‘You heard the girl, doctor!’ shouts Jilly, sticking up for her friend.
‘I’m not touching you,’ I say, putting my hands in the air, just wishing the whole thing would end – or had never started in the first place.
‘Yes, you are!’ yells Jilly.
‘I’m not. Just please leave, the pair of you.’
They weave their way through the double doors, Emma looking extremely annoyed and tugging at her short skirt. She staggers slightly in her wedges and goes over on one ankle.
‘You OK?’ I ask after her.
‘Fine,’ she says, trying to walk like she’s completely sober.
‘I’m sorry,’ I say as the doors close behind them. ‘I’m working.’
‘Fuck you!’ she says, turning around. She walks off backwards while giving me the finger.
‘Oops,’ says Ben, appearing right next to me. ‘That went well. Girlfriend?’
‘Yes.’
‘Not for much longer,’ he says, sucking the back of his teeth, like a builder who’s discovered rising damp.
‘And I’ve only just got her,’ I say.
‘I wouldn’t worry,’ he says, patting me on the back, ‘a good-looking bloke like you. I’m sure you could have your pick of the city’s young ladies. And if not,’ he smirks, ‘there are always the nurses.’
It’s weird watching Emma walk away. I’m not really sure what she wanted me to do. Bring her into A&E to have a good gawp at some ill people? Show her where we put the corpses and have a fuck on the operating table? People have been known to shag in the operating theatre. It’s nice and quiet, and you can close the door. But it’s not my scene, I have to say. The bed’s a bit narrow and I’m not that keen on the overhead lighting. Anyway, I’m sorry I disappointed her, but I wouldn’t turn up at her office drunk, wanting a tour and a fumble in the filing cabinet in the middle of the day. Maybe it’s because A&E is open to the public that she feels she has the right to just pop in whenever – much like everyone else, I suppose. We are paid for by the public, therefore we are public property. But I’m afraid it doesn’t quite work like that.
‘Hi, sorry,’ says a very sweet-looking nurse who looks about twelve. ‘You haven’t seen a patient walk this way, have you?’
‘A patient?’ both Ben and I ask. Well, she is one of those nice-looking people you want to help.
‘Yes,’ she replies, her red-rimmed eyes darting up and down the corridor. ‘She’s, um, one of the prostitutes on the Hepworth Ward.’
Hepworth is one of the more notorious wards in the hospital. It’s where we put all the intravenous drug users. We are in a difficult catchment area in the city, where there’s quite a high number of heroin addicts. They are invariably homeless or prostitutes and are prone to a habit called skin-popping, a sort of last-resort form of injecting after all your veins have given up the ghost. The addict will inject the heroin under the skin, after which they will get a delayed hit, but at the same time the fix can burn the skin. The dirtier the stuff in the syringe, the more likely it is to burn. And we get some terrible presentations here. Huge soft-tissue infections, big abscesses under the skin affecting arms, forearms, legs … eventually they end up with necrotizing fasciitis, which eats away at the skin as you watch.
The other problem with the ward is that all the patients are addicts, otherwise they would not have ended up there, so they have a tendency to abscond. Mostly they will lie in there for a few days, on an antibiotic drip, waiting for the infection to subside slightly, and then as soon as they can, they sneak out of the hospital to score. The prostitutes, of course, end up turning tricks in order to score, so the whole thing can get very seedy indeed. One of the worst things you get asked to do as a junior on that ward is fish out old condoms. The girls often come in and say that the punter had one on but that now she can’t find it. In fact it usually transpires, after about twenty minutes of looking, that the punter never had one on at all and had been lying in the first place.
Quite a bit of dealing goes on in the ward too. Mates bring in drugs to sell, and the patients themselves go out to score. Occasionally the situation gets out of control and all the patients get grounded and no one is allowed into or out of the ward. But that only serves to make everyone agitated, and eventually the ward sister relents and then the dealing begins all over again.
Of course, along with all the drug-taking comes the possibility of overdose, and we do occasionally find the odd Hepworth patient dead or in a coma somewhere around the hospital. The favourite places for corpses are the lavatories on the second floor and the stairwell next to the lift. I think we’ve had about five or six go that way in the last year. One of them was dead at least six hours before anyone noticed her curled up on the stairs.
