Chapter81

atthebeginningofthewintersessionphilipbecameanout-patients’clerk.therewerethreeassistant-physicianswhotookout-patients,twodaysaweekeach,andphilipputhisnamedownfordr.tyrell.hewaspopularwiththestudents,andtherewassomecompetitiontobehisclerk.dr.tyrellwasatall,thinmanofthirty-five,withaverysmallhead,redhaircutshort,andprominentblueeyes:hisfacewasbrightscarlet.hetalkedwellinapleasantvoice,wasfondofalittlejoke,andtreatedtheworldlightly.hewasaessfulman,withalargeconsultingpracticeandaknighthoodinprospect.fromcommercewithstudentsandpoorpeoplehehadthepatronisingair,andfromdealingalwayswiththesickhehadthehealthyman’sjovialcondescension,whichsomeconsultantsachieveastheprofessionalmanner.hemadethepatientfeellikeaboyconfrontedbyajollyschoolmaster;hisillnesswasanabsurdpieceofnaughtinesswhichamusedratherthanirritated.

thestudentwassupposedtoattendintheout-patients’roomeveryday,seecases,andpickupwhatinformationhecould;butonthedaysonwhichheclerkedhisdutieswerealittlemoredefinite.atthattimetheout-patients’departmentatst.luke’sconsistedofthreerooms,leadingintooneanother,andalarge,darkwaiting-roomwithmassivepillarsofmasonryandlongbenches.herethepatientswaitedafterhavingbeengiventheir‘letters’atmid-day;andthelongrowsofthem,bottlesandgallipotsinhand,sometatteredanddirty,othersdecentenough,sittinginthedimness,menandwomenofallages,children,gaveoneanimpressionwhichwasweirdandhorrible.theyestedthegrimdrawingsofdaumier.alltheroomswerepaintedalike,insalmon-colourwithahighdadoofmaroon;andtherewasinthemanodourofdisinfectants,minglingastheafternoonworeonwiththecrudestenchofhumanity.thefirstroomwasthelargestandinthemiddleofitwereatableandanofficechairforthephysician;oneachsideofthisweretwosmallertables,alittlelower:atoneofthesesatthehouse-physicianandattheothertheclerkwhotookthe‘book’fortheday.thiswasalargevolumeinwhichwerewrittendownthename,age,sex,profession,ofthepatientandthediagnosisofhisdisease.

athalfpastonethehouse-physiciancamein,rangthebell,andtoldtheportertosendintheoldpatients.therewerealwaysagoodmanyofthese,anditwasnecessarytogetthroughasmanyofthemaspossiblebeforedr.tyrellcameattwo.theh.p.withwhomphilipcameincontactwasadapperlittleman,excessivelyconsciousofhisimportance:he

treatedtheclerkswithcondescensionandpatentlyresentedthefamiliarityofolderstudentswhohadbeenhiscontemporariesanddidnotusehimwiththerespecthefelthispresentpositiondemanded.hesetaboutthecases.aclerkhelpedhim.thepatientsstreamedin.themencamefirst.chronicbronchitis,“anasty‘ackingcough,”waswhattheychieflysufferedfrom;onewenttotheh.p.andtheothertotheclerk,handingintheirletters:iftheyweregoingonwellthewordsrep14werewrittenonthem,andtheywenttothedispensarywiththeirbottlesorgallipotsinordertohavemedicinegiventhemforfourteendaysmore.someoldstagersheldbacksothattheymightbeseenbythephysicianhimself,buttheyseldomeededinthis;andonlythreeorfour,whoseconditionseemedtodemandhisattention,werekept.

dr.tyrellcameinwithquickmovementsandabreezymanner.heremindedoneslightlyofaclownleapingintothearenaofacircuswiththecry:hereweareagain.hisairseemedtoindicate:what’sallthisnonsenseaboutbeingill?i’llsoonputthatright.hetookhisseat,askediftherewereanyoldpatientsforhimtosee,rapidlypassedtheminreview,lookingatthemwithshrewdeyesashediscussedtheirsymptoms,crackedajoke(atwhichalltheclerkslaughedheartily)withtheh.p.,wholaughedheartilytoobutwithanairasifhethoughtitwasratherimpudentfortheclerkstolaugh,remarkedthatitwasafinedayorahotone,andrangthebellfortheportertoshowinthenewpatients.

