‘Have you heard the joke about the two plastic surgeons talking to each other?’ asks Chris.
‘Sorry? No,’ says David, looking even more confused than ever.
‘One says to the other, “I had a vision just now that God came and spoke to me and said that I was the best surgeon who ever lived.” And the other surgeon replied, “But I haven’t spoken to you today.”’
Chris laughs, even Jon Berry joins in with a little snigger, but David just stands there.
‘Anyway,’ he says, ‘I’ll just go and do the paperwork, but he looks OK for some grafts tomorrow, which should, you know, help with the hands. It’ll take some time because it looks as if the petrol ran down his arm before anything else, but we can start, get cracking …’
‘Good, good,’ says Chris. ‘You can use Andrea’s office if you like. Ignore Mr Lee sitting in there. We’re trying to find him a position in the hospital. You don’t speak any Chinese, do you?’
‘Me? No. A little Swahili, which I picked up when I was working in Africa. Amazing experience. I got four years’ training in three months.’ No one is listening to him now. ‘In here, then?’ he says slowly, wandering into Andrea’s office.
I turn round to see Andrea coming towards me.
‘Woman, cubicle two,’ she says. ‘She’s a little pissed off.’
‘They’re always pissed off,’ I say, searching for my user-friendly smile and gentle bedside manner.
Just over two hours left and counting.
‘Good afternoon,’ I say as breezily as I can when I get to the cubicle. I look down at the notes. ‘Mrs Parker? What seems to be the problem?’
‘The problem, mister,’ says the obese woman sitting opposite me who has poured herself into a pair of black leggings and a large white T-shirt with a pink glitter Playboy bunny logo stretched across her huge bosom, ‘is that we’ve been here for three hours.’
‘Well, I’m very sorry about that,’ I say. ‘We have had a lot of poorly people in today. You’re entitled to complain if it’s over four hours.’
‘Yeah, well, anyway, the thing is, Brandon here has got ADHD and we need the drugs for it.’
A neon-pink finger is pointing at an overweight boy in a pair of blue tracksuit bottoms who is sitting on a red plastic chair, his thighs seeping over the edge of the seat.
‘ADHD?’ I say, looking at Brandon, who looks as active as an atrophied blancmange. ‘And what sort of symptoms is he having?’
‘Umm,’ says Mrs Parker, clearly trying to remember something. ‘He has attention problems.’
‘Ri-i-ight. And?’
‘He is hyperactive. He has problems at school. His learning and that.’
‘OK …’
I’m taking notes but I don’t believe a word of it. Brandon couldn’t look less hyperactive if he tried. His arms are folded across his soft stomach and he has a pair of breasts large enough to pique Steve’s interest. Not that children with ADHD are necessarily slim, but they do tend not to be able to sit still, buttocks glued to a chair, particularly if they have been kept waiting for three hours.
‘How old is Brendon?’
‘Brandon.’
‘Yes. How old is he?’
‘Seven,’ she says. ‘And as sole carer I find it very hard to take care of him. I’m a single parent, you see. All three of my other children have ADHD …’
Mrs Parker continues with her story, which I am afraid I have heard a thousand times before. She knows what things to say to me, what boxes to tick for me to believe her. Except I don’t. I had a heroin addict in last week trying the same scam, trying to convince me that her poor fifteen-year-old son had ADHD as well. Claim your child has ADHD and you are entitled to more benefits; play the system correctly and you siphon off an extra £10,000 a year. You claim through the Disability Living Allowance, which then entitles you to extra income support and extra child tax credits, and if you are really good you can get a carer’s allowance thrown in as well. This goes some way towards explaining why only two thousand children were diagnosed with ADHD in 1991 but now some 5 per cent of children in the country suffer from the disorder, with one in five children in the state sector said to have ‘special needs’. So while the parents pocket the cash to cater for their needs, their children end up taking drugs, like Ritalin, that they don’t actually need.
