‘Don’t breathe in,’ she replies. ‘Anyway, we all know that you doctors would much prefer it if the mothers had a simple C-section and a whole load of drugs.’
‘I like those TOBP women. I can appreciate why they are tired of being pregnant and want a C-section and then a nice lunch. It makes it quieter and easier, that’s for sure.’
‘D’you know,’ says Mary, flicking ash at her feet, ‘you can always tell a smoker by their grey, gritty placenta.’
‘I think I saw pictures of that when I was training,’ I say. ‘That and the gonorrhoea baby covered in gunk. Its eyes stuck shut … I actually now want to be sick.’
‘Even I haven’t seen one of those, and I’ve seen pretty much everything,’ she says. ‘Crack babies, smack babies, babies so small they fit entirely in one hand.’
It must be quite depressing running a unit looking after the youngest addicts in town and having to watching them shiver and vomit their way through withdrawal. Quite a few of the drug-dependent pregnancies are women off the streets. Either that or they have been living in hostels or bedsits. There is usually a multi-discipline team on hand after the baby is born to see if the child needs to be taken into care. They hang around to see if the mother bonds with the baby, doesn’t leave it crying, and to assess whether she’s suffering from post-natal depression and might self-harm.
‘Wasn’t she young,’ I remark, thinking of Marsha and her incredibly shocked mother.
‘Young?’ replies Mary. ‘I had a girl of twelve in last week.’
‘Twelve?’
‘Yup. You know, one of those lost girls in the care system who gets pregnant because there’s nothing else to do and because school isn’t for them.’
‘Only to repeat the whole cycle all over again,’ I sigh.
‘Teenage mums are nearly always daughters of teenage mums,’ Mary agrees. ‘We had four generations in the other day. She was fourteen, her mum was thirty, I think, her mum was late forties, and her mum was in her sixties. Extraordinary. They all seemed quite happy about it. It was a very nice little baby.’
‘Who was the father?’
‘Oh, some fifteen-year-old toe-rag.’
‘I don’t suppose that was a water birth with twenty scented candles and a whole load of om shanti,’ I say, stubbing my fag out on the ground.
‘God,’ Mary says. ‘Really, never do one of those. I had a posh woman in the other day who’d had the whole water birth thing set up in her sitting room. You know, the paddling pool and candles, all in a bay window. The midwife was on her way when the contractions really kicked off. The woman pushed out a poo and the husband panicked and ran around trying to fish the thing out with a net. He then slipped over in the poo water and the candles fell off the pool and set fire to the curtains. Meanwhile the woman was screaming, giving birth. The husband eventually had to call the fire brigade and the woman actually gave birth in the ambulance in the street. And,’ she adds with a smile, ‘there’s nothing om shanti about that!’
‘Christ!’ I laugh.
‘Moral of that story?’ she asks.
‘Don’t shit in the birthing pool?’
‘Don’t have a birth plan,’ she says, flicking her fag butt across the car park. ‘Shall we go?’
I follow Mary back into the hospital through the side door. We are both chewing a mint like a couple of teenagers trying not to be caught smoking.
‘See you later,’ she says. ‘We’ll take good care of Marsha.’
I pause and take a breath, bracing myself before going back into A&E. It’s only when I slip through the swing doors that I realize something major has gone down while I’ve been flicking fag ash on the pavement round the back. There are police everywhere. Not your usual gentle bobby with a pen and pencil and an old granny who’s had a dizzy spell at the bus stop. Armed police. SO19. They’ve got their semi-automatic machine guns out, their flak jackets on, and they are crawling all over the place.
Andrea rushes past, her white plastic apron covered in blood, in her hands a stainless-steel tray full of bloody swabs. ‘Where the fuck have you been?’ she barks at me, exuding professionalism. ‘Didn’t you get your page?’
‘Page?’
‘Yes, your fucking page.’
I rather sheepishly pull my pager out of my scrubs trouser pocket. It’s switched off. I almost begin to explain that I haven’t left A&E all shift and I was just taking some air after delivering a baby, but I can see that she does not give a flying fuck what weedy excuse I have.