theycameinonebyoneandwalkeduptothetableatwhichsatdr.tyrell.theywereoldmenandyoungmenandmiddle-agedmen,mostlyofthelabouringclass,docklabourers,draymen,factoryhands,barmen;butsome,neatlydressed,wereofastationwhichwasobviouslysuperior,shop-assistants,clerks,andthelike.dr.tyrelllookedatthesewithsuspicion.sometimestheyputonshabbyclothesinordertopretendtheywerepoor;buthehadakeeneyetopreventwhatheregardedasfraudandsometimesrefusedtoseepeoplewho,hethought,couldwellpayformedicalattendance.womenweretheworstoffendersandtheymanagedthethingmoreclumsily.theywouldwearacloakandaskirtwhichwerealmostinrags,andneglecttotaketheringsofftheirfingers.

“ifyoucanaffordtowearjewelleryyoucanaffordadoctor.ahospitalisacharitableinstitution,”saiddr.tyrell.

hehandedbacktheletterandcalledforthenextcase.

“buti’vegotmyletter.”  “idon’tcareahangaboutyourletter;yougetout.you’vegotnobusinesstocomeandstealthetimewhichiswantedbythereallypoor.”

thepatientretiredsulkily,withanangryscowl.

“she’llprobablywritealettertothepapersonthegrossmismanagementofthelondonhospitals,”saiddr.tyrell,withasmile,ashetookthenextpaperandgavethepatientoneofhisshrewdglances.

mostofthemwereundertheimpressionthatthehospitalwasaninstitutionofthestate,forwhichtheypaidoutoftherates,andtooktheattendancetheyreceivedasarighttheycouldclaim.theyimaginedthephysicianwhogavethemhistimewasheavilypaid.

dr.tyrellgaveeachofhisclerksacasetoexamine.theclerktookthepatientintooneoftheinnerrooms;theyweresmaller,andeachhadacouchinitcoveredwithblackhorse-hair:heaskedhispatientavarietyofquestions,examinedhislungs,hisheart,andhisliver,madenotesoffactonthehospitalletter,formedinhisownmindsomeideaofthediagnosis,andthenwaitedfordr.tyrelltocomein.thishedid,followedbyasmallcrowdofstudents,whenhehadfinishedthemen,andtheclerkreadoutwhathehadlearned.

thephysicianaskedhimoneortwoquestions,andexaminedthepatienthimself.iftherewasanythinginterestingtohearstudentsappliedtheirstethoscope:youwouldseeamanwithtwoorthreetothechest,andtwoperhapstohisback,whileotherswaitedimpatientlytolisten.thepatientstoodamongthemalittleembarrassed,butnotaltogetherdispleasedtofindhimselfthecentreofattention:helistenedconfusedlywhiledr.tyrelldiscoursedgliblyonthecase.twoorthreestudentslistenedagaintorecognisethemurmurorthecrepitationwhichthephysiciandescribed,andthenthemanwastoldtoputonhisclothes.

whenthevariouscaseshadbeenexamineddr.tyrellwentbackintothelargeroomandsatdownagainathisdesk.heaskedanystudentwhohappenedtobestandingnearhimwhathewouldprescribeforapatienthehadjustseen.thestudentmentionedoneortwodrugs.

“wouldyou?”saiddr.tyrell.“well,that’soriginalatallevents.idon’tthinkwe’llberash.”

thisalwaysmadethestudentslaugh,andwithatwinkleofamusementathisownbrighthumourthephysicianprescribedsomeotherdrugthanthatwhichthestudenthadested.whenthereweretwocasesofexactlythesamesortandthestudentproposedthetreatmentwhichthephysicianhadorderedforthefirst,dr.tyrellexercisedconsiderableingenuityinthinkingofsomethingelse.sometimes,knowingthatinthedispensarytheywereworkedofftheirlegsandpreferredtogivethemedicineswhichtheyhadallready,thegoodhospitalmixtureswhichhadbeenfoundbytheexperienceofyearstoanswertheirpurposesowell,heamusedhimselfbywritinganelaborateprescription.

