St. Bernard's: The Romance of a Medical Student

    – Elizabeth B. Browning.

When it was found that Elsworth had quite disappeared, and nothing more was heard of him, many of the good sisters and kind-hearted nurses were really sorry to have lost him. None more so than Sister Agnes. Sister Agnes was the brightest, cleverest, and most devoted nurse that could be imagined. She never wearied of her work, never grew snappy and huffy, as the best of women will when worn and weary with hard work and watching. She never seemed to need rest; that is to say, she never exhibited in her perfect temper the strain upon her system which her heavy duties entailed. She was not only the intimate personal friend of all the nurses under her, but she made it her business to aid in a thousand ways all her patients and smooth their pillows by the many sweet attentions such a loving woman could bestow. She was the widow of a clergyman who had died two years after his marriage, and having no family she was free to follow a long cherished desire, and so devoted herself and her admirable talents to the sacred office of nursing. She was tall and dark, with charming wavy hair and a healthy, not to say ruddy, complexion, which bespoke more than the usual health of a London woman. Deeply religious, of High Church principles, she was yet entirely free from those prejudices against other forms of belief which often detract from the usefulness of a hospital sister. It was enough for her to know that a patient loved her Master, in whatever outward form that love was expressed, to make Sister Agnes at once a friend. In many a way she contrived to instil even into the hearts of the most indifferent some thought of better things, some hope of a life beyond. Most of her patients left her wards the better for having come into contact with her. Sister Agnes often said she had observed in Elsworth traits that promised a great and useful man, and she was always unwilling to believe that he had gone wrong in any way. For many months past she had found difficulties in her work at St. Bernard’s in consequence of the growing dissatisfaction she felt at the conduct of most of the doctors who attended her patients. It pained her and roused her indignation that needless and dangerous things were constantly done to patients who had no idea of their import, and who would have protested with all their might if the opportunity had been given them. Valuable lives of patients who had become her friends had been sacrificed to the growing taste for novelty in methods and instruments, daily introduced from all parts of the world. What one man had done in Berlin must be imitated here, and what had proved fatal in New York was tried at St. Bernard’s in the hope of better success and the increased reputation of the operator. One man extirpated one organ and one another; one resected this and another that, till poor Sister Agnes began to wonder what, and if any, part of the frame would ultimately claim exemption from the rage for taking it away. And she was expected to do her part in paving the road for all these mutilations. The wiser she grew, and the more she learned of her business, the more she saw that much, if not most, of all this was not for the patient’s good; and no wonder she began to rebel. She was brought principally in contact with Dr. Stanforth, who was the chief physician of the women’s wards. Not alone did she object to his professional methods, but the manner he used in the wards. It was neither useful nor expedient for Dr. Stanforth to regale his class, in the presence of herself and nurses, with his most salacious anecdotes, his coarse allusions and indecent jokes. Some patients no doubt enjoyed them, but these were a minority which should have been made better instead of worse by living in the hospital. To most, however, these things were painful in the extreme. It required better health and stronger nerves than the women generally possessed to cope with Dr. Stanforth and his rollicking lads. The valley of the shadow of death is an ill place for satyric abominations. The sympathetic nerves of the poor sister’s face were too habituated to Dr. Stanforth’s little ways to cause her cheeks to flush at all of their manifestations, but there were times when her indignation would make her turn away with her note-book and inkstand, and remove out of earshot. At such times the funny man would apologise in a way which only made matters worse, and she would often wonder in her own mind how much longer she could or ought to be a party to these improprieties.

CHAPTER XXVII.

“ANOTHER PATIENT, SISTER!”

He was happier using the knife than in trying to save the limb.

    – Tennyson.

And whom have ye knowen die honestly
Without help of the Poticary?

    – Heywood.