I look at Brandon and his mum. They are examples of just one of the numerous social health issues that come into A&E on a daily basis. What Brandon needs is a better diet – some fruit and vegetables instead of endless sugars and carbohydrates – and some regular exercise. He is already obese at the age of seven; he’ll probably be morbidly obese by the age of fifteen and he’ll probably develop diabetes and other complications, dying of one of them in his late fifties. Coming from this arse end of town, his life expectancy is seventeen years lower than the richest members of our society. But it’s not my place to advise someone like Mrs Parker on how to live her life and bring up her children.
If I give her a prescription for Brandon then I’m not being true to my training, or indeed my beliefs; if I don’t, her life and Brandon’s life remain difficult. So what do I do? I do what every good doctor does when faced with a tricky dilemma: I pass the buck.
‘Mrs Parker,’ I say, ‘I would love to be able to help you and Brandon out, but I’m afraid this is a GP issue. We are Accident and Emergency, and Brandon, I’m afraid, is neither.’
‘But,’ she says, heaving herself out of her seat, ‘I brought Kelly in here a few months back—’
‘It’s the system,’ I say. ‘What can I do?’
She looks at me, and as a connoisseur of the system, she immediately understands. She has played me and lost. She needs to try a little harder next time.
‘I’ll get my GP to sign the form then,’ she says. ‘He won’t mind a bit.’
4–5 p.m.
As I escort Mrs Parker and Brandon through the door of the waiting room to scam another day, I bump into a rather attractive woman in her late forties just coming in. She is carrying a large box of expensive-looking chocolates and a bunch of pink peonies. She looks up and down the waiting room, which has emptied a bit since I was last here. The OAPs near the television appear to have wended their way home to catch Countdown in the comfort of their own sitting rooms, to be replaced by the usual sort of playground cuts and scrapes that are currently Ewan’s (being the most junior) bread and butter.
The woman stands in the middle of the waiting room looking around. She clearly has no idea where she is supposed to be.
‘Can I help you?’ I ask.
‘Um, I’m not sure,’ she says. She is wearing a floral summer wrap dress that stops just below her knee, and blue flip-flops. Her blonde hair is tied in a ponytail. ‘My mother was admitted here this morning. She’s broken her hip. June Bartley? Old woman? Quite chatty?’
‘June Bartley,’ I say, trying to buy myself some time. ‘And you are?’ Though I already know the answer.
‘Her daughter,’ she replies.
‘Right … um …’
‘Audrey,’ she says.
‘Audrey,’ I repeat. ‘If you would like to follow me.’
‘Oh, good.’ She smiles. ‘You know where she is, that’s lucky. My neighbour told me I might be wandering around for hours. These places are so big, aren’t they? Hospitals? Enormous! Well, I suppose they have to be, the amount of sick people we have.’ She laughs. She is gabbling and clearly nervous. ‘She’s OK, though, isn’t she? Mum? She’s never had a fall before. So weird. She lives on her own, you see. Since Dad died. She doesn’t want to live with us. Or the others. She much prefers it on her own. She’s got her friends. She is all right, isn’t she? Because her neighbour was a little bit doubtful. I said she’s as strong as an ox. Mum. Strong as an ox.’
‘If you’d like to wait in here,’ I say, pointing to one of the empty rooms that we have with a door. ‘I’ll go and get someone to talk to you.’
I suppose I could have told her
there and then that her mother was dead, but we’ve been taught to make sure people are sitting down and out of the way, just in case something kicks off. Also, I just don’t feel in the mood to break her heart. I have less than two hours left and I just don’t think I can cope with the questions, because I’m going to find it hard to answer them without telling her that her mother was lying on her own in a corridor for several hours and that she was my patient. I would much prefer Chris to tell her. People accept sad news much better from people with grey hair; they look distinguished and trustworthy. She doesn’t want to hear about her mother’s passing from someone who’s got another half-century left.
Chris takes it in his stride when I ask him. After eight years in A&E he has become rather good at delivering bad news. I see him walk over to the consulting room and close the door.
‘You OK?’ asks Louise, surprising me from behind. ‘Was that your NOF’s daughter?’
‘What?’ I say, jumping slightly.
