Hospital Babylon

by Imogen Edwards-Jones

‘Oh no,’ he says, his face scrunching up in disgust. ‘I know my tremor triggers,’ he adds, holding out the most immaculately maintained pair of hands I have ever seen.

  Plastic surgeons tend to be a little obsessive. It is one of the most competitive disciplines to get into, and therefore attracts the highest achievers from medical school. As their job requires an eye for detail and concentrated patience, this often translates into pernickety and mannered behaviour outside the operating theatre. When I was in Bognor we used to have a visiting plastics bloke who refused to carry his own box of instruments in case he injured himself. He would arrive like the star turn and demand that two orderlies help with £15K worth of kit, always claiming that his hands were his tools and he didn’t want to damage or strain them with heavy work of any kind. Needless to say, the rest of us weren’t exactly enamoured with him.

  ‘Let me take you up there,’ I say to David, turning around to pour my coffee down the sink.

  ‘Tremor triggers,’ I hear Ian spit, under his breath. ‘Just put your elbows on the fucking table.’

  1–2 p.m.

  Having deposited David and his £1,300 custom-made surgical magnifying specs that he got from the States in the ICU with the harridan McRae, I make a speedy exit down the stairs. I had no idea the lift journey from A&E up to ICU could take so long. I heard all about Dave’s specs and his last three burns victims before thankfully we were forced apart by a bloke with a broken leg on his way back from X-ray.

  Back down in A&E and there are still SO19 everywhere. It does rather change the atmosphere of a place to have armed police patrolling around, especially when you are supposed to be reaching out to your community.

  ‘Are you coming to the drugs lunch?’ asks Louise as she approaches in a fresh pair of scrubs.

  ‘What are they selling?’

  ‘I’ve no idea, I’m just after the free sarnies. M&S apparently.’

  ‘Nice. I’m in.’

  ‘Drugs lunch,’ says Steve, tapping the side of his nose as he walks over to the computer. ‘Starts in fifteen.’

  ‘Absolutely,’ says Louise. ‘I am bloody starving. Some bastard stole my KitKat from the fridge!’

  ‘Terrible,’ I say, hoping my cheeks are not as red as they feel.

  Once a week, or twice a month, or whenever anyone can get it together, we have what is known as In-House Teaching, which is when one of the surgeons or doctors comes in and shares a few pearls with us over what is laughably called our lunch break. Not to be confused with the Grand Round, which is very grand and round, when glamorous, important surgeons come and share their splendid knowledge with us, and half the hospital turns out to pay its respects. An In-House Teaching session is much more informal, more social, and obviously a whole lot less useful. But we do get to sit in rows and eat our lunch while listening to someone wang on about something they did last week. The idea is that they can still say we are being ‘trained on the job’ and are not working our guts out at the coalface of healthcare.

  Occasionally, however, the In-House Teaching session is given over to a drugs company with some new pills to flog. They take over the hall and fill it full of leaflets and charts and, most importantly, sandwiches and doughnuts – and if we are extremely lucky, hot snacks – and we go and listen for half an hour and get fed for our generosity. Like the bunch of canapé mercenaries that we are: no one really cares what they are selling, just so long as we get some food. Most of the time the drugs rep is singing the praises of a drug we already use, which always seems a little pointless to me. Sometimes they extol the virtues of a drug we don’t use, but seeing as none of us in the room has the power to purchase a new drug for the NHS, I also think this seems a little pointless. But they say they are networking us for the future. Planting seeds in our addled little brains so that when we are powerful, with corporate cheque-books in our briefcases, we’ll come knocking on their door because they gave us a prawn sandwich and a bag of salt and vinegar crisps eight years back.

  It is all rather doubtful, I think, especially as each hospital has its own drugs policy, which is dictated by NICE (the National Institute for Health and Clinical Excellence) and is fairly simple: we try to keep costs down and buy the cheapest drugs unless there is an important reason not to. But because the NHS orders in such vast quantities, it is a sitting duck for drugs companies who want to take advantage of the bulk ordering system, particularly if they have a monopoly on selling the drug in the first place.

