Hospital Babylon

by Imogen Edwards-Jones

  You can’t say that it doesn’t affect you, because it does. When you first qualify you take every death personally and you can remember exactly how or why and what their names were, but obviously the more deaths you see, the less they affect you. You come to expect grannies to die at bus stops and old boys to slip over on the ice, but if they arrive talking and compos mentis through the doors and you strike up a conversation with them, like I did with June, then you are hit a little harder when they go.

  I remember a mate who was asked about the point at which a hospital death became a tragedy saying, ‘When they are younger than you.’ So anyone coming in here who dies under the age of thirty is obviously going to affect me more than, say, some sixty-five-year-old with pneumonia. Then again, the circumstances of the death, or the way they speak or look, or an attitude they have, or just their age, can remind you of a friend, brother, father or lover, and then you are ten times more likely to be affected. Earlier this year an old boy came in who was the spitting image of my dad. He had a blocked bowel and died five days later of inoperable cancer. He was a little bit gruff, like my dad, and couldn’t express himself very well, just like my dad, and when he died I found myself shedding a tear for him in the Gents. It was very weird.

  Obviously children and babies are the worst. We had an eleven-year-old boy die back in March when I was still new here and I found it very hard to be on my own for a couple of days. I wanted to sort of offload some of my thoughts and opinions but no one else was interested. There’s always a departmental debrief after a child dies, so that everyone can have a say about what they are feeling, but no one ever does. They just head off home as early as they can and drink a bit more vodka than usual.

  When babies die there is a whole protocol that staff have to follow. Upstairs they oversee between six and seven thousand births a year, and a couple of babies die each week. They hope not to get any dead mothers, but about three or four a year don’t make it. After twenty-four weeks of gestation a stillbirth is viewed as a baby that requires a proper burial; before twenty-four weeks it is clinical waste and is more or less treated as such. After twenty-four weeks, the birth and the death have to be registered at the same time, and the chaplain is called. The baby is dressed and put in a room and the parents are encouraged to go and see it and take photographs so that they can begin to mourn it properly. Or so the current philosophy goes. Some women know their babies are going to die and give birth to them fully aware that they have only a few hours at the most, say because their child has an incurable heart condition. But for some it comes as a complete shock. There is still so much that is not picked up on the scans.

  ‘Time of death?’ says Chris as he starts to fill in June’s paperwork.

  ‘Fourteen fifty-eight,’ I say.

  ‘Does anyone know if she wants to be cremated?’ asks Ewan, who has apparently appeared from nowhere.

  ‘You greedy little sod,’ says Ian, wiping the sweat off his forehead. ‘I think I need some air.’

  3–4 p.m.

  Poor old Ewan. He was only asking the same question many of us hard-up student doctors have asked over the years. There was no need for Ian to make him feel so grubby about it.

  ‘What?’ says Ewan, two huge patches of red bursting across his cheeks. ‘Someone’s got to do it!’

  And he’s right. Someone does have to sign her death certificate, go through all her notes and release her to the undertakers. And whoever signs all the papers has to check that if she wants to be cremated she hasn’t got a pacemaker. If they don’t check properly and the crematorium blows up as a result they are liable for the first £10,000 worth of damage. For their pains they will get paid £71. Well, actually two doctors have to sign the certificate and they are paid £142. It’s the dead person’s family, or the deceased’s estate, who pays. Normally it is part of the costs charged to the family by the undertaker.

  ‘Ash cash’, as it is rather pleasantly referred to, is one of the perks of being a junior doctor. It’s a way of supplementing your income and ensuring a few more drunken nights out. Each hospital has its own system when it comes to ash cash. The last place I was at there was a very clear pecking order. If it was your patient who died then you were entitled to the money, and if you weren’t in or were away on holiday then the person below you got to sign. You were supposed to give a tenner to the Mess Fund to help towards one of the numerous piss-ups, and the rest you could keep. Other hospitals pool the whole lot into the Mess Fund for everyone to enjoy. Here it’s a bit more of a free-for-all, which can lead to the rather undignified sight of a scrum of junior doctors around a tepid corpse.

  ‘You are very welcome to sign the certificate, if you want,’ I say to Ewan. Quite frankly I have better things to do with my time, and I’m also slightly upset, to be honest, that June, who presented as such a robust patient, could go down so quickly. ‘Remember, you’ll only get the cash if she’s cremated in the end, and only after about two or three months. So don’t go spending it all at once.’

