AMONG the more painful experiences which haunt a doctor’s memory are the occasions on which it has been necessary to tell a patient that his malady is fatal and that no measure of cure lies in the hands of man. Rarely indeed has such an announcement to be bluntly made. In the face of misfortune it is merciless to blot out hope. That meagre hope, although it may be but a will-o’-the-wisp, is still a glimmer of light in the gathering gloom. Very often the evil tidings can be conveyed by the lips of a sympathetic friend. Very often the message can be worded in so illusive a manner as to plant merely a germ of doubt in the mind; which germ may slowly and almost painlessly grow into a realization of the truth. I remember being present when Sir William Jenner was enumerating to a friend the qualities he considered to be essential in a medical man. “He needs,” said the shrewd physician, “three things. He must be honest, he must be dogmatic and he must be202 kind.” In imparting his dread message the doctor needs all these qualities, but more especially the last—he must be kind. His kindness will be the more convincing if he can, for the moment, imagine himself in the patient’s place and the patient in his. The mind associates the pronouncing of a verdict and a sentence of death with a court of justice, a solemn judge in his robes, the ministers of the law, the dock, a pallid and almost breathless audience. Such a spectacle, with its elaborate dignity, is impressive enough, but it is hardly less moving when the scene is changed to a plain room, hushed almost to silence and occupied by two persons only, the one who speaks and the one who listens—the latter with bowed head and with knotted hands clenched between his knees.
The manner in which ill-news is received depends upon its gravity, upon the degree to which the announcement is unexpected and upon the emotional bearing of the recipient. There may be an intense outburst of feeling. There may be none. The most pitiable cases are those in which the sentence is received in silence, or when from the trembling lips there merely escapes the words, “It has come.”
The most vivid displays of feeling that occur203 to my mind have been exhibited by mothers when the fate of a child is concerned. If her child be threatened a mother may become a tigress. I remember one such instance. I was quietly interviewing a patient in my consulting room when the door suddenly flew open and there burst in—as if blown in by a gust of wind—a gasping, wild-eyed woman with a little girl tucked up under her arm like a puppy. Without a word of introduction she exclaimed in a hoarse whisper, “He wants to take her foot off.” This sudden, unexplained lady was a total stranger to me. She had no appointment. I knew nothing of her. She might have dropped from the clouds. However, the elements of violence, confusion and terror that she introduced into my placid room were so explosive and disturbing that I begged my patient to excuse me and conducted, or rather impelled, the distraught lady into another room. Incidentally I may remark that she was young and very pretty; but she was evidently quite oblivious of her looks, her complexion, her dress or her many attractions. I had before noticed that when a good-looking woman is unconscious of being good-looking there is a crisis in progress.
The story, which was told me in gasps and at white heat, was as follow. The child was a204 little girl of about three, almost as pretty as her mother. She was the only child and had developed tuberculous disease in one foot. The mother had taken the little thing to a young surgeon who appears to have let fall some rash remark as to taking the foot off. This was enough for the mother. She would not listen to another syllable. She, whom I came to know later as one of the sweetest and gentlest of women, changed at the moment to a wild animal—a tigress.
Without a word she snatched up the baby and bolted from the house, leaving the child’s sock and shoe on the consulting-room floor. She had been given my name as a possible person to consult and had dashed off to my house, carrying the child through the streets with its bare foot and leg dangling in the air. On being admitted she asked which was my room. It was pointed out to her, and without more ado she flung herself in as I have described. The child, I may say, was beaming with delight. This dashing in and out of other people’s houses and being carried through the streets without a sock or a shoe on her foot struck her as a delicious and exciting game.
The mother’s fury against my surgical colleague was almost inexpressible. If the poor man had suggested cutting off the child’s head he could205 not have done worse. “How dare he!” she gasped. “How dare he talk of cutting off her foot! If he had proposed to cut off my foot I should not have minded. It would be nothing. But to cut off her little foot, this beautiful little foot, is a horror beyond words, and then look at the child, how sweet and wonderful she is! What wickedness!” It was a marvellous display of one of the primitive emotions of mankind, a picture, in human guise, of a tigress defending her cub. By a happy good fortune, after many months and after not a few minor operations, the foot got well so that the glare in the eyes of the tigress died away and she remembered again that she was a pretty woman.
It is well known that the abrupt reception of ill-tidings may have a disastrous effect upon the hearer. The medical man is aware that, if he would avoid shock, the announcement of unpleasant facts or of unhappy news must be made slowly and with a tactful caution. In this method of procedure I learnt my lesson very early and in a way that impressed my memory.
I was a house-surgeon and it was Christmas time. In my day each house-surgeon was on what was called “full duty” for one entire week in the month. During these seven days all accident206 cases came into his surgeon’s wards. He was said to be “taking in.” On this particular Christmas week I was “taking in.” Two of my brother house-surgeons had obtained short leave for Christmas and I had undertaken their duties. It was a busy time; so busy indeed that I had not been to bed for two nights. On the eve of the third night I was waiting for my dressers in the main corridor at the foot of the stair. I was leaning against the wall and, for the first and the last time in my life, I fell asleep standing up. The nap was short, for I was soon awakened, “rudely awakened” as novelists would put it.
I found myself clutched by a heated and panting woman who, as she clung to me, said in a hollow voice, “Where have they took him?” The question needed some amplification. I inquired who “he” was. She replied, “The bad accident case just took in.” Now the term “accident” implies, in hospital language, a man ridden over in the street, or fallen from a scaffold, or broken up by a railway collision. I told her I had admitted no such case of accident. In fact the docks and the great works were closed, and men and women were celebrating the birth of Christ by eating too much, by ge............