In 1974 Dalrymple began his first paid employment “in a small hospital in a town in the Midlands…” On pages 3-11 of Fool or Physician: the Memoirs of a Sceptical Doctor, he explains his decision to pursue an unconventional medical career:

Once qualified, I remembered the advice proffered by a senior consultant to a group of us at the outset of our clinical studies. He was teaching us how to examine patients; he had just discovered that he had cancer of the bowel, which he took to be a sentence of death. His life was at an end, he said, and now he realised that he had devoted it to a worthless ambition, namely to become a consultant in a teaching hospital. To achieve this he had led a deformed life for many years: he had been endlessly on duty at night, ruining his family life; he had toadied for years to men whom he detested; he had failed to develop other interests; and he had played silly academic games by doing research which he knew from its inception to be futile, since it was undertaken from a desire for promotion rather than from love of knowledge. Worst of all, he had lived his entire adult life in a single institution, knowing nothing of the world beyond. And now it was too late, he was dying.

‘I know you don’t like me,’ he said, which was no more than the truth, for he had been an irascible and intimidating teacher. ‘But I want to give you a piece of advice. You won’t take it, I know, but I’ll give it you all the same. On no account pursue a career only for power or prestige. To live an interesting life, that is the main thing. You don’t appreciate it yet, but this is the only life you have, so make the most of it. Don’t do what I’ve done. The world is much bigger than any hospital.’

His words, I think, fell largely on deaf ears… I, on the other hand, was receptive to his embittered message, because it coincided so exactly with my own feelings. Whenever I had been on duty in the hospital over the weekend I felt a sense of physical release, as though from prison, when I left the building. I knew it was a poor omen for a conventional medical career.

My first paid employment was in a small hospital in a town in the Midlands…

….

The consultant with whom I spent most time was a woman in her mid-fifties, a spinster for whom her patients were her family, her recreation, her whole life. Her devotion to them was absolute. On her ward rounds she examined each with minute care, read their notes from start to finish, and ordered long batteries of tests in case she had missed something, even when the diagnosis had been made weeks before. Though she was clearly a woman of the greatest kindness, her ward rounds were a terrible ordeal for all concerned – patients, doctors, nurses – lasting eight or ten hours. By the end of them one wished to scream, to kick the walls, to smash plates. And the worst of these ordeals was that they benefited no-one. I do not recall a single patient whose life was saved, whose diagnosis was made, whose prognosis was improved, by this minute sifting of details.

Though she was a very clever woman who, had she been a man, would have achieved far greater distinction within the profession, she nevertheless displayed an ignorance of what went on in her own hospital which was at once naive and utterly invincible.

In one of the geriatric wards there were two old-time nurses, who had returned to nursing. They were splendid creatures, ample of girth, one of them in crisp green uniform, the other in fine blue and white stripes. Each vast bosom was kept in order by a stiffly-starched apron of dazzling whiteness: one would get snow-blindness looking at it for too long.

These two nurses had a no-nonsense attitude to their calling. They didn’t hold with new-fangled ideas, like science. They believed that when a patient was destined to die no power on earth – certainly not hospitals, conceited doctors, or nurses – could intervene. The geriatric ward was their domain. Visited rarely by a doctor, and then only to withhold antibiotics from a stroke patient who had contracted pneumonia, these nurses had an elemental view of their calling: to keep the ward clean, the bowels moving, and to suppress by sedatives any human noise in competition with the television…

Occasionally, however, the two nurses were called upon to exercise less custodial and more therapeutic skills. When other wards in the hospital ran short of staff they were seconded to them. And it was here that the trouble began. One of their duties was to keep fluid balance charts – the quantity of fluid a patient took in each day compared with the quantity he lost by all routes in the same period. These charts were as tablets from Sinai to the meticulous woman consultant, whom the two nurses hated as only female nurses can hate female doctors.

A couple of hours before the consultant’s ward round, the two nurses would sit down together to make up the charts which they had failed completely to keep since the last ward round. Knowing nothing of physiology, they put down on the charts the first figures that came into their heads, and then sailed majestically round the ward clipping a chart to the end of each bed.

