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A Country Doctor by Sarah Orne Jewett
A STRAIGHT COURSEThe next year or two was spent in quiet life at home. It was made evident that, beside her inclination and natural fitness for her chosen work, our student was also developing the other most important requisite, a capacity for hard study and patient continuance. There had been as little said as possible about the plan, but it was not long before the propriety of it became a favorite subject of discussion. It is quite unnecessary, perhaps, to state that everybody had his or her own opinion of the wisdom of such a course, and both Dr. Leslie and his ward suffered much reproach and questioning, as the comments ranged from indignation to amusement. But it was as true of Nan's calling, as of all others, that it would be her own failure to make it respected from which any just contempt might come, and she had thrown herself into her chosen career with such zeal, and pride, and affectionate desire to please her teacher, that the small public who had at first jeered or condemned her came at last to accepting the thing as inevitable and a matter of course, even if they did not actually approve. There was such a vigorous determination in the minds of the doctor and his pupil that Nan should not only be a doctor but a good one, that anything less than a decided fitness for the profession would have doomed them both to disappointment, even with such unwearied effort and painstaking. In the earlier years of his practice Dr. Leslie had been much sought as an instructor, but he had long since begun to deny the young men who had wished to be his students, though hardly one had ever gone from the neighborhood of Oldfields who did not owe much to him for his wise suggestions and practical help.
He patiently taught this eager young scholar day by day, and gave her, as fast as he could, the benefit of the wisdom which he had gained through faithful devotion to his business and the persistent study of many years. Nan followed step by step, and, while becoming more conscious of her own ignorance and of the uncertainties and the laws of the practice of medicine with every week's study, knew better and better that it is resource, and bravery, and being able to think for one's self, that make a physician worth anything. There must be an instinct that recognizes a disease and suggests its remedy, as much as an instinct that finds the right notes and harmonies for a composer of music, or the colors for a true artist's picture, or the results of figures for a mathematician. Men and women may leam these callings from others; may practice all the combinations until they can carry them through with a greater or less degree of unconsciousness of brain and fingers; but there is something needed beside even drill and experience; every student of medicine should be fitted by nature with a power of insight, a gift for his business, for knowing what is the right thing to do, and the right time and way to do it; must have this God-given power in his own nature of using and discovering the resources of medicine without constant reliance upon the books or the fashion. Some men use their ability for their own good and renown, and some think first of the good of others, and as the great poet tells the truths of God, and makes other souls wiser and stronger and fitter for action, so the great doctor works for the body's health, and tries to keep human beings free from the failures that come from neglect and ignorance, and ready to be the soul's instrument of action and service in this world. It is not to keep us from death, it is no superstitious avoidance of the next life, that should call loudest for the physician's skill; but the necessity of teaching and remedying the inferior bodies which have come to us through either our ancestors' foolishness or our own. So few people know even what true and complete physical life is, much less anything of the spiritual existence that is already possible, and so few listen to what the best doctors are trying their best to teach. While half-alive people think it no wrong to bring into the world human beings with even less vitality than themselves, and take no pains to keep the simplest laws of health, or to teach their children to do so, just so long there will be plenty of sorrow of an avoidable kind, and thousands of shipwrecked, and failing, and inadequate, and useless lives in the fullest sense of the word. How can those who preach to the soul hope to be heard by those who do not even make the best of their bodies? but alas, the convenience and easiness, or pleasure, of the present moment is allowed to become the cause of an endless series of terrible effects, which go down into the distance of the future, multiplying themselves a thousandfold.
