Part 4

It was not my wish to enter into a long discussion of all the qualities which go to make up the ideal physician. I desired chiefly to consider his principal needs, to point out in big defence certain of his embarrassments, and to leave the reader with some sense of help towards knowing whether his adviser was such as he should be in the more important qualities which go to make the true physician. There are other and minor matters which are not without their relative gravity in his life. Some are desirable but not truly essential, and yet help or hurt him much. Whether he is gentle and well-mannered, is socially agreeable, or as to this negative, influences much the choice of the woman on whom, as a rule, comes finally the decision of who her family physician shall be. Too often she is caught by the outside show of manners, and sets aside an abler and plainer man, who has more really the true manners of the heart, yet lacks the power to make himself pleasant. Desirable it is, of course, to be what so many of the best physicians have been, refined and tactful gentlemen, and also charming companions. But a man may be a most competent, clear-headed, honest, scrupulously careful doctor, and yet be plain, ill-dressed, and uninteresting, and all this it is as well to understand. The mass of professional opinion is not so easily pleased as are individual patients. It decides pretty early in any large community, and classifies its members accurately, reversing very often the verdict of the juries of matrons, who do so much to make or mar our early fates. Soon or late it sifts the mass, knows who are the thorough, trustworthy, competent, hard-headed practitioners, who are the timid, who the too daring, who ride hobbies, and who trust too much to drugs. Soon, too, it distinguishes those on whom it can call in emergencies, and the highest class of men who have the great gift of discovery and the genius of observation.

From the public we can look for no such justice, and our professional manners forbid us to speak of our brethren, save among ourselves, with perfect freedom. As a profession, it is my sincere conviction that in our adherence to a high code of moral law, and in the general honesty with which we do our work, no other profession can be compared with ours. Our temptations, small and large, negative and positive, are many and constant, and yet I am quite sure that no like group of men affords as few illustrations of grave moral weaknesses. It is commonplace to say that our lives are one long training in charity, self-abandonment, all forms of self-restraint. The doctor will smile at my thinking it needful to even state the fact. He begins among the poor; all his life, in or out of hospitals, he keeps touch of them always. He sells that which men can neither weigh nor measure, and this sets him over all professions, save one, and far above all forms of mere business. He is bound in honor to profit by no patent, to disclose all he has learned, and to give freely and without reward of his best care to all others of his profession who may be sick. What such a life makes of a man is largely a question of original character, but in no other form of occupation is there such constant food useful to develop all that is best and noblest.

Popular opinion has been prone to decide that the physician who is anything else than this is a person not to be trusted. The old axiom is too often quoted as concerns us, "Jack of all trades, master of none." But there are enough men who have the power to be master of many trades and passed master of one. It is a question of applicative energy. Few men in early life can do much more than is needed to learn our art and its sister sciences; but, as time goes on, there are many who can add to it other pursuits which greatly benefit them in a wide sense, and enlarge and strengthen their mental powers, or pleasantly contribute to the joys of life, and so even to the growth of a man's moral nature. The wise physician, who is fond of etching or botany, the brush, or the chisel or the pen, or who is given to science, does well to keep these things a little in the background until he is securely seated in the saddle of professional success. Then usually he may feel free to reasonably follow out his tastes, and to write, or in any other way insist on freedom to use or make public his results. If only he has the competent fund of persistent industry to draw upon, he will be not the worse, but the better, physician for such enlargement of his pursuits as I refer to, for we may feel sure that in my profession there is room for the direct or indirect use of every possible accomplishment.

CONVALESCENCE.

To my mind, there is nothing more pleasant than the gradual return to health after some revolutionary disease which has removed a goodly portion of the material out of which is formed our bodily frame. Nature does this happy work deftly in most cases, where, at least, no grave organic mischief has been left by the malady; and in the process we get such pleasantness as comes always from the easy exercise of healthy function. The change from good to better day by day is in itself delightful, and if you have been so happy, when well, as to have loved and served many, now is the good time when bun and biscuit come back to you,--shapely loaves of tenderness and gracious service. Flowers and books, and folks good and cheery to talk to, arrive day after day, and have for you a new zest which they had not in fuller health. Old tastes return and mild delights become luxuries, as if the new tissues in nerve and brain were not sated, like those of the older body in which they are taking their places.

