Chapters 15 -16 -17 (Abridged)

To a medical student the final examinations are something like death: an unpleasant inevitability to be faced sooner or later.

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.

An examination is nothing more than an investigation of a man's knowledge, conducted in a way that the authorities have found to be the most fair and convenient to both sides. But the medical student cannot see it in this light. Examinations touch off his fighting spirit; they are a straight contest between himself and the examiners, conducted on well-established rules for both, and he goes at them like a prize-fighter.

There is rarely any frank cheating in medical examinations, but the candidates spend almost as much time over the technical details of the contest as they do learning general medicine from their text-books.

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 the 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 men to continue the examination at all.

I went with a hundred other students into one of 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 freshly-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 looked impassionately down at the poor victims, like the policemen that flank the dock at the Old Bailey.

 Three hours were allowed for the paper. About halfway 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 bell 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 square outside the first person I recognized was Grimsdyke.

'How did you get 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 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 judgment 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. This sort of mental attitude had already led to the disgrace of Harris, who had been reduced to a state just short of speechlessness by a terrible succession of “faux pas”. The examiner finally decided to try the poor fellow with something simple and handed him a breast-bone that had been partly worn away with the life-long pressure of an enlarged artery underneath. 'Now, my boy,' said the examiner. 'What do you think caused that hollow?' All he wanted for a reply was the single word 'Pressure,' but Harris looked at the specimen in blank silence. With a sigh, the kindly examiner removed his pince-nez and indicated the two indentations they left on each side of his nose. 'Well,' he continued helpfully, 'what do you think caused that?' Something clicked in Harris's panicky brain. The depressed nasal bridge…a picture flashed up that he had seen so often in the opening pages of his surgery book. 'Congenital syphilis, sir,' he replied without hesitation.

I was shown to a tiny waiting-room furnished with hard chairs, a wooden table, and windows that wouldn't open, like the condemned cell. There were six candidates from other hospitals waiting to go in with me, all of them in their best clothes. They illustrated the types fairly commonly seen in viva waiting-rooms. There was the Nonchalant, lolling back on the rear legs of his chair with his feet on the table, showing the bright yellow socks under his blue trouser-legs. He was reading the sporting page of the Express with undeceptive thoroughness. Next to him, a man of the Frankly Worried class sat on the edge of his chair tearing little bits off his invitation card and jumping irritatingly every time the door opened. There was the Crammer, fondling the pages of his battered text-book in a desperate farewell embrace, and his opposite, the Old Stager, who treated the whole thing with the familiarity of a photographer at a wedding. He had obviously failed the examination so often he looked upon the viva simply as another engagement to be fitted into his day.

The other occupant of the room was a woman. A trim little piece, I noticed, probably from the Royal Free. She sat pertly on her chair with her hands folded on her lap. Women students-the attractive ones, not those who are feminine only through inescapable anatomical arrangements-are under a disadvantage in oral examinations. The male examiners are so afraid of being prejudiced favourably by their sex they usually adopt towards them an undeserved sternness. But this girl had given care to her preparations for the examination. Her suit was neat but not smart; her hair tidy but not striking; she wore enough make-up to look attractive, and she was obviously practicing, with some effort, a look of admiring submission to the male sex. I felt sure she would get through.

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?'

'Yes, sir.'

'Well, why didn't you say so? How would you treat a case of tetanus?'

My heart leapt 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 cut 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 like a rugger scrum and became confused and unidentifiable…

…The days after the viva were black ones. It was like having a severe accident. For the first few hours I was numbed, unable to realize what had hit me. Then I began to wonder if I would ever make a recovery and win through. One or two of my friends heartened me by describing equally depressing experiences that had overtaken them previously and still allowed them to pass. I began to hope. Little shreds of success collected together and weaved themselves into a triumphal garland.

'One doesn't fail exams,' said Grimsdyke firmly. 'One comes down, one muffs, one is ploughed, plucked, or pipped. These infer a misfortune that is not one's own fault. To speak of failing is bad taste. It's the same idea as talking about passing away and going above instead of plain dying.'

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 step. Under his arm would be a thick, leather-covered book containing the results. One of the porters would carry a list of the candidates' numbers and call them out, one after the other. The candidate would step up closely to the Secretary, who would say simply 'Pass' or 'Failed.' Successful men would go upstairs to receive the congratulations and handshakes of the examiners and failures would slink miserably out of the exit to seek the opiate of oblivion.

One minute to twelve. The room had suddenly come to a frightening, unexpected silence and stillness, like an unexploded bomb. A clock tinged twelve in the distance. My palms were as wet as sponges. Someone coughed, and I expected the windows to rattle. With slow scraping feet that could be heard before they appeared the Secretary and porters came solemnly 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 the front and lined up before the staircase. The numbers were not called in order, and the candidates strained to hear their own over the low rumble of conversation and scraping of feet that rose from the 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 from 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.

Gordon, Richard, Doctor in the House, Penguin Books Ltd, 1977, chapters 15-17, p.p. 159-183

Notes.

1. UHC grades the exam in practical medicine and awards the title of a doctor.

2 Harley Street– the street in central London, famous for its large number of  

private specialists in medicine and surgery.

3. Oxford Street – a major road in the City of Westminster in the West End of 

London. It’s Europe’s busiest shopping street.

4. Bayswater – an area in Central London. It has attractive streets and garden

squares. The property ranges from very expensive apartments to small

studio flats.

5. “Lancet” – UK medical journal.

6. Old Bailey – The Central Criminal Court of England and Wales.

7. Royal Free (Royal Free Hospital) – a major teaching hospital in London.

8. St. Swithin - a fictional hospital in London.