by Adam Kay
When I get there she’s smiling warmly, like Princess Diana at an orphanage. She sticks her hand out and asks for my bleep. ‘My husband’s taking the kids to the park – why don’t you go out for a few hours?’ My brain can’t process this level of unexpected and extreme altruism. At first I can’t understand if she’s asking me to babysit the children or go dogging with her husband, but when the penny drops and I realize I’m being invited to play hookey, I manage to stutter out some vague vowel sounds by way of thanks. I hand over the bleep slowly, like it’s a grenade, just in case this is a trick. But, no, off she skips to the ward with it.
I wander down the high street feeling bewildered, like I’ve had a phone call telling me I’m now the king or have found an amulet that gives me the ability to fly.
I stop off for a coffee then mooch across to the cinema. My options are an action film I quite want to see but have missed the first half of, a family blockbuster I don’t especially want to see, or something arty and French that I would rather boil my eyes in molten manure than watch. I choose the least-worst option and settle down for 120 minutes of Pixar.
The film is actually much better than I thought it would be, and I even get to have my guilty-pleasure treat – something I only eat in darkness and either alone or in the company of people who’ve known me over two decades and on whom I have plenty of reciprocal blackmail material – a tub of sweet popcorn with a large bag of Skittles mixed in. All for only slightly more than the price of a week in Santorini!
I return to work, high on e-numbers and the kindness of the human spirit.
‘Did you get up to anything nice?’ asks Kate.
‘Yes actually,’ I beam back. ‘I went to see The Incredibles.’
‘Oh, that’s so sweet you call them that! Do they live round here?’
Did I come out the wrong exit of the cinema and emerge into a parallel universe?
‘It’s sweet?’
‘Yes, that you call your parents The Incredibles!’
I smile like the wonderful, benevolent son I am not, and tell her that, yes, I do. That way, she can at least think she did a nice thing for an equally nice person – not a bastard who never even considered seeing his family and instead just went to the cinema and got off his tits on additives.
Wednesday, 29 December 2004
‘Help me out here,’ I say to the patient after I finally tire of our silent staring contest. ‘Have you got any idea at all what might have caused it?’
The twenty-year-old stays mute, only shrugging his shoulders and brushing his hair out of his eyes as I examine his translucent-skinned penis: a canapé-sized recreation of the bag of giblets you used to find inside supermarket chickens.
I don’t want to accuse him of dipping it in a pot of acid every evening, but that’s pretty much what it looks like. Whatever he’s been doing, he’s managed to wear away his foreskin to such a watery shine that I certainly won’t be ordering summer rolls next time I’m in a Vietnamese restaurant.
Twenty minutes later we’ve all learned something. I’ve learned what kind of person clicks on penis enlargement adverts on the internet and parts with actual money for magic cock-growing cream. He’s learned the cream he’d pinned his hopes on is almost certainly a potent steroid, and that steroids thin the skin. And, unless of course the wretched thing started out the size of a drawing pin, it unfortunately hasn’t had the desired effect.
Thursday, 30 December 2004
Patient VY is eighty-two years old and was admitted last week with a strangulated hernia,* requiring emergency surgery. I suspect he’s keen to go home, given he’s sat up in a chair and dressed like Mr Banks from Mary Poppins in a three-piece suit with matching tie and handkerchief. All that’s missing is a pocket watch. I jokily say how nice it is that he’s made the effort for my ward round.
‘See?’ he tells his daughter, who is sitting next to him. She rolls her eyes and explains that the ambulance had to wait for five minutes while her dad changed into formal wear, despite the eye-watering agony he must have been in. ‘No excuse to look slovenly,’ he tells me.
‘And then,’ she adds, ‘he wouldn’t let them take him to hospital until he’d brushed his teeth!’
‘In case I needed mouth-to-mouth,’ he explains.
* A hernia is when a bit of your bowel (usually) pokes through a weak point in muscles or other tissues. A strangulated hernia is an emergency that occurs if the bowel’s blood supply gets cut off, generally causing vomiting and the kind of pain you’d expect if your intestines were in a vice.