During the interminable ward round that followed, the consultant would pore over the charts, trying to unravel their physiological mysteries. For example, a patient would be shown as having drunk twenty litres less over a week than he urinated, though he demonstrated as yet none of the signs of dehydration. Or he would be shown as having drunk twenty litres more than he urinated. She took the charts to the office, where we sat round a table trying – for hours at a time – to reconcile them with any known laws of physiology or pathology. It never once occurred to her that they were entirely bogus, works of cheap fiction. She was too devoted to her patients, too conscientious herself, to imagine such a thing of others. Everyone else in the room went mad alternately with boredom and suppressed laughter. Eventually she came up with a rare diagnosis, the nearest that she could somehow reconcile with the figures before her, and order[ed] a battery of expensive and time-consuming laboratory tests to confirm or refute it. No-one ever dared tell her about the two nurses, who laughed most of all; and thus a stream of patients was subjected to all kinds of unnecessary tests, and the resources of the health service frittered away, because of the child-like innocence of this clever woman.

She died not long afterwards, of secondaries from a primary cancer that had been removed some years before. Her aged mother, with whom she had lived all her life, survived her. When I learnt of her death I was seized by melancholy. A good and talented woman (she had studied under some of the most famous medical scientists of her day, and had had their good opinion), she had not, I suspected, known much personal happiness. At best she had made an accommodation with life. Her death would have been greeted with secret relief by all those who had still to endure her ward rounds; and a week later, it would have been entirely forgotten that she ever existed.

….

My time in that hospital was neither happy nor productive. Doctors are often accused of treating their patients as physiological objects rather than as ‘whole human beings,’ but the reverse is just as true: patients often treat doctors as mere curative devices. Whenever I tried in the wards to talk to the patients about some aspect of their lives other than illness they always brought the subject back to their constipation, or this pain that shoots from my left knee, doctor, twists round my waist and up into my right eye. Prolonged contact with the patients usually provoked a string of new, unfathomable complaints and left me with a feeling of impotent rage. So when I had a moment to spare I spent it not with the patients, as I had once idealistically thought I should, but in a corner, reading Russian novels.

My greatest excitement came with the death of one of my patients. He was a rich old colonel, dying slowly of an insidious disease. He and I had got along famously…he was one of the few patients who preferred not to catalogue almost lovingly the minute fluctuations of every symptom. On one occasion he had a heart attack while I was in the room and hi
s heart stopped beating. His case notes had yet to be marked N.T.B.R. – not to be resuscitated – and I managed to bring him back to life.

Some time later I heard from a nurse that he was so grateful to me for his temporary reprieve from oblivion that he had decided, having no close relations, to leave his money to me… However, when the colonel died (shortly after my departure from the hospital, I hasten to add), I did not hear from his solicitors.

I decided that if the greatest excitement I could expect from working in a British hospital was the off-chance of a legacy, I had better seek employment elsewhere. I learnt that a hospital in Bulawayo, in what was still then Rhodesia, sought house officers. By a strange chance, the hospital was recognised by the General Medical Council for registration purposes. (Every doctor, after graduation, must work a year under supervision in an approved hospital.) I received an offer from Bulawayo, and all the people who thought they ought to advise me warned me that to accept it was the end of my career, if not worse. It was tantamount to professional suicide, they said; I should never get another job when I returned to Britain; the regime had a terrible reputation for brutality; besides which, it was illegal for a Briton to give aid and comfort to the white rebels of Africa.

I did not find these arguments compelling. I could not conceive that my presence would bring aid and comfort to anyone (not even patients, let alone whole regimes); and as for my career in Britain, supposing I had one, I gave it no further thought.

Copyright 1987 Anthony Daniels. Reprinted with permission.

The latest excerpt from Second Opinion:

There are two types of people who attend provincial book fairs: the tweeded pedants, of whom I am one, and the nylon-padded monomaniacs, who tend to smell unwashed and who collect books on (say) road building or double-decker buses of the world….But we are all eyed with something approaching malevolence by many of the booksellers…

….

I knew a bookseller who was so ill-disposed to his clientele that he often would not open his door to them, and those privileged persons that he allowed to enter were subjected to recordings of Schoenberg to ensure that they did not linger. He once refused to sell me a history of Sierra Leone – I was writing a book about Liberia at the time – because he thought my purposes in wishing to possess it were insufficiently serious. He thought my projected book frivolous. Several reviewers agreed with him, I am sad to say.

