This is Going to Hurt

by Adam Kay

  Monday, 14 August 2006

  My rota involves scanning in the Early Pregnancy Unit once a fortnight. Today, having never so much as seen a scan like this performed before, I had to single-shaking-handedly run a clinic of twenty patients, peering at 4-mm lumps of cells using a trans-vaginal probe.*

  I asked (begged) a registrar to give me a quick demo, and he had time to see one patient with me before he dashed off to theatre. My SHO colleague on the afternoon shift had never done it before either, so I passed on my new skill by scanning her first patient for her. See one, do twenty, teach one.

  * This sounds like a high-speed train service in the Caucasus but is considerably less sophisticated. You look inside with an ultrasound stick to decide if a pregnancy is viable, miscarrying or ectopic. Misdiagnosis can see you the wrong side of a negligence/manslaughter charge.

  Wednesday, 16 August 2006

  Just out of a delivery, my slickest ventouse yet. The midwife told me afterwards she assumed I was a registrar (although she is known as Dangerous Dawn, so I’m not going to put vast quantities of stock in that).

  A phone call from Mum to say my sister Sophie’s got into med school. I send Soph a text with huge congratulations, then a picture of me thumbs-upping in scrubs (cropped above the splatter-zone) and ‘You in six years’ time!’

  Had the call come at the end of the shift, my text would have read, ‘RUN LIKE THE FUCKING WIND.’

  Monday, 21 August 2006

  I’ve been carrying a Post Office ‘Sorry, you were out’ card around with me for over a fortnight. I keep taking it out and looking at it meaningfully like it’s a photograph of my firstborn or some long-dead childhood sweetheart, pathetically rereading the collection office’s opening times in the hope they will magically alter before my eyes. They do not.

  I wouldn’t have time to get to the Post Office and back in my lunch hour, even if I had a lunch hour, which of course I don’t, but I’ve been holding on to a glimmer of hope that I might knock off work early one day – if the hospital burnt down, say, or nuclear war was declared. Today I start a week of nights so nip off to collect the parcel. Unfortunately, it turns out the Post Office only hold on to items for eighteen days, every one of which I’ve been at work, so it’s been returned to sender.

  Long story short, H won’t be getting a birthday present tomorrow.

  Thursday, 14 September 2006

  Patient CW on the antenatal ward needs some imaging done of her lungs, so I book her in for an MRI and go through the checklist.* She is in fact ineligible for an MRI, having had a small but powerful magnet implanted in the pulp of her right index finger a few years ago. Apparently there had been a limited trend for this, performed by tattoo artists and intended to give the recipient an ‘extra sense’ – an other-worldly awareness of metal objects around them, like a kind of vibrating aura (her words) or a slightly low-rent X-Man (my words).

  Her sales pitch needs work, to be honest. It turned out not to be the mystical, ethereal experience she had been looking for, but a regal pain in the arse – she tells me it’s become infected a number of times and going through airport security is now a living hell. I briefly toy with asking her to brush past my colleague Cormac to either confirm or refute the rumour that he has a Prince Albert,† but she says the implant has recently become either dislodged or demagnetized and she now barely feels a thing, except for a lump in her finger. She wants to have the magnet removed, in fact, but the scar tissue that will have formed around it makes it a slightly involved operation, and one not covered on the NHS. I book her in for a CT scan – she can wear a lead apron and there’ll be very little radiation exposure for the baby. Although if I’d only gone ahead and booked her an MRI, I’d have saved her the cost of that private operation.

  * Ordinarily you’d do a CT scan, but we try to avoid those in pregnancy as they involve a large quantity of X-ray exposure; and anyone who’s stayed up for the late-night horror can tell you that radiation plus baby is not a good idea. I’ve had the mechanism of MRIs explained to me any number of times and I’m still none the wiser, but no X-rays are involved: images are obtained using a combination of protons, magic and an enormous fucking magnet. And I mean enormous; the size and weight of a one-bedroom flat. The MRI checklist asks if they’ve got a metal heart valve (it would tear out of their now-dead chest at 80 mph and splat onto the machine) or worked in a metal factory (tiny bits of metal would have found their way into their eyes, making both eyeballs explode upon opening the door to the MRI suite).

  † The already close-to-zero appeal of a genital piercing instantly evaporated as a house officer when I saw a patient present with a ring that had ripped out during sex. This happens frequently enough that urologists have a term for it: ‘Prince Albert’s revenge’.

  Sunday, 17 September 2006

  Either the printer has gone insane or one of the receptionists has – huge quantities of paper have engulfed the nursing station. Everyone in sight has collected around to try and fix it, all doing exactly the same thing – jabbing random buttons to absolutely zero effect.

