It takes another fifteen minutes or so of squeezing the lanced buttock to get all the blood out. Fortunately, after a while the coagulant starts to kick in and slow down the bleeding. Andrew flops back on to his trolley. He will be admitted on the ward in a while, where he can be monitored. He’s lost a lot of blood and will be feeling quite lousy for the next twenty-four hours or so – quite apart from the fact that he’ll be coming down soon as well, having lost half his heroin hit through his backside. Not that it will teach him a lesson. I’m pretty sure we’ll see him back here again in a couple of weeks.
If you stay here long enough you begin to get to know the faces. There are patients who come in here whom Chris, Ian and the other consultants know if not entirely by name, then at least by faces and symptoms – the junkies, the alkies, the prostitutes. It is never a question of curing them; your job is to patch them up and send them on their way so they can carry on their abusive lives. When I first came here I remember complaining to Chris what a pain in the arse they were, how they were nothing but trouble, a pointless waste of time, talent and resources. He told me that they weren’t trouble, they were a challenge. He also reminded me that they were victims of life, that what we should do is turn back the clock and see how it all started. We should try to understand rather than sit in judgement. Some people were born victims, there was no question of that. But some were also weaker than others. They were simply not able to cope with what life had thrown at them. Some had fallen to the bottom of the pile because they didn’t have the discipline or the strength of character to keep standing, to keep fighting. They were just not capable of sorting themselves out. I have to say that Chris is a much nicer, kinder doctor than I am. After all this time I still find it hard sometimes not to show my irritation.
I say goodbye to Chris as he is leaving and go to the changing room to put on my fourth set of scrubs today. There, I greet Sanjay and Alex, two more consultants who will be on now for the whole night. Sanjay is in his late forties and has been a consultant in A&E for about five years; Alex, around ten years younger, has just been given the post.
‘I’ve heard you’ve had quite a day of it,’ says Sanjay.
Born and trained in Delhi, Sanjay always says that he dreamt of being a doctor in the UK. Although these days he is seriously thinking about returning to India to set up a hospital on the outskirts of the city.
‘A resurrection, no less,’ he smiles.
‘Good news travels fast,’ I say, searching through the pile of scrubs for a large top.
‘Not such great news for the transplant team,’ adds Alex.
From the home counties and Cambridge-educated, Alex is one of the brightest new recruits in the team. He is also a bit of a hit with the physio girls, the nurses, and indeed all the girls. He is married with a brand-new baby daughter, but that doesn’t stop anyone from trying.
‘No, but good news for our stats,’ says Sanjay.
‘We’ve actually had two deaths already today,’ I say. ‘And we are still waiting for the debrief.’
‘Really?’ says Alex. ‘I think it’ll be tomorrow morning now.’
‘Anything else we should know about?’ asks Sanjay.
‘We haven’t got many on tonight,’ I say. ‘And I’m on a double.’
‘Yeah,’ says Alex, ‘I wondered what you were still doing here. Can’t keep away?’
‘Well, you know,’ I shrug, finally finding a top.
‘Good dancing last night,’ smirks Alex as he walks out of the room. ‘I didn’t have you down as an Abba man.’
‘Oh, I missed that moment,’ says Sanjay as he follows Alex out into the corridor.
I leave them to it and have a quick look through my stuff for my iPhone. I need to send Emma a quick text just to tell her that I am working right through tonight and not to expect me home. Fortunately my phone is still in my jeans pocket wrapped in a handkerchief, where I left it. I have three missed calls, all from her. She’s left one irate message. My text is brief and to the point and devoid of apology. To be honest, I’m not sure how long this relationship is going to last.
I can feel myself flagging a bit. The image of the teenage boy pouring blood from every inch of his body flashes in front of my mind. I need a cup of coffee before I go back in there. Sometimes it is hard to take the pace.
Melissa, one of the more functional anaesthetists, is sitting on a chair in the common room, speed-eating a sandwich while finishing off a sudoku puzzle on her lap.
‘All right?’ she asks, wiping her nose on the back of her hand.