“we’llgivethedispensersomethingtodo.ifwegoonprescribingmist:alb:he’lllosehiscunning.”

thestudentslaughed,andthedoctorgavethemacircularglanceofenjoymentinhisjoke.thenhe

touchedthebelland,whentheporterpokedhisheadin,said:

“oldwomen,please.”

heleanedbackinhischair,chattingwiththeh.p.whiletheporterherdedalongtheoldpatients.theycamein,stringsofanaemicgirls,withlargefringesandpallidlips,whocouldnotdigesttheirbad,insufficientfood;oldladies,fatandthin,agedprematurelybyfrequentconfinements,withwintercoughs;womenwiththis,that,andtheother,thematterwiththem.dr.tyrellandhishouse-physiciangotthroughthemquickly.timewasgettingon,andtheairinthesmallroomwasgrowingmoresickly.thephysicianlookedathiswatch.

“aretheremanynewwomentoday?”heasked.

“agoodfew,ithink,”saidtheh.p.

“we’dbetterhavethemin.youcangoonwiththeoldones.”

theyentered.withthementhemostcommonailmentswereduetotheexcessiveuseofalcohol,butwiththewomentheywereduetodefectivenourishment.byaboutsixo’clocktheywerefinished.philip,exhaustedbystandingallthetime,bythebadair,andbytheattentionhehadgiven,strolledoverwithhisfellow-clerkstothemedicalschooltohavetea.hefoundtheworkofabsorbinginterest.therewashumanitythereintherough,thematerialstheartistworkedon;andphilipfeltacuriousthrillwhenitoccurredtohimthathewasinthepositionoftheartistandthepatientswerelikeclayinhishands.herememberedwithanamusedshrugoftheshouldershislifeinparis,absorbedincolour,tone,values,heavenknowswhat,withtheaimofproducingbeautifulthings:thedirectnessofcontactwithmenandwomengaveathrillofpowerwhichhehadneverknown.hefoundanendlessexcitementinlookingattheirfacesandhearingthemspeak;theycameineachwithhispeculiarity,someshufflinguncouthly,somewithalittletrip,otherswithheavy,slowtread,someshyly.oftenyoucouldguesstheirtradesbythelookofthem.youlearntinwhatwaytoputyourquestionssothattheyshouldbeunderstood,youdiscoveredonwhatsubjectsnearlyalllied,andbywhatinquiriesyoucouldextortthetruthnotwithstanding.yousawthedifferentwaypeopletookthesamethings.thediagnosisofdangerousillnesswouldbeacceptedbyonewithalaughandajoke,byanotherwithdumbdespair.philipfoundthathewaslessshywiththesepeoplethanhehadeverbeenwithothers;hefeltnotexactlysympathy,forsympathyestscondescension;buthefeltathomewiththem.hefoundthathewasabletoputthemattheirease,and,whenhehadbeengivenacasetofindoutwhathecouldaboutit,itseemedtohimthatthepatientdeliveredhimselfintohishandswithapeculiarconfidence.

“perhaps,”hethoughttohimself,withasmile,“perhapsi’mcutouttobeadoctor.itwouldberatheralarkifi’dhitupontheonethingi’mfitfor.”

itseemedtophilipthathealoneoftheclerkssawthedramaticinterestofthoseafternoons.totheothersmenandwomenwereonlycases,goodiftheywerecomplicated,tiresomeifobvious;theyheardmurmursandwereastonishedatabnormallivers;anunexpectedsoundinthelungsgavethemsomethingtotalkabout.buttophiliptherewasmuchmore.hefoundaninterestinjustlookingatthem,intheshapeoftheirheadsandtheirhands,inthelookoftheireyesandthelengthoftheirnoses.yousawinthatroomhumannaturetakenbysurprise,andoftenthemaskofcustomwastornoffrudely,showingyouthesoulallraw.sometimesyousawanuntaughtstoicismwhichwasprofoundlymoving.oncephilipsawaman,roughandilliterate,toldhiscasewashopeless;and,self-controlledhimself,hewonderedatthesplendidinstinctwhichforcedthefellowtokeepa