‘Get yourself in there with Steve,’ she tells me, flicking her head in the direction of the closest resus bay. ‘We’ve got three with severe gunshot wounds. Some gangland shoot-out.’
Oh fuck, I think as I snap on some fresh gloves and pull back the curtains, there’s no time to scrub in for this. We need to stabilize this bloke right now and it’s going to be messy.
The problem with firearms injuries in this country is that half the villains don’t know how to shoot. They use the wrong weapons, with the wrong ammunition, which doesn’t kill you, so you don’t get a nice clean bullet hole, a nice clean shot, or indeed a nice clean death. It is always such a bloody mess.
We had a bloke in the other day who was either incredibly stupid or incredibly unlucky, I never quite worked out which. Either way, he stole a car that was full of drugs. It had something like a million pounds’ worth of cocaine in it, which he drove off with, much to the irritation and annoyance of the gangs involved. Obviously the said gangs wanted their car and coke back so they shot him twelve times, nine times in the back as he was running away. He only survived because none of them could shoot properly, but the mess was terrible. They shattered his shoulder blade, ribs and arms; he lost the right one completely, we just couldn’t put it back together. He did, incredibly, manage to walk out of here about three weeks later.
But this guy might take a little longer than that. Steve’s already cracked his chest and opened him up like a cadaver in an anatomy class, he’s wired up to a heart monitor, he’s being given pure oxygen, and there are three empty bags of O neg on the side.
‘Good to see you,’ says Steve, amazingly without a hint of sarcasm. ‘I can’t find this fucking bullet, there’s too much blood. Can you give us a hand?’
For a bloke who’s about to bugger off up north and specialize in kids, Steve has done his fair share of bullet holes. Before coming here he spent six months in east London just when there was a turf war between the Yardies and the Turks as the Russians moved in – or some such unsavoury Euro melange. Anyway, they had bodies coming in on a regular basis; he used to joke that it was like doing a tour as a medic in Vietnam. Although even Louise, I remember her saying, had two shootings and four stabbings, one through the heart, when she was in sleepy Eastbourne – something to do with rival Lithuanian gangs. It seems nowhere is immune these days.
I step in and start suctioning around in the man’s chest while Steve fishes through his lacerated flesh and punctured organs. The man, who looks Eastern European, is so pumped full of drugs he is dead to the world. I look over to see Andy sitting on his gas canisters, fumbling between his big syringe and his little syringe; he has beads of sweat glistening on his fat top lip. He catches my eye, but appears to look straight through me. The beeps on the heart monitor start to slow down.
‘Pressure’s dropping,’ Andy says, stating the obvious.
There’s always a bit of a battle between the surgeon and the anaesthetist when it comes to an operation, but this sort in particular. The doctor likes the blood pressure to be nice and low so as to minimize the bleeding, and the anaesthetist likes the pressure high as it means the blood and brain are oxygenating properly.
‘Thanks, Andy,’ says Steve, somewhat tersely. ‘We all have ears.’
‘I was just saying,’ he replies.
‘Can you see anything?’ Steve asks me, huffing through his mask.
‘D’you want me to have a go?’ I ask.
‘Go on,’ he says, st
epping aside.
I hand over the suction tube, he gives me the tweezers, and I start searching.
‘I’ve taken two bullets out already,’ he continues, indicating a small metal dish containing two bloodied slugs. ‘There’s another in the arm, above that snake tattoo.’ He points. ‘And there’s another in here, but I’m damned if I can find it.’
We both lean over. The man’s insides are all red and shiny and gelatinous, like a shaken-up Christmas trifle. I follow the direction of Steve’s tube, peering in where he has cleared the blood.
‘Shall I go and get some more blood?’ asks one of the Filipina nurses, whose name I am ashamed to say I don’t know.
‘That would be good,’ says Steve, without looking up. ‘Just in case we don’t get the bastard soon.’
‘There!’ I say, stopping the nurse in her tracks. I gently move a piece of flesh. ‘Just behind the liver. He’s a lucky boy, it just clipped the bottom as it went in.’