‘I’m a bit tired,’ I reply.
‘You and me both,’ she says. ‘I’ve been in the longest bloody operation this afternoon with the world’s slowest bloody paediatric surgeon trying to cut a carcinoma out of a twelve-year-old’s liver.’
‘Sounds nasty.’
‘It was. But the surgeon – do you know him, Geoff Bank?’
‘Yes.’
‘He was so fucking slow that the patient twitched and he asked me if the child had moved and I said, “No, it’s natural bloody growth!”’ She takes a huge bite of her sandwich. ‘I am so hungry I could eat two bloody horses.’
‘Geoff’s a bit old now,’ I say.
‘Old!’ she snorts. ‘I’m amazed he can still get insured.’
‘Perhaps he can’t,’ I say. ‘That’s why he’s working for us.’
‘And he left a swab behind,’ she adds.
It transpires that Geoff had asked the nurses three times to count the swabs and they’d insisted he had taken them all out. It wasn’t until the final count at the end that they’d realized their mistake. Swabs and equipment always get counted in and out of an operation to prevent just what happened this afternoon. Of course it’s not a foolproof system. There are endless stories of the most extraordinary things being left behind in bodies after operations – swabs, needles, screws, bolts. The guys dealing with big cavities have to be especially careful. Earlier this month one of the surgeons left a ruler inside someone’s stomach; it was only after the patient complained of stomach ache that anyone bothered to check. There are a lot of people in theatre for the big operations and each has their own sometimes quite small part to play, so you can see how things can get lost. It’s hard to make sure everything is done properly when the person who is ultimately accountable for running the show often leaves before the end.
‘Anyway, we got it in the end,’ she says. ‘We had to open the poor boy up again to fish it out. Added another half-hour to the operation.’
‘No wonder you’re so hungry.’
‘Starving. You on all night tonight?’
‘Doing the graveyard,’ I say.
‘I’m off at ten,’ she says, looking at the clock. ‘Not long now.’
I leave Melissa to her sudoku and her sandwich and once more launch myself at the coalface of the community.
‘You took your time,’ says Sandra.
‘I couldn’t find any scrubs,’ I lie again. What is it about this woman that puts my back up so much?
I walk over to the computer and click on the next patient.
The waiting room is surprisingly clear when I walk in. There is a distinct smell of McDonald’s in the air. Two blokes in the far corner are demolishing the remnants of a quarter-pounder meal. There’s an old man asleep; I’m not sure if he’s actually waiting to be treated or just using the plastic seating as a convenient resting place. A group of teenage girls are texting in a row right in front of me. None of them bothers to look up. A drunk in a suit catches my eye, then tries to keep his own open.
‘Mr Hughes?’ I ask, looking around the room. ‘Mr Hughes?’
A middle-aged man with brown floppy hair raises himself gingerly off the seat. He walks very slowly towards me. Each step is clearly quite painful for him. He huffs and puffs in little tiny breaths, trying to control his pain.
‘Mr Hughes?’ I check.
‘Yes,’ he just about manages to say.
‘Severe abd
ominal pain?’ I hazard, a little puzzled.
‘Yes, yes,’ he replies, sounding a little annoyed.
‘I am sorry to have kept you waiting,’ I say as I lead him to the consulting area.
‘Two hours twenty minutes,’ he says.
‘Sorry about that,’ I say again – it’s practically a reflex action these days. ‘If you’d like to pop yourself up on the bed then I’ll take a look at your stomach.’
Mr Hughes slips off his brown leather shoes and very slowly crawls up on to the bed and lies back down. There is much inhaling and exhaling and wincing. He is obviously in a lot of pain. He pulls his shirt up to reveal what appears to be a totally normal stomach. I stand above him and start pressing the abdomen, checking for any irregularities. Then I stop. I can feel something weird. He seems to be vibrating from the inside.
‘I’m sorry, Mr Hughes,’ I say, ‘but you appear to be buzzing.’
‘Yes,’ he says. ‘I can explain.’
9–10 p.m.
