She takes the cigarette. Her arms are covered in bandages and strapping. I half expect her to lean in for a light. But she doesn’t. She takes the fag and pops it behind her ear.
‘See you later,’ she smiles, and heads for the side door.
It’s locked. You need a swipe key to get in.
‘Can you open this?’ she says.
I go over to let her in. She smiles again, and in the light of the stairwell I can tell that she was once a very pretty girl. But now her skin is dull, her eyes have no focus and some of her teeth are black.
She turns and walks slowly up the stairs.
I finish my cigarette and throw the butt into the car park, to join my ever-growing pile. What I wouldn’t give for a few Treat and Street, or a quick turnaround of patients, now just to keep me occupied before I clock off at three a.m.
Back in A&E I bump into Ben, who is just coming out of a cubicle.
‘You OK?’ he asks.
‘Not too bad. You?’
‘Fucking hell, you should see the beast I’ve got in there. Tooth to tattoo ratio is not good.’ He shakes his head.
I smile. I haven’t heard that phrase in a while. A positive ratio of more teeth than tattoos is shorthand for ascertaining the IQ of the patient. More tats than teeth and you are fucked.
‘What’s he done?’
‘Brained himself in a fight, obviously,’ he says. ‘It’s a simple stitch-up, that’s all.’
Beyond Ben, the place is heaving. Sanjay is flapping out an X-ray, Alex has a load of bloods in his fist, Stacy is walking an old bloke to a cubicle, there are a couple of juniors in other cubicles coping with some drunks, and Ian is still here.
‘No home to go to?’ I say.
‘Nor do you,’ he replies.
‘But I’ll be paid extra.’
‘And I have nothing better to do,’ he smiles. I must look like I believe him, so he laughs. ‘No, I’m waiting for Mr Armstrong to finish up.’
‘Is he still here as well?’
‘He’s just doing some final checks on Mr Hughes, checking his bowels have not been perforated by the vibrator, and then I think he and I are going off for a nightcap somewhere.’
‘What, alcohol?’ Weirdly, my mouth starts to salivate, it sounds so tempting.
‘I know plenty of places where you can get a few brandies at two a.m.,’ he says, tapping the side of his nose. ‘You can join us if you’d like.’
‘I’d love to, but I’ve got a drunk girlfriend waiting for me at home.’
‘Oh God.’ His nose crinkles in disgust. I’m not sure if it’s the word ‘drunk’ or ‘girlfriend’ that’s putting him off so much. ‘If I were you I’d sleep here. Let her sober up and deal with her in the morning.’
‘Here?’
‘There are plenty of beds,’ he shrugs.
I amble over to the computer, thinking about Ian’s suggestion. It’s not a bad idea. It could possibly be a good solution to a tricky problem. Let her sleep it off and go back home when she’s gone to work. That way we’d avoid any confrontation, and quite frankly I don’t have the energy for an argument.
I walk out into the waiting room. It now smells properly of alcohol and old sweat. I call out the next name on the list and a Mr Lundy gets off his chair and starts to shuffle towards me. In his sixties, dressed in a macintosh, with thick glasses, he appears neither drunk nor like he is having a heart attack. I am slightly wondering why he is here. I sit him down in a cubicle and take his details.
‘Now, how can I help you?’ I ask.
‘It’s my head,’ he starts. ‘It’s hurting.’
My heart sinks. There is nothing worse than a headache in the middle of the bloody night. Of all the presentations to wish for, this is one of the worst. It sounds so simple but it’s a bloody nightmare. A stomach ache is fine. So much more bog standard. You have a feel around, there are certain things you can rule in or out, you can do a quick ultrasound if you are worried. But with a head, there are so many things it could be, from a full-blown brain tumour to just a touch of dehydration. What you really want to do is kick awake the radiology consultant and get your patient a CT scan, but they will only do that in an emergency and more often than not your patient does not fit the criteria. You need a blown pupil or blood coming out of the nose or eyes before anyone will so much as answer the phone.