Dr. Stanforth was considered a model hospital physician – for the students. They were ever the first in his thoughts; to touch one of them was to touch the apple of his eye. He lived for them (and by them), yet he never allowed any of his patients to suspect anything of the kind. There was nothing he grudged his pupils, and they consequently worshipped him. To serve any of his boys he would sacrifice the feelings of any interesting bit of “clinical material” that came in his way, and he boasted that he turned out more proficient practitioners than any one of his colleagues. His methods were startling even to them, and many were the wrinkles he put them up to. His fame in his speciality – gynæcology, was so great, and his really remarkable abilities so well recognised, that nothing he did, startling though it was to the outside world, diminished the crowds of patients who flocked to his consulting rooms. Of course he had the bonhomie and social tact that are needful in attaching young men to a teacher; he was, in addition, able to prove to them that by attending his practice they were acquiring a practical knowledge of their work which they could obtain in no other way.

Dr. Stanforth held all his patients at the disposal of any pupil of his who desired to do or see something new. “Do what you like, my lad,” he used to say to a favourite assistant. “You are in these wards to learn all you can, and all my beds are at your service. Would you like to do a gastrotomy? You ought to do one or two before you leave; it’s a very pretty operation. I never knew a case survive more than a week; but there’s nothing like trying, and if you pick out a case that must die any way, you are welcome to use any of my cases that we can get to consent: and with Sister Agnes’ help – Sister is capital at getting consent to anything, aren’t you Sister? – it can generally be managed. Yes, you had better do one or two; it will be a fashionable operation before long. Rabbits do very well with it, better than dogs in my hands; but humans don’t take nicely to it at all. Now, don’t scruple to let me know anything you’d like to do. I owe you something good for keeping that pretty Pemphigus going so nicely while I was on my holiday – very good of you, very good indeed – I sha’n’t forget you; bye-bye.”

At what awful cost all this was to the “material” he never troubled to estimate. The scandal at last got too strong for St. Bernard’s, and he was soon promoted “out of the opportunities of his art” – as he complained.

“Sister, let us have another patient!” said Dr. Stanforth, on one occasion, just as one might say, “Hand me another chair,” or “Bring me another book.” It was in the private operating room at St. Bernard’s, screened off from the ward specially set apart for women. The assistant physician of this important department had invented a new apparatus for administering anæsthetics, and it was tried that day for the first time – tried on hospital patients first, of course. It promised materially to assist in bringing the patient under the influence of the anæsthetic with rapidity and comfort. Being a complicated machine, with various ingeniously constructed valves, it was not by any means an easy thing to manage, and the least error might have fatal consequences; it would never do, therefore, to use such a thing out of doors till all its bearings had been taken at the hospital, where any mishap could be adroitly attributed to some other cause. Long before one dare use such a thing on Lady Millefleurs, its capabilities and little eccentricities must be exhibited on the unimportant carcass of Eliza Smith; and so it fell out that day that a little knot of students, interested in giving chloroform or ether, with due address, were assembled to see the working of this pretty bit of mechanism.