  In the last couple of years there have been some staggering price hikes for some of the most basic drugs. Flucloxacillin syrup, which is one of the most common antibiotics prescribed for children with throat infections etc., used to cost us £4 per 125ml bottle but has now gone up to over £20. The five-fold increase came about after one drugs company became the sole supplier of the syrup. The purchase of this drug alone will cost the taxpayer an extra £44 million a year. And they are not the only ones. Gabapentin, an anti-epilepsy drug, has gone up from £5.52 per 600mg to over £41. Cimetidine, a treatment for stomach ulcers, has risen from £16 per 800mg pack to over £22. But perhaps the worst offenders are hydrocortisone tablets, of which the NHS buys sixty thousand packets a month: they have rocketed from £5 per 10g to £44.40. The company responsible is blaming a need for a new factory to make the pills, but it is we who are footing the bill. Let no one ever say that pharmaceutical companies are in the business out of the kindness of their own hearts! So I don’t feel at all guilty about filling my pockets with pens and sandwiches, and sitting there trying to do the Times crossword while they witter on about statins.

  I went to a statins dinner a couple of months back. The specialist trainee who is in charge of Grand Rounds and talks had managed to get the statins company to sponsor dinner in the Chinese around the corner. We had to listen to the talk about a statin we already prescribed in the hospital by the truckload for about twenty minutes, while shovelling in as much chow mein and free beer as we could. I have to say it got quite ugly after the rep left. Well, he made the mistake of leaving another £200 behind the bar, which we all thought was our duty to use up as quickly as possible. I made a bit of a tit of myself by telling Louise that I fancied her; she has been gracious enough never to mention it since. I am hoping, obviously, that she can’t remember the incident. But somehow I know she can. She is the sort of ambitious, go-getting woman who always has total recall at the end of a night – mainly because she doesn’t get completely plastered like the rest of us.

  In olden days, though, drugs companies used to splash out a bit more than taking fifteen doctors to the Lotus Flower. I have a mate who just after he was made a consultant was flown to South Africa, Hawaii and Rome, all first class, within a month. I’m not sure what they were hoping he might do for them, but they were very much on the charm offensive. Sadly, the drugs companies have recently decided to save themselves some cash and have signed up to the Association of the British Pharmaceutical Industry guidelines committing them to fly their doctors economy class, which is nowhere near as much fun and obviously takes the shine off any foreign trip.

  But all the flights and entertainment do work. Some doctors get caught up in the drugs company whirl and find themselves pronouncing on the merits of such and such a drug. GPs are a little more susceptible because the ailments they’re treating are usually not so life-threatening, so the merits of one drug over another are all much of a muchness. If you’re a specialist it’s a lot less witty to prescribe something because it reminds you of your recent trip to Florida. But that didn’t stop a few doctors overzealously claiming extraordinary things. There was one who declared that he had found the cure for MS. He went from conference to conference announcing the miracle drug – forgetting to question the P-value, which is the statistical measure of something happening by chance. When the smoke disappeared from up his arse and the PR lunches dried up, he was left looking rather embarrassed.

  The world of plastic surgery is a little more murky. There are obviously plenty of private c
linics that are a lot less regulated than the NHS, and they are not governed by NICE, so they can take as many kickbacks and jolly weekends abroad as they like. I have a mate who does plastics for the NHS as well as working for a private clinic and he is full of stories of dodgy doctors recommending one type of filler over another because they’ve been slipped a little extra. There’s one who lauded one filler at a meeting in Miami, only to be heard backing something else three months later at a conference in New York. He was being paid to do ‘research’ for the different drugs companies, which clearly consisted of him going from gathering to gathering telling everyone how marvellous their stuff was.

  When drugs companies discovered the power of celebrity, no one needed creepy doctors selling their reputations for twelve holes in Palm Springs so much any more. Viagra sales were fairly moribund until Jack Nicholson was busted taking the drug back in 2001, when his then girlfriend Lara Flynn Boyle was pictured collecting his prescription at the chemist. One sniff of celeb endorsement and sales went through the roof. Jack then later proclaimed, ‘I only take Viagra when I am with more than one woman.’ Which of course sent sales up even further. Obviously, given the nature of the beast, there is a limit to the number of medical products that can attract a celebrity endorsement; no one is going to admit using Anusol pile cream because it helps them sit longer. Then again, Bill Clinton did up the sales of Siemens Signia hearing aids when he was pictured using one at an international conference.