  ‘Well, actually, I was thinking I might put it towards a holiday,’ says Ewan.

  ‘A holiday! On June!’ says Ian. ‘I’m sure she’d be delighted to know that her passing helped you to bang three Es and large it with your mates on a podium in Ibiza.’

  ‘I wasn’t planning on going to Ibiza,’ Ewan counters.

  ‘Really,’ says Ian, clicking the top of his pen in and out in irritation. ‘Where’s June sending you then?’

  ‘Australia.’

  ‘I’m sure she’d be delighted to know that—’

  ‘I saved up for a computer with my ash cash,’ Louise chips in.

  ‘A computer!’ I exclaim, staring at her.

  ‘Yup,’ she nods. ‘It took ten deaths but I got it in the end.’

  ‘Only ten!’ declares Ian, his small red eyes now totally spherical.

  ‘Well,’ says Louise, ‘I didn’t want to drink it so I thought I would do something useful with it. I needed a computer to pass my exams so I thought that would be a good thing to spend it on. I thought they would approve. I do remember most of the people who died when I use it.’

  ‘What?’ says Ian. ‘You think of Maureen while you chat to your mates on Facebook?’

  ‘I’m not on Facebook,’ Louise responds.

  ‘Aren’t you?’ asks Ewan.

  ‘There has to be at least one perk for working in Oncology,’ she says. ‘Anyway, what did you spend your ash cash on, then, Ian? Booze and fags?’

  ‘Booze and fags,’ he confirms.

  ‘And that’s so much more fitting, don’t you think?’ she purrs before walking back into the department.

  ‘She needs a good shag, that girl,’ says Ian.

  I am just about to offer my services to the lovely Louise when Andrea pokes her head through the doors and says, ‘There’s a Mrs Maynard to see you.’

  My heart sinks. Poor Mrs Maynard. The very sad Mrs Maynard. I do feel sorry for the woman but she is driving me crazy with her mad obsession. About a month ago Mrs Maynard lost her son, Paul. He was obviously once a nice young man who loved his mum and remembered her birthday, but sadly he became a desperate, grubby, rank old crackhead who sold his life and soul for rocks and who eventually died of a crack-induced heart attack in a crack den about ten streets away from here. Anyway, between the crack den and A&E the paramedics performed mouth-to-mouth and CPR and in all the trauma and the battle Paul lost his T-shirt. And Mrs Maynard wants it back. This is the fourth time she has come asking for it and I am afraid that my sympathy wanes a little more each time I see her. I understand that she is miserable at the loss of her son. That she is upset and wants something to remind her of him. But a stinking, filthy crack-shirt covered in spittle and vomit is not the answer. Nor, indeed, do we have it. I have looked high and low for the foul and fetid thing, to no avail. She has written to the hospital, I have had meetings about the T-shirt, but there is no way I can magically find something that has been lost for a month now. She has even appa
rently been staking out the crack house, trying to get in and search it in the hope of finding her son’s top. It is sad, desperate, and bloody annoying.

  I take a deep breath.

  ‘Good afternoon, Mrs Maynard,’ I say, trying to be charming and positive.

  The poor woman looks frantic and distraught. Her thin brown hair hangs lank and unwashed from a centre parting and her clothes look like they haven’t seen any Persil for weeks. Her gaunt face looks grey and there are large red bags under her eyes. If I didn’t know she was a staunch Seventh-Day Adventist I would swear she was on the crack herself.

  ‘Is it good?’ she asks, her hands and fingers tying themselves in knots.

  ‘Well, perhaps not,’ I say.

  ‘I have left you messages,’ she starts.

  ‘Oh really? I’m very sorry, I haven’t got them.’

  Weirdly, I’m not lying. The message system in this place is shit. I have more or less accepted that I am completely uncontactable at work; it’s like living and working in some sort of bubble. The real world goes on outside and occasionally crashes in, mostly on a stretcher, but I do my shift and then emerge blinking into the light at the end of it, like a small myopic mole.

  ‘Well, I’ve left you more than six,’ she says, counting them off on her fingers.

  ‘I am sorry,’ I say, taking a step towards her. She recoils, like I’m about to do her serious harm. ‘Would you like a cup of tea?’

  ‘A cup of tea?’

  Oh no, I think, what have I said now?

