‘Jesus,’ says Margaret as we get back in the lift, ‘that woman is unpleasant.’
‘Yup,’ I agree.
‘She’s a jumped-up anaesthetist who hasn’t had a fuck in years,’ she adds, looking down and flicking fluff off her bosom.
Her hair is no longer shiny; it is covered in a dull crisp layer of hardened sperm. You have to admire her willingness to get on and down with it this early in the morning. Then again, there’s nothing like seeing the daily results of the fickle hand of fate to make you grab that day-blow-job opportunity just a bit more firmly.
‘D’you know which hospital Steve is going to tomorrow?’ I ask as we watch the lift light descend through the floors.
‘No,’ she replies, looking at me like I need certifying.
‘I just thought that—’
‘I’d care? Or give a shit?’ She smiles. ‘Don’t be ridiculous! How long have you worked here?’
‘So you’re not going …?’
‘Going out with him?’ she shrieks. ‘Since when?’
‘I thought it might be a new thing.’
‘A, I think Steve is seeing a Max Fox on the third floor. B, he is leaving tomorrow, so who cares? And C, I am too busy for a boyfriend.’
The lift pings. The doors open, and Margaret does a little indignant head wobble as she marches out of the lift.
‘I was only asking!’ I shout after her.
She turns around and gives me the finger.
I had no idea she liked him that much.
I just manage to get out of the lift myself before the lunch trolley crashes in. I look down at the stack of municipal green plates piled with peas, sweetcorn and non-specific meat stew and potatoes, each one covered with a transparent plastic lid. I check my watch. Who wants to eat lunch at 11.14 in the morning? And who wants to eat that? The food in this hospital is always bad and always turns up at the wrong time. The NHS shells out over £500 million a year on food with a budget of £1.70 per person per day, which is for two meals, lunch and dinner; breakfasts and cups of tea come out of another budget. It doesn’t sound a huge amount, 85p a meal, and when you realize that only 60 per cent of that is actually spent on food with the other 40 per cent going on overheads, you realize why the stuff looks so unpalatable. They get more money in the prisons, apparently, which doesn’t seem right to me. We also don’t have enough staff to serve the food, so instead of it taking a gang of twenty half an hour to get around the wards in this building they have four on the job and it takes anything between one and two hours. So what starts out as piping hot and, I suppose, edible becomes cold and inedible by the time it reaches the majority of patients, which obviously defeats the point. The ill are supposed to eat well, otherwise they will not improve. Looking at this crap, it almost makes you want to be HIV positive and in the Chelsea and Westminster, which reputedly has the best food in any hospital in the UK. Elton John pays for it. Or at least his foundation does. He does an extraordinary amount for HIV patients on the NHS. He pays for wings, dolls up existing wards and makes their lives a whole lot more pleasant.
I look at the shelf below the plates and retch slightly. I’m not sure if it’s my hangover or if the sight of the congealed custard is enough to turn any man’s stomach. It’s rank. No wonder half the stuff comes back uneaten. And you get supper at 4.30 p.m., so once you’ve refused that there’s nothing to keep you going till your cup of tea, roll and warm yoghurt in the morning.
‘Don’t worry,’ says Louise as she walks past, ‘they’ll grow back.’
‘What will?’
‘Your bollocks,’ she says, with a smile. ‘I presume she ripped them off?’
‘She is a total bitch.’
‘We’re cluttering up her ward. We’ve given her two patients today already.’
‘Who else has gone up there?’ I ask.
‘The burns man. He was far too ill to sit down here waiting for plastics to turn up. He went up about half an hour ago.’
We both go over to the computer to get our next patient.
‘Ladies first,’ I say, gesturing towards the desk.
‘Thanks, mate,’ says Steve, barging in front. ‘I need to get my stats up a bit.’ He peers over the list. ‘Any doctor referrals?’ he sniffs. ‘Aha. A nice urinary tract infection. Fingers crossed she’s twenty-three!’ He taps away on the screen.
Louise is next, taking an ankle sprain. ‘Which leaves you with … oh, Mrs Singh and chest pain!’ She smiles at me and I start to shake my head. This is going to be very annoying indeed.
