‘Stacy?’ I open my eyes and see one of the male nurses standing in the doorway. ‘Oh!’
‘You’ve got to come quickly,’ he says, sounding a little panicked. ‘They’ve found a body.’
‘A body?’ I say, stretching.
‘Yeah, a dead body,’ he adds, sounding like he’s never seen a stiff before.
‘So?’
‘So we need you. All the other doctors are busy.’
‘I’m not getting out of bed for a dead person,’ I say.
‘Sorry?’ Now he sounds completely confused.
‘The person is dead. What can I do to help now?’ I yawn and lie back down. ‘No doctor gets out of bed for a corpse.’
‘Please,’ he says, sounding completely pathetic.
For some unknown reason I find myself getting out of bed. The last time someone woke me up in the night I had a massive row with him. It was another junior doctor who wanted me to take the pacemaker out of a corpse, as he was my patient and he thought I might want the ash cash. It was very kind of him to offer and all that, but there’s something totally abhorrent to me about delving around in a cold chest looking for a pacemaker. I told him I didn’t want the £71 that badly and only to wake me again if there was a possibility of my doing some good. So why am I helping out this sod? Maybe because he said please and asked me politely.
Rubbing my eyes under the bright strip light, I follow him down the corridor, expecting him to lead me into A&E. Instead he takes me to the toilets.
‘In there,’ he says, turning away.
‘Here?’ I look at the sign. ‘The Ladies?’
He nods.
Inside, the place smells of urine and stale perfume. There are three basins down one wall, two of which have dripping taps, and there’s paper everywhere. The hand towel dispenser is empty, mainly because its contents are spewed all over the grey texture-tiled floor. The three toilet cubicles are open and there is toilet roll curling under the door of the two closest to the main door. Women, it appears, are just as messy as men when they go to the loo. What an appalling place to die, I think, as I walk towards the furthest cubicle. I push the door with my finger and it slowly creaks open. There, lying curled up on the floor in the foetal position, the heroin syringe still in her right hand, is Nadine, the prostitute I spoke to in the car park earlier. It is too sad really. Her mouth is open, her eyes are half shut, and her long dark curls are wet with the water from the leaking toilet. She is barefoot and still wearing her hospital gown, which gapes at the back. She is not wearing any underwear.
‘She must be a patient,’ says the nurse.
‘Her name’s Nadine,’ I say. ‘She’s from Hepworth.’
‘What’s she doing down here?’
‘Looking for a quiet place to shoot up?’ I say.
‘How long has she been here, do you think?’
‘I’m not sure,’ I say, feeling the body. ‘She’s still a tiny bit warm but rigor mortis is settling in her eyes. Two to three hours, maybe more. I saw her at about oneish, one thirty?’
‘What shall we do?’ he asks.
‘Move the body back up to Hepworth and let them deal with it,’ I say. ‘They are quite used to dealing with bodies that have been dead for a few hours. The nurses there have been known to find bodies and put them back into bed to let the doctors deal with them in the morning.’
‘Do you think so?’ he asks.
‘I don’t see why not. She was one of theirs. I’ll stay with her if you want and you can go up and get them.’
He scurries off up to the fourth floor while I stay with Nadine. Knowing her name and having seen her swaggering about the car park does make it a little worse, looking at her here with her mouth open and her buttocks hanging out. I pull her gown around her a little more neatly. There’s no need for her to be completely degraded.
I turn around and catch a glimpse of myself in the mirror. I look terrible. My skin is waxy, my eyes are red and I have purple bags under my eyes. I could also do with a shave. I lean over a basin and splash some water on my face; I can see Nadine’s dead body reflected in the mirror behind me. For some reason the reflection looks more creepy, like some alternative reality.
Before I have a chance to spook myself completely, the nurse returns with a few more nurses in tow. As old Hepworth hands, they treat Nadine’s demise with complete nonchalance. How long ago was she found? When did I last see her alive? She had apparently been up on the ward causing havoc, pissing everyone off just a few hours ago. The sister had accused her of dealing on the ward; there had been shouting and swearing, which is probably why she had come down so many floors to take her hit. She had apparently been in and out of that ward for the best part of a year. They all kind of knew that she would come to a sticky end. There was no other outcome for her.