When you are acutely ill, the doctor is business-like and gravely kind; you want him in a way, are even anxious to see him for the relief he may bring, or the reassurance. But when you begin to feel as if you were a creature reborn, when you are safe and keenly enjoying the return of health, then it is that the morning visit is so delightful. You look for his coming and count on the daily chat. Should he chance to be what many of my medical brothers are,--educated, accomplished, with wide artistic and mental sympathies,--he brings a strong, breezy freshness of the outer world with him into the monastic life of the sick-room. One does not escape from being a patient because of being also a physician, and for my part I am glad to confess my sense of enjoyment in such visits, and how I have longed to keep my doctor at my side and to decoy him into a protracted stay. The convalescence he observes is for him, too, a pleasant thing. He has and should have pride in some distinct rescue, or in the fact that he has been able to stand by, with little interference, and see the disease run its normal course. I once watched a famous surgeon just after he had done a life-saving operation by dim candle-light. He stood smiling as the child's breath came back, and kept nodding his head with pleasant sense of his own competence. He was most like a Newfoundland dog I once had the luck to see pull out a small child from the water and on to a raft. When we came up, the dog was wagging his tail and standing beside the child with sense of self-approval in every hair. The man wagged his head; the dog wagged his tail. Each liked well what he had done.

Thus it is that these half-hours by the convalescent's couch are full of subtle flattery for the doctor, and are apt to evolve the social best of him, as he notes the daily gain in strength and color, and listens, a tranquil despot, to one's pleas for this freedom or that indulgence. He turns over your books, suggests others, and, trained by a thousand such interviews, is likely enough a man interesting on many sides.

You selfishly enjoy his visit, not suspecting that you, too, are ignorantly helpful. He has been in sadder homes to-day, has been sorely tried, has had to tell grim truths, is tired, mind and body. The visit he makes you is for him a pleasant oasis: not all convalescents are agreeable. He goes away refreshed.

Most doctors have their share, and more, of illness, and are not, as I have seen stated, exempt from falling a prey to contagious maladies. Indeed, our records sadly show that this is not the case. Perhaps there is value for them and their future patients in the fact that they have been in turn patient and doctor and have served in both camps. Like other sick folks, the physician, as I know, looks forward, when ill, to the "morning visits" quite as anxiously as do any of those who have at times awaited his own coming.

That medical poet who has the joyous art of sending a ripple of mirth across the faces of the Anglo-Saxon world recognizes this fact in a cheerful poem, called "The Morning Visit," and to which I gladly refer any of my readers who would like to know from the lips of Oliver Wendell Holmes what manner of delightful patient he must have been. I can fancy that he lost for his doctor many a pleasant hour.

It has seemed to me as if this wonderful remaking and regrowing of the tissues might be likened to a swift change from the weak childhood of disease to a sudden manhood of mind and body, in which is something of mysterious development elsewhere unmatched in life. Death has been minutely busy with your tissues, and millions of dead molecules are being restored in such better condition that not only are you become new in the best sense,--renewed, as we say,--but have gotten power to grow again, and, after your terrible typhoid or yellow fever, may win a half-inch or so in the next six months,--a doubtful advantage for some of us, but a curious and sure sign of great integral change.

The Greeks had a notion that once in seven years we are totally changed, the man of seven years back having in this time undergone an entire reconstruction. We know now that life is a constant death and a renewing,--that our every-day nutrition involves millions of molecular deaths and as many millions of births,--although to liken that which is so exquisitely managed, so undisturbingly done, to the coarser phenomena of death and birth is in a measure misleading.

Diseases such as typhoid fever, or a sharp local lung-trouble like pneumonia, really do make these minute changes approximate in abruptness to death. You weigh, let us say, one hundred and eighty pounds, and you drop in three weeks of a fever to one hundred and thirty pounds. The rest of you is dead. You have lost, as men say, fifty pounds, but your debt to disease, or to the blunders of civilization, for it is a case of creditor behind creditor, is paid. Your capital is much diminished, but you have come out of the trial with an amazing renovation of energy. This is the happy convalescence of the wholesome man. The other, the unlucky, fellow, does not get as safely through the cleansing bankruptcy of disease. The vicious, unlucky, or gouty grandfather appears on the books of that court in mysterious ways; his sins are pathologically visited on his child's child in this time of testing strain.