Dr. Stanforth was an amiable creature, who lived and worked for, and devoted all his energies to his “boys,” as he called his students; for them he spared his patients neither shame nor pang; for them his beds were occupied by so much “teaching stuff.” He was skilful to cure, but at St. Bernard’s he often forebore to cure too rapidly, lest the “pretty case” might get well before all his boys had had their fill of it. It was far better, he used to say, that a patient should “bide a wee,” if any interest attached to her case, than that any budding obstetrician should leave the hospital imperfectly equipped with all the weapons he required. “Have as many patients as you want, my lad,” he said; “let us get the thing right while we are about it.” “The thing” was the new apparatus, and on its first trial on patient number one, had narrowly escaped sending her to kingdom come by suffocation. She appeared to be “going off lovely,” as funny Mr. Philips said, till Dr. Stanforth, suddenly turning round in the middle of a droll story about his friend “Wales and the actress,” seized the patient’s hand, and declared she was “going” in quite another sense. Artificial respiration was performed, and the woman restored to life and consciousness. It was generous not to subject her to any further experiment that day, and she was sent back to her bed, which she had not left for any benefit likely, under any circumstances, to accrue to herself, while the instrument which had so terribly failed was carefully examined for the cause of the mishap. On taking it to pieces, a mechanical genius amongst the students found that a valve had got fixed, and as it was speedily put to rights, the operator was encouraged by Dr. Stanforth with “Better luck next time my boy. Sister, let us have another patient!” How the sister managed to induce a second woman to undergo a mysterious ordeal, the purport of which she was not permitted to question, and after the experiences of the first victim, which did not appear to the curious ward as having been altogether pleasant, we do not pretend to understand; but hospital sisters who know their business have clever little ways whereby they aid and abet the doctors in their search for wisdom. Sister Agnes had long felt that her conscience was being overstrained at St. Bernard’s. Her work was developing itself as quite other than she had expected when she gave herself up to the life of a nurse. These good women, at any rate, had a lofty ideal, and followed it with no hope of other than its own reward. They were not seeking fame, or money, or any worldly reward; it was no wonder therefore that a noble-minded woman like Sister Agnes should see that unless the great work of her life, for which she had given up all else, were undeviatingly followed, she at any rate had failed in attaining her mission. It was not to help doctors to get knowledge; it was not by trickery and “white lies,” used to induce defenceless sufferers to submit to horrible ordeals, and indescribably painful examinations for no benefit to themselves, but simply to teach their business to young men, that she had devoted herself to work in the wards of a general hospital. And daily the conduct of Dr. Stanforth and his assistants clearly showed that the patient’s benefit was quite a secondary object, and the chief end of his or her residence in the wards of St. Bernard’s was precisely that of an artist’s model visiting a studio. Very good, doubtless, in its way, but not what the main body of hospital subscribers intend; still less what the patients come for, and only partially, surely, what such as she had left the world to aid. In a word, she saw plainly that the whole system of the modern hospital in great cities was a gigantic sham, a cruel fraud on the subscribers, and an atrocious delusion and a snare to the patients themselves.

How difficult a task it would be to convince the world of all this! What an Augean stable for a weak woman to cleanse! Then again nothing annoys the public more than to open the doors of its whited sepulchres. Of course, it was no use to condemn the present system without putting something better in its place. The workhouse infirmary was far better in one sense; there, the object was to help the patient to get well as speedily as possible, and take himself off the books; but there attaches a stigma to the infirmary from which the hospital is free, yet the hospital must be reformed on the model, in some respects, of the infirmaries.

The sister was a clever woman, a woman of ample means, and with great influence; why should not this be her life-work to found a new order of charity? It had been the work of many a noble woman to do greater things than this, and with apparently less foothold; and that night, before she went to rest, she prayed that strength and wisdom might be given to her to carry out the scheme which was taking hold upon her heart. “I shall want half a million of money to make a beginning. What is that? A man dies, and leaves a quarter of a million to a college of anatomy and surgery, to be spent in skeletons and pickled specimens of curious fish and odd deformities. Many a man’s picture gallery has had that spent upon it; it might buy a moderately good ironclad; would make a mile or two of suburban railway, and execute a few hundred yards of submarine tunnel. Somebody will come along who will see with me that humanity and cruelty, whom God hath disjoined eternally, shall not be forced into unholy union. Let me be the Joan of Arc to fight this out.”

But not yet. She must arrange her plan of campaign, collect her forces. So enormous a task must demand an adequate inception, and though she shrank from nothing, she ventured nothing rashly.

CHAPTER XXVIII.

DR. STANFORTH WITH HIS PUPILS

His story would not have been worth one farthing if He had made the hat of him whom he represented one inch narrower.

    – Steele.

Natural ferocity makes fewer cruel people than self love.

    – La Rochefoucauld.

Dr. Stanforth knew everybody, from “a very exalted personage,” with whom he led the students to believe he was on terms of close intimacy, down to the most insignificant disciple of Galen who had ever been connected with the hospital. He never permitted a patient to baffle him; he always pretended that he knew all about him or her, and had his or her medical history at his fingers’ ends. His days in the out-patients’ rooms were looked forward to by the students with delight. He was so droll; he teased the pert and knowing patients worse than any Old Bailey barrister. “There was no getting over Stanforth,” they declared; “he was too much for the artfullest of ’em.” His bete noir was the over-dressed, robust, viragoish lady patient, who could well afford to pay for medical advice, but wanted it for nothing.

