DOCTOR IN THE HOUSECategory: Education
To a medical student the final examinations are something like death: an unpleasant inevitability to be faced sooner or later, one’s state after which is determined by the care spent in preparing for the event.
The examinations of the United Hospitals Committee are held twice a year in a large dingy building near Harley Street. Three or four hundred students arrive from every hospital in London and from every medical school in the United Kingdom. Any country that accepts British qualification is represented. There are brown bespectacled Indians, jetblack gentlemen from West Africa standing in nervous groups and testing their new fountain-pens; fat coffee-coloured Egyptians discussing earnestly in their own language fine points of erudite medicine; hearty Australians, New Zealanders, and South Africans showing no more anxiety than if they were waiting for a pub to open; the whole diluted thoroughly by a mob of pale, fairly indifferent, untidy-looking British students conversing in accents from the Welsh valleys to Stirlingshire.
The examination is split into three sections, each one of which must be passed on its own. First there are the written papers, then “viva voce” examinations, and finally the clinical, when the student is presented with a patient and required to turn in a competent diagnosis in half an hour.
On the morning the examination began the five of us left Bayswater flat early, took a bus along Oxford Street, and walked towards the examination building in a silent, sickly row. I always found the papers the most disturbing part of the contest. They begin at nine o’clock, an hour when I am never at my best, and the sight of other candidates en masse is most depressing. They all look so intelligent. They wear spectacles and use heavy fountain-pens whose barrels reflect their own mental capacity; once inside they write steadily and sternly, as though they were preparing leaders for the next week’s Lancet, and the women students present such an aspect of concentration and industry it seems useless for man to continue the examination at all.
I went with a hundred other students into one of the three large, square halls used for the examination. The polished wooden floor was covered with rows of desks set at a distance apart that made one’s neighbour’s writing completely indecipherable if he had not, as was usually the case, already done so himself. Each desk was furnished with a card stamped with a black examination number, a clean square of pink blotting paper, and a pen apparently bought second-hand from the Post Office. The place smelt of floor-polish and fresh-sharpened pencils.
A single invigilator sat in his gown and hood on a raised platform to keep an eye open for flagrant cheating. He was helped by two or three uniformed porters who stood by the doors and lcfoked impassionately down at the poor victims, like the policemen that flank the dock at the Old Baily. The students scraped into their chairs, shot a hostile glance at the clock, and turned apprehensively to the buff question paper already laid out on each desk.
The first paper was on general medicine. The upper half of the sheet was taken up with instructions in bold print telling the candidate to write on oneside of the paper only, answer all the questions, and to refrain from cribbing at peril of being thrown out. I brought my eyes painfully to the four questions beneath. At a glance I saw they were all short and pungent.
‘Give an account of the signs, symptoms, and treatment of heart failure’ was the first. “Hell of a lot in that!” I thought. I read the second one and cursed. ‘Discuss the changes in the treatment of pneumonia since 1930.’ I felt the examiners had played, a dirty trick by asking the same disease two years in succession. The next simply demanded ‘How would you investigate an outbreak of typhoid fever?’ and the last was a request for an essay on worms which I felt I could bluff my way through.
Three hours were allowed for the paper. About half-way through the anonymous examinees began to differentiate themselves. Some of them strode up for an extra answer book, with an awkward expression of self-consciousness and superiority in their faces. Others rose to their feet, handed in their papers, and left. Whether these people were so brilliant they were able to complete the examination in an hour and a half or whether this was the time required for them to set down unhurriedly their entire knowledge of medicine was never apparent from the nonchalant air with which they left the room. The invigilator tapped his hell half an hour before time; the last question was rushed through, then the porters began tearing papers away from gentlemen dissatisfied with the period allowed for them to express themselves and hoping by an incomplete sentence to give the examiners the impression of frustrated brilliance.
I walked down the stairs feeling as if I had just finished an eight- round fight. I reached desperately for my packet of cigarettes. The other candidates jostled round, chattering like children just out of school. In the suuare outside I recognized Grimsdyke.
“How did yout on?” I asked.