In the happy rush towards useful health, of a convalescence undisturbed by drawbacks, it is pleasant to think, as one lies mending, of the good day to come when my friend, recovering from typhoid or smallpox, shall send for his legal adviser and desire him as usual to bring suit against the city for damages and loss of time.

A little girl coughed in my face a hideous breath of membraneous decay. I felt at once a conviction of having been hit. Two days later I was down with her malady. She herself and two more of her family owed their disease to the overflow of a neighbor's cesspool, and to them--poor, careless folk--Death dealt out a yet sterner retribution. There was a semi-civilized community beyond both. Should one go to law about it and test the matter of ultimate responsibility?

The amiability of convalescence is against it. One feels at peace with all the world, and so lies still, and reflects, "like souls that balance joy and pain," as to whether, on the whole, the matter has not had its valuable side. Certainly it has brought experiences not otherwise attainable.

Of the deeper and more serious insights a man gathers in the close approach of death and the swift, delicious return to safety and enlarging powers I hardly care to speak. To a physician, it is simply invaluable to have known in his own person pain, and to have been at close quarters with his constant enemy, and come off only wounded from the contest. In the anxiety about you is read anew what you look upon in other households every day, and perhaps with a too accustomed eye. And as to pain, I am almost ready to say that the physician who has not felt it is imperfectly educated. It were easy to dwell on this aspect of convalescence, but the mental state of one on the way to health is not favorable to connected thought. It is more grateful to lie in the sun, at the window, and watch the snow-birds on the ice-clad maples across the way, and now and then, day after day, to jot down the thoughts that hop about one's brain like the friendly birds on the mail-clad twigs.

I make no apology for the disconnectedness of my reflections, but turn gladly to my records of the joyous and less grave observations which the passing hours brought me. Much as I have seen of disease and recoveries in all manner of men and women, the chance to observe them in my own person presented me with many little novel facts of interest. I find in my brief notes of this well-remembered time many records of the extraordinary acuteness won for a while by the senses.

Not dubious, but, alas! brief, is the gain which the sensorium acquires in this delightfully instructive passage out of death's shadow into certain sunshine. In my own case there was a rapid exfoliation, as we call it, of the skin, a loss and renewal of the outer layer of the cuticle. As a result of this, the sense of touch became for a while more acute, and was at times unpleasantly delicate. This seemed to me, as I first thought of its cause, a mere mechanical result, but I incline to suspect now that it was in a measure due to a true increase in capacity to feel, because I found also that the sister sense of pain was heightened. Slight things hurt me, and a rather gentle pinch gave undue discomfort. No doubt a part of this was owing to my having taken a good deal of opium, and then abruptly laid it aside. As I have elsewhere stated, this is apt to leave the nerves oversensitive for a season. The sense of hearing seemed to me to be less wide awake. I did not hear better, but high notes were for a while most unpleasant. The sense of taste grew singularly appreciative for a time, and made every meal a joyful occasion. The simplest food had distinct flavors. As for a glass of old Madeira,--a demijohned veteran of many ripening summers,--I recall to this day with astonishment the wonderful thing it was, and how it went over the tongue in a sort of procession of tastes, and what changeful bouquets it left in my mouth,--a strange variety of varying impressions, like the play of colors. In these days of more unspiritual health and coarser sense I am almost ashamed to say what pleasure I found in a dish of terrapin.

The function of smell became for me a source both of annoyance and, later on, of pleasure. I smelt things no one else could, and more things than I now can. The spring came early, and once out of doors the swiftly-flitting hours of sensory acuteness brought to me on every breeze nameless odors which have no being to the common sense,--a sweet, faint confusion of scents, some slight, some too intense,--a gamut of odors. Usually I have an imperfect capacity to apprehend smells, unless they are very positive, and it was a curious lesson to learn how intense for the time a not perfect function may become. Recent researches have shown that a drug like mercaptan may be used to test the limit of olfactory appreciation. We have thus come to know that the capacity to perceive an odor is more delicate than our ability to recognize light. Probably it is an inconceivable delicacy of the sense of smell more than anything else which enables animals to find their way in the manner which seems to us so utterly mysterious. Yet, even in human beings, and not alone in a fortunate convalescence, do we see startling illustrations of the possibilities of this form of sensorial acuteness. I know of a woman who can by the smell at once tell the worn gloves of the several people with whom she is most familiar, and I also recall a clever choreic lad of fourteen who could distinguish when blindfold the handkerchiefs of his mother, his father, or himself, just after they have been washed and ironed. This test has been made over and over, to my satisfaction and surprise.