Friday, 31 December 2004
I can smell it before I arrive on the ward, the unmistakable pong of bleach and obsequiousness. One of our beloved health ministers will be visiting today.* These cartoon villains must travel the length of the country, thinking the entire UK smells like Flash All-Purpose Cleaner.
No doubt he’ll parrot whichever plaudit he’s written on the back of his hand. ‘Thank you for working so hard’ will probably feature – though presumably any job looks like hard work when yours only occupies 150 days of the year and involves falling asleep on leather benches and eating taxpayer-subsidized beef Wellington.
And like the tree that falls in the forest, if the minister isn’t accompanied by a phalanx of press and photographers, would he even be here at all? I conjure up the carefully framed photograph in tomorrow’s papers: the minister pretending to look interested and angling his bald spot away from the camera while exchanging pleasantries with a nurse. The nurse will somehow manage to resist all her natural urges and smile back at him rather than spiking him in the neck with a scalpel. Some tinsel will be artfully draped on the wall to remind us that not only healthcare staff but, much more importantly, politicians are working hard over the festive period.
I suspect I won’t be one of the chosen few to shake the dead, clammy hand of one of the government’s weasels-in-chief (would it snap off at the wrist?), but I still find myself worrying about my duty to the patients’ confidentiality. It would be unforgivable if any identifying information were photographed and published, so I dash over to the ward whiteboard. The names of all patients are initialized in any case, but who can say if that’s enough of a cipher to adequately protect their anonymity? Ever-diligent, I err toward caution and put them under even deeper cover, replacing the initials of the eight patients in the first bay with some totally random letters that just happened to come into my head.
F.U.
C.K.
Y.O.
U.T.
O.N.
Y.B.
L.A.
I.R.
* In an example of ‘don’t know what you’ve got till it’s gone’ that would make Joni Mitchell urgently rewrite ‘Big Yellow Taxi’, I worked as a doctor under Labour governments, before politicians of the other persuasion started hacking back health budgets like they were overgrown wisteria. Since I was a kid, every time Satan’s merry-go-round span another rotation and gave us a new Health Secretary, I would ask my dad – a GP – what the new boss was going to be like. His answer was always the same: ‘They’ll be the worst one since the last one.’ This generally proved right. Personally I think of Health Secretaries like Defence Against the Dark Arts teachers in the Harry Potter books. They’re obviously going to turn out to be evil, but you’ll have to wait a while to find out precisely how.
Tuesday, 4 January 2005
It’s important to have a hobby, I suppose. A way of switching your brain into a different gear and shaking out the stresses that have been clogging up your neurons after a hard day’s work. I’ve got writing and playing the piano, which are, if not enough, then all I’ve got the time for. For other people it’s jogging, or macramé, or track days, or fishing. And for Patient AM – a hip-hop artist in his twenties – it’s visiting prostitutes and handing over a wad of cash in return for having them stick needles through his penis. Acupuncture as reimagined by the Marquis de Sade.
But you know how it is over Christmas – everyone�
�s on their holidays, so you have to make do with a temp. You go to the barber and your normal guy’s away, so your hair doesn’t sit quite right. The Christmas postman doesn’t know to leave your parcels behind the wheelie bin if you’re out, so they end up at some godforsaken depot 30 miles away. And the locum prostitute uses a different bore of needle when she’s driving them through your cock, which explains Patient AM’s referral from A&E to urology with ‘difficulty passing urine’. And not in the normal sense of painful or poor flow. Quite the opposite in fact – it was more a case of controlling it. In Eminemmental’s own words, he’s got a ‘cock like a colander’. I insert an (advent) catheter, admit him to the ward, and resist the temptation to text about thirty people.*
* Although admittedly, I have just published his story in a book.