It seems that Mr Hughes was having an amusing and sexually inventive afternoon with his lover/secretary. They had booked into a hotel room, around the corner from the hospital, and got themselves some entertainment from Ann Summers, including a French maid’s outfit, a large tub of lube and one purple dildo. The lover/secretary had put the maid’s outfit on and covered Mr Hughes in lube before switching the dildo to super-vibrate and popping it up Mr Hughes’s backside. He is then at a loss to explain quite how she let go of the dildo, or quite how it slipped so far inside, but suffice to say it did. According to the X-rays I have just got back, it has progressed rather a long way up the anal canal. Indeed, the particular alchemy of vibration and peristalsis means that the Bliss 8 Vibe is quite speedily making its way up beyond the sigmoid colon and into the large intestine.
‘How long have you had the vibrator up there?’ I ask.
‘Four or five hours,’ replies Mr Hughes, shifting uncomfortably on the bed. ‘We spent about an hour trying to get it out by ourselves but then Sally had to go home – to her husband.’
‘Right. Should I call your wife?’
‘No!’ he says, immediately.
‘But the thing is, you are going to be here for some time,’ I say.
‘Can’t you just put some gloves on and pull it out?’ he asks. I can hear the panic rising in his voice.
‘I’m afraid it has gone a bit far for that.’ I pause. ‘We need to wait for it to run out of batteries, I think.’
‘No, we can’t,’ he objects. ‘We’ve used long-life ones. You know, like with the pink bunny that carries on drumming for ever?’ He looks like he is about to weep as the awfulness of his situation dawns on him.
‘You need an operation,’ I say. ‘We need to call in a specialist.’
He nods.
‘A proctologist,’ I add.
‘A what?’
‘A doctor who deals in the lower gut.’
He looks confused.
‘They’re called bums and tums doctors.’
‘A man who just deals with arseholes?’ he asks.
‘Not just arseholes. Arseholes and other things.’
Mr Hughes flops back on to the bed. I swear I have never seen a man more miserable or depressed. A silly sexy afternoon with his secretary has resulted in him having to have an arse op, and probably a very serious discussion indeed with his wife. And hopefully he’s one of the lucky ones at the end of it. There are plenty of patients who think it witty to shove something up their backsides only for them to damage themselves so badly they need a colostomy bag for ever after.
And it’s not just vibrators that end up up there. Deodorant bottles, beer bottles, toilet brushes, carrots, leeks, turnips – any number of root vegetables, in fact, and anything with a handle. One of my favourites was a man who arrived in A&E with a carrot up his backside; when asked how he did it, he replied that he had fallen over while gardening. Clearly, in his eyes, gardening with no clothes on was more acceptable than buggery by vegetable. And sometimes the excuses are more interesting than the presentation. Another middle-aged man (it is always middle-aged men with things up their backsides, and they are more often than not straight; it seems gay men know what they are doing a little better) arrived with a tennis ball very firmly wedged up his bottom. Before the anaesthetic, the surgeon asked him how he did it, and the man explained that he went downstairs naked in the middle of the night to get something from the sitting room. He was standing by the fireplace, and when he bent down to pick up what he had forgotten, a tennis ball fell off the mantelpiece, bounced, and shot up his parted buttocks. No one believed him, of course. The surgeon then instructed the anaesthetist to ask him the same question as he came round after the anaesthetic. All of us tell the truth at that moment of complete vulnerability. The anaesthetist did as he was told, and the man came up with exactly the same answer!
It also seems that in a fit of passion, or indeed insanity, any hole will do. I remember spending one New Year’s Eve pulling a balloon out of someone’s bladder. I have no idea how it got up there, or why you would want to put a balloon up your penis, or how you could derive any sexual pleasure from it. I am also not sure if the idea was to inflate it afterwards. But I am pretty sure the bloke won’t be doing it again. The whole thing proved to be very painful, and I think it was over a month before he was able to piss straight.