They make short work of Nadine, and within about five minutes her body has been packed up on a trolley and covered in a sheet and is being taken upstairs for the paperwork to begin. The nurse and I walk in silence back to A&E. He collars a cleaner on the way and asks him to close the toilets and hose down the area thoroughly before allowing the public back in the place.
Through the double doors, and the drunks on drips are beginning to stir. Sandra is bustling them awake, clearly thinking about making them a cup of tea and kicking them out soon. The last thing she wants is for the next shift to inherit a row of pissheads on their arrival. She likes to run a tight ship, and if she can possibly hand over an empty A&E in a couple of hours to Andrea, she will. It’s a matter of pride.
It’s all part of the new policy of getting patients out of hospital as quickly as we can. Early Discharge is one of the shiny new flagship policies. I’ve sat in endless meetings with endless physios and occupational therapists working out how to get rid of patients. It’s one of those tricky things: you don’t want to send a patient home so early that they can’t cope on their own; equally they are a pain in the butt to have hanging around if all they have is a broken wrist. And we have to involve so many bloody people. Half the patients’ houses don’t cater for them and their broken leg, particularly if they are elderly or live on their own, and then we have to involve Social Services, or get home help organized, or arrange the loan of expensive equipment to help them get out of bed, wash, dress and go to the loo. By the time we’ve finished with all that jazz, we might just as well have kept them in for another week. The problem is that people don’t have families any more; we have had to become their family. Only that’s not really what the NHS was set up for. We are supposed to be here in a crisis. We are not supposed to take the place of your extended family.
And woe betide us if we kick them out and they come back! We are judged on our readmission rates, and they are rising. Something like 13 per cent of over-seventy-fives are readmitted within twenty-eight days of being dispatched back into the community, and that rate is rising, up 31 per cent in the last five years. The under-seventy-fives fare a little better, with an 8.6 per cent return within four weeks, but that’s bound to get worse. Some local councils are so terrible at looking after their ex-patients that I’ve heard of pensioners asking that rather than run the gamut of their appalling aftercare, might there be a kindly doctor who is interested in participating in an assisted suicide?
But these boozing boys getting their vitamin B shots will be back by the end of the week, or at least within the next month. Some of them are homeless but a surprising number are not. They just live on their own and have no one else to talk to except a TV and a brandless bottle of vodka.
I shall miss this place, I think, looking around. It’s a love/hate thing. Helping people at their most vulnerable – it’s why almost all of us went into medicine in the first place. It’s just all the other shit that goes with it that I find hard to deal with.
‘Oh good,’ says Sandra, a look of panic in her eyes. ‘We’ve got an RTA arriving in five minutes and everyone’s in theatre. You have to stay.’
5–6 a.m.
Sandra pages both Alex and San
jay, who are in theatre repairing the sliced-up Lithuanian and the open-necked Ritalinhead, and there’s no one else about expect for a couple of juniors who’ve been on drunk duty for the last few hours. Even Dr Death is scrubbed, in with some poor unfortunate sod with appendicitis. I send a nurse to hunt up and down the empty rooms on E corridor in the hope that I might find Ben still pleasuring the implacable Sally. But to no avail: it seems they’ve both disappeared off into the night.
So we have an RTA on its way with four young male casualties and three doctors on call to deal with it. And one of them, me, has been up for nearly twenty-four hours and the other two have six months’ real-life training under their belt.
Stacy and Sandra grab the drunks and clear them out of the area. They walk them and wheel their IVs down to the CDU, to join the grannies and other alcoholics who have already been placed there. We then all stand by the double doors, waiting, braced.