‘Your hip fracture? Was that her daughter?’
‘Yes. I think she is going to be very sad.’
‘Do you want a cup of coffee?’
That is the first time in six months she has offered to get me anything. And I’m a little stunned. ‘That’s very kind of you.’
‘Well, you know, last day and everything.’
I follow her to the common room.
‘You excited about moving on?’ she asks me.
‘I can’t wait not to be doing A&E. Where are you going?’ Like I don’t already know.
‘St Thomas’s.’ She smiles, slightly apologetically, knowing that it’s one of the top postings in the country. ‘General surgery, and then I think, you know, I might go on to do max fax or plastics.’
‘I’m sure you will,’ I smile. ‘You’ll get the good references.’
‘What’s that supposed to mean?’ she asks, reaching the kettle and flicking it on.
‘Nothing. You know, just that you’re good.’
‘Good at what?’ she says, raising her eyebrows.
‘Being a doctor,’ I say.
‘Someone’s a bit defensive,’ says Steve, coming in behind.
The terrible thing about this common room is that there are two swing doors into it, which means that no conversation is ever private.
‘I’m not defensive,’ she says.
‘Well, you should be.’ He grins.
Why does he have to come in right now, just as Louise and I are about to have a proper chat? I’m sure I could have managed to secure her telephone number. He is so annoying. I have only got just under two hours left and he is raining on my bloody parade. Not that there was much of a parade going on. But there could have been, if he’d given me five minutes. I can be quite charming when I put my mind to it.
‘Well, I’m not defensive,’ she says, defensively.
Steve opens the fridge. ‘There’s never any chocolate when you need it.’
‘Did you nick my KitKat?’ she asks.
‘No, I didn’t nick your bloody KitKat,’ Steve replies. ‘Honestly, have you got your period?’
‘What?’ she says, watching him amble out of the common room. ‘That man is a total prick!’
‘I heard that!’ he shouts back through the swinging door.
‘Good!’ she says, marching out of the room.
‘She fancies him,’ announces Andrea, who is sitting in the corner, her mouth full of Jaffa Cakes.
‘I think he likes Margaret,’ I say.
‘Don’t be silly,’ she chortles. Bits of cake fly out of her mouth. ‘Margaret is just one of those very giving girls.’ She looks at me to see if I am understanding her. ‘She has been generous to a few patients in the past, you know.’
‘Really?’ I frown. Is she saying what I think she is saying?
‘Oh yes. Very generous and giving indeed.’ She mouths the word ‘fellatio’ at me and taps the side of her nose, giving me another little nod.
I leave the common room a little confused. It seems to be all kicking off on my last day. So Louise fancies Steve but may or may not be doing the senior consultant. And if she is, is it just to further her career? She is an ambitious piece of work. On the other hand Margaret is blowing Steve, who possibly fancies Louise, but she blows everyone – Margaret, that is, not Louise.
When I get back to A&E, Ewan, who is looking a little pale, grabs me.
‘Mate,’ he swallows. ‘There’s a DSH in resus one. Can you take it? I just can’t cope with that amount of blood.’
A deliberate self-harm, or suicide attempt, presentation does tend to get a doctor’s back up. There’s enough shit going on without someone giving us extra work on purpose. It does tend to annoy us and make us a little unsympathetic. Particularly as there are so many repeat offenders. We have one woman who comes in here practically every other day having taken twenty paracetamol. Not enough to kill her, just enough to make her really rather poorly. It would bugger her liver if we did nothing, so we have to go through the motions, pumping her stomach and flushing her blood until it has all disappeared, only for her to come back a few days later having done the same thing all over again. You can imagine how popular she is round here. Even the resident psych team are bored witless by her.
But then she is, of course, only really seeking attention, crying for help. Men are much more successful than women when it comes to killing themselves. Although we get broadly the same number of attempts in through our doors, the male suicide rate of 17.7 per 100,000 is over triple that of women, which is only 5.4 per 100,000. Weirdly, it was the over-seventy-fives who used to account for most suicides in blokes, money problems and loneliness being the most obvious reasons, but that has changed recently: young men between fifteen and forty-four are now much more likely to kill themselves – for, I imagine, the same reasons. Women are more likely to kill themselves in middle age, between forty-five and seventy-four.