Second Christmas
While Santa is flying his sleigh full of gifts
I’m wrenching out babies on unending shifts
Friday, 16 December 2005
I put the Sonicaid probe onto a mum’s abdomen in antenatal clinic and turn it on, waiting for the familiar SWOOSH SWOOSH SWOOSH of baby’s heartbeat. Nothing. Bloody batteries. I flick the on/off switch a couple more times, then apologize to the patient.
‘Sorry, I think this one’s dead.’
As the mum’s face collapses like a bouncy castle at closing time, I urgently clarify: ‘The Sonicaid! The Sonicaid!’
Tuesday, 20 December 2005
Christmas card from Mr Polinksi, one of the consultants:
Wishing you and yours
a happy and healthy Christmas
and all the best for 2006.
Dictated but not signed to avoid delay.
Wednesday, 21 December 2005
It started with a length of tinsel being Blu-tacked to the gynaecology ward wall in the shape of an ECG trace.* Then the Christmas tree was decorated with a bunch of inflated rubber gloves and a few baubles fashioned from ring pessaries. The gynae nurses pimped a few speculums with googly eyes and red cardboard noses to turn them into the world’s most repulsive reindeer – you would not want these lads guiding your sleigh anywhere tonight.
This evening I made a beautiful wreath with the help of one of the healthcare assistants. We took a box of out-of-date condoms, unwrapped and unfurled them, braided them into a big circle and stuck it on the door to the ward. Sadly, it didn’t see out a whole shift before some Scrooge pulled it down.
Thankfully they’re yet to spot that the fairy sitting on top of the tree has an umbilical cord knitted from suture material, dangling menacingly from under her tutu.
* I never quite know where to draw the line with explaining terminology. All the words make sense to me – whether it’s haemoptysis (hacking up blood) or hospital (the sprawling, dilapidated building in which you hack up said blood). Anyway, an ECG, or electrocardiogram, is the squiggly printout of your heart’s electrical activity, much beloved of medical drama title sequences. It’s obtained by putting sticky pads on your chest, arms and legs. For good electrical contact, men often need their chests shaved first. I once asked a medical student to shave a patient before an ECG. Fuck knows what the poor patient thought was happening when the student came into his cubicle, removed his five o’clock shadow and tidied up his sideburns.
Saturday, 24 December 2005
Trying to work out whether I’m hallucinating through lack of food or lack of rest, but no, it seems everyone can hear a brass band playing ‘O Little Town of Bethlehem’. It’s an A for effort but a JESUS CHRIST NO PLEASE STOP for quality. When I’m done with my needlework, restoring a perineum back to factory settings, I go and investigate, wandering to the second-floor railings and leaning over to identify the source of this hell-scream. In the foyer are about six or seven schoolkids with instruments and a choir of about thirty more, standing around them in a semicircle.
As they honk and wail their way through the classics, decreasing in confidence with each verse, I find myself inexplicably . . . what is this feeling? Not quite enjoying it, but . . . OK, fine, enjoying it. It’s like this cacophony is somehow magically tapping into happy memories of Christmases gone by and giving my limbic system a hug.
Seeing these kids dressed up smartly in their uniforms on Christmas Eve (when I’m sure they’d much rather be giving their presents exploratory rattles or learning the basics of gang violence) – well, it’s like the end of a Richard Curtis movie.
My bleep goes off and I feel strangely reluctant to head back to labour ward. A man walks past me, leans over the railings and says to his partner, ‘Good advert for contraception.’ I’m about to tut pointedly when a patient from yesterday gestures at me and says, ‘You should try having this bloke rip you a new one.’
Sunday, 25 December 2005
It’s my first Christmas on labour ward. I’ve been trying to convince myself (and H, with more limited success) that doing two years on the trot means being off work for the big day next year is practically a certainty.