The doctor told Nan many curious things as they drove about together: certain traits of certain families, and how the Dyers were of strong constitution, and lived to a great age in spite of severe illnesses and accidents and all manner of unfavorable conditions; while the Dunnells, who looked a great deal stronger, were sensitive, and deficient in vitality, so that an apparently slight attack of disease quickly proved fatal. And so Nan knew that one thing to be considered was the family, and another the individual variation, and she began to recognize the people who might be treated fearlessly, because they were safe to form a league with against any ailment, being responsive to medicines, and straightforward in their departure from or return to a state of health; others being treacherous and hard to control; full of surprises, and baffling a doctor with their feints and follies of symptoms; while all the time Death himself was making ready for a last, fatal siege; these all being the representatives of types which might be found everywhere. Often Dr. Leslie would be found eagerly praising some useful old-fashioned drugs which had been foolishly neglected by those who liked to experiment with newer remedies and be "up with the times," as they called their not very intelligent dependence upon the treatment in vogue at the moment among the younger men of certain cliques, to some of whom the brilliant operation was more important than its damaging result. There was, even in those days, a haphazard way of doctoring, in which the health of the patient was secondary to the promotion of new theories, and the young scholar who could write a puzzlingly technical paper too often outranked the old practitioner who conquered some malignant disorder single-handed, where even the malpractice of the patient and his friends had stood like a lion in the way.*
But Dr. Leslie was always trying to get at the truth, and nobody recognized more clearly the service which the reverent and truly progressive younger men were rendering to the profession. He added many new publications to his subscription list, and gleaned here and there those notes which he knew would be helpful, and which were suited to the degree of knowledge which his apprentice had already gained. It is needless to say what pleasure it gave him, and what evening talks they had together; what histories of former victories and defeats and curious discoveries were combined, like a bit of novel-reading, with Nan's diligent devotion to her course of study. And presently the girl would take a step or two alone, and even make a visit by herself to see if anything chanced to be needed when a case was progressing favorably, and with the excuse of the doctor's business or over-fatigue. And the physicians of the neighboring towns, who came together occasionally for each other's assistance, most of whom had known Nan from her childhood, though at first they had shrunk from speaking of many details of their professional work in her hearing, and covered their meaning, like the ostriches' heads, in the sand of a Latin cognomen,* were soon set at their ease by Nan's unconsciousness of either shamefacedness or disgust, and one by one grew interested in her career, and hopeful of her success.
It is impossible to describe the importance of such experiences as these in forming the character of the young girl's power of resource, and wealth of self-reliance and practical experience. Sometimes in houses where she would have felt at least liberty to go only as spectator and scholar of medicine, Dr. Leslie insisted upon establishing her for a few days as chief nurse and overseer, and before Nan had been at work many months her teacher found her of great use, and grew more proud and glad day by day as he watched her determination, her enthusiasm, and her excellent progress. Over and over again he said to himself, or to her, that she was doing the work for which nature had meant her, and when the time came for her to go away from Oldfields, it seemed more impossible than it ever had before that he should get on without her, at home, or as an independent human being, who was following reverently in the path he had chosen so many years before. For her sake he had reached out again toward many acquaintances from whom he had drifted away, and he made many short journeys to Boston or to New York, and was pleased at his hearty welcome back to the medical meetings he had hardly entered during so many years. He missed not a few old friends, but he quickly made new ones. He was vastly pleased when the younger men seemed glad to hear him speak, and it was often proved that either through study or experience he had caught at some fresh knowledge of which his associates were still ignorant. He had laughingly accused himself of being a rusty country doctor and old fogy who had not kept up with the times; but many a letter followed him home, with thanks for some helpful suggestion or advice as to the management of a troublesome case. He was too far away to give room for any danger of professional jealousy, or for the infringement of that ever lengthening code of etiquette so important to the sensitive medical mind. Therefore he had only much pleasure and a fine tribute of recognition and honor, and he smiled more than once as he sat in the quiet Oldfields study before the fire, and looked up at Captain Finch's little ship, and told Nan of his town experiences, not always omitting, though attempting to deprecate, the compliments, in some half-hour when they were on peculiarly good terms with each other. And Nan believed there could be no better doctor in the world, and stoutly told