‘In here, in here!’ shouts Ian, waving his hands.
They rush the trolley into Resus 2 and everyone sets to work. This is a well-practised, well-run manoeuvre. There really is nothing like the NHS when it comes to an acute emergency like a heart attack. We are a well-oiled crash team, and everyone knows the drill. All the drugs and equipment are on tap.
On goes a new oxygen mask, on goes the heart monitor, in go the IV tubes. It’s like clockwork.
‘Any knowledge of any ops?’ Ian asks the paramedics.
‘Not that we know of,’ one of them replies.
‘Administering clot-busters,’ announces Ian. ‘Let’s hope no one’s cut her open in the last couple of weeks.’
I look at the dental nurse. Her face is drained of colour, her skin is covered in sweat, her stats are looking poor on the monitor, and she’s a big girl. Her BMI must be over 40. It’s not looking good for her, despite the fact that she’s in her early twenties. But we have all done this before, so no one is rushing and no one is panicking.
‘Adrenalin,’ announces Stacy, approaching with a large syringe and an even larger needle.
‘In the heart,’ says Ian, looking at the girl’s stats.
‘The heart?’ checks Stacy. ‘Really?’
‘We don’t want to lose her. D’you hear?’ says Chris.
‘But the heart?’
‘Straight into the heart,’ both Ian and Chris say at the same time.
‘OK,’ I say. I take the syringe and spritz some liquid out of the end to make sure there are no bubbles. ‘Here goes.’ I plunge the needle into her sternum, avoiding the large expanse of bosom, and aim for the heart. I inject the transparent liquid and pull quickly out.
We all stand back, waiting for the drugs to kick in. But instead of her system rebooting, she flatlines.
‘Shit! Fuck! Defibrillator!’
Stacy rushes the machine forward.
‘Stand back!’ continues Ian, holding the panels aloft, waiting for them to clear. ‘Clear!’
He shocks the girl. Her whole body spasms off the trolley. And then relaxes back down again. We all look at the monitor. Nothing.
‘Clear!’ commands Ian.
He shocks her again. Still nothing.
‘Clear!’ he says again.
The dental nurse’s back arches up and falls back down again. Again nothing.
‘Massage!’ Ian shouts at me.
I leap on her chest and start pounding it with my fists, trying to get her heart moving.
‘Keep going! More adrenalin!’
I leap off as Ian injects another huge jab of liquid into her IV. We all fall silent and stare at the monitor. Hoping for a beep, a sign that there is still hope. Nothing.
‘OK then, clear!’ shouts Ian.
He has the paddles in the air; he barely waits for us to move. Bang. Her body lifts off the table and collapses down. The monotone hum continues.
‘Clear!’
Nothing.
‘Clear!’
Nothing.
‘Clear!’
Nothing.
‘Adrenalin!’
This goes on and on and on. None of us wants to lose her. She’s twenty-three, for Chrissake. We’ve had one youngster die in here already today, no one wants another. We carry on with the paddles and the massage. We are supposed to wait two minutes between each shock and administer constant CPR, but we don’t. Ian is desperate to restart her heart. I am desperate to restart her heart. We are all bloody desperate. For ten, fifteen minutes we shock, massage and hope.
‘I think I am going to call it,’ says Chris.
‘Just a bit longer,’ says Ian, sweat pouring down the side of his face.
‘No, no, that’s it,’ says Chris, shaking his head. ‘Nineteen forty-three. Well done, Ian. You tried your best. We gave it our all, there was nothing else we could have done. Really, team, honestly, nothing else we could have done. Poor girl …’
We all stand and stare, sweating, shattered. Open-mouthed. How did that happen so quickly? What a huge shock. And the girl is so young.
‘You did what you could,’ Chris continues. ‘We all did what we could …’
None of us can move. My heart is pounding in my chest. My limbs feel like lead. We all carry on standing there. No one moves. No one says anything.
‘Can someone look through her pockets and see if she has a donor card,’ asks Chris finally, interrupting the exhausted silence. ‘Are her parents here? We need to persuade them of the merits of transplant.’