It seems we missed an excerpt from Second Opinion on the Monday Books blog. You won’t want to make the same mistake, because it’s hilarious. An excerpt of the excerpt:

The current favourite among the park-benchers, if I may so call them, is 8.4 per cent cider, an appalling liquid which comes in two- and three-litre bottles known technically as ‘rubber ducks’.

‘Why are they called that?’ I asked a patient who belonged to the park-bench culture.

‘I don’t really know. It’s because they float in the bath or the pond, I suppose.’

‘Not with two or three litres of cider in them.’

‘But they never have two or three litres in them for long.’

True enough: I’ve seen many a rubber duck in the gutter, but never a full one.

‘And when did you last work?’ I asked.

He screwed up his eyes and scoured his brain, like an archaeologist scratching around in the sand for traces of remote antiquity.

‘1976,’ he said, after much delay.

In 1987 Anthony Daniels published his memoirs at the age of 38, a brief span of life he had nevertheless already managed to fill with wide-ranging and provocative experience. The book, “Fool or Physician: The Memoirs of a Sceptical Doctor“, is by turns funny, poignant and fascinating – a must-read for every Dalrymple admirer.

In the opening pages, which we present to you here, he describes the process by which he became a doctor:

PREFACE

Twenty years ago, while I was still at school, I went to Battersea Funfair. There was a small booth with the following notice attached:

MADAME GYPSY ROSE LEE
As Patronised by the Gentry and seen on TV

I entered. Across a small round table with a floral tablecloth and a water-filled glass that substituted for a crystal ball sat a somewhat bored-looking lady with large copper earrings and a scarf over her head to match the tablecloth.

‘One ‘and or two?’ she said.

‘What’s the difference?’ I asked.

‘Five bob one ‘and, ten bob two. Or a pound the tealeaves.’

I chose one hand.

She took it with a slight curl of her lip as if to say, I thought as much, and followed a few of my palmar creases with her long crimson nail.

‘You’ll be educated’, she said. ‘It’ll take a long time.’

I did not demur.

‘A lawyer…or a doctor perhaps. Yes, a doctor.’

I was taken aback.

‘You’ll travel a lot. And you’ll live to be eighty-four.’

My five shillings’ worth of prophecy was over. I did become a doctor and I have travelled a lot. Whether I live to be eighty-four remains to be seen.

ONE

England

‘And why do you want to be a doctor?’

I, a somewhat callow youth of seventeen, faced the men of the medical school interview board across the shining table.

It was not an unexpected or an unreasonable question to ask. Indeed, I had rehearsed my answer on the train. I had vowed against replying with any clichés about wishing to help humanity, relieve suffering, etc.

‘I would like to help people,’ I said.

‘Have you ever helped people before?’ asked a rather stern member of the board.

I did not know what to answer. I wondered whether relinquishing my seat on buses for old ladies counted.

‘You say you want to help people. Have you joined the St John’s Ambulance Brigade? Have you attended first aid courses?’

‘No,’ I said, shamefacedly.

‘Why not?’

Having scored a small dialectical triumph, the member of the board wanted to pursue the point.

‘I haven’t had time.’

‘Haven’t had time to help people? You can’t want to help them very much.’

He was right, of course. I didn’t wish humanity any harm, but on the other hand I wasn’t excessively anxious about its welfare either.

I had, in a manner of speaking, been found out. My looks of dismay must have revealed more to the board than my answers, but not quite the depths of my discomfort. For the question ‘Why do you want to be a doctor?’ contained a premise that, in my case, was completely unjustified, namely that I did actually want to be a doctor. ‘Why have you applied to medical school?’ would have been a less tendentious question.