The more I listen to Mr Lundy, the more alarm bells start to ring. He tells me his wife has terminal lung cancer and he’s been looking after her for the past eleven months. She hasn’t got long left. She’s asleep at the moment, which is why he’s come in the middle of the night; he doesn’t have time in the day. His headaches have been bothering him for a few months now; he gets double vision and excruciating pain. He’s been stealing a few of his wife’s painkillers, but the pain is now becoming unbearable.
‘So, on a scale of one to ten, with ten being the most painful, how bad is your headache now?’
‘Um, eight?’ he says, moving his head gingerly, his left eye flickering with pain.
We both know he means ten, but I jot down his rating anyway.
I have seen this happen quite often in elderly patients, where one is ill and the other is caring for them. The carer starts to feel unwell but does nothing about it because they don’t have time, and then when they finally get round to it they don’t present until it is far too late.
‘Well, I’ll tell you what we’ll do,’ I say, with a smile, ‘we’ll give you something for the pain and I’ll have a word and see if we can have a look inside that head of yours.’ I write ‘Vit M’ down on his file – Vitamin M, or morphine – and go to find Ian to try and work out my chances of getting Mr Lundy scanned here and now.
Ian is sympathetic enough for a bloke who’s worked a twelve-hour shift and is desperate for a drink at half one in the morning, but he tells me what I already know: Mr Lundy needs to go home, make an appointment with his GP and get himself referred in the hope that there is an appointment available for him within the next five or six weeks. And he also needs to hope that whatever it is that’s going on inside his head does not get any bigger or badder between now and then.
By the time I’m back with Mr Lundy, Stacy’s administered the shot of morphine and he seems to look a little less agonized. I think the fact that I haven’t taken one look at him and immediately wanted to cut his head open has cheered him up a little – that and, perhaps, the fact that someone else is looking after him for a change.
‘I will be all right, though, won’t I, doctor?’ he asks. ‘Because my wife needs me.’
I have no idea if he’ll be fine or not, but the symptoms aren’t stacking in his favour. He is the wrong side of fifty, and he’s got a stinking headache that he says he’s had for a while, and that makes me think he’s probably had it for at least six months. But instead of saying what I really think, I decide to lie.
I hate doing it. I remember a few months back being with a woman who had pancreatitis and had just had a pancreaticoduodenectomy, and all she kept on asking me was when she could go home, and all I could think was ‘I know you’re not leaving this place, unless you go out feet first.’ But you can’t say that. You can’t tell someone who still has a bit of hope in their eyes that they are going to die. It’s cruel. Equally, it’s not so brilliant to lie. So you say things like ‘Well, you still need our help a bit.’ Or ‘Maybe just a couple more weeks.’ Or ‘You’re doing very well, let’s see what happens in the next couple of days.’ Then they start to deteriorate, and then they stop asking when they are leaving and start concentrating on the battle at hand.
And it is a battle. Sometimes you can almost see and hear death approaching. You can certainly smell it. There is a sweet odour of putrefaction that suddenly sets in. Like the person has turned, and you know it won’t be long. The air around them becomes heavy, and, oddly, the human survival instinct means that you don’t want to stay with them long. I’m sure that stems back to the time when to stay with the sick and dying me
ant you too might end up sick and dying. It’s certainly true that when patients are close to death you want to be with them less. It’s an urge that as a doctor you learn to fight. They also seem to turn away from the light. They engage less, they refuse visitors who are not completely necessary; needy friends are often turned away.
And of course we help them on their way. To say that we don’t assist patients who are dying to go more comfortably or quickly would be a lie. We do. And often. The old Brompton Cocktail is still in existence – a fatal mixture of cocaine, morphine and, in the old days, gin. The Brompton Cocktail was originally used in the 1920s to allow terminally ill patients to have a less painful death. Pioneered at the Royal Brompton for patients with tuberculosis, hence the name, it was originally the idea of Dr Herbert Snow, who had first thought of helping the terminally ill on their way in the late 1890s. These days we just up the morphine in their drip. It’s one of those great unsaids within the hospital system. There’s never much chat about what’s going on. You instruct the nurse to up the morphine, which causes respiratory arrest; she tells you that the respiratory rate is falling, you nod; she says that the rate is now down to less than twelve and that you should do something to reverse the effects, and you nod again and walk on by. With any luck it’s over quickly. The patient doesn’t fight too long and hard and they are at peace. At last.