Organ donation is one of the more controversial areas of our job. The problem is that the number of people wanting organs is on the increase, whereas the number of people donating is not. We currently have about ten thousand patients awaiting transplants in the UK with three people a day dying while still waiting. We don’t have an opt-out donor policy in this country where you are considered onboard unless you state otherwise, so one of the more unpleasant aspects of our job is to persuade grieving parents or loved ones to sign a donor form, while the patient is still useful. Obviously the longer we wait the less useful the body is.
There are three ways of donating. Heart-beating donation, where the patient is dead but the heart is still working and oxygenating the blood, making the transplant much more likely to succeed. This is often the case with brain-damaged patients. Or there is non-heart-beating donation where the patient is dead, from a heart attack for instance, and the heart has stopped working. Speed is of the essence here, as the longer we wait the more the organ quality deteriorates. Then there is live-organ donation – kidneys and bone marrow, that sort of thing. They are usually donated by relatives and siblings. Occasionally some extremely altruistic donor will donate to someone they don’t know, but this is rare.
With such a huge demand for organs and so few donors, there is also of course an illegal worldwide trade in organs. The kidney market dominates this trade in body parts, as they are in greatest demand and are easiest to harvest and transport. According to the World Health Organisation, of the seventy thousand or so kidney transplants that take place worldwide, some 20 per cent, perhaps up to fifteen thousand kidneys, could be trafficked. China, India, Pakistan, Egypt, Brazil, the Philippines, Moldova and Romania are among the leading providers of trafficked organs, which are exported to the US, Europe, the United Arab Emirates, Saudi Arabia and especially Israel. This is tantamount to a body tax on the very poor for the benefit of the rich. Kidneys go for around £75,000, with the donor getting between £1,500 and £7,000 for their kidney; the rest is paid to the traffickers. But when the average waiting time for a kidney in the US is ten years and most dialysis patients die within half that time, you can see why there is an ask-no-questions policy operating in some of their less scrupulous hospitals. But when you hear the stories of Indian women being forced to sell a kidney to provide a dowry for their daughters, or children growing up in the Third World being offered lock, stock and barrel to the highest bidder, it makes it more important to sign a donor card. It’s hard to ascertain how many trafficked organs are transplanted here in the UK. All I know is that the number will be increasing rather than diminishing.
Stacy very sweetly volunteers to go with Chris to ask the girl’s parents, who are sitting in Andrea’s office. It is not something I have found easy to do in the past. So sorry your daughter’s dead, do you mind if we carve her up? We have all been on this course that basically teaches us how to ask nicely and not cause offence. But all the same, it’s extremely difficult.
Ian is standing next to the dead girl filling in the relevant post-death forms and Andrea is pulling out tubes and unplugging all the machines when Stacy comes back.
‘That was quick,’ says Ian.
‘The answer’s yes,’ says Stacy. ‘Apparently she has always said that is what she wants to do.’
‘Great, well done.’ Ian slaps her on the back. ‘Good job.’
‘I know, I’m amazed. I was prepared for so much more back-chat.’
&
nbsp; ‘Well, well done, you’ve made some very ill people very happy.’
‘Yeah, I’m thrilled.’
Just then the heart monitor beeps. We stop what we are doing. It beeps again. We all stare.
‘What are you doing to the machine?’ asks Ian, in a slow and quiet voice.
‘Nothing,’ replies Andrea.
‘Really nothing?’ asks Ian. ‘Because this is not a good time to crack a joke.’
‘Yes, really nothing,’ she replies.
There is a loud rasping sound as the corpse inhales a huge gulp of air and then coughs.
‘Jesus fuck!’ gasps Ian. ‘Stacy, run along and tell Mr and Mrs Whatever-their-name-is that their daughter is still alive!’
8–9 p.m.
To say that we are surprised by the Lazarus-like resurrection of Gabriella Turner is an understatement. Ian is fairly mortified, but the person who is the most embarrassed is Chris. It’s not often that he calls a death only for the person to wake up a few minutes later.
