Hospital Babylon

by Imogen Edwards-Jones

  ‘Now I’m sorry, Vicky, but we have to do this, just to check that you haven’t really hurt yourself. As part of a bones and joints check we need to do the spinal column, and that means a rectal exam. So I will put my finger up your backside and then I want you to clench – OK?’

  Vicky squeals with laughter and nods her head.

  ‘OK then, Vicky, here we go.’

  Alex’s hand moves up between Vicky’s legs and between her buttocks. She suddenly falls silent.

  ‘And clench!’ orders Alex. ‘Clench, Vicky!’

  ‘I’m sorry,’ says Vicky rather quietly, turning around to look at Alex, ‘but I think you’ve got the wrong hole.’

  ‘Sorry! Oh my God, have I? I can only apologize!’

  I have never seen a man move his hand more quickly or his face blush so profoundly in my life. Alex withdraws from the cubicle at speed, muttering under his breath, ‘I think you’d better finish up here.’

  It turns out that Vicky is completely fine. She managed to roll her car three times and write it off, but because she was only going at about 7 mph and due to the large amount of Baileys in her system, she came to no harm. Her Clio was a write-off, but she is completely fine. Alex, on the other hand, is so mortified that he has to take himself off for a few minutes in order to calm himself down.

  ‘I can’t believe I just did that,’ he says, pacing up and down in the corridor outside.

  ‘It’s an easy mistake to make,’ says Ben, joining us.

  ‘Well, not really,’ says Alex. ‘One hole is fairly distinct from the other.’

  ‘She didn’t seem to mind,’ I add, trying to be helpful.

  ‘She probably enjoyed it!’ encourages Ben. ‘I remember when I was very junior a consultant asked me to do a pelvic on a rather large Afro-Caribbean lady. She was there, legs akimbo, and the consultant kept on saying to me, “Can you feel the uterus? Can you feel the cervix?” And after about five minutes of sweating and prodding and poking, the woman pops her head up off the bed and shouts, “Boy! You carry on like that and you are going to ring my bell!”’

  ‘That was quite clearly the end of your obs and gynae career,’ I laugh.

  ‘I made a large lady very happy!’ he laughs.

  ‘Well, I suppose it’s only marginally worse than the rectal I did the other day,’ says Alex. ‘This old biddy had a swollen abdomen and I had to pop the finger in. I rolled her over, and as it went in she said, “Oh, Gerald! Is that you?”’

  ‘Jesus Christ!’ laughs Ben.

  ‘I had to apologize and say sorry, I wasn’t Gerald,’ says Alex. ‘And all I could think of was “Gerald, you dirty bugger!” ’

  ‘Quite literally,’ I add.

  ‘Exactly!’ he agrees, and then yawns loudly. ‘I think I need a cup of coffee. I am actually asleep on my feet.’

  ‘I’ve done that before,’ says Ben.

  ‘What?’ I ask.

  ‘Fallen asleep on my feet. You can actually do it. You’ve just got to get the balance right.’ He starts to demonstrate. ‘You have this hunch when you get your centre of gravity and you don’t need anything to support you and you stand and sleep. And you can make it look like you are looking at the op. I used to do it when I was training, helping someone operate, or sitting down doing surgery in the middle of the night. It just means you are a little slow to hand things over to them. They just ask you twice.’

  Watching Ben laugh at his own joke, throwing his nose back to reveal a small lump of coke still lodged in his right nostril, I am struck by how much this profession has changed over the past few years. Ben is old-school. He is bright and charming and funny and quite likely to help himself to the contents of the pharmacy. And he is also a good doctor. But the system doesn’t like people like him so much any more. They like the dull wads who put in the time and clock off when they’re supposed to. They don’t think laterally, they have never worked out how to sleep standing up, and I think, bizarrely, our profession will suffer as a result. Maybe it’s because I’m tired and beginning to get a little emotional at the thought of leaving this place, but I think the system needs a few Bens around to make it take risks and come up with interesting solutions to everyday problems. Otherwise things will just remain static.

  ‘A young woman, pelvic bleeding?’ says Sandra, poking her long thin nose through the double doors.

  Alex looks at me, and I look at Ben.

  ‘OK then,’ I say, ‘I’ll do it.’