  ‘I hope the talk is better than the Jehovah’s Witness we had last week,’ says Steve, typing at the computer.

  ‘I didn’t go,’ I say. ‘I didn’t fancy the idea of religious sandwiches.’

  ‘Oh, the snacks were good,’ he insists. ‘Hummus and everything.’

  ‘I can’t stand a chickpea.’

  ‘Really?’ He looks up at me. ‘One of my favourite things. I love a falafel, with pitta and sauce. God I’m hungry. How long till this lunch?’

  ‘Excuse me,’ Jon Berry chips in with his whining nasal tones, ‘this is not an area for staff to use their communication skills.’

  ‘What?’ says Steve.

  ‘This is not an area for vocalizing, communicating … talking. The communication area is the common room. This is a designated work area. For work.’

  ‘Right,’ says Steve, not looking at Jon, who is rocking back and forth on thick soles. ‘Anyway, as I was saying, there is this great place near me – Falafel King. I am there every Saturday. Bloody delicious, it really is.’

  ‘I think they taste like ear wax,’ I say, reaching down and clicking on another patient.

  ‘Ear wax? Do you eat ear wax?’

  ‘How long has that one been waiting?’ asks Jon, poking his spotty chin over my shoulder. ‘Oh, three hours ten.’

  ‘There’s been a gang shooting,’ says Steve, pointing to the two armed police pacing up and down the corridor.

  ‘That’s as may be,’ Jon responds, ‘but rules are rules.’

  ‘Yes, well, she’s in under four hours so everyone’s happy,’ I say.

  ‘At three hours ten, she won’t be,’ says Steve.

  And he’s not wrong. Sarah Clark is so pissed off by the time I pull back the curtain to treat her that she can barely be bothered to look up from her iPhone.

  ‘Some of us have got jobs,’ she says. ‘I have been sitting here all morning.’

  ‘I am very sorry for the delay,’ I say. ‘We have had quite a large incident come into the hospital this morning.’

  ‘Really,’ she says, sounding unimpressed.

  ‘That’s why we have all the police here,’ I add.

  ‘Yeah, well. Back to me. I have a stomach ache and I think I’ve got appendicitis.’

  ‘Really,’ I say. ‘OK, if you pop up on to the bed and let me take a look. How long has it been hurting?’

  ‘Ever since I woke up this morning.’

  ‘So, not too long then? Are you having your period at the moment?’

  ‘No,’ she answers. ‘It’s my appendix. It says here that the symptoms I’ve got are appendicitis.’ She flashes her iPhone at me. ‘“Pain in the lower abdomen that after to four or five hours will localize.” Well, I haven’t been in pain for that long yet …’

  If there’s anything more annoying than a pissed-off patient, it’s a pissed-off patient with access to Google. I have lost count of the number of times a patient has sat there and told me I am wrong, or that my diagnosis is incorrect. They are almost always young, with an iPhone in their hand, or they have printed a whole load of stuff off the internet before coming in. It’s a generational thing. No one in their eighties would question a doctor’s judgement. Yet someone who has no medical training whatsoever thinks it is perfectly fine to look you in the eye and say ‘I’ve looked it up on the internet and you are completely wrong.’ And then they start quoting stuff back at you that is invariably crap and invariably from the States, where the protocol is different and usually more cost-based. I had an argument only last week when I suggested to someone that they would have to stay in hospital another twenty-four hours after their operation for observation, and they started to shout at me that I was wrong, flashing some website results from a hospital in Baltimore. Also, of course, nowadays, due to all the press reports about cutbacks, everyone accuses you of trying to save money rather than doing something for the good of the patient. ‘You’re just doing that because it’s cheaper,’ they say. No one listens when you argue otherwise.

  I start to feel around Ms Clark’s stomach for anything swollen or out of the ordinary, while she continues to type away on her iPhone.

  ‘On a scale of one to ten, how painful is it?’ I ask.

  ‘Ten, obviously,’ she replies. ‘Otherwise I wouldn’t have sat in the waiting room for all this time, would I?’