him so, and yet listened only half-convinced when he said that he had a great mind to go to town and open an office, and make a specialty of treating diseases of the heart, since everybody had a speciality nowadays. He never felt so ready for practice as now, but Nan somehow could not bear the thought of his being anywhere but in his home. For herself, she would have been ready to venture anything if it would further her ever-growing purpose; but that Dr. Leslie should begin a new career or contest with the world seemed impossible. He was not so strong as he used to be, and he was already famous among his fellows. She would help him with his work by and by even more than now, and her own chosen calling of a country doctor was the dearer to her, because he had followed it so gallantly before her loving and admiring eyes. But Dr. Leslie built many a castle in the air, with himself and a great city practice for tenants, and said that it would be a capital thing for Nan; she could go on with it alone by and by. It was astonishing how little some of the city doctors knew: they relied upon each other too much; they should all be forced to drive over hill and dale, and be knocked about in a hard country practice for eight or ten years before they went to town. "Plenty of time to read their books in June and January," the doctor would grumble to himself, and turn to look fondly at the long rows of his dear library acquaintances, his Braithwaites and Lancets,* and their younger brothers, beside the first new Sydenham Society's books,* with their clumsy blot of gilding. And he would stand sometimes with his hands behind him and look at the many familiar rows of brown leather-covered volumes, most of them delightfully worn with his own use and that of the other physicians whose generous friend and constant instructor he had been through years of sometimes stormy but usually friendly intercourse and association.
When people in general had grown tired of discussing this strange freak and purpose of the doctor and his ward, and had become familiar with Nan's persistent interest and occupation in her studies, there came a time of great discontent to the two persons most concerned. For it was impossible to disguise the fact that the time had again come for the girl to go away from home. They had always looked forward to this, and directed much thought and action toward it, and yet they decided with great regret upon setting a new train of things in motion.
While it was well enough and useful enough that Nan should go on with her present mode of life, they both had a wider outlook, and though with the excuse of her youthfulness they had put off her departure as long as possible, still almost without any discussion it was decided that she must enter the medical school to go through with its course of instruction formally, and receive its authority to practice her profession. They both felt that this held a great many unpleasantnesses among its store of benefits. Nan was no longer to be shielded and protected and guided by some one whose wisdom she rarely questioned, but must make her own decisions instead, and give from her own bounty, and stand in her lot and place.* Her later school-days were sure to be more trying than her earlier ones, as they carried her into deeper waters of scholarship, and were more important to her future position before the public.
If a young man plans the same course, everything conspires to help him and forward him, and the very fact of his having chosen one of the learned professions gives him a certain social preŽminence and dignity. But in the days of Nan's student life it was just the reverse. Though she had been directed toward such a purpose entirely by her singular talent, instead of by the motives of expediency which rule the decisions of a large proportion of the young men who study medicine, she found little encouragement either from the quality of the school or the interest of society in general. There were times when she actually resented the prospect of the many weeks which she must spend in listening to inferior instruction before gaining a diploma, which was only a formal seal of disapproval in most persons' eyes. And yet, when she remembered her perfect certainty that she was doing the right thing, and remembered what renown some women physicians had won,* and the avenues of usefulness which lay open to her on every side, there was no real drawing back, but rather a proud certainty of her most womanly and respectable calling, and a reverent desire to make the best use possible of the gifts God had certainly not made a mistake in giving her. "If He meant I should be a doctor," the girl told herself, "the best thing I can do is to try to be a good one."
So Nan packed her boxes and said good-by to Mrs. Graham, who looked wistful and doubtful, but blessed her most heartily, saying she should miss her sadly in the winter. And Marilla, who had unexpectedly reserved her opinion of late, made believe that she was very busy in the pantry, just as she had done when Nan was being launched for boarding-school. She shook her own floury hands vigorously, and offered one at last, muffled in her apron, and wished our friend good luck, with considerable friendliness, mentioning that she should be glad if Nan would say when she wrote home what shapes they seemed to be wearing for bonnets in the city, though she supposed they would be flaunting for Oldfields anyway. The doctor was going too, and they started for the station much too early for the train, since Dr. Leslie always suffered from a nervous dread of having an unavoidable summons to a distant patient at the last moment.