I remember talking to a friend of mine who was working the day of the 7/7 London bombings and he said that not only was it carnage, it was also chaos. But somehow they managed to get through the first twenty-four hours. Mostly he remembers spending hour after hour with a nail brush in his hands, scrubbing flesh. It was his job to get all the tiny bits of shrapnel and grit out of the skin to prevent ‘tattooing’, where the flesh grows over the lumps and bumps in the skin and becomes pocked and pitted like a form of tribal art. He said that everyone coped with the initial shock and trauma and heavy workload rather well. It was a Thursday morning, and everyone worked flat out through Friday and over the weekend to help sort out the wounded. Then on the Monday his department was sent an email from those on high that said something like ‘Well done for all your hard work, at least we know that our major incident plans do work, and we will be ready should there ever be a next time.’ He said what they had completely failed to grasp was that all the patients, all the injured and wounded, were still there. They would be there for weeks, if not months, and they were sending out emails like the whole thing was over. All the beds were full and all the doctors were still flat out; they worked sixteen-hour days for the next four weeks at least. They worked weekends, too; no one took any breaks at all. It was exhausting, and some of the critically ill patients were in and out of operating theatres every other day. It wasn’t an incident that they managed to get through in forty-eight hours, this was weeks and weeks of work.
Although this car crash is, of course, nowhere near that level, the ramifications will play out in this hospital for the next few weeks, if not months.
The double doors slam open and the paramedics come sprinting in, one after the other. The noise is awful – low-level screaming, moaning and writhing around in pain. The stench of burning flesh and petrol hits us too. Sandra’s directing which resus each of them should go into and the nurses are rushing around with IV stands, heart monitors and bags of blood and fluids.
The first boy is completely covered in burns. His face is black, his hands are charred and his clothes hang in smouldering tatters off his body. Jesus Christ, I almost can’t look. The paramedics have managed to put a line in his arm, which is a feat in itself. There’s no way I would have found a vein.
‘The driver,’ says the medic, looking sweaty and exhausted. He’s covered in black soot and stinks of petrol. ‘Trapped behind the steering wheel,’ he says, shaking his head. ‘The car was on fire, we couldn’t get him out. He’s about seventy per cent burns. He’s dead. Died in the ambulance.’
‘Right,’ I say, checking his chest and heart for breathing or any other sign of life. ‘Yes, you’re right. Over there.’
We push him to one side. We cannot help him now. We must focus on the ones we can help.
‘Next,’ I say, without wanting to sound heartless. ‘Keep talking to me.’
The next two lads aren’t in great shape either. One looks the wrong side of barbecued, his forearms so badly burned the flesh itself is practically cooked. The other looks like he’s been through the windscreen and back, with lacerations to prove it. We secure their airways and pump them with as many painkillers and fluids as we can. The burns boy continues to scream the whole time; I think it’s the shock as much as the pain. It sounds terrible. It is incredibly hard to handle something like this, and it’s made worse by the fact that they are all under twenty. The paramedics don’t know what happened. They think that drink and maybe drugs were involved. The lads seem to have driven off the road while going around a corner too quickly. But all they know for a fact is that the car rolled twice, blew up, and turned into a fireball. To be honest, it’s touch and go for both these boys.
I’m more confident about the fourth casualty, who seems to have escaped the worst of the fire and much of the impact of the crash. His left arm is bust, half the road is still in his chest, one of his legs is twisted and he has an enormous welt across one shoulder, which may well be dislocated, but it looks like his seat belt saved him from the worst of it, and he’s only slightly burned. I think he must have been in the front passenger seat, and managed to get out more easily.
We are working up these cases like clockwork. Stacy is running back and forth with more blood and fluids. We are trying to keep the burns boy from completely drying out, dressing his skin, trying to cool it and prevent the burns from going any deeper. But his blood pressure is rising, his heart is not coping with the shock, his system is completely overloaded. Suddenly the heart monitor attached to him goes from pumping nineteen to the dozen to that familiar monotone as he flatlines.
‘Adrenalin!’ I shout. ‘Paddles!’