‘What’s her name?’ asks Ben.
‘Nadine,’ says the nurse. ‘She’s mixed race, quite attractive.’
‘What, apart from the abscess and the heroin problem,’ says Ben.
‘You know what I mean,’ she says.
‘How long ago did you notice her gone?’ I ask.
‘About fifteen minutes,’ she says.
‘She could be anywhere by now,’ says Ben.
‘Actually she hasn’t got any shoes on so she can’t have gone far,’ she replies.
‘OK then, you do this floor,’ Ben says to the nurse, ‘I’ll go up, and you can go down,’ he adds, looking at me.
‘Cheers,’ I say, not relishing the idea of looking in the basement.
‘Someone’s got to check,’ he says.
There’s something very depressing about wandering around this place in the middle of the night. It’s almost as if the hustle and bustle of the hospital prevents you from seeing quite how poorly maintained the actual building is. For all the talk of cleaner hospitals and the desperate desire to combat MRSA, the place is filthy, the toilets are disgusting, and half the building is falling down. The windows are draughty, the roof leaks, and there’s mould and damp almost everywhere.
The main problem is that the cleaning staff don’t really give a shit. Maybe that’s a little strong, but you can understand why they don’t feel part of the hospital, or part of our team, because they are not contracted by us. They are contracted out by an agency like Medirest or Sadexo, so I imagine it’s hard to feel part of a community where no one speaks to you or even knows your name. The cleaning staff are never invited to any of the parties; no one asks them for a drink in the bar. I imagine they can go through a whole shift, getting paid £6 an hour, without anyone addressing a single word to them.
The problem is that as part of the Private Financial Initiative, where private capital was used to fund public projects such as hospitals, some of the companies that built the new hospitals were given the cleaning contracts as well. The fact that they knew nothing about cleaning hospitals was not an issue; it was a nice little earner to keep them onside. They also, of course, self-regulate. You can always tell when an inspection is coming as the place gets buffed and polished within an inch of its life. Even the swing doors shine.
They are clearly not planning an inspection any time soon, I think as I walk to the stairwell on the ground floor. It smells as if people have been urinating in the corner, which I presume they have.
The same cleaner I saw earlier listening to tunes as he polished the entrance hall floor comes up the stairs towards me. He smells of cigarettes. He looks a little shocked to see someone going down into the basement.
‘Excuse me,’ I say.
He takes his earphones off.
‘Sorry to bother you. I was just wondering if you have seen a woman, a patient, mixed race, come down here?’
He waits for me to finish and doesn’t say word.
‘A woman? A patient? Down here?’
He clears his throat. He clearly hasn’t used his voice for a few hours. ‘Je ne comprends rien,’ he says, in a thick West African accent. ‘I don’t understand nothing.’ He puts his earphones back on and continues up the stairs.
&n
bsp; I walk deeper and deeper into the bowels of the building. It is dark. I can hear the sound of dripping water and the air is cold and damp.
‘Hello! Nadine? Are you down here?’
All I hear is my own voice echoing back at me.
Just a few feet away from the stairs there’s a pile of broken hospital beds and piles of boxes of what look like IV fluids. They must be out of date otherwise why on earth are they down here?
‘Hello!’ I shout again.
A scuttling noise comes from the far corner. I’m afraid I don’t like the sound very much.
‘Nadine?’ I try again.
This place is horrible, I think to myself; no one is going to come down here, no matter how desperate they are for a fix. I start to walk up the stairs and for some reason I am spooked slightly and break into a run. I’m quite out of breath by the time I reach the top of the stairs.
Although not as short of breath as the woman panting over her suitcase in the entrance hall.
‘My God! You OK?’ I ask, running over to her.
She just looks at me. Her face is puce, her cheeks are puffing nineteen to the dozen, her mouth is circular as she inhales and exhales short little breaths. She grabs hold of my hand and gives it a tight squeeze.
‘Ahhh!’ she says, finally, as she relaxes. ‘Jesus! That was a bad one.’