  Pages are cascading out of the printer and onto the labour ward floor. I pick one up – they’re patient identification stickers for a neonate, to go on notes, wristbands, etc. For the rest of the day, everyone checks their shoes and backs in paranoia, just in case a stray one has become attached – this is one label nobody wants to be walking around with. A slightly unfortunate surname means that every sticker says BABY RAPER.

  Monday, 25 September 2006

  How the other half live. In antenatal clinic, an extremely posh patient attends for a routine appointment. All is well with her extremely posh fetus. Her extremely posh eight-year-old asks her a question about the economy (!), and before she answers she asks her extremely posh five-year-old, ‘Do you know what the economy is, darling?’

  ‘Yes, Mummy. It’s the part of the plane that’s terrible.’

  You can see how revolutions start.

  Wednesday, 27 September 2006

  I’m off sick for the first time since qualifying. Work weren’t exactly sympathetic.

  ‘Oh, for fuck’s sake,’ spat my registrar when I rang in. ‘Can’t you just come in for the morning?’ I explained I had quite bad food poisoning and was in some kind of gastrointestinal meltdown. ‘Fine,’ he said with the kind of weary, simmering passive-aggression I normally only get at home. ‘But phone around and find someone who’s on leave to cover you.’

  I’m pretty sure this isn’t the protocol at Google or GlaxoSmithKline or even Ginsters. Is there a single other workplace where you’d conceivably be asked to arrange your own sickness cover? The North Korean army maybe? I wonder what level of illness would stop it from being my responsibility. Broken pelvis? Lymphoma? Or just when I was intubated on ITU and denied the power of speech?

  Luckily, I could manage to force out a few words in between bouts of vomiting (if not in between bouts of diarrhoea), so I was able to organize a stand-in. I didn’t explain what I was doing during the call – it probably sounded like I’d gone paintballing. And I now owe her a shift in return, so it’s not even sick leave.

  I’d always suspected if I ended up off sick it would be work that caused it. My money would have been on some form of emotional collapse, maybe renal failure from dehydration, getting beaten up by an angry relative or smashing my car into a tree after a sleep-deprived night shift. As it happens, it was an altogether stealthier assassin – a portion of noxious homemade moussaka from a labouring patient’s mother. I can be fairly sure that was the culprit: it was the only thing I’d managed to eat all day. There should be a saying about Greeks bearing gifts, I thought, shitting through the eye of a hypodermic needle, the taste of bile and faint tinge of aubergine in my throat.

  Saturday, 30 September 2006

  Review a woman in triage, who just arrived huffing and puffing away in labour. I ask how frequently the contractions are coming and the husband tells me they’re three to four times every ten minutes,
lasting up to a minute each. I explain I’ll need to do an internal examination to assess how far dilated* she is.

  The husband tells me he checked before they left home and she was 6 cm. Most dads-to-be don’t peek under the hood so I ask him if he’s a medic. No, he tells me, he’s a plasterer, but ‘I know what a centimetre is, mate’. I examine the patient and agree with his findings, making him more competent than most of my colleagues.

  * The contractions of the womb make its neck, or cervix, go from closed before labour to full (10 cm) dilatation at the end of labour, at which point baby can make its grand entrance. The first few centimetres can take an extremely long time, so women aren’t generally admitted to labour ward until they’re at least 3 cm dilated – like a strange nightclub you can’t get into until you’ve had two gloved fingers in your vagina. Actually, there’s probably one of those in Soho already.

  Saturday, 7 October 2006

  I’ve now spent six months being Simon’s on-call mental health helpline since that first Facebook post – any time he’s having worrying thoughts, I’ve told him he can ring me, and he does. I’ve also told him repeatedly to engage more formally with mental health services, but he’s not so keen on listening to that bit. Aside from the fact it’s a bit overwhelming to now have a second bleep threatening to go off with bad news any minute, I suspect he can get better help from someone who didn’t have to panic-google ‘What to say to someone who’s suicidal?’ But it seems I’m better than nothing – at the very least, he’s still alive.

  The most stressful part is discovering I’ve missed a call from him – if I call back too late and he’s done himself in, does that make it my fault, like I’m the one who kicked away the chair? I suppose it doesn’t, but that’s how you feel as a doctor, and probably why I’m in this situation to begin with. If you’re the first to notice someone else’s patient is breathing strangely or has abnormal blood tests, it’s your responsibility to deal with it, or at least ensure someone else does. I’m pretty sure heating engineers don’t feel the same way about every kaput boiler they encounter. The difference is obviously the whole ‘life and death’ thing, which is what separates this job from all others, and makes it so unfathomable to people on the outside.

  I call Simon back after a caesarean this evening. I’ve got my counselling sessions down to about twenty minutes – it’s just a case of listening, being sympathetic and reassuring him the feelings will pass. He must realize we have the same chat every time, but it clearly doesn’t matter – he just wants to know there’s someone out there who cares. And actually, that’s a very large part of what being a doctor is.

