Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

The forward to Denton Welch’s last, unfinished, posthumously published novel, A Voice Through a Cloud, is very moving:

The manuscript of this nearly completed novel by Denton Welch was at his bedside when he died at the age of thirty-one. He had suffered thirteen years of chronic and painful illness caused by a road accident in which he sustained a serious fracture of the spine… Towards the end he could work for only three or four minutes at a time… Even then, he made colossal and nearly successful attempts to finish the book. He died on the afternoon of December 30th, 1948, still upheld in his last hours by the high courage which seemed somehow the fruit of his rare intelligence.

Actually, Welch (1915 – 1948), who was also an accomplished painter, was thirty-three when he died. He suffered from Potts disease of the spine as well as the injury; his heroic efforts to remain productive make one ashamed (at least temporarily, while one recalls them) to carp about trivial inconveniences.

The novel is autobiographical, or semi-autobiographical, and the first half at least ought to be given to every medical student to read. There is a graphic account of what it is like to come round after an accident:

Everything about me seemed to be reeling and breaking up. Bright little points glittered all down the front of the liquid man kneeling beside me. I knew at once that he was a policeman, and I thought that in his official capacity, he was performing some ritual operation on me.

Welch observed his own injuries with a detachment that allowed him later to describe them so accurately:

When the nurse touched the flesh of the bruised leg, it yielded in just the way that a wine jelly yields to the pressure of the spoon.

But above all, and most valuably, he describes the petty cruelties and humiliations visited upon him by the nurses, who tell him to try to sleep when he is in severe pain, and to keep quiet when he cries out with pain.

Suddenly, without warning, the nurse gave my body a sharp little jerk which sent such agony though me that I screamed out… The woman, after the first shock of my scream, said: “Oh, I never pinched you! Fancy making all that fuss! I never pinched you!”

This, of course, suggests that the nurse was in the habit of pinching patients.

Later he is moved to a ward in the National Hospital, Queen Square (or so I infer from the description).

One day a specialist was in the ward, examining a patient, when the patient fell down in front of him in a fit. The patient was a fat middle-aged man; he shrieked and trembled and rolled on the floor… It was a terrifying and grotesque sight, but the specialist watched it with a smile on his face. He neither raised the patient up nor prevented him from cutting his head on the corner of the bedside locker.

When the patient recovered consciousness, but was still confused, the specialist said, for all to hear:

Well, I must say there’s one improvement this week – you’re falling so much more gracefully!

And then “he gave a light little well-bred laugh.”

Students should read the book because a bad example is a very good example.