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 see............