And it’s not only men who go in for the insertion of foreign objects. Last year there was a student nurse who quite frankly should have known better. She was from Poland so maybe one’s kicks are a little different there, but she came in with a shattered light bulb up her fanny. Apparently she had been warming it up by turning the light on, then she’d taken the warm bulb out and had been using it to pleasure herself when the thing broke. Needless to say it was all a bit of a mess. I also remember fishing around in a woman’s vagina for a squash ball one tricky afternoon. I tell you, after half an hour of looking, it made you realize why tampons have strings. When I finally got it out, all anyone in A&E wanted to know was what speed the ball was. For the record, it was a blue spot, which I think is the fastest you can get.
‘You’re in luck,’ says Ian, poking his head around the curtain. ‘I’ve managed to get Mr Armstrong out of a dinner round the corner. He’s going to be here in about twenty minutes.’
‘Mr Armstrong?’ asks Mr Hughes.
‘One of the best proctologists in the country,’ I tell him. ‘You are honoured.’
‘You say that,’ he replies, wincing slightly. He looks completely defeated and utterly mortified.
I decide to give him some space – the last thing Mr Hughes needs is someone constantly checking up on his humiliation. He has been alone for all of two seconds when Melissa comes up the corridor looking a lot jollier since her tuna sandwich, closely followed by Ben.
‘Your patient,’ she says. ‘Vibrator up the rectum?’ She checks on her list. ‘Do you know if he has eaten anything?’
‘I didn’t ask, I’m afraid.’
‘Alcohol?’
‘Not that I can smell.’
‘No one puts a purple rubber cock up their arse if they’re sober,’ says Ben.
‘Oh I don’t know,’ says Melissa, and disappears behind the curtain.
‘She’s got to be a goer,’ says Ben, tapping the side of his nose.
‘I haven’t had much to do with her, I’m afraid.’
‘Shame,’ says Ben. ‘She’s got lovely tits.’
‘Really?’
‘You have really got to be more observant,’ he says. ‘I hear we have the King of Bums coming in,’ he continues. ‘We’re probably tearing him away from an Upper Gut Society dinner.’
‘Or a Lower Gut Society dinner,’ I add.
‘Or a Vascular Society do, or an Association of Surgeons buffet,’ he laughs.
‘I bet none of that lot have attended a buffet in twenty years,’ I add.
Right at the top of the consultant food chain, the air gets very rarefied. The l
unches get longer, the operations get shorter, the offices are obviously larger and the cars get very fat indeed. Mr Armstrong is hugely in demand. He is invited all over the world to chat to other splendid surgeons who are also in demand, and he gets paid for it. His earnings are touching, if not over, the million-pound mark. His list of private clients is global. He deals in international arseholes and is remunerated accordingly. He has a Harley Street practice, and if he can keep getting insured he’ll carry on with that until way after he has finished keeping his hand in with the NHS.
‘It’s a weird specialism, dealing entirely with backsides,’ I observe. ‘I wonder if he finds it hard to remember his patients’ faces.’
‘I don’t know,’ says Ben. ‘I think the more you specialize in this business, the more interesting it becomes. I was at a Christmas party last year and I met a doctor who specializes in bum enlargements. He spends twenty-eight days a year in Trinidad and Tobago putting silicone pads into patients’ butt cheeks and the rest of the year he plays golf. Occasionally he is flown somewhere to speak; sometimes he might come in and fill some cancerous-tumour cavity on the NHS just to make himself feel a little better, and remind himself he is not a total charlatan. What a perfect life.’ He looks around the strip-lit hall we are both standing in which stinks of piss, booze and disinfectant. ‘But sadly no one told me at medical school that you could specialize in arse enlargements. They say variety is the spice of life, but not in the medical world. If you choose variety, you end up here.’ We both look around. ‘The truth is, the more specialized you are, the more fantastic your life is. If you do eyelids, for example, you end up flying to LA to do half of Hollywood. You’d think it would be dull doing one thing, but intrinsically everything is interesting.’
‘What would you like to do?’
‘I quite fancy being an orthopaedic surgeon.’
Hospital Babylon Page 16