  A few minutes later I find myself in a cubicle with Shannon, a pair of rubber gloves and her two mates. We have been trained to be especially sensitive when it comes to young women and pelvic examinations. Normally these are done with a female nurse present to try to minimize any stress and embarrassment, and they are also instructed to talk to the woman afterwards about any fears they have about what the doctor has said. These three, however, are treating the whole thing like some sort of cocktail party.

  ‘All right then, doc?’ says one of the friends, who introduces herself as Debbie.

  ‘I’m fine, thanks,’ I say, before trying to talk Shannon through the procedure.

  ‘Yeah, yeah, yeah,’ she replies, before getting on the bed and pulling up her skirt.

  ‘Steady on there, Shan,’ laughs her other mate, who tells me while chomping away on her chewing gum that her name is Grace.

  I’m not sure if it’s nerves or bravado or both, but these girls are acting strangely. Their friend appears to be having a miscarriage and none of them seems to be taking it at all seriously. I ask the girls to leave the room before I examine their friend but they all insist, including Shannon, on staying. This is the first time I have done a pelvic with an audience, expect when I was a student of course, when the poor patient had to put up with a couple of amateurs rooting around her ovaries in the name of education.

  ‘Ouch,’ says Grace, helpfully, as I start.

  ‘Cheers,’ giggles Shannon. ‘There’s no need to look right up my fanny, Grace!’

  ‘Oh my God!’ adds Debbie, covering her mouth with her hands. ‘He’s right up there!’

  ‘Shut it, you two,’ smirks Shannon. ‘I’m concentrating!’

  Thankfully, it doesn’t take me long to be able to confirm what I think we all knew, that Shannon is having a miscarriage.

  ‘Yeah, thanks, doc,’ she nods from the bed. ‘I thought as much.’ She appears neither upset nor bothered. She’s young, nineteen years old, maybe she’s relieved.

  ‘The worst of it appears to be over,’ I continue, scanning her young face for any kind of reaction.

  Her hair is scraped back tightly off her pale freckled forehead. She has about fifteen studs in her right ear, decreasing in size as they ascend the lobe, like a lesson in perspective. She has long square-tipped fingernails which are painted different colours and covered in tiny diamond studs. I can’t help but think if she took as much care over herself as she does her nails, she might not be in this position.

  ‘Telling me!’ she laughs with her mates. ‘It’s been killing me all afternoon.’

  ‘I said you should of come in earlier!’ chomps Grace, wagging another bejewelled fingernail. ‘I told her she should of,’ she says to me.

  ‘Yes, you should have,’ I say. ‘If only to make sure everything was OK. Did you know how many weeks pregnant you were?’

  She looks at me like I’ve asked her to split the atom. ‘Seven? Eight? Nine? Ten?’

  ‘Eleven? Twelve? Thirteen?’ laughs Debbie.

  ‘When was the date of your last period?’ I ask.

  ‘How should I know!’

  ‘Well, you’d probably know better than me,’ I say, beginning to get a little irritated. If she didn’t care what was happening to her, why should I?

  ‘Eight, nine weeks ago, I think. Do you know when your last period was, Debs?’

  ‘Me?’ says Debs. ‘No idea! How about you, Grace?’

  ‘Now!’ she laughs. She throws her head back so hard she nearly chokes on her gum.

&nbs
p; ‘Anyway, as I said, I think the worst is over so I think it’s probably best if you take yourself back home, then come back to Outpatients in the morning just to make sure everything’s OK,’ I continue, ignoring their laughter.

  ‘Hey, doc,’ says Grace. ‘You on Facebook?’

  ‘Sorry?’

  ‘Are you though? On Facebook?’

  ‘Yeah, are you, doc?’ asks Shannon, sitting up and pulling her skirt back down.

  ‘Um, yes, I am, but—’ I’m not sure I should have said that.

  ‘Wicked!’ says Shannon, getting off the bed. ‘We’ll look you up.’

  ‘Um, well, that’s probably not a good idea—’

  ‘Why not?’ asks Grace, picking her handbag up off the floor.

  ‘Yeah, chill out, doc,’ adds Debbie. ‘It might never happen.’

  ‘That your name?’ asks Grace, checking the ID card that’s clipped to the top of my scrubs trousers. She’s a little sharper than the shouting Mr Richards, I’ll give her that.