‘How far apart are your contractions?’
‘Three, four minutes,’ she says. ‘Not long now.’
‘No,’ I say, feeling slightly alarmed. ‘Anyone else with you?’ I look towards the door, expecting a frantic husband to sprint in with more bags, fluffy pillows and a CD player.
‘No, just me,’ she says, grabbing my hand again, with her left hand. She is wearing a wedding ring. ‘I’ve got two other kids, he’s at home with them.’
‘Oh. Right.’ I pick up her bag for her and put my arm around her very expansive waist. ‘Let me get you to Maternity.’
She walks very slowly towards the lift. I look around for a bit more help. Neither of the security guards is anywhere to be seen.
‘Are you sure you can do this on your own?’
‘I’ve got my phone,’ she huffs. ‘I did the last one on my own – oh God!’ She turns and grabs my shoulders. ‘That huuuuuurts!’
Now I am frightened. I really don’t want to deliver this baby in the entrance hall. ‘Don’t push!’ I say.
‘I want to!’ she yells.
‘Well, don’t!’ I yell right back. ‘Let’s get you into the lift!’
12–1 a.m.
Fortunately I manage to deposit the labouring Justine at Maternity, but not before she has attempted to squeeze my right hand off, wrench both my shoulders and succeed in peeing on my left shoe. It seemed like we waited an age slumped against the locked door, but fortunately two midwives and a nurse came to my rescue, ushering the lowing Justine to a delivery suite. I did offer to come and hold her hand but she was not keen, and seeing as we had only just met I did not see the point in persisting.
A surprising number of women who have partners deliver babies alone in hospital. Either, like Justine, because they have no one else to look after their children, or their partners can’t make it as their labour comes on early and they are at the other end of the country, or things happen too quickly and they arrive only at the last moment. There are of course some women who would rather the father were not there at all. As I stand waiting for the lift with one soggy shoe, I can’t help but admire Justine. If that were me in there, I’d want the full drugs menu, as well as gas and air, and a brass band outside trumpeting my marvellousness.
Back down in A&E, Sandra is none too keen on singing my praises. ‘Where on earth have you been?’ she asks, her steely grey eyes narrowing. We both know she wants to say either ‘fuck’ or ‘hell’ in that sentence but is too professional to do so.
I begin with Nadine the prostitute and am about to get on to Justine the mother-to-be when she waves her hand and walks away, like she’s dealing with an errant mendacious teenager. I begin to walk after her when I hear a commotion at the doors of A&E.
‘Look, I’m dying! I need to see a doctor right now! Do you understand? I am dying!’
A man in his early thirties is shouting at the spotty junior on reception, whose name is Kareem – one of our more regular temps. He does eight hours at a time on the front line for about £17,000 a year. Devoid of medical qualifications and only possessing minor secretarial skills, he is responsible for organizing the triage system and therefore the order in which the patients are seen. This, as you can imagine, becomes increasingly difficult and demanding as the night progresses.
Standing next to the screaming man in the suit is a flapping woman in silver high heels and pink silk cocktail dress. ‘Jerry, Jerry,’ she pleads, ‘calm down, you’re only making it worse.’
‘Worse? How can I be making it worse? I am having a fucking heart attack!’ He bends over to the left, clutching his chest. ‘I can’t breathe! I’m dying! See? Help me!’ he begs Kareem.
‘OK,’ I say, running over to gather Jerry as he collapses on the floor. ‘Can you give me a hand?’ I ask the girlfriend.
Together we drag Jerry into resus. He is shouting and screaming and grabbing his chest. Ben comes rushing over, as does Stacy. We all get him on to a bed and start taking his clothes off and attaching monitors to him. Jerry’s expensive cotton shirt is ripped off him and his leather brogue shoes are chucked on the floor.
‘Where does it hurt?’
‘What have you been doing tonight, Jerry?’
‘Are you allergic to anything?’
‘On a scale of one to ten, what is the pain?’
‘Jerry?’
‘Jerry?’
‘Talk to us, Jerry.’