  ‘My son is dead and all you offer me is a cup of tea?’ Some colour is coming back to her cheeks.

  ‘No, no, I was just wondering if you want a cup of tea while we talked about your son,’ I try. I’m really not very good at this.

  ‘I don’t want a cup of tea,’ she shrieks, ‘I want my son’s T-shirt, which you have stolen!’

  ‘I haven’t stolen your son’s T-shirt, Mrs Maynard.’ I’m trying to be consolatory. I’m not sure it’s working. ‘It was lost on the way here in the ambulance.’

  ‘I have been in contact with the police,’ she continues, her head wobbling with defiance, ‘and I am going to have you charged with theft.’ She jabs the air with a skinny white finger. ‘Theft! Do you hear? Theft!’

  ‘OK, that’s fine,’ I say, ushering her towards the exit. ‘I’ll be very happy to talk to the police when they get here.’

  ‘They won’t be coming to talk to you, they’ll be coming to arrest you!’

  ‘OK then, arrest me. I’ll look forward to that.’

  ‘So will I!’ she yells as she marches off. ‘You’re a thief, doctor! You are nothing more than a thief who steals from dead people!’

  She walks out of the building, leaving me standing in the waiting room with about thirty pairs of eyes staring at me. Some of them are looking at me in befuddled amusement; others clearly believe her story and are staring at me with indignation. All I can do is smile and shrug my shoulders. Anything I say will only sound hollow.

  I walk back into A&E and send a bloke with a suspected broken toe up to X-ray and dress a cooking burn before I am approached by a smirking Steve. He’s standing there grinning at me, his blue eyes shining, as he runs his hands through his thick dark hair.

  ‘Woman,’ he says, with a sniff. ‘Cubicle three – I need a second opinion.’

  ‘Really?’ I say. I’m feeling tetchy and quite frankly have better things to do.

  ‘Yup,’ he smiles. ‘Just check the apex pulse, please.’

  ‘Apex?’

  ‘Apex.’ He smiles and taps the side of his nose. So I poke my head around the curtain and smile. ‘Excuse me, Mrs …?’

  A well-preserved woman of about sixty raises her head off the pillow. ‘Ms Evans,’ she says.

  ‘Excuse me, Ms Evans. Would you mind if I repeated the pulse check my colleague here has just carried out? He’s asking me for a second opinion.’

  ‘No, go ahead,’ she says, unbuttoning her shirt to reveal a very striking, somewhat unexpectedly ample bosom and a shocking pink and purple lace push-up bra.

  ‘I’m very sorry about this,’ I say, rounding my hand and cupping her firm, full bosom. I squeeze it and feel around underneath for a pulse, checking its rate, rhythm and strength. ‘Well, that all seems fine to me.’ I nod to her to button up her cream cotton top. ‘Thank you very much.’

  ‘No problem, doctor,’ she says.

  I close the curtain behind me only to turn round slap-bang into Steve, who is now grinning broadly.

  ‘Well?’ he whispers. ‘What do you think?’

  ‘The pulse seems fine to me.’

  ‘Not the pulse, you idiot, the tits!’

  ‘What do you mean, “the tits”?’

  ‘Aren’t they cracking?’ He nods and grins like an oversexed schoolboy. ‘Quite spectacular!’

  ‘Jesus Christ, Steve, what the hell is wrong with you? She’s a hundred and five!’

  ‘Actually she’s sixty-three. It must be one of the earliest boob jobs on record.’

  They were amazing, I have to agree. They must have been very expensive in their day. Not the usual knobbly-knees cheap tits we often see around here.

  ‘Whoever did them did a good job,’ I admit finally.

  ‘You’ve got to love a TUBE,’ says Steve.

  ‘A TUBE?’

  ‘Yup.’ He nods.

  ‘What the hell was she in for?’

  ‘Twisted her knee!’ He laughs. ‘She didn’t seem to mind!’