‘Mrs Singh?’ I say, poking my head into the waiting room, which is now almost completely full.
The old ladies’ tea party is in full swing in the corner as they munch on their biscuits and hang on Phillip Schofield’s every word. He appears to be sharing with them next season’s latest fashions, along with tips on how to mix and match trends. They all look gripped. Over in the far corner there’s a mother and her son. He has a nosebleed but is undeterred as he holds his nose with one hand and tries to play his DS with the other. A few rows have been taken over completely by patients who have entirely given up the ghost. They are no longer listening out for their name and have passed out over the red plastic bucket seats, dead to the world.
‘Mrs Singh?’ I repeat, looking around the room, only to have my worst fears confirmed.
Mrs Singh is a large elderly lady of Indian origin and she is walking towards me with a sizeable family entourage comprising a son and daughter-in-law and three grandchildren, one a mewling and spewing babe in arms.
‘Mrs Singh,’ I smile. My teeth gritted.
The old woman nods.
‘How is the chest?’
Mrs Singh grabs her rather ample right bosom and does her best to look pained. Meanwhile her granddaughter is talking about ‘paining, paining, lots of paining’. I nod away, wanting to tell Mrs Singh that if she really wanted me to think that she might possibly have a heart condition, no matter how benign, she would at least get the correct bloody tit. Obviously I don’t say that. I carry on smiling and usher the whole lot of them into a cubicle.
Mrs Singh is what is known in the trade as a ‘health tourist’. She doesn’t live in the UK, she does not pay UK taxes, but since she is visiting her son here in the UK who does pay UK taxes she has decided to take advantage of the NHS’s free-at-the-point-of-demand policy and get herself a medical. When I worked in Ealing hospital for six months this time last year, health tourism used to drive us mad. It happens more in the summer and around Christmas, which is when families travel from the Indian subcontinent to see each other. And there is nothing you can do about it, as you don’t want to be the one doctor who failed to spot a genuine case of angina because he was trying to get an old biddy in and out of the hospital system as quickly as possible. But I have to say, I really don’t need Mrs Singh and her entourage today. I am tired and, I think, rather upset by Rebecca Benson. They always say that it’s the patients who are like you or who look like you or one of your relatives who are the ones that affect you most, and I suppose she is around my age. A little bit older, but even so, a contemporary of sorts. So what I don’t need is a woman ligging a freebie off the NHS, even if she is perfectly charming and in her seventies. I quickly listen to her heart just to make sure she isn’t about to keel over on me, then walk out of the cubicle and pull rank. Ewan is two years more junior than me and he doesn’t look busy, so I usher him in on the pretext that I might want to show or teach him something. Not technically my job, grant you, but Chris is busy and Ewan has made the mistake of walking by. Before he quite realizes what has happened, even as he is pumping up the blood pressure cuff, I am off and out of there and clicking on my next patient.
My next is an ambulance delivery, which seems rather odd for a young woman who appears to be perfectly capable of walking and talking and indeed taking the bus.
‘So’ – I glance down to check her name – ‘Jackie, what can we do for you today?’
Dressed head to
toe in pink velour, she is eighteen years old and presenting with a headache.
‘Well,’ she says, running her hands through her very dry, very white-blonde hair. She appears to have a ring on every finger, as well as her thumb. ‘I’ve got this headache.’
‘Right.’ I nod. ‘Does it hurt when you look at bright lights?’
‘Yes. Well, no. Well, a bit.’
‘OK.’ I nod again, and shine a torch into her pupils. She doesn’t look away. Perhaps not meningitis then, I think. ‘Do you have a rash anywhere?’
‘No,’ she coughs.
‘Pains at the back of the neck? Do this.’ I show her, putting my chin on my chest. She copies me. Not meningitis. ‘Any other symptoms?’
‘I am feeling sick,’ she says.
‘Have you been sick?’
‘No. But I don’t feel well. And I’m tired.’ She yawns in my face. Her breath smells of old booze.
‘Did you drink alcohol last night?’
‘Yeah,’ she says.
‘How much?’
‘Four White Lightning and half a bottle of cherry Lambrini,’ she replies. ‘Well, actually, nearly a bottle.’