‘Well, not that lucky,’ says Steve.
‘I imagine a good shooting is an occupational hazard in his line of work,’ I say. ‘What did he do anyway?’ I’m slowly taking the bullet out while trying not to damage any other organs as I do so.
‘Guns or drugs,’ says Steve, ‘something like that. I wasn’t really listening when the police were telling me, I was much more interested in cutting his shirt off. All I know is that it was two against one, and he was the one, although he seems to have given them a healthy run for their money.’
‘Who’s with the others?’
‘Chris, Louise and Ewan, and I think, thankfully, Ian came in early.’
Ian is another A&E consultant who is just that bit less senior than Chris but who is also extremely good at his job, despite his fondness for poppers and clubs at the weekend. He is good-looking and very popular with the staff, mainly because he’s always got an opinion, a joke and a filthy story. He is the perfect person to sympathize with your hangover. Although last night he was not his usual badly behaved self. For a start, he did not hog the karaoke like he did at Christmas, when he finished the evening crashed out among the spinning beer bottles and streamers. Perhaps he’s grown up, got his eye on a senior consultancy, and is trying to set an example to the juniors.
The bullet clatters into the metal tray and both Steve’s and my shoulders move a few centimetres away from our ears. What a relief. There is nothing worse than searching through someone’s insides trying to find a bullet. The pressure mounts and the longer you take the less positive the prognosis gets. And you can’t really leave it in there. Some people live happily for years with bullets and shrapnel lodged in their flesh, but it is not an ideal scenario.
It takes Steve and me another twenty minutes or so to locate the other bullet in his arm and stitch him up. Sadly, neither of us is at that top surgeon stage where the patients are made ready for us – anaesthetized, laid out and opened – awaiting our crucial incisions, only for us to leave immediately after, our rarefied hands held slightly in the air, as someone else does the closing and finishes and clears up around us. It is no wonder really, with that sort of service, that most top surgeons are arrogant arses with terrible God complexes who find it hard to relate to their patients as anything more than a bit of flesh surrounded by green material. They are no longer patients with problems, they are just a problem, or indeed in some cases just a nameless tumour. Although obviously I too am looking forward to the day when I can become an arrogant arse, as there is nothing more boring than stitching up. There are also some people you make a bit more of an effort with. I am much more likely to try to get the scar all neat and small and compact if the patient is a young woman who has been in a car accident rather than, say, some tattooed gangster who’s blown ten tons of shit out of a few work colleagues.
Louise, Chris and Ian are still with their patients when Steve and I come out. The police are looking particularly grim-faced as they ask us for the bullets, to be bagged as evidence. From talking to them, it sounds like one of the other blokes is touch and go at the moment, so our bloke may well wake up to find that not only does he look like a patchwork quilt, he’s also going to be charged with murder.
‘Has he said anything?’ one copper asks me.
‘He was out cold and intubated by the time I saw him,’ I reply.
‘And how many bullets?’
‘Four.’
I walk back up the corridor towards the common room. I have definitely earned myself a full fat Coke break, I think, and, looking down at my blood-spattered scrubs, another change of clothes.
Freshly kitted out in my third pair of scrubs, I make my way into the common room. The place is packed with nurses eating their lunches, all brought in from home. They sit together, huddled in groups that are very much divided along racial lines. There are the Filipinas in one corner, many of them tucking into plastic containers of rice or noodles with the occasional fish head thrown in, while over in another corner is the African contingent, some munching on sandwiches, others digging into their rice and yams with a little lamb or goat garnish. And never the twain shall meet. In fact, there is practically a form of apartheid that goes on among the nursing staff, with the remaining Brits and Irish as a buffer zone. It’s not that they hate each other, they are just much happier working in their different gangs. They will work together if they have to, but they would rather not.