  A TUBE, or totally unnecessary breast examination, is one of Steve’s favourite shticks. He fancies himself as a bit of a breast connoisseur, having felt up half the country. Well, him and half the junior doctors on staff. If they think they can get away with a TUBE, they will slip one in, so to speak, and no one ever really notices or even thinks to complain. Steve maintains that it is one of the perks of the job. It jollies up his day. He puts on his best doctor face, speaks in his VTMK (voice to melt knickers – a voice deliberately cultivated by some doctors), and no one is any the wiser. He likes doing that sort of thing, taking the piss slightly. He’s also one for laughing or having a good look at a body when it’s out cold on the slab. He is liable to drag a colleague out of a consultation just to have a cop at someone’s interesting pubic hair, a ridiculously small or large penis, or a huge pair of breasts. He’s also very fond of a piercing, which are two a penny in Gynaecology. The number of times you have to ask women in labour to take out clitoral piercings is extraordinary. I imagine he will find himself a little bereft of entertainment when he goes up north to do paediatrics. It won’t be nearly so diverting.

  Although doctors can usually find some means of entertaining themselves. If you look carefully on your notes, you will see they are littered with acronyms, or little jokes between staff. There are the old ones, like NFN (Normal for Norfolk) and FLK (Funny-Looking Kid), for those patients whose looks and behaviour are a little strange. Odd- or ugly-looking babies often have ILWF on the bottom of their charts, which means In Line With Family. There are others, like E17 or Barking, which means the patient is obviously bonkers, and TTFO (Told to Fuck Off), which means the patient is difficult. TSL – Too Stupid to Live. TFTB – Too Fat to Breathe. There are other codes in referral letters that serve as warnings. For instance, a doctor referring to a patient as ‘interesting’ or ‘complex’ in a case letter is telling the other doctor to run a mile. My personal favourite, which I have only seen twice in my career so far, is TFBUNDY – Totally Fucked But Unfortunately Not Dead Yet.

  I leave Steve to enjoy his little joke a bit longer and head off to the computer to get my next presentation. David the cleanshaven keen-faced general plastic surgeon is back from checking out the burns victim and is talking to Chris.

  ‘So what have you got on your list this afternoon?’ asks Chris, leafing through some X-rays.

  ‘More skin cancer,’ replies David, rolling his little brown eyes. ‘It’s just so not challenging. I can do it with my eyes shut.
’

  ‘You can’t do the big stuff all the time,’ says Chris, holding a sheet up to the ceiling strip light.

  ‘I know, I know,’ David says, cracking his fingers. ‘But it doesn’t stop you wishing. Last week I had a twenty-two-hour operation, a woman with a tumour so large it was like an alien coming out of her stomach. She said she’d only had it for a couple of weeks, but they all say that, don’t they? A couple of weeks, when what they really mean is five years. Because this thing had actually burst through the stomach lining and the skin and was sticking out like a stalagmite, and that simply can’t have taken two weeks!’

  ‘Twenty-two hours?’ says Chris, looking impressed.

  ‘You have a bacon sandwich to get yourself going and then, you know, you pop out when you want, just so long as there’s an anaesthetist. They’re warm and asleep, what does it matter?’

  ‘You could pop home and watch EastEnders!’ jokes Jon Berry, butting in.

  ‘No,’ says David, looking at him like he’s an idiot. Then he picks up where he left off. ‘It’s not so much the tumour that takes all the time, it’s the hole we have to fill afterwards.’

  ‘I can imagine,’ says Chris, who I can tell has already lost interest.

  ‘Me? I’m a fan of the thigh when it comes to filling holes. You can get all you want from the thigh. Skin, flesh, muscle, fat, blood supply – it’s all there. Just slice it off and attach all the veins. Brilliant. There’s a surgeon I know, James Kerr. Do you know him?’

  ‘Hummm …’ Chris is pretending to search through his memory banks.

  ‘Well, he’s amazing, he can fill any hole in the history of holes. There isn’t a hole he can’t fill.’

  ‘Your cakehole?’ Steve mutters as he walks past.

  ‘What?’ asks David, turning round and looking bemused.

  Poor old David, he’s just like all the other plastic surgeons I know: obsessive and overachieving. It’s almost like they have an extra six hours in the day over the rest of us. I know one bloke who drives a very nice Maserati who decided four years ago that he wanted to take up diving, and then three years ago he took up underwater photography. Last month he had two seahorse photos in National Geographic. No one was in the least bit surprised. They are all geniuses who verge on the insane. This same surgeon will only operate to Elvis, and will always close, in so much as he does his own stitching, to ‘Return to Sender’ (he once had an operation that was going badly until that track came on, and now he always uses it). Rumour also has it that he used to put his cigar through the Central Sterile Supply Department so that he could chew on it during operations.