And when the examinations were over, and Nan had been matriculated, and the doctor had somewhat contemptuously overlooked the building and its capabilities, and had compared those students whom he saw with his remembrance of his own class, and triumphantly picked out a face and figure that looked hopeful here and there; he told himself that like all new growths it was feeble yet,* and needed girls like his Nan, with high moral purpose and excellent capacity, who would make the college strong and to be respected. Not such doctors as several of whom he reminded himself, who were disgracing their sex, but those whose lives were ruled by a pettiness of detail, a lack of power, and an absence of high aim. Somehow both our friends lost much of the feeling that Nan was doing a peculiar thing, when they saw so many others following the same path. And having seen Nan more than half-settled in her winter quarters, and knowing that one or two of her former school friends had given her a delighted and most friendly welcome, and having made a few visits to the people whom he fancied would help her in one way or another, Dr. Leslie said good-by, and turned his face homeward, feeling more lonely than he had felt in a great many years before. He thought about Nan a great deal on the journey, though he had provided himself with some most desirable new books. He was thankful he had been able to do a kind turn for one of the most influential doctors, who had cheerfully promised to put some special advantages in Nan's way; but when he reached home the house seemed very empty, and he missed his gay companion as he drove along the country roads. After the days began to grow longer, and the sun brighter, such pleasant letters came from the absent scholar, that the doctor took heart more and more, and went over to Mrs. Graham with almost every fresh bit of news. She smiled, and listened, and applauded, and one day said with delightful cordiality that she wished there were more girls who cared whether their lives really amounted to anything. But not every one had a talent which was such a stimulus as Nan's.
"Nothing succeeds like success," rejoined the doctor cheerfully, "I always knew the child would do the best she could."
stood like a lion in the way: In John Bunyan's (1628-1688) Pilgrim's Progress (1678, 1684), Christian meets Timorous and Mistrust who are fleeing from lions in their way on the journey to Zion. See Jewett's 1873 essay, "Doctors and Patients."
like ostriches' heads, in the sand: It is true that ostriches put their heads in the sand, but not to hide from danger as popularly believed. Rather they obtain water in this way. (Research: Gabe Heller).
Braithwaites and Lancets: In his edition of A Country Doctor, Frederick Wegener identifies The Retrospect of Practical Medicine, a twice-yearly overview of medical research. Its founding editor was Dr. William Braithwaite (1807-1885). The Lancet is a weekly medical journal, published in London since the mid-nineteenth century.
Sydenham Society: See above in Chapter 9 for information on Thomas Sydenham (1624-1689), for whom the society was named. This 19th-century organization was founded in 1845, and refounded in 1854 as the "Sydenham New Society." It's mission included the publication of medical texts, including those of Sydenham. (Research: Gabe Heller).
stand in her lot and place: This phrase is echoed in a variety of places, for example in Ralph Waldo Emerson (1803-1882), "Self-Reliance" (1841), near the beginning, where he admonishes the reader to "Trust thyself" and to "Accept the place divine providence has found for you." See also Daniel 12:12-13.
what renown some women physicians had won: Elizabeth Blackwell (1821-1910) was one of the more famous woman physicians of Jewett's time, the first American woman to gain an American medical degree (1849). Despite almost constant opposition, she studied in London and Paris, and eventually founded the New York Infirmary for Women and Children (1853) and a medical college for women at the Infirmary (1868). (Source: Encyclopedia Britannica).
like all new growths: It appears that Nan attends a women's medical college, though Jewett seems somewhat reticent about making this clear. Among the new medical colleges for women to open after the American Civil War (1860-1865) were the Women's Medical College of Philadelphia (1865) and the Women's Medical College of the Infirmary for Women and Children in New York City. Before such colleges opened, women were virtually unable to obtain a formal education in medicine in the United States, as the life of Elizabeth Blackwell illustrates.
Wegener argues that Jewett probably intended to suggest that Nan attends the New England Female Medical College.
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