‘And you feel sick and you have a headache?’ I can feel my pulse quickening and my palms beginning to sweat. I can feel the anger mounting. ‘Do you possibly think that you might just have a hangover?’
‘Yeah, maybe,’ she shrugs.
‘And you called an ambulance for a hangover?’ I am beginning to raise my voice.
‘Yeah, I might of,’ she says. She is looking me in the eye. She doesn’t seem ashamed or embarrassed. ‘I’m entitled.’
‘You are not entitled to a bloody ambulance to take you to hospital because you have a hangover.’
‘What’s going on in here?’ asks Andrea, bustling in bosom first.
‘Do you know how much an ambulance costs?’ I continue, ignoring her. ‘Eight hundred pounds.’
‘Well, that’s not my fault, is it!’ she yells back at me, getting off her chair and putting her hands on her hips. ‘This place is shit! You’re all wankers! I don’t need your help anyway!’ And she marches off down the corridor like some pissed-off chat show contestant.
‘Well we—’ I start to yell after her.
‘Don’t,’ says Andrea, putting her hand on my mouth. ‘Stop. Breathe. And let it go. Otherwise you will be the one in trouble.’
She’s right, I know. I’d be the one at a disciplinary hearing and she’d get to wag her many-ringed fingers at me while I watched my career go down the pan. I recall the surgeon and his extra croutons in the canteen. Shouting at patients is surely more of an offence than taking a few extra fried bread squares. I inhale and exhale and look up to see what I immediately fear is Rebecca Benson’s husband sitting in tears in a chair clutching his toddler son. Chris Williams has a comforting hand on his shoulder.
‘Come on,’ says Andrea, following my gaze. ‘There’s a young woman in here who needs your help.’
She ushers me next door where the young woman in question is lying on the bed looking slightly terrified. Actually, now I look more closely, she is more of a child: she is wearing knee-length socks, a long pink skirt and a white T-shirt.
‘This is Marsha,’ Andrea announces. ‘She is fifteen and has heavy pelvic bleeding.’
‘Right,’ I say, giving Marsha a smile.
She is quite a big girl, clearly fond of her grub, and she looks like she’s in a bit of pain.
‘Mum’s just up the corridor, getting a coffee,’ says Andrea, handing me a pair of surgical gloves.
‘OK, then,’ I nod. ‘How long ago did the bleeding start, Marsha?’
‘This morning,’ she replies.
‘Is it heavy?’
‘And painful.’
‘I’m just going to give you a quick pelvic examination. Would you mind removing your underwear?’
Marsha takes off her pants. There is a significant amount of blood and the girl does look quite uncomfortable. I put my hands up between her legs and straight away I can feel something hard and round. What the fuck is that? I lift up her skirt to take a closer look.
‘Marsha?’ I ask.
‘Mmm?’
‘Do you feel the urge to push?’
‘Yes,’ she replies.
‘Yes, well, you’re having a baby.’
‘A baby?’ her mother screams behind me, dropping two hot cups of coffee on the floor. ‘A baby? You never told me you were pregnant!’
‘I didn’t know!’ Marsha yells back.
‘A baby?’ The woman looks exasperated. ‘You’re only fifteen!’
All hell then breaks loose. Marsha is screaming with pain. Her mother is screaming with fury. I am screaming on the phone to get a midwife down from the second floor. I have delivered a baby or two but it was right at the beginning of my training and I didn’t enjoy it very much. Also, Marsha is fifteen and has never been to an antenatal class in her life. The last thing she needs is another relative amateur at the business end telling her what to do.
Marsha is not that unusual. We usually get two or three girls in a year who give birth in A&E not knowing they were pregnant. They are usually young and usually Catholic and have said nothing for nine months because they were either terrified or in denial. Although Marsha does seem a little different in that she genuinely appears not to have known.
By the time a red-headed midwife called Mary arrives, some five minutes later, Marsha’s mother, Denise, is sitting down in a chair in tears. ‘No one knew, no one knew!’ she keeps saying over and over again. ‘And she’s only fifteen!’