“Put out your tongue, madam.”

The lady complied. Carefully adjusting his gold eye-glasses, he would minutely inspect it.

“Did I understand you to say you were a strict teetotaler?”

“No, sir, I am not exactly that: but it’s little I ever touch except a glass of beer with my dinner.”

“No spirits, madam?”

“Very seldom, sir.”

Dr. Stanforth would take off his glasses, carefully wipe them with his handkerchief, and readjust them.

“Permit me to see your tongue again, madam. Um – ah – h – h.” Then, after looking at the organ closely for some moments, he would ask, incredulously —

“You never take spirits, madam?”

“I said very seldom, doctor – never more than a teaspoonful of brandy in a little water the last thing at night. You know you told I might do that last time I was here.”

“One teaspoonful, madam?” with another scrutiny of the tongue; “only one teaspoonful of brandy?”

“That is all, sir,” said the patient, bridling up and getting restive.

Dr. Stanforth took off his glasses, folded them, and leaning back in his chair, asked in his blandest tones, “Pray, where do you procure your brandy? It must be very strong. I can get none so good!”

The woman would bear no more roasting that day, and having taken her prescription, left the room, the assembled students heartily enjoying her discomfiture.

The way to annoy him and put him on his mettle was for a lady patient to object to an examination in the presence of his very large class of students.

“Can’t I see you privately, doctor?”

“Why?”

“Well, sir, I do not like to undergo all this before these young gentlemen.”

“You are married, I believe?”

“Yes, sir.”

“Have you any boys?”

“Two, doctor.”

“Would you like your eldest to be a great physician when he grows up?”

“Oh, yes, indeed I should, if he were clever enough!”

“I thought so. Now all these young gentlemen’s mammas have the same desire, and have sent them to me for that purpose. If you don’t help them, they can’t learn to be doctors. Now, nurse, assist this lady to undress.” And, without sparing the poor creature a pang of shame, he would submit her to a degrading ordeal, so that every one of his boys might have the chance of learning that for which, as he said, “they have paid large sums of money.”

To amuse them and impress them with the idea of his wit, he would, in the presence of patient and nurses, often tell shady stories as broad as they were long. Such droll scenes, such lively contests between one weak, suffering woman (for he would never permit a patient to bring mother or friend into his room), and this brilliant physician and his admiring, tittering pupils, made the gynæcological out-patients’ days the great fun of the place. “Beats Punch into fits!” said Murphy. “Never half as much spree at the play!” vowed Robins. But it was poor spree and very mitigated fun to the hundreds of afflicted creatures who sought this great doctor’s aid; for great he was and very skilful, and had saved many thousands of sufferers from pain and discomfort. He was a generous, patient, useful man, and in his private practice was everything that could be desired in a doctor; but he thought, and that thoroughly, that he was at St. Bernard’s first to interest and teach in the completest manner all the men who attended his classes. If in this doctor-factory any sick woman could avail herself of the by-product or waste for her cure or relief, she was heartily welcome. In any case, her attendance served his purpose very well indeed – unless she became troublesome, and refused to comply with some of his too outrageous demands, and then her letter would be taken from her, and marked by the doctor “Refuses treatment,” and she would be escorted out of the hospital by one of the nurses.

Sometimes “a very pretty case,” as they called good clinical subjects, would be taken into the wards, with the assurance that it could only be effectually treated there, but really that it might be daily examined and watched by the students, although it would have done as well or even better at home. Thus he used a bed – at say a cost of a pound a week for two months, – a bed which in another case, far worse but not so interesting, would have been much better engaged. Of course the pupils were not unmindful of all these efforts for their advancement when they got into practice; and as they were daily qualifying, Dr. Stanforth was daily making a number of valuable friends.