If a man could possess in the highest degree and in combination all of the possible extremes of sensory appreciativeness seen in disease, in hysteria, and in the hypnotic state, we should have a being of extraordinary capacities for observation. Taylor, in his "Physical Theory of Another World," a singular and half-forgotten book, has set this forth as conceivable of the beings of a world to come, and dwelt upon it in an ingenious and interesting way. For a long time even the inhalation of tobacco-smoke from a friend's cigar disturbed my heart, but one day, and it was, I fear, long before my physician, and he was wise, thought it prudent, I suddenly fell a prey to our lady Nicotia. I had been reading listlessly a cruel essay in the Atlantic on the wickedness of smoking, and was presently seized with a desire to look at King James's famous "counterblast" against the weed. One is like a spoiled child at these times, and I sent off at once for the royal fulmination, which I found dull enough. It led to results the monarch could not have dreamed of. I got a full-flavored cigar, and had a half-hour of worshipful incense-product at the shrine of the brown-cheeked lady,--a thing to remember,--and which I had leisure enough to repent of in the sleepless night it cost me.

This new keenness of perception, of taste and touch, of smell and sound, belongs also, in the splendid rally which the body makes toward health, to the intellectual and imaginative sphere of activities. Something of the lost gifts of the fairy-land of childhood returns to us in fresh aptitude for strange, sweet castle-building, as we lie open-eyed, or in power to see, as the child sees, what we will when the eyes are closed,--

Pictures of love and hate, Grim battles where no death is. Tournaments, Tall castles fair and garden terraces, Where the stiff peacock mocks the sunset light, And man and maiden whisper tenderly A shadowy love where no heart ever breaks,-- Love whose to-morrow shall be as to-day.

With the increase of intellectual clearness, within a certain range, come, as with the brightened senses, certain drawbacks, arising out of the fastidiousness which belongs to the changing man just at this time. Let him, therefore, be careful what novels he chooses, for of all times this is the one for fiction, when we are away from the contradictions of the fierce outer world, and are in an atmosphere all sun and flowers, and pleasant with generous service and thankful joy. Be careful what Scheherezade you invite to your couch. By an awful rule of this world's life, in all its phases, the sharper the zest of enjoyment, the keener the possible disgusts may be. I recommend Dumas's books at this crisis, but they should be read with acceptance; as stories, their value lying largely in this, that no matter who is murdered or what horror occurs, you somehow feel no more particular call upon your compassion than is made when you read afresh the terrible catastrophes of Jack the Giant-Killer.

A delightful master of style, Robert Louis Stevenson, in a recent enumeration of the books which have influenced him in life, mentions, as among the most charming of characterizations, the older Artagnan of the Vicomte de Bragelonne. I feel sure that on the sick-bed, of which he does not hesitate to speak, he must have learned, as I did, to appreciate this charming book. I made acquaintance then, also, with what seems to me, however, the most artistic of Dumas's works, and one so little known that to name it is a benefit, or may be, the Chevalier d'Harmenthal.

In the long road towards working health, I must have found, as my note-books show, immense leisure, and equal capacity to absorb a quantity of fiction, good and bad, and to find in some of it things about my own art which excited amused comment, and but for that would long ago have been forgotten. Among the stuff which I more or less listlessly read was an astonishing book called "Norwood." It set me to thinking, because in this book are recounted many things concerning sick or wounded folk, and those astonishing surgeons and nurses who are supposed to have helped them on to their feet again.

The ghastly amusement which came to me out of the young lady in this volume, who amputates a man's leg, made me reflect a little about the mode in which writers of fiction have dealt with sick people and doctors. I lay half awake, and thought over this in no unkindly critical mood,

"With now and then a merry thought, And now and then a sad one,"