‘Hello there,’ says Mary, introducing a calm note to the fraught atmosphere. ‘I am Mary and I am here to deliver the baby. Now, Mum’ – she says this to Denise – ‘you need to go up that end and hold …’
‘Marsha,’ I say.
‘Hold Marsha’s hand, because she is going to need some help to push this baby out.’ She smiles, and turns to me. ‘And you, you need to give me a hand. How dilated is she? What is her blood pressure? Can we get our hands on a foetal heart monitor?’
We both look at Marsha. She’s a big girl, never mind that she’s full term. Neither of us is sure the foetal heart monitor is going to be any use.
Obesity is a huge problem for the NHS. Fat people are more difficult to move and operate on, they are more likely to fall ill, they heal more slowly and they are more likely to have complications such as diabetes. The big problem, excuse the pun, in Maternity is you can’t hear a tiny heartbeat through all the flesh. It is essential to hear the baby’s heart during the birth process because there is no other way of determining if the baby is in distress or pain, or needs to come out right away. Therefore anyone with a body mass index over 40 uses up extra staff, as someone has to hold the foetal heart monitor hard against the flesh so that the midwife or consultant stands a chance of hearing it. The heart monitor holders are usually medical students and they can be made to stand there for up to twelve hours at a time. Obese mothers-to-be are also the anaesthetist’s nightmare. Can you imagine how hard it is to anaesthetize a large woman in labour? It’s enough to make them go for two big syringes at once!
Marsha utters an enormous low moan that grows into another scream.
‘OK,’ says Mary, crouching low between Marsha’s legs. ‘There’s no time for anything. This baby’s coming into the world whether we are ready or not. Marsha, listen to me. I am going to ask you to push, and when I tell you to stop pushing, you stop. OK?’
A strained ‘OK’ is all that Marsha can manage.
‘OK now, push!’ commands Mary. ‘Like it’s coming out of your bottom!’
‘Push, baby, push!’ Denise joins in.
‘Push!’ I find myself saying.
Marsha’s entire face turns bright red and she lets out an enormous scream.
‘That’s it!’ says Mary. ‘Now stop! We have the head!’ Mary runs her fingers quickly around the head to check for the umbilical cord. ‘OK, my Marsha, just two mor
e big pushes. Two … big … pushes. Push!’
‘Aaaarrrrrrrgh!’ screams Marsha.
‘Oh my God!’ screams her mother.
‘It’s a girl!’ declares Mary as a fat, grey squirming thing slithers out on to the trolley. It opens its small toothless mouth and yells. ‘Well done, Marsha. You have what looks like a very healthy little girl.’
12–1 p.m.
I’m not even halfway through my shift and I’m already shattered and in my second pair of scrubs for the day. I’m quite relieved when Mary asks if I’d like to come outside and have a cigarette. Perhaps not the healthiest example to patients, I admit. We’re always preaching that patients should give up smoking if they are to get an operation on the NHS, which is obviously rich coming from a staff at least half of whom smoke. But hypocrisy was ever thus.
‘You guys need to learn to deliver babies a bit better,’ says Mary, leaning against the redbrick wall of the hospital and taking a long deep drag on her cigarette. ‘It’s pathetic the way you all come running to us as soon as you see a screaming fat woman.’
Short and stocky with her henna-dyed bob, Mary is one of the younger midwives so is on a twelve-and-a-half-hour shift for which she will be paid about £38,000 a year. But her rise through the ranks and up the pay band scale will be fast. Before, time served was an indicator of how much you’d be paid, now, if you have a degree you will earn more money more quickly. Her contract will, however, be a little more rigorous than those of the older midwives who have, over the years, managed to negotiate two days, day shifts only or weekend jobs as they have families of their own. She can already earn significant overtime, which can easily take her to £50,000 a year, but then she has plenty of responsibility. She used to specialize in drug-addicted pregnancies but has recently moved on to teenage pregnancies. Needless to say, we see a fair number of them in A&E.
‘Thing is,’ I say, after taking such a deep drag on my fag that I’ve given myself a bit of a head rush, ‘I’m not that keen on the whole birth thing. It stinks for a start.’
Hospital Babylon Page 6
