guinea-pig, sir.’
‘Yes, but you’ve got to have an animal of a standard weight, haven’t you?’
‘Oh yes…a hundred kilogrammes.’
The two men collapsed into roars of laughter.
‘It would be as big as a policeman, you fool!’ shouted the first examiner.
‘Oh, I’m so sorry,’ I stammered miserably. ‘I mean a hundred milligrammes.’
The laughter was renewed. One or two of the examiners at nearby tables looked up with interest. The other candidates felt like prisoners in the condemned block when they hear the bolt go in the execution shed.
‘You could hardly see it then, boy,’ said the surprised man, wiping his eyes. ‘The creature weighs a hundred grammes. However, we will leave the subject. How would you treat a case of simple sore throat?’
‘I would give a course of sulphonamide, sir.’
‘Yes, that’s right.’
‘I disagree with you, Charles,’ the other interrupted forcibly. ‘It’s like taking a hammer at a nut. I have an excellent gargle I have been prescribing for years which does very well.’
‘Oh, I don’t know,’ said the surprised fellow warmly. ‘One must make use of these drugs. I’ve always had excellent results with sulphonamides.’
‘Did you read that paper by McHugh in the
Clinical Record
last winter?’ demanded the first examiner, banging the table again.
‘Certainly I read it, George. And the correspondence which followed. Nevertheless, I feel it is still open to doubt–’
‘I really cannot agree with you–’
They continued arguing briskly, and were still doing so when a second tinkle of the bell allowed me to slide out and rush miserably into the street.
The days after the viva were black ones. It was like having a severe accident. For the first few hours I was numbed, unable to realize what had hit me. Then I began to wonder if I would ever make a recovery and win through. One or two of my friends heartened me by describing equally depressing experiences that had overtaken them previously and still allowed them to pass. I began to hope. Little shreds of success collected together and weaved themselves into a triumphal garland. After all, I thought, I got the bottle right, and I knew about tetanus…then I forgot about it in my anxiety over the last section of the examination, the clinical.
The clinical is probably the most chancy of the three parts. The student may be allotted a straightforward case with sounds in the chest that come through his stethoscope like the noise of an iron foundry; or he may get something devilish tricky.
The cases for clinical examinations were collected from the out-patient departments of hospitals all over London, and were in the class referred to by physicians informally as ‘old chronics.’ They had their lesions healed as far as possible; now they walked round in fairly good health but with a collection of clicks, whistles, or rumbles inside them set up by the irreversible process of their diseases. These are just the sort of things examiners like presenting to students. A case of vague ill-health or an indefinite lump are too arguable, but a good hearty slapping in the chest gives a right to fail a man forthrightly if he misses it.
For this service the patients were given seven-and-six and free tea and buns. But most of them would happily have performed with a strictly amateur status and provided their own sandwiches. The six-monthly visits to the examination were their principal outings of the year. They attended their own hospitals monthly to show off the signs they proudly possessed to a single doctor and discuss their ailment with fellow-patients on the benches outside, but in the exam they were inspected by hundreds of doctors – or as good as – and chatted to the élite of fellow sufferers. It is much the same as winning an international rugby cap.
I arrived at the examination building in plenty of time, to find out what I could of the cases from men who had already been examined. I knew Benskin had been in early and looked for him in the hall to ask what there was upstairs.
‘There’s an asthma in a red scarf, old boy,’ he said helpfully. ‘And an old man with emphysema just behind the door as you go in – if you get him be sure to examine his abdomen, he’s got a couple of hernias thrown in.’
I made a mental note of it.
‘Then there’s a little girl with a patent ductus – you can’t miss her, she’s the only child in the room. Oh, and a woman with burnt-out tabes. He’ll ask you what treatment you’d give her, and he expects the answer “None”.’
I nodded, thanked him, and made my way to the examination room.
My first impression of the clinical examination was of a doctor’s surgery gone into mass-production. Patients were scattered across the room on couches, beds, and wheelchairs, the men divided from the women by screens across the centre. They were in all stages of undress and examination. Circulating busily between them were a dozen or so nurses, examiners in white coats, and unhappy students dangling their stethoscopes behind them like the tails of whipped puppies.