Jerry is getting very pale, his mouth is going blue; he looks from Ben, to me, to Stacy, unable to speak. The heart monitor kicks in. His heart is beating like he’s sprinting a bloody marathon. His BP is 160/110. All the alarms are ringing on the machines.
‘He’s been taking cocaine!’ the girl in pink shouts, throwing her hands in the air. ‘Two grams, maybe more.’
‘Coke?’ I say, looking at the heart monitor and Jerry’s white face.
Ben riffles through Jerry’s suit pocket and pulls out a small white envelope. ‘Coke,’ he confirms.
‘Yes, yes, yes, coke!’ repeats the girl, wiping her nose on the back of her hand. ‘Is he having a coke stroke?’
‘More like a coke-induced heart attack, I’d say,’ says Ben, grabbing the ECG machine.
Cocaine accounts for about 25 per cent of all heart attacks in men in their thirties. In some parts of the UK, like ours, as many as one in three strokes or heart attacks in young men is coke-related. And old Jerry here is the perfect example. We need to stabilize his heart, calm him down and stop the irregular beating. The ECG results are not looking good for him, but on the other hand, it’s unlikely to be fatal. It’s a huge shock to his system but he got here in time and he’s young enough to recover. We hope.
‘Please don’t let him die,’ begs the girl. ‘Please don’t let him die. He’s only thirty-three.’ She starts to pace the room, rubbing her nose and scratching herself with worry. ‘You’ve got to help him! Hang on in there, Jerry.’ It’s clear she’s been at the coke as well. She sits down and stands up, scratches her arm, scratches the back of her neck, and rubs her nose again and again, while we pump Jerry with more drugs – GTN, morphine – and cover his face with an oxygen mask.
Eventually I shoot Stacy a look to try to get rid of this irritating woman.
‘Would you like a cup of tea?’ asks Stacy, trying to shift her out of the area.
‘Tea?’ the girl says, stopping in her tracks. She looks like she is about to retch at the very idea.
‘With milk?’ adds Stacy.
The girl’s shoulders flex involuntarily; she’s nearly sick. ‘No thanks,’ she manages to say as all the saliva drains from her mouth.
Stacy finally extracts h
er from the room, suggesting that she must have some phone calls to make. She mutters something about Jerry being in capable hands and in the right place, and slowly but surely the girl leaves. The tension automatically dissipates, leaving Ben and me to get on with the job. And by the time Stacy comes back Jerry is breathing a little more normally. The strong drugs are beginning to calm the effects of the cocaine, his arteries are opening, and Jerry’s cheeks are pinked up a little.
He opens his eyes and blinks as he takes in the tubes, machines and oxygen mask.
‘You’ll be OK,’ says Stacy, giving his hand a squeeze.
He looks pathetically grateful.
‘And your girlfriend is outside calling a few people, including your parents.’
His BP suddenly increases and he breathes heavily into his mask.
Stacy looks at me and then at Jerry. ‘Don’t worry, there are no visitors allowed in here.’
He looks relieved.
‘We’ll be sending you up for an angioplasty just as soon as we can track down a consultant.’
‘You’ll go to the angiography suite for a primary angioplasty,’ I explain, ‘where they stick a catheter up through the arteries in the groin or wrist and into the heart, to find the blocked artery, and open it up with a stent.’
His eyes widen with terror over the top of his mask. Never before has a man regretted a night out more.
‘Don’t worry,’ I say, slapping the back of his cannulated hand. ‘You’ll be fine.’
I leave Jerry to contemplate minor heart surgery and go and have a piss. I’ve been desperate to go for a while now and I definitely need a cup of coffee. You tap into your adrenalin when you are dealing with an emergency like Jerry. Your heart beats faster, almost as fast as his, and you concentrate and focus and get through it, riding the wave. It’s only when the job’s over that you feel a little flat, and now I have to say I feel very tired indeed.
I stand in front of the urinal, trying not to let my head fall forward and hit the wall. I’m wondering if I might slope off for a snooze soon. The next few hours are always the busiest in A&E and then I’m off at three a.m. The end of the graveyard shift. Off back to my flat and a pissed, pissed-off girlfriend. I can’t wait.
Hospital Babylon Page 19