And the true answer would scarcely have secured me a place. I applied to medical school because I was middle class; because I had to do something; but more than anything else, because my father had pushed me into it. There had been a time, it is true, when I was ten or eleven, when I and a close friend of mine dreamed jointly of becoming doctors; of scientific fame and glory, of winning the Nobel Prize at the unprecedented age of fourteen by discovering the secret of cancer, which we felt must lie in the ugly, knobbly growths that affected all the apple trees in my garden. But those dreams had long since faded and my ambitions lay elsewhere. I wanted to be an historian or a philosopher rather than a doctor, but my father insisted – not unreasonably, perhaps – that it was unlikely I should ever be able to earn a decent living that way. Science, he said, and science alone, was the passport now to worldly success. He was not the kind of man lightly to be contradicted, and since biology was to me the most congenial of the sciences I chose medicine as a career, though I knew even then that I should never be wholeheartedly devoted to it.

Thus I entered medical school with reservations from the first. My career as a student was undistinguished, quite unlike those of doctors who achieve an obituary in The Lancet. I specialized in doing and knowing the least necessary to pass the examinations. Only occasionally did I exert myself beyond the minimum, to assure myself that I could, if I so desired, achieve excellent marks. I found that I could get by (or ‘satisfy the examiners’, as they put it) with very little effort, leaving myself free to study matters that then, but not now, seemed to me more important.

The course of study I prescribed for myself consisted largely of philosophy, with the result that while I can discourse with fluency on the ontological argument of St Anselm, my knowledge of the anatomy of the inner ear is a little hazy (not that it matters greatly: most doctors, other than specialists, treat ears with antibiotics and then, if they fail to improve, with referrals to specialists). I can also provide my patients with a satisfactory refutation of Marxian epistemology, but not, alas, a convincing explanation of how some of the drugs I prescribe achieve their effects. I now bitterly regret my inattention to my medical studies, for the fundamentals of a subject are never satisfactorily acquired later; but I was young and chose not to believe that anything I did then, or failed to do, would affect me for the rest of my life. I imagined that by taxing my brain with Descartes and Hume I was treating of questions larger than why Mrs Smith’s leg had swelled up. Now I should reverse my priorities; for, as Hume would have been the first to admit, toothache is quite sufficient to destroy any philosophy.

Copyright 1987 Anthony Daniels. Reprinted with permission.

We received a message today from Monday Books publisher Dan Collins, informing us that they will re-publish If Symptoms Persist and If Symptoms Still Persist, the collections of Dalrymple’s first Spectator columns. The two will be combined into a single book. As Dan explains in this blog entry, an e-book version will go on sale early next week on Amazon.com, with a hard copy available sometime in 2011.

This is good news for Dalrymple admirers, as the books have been out of print for many years. This description from the aforementioned blog is entirely accurate: “Short, bittersweet pieces, sometimes very funny, sometimes very depressing, always beautifully written”. Trust me: you will be unable to read some of these without laughing out loud. The columns also mark the birth of “Theodore Dalrymple”, as they were the first instance of his use of that nom de plume.

Do be sure to read Dan’s blog entry, as it contains one of the included columns.

Monday Books blogs another Second Opinion excerpt:

There has been an epidemic of swallowing lately. One poor deluded soul swallowed a battery because he thought he was a robot and needed power. Another poor deluded soul thought he could elude the attentions of the police by swallowing the evidence, in this case heroin wrapped in condoms. He refused to have blood tests until his solicitor was present.

In the prison the day before, a prisoner informed me that he had swallowed a bottle of washing-up liquid. I asked him why.

‘My cellmate said he’d beat me up if I didn’t.’

This, of course, brings us to the interesting question as to why anyone would demand of another that he drink a bottle of washing-up liquid. I suppose it would take a Nietzsche to answer that particular question; but then Nietzsche had the inestimable advantage, from the point of view of explaining human behaviour, of suffering from neurosyphilis.

Monday Books has posted another excerpt from Second Opinion on their blog.

I think most Dalrymple readers will find this one of his most enjoyable books, focusing as it does on the hilarious dialogue with his patients that so enlivens some of his more serious-minded essays. Buy it here and get free shipping worldwide.

You’ll know by the first paragraph that you are going to enjoy Monday Books‘ new excerpt from Second Opinion:

IT IS IN LISTENING to other people talk that you learn to appreciate silence. What higher praise of a man could there be than that he is taciturn? People have only to talk for a short time for it to become obvious that the greatest of human rights is not freedom of opinion, but freedom from opinion. It is a mercy that there are so many languages that one does not understand.