  ‘Um, yes.’

  ‘Excellent,’ she says.

  ‘Thanks, doc,’ says Shannon, pulling her pants up and then slapping me on the back.

  ‘Do you want anything for the pain?’ I ask, as she appears to be on the point of walking straight out of the door.

  ‘No thanks,’ she says. ‘I’ve got Solpadeine at home.’

  ‘If you’re sure.’

  ‘Cheers,’ she says, and she and her mates move straight off down the corridor.

  I stand and watch and listen to them giggle their way to the double doors. I don’t know whether to be shocked or depressed. I can’t help wondering what has happened to those girls for them to be laughing and chatting as their friend is having a miscarriage. Maybe I’m just sentimental, or overtired, and maybe their reaction is more healthy. Nature is a wasteful creature. As many as one in seven pregnancies ends in early miscarriage; maybe we should take these things a little more in our stride. She obviously didn’t want the child. And why should she? She’s a nineteen-year-old girl with her whole life ahead of her. But some emotion, some regret, some acknowledgement of what was happening would have actually made it a little easier for me.

  I let the irony of that thought linger in my head.

  Suddenly the swing doors slam open and three paramedics come sprinting towards me. Their faces are determined, their expressions are grim, and they really are moving very fast.

  ‘Male, twentysomething years old!’ he yells at me. ‘Machete attack!’

  Who the fuck attacks someone with a machete?

  Bang! The doors slam again. Another trolley comes careering towards me with another three paramedics looking equally focused.

  ‘Male, twentysomething years old!’ they yell at me. ‘Machete attack!’

  The whole department drops what they are doing; soon there’s a sea of nurses, doctors, drips and machines being pulled and pushed everywhere. The first bloke is squealing and weeping and shrieking. His body has been sliced all over the place; there is blood and open flesh everywhere. It’s like something out of a hideous slasher movie. The second bloke on the stretcher is making a sort of low moaning noise; his arms have been sliced, particularly across the front of his forearms where he’s had his hands up trying to protect his face. They have both been subjected to one of the most horrific attacks I have ever seen.

  Ben and Alex take the screamer. They tube him and secure his airways, then line up all the machines and shift him across. As they move him he lets out a piercing wail that sends shivers down my spine. Sanjay and I have the other bloke. We tube him and secure his airways too, then Sanjay says, ‘On the count of three we move him. One, two, three!’ We all lift him up off the stretcher and roll him as quickly and as neatly as we can on to the bed. Stacy rushes around attaching him to all the monitors and I yell out an order for O neg.

  ‘Stop!’ shouts Sanjay, his arm raised in the air.

  We stop in our tracks, and he points back across to the stretcher. There, in the middle of the stretcher, where the young man’s head had been, is his brain. A whole brain. We all stare. Sanjay rolls the dead man over. The whole of the back of his skull has been sliced off. I look at the cavity, then I look at the brain, and then I’m afraid I throw up all over my shoes.

  3–4 a.m.

  We are all so shocked that none of us speaks for several minutes. I stand there rooted to the spot, my arms hanging by my side, warm vomit seeping slowly into my shoes. Sanjay just scratches his head. No one calls the death. All Stacy can do is stare at the brain, her whole body shaking in disbelief. Even the other well-seasoned members of the team are knocked off their stride. Ben mumbles some profanity, and Alex drops his scissors.

  I’m not usually this squeamish. It takes a lot to make me sick, and I have seen a whole human brain many times before – I’ve even dissected one. So it’s not the brain itself that set me off. I think it was the speed of it all. The idea that we had a living breathing man with us one second, then a second later we’re left with a corpse and a brain sitting on a stretcher. It’s like someone took the batteries out. Flipped the switch. One moment he was moaning, the next he was dead.

  ‘Um, time of death,’ says Sanjay, eventually, ‘three zero three a.m. OK, let’s get him out of here. Amazing,’ he adds, turning to have another look at the back of the skull like the true and proper scientist he is. ‘I have never seen a skull sliced off like that. Have you?’

  ‘Only in a film,’ I reply, slightly less keen on closer inspection.

  ‘It must have been a hell of a blow,’ he adds, tracing the line of the skull with his fingertip. ‘I know how hard it is to crack open a skull, I’ve stood in on brain surgery.’