stiffupper-lipbeforestrangers.butwasitpossibleforhimtobebravewhenhewasbyhimself,facetofacewithhissoul,orwouldhethensurrendertodespair?sometimestherewastragedy.onceayoungwomanbroughthersistertobeexamined,agirlofeighteen,withdelicatefeaturesandlargeblueeyes,fairhairthatsparkledwithgoldwhenarayofautumnsunshinetoucheditforamoment,andaskinofamazingbeauty.thestudents’eyeswenttoherwithlittlesmiles.theydidnotoftenseeaprettygirlinthesedingyrooms.theelderwomangavethefamilyhistory,fatherandmotherhaddiedofphthisis,abrotherandasister,thesetwoweretheonlyonesleft.thegirlhadbeencoughinglatelyandlosingweight.shetookoffherblouseandtheskinofherneckwaslikemilk.dr.tyrellexaminedherquietly,withhisusualrapidmethod;hetoldtwoorthreeofhisclerkstoapplytheirstethoscopestoaplaceheindicatedwithhisfinger;andthenshewasallowedtodress.thesisterwasstandingalittleapartandshespoketohiminalowvoice,sothatthegirlshouldnothear.hervoicetrembledwithfear.

“shehasn’tgotit,doctor,hasshe?”

“i’mafraidthere’snodoubtaboutit.”

“shewasthelastone.whenshegoesishan’thaveanybody.”

shebegantocry,whilethedoctorlookedathergravely;hethoughtshetoohadthetype;shewouldnotmakeoldboneseither.thegirlturnedroundandsawhersister’stears.sheunderstoodwhattheymeant.thecolourfledfromherlovelyfaceandtearsfelldownhercheeks.thetwostoodforaminuteortwo,cryingsilently,andthentheolder,forgettingtheindifferentcrowdthatwatchedthem,wentuptoher,tookherinherarms,androckedhergentlytoandfroasifshewereababy.

whentheyweregoneastudentasked:

“howlongd’youthinkshe’lllast,sir?”

dr.tyrelledhisshoulders.

“herbrotherandsisterdiedwithinthreemonthsofthefirstsymptoms.she’lldothesame.iftheywererichonemightdosomething.youcan’ttellthesepeopletogotost.moritz.nothingcanbedoneforthem.”

onceamanwhowasstrongandinallthepowerofhismanhoodcamebecauseapersistentachingtroubledhimandhisclub-doctordidnotseemtodohimanygood;andtheverdictforhimtoowasdeath,nottheinevitabledeaththathorrifiedandyetwastolerablebecausesciencewashelplessbeforeit,butthedeathwhichwasinevitablebecausethemanwasalittlewheelinthegreatmachineofacomplexcivilisation,andhadaslittlepowerofchangingthecircumstancesasanautomaton.completerestwashisonlychance.thephysiciandidnotaskimpossibilities.

“yououghttogetsomeverymuchlighterjob.”

“thereain’tnolightjobsinmybusiness.”

“well,ifyougoonlikethisyou’llkillyourself.you’reveryill.”

“d’youmeantosayi’mgoingtodie?”

“ishouldn’tliketosaythat,butyou’recertainlyunfitforhardwork.”

“ifidon’tworkwho’stokeepthewifeandthekids?”

dr.tyrelledhisshoulders.thedilemmahadbeenpresentedtohimahundredtimes.timewaspressingandthereweremanypatientstobeseen.

“well,i’llgiveyousomemedicineandyoucancomebackinaweekandtellmehowyou’regettingon.”

themantookhisletterwiththeuselessprescriptionwrittenuponitandwalkedout.thedoctormightsaywhatheliked.hedidnotfeelsobadthathecouldnotgoonworking.hehadagoodjobandhecouldnotaffordtothrowitaway.

“igivehimayear,”saiddr.tyrell.

sometimestherewascomedy.nowandthencameaflashofcockneyhumour,nowandthensomeoldlady,acharactersuchascharlesdickensmighthavedrawn,wouldamusethembyhergarrulousoddities.onceawomancamewhowasamemberoftheballetatafamousmusic-hall.shelookedfifty,butgaveherageastwenty-eight.shewasoutrageouslypaintedandogledthestudentsimpudentlywithlargeblackeyes;hersmilesweregrosslyalluring.shehadabundantself-confidenceandtreateddr.tyrell,vastlyamused,withtheeasyfamiliaritywithwhichshemighthaveusedanintoxicatedadmirer.shehadchronicbronchitis,andtoldhimithinderedherintheexerciseofherprofession.

“idon’tknowwhyishould‘avesuchathing,uponmywordidon’t.i’venever‘adaday’sillnessinmylife.you’veonlygottolookatmetoknowthat.”