I was directed to a pleasant, tubby little examiner.
‘Hello, my lad,’ he began genially. ‘Where are you from? Swithin’s, eh? When are you chaps going to win the rugger cup? Go and amuse yourself with that nice young lady in the corner and I’ll be back in twenty minutes.’
She was indeed a nice young lady. A redhead with a figure out of
Esquire
.
‘Good morning,’ I said with a professional smile.
‘Good morning,’ she returned brightly.
‘Would you mind telling me your name?’ I asked politely.
‘Certainly. Molly Ditton. I’m unmarried, aged twenty-two, and my work is shorthand-typing, which I have been doing for four years. I live in Ilford and have never been abroad.’
My heart glowed: she knew the form.
‘How long have you been coming up here?’ I asked. ‘You seem to know all the answers.’
She laughed.
‘Oh, years and years. I bet I know more about myself than you do.’
Just the thing! There is a golden rule for clinical examinations – ask the patient. They attend the examination for so many years and hear themselves discussed so often with the candidates they have the medical terms off pat. All I had to do was play my cards correctly. I talked to her about Ilford, and the wonderful advantages of living there; of shorthand-typing and its effects on the fingernails; of her boyfriends and her prospects of matrimony (this produced a few giggles); of the weather and where she went for her holidays.
‘By the way,’ I said with careful casualness, ‘what’s wrong with you?’
‘Oh, I’ve mitral stenosis due to rheumatic fever, but I’m perfectly well compensated and I’ve a favourable prognosis. There’s a presystolic murmur at the apex, but the aortic area is clear and there are no creps at the bases. By the way, my thyroid is slightly enlarged, they like you to notice that. I’m not fibrilating and I’m having no treatment.’
‘Thank you very much,’ I said.
The tubby man was delighted when I passed on to him the patient’s accurate diagnosis as my own.
‘Capital, capital!’ he beamed. ‘Spotted the thyroid, too… glad some of you young fellers use your powers of observation. Been telling my own students for years – observe, observe, observe. They never do, though. Right you are, my lad. Now just take this ophthalmoscope and tell me what you can see in that old woman’s eye.’
My heart, which had been soaring like a swallow, took a sharp dive to earth. The examiner handed me the little black instrument with lenses for looking into the eye. I had often seen it used in the wards but I never seemed to find time to learn how to employ it myself. There was a knack to it, which I did not possess; and I knew plainly enough that the defect was sufficient to fail me out of hand. I imagined the examiner’s sunny friendliness turning into a storm of irritation; my hand shook as I took the instrument. Slowly I placed it closely between my eye and the patient. All I could see was something that looked like a dirty tank in an aquarium with a large, dim fish in it. The time had come for quick thinking. Looking intently through the instrument I let out a long whistle of amazement.
‘Yes, it is a big retinal detachment, isn’t it?’ the examiner said happily, taking away the ophthalmoscope and patting me on the back. I saw myself marked over the pass number, and with a grateful smile at the redhead tripped downstairs in elation.
In the hall I met Benskin again. He was looking profoundly miserable. ‘What’s up?’ I asked anxiously.
Benskin shook his head and explained in a choked voice what had happened. While I was examining medical cases he had been questioned in practical midwifery. One of the tests for prospective obstetricians was provided by a life-size papier mâché model of half the female trunk, into which a straw-stuffed baby was slipped through a trapdoor. The candidate was then provided with a pair of obstetrical forceps and required to deliver it
per via naturalis
. This was demanded of Benskin. He solemnly applied the two blades to the head, taking care to put the correct one on first. He locked the handle, took it in the approved grip, and gave a strong pull. Nothing happened. He pulled harder, but the straw foetus refused to be born. He felt sweat on his brow and his mouth went dry; he saw his chances of passing fading like a spent match. He gave a desperate heave. His feet slipped on the polished floor and over his head flew mother, baby, forceps, and all.
The examiner looked at him lying on the floor for a second in silence. Then he picked up one blade of the forceps and handed it to him.
‘Now hit the father with that,’ he said sourly, ‘and you’ll have killed the whole bloody family.’