‘I hope you feel a little better,’ I say to Mr Lundy. ‘And make sure you make an appointment with your GP first thing tomorrow morning.’
‘I will be OK, though, won’t I?’ he asks again.
‘Just make the appointment,’ I say, leaving the room. ‘I shall leave you in Stacy’s capable hands.’
I’m feeling very jaded. I suppose it’s because I was thinking about a nice Treat and Street case; I was just after something a little less emotional. Some stitches maybe. Or a drunk. As I reach the computer I look across and see Alex walking another weaving, listing pisshead towards a cubicle. Oh God, I think, rubbing my eyes and rolling my stiff shoulders, only another hour to go.
‘Jason Grove?’ I shout into a waiting room full of increasingly bizarre-looking people. Underneath the cold strip lights, their evening outfits, the cropped tops, the heels and the smudged make-up look bright and lurid. Another collection of drinking injuries.
I look across at Jason Grove, who is walking towards me like some paranoid, twitching freak. He is white-faced, hollow-cheeked, and his eyes are red-rimmed. The man is clearly in need of cocoa and a good night’s sleep.
‘Oh thank God, finally,’ says a rather plump young woman who is accompanying him. ‘We’ve been waiting ages.’
‘Sorry,’ I lie. I am beyond caring. ‘Follow me.’
Jason is behaving like some cowering idiot. The door is scary. The nurses are scary. The cubicle is clearly an awful place.
‘Don’t tell me – LSD?’ I suggest, double-clicking my pen and rolling my eyes slightly.
‘Meow meow,’ says Jason, his eyes narrowing, scratching his sandy-blond stubbled chin. ‘Meow meow,’ he repeats manically. ‘Meow meow.’
I’m afraid I am slightly at a loss as to what to do. I look across at the plump girlfriend for some sort of enlightenment.
‘He’s been up for three days,’ she offers.
‘Three?’
‘Yup,’ she nods, despairingly. ‘He works in a bank.’
‘What, as a trader?’
‘No, a cashier,’ she says, looking at me like I’m a dick.
‘How much has he done?’
‘Six,’ she says.
‘Lines?’
‘Grams,’ she corrects.
That sounds a lot. But I’m not sure. I have heard of meow meow but I haven’t come across it before. It’s clearly a stimulant, otherwise Jason wouldn’t still be awake. The delusions and paranoid outlook may well be the result of both his lack of sleep and the drug, or just the lack of sleep. Six grams sounds like quite a lot though. Six grams of coke is certainly a lot. Meow meow must be similar.
‘Right, back in a tick,’ I say. I need to find Ben, or Ian, or someone who knows about this shit.
Thankfully, I bump straight into Ben.
‘Meow meow?’ I ask.
‘What?’ he asks keenly. He’s looking a little bit wired himself.
‘Meow meow?’ I ask again.
‘What, the drug so good they named it twice?’
‘It is what?’
‘Fuck knows,’ he replies. ‘It’s a plant fertilizer, mephedrone – a bloke’s got standards!’ He smiles. ‘I did hear the other day that some teenager ripped his own bollocks off after eighteen hours on the stuff.’
‘That’s not what I call a good night out.’
‘I agree,’ he laughs.
‘Benzo?’ I venture.
‘Benzo,’ he agrees.
Stacy is with Jason when I get back. It seems he’s managed to rip a whole load of paper off the giant paper roll we use to cover each trolley, and thrown some equipment around. He’s also now convinced that he’s covered in centipedes, and he has a nosebleed. It has exploded down the front of his T-shirt, but he can’t sit still enough to stem the flow of blood because he keeps tearing at his own creeping crawling flesh with his fingernails.
‘Hurry up!’ the girlfriend shrieks at me. ‘You’ve got to do something!’
2–3 a.m.
A great big dose of the sedative, hypnotic, anticonvulsant and muscle relaxant benzodiazepine does the trick and Jason finally gives up on scratching at the imaginary bugs crawling all over him and goes to sleep. He is taken upstairs for observation in case of seizures, more nosebleeds, or indeed scratching himself stupid.