  ‘No, of course.’

  I push in the middle of her stomach, which is quite taut and hard, ballooned even. I push again. Then she lets off an enormous loud long fart. I bite the inside of my cheek to stop myself from laughing.

  ‘Better?’ I ask, my voice slightly strained.

  ‘I’m fine,’ she says, swinging her legs swiftly off the bed and pulling down her shirt. She quickly picks up her handbag, her cheeks burning red. ‘How the hell do you get out of this place?’

  I follow her out of the bay and point her in the direction of the exit. I have never seen anyone move so fast. She doesn’t turn back and she doesn’t say thank you.

  ‘That was quick,’ says Steve.

  ‘A bad case of wind,’ I reply.

  ‘Excellent,’ he smirks. ‘Shall we go and grab some lunch?’

  When we get to the lecture hall, the place is packed. It’s amazing how many staff will turn out for a free ham roll. There’s a long table below the line of large sash windows on the other side of the room that is covered in plastic trays of party-pack sandwiches.

  ‘Great,’ says Steve, ‘Marks and Spencer. Come on, we’d better get stuck in before it all goes.’

  Steve and I grab a white plastic plate each and start to pile on as many sandwiches as we can. Then we find a pew far enough back so as not to have to engage in any way with the speaker, and start to scoff. I have a mouth full of egg and cress when Louise suddenly appears out of nowhere.

  ‘Can I sit here?’ she asks.

  I can only mumble something vaguely positive-sounding, which she takes for a yes and sits down.

  ‘Jesus,’ she says, clocking my plate, ‘don’t hold back.’

  ‘I’m hungry,’ I mutter.

  ‘I can see that,’ she says, taking the corner off a prawn sandwich. ‘Nice to see half the hospital here.’

  She is exaggerating slightly, but the turnout is large. Each of the departments is more or less sitting together in their teams. The surgeons are sitting apart from the physicians and there is a healthy air of disrespect emanating from each of the groups. The cardiologists think they are better than the oncologists, the paediatricians think they are better than the ort
hopaedists, and everyone, obviously, thinks they are better than A&E. But what is more amusing is that the surgeons think they are better than the doctors and the doctors think that the surgeons are no better than Neanderthals and only one up from the barber-surgeons of the eighteenth century. Some of the doctors take great pleasure in addressing surgeons as Mr, just to remind them of a time when surgeons were tradesmen who were not properly trained. They really do think that they just walk into an operating theatre, saw off a leg while listening to Tina Turner’s ‘Simply the Best’, and walk straight out again.

  Sitting next to Louise, I am suddenly conscious that egg sandwiches were perhaps not the sexiest choice, as each time she leans in to talk to me all I can think of is the waft of eggy breath she must be getting with my reply.

  ‘Good afternoon everyone!’ begins the drugs rep, walking into the middle of the room.

  I look between the shoulders of the paeds in front of me. ‘Oh my God,’ I say to Steve. ‘She used to sit next to me in anatomy class. Her name is Karen.’

  ‘My name is Karen,’ says Karen, ‘and I am here to talk to you about statins.’

  ‘Really?’ Steve says.

  ‘Yeah. She was always quite weird. She used to keep her packed lunch inside her body.’

  ‘What? The cadaver?’

  ‘Yup,’ I whisper. ‘She’d pop her sandwiches in the heart cavity when the lecturer came round.’

  ‘Gross,’ says Steve.

  I used to love anatomy class. Two years of total enjoyment. There is something quite amazing about being allowed to cut up someone’s body and get right in there. It is also amazing that people actually leave their bodies to science in the first place. And they are mostly not old doctors, they are ordinary people who leave their bodies to the London Anatomy Office. Just so long as they don’t die of cancer, or have certain pathologies that render them abnormal, we get to chop them up. Very respectfully, of course. Their organs are taken out and bagged and tagged, the body is preserved, and at the end of the year they are all put back together to make a complete corpse. We then go to a Service of Thanksgiving at Southwark Cathedral. It’s an extraordinary event, a rather moving and well-attended service. The families of the dead come and celebrate along with the students. After a year you do get to know your body quite well, so it’s an odd feeling to meet the family and find out who they were in real life. It is a most extraordinary day.