Amazingly, resurrections are not as rare as you might think. We get one or two a year. The drugs we use are so goddamn strong these days that it takes a fairly determined heart to die. But they can also take a bit of time to react. I can’t help but think that in Gabriella’s case it was the second jab of adrenalin that launched her back into the land of the living. Sadly, the transplant team will be a little put out. Chris was straight on the phone to them when Gabriella came back. And apart from getting their hopes up, we also look like a right bunch of knob-end idiots who can’t tell the dead from the living. I imagine the joke will be around the hospital by tomorrow morning. Fortunately I won’t be here to take the rap.
I remember when I was just out of training nearly four years ago and I was working up near Manchester. We had a woman come in who’d had a head trauma, which had left her with part of her brain coming out of her ear. The surgeon basically wrote her off. I mean, you would, wouldn’t you? Who can survive with a bit of brain seeping out of their head? So we lined her up for a total organ transplant. Even her corneas were pledged to someone. Anyway, in the end we removed the bit of brain from her ear, and she lived! She didn’t just pull through, she was totally fine, and everyone had to stand down. No one was best pleased with the surgeon. Fortunately I was so far down the pecking order that no one remembered me even being there. The surgeon got the piss taken out of him for months after that.
But it is rare for a patient to come out of something like this unscathed. You can’t have that much downtime and expect to emerge the other side with all five senses intact. You never know though. There are always exceptions. Maybe Gabriella is one of those.
Her parents crowd into the cubicle to witness their daughter’s miraculous recovery for themselves. Her large, big-chested mother weeps; her father just keeps shaking his head like he can’t quite believe it; the younger brother stands around in the background, his mouth open, catching flies.
‘I think I need a cigarette,’ I say to no one in particular.
‘I’ll come with you,’ says Ben.
‘How about your PFO?’
‘He’s being stitched,’ he says. ‘I’ve let one of the shiny new students loose on him.’ He shrugs. ‘He’s pissed, he won’t notice a thing.’
‘True,’ I say, glad of the company. ‘Come this way.’
Outside in the fresh air I feel a little better. I hadn’t realized quite how exhausted I was until I met with the real world. The sky is that glorious pale fresh blue it turns immediately after a sunset. It will be dark soon and the city will start to unleash its shadowy secrets upon us. We always get the weirdest, saddest things during the night-shift. There are some presentations that only come out after dark.
‘You again,’ says Mary, walking towards me in her coat.
‘Ditto,’ I say. I do the introductions with Ben. ‘I thought you were out for the day.’
‘I came back to check on Marsha,’ she says, lighting up a menthol cigarette.
‘That’s nice of you.’
‘Well, she’s only fifteen and I only live around the corner.’ She smiles. ‘You can’t keep me away from here.’
‘You been here long?’ asks Ben, very much giving her the once-over.
‘A couple of years,’ she replies. ‘I used to be a legal secretary.’
‘Really?’ he says.
‘Then I retrained. I wanted to do something more worthwhile.’
‘Didn’t we all,’ I say.
‘And you liked babies,’ adds Ben.
‘People,’ she corrects. ‘I spend most of my time talking to the mothers. Particularly when they are in labour. What else are you supposed to do, sitting there for hours at a time?’
‘How is Marsha?’ I ask.
‘She seems OK. The father has gone, pending a DNA test. But baby Destiny is well.’
‘Good.’ I nod. ‘It’s nice to hear some good news for a change.’
‘Oh,’ says Ben, scratching his groin. ‘While you’re here. Would you mind checking out my genital warts?’
‘What?’ Mary almost chokes on her fag.
‘My warts,’ he says. ‘The midwives at St Joseph’s do it all the time.’
‘Just because I look up fannies all day doesn’t mean I’m happy to look at your genitals,’ Mary says. ‘Check out your own warts. You’re a doctor, aren’t you?’
‘True. But I’m not a bloody gymnast. Do you honestly think that if a man could properly examine his own penis he would ever go out to work?’
‘I am not going anywhere near your cock,’ she says, putting her hands in the air.
‘Mate?’ Ben says, turning to me with a pleading look in his eyes. ‘They’re very painful.’
‘Fuck off,’ I say, throwing my fag across the car park. ‘Have you got a mint?’ I ask Mary.
‘Of course,’ she says, rooting around in her pocket. ‘Are you on all night?’