Stacy hands me the syringe, and I plunge the needle into the boy’s IV bag. One of the SHOs, Aiden, charges the defibrillator.
‘Clear!’ he shouts, holding the paddles dramatically above his head, before leaning over and shocking the boy.
He barely moves.
Aiden steps back, waiting for his machine to charge, then shouts ‘Clear!’ again and shocks the boy a second time.
Again the boy doesn’t move, and the heart monitor remains monotone.
We carry on this dance for another fifteen futile minutes. We’d normally call it earlier than that but he’s young so no one wants to give up. But it’s like some macabre hokey-cokey: we’re all stepping in and out of a circle, all of us knowing exactly what is going to happen, but forced to go through the motions all the same. If only to be able to tell the boy’s parents that everything was done to save him.
‘I’m going to call it,’ I say eventually, safe in the knowledge that no one will dissent. ‘Time of death five thirty-three a.m.’
Over in the other cubicle they are fast losing the other lad. He damaged his sternum on the way through the windscreen and is bleeding slowly but surely into himself. The cuts on his arms, legs and face are too numerous and the trauma is too much for his young body to cope with. This has to be one of the worst car crashes I have ever had to attend to. Within minutes I hear once again the deathly monotone of a heart monitor; the high-pitched squeak as the SHO charges up his defibrillator; the shouts of ‘Clear!’ and ‘Again!’ coming thick and fast.
It’s all over so quickly. Three young lives taken within the space of about thirty minutes – it feels like a huge body blow. The department is left reeling, punch-drunk from so much chaos, so much blood and burning, so many frantic attempts at resuscitation, so much death. And it all happened just as we were contemplating a sit-down, a cup of tea and a catch-up on a few notes, or maybe slapping a few backs goodnight and sloping off to bed. This job just seems to know when your guard is down and you’re feeling in need of a little sleep. It’s only then that it comes right back at you and hits you hard between the eyes.
All efforts are now concentrated on the sole survivor. He is moaning and mumbling, trying to speak through his oxygen mask. By the look of his injuries, after some extensive surgery, physio and rehabilitation he will probably survive this whole thing. Poor bastard. He’ll be walking out of a place where his three best mates died to become the foc
us of everyone else’s questions and everyone else’s grief. I can’t think of anything worse.
‘How are they?’ he manages to ask, his scared eyes looking from Stacy to me to Aiden.
‘Let’s not worry about them now,’ says Stacy, putting a hand on his shoulder.
‘They’re dead, aren’t they?’ he mumbles through the plastic mask.
‘Let’s concentrate on you,’ Stacy says.
‘Angus is dead, isn’t he?’
‘Which one is Angus?’ I ask.
‘The driver,’ he says, staring at me, willing me to say the opposite of what he knows I’m about to say.
‘I’m sorry.’
Stacy shoots me a look like I’m not supposed to tell him. But I’m afraid I can’t lie, and he has a right to know. They were all in that fireball together, and he must strongly suspect, otherwise he wouldn’t have asked the question.
The young man squeaks. It’s an odd sound. Like a baby working its way up to tears. He inhales a large gulp of oxygen and a tear runs down over his temple.
‘And Mike?’ he asks.
I bite the corner of my bottom lip and shake my head slightly.
The squeak is the same, but just that tiny bit louder. More tears flow down the side of his face and into his ears.
He can barely voice the last question he needs to ask: ‘J-J-Jamie?’
‘I am very sorry,’ I say, taking hold of his heavily grazed hand.
He pulls it away from me and turns his head carefully to face the other way. His shoulders move slightly as he starts to sob.
He then turns back to look at me with bright-red eyes. ‘All of them?’
I nod.
He inhales heavily again and looks at me furiously, like it was my fault. Then he lets out a low, awful wail. He tries to move his hands up to his face, but it proves too painful. The sobbing gets louder. He struggles in his bed, his legs and arms kicking. ‘No-o-o–oo—ooo!’ he shouts at the top of his voice before descending into a fit of coughing that brings two nurses running over.
Hospital Babylon Page 24