  Four policemen arrive in A&E. It’s like some police merry-go-round here today. No sooner have SO19 gone upstairs with their gangland shooters than they are replaced by another load of coppers clogging up the doorways, asking questions.

  According to the police, these two sliced and diced bodies are the results of a group of Lithuanians having an argument. One of them got a machete and started to attack the other two, before leaving them for dead. The one who is still alive apparently got on his hands and knees and dragged himself along the pavement to the local pub, where he managed to wake the landlord and raise the alarm. He tried very hard to save his friend.

  ‘Poor sod,’ said one of the coppers, taking a look at the dead young man on the bed next to us. ‘So, how did he die? Loss of blood?’

  ‘No, his brain fell out of the back of his head,’ says Sanjay, pointing to the brain still sitting on the stretcher.

  The policeman looks across, just to make sure that Sanjay is joking. As soon as he clocks the brain sitting there, still warm and pink, he passes out. His legs fold under him and he hits the floor with an almighty thump, taking a tray of instruments with him.

  ‘I thought they were trained for this sort of thing,’ says Sanjay, leaping forward to help the man.

  ‘No one is trained for that,’ I say.

  ‘I suppose so,’ says Sanjay, feeling the policeman’s pulse. ‘Did he hit his head? Did you hit your head?’ he repeats as the policeman starts to come round.

  The policeman mumbles something in reply.

  ‘Put your head between your legs and breathe slowly.’ Sanjay looks up at Sandra, who is standing there wondering why her department has been reduced to this chaos. ‘Sister, could you make this man some sweet tea?’

  ‘Leave him to me,’ she says, bending over and putting a slim arm around the policeman’s shoulders. ‘Get up, in your own time,’ she says. ‘And come this way.’

  I have to admit that a cup of sweet tea is exactly what I need. I should really be going home. It’s the end of the graveyard shift and I am entitled to bugger off. But my shoes are covered in vomit and I am feeling quite out of sorts. Also, the drunken Emma is not exactly a siren beckoning me on to the rocks. I squelch my way into the common room and flick the kettle on.

  ‘Ooh, you read my mind,’ say
s an anaesthetist called Sally as she breezes into the room rubbing her hands. ‘I have just been at the best operation,’ she says as she bustles around looking for milk in the fridge.

  I don’t know her that well but I’ve always found her efficient short hair and tight, pleased smile more than a little annoying.

  ‘It was the smoothest wake-up I have ever done. Literally the man just woke up and opened his eyes. No coughing, or spluttering, or teeth chattering. Nothing. It was a perfect ten out of ten, even though I say it myself.’

  ‘Good,’ I say, with zero enthusiasm.

  ‘It was,’ she smiles. ‘I am.’

  ‘I’m very happy for you. What was the operation?’

  ‘Sorry?’ she asks, looking a little distracted, lost in marvelling at her own marvellousness.

  I can’t be bothered to repeat the question. I’m knackered, my girlfriend is an aggressive pisshead, and I stink of puke. I don’t give a shit what idiot patient of hers woke up so splendidly.

  ‘Nothing,’ I reply.

  ‘How about you?’ she asks.

  I should launch into a long description of the Lithuanian machete fight, but I simply don’t have the energy.

  ‘Nothing much,’ I say.

  ‘Oh, what time is it?’ She checks her watch. ‘I suppose that’s about right, no? All you get in now are the night-shift workers?’

  Sally is right. It’s about this time of night that things are supposed to quieten down a bit, when even this city starts to run out of drunks to deposit on our doorstep. After about three a.m. the rhythm of A&E changes. Staff do eventually get a chance to eat something, put their feet up for five minutes, write some notes, have a chat with each other, or even with a patient. You can take a bit more time, a bit more care. There’s more of an opportunity for a bit of bedside manner to come out, if you will. Also, if the hospital is near a large twenty-four-hour employer – like, for example, the West Middlesex near Heathrow – then as Sally has just said, the night-shift workers start coming in. They don’t have anything better to do. The TV is on, the place is warm, they may as well hang out here and get their bad foot seen to as soon as go home. But you know, if you had to pick a time to come down to your local A&E, then after three a.m. is one of the best. The queues are much shorter, and the doctors are a little less run off their feet.