The nursing community has changed very much in the last few years. The days of finding the likes of Abi Titmuss in her push-up bra and stay-up stockings emptying your bedpan are over. Nowadays the nurses, particularly in the capital or in the inner-city hospitals, are almost entirely Filipina or African. In fact, if it weren’t for Filipina nurses the NHS would grind to a halt. After the Irish went back to Ireland when they realized they could earn just as much money at home, the NHS decided it had to recruit elsewhere. Some drives, like the ones in the Philippines, were successful; others, like the one in West Africa, went spectacularly wrong.
A few years back, the NHS recruited a group of nurses from Nigeria to work in the UK. However, when they arrived in this country it turned out that 60 per cent of them were HIV positive. So, instead of working for the NHS, they became patients. There is a rule that if you come to this country and you are HIV positive, you have an automatic right to stay. It is one of your many human rights. There was a huge amount of HIV tourism to the UK in the early nineties, people arriving and then declaring that they had the virus, which meant that they could not be sent home. Oddly, this seems to have slowed down of late due to the fact that we no longer fund ongoing HIV treatment here in the UK and HIV treatment in Africa is now a little better.
So the likes of Margaret and Andrea are the last of a dying breed. And as a result, the sexual politics of the wards have also changed. Nigerian and Filipina nurses tend not to put out that much. So sadly there are not so many doctors-and-nurses games any more. Randy, drunk student doctors have had to find other prey to sex-pest. They more usually have their sights set on the growing number of randy, drunk student female doctors, or indeed the physios. You usually need straight As at A-level to become a physio and they tend to be quite a sporty bunch of bright, sparky girls, which is the sort of criteria that suits an over-sexed student doctor down to the ground.
The African/Filipina stand-off continues in food-chomping silence. Occasionally there’s some inter-group dialogue, in a dialect that only three people in the room can understand, but otherwise the atmosphere of mutual mistrust is broken only by the smell of exotic food, which is gently overtaking the room. I’m leafing through the pages of a rubbish celebrity magazine and waiting for the kettle in the corner to boil.
Ian walks in and looks over my shoulder. ‘Botox … Botox … Botox … fillers … Sculptra … Fuck me! Look at the trout pout on that!’ he declares as his very clean, very manicured finger jabs its way along a line of orange-coloured bridesmaids at some celeb nuptials. ‘And the whole bloody lot of them have been Tangoed! Some massive napalm bomb of fake
tan has been sprayed all over the wedding. Jesus Christ, is that the dad?’ He squints in closer for another look.
‘How’s your gangster?’ I ask.
‘He lives! It was like raising Lazarus, though. We nearly lost him twice. But so good to know that he has been saved and can now murder and traffic drugs again, don’t you think?’
The kettle flicks off.
‘Coffee?’
‘No thanks,’ he says. ‘I just came in to see what I can steal from the fridge. I am bloody starving and the drugs lunch isn’t for another half-hour. Are you going?’
‘Free sandwiches,’ I reply. ‘What’s not to love?’
‘How’s your head from last night?’
‘Bad. Yours?’
‘Quite shit,’ he admits. ‘I hate cheap alcohol. Note to self: stop drinking wine out of a box. But you know what they say. Nothing like a good gang shoot-out to clear the cobwebs!’ He opens the fridge and looks over the shelves and in the door. ‘Oh God,’ he sighs. ‘Where’s a wrapped KitKat when you need one?’
‘Hi there,’ says a very clean-shaved, keen-faced bloke as he pokes his head round the door. ‘David. Plastics? I’m looking for Mr Williams.’
‘Ah,’ says Ian, checking him over with a swift expert glance. ‘He’s just saving the life of a terribly nice gangster. Can we help?’
‘I was wondering why the place was crawling with SO19.’ David smiles.
‘This is a charming neighbourhood,’ observes Ian.
‘I think he wanted you to look at our burns man,’ I say.
‘Right,’ he nods. ‘Accident, assault or self-immolation?’
‘He set fire to himself in Sainsbury’s car park.’
‘Oh dear,’ says David. ‘That’s sad.’
‘He’s forty-five per cent, and I think he’s in ICU.’ I take a sip of my coffee. He watches me intently. ‘Um, do you want a cup before you go up and see him?’
Hospital Babylon Page 7
