A Book of Words

Rudyard Kipling

VII A Doctor’s Work

I was Pausanias, Physician, reported to have died of natural disease, but (I tell you) harried to death by sick people always asking aid. In bodiless Hades, however, where (the) one medicine has already been given, I sleep the night through.

Middlesex Hospital: October 1908
GENTLEMEN—It may not have escaped your professional observation that there are only two classes of mankind in the world—doctors and patients. I have had some delicacy in confessing that I have belonged to the patient class ever since a doctor told me that all patients were phenomenal liars where their own symptoms were concerned. If I dared to take advantage of this magnificent opportunity which now is before me I should like to talk to you all about my own symptoms. However, I have been ordered—on medical advice—not to talk about patients, but doctors. Speaking, then, as a patient, I should say that the average patient looks upon the average doctor very much as the non-combatant looks upon the troops fighting on his behalf. The more trained men there are between his body and the enemy the better.

I have had the good fortune this afternoon of meeting a number of trained men who, in due time, will be drafted into your permanently mobilised Army which is always in action, always under fire against death. Of course, it is a little unfortunate that Death, as the senior practitioner, is bound to win in the long run; but we noncombatants, we patients, console ourselves with the idea that it will be your business to make the best terms you can with Death on our behalf; to see how his attacks can be longest delayed or diverted, and, when he insists on driving the attack home, to see that he does it according to the rules of civilised warfare. Every sane human being is agreed that this long-drawn fight for time that we call life is one of the most important things in the world. It follows, therefore, that you, who control and oversee this fight, and who will reinforce it, must be amongst the most important people in the world. Certainly the world will treat you on that basis. It has long ago decided that you have no working hours which anybody is bound to respect, and nothing except your extreme bodily illness will excuse you in its eyes from refusing to help a man who thinks he may need your help at any hour of the day or night. Nobody will care whether you are in your bed, or in your bath, or at the theatre. If any one of the children of men has a pain or a hurt in him you will be summoned; and, as you know, what little vitality you may have accumulated in your leisure will be dragged out of you again.

In all time of flood, fire, famine, plague, pestilence, battle, murder, and sudden death it will be required of you that you report for duty at once, and go on duty at once, and that you stay on duty until your strength fails you or your conscience relieves you; whichever may be the longer period. This is your position—these are some of your obligations—and I do not think that they will grow any lighter. Have you heard of any legislation to limit your output? Have you heard of any Bill for an eight hours’ day for doctors? Do you know of any change in public opinion which will allow you not to attend a patient when you know that the man never means to pay you? Have you heard any outcry against those people who can really afford surgical appliances, and yet cadge round the hospitals for free advice, a cork leg, or a glass eye? I am afraid you have not.

It seems to be required of you that you must save others. It is nowhere laid down that you need save yourselves. That is to say, you belong to the privileged classes. I am sorry you have met my demonstration with a certain amount of levity. May I remind you of some of your privileges? You and Kings are the only people whose explanation the Police will accept if you exceed the legal limit in your car. On presentation of your visiting-card you can pass through the most turbulent crowd unmolested and even with applause. If you fly a yellow flag over a centre of population you can turn it into a desert. If you choose to fly a Red Cross flag over a desert you can turn it into a centre of population towards which, as I have seen, men will crawl on hands and knees. You can forbid any ship to enter any port in the world. If you think it necessary to the success of any operation in which you are interested, you can stop a 20,000-ton liner with mails in mid-ocean till the operation is concluded. You can tie up the traffic of a port without notice given. You can order whole quarters of a city to be pulled down or burnt up; and you can trust to the armed co-operation of the nearest troops to see that your prescriptions are properly carried out.

To do us poor patients justice, we do not often dispute doctor’s orders unless we are frightened or upset by a long continuance of epidemic diseases. In this case, if we are uncivilised, we say that you have poisoned the drinking-water for your own purposes, and we turn out and throw stones at you in the street. If we are civilised we do something else: but civilised people can throw stones too. You have been, and always will be, exposed to the contempt of the gifted amateur—the gentleman who knows by intuition everything that it has taken you years to learn. You have been exposed—you will always be exposed—to the attacks of those persons who consider their own undisciplined emotions more important than the world’s most bitter agonies—those people who would limit, and cripple, and hamper research because they fear research may be accompanied by a little pain and suffering. But you have heard this afternoon a little of the history of your profession. You will find that such people have been with you—or, rather, against you—from the very beginning, ever since, I should say, the earliest Egyptians erected images in honour of cats—and dogs—on the banks of the Nile. Yet your work goes on, and will go on.

You remain now, perhaps, the only class that cares to tell the world that we can get no more out of a machine than we put into it; that if the fathers have eaten forbidden fruit, the children’s teeth are very liable to be affected. Your training shows you, daily and hourly, that things are what they are, and the consequences will be what they will be, and that we can deceive no one except ourselves when we pretend otherwise. Better still, you can prove what you have learned. If a patient chooses to disregard your warnings, you have not to wait a generation to convince him. You know you will be called in in a few days or weeks, and you will find your careless friend with a pain in his inside or a sore place on his body, precisely as you warned him would be the case. Have you ever considered what a tremendous privilege that is? At a time when few things are called by their right names—when it is against the Spirit of the Time even to hint that an act may entail consequences—you are going to join a profession in which you will be paid for telling a man the truth, and every departure you may make from the truth you will make as a concession to man’s bodily weakness, and not to your own mental weakness.

Realising these things, I do not think I need stretch your patience by talking to you about the high ideals and lofty ethics of a profession which exacts from its followers the largest responsibility and the highest death-rate—for its practitioners—of any profession in the world. If you will let me, I will wish you in your future what all men desire—enough work to do, and strength enough to do the work.

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