  Monday, 9 October 2006

  Today crossed the line from everyday patient idiocy to me checking around the room for hidden cameras. After a lengthy discussion with a patient’s husband about how absolutely no condoms fit him, I establish he’s pulling them right down over his balls.

  Tuesday, 10 October 2006

  I missed what the argument was about, but a woman storms out of gynae outpatients screaming at the clinic sister, ‘I pay your salary! I pay your salary!’ The sister yells back, ‘Can I have a raise then?’

  Thursday, 19 October 2006

  My poker face has served me well over the years. It’s seen me through an eighty-year-old telling me about his use of a colossal butt-plug called The Assmaster and gently explaining to a couple in infertility clinic that massaging semen into her navel isn’t quite going to cut it, conception-wise. I sit there nodding along blankly like the dog from the Churchill advert. ‘And which size of Assmaster, sir?’

  Today, however, my poker face cracked. On this morning’s ward round, a medical student presented Mrs Ringford – a seventy-year-old gynae patient, recovering on the ward after a posterior repair for a large prolapse.* Unfortunately, he called her ‘Mrs Ringpiece’ and, much like the patient, I unexpectedly lost my shit.

  * When you reach a certain age, your body attempts to turn itself inside out via your vagina, but you can avoid all this by performing pelvic floor exercises. There are leaflets that describe these exercises in confusing detail, but I always just used to tell patients, ‘Imagine you’re sitting in a bath full of eels and you don’t want any of them getting in.’

  Monday, 23 October 2006

  Called to A&E to review a gentleman in his seventies. I check with the A&E officer that he realizes he’s bleeped gynaecology: reviewing a man would be rather pushing my remit. It’s complicated, apparently; he’ll explain when I get down there.

  I meet patient NS, a Sikh gentleman who speaks no English at all. He is on holiday, visiting family, and has been unhelpfully accompanied to the hospital by a relative who also speaks no English. His history is therefore taken with the assistance of a telephone interpreter service – in this instance, a Punjabi translator is on the line and the phone is passed back and forth. This particular interpreter may have rather fudged his CV – he seems to be able to speak only slightly more Punjabi than someone who can’t speak any Punjabi whatsoever.

  The stoic A&E staff have been making glacial progress using the interpreter, and relay what they’ve established: the patient is bleeding from ‘down below’, has been doing so for the past week and – crucially to my attendance – is a hermaphrodite.* I tell the A&E officer that I sincerely doubt this elderly bearded man is part of the intersex community, and ask to speak to the interpreter.

  ‘Can you ask if the patient has a womb?’ The phone gets passed back, and the patient starts to repeat a word to us very loudly and angrily in Punjabi. The patient furiously unbuttons his shirt to reveal a Port-a-Cath† – our eureka moment. In unison we all say, ‘Haemophiliac!’ and I leave them to deal with his rectal bleed.

  * Hermaphroditism is a very rare intersex disorder where the patient possesses both testicular and ovarian tissue. It’s named after the Greek legend of Hermaphroditus, who was said to be both male and female. He/she was the son/daughter of Hermes and Aphrodite, who it must be said had a pretty lazy system for naming their children.

  † A Port-a-Cath is a device that sits under the skin to allow easy injection of drugs and taking of blood, for people who need it done frequently.

  Tuesday, 31 October 2006

  Moral maze. In the labour ward dressing rooms after a long shift. I’m leaving at 10 p.m. rather than 8 p.m. thanks to a major obstetric haemorrhage ending up back in theatre. I’m meant to be going to a Halloween party, but now I don’t have time to go home and pick up my costume. However, I am currently dressed in scrubs and splattered head to toe in blood. Would it be so wrong?

  Saturday, 4 November 2006

  Get bleeped to see a postnatal patient at 1 a.m. The ODP* relays to the bleeping midwife that I’m in the middle of a caesarean. I get bleeped again at 1.15 a.m. (still doing the section) and 1.30 a.m. (writing up my operation notes). Eventually, I head off to review the patient. The big emergency? She’s going home in the morning and wants to have her passport application countersigned by a doctor while she’s still in here.

  * An Operating Department Practitioner (ODP) is Muttley to the anaesthetist’s Dick Dastardly.

  Wednesday, 15 November 2006

  I have entered the MRCOG* Part One exam. A textbook advises me to try a past paper before I start revising – ‘You might be pleasantly surprised how much you already know!’ I attempt one.

  March 1997, Paper 1, Question 1.

  True or false? Chromaffin cells:

  A. Are innervated by pre-ganglionic sympathetic nerve fibres

  B. Are present in the adrenal cortex

  C. Are derived from neuro-ectoderm

  D. Can decarboxylate amino acids

  E. Are present in coeliac ganglia

  Aside from the fact I know what less than half of