This patient appears to be a young woman in her early twenties.
‘Her name is Katie Heywood,’ says Connie, one of the more outgoing of the Filipina nurses. She reels off her BP, temperature and stats (blood oxygen saturation).
‘Hello, Katie, can you hear me?’ I begin.
She moves her head slightly. A curl of mouse-brown hair falls across her white, spotty face.
‘Can you hear me, Katie? You’re in hospital. You are still alive.’
I pick up her left arm, which has been bound tightly by the ambulance crew. Judging by the number of scars and lines all the way up her arm, she appears to be a dab hand at this self-harming lark. She has at least twenty scarred cut marks on this arm alone. I pick up the right arm and it’s a similar story. Looking at all of this, I’m not sure if in this case she was meaning to kill herself or was just cutting herself again. But I have a feeling the latter is more likely. I snip away at the bandages that have been expertly tied by the ambulance crew and check the wound. It is deep and long and very bloody, but by the look of things she hasn’t had the required strength actually to cut completely through the artery. Like most people who attempt to slash their wrists she has only nicked the main vein rather than spliced the whole thing open.
I have to say I have learnt to be wary of young females who attempt suicide. During one of my first rotations I was placed on Psychiatry in a rather small provincial hospital where I was a non-resident on call for twenty-four hours at a time. A young woman came in who had attempted to slash her wrists and I was asked to stitch her up. Then about an hour later I got another call saying that she had done it again and could I come and re-stitch her. The psychiatric nurses had their hands tied really. They were not allowed to do very much, all they could do was stand by and watch her cut herself again. While I was talking to the nurses about what to do if she attempted to cut herself again, we got a call saying that she had tried to hang herself. She was put into solitary, but the next day she tried to hang herself again using a sheet that she had wrapped around her neck and pulled with her foot like a tourniquet. Ho
wever, as she pulled with the foot, the sheet tightened and she passed out, and the foot lost its strength. It is, in fact, impossible to kill yourself using this method. But we took away her sheets anyway. By day three this was developing into a serious and deadly game of cat and mouse. She was developing a fixation on me and was using ever more elaborate ways to get my attention. She started to goad me, telling me that I was rubbish and didn’t know my job. I was newly qualified so perhaps she had a point. The whole thing eventually became untenable when she stashed a sharp in the loo, and having persuaded a nurse that she could be trusted on her own, she locked the door and started shouting for me, telling me how shit I was, that she was going to do it again. She was trying to draw me into her vortex, drag me into her game. I have to say it was one of the hardest few days of my career. In the end she didn’t manage to kill herself. She was sectioned and became somebody else’s problem.
Connie tells me that she has already called the rapid response psych team to come down and evaluate Katie to see if she needs to be kept in under the Mental Health Act on a section 5.2 (for short-term assessment). Although these guys don’t have the best track record, and I have had a few run-ins with them in the past. A few months ago I had a drunk tramp come in with a suspected overdose. This bloke was a bit of an A&E regular; the police had found him a few times in the past slumped in a doorway, and had brought him in to sober up. But this time he had taken an overdose, paracetamol as well as alcohol; it was not his normal behaviour. He had also been found on a train track waiting to be hit by a passing train. So I called the psych team to try to keep him in and assess him for twenty-four hours, as the man clearly needed help. The team came, checked him over, and said that he was perfectly OK to go home. I told them he lived on the streets. They said that he was fine to go back out on to the streets. They promised me that they would check up on him in a week, that they would find out where he was and bring him in for assessment. I warned them that he might attempt suicide again but they insisted he was fine. So he was released, there was nothing I could do to stop it. Two hours later he was found dead on the tracks. He’d walked straight out of A&E and straight under a train. I was livid, and of course I felt awful. I’d tried to do something but no one was listening. That sort of thing happens a lot around here.
Hospital Babylon Page 11