I chat briefly to Mary before returning to A&E. She’s a nice girl, with a feisty attitude; ironically for Ben, I think she lives with one of the STD doctors attached to Maternity. I remember her telling me once you could always tell when the university students were back in town or there had been a particularly festive freshers week as the STD doctors were rushed off their feet. The tropical disease department also always gets a surge at the beginning of term. Sex and travel – God, I’d love to go back to being a student again. Life was so much simpler then.
Back in A&E I find that Andrea has gone, to be replaced by Sister Sandra, who is in her mid-fifties and one of our less jolly members of staff. She has grey hair, thin hips and even thinner lips. I made the mistake of shaking her hand once: not only does she have the grip of Lennox Lewis, but her skin is so rough and dry it could take the paint off a car. I’m not sure what she has done to them over the years but they are clearly not great pals with hand cream.
‘Where have you been?’ she asks.
‘The lavatory,’ I find myself lying. When is she going to realize that I am not fresh out of medical school? That I start specialist training next year? Just because I have the face of a twenty-year-old choirboy who’s never seen a razor, it doesn’t mean I am one.
‘Right, well, the consultant has been looking for you,’ she says rather tartly. ‘In one.’ She looks across at the cubicle.
I draw back the curtain, and I have to say I am shocked by what I see. Lying on the bed is a white-faced young man with filthy matted hair, stained teeth and sores on his face and arms with the largest blown-up backside I have ever seen. It is huge, swollen like a beach ball; the skin is so red it has gone maroon and purple in parts.
Ian looks at me, his eyes rounded and slightly panicked. ‘Andrew here,’ he begins, his voice sounding remarkably controlled bearing in mind the situation, ‘is an intravenous drugs user.’
‘OK.’
‘It appears that the heroin he’s been using has been cut with warfarin.’
‘What? Why would anyone cut heroin with blood thinner?’
; ‘Who the hell knows? Anyway, there appears to be a lot of the stuff in the smack because he’s come up with an INR eighteen.’
‘Eighteen?’
I’m now finding it hard to believe the man is still alive. Normally an INR – or international normalized ratio, which determines the clotting tendency of blood – is 1. If you are thinning the blood down after a clot you’d aim for 2 to 3. A 4 would be high. I would have thought that 18 would be fatal. But apparently not.
‘So I gave him an injection for pain relief,’ continues Ian.
‘Inter-muscular?’ I check, as the situation dawns on me.
‘Yup,’ says Ian.
‘OK,’ I nod. And the patient has obviously seriously bled into the muscle and, as he can’t clot properly, his backside is still filling with blood. If left alone in this state, Andrew’s nerves and blood vessels will collapse and he will die. ‘And the plan is …?’
‘The plan is to pump the patient with Beriplex, slice open the buttock and bleed him.’
‘Bleed him?’
‘Bleed him.’
So this is exactly what we do. It’s like something out of a Victorian horror movie. Ian pumps the coagulant into Andrew, then sticks his scalpel in his butt-cheek and slices open the skin, which is under so much pressure from the blood pouring into the muscle that it bursts apart like an overly ripe piece of fruit. Blood sprays out of the small incision. It is clearly a relief for Andrew, who moans slightly and rolls his eyes. He is, of course, high as a kite on heroin and morphine, which I imagine must be quite a potent mixture. I’m not sure he can feel a thing, actually, maybe just the pressure of blood in his buttock. Connie is standing by, armed with wads and wads of swabs to soak up the flow of blood, which keeps on gushing out. The colour is draining even more from Andrew’s face. His lips have gone blue. He looks like he is about to faint.
‘Jesus,’ I say. ‘That’s a lot of blood.’
‘We worked out he had about three litres in his backside,’ says Ian, now applying pressure to the wound, forcing the remaining blood out.
Andrew is going to have the most monumental bruise on his arse tomorrow when he wakes up on the ward. I wonder how many other junkies in the area have taken this dirty heroin. I’m pretty sure Andrew won’t be the only one to get a massive haematoma with that amount of warfarin cut with the smack. He’s one of the lucky ones. This really is lethal stuff.
Hospital Babylon Page 15