Thankfully, it’s jolly enough on labour ward, and there’s a decent haul of festive names. Welcome to baby Holly and baby Casper, though in full disclosure, Lesley – a midwife in her sixties – had to explain why Casper was at all Christmassy. I just assumed it was one of those names that normal people give their dogs or upper-class people call their eighth son. But it turns out I nodded off in RE one too many times and the names of the three wise men had passed me by until today. At least the kid’s not called Balthazar, limiting his career options to society photographer or Disney baddie.
Casper’s arrival kicks off a long discussion among the midwives of various other festive first names – from Robin to Grace to Gabriel, then talk of the ones that have fallen out of fashion – the Carols and the Glorias. Lesley looks wistful: ‘Noel always used to be very popular. But Edmonds seems to have fucked that.’
We’re interrupted by my bleep. Patient BK is thirty weeks pregnant and bleeding from her left earlobe. To be more accurate, blood is cascading out of her left earlobe. Between what’s soaked through the tea towels she brought in, the clothes she’s wearing and the scrubs I’m wearing, I think it must be a litre. I don’t know what’s happening, but I do at least know that blood is a finite resource.
I call Stan, one of the registrars. If ‘first do no harm’ tops the list of medical commandments, then ‘don’t blag it’ can’t be that far down.* He suspects I’m being a drama queen and my patient just has a spot on her ear. ‘It’s not a litre – a little blood goes a very long way.’ I beg him to come quickly, then put in a drip, send some bloods off, order four units of crossmatched blood, and hold some large swabs very hard against her ear.
Stan arrives a few minutes later. ‘Wow, yes, that’s definitely a litre.’ And counting. He asks the same questions I did: ‘Has this happened before?’ – no. ‘Do you have any blood clotting disorders?’ – no. ‘Have you hurt your ear?’ – no. He performs a brief but puzzled examination of the patient, although there’s not much to see beyond the jet of blood. He then does his own phone-a-friend. Mr Hess, the labour ward consultant, advises him to give the patient a shot of steroids to help the baby’s lungs in case it needs premature delivery today, and to call the Ear, Nose and Throat team.
A general surgical registrar answers the bleep because ENT are on call from home today.† He takes a look at the patient – who is, understandably, looking pretty worried by this point – and tells the ENT registrar she needs to come in. It’s all become rather more serious now – a parade of increasingly specialized doctors but no hint of a solution. The patient is moved to the high dependency unit on labour ward, and a further four units of blood are on their way. The ENT registrar drags her consultant in from home immediately, and the rest of us feel better about not knowing the answer ourselves.
The ENT consultant tells the patient he needs to operate immediately to stop the bleeding and seems to have some kind of plan as to how to achieve this. Mr Hess comes in. With every passing minute more people arrive – anaesthe
tists, interventional radiologists, haematologists. A matryoshka of medics.
But labour ward never stops, and as I can’t claim to be bringing much to this particular party, I head off to review the nine patients who have accumulated in triage while we’ve been playing ‘What The Fuck Is Happening To This Patient And If She Dies Is It My Fault?’ Then it’s down to A&E for some gynae goings-on before running upstairs to assist in a caesarean.
By the time I come up for air, I hear that Patient BK is out of theatre, baby still in situ and doing well, and there’s no more spurting blood. The diagnosis was an AV malformation in her ear.‡ Not something I’ve ever read about before, but ‘bodies don’t read textbooks’, as the bon mot goes. They clearly don’t read calendars either. Between the doctors, nurses, midwives and theatre staff, she must have had twenty people looking after her, many of them hauled away from their families halfway through Christmas dinner. Life goes on – and that can be negative as well as positive – whether it’s Christmas Day, New Year’s Eve or Albatross Appreciation Day.
I realize with a shudder that I haven’t had time to look at my phone since all this started. There are at least a dozen messages from H, whose good humour leaks away with each subsequent one until ‘Appreciate you’re busy – won’t interrupt you any more.’
* I was surprised to discover quite early on in this job that patients don’t care in the slightest when you hold up your hands and tell them you’re going to call in someone more senior. They actually seem to like it – they’re getting to see someone better. It’s an unexpected upgrade at check-in, a double-yolker.