“So-so”, he replied. “However, I am not worried. They never read the, papers, anyway. I’m perfectly certain of that. Haven’t you heard how they mark the tripos at Cambridge, my dear old boy? The night before the results come out the old don totters back from the hall and chucks the lot down his staircase. The ones that stick on the top flight are given firsts, most of them end up on the landing and get seconds, thirds go to the lower flight, and any reaching the ground floor are failed. This system has been working admirably for years without arousing any comment. I heard all about it from a senior wrangler.”
The oral examination was held a week after the papers. I got a white card, like an invitation to a cocktail party, requesting my presence at the examination building by eleven-thirty. It is the physical contact with the examiners that makes oral examinations so unpopular with the students. The written answers have a certain remoteness about them, and mistakes and omissions, like those of life, can be made without the threat of immediate punishment. But the viva is judgement day. A false answer, an inadequate account of oneself, and the god’s brow threatens like an imminent thunderstorm. If the candidate loses his nerve in front of this terrible displeasure he is finished: confusion breeds confusion and he will come to the end of his interrogation struggling like a cow in a bog.
The porter marshalled us into line outside the heavy door of the examination room. There was a faint ting of the 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?”
“Well, why didn’t you say so? How would vou treat a case of tetanus?”
My heart leaped 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 cu,t 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, 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 do 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. 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, 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. They continued arguing briskly, and were still doing so when a second tinkle of the bell allowed me to slide out and rush miseralby into the street.
At noon we arrived in the examination building. The same number of candidates were there, but they were a subdued, muttering crowd, like the supporters of a home team who had just been beaten in a cup tie.
We pushed our way into the large hall on the ground floor. It was packed full with anxious students. On the side of the hall facing us was the foot of a marble staircase. To the left of the staircase was a plain open door, over which had been recently pinned a large black and white card saying EXIT. To the right was a clock, which stood at a few minutes before twelve.
We had heard exactly what would happen. At midday precisely the Secretary of the Committee would descend the stairs and take his place,, flanked by two uniformed porters, on the lowermost ste Under his arm would be a thick, leather-covered book containi the results. One of the porters would carry a list of the candidate numbers -and call them out, one after the other. The candidat w’ould step up closely to the Secretary, who would say simply “Pas or “Failed”. Successful men would go upstairs to receive the со gratulations and handshakes of the examiners and failure’s would sli miserably out of the exit to seek the opiate of: oblivion.
“One thing, it’s quick”, Benskin muttered nervously.
“Like the drop,” said Grimsdyke.
One minute to twelve. The room had suddenly come to a frightfu unexpected silence and stillness, like an unexploded bomb. A cloc tinged twelve in the distance. My palms were as wet as spong Someone coughed, and I expected the windows to rattle. Wit slow scraping feet that could be heard before they appeared th Secretary and the porters came slowly down the stairs.
They took up their positions; the leather book was opened The elder porter raised his voice.
“Number two hundred and nine,” he began. “Number thirty seven. Number one hundred and fifty.”
The tension in the room broke as the students shuffled to th front and lined up before the staircase. The numbers were not calle in order, and the candidates strained to hear their own over th low rumble of conversation and scraping of feet that rose from th assembly.
“Number one hundred and sixty-one,” continued the porter. “Number three hundred and two. Number three hundred and six.’
Grimsdyke punched me hard in the ribs.
“Go on,” he hissed. “It’s you!”
I jumped, and struggled my way to the front of the restless crowd. My pulse shot high in my ears. My face was burning hot and I felt my stomach had been suddenly plucked ffom my body.
I lined up in the short queue by the stairs. My mind was empty and numb. I stared at the red neck of the man in front of me, with its rim of blue collar above his coat, and studied it with foolish intensity. Suddenly I found myself on top of the Secretary.
“Number three oh six?” the Secretary whispered without looking up from the book. “R. Gordon?”
“Yes,” I croaked.
The World stood still. The traffic stopped, the plants ceased growing, men were paralysed, the clouds hung in the air, the winds dropped, the tides disappeared the sun halted in the sky.
“Pass,” the man muttered.
Blindly like a man just hit by blackjack, I” stumbled upstairs.
(From Doctor in the House by R, Gordon)