As he disappears off towards the lift with his fat-thighed girlfriend in tow, I see Mr Lundy disappearing off into the night to continue looking after his extremely sick wife. I can’t help thinking, as I watch him shuffle away, that we’ve got this system wrong. A fuckwit can stay up for three days, willingly shoving plant fertilizer or whatever up his nose, and expect us to gather him up with open arms when he can no longer deal with the consequences of it all. But an old boy who has been nursing his wife for nearly a year comes for our help and gets shunted off with an appointment card and the possibility of a six-week wait for a CT scan he needs but which I can’t order up because he doesn’t meet the criteria. The sad thing is, both he and I know there is possibly something rather large and malignant inside his skull and there is probably very little we can do about it.
Sanjay walks past me with a large IV bag full of luminous green liquid. ‘Have you seen the drop-in centre we’re running?’ he asks, indicating the other side of the room where three men are lined up in a row, each with a bag of Pabrinex hanging next to them.
‘Bloody hell.’
‘I know,’ nods Sanjay. ‘And there’s another one about to join them. It’s drunk night tonight. The tramps must be having a party.’
It’s an odd sight, three of them sitting in a row, attached to their vitamin B drips, chatting away – in so much as full-blown fall-down-drunk alcoholics can chat. Most alcoholics are vitamin B deficient, which leads to Wernicke’s encephalopathy, or wet brain, a condition that results in short-term memory loss. This is often left untreated, and recent reports suggest that alcohol-related memory loss could account for between 10 and 24 per cent of dementia cases. So it’s hard to begrudge them their treatment, but at the same time you can’t help thinking that perhaps there are better ways of dealing with the nation’s pissheads than patching them up and moving them on. Although I suppose there’s only so much we can do with the number of people we have working here and the money available.
‘RTA on its way,’ announces Sandra, looking at me.
‘I’m ready.’ I smile at her, attempting to thaw the icicles in her heart. ‘Drunk driver?’
‘I presume,’ she agrees.
A few minutes later the doors slam open and two green paramedics come running in, pushing a trolley at high speed. Alex rushes over to join me. We both lean ov
er the gurney expecting to see a mutilated, mashed, bloodied face. Or at least a smashed-open chest, where the steering wheel has gone through, plus a couple of mutilated limbs and some random intestines. Instead, there’s a rather attractive twentysomething female wearing an oxygen mask and a neck brace, giggling her head off.
‘Her name’s Vicky,’ says the lanky member of the ambulance crew. ‘She’s twenty-three and rolled her Clio off the road.’
At which the girl shrieks with laughter. We all look at her.
‘She’s been like this since we picked her up,’ shrugs lanky bloke.
‘Shock?’ I suggest.
‘Or a nutter,’ he whispers in my ear.
‘Yes,’ I nod. ‘Or indeed one of those.’
‘OK then, Vicky,’ says Alex, ‘does it hurt anywhere? Can you feel and move all your limbs?’
Vicky carries on laughing.
‘Well, she’s certainly consistent, I’ll give her that,’ I say. ‘On four. One, two, three, four!’
Alex, Stacy and I lift Vicky off the stretcher and on to the bed. This only serves to delight her even more.
‘She seems fine to me,’ says Stacy.
‘If somewhat hysterical,’ I say.
‘We’re going to have to check her over,’ says Alex, taking a small torch out of his pocket to check her pupils. ‘She is effectively non-responsive.’
‘The full trauma handshake?’ I say, so-called because almost every RTA gets a finger up the arse when they come into A&E. It’s standard procedure, to see if the spinal cord is intact. You put a finger up their backside, ask them to clench their buttocks, and if they can then all systems are go.
‘Don’t worry, I’ll do that,’ says Alex, pulling rank.
‘Fine by me,’ I say. I can’t think of anything worse.
Sandra cuts off Vicky’s trousers and we roll her over. She is now laughing uncontrollably. I’m beginning to think it’s a mixture of shock and embarrassment that has set her off. Alex slaps me on the leg and gestures for me to look at Vicky’s rather nice backside. She’s wearing a G-string with the words ‘Kiss My Arse’ written across the top. Alex winks and grins before snapping on his rubber gloves.
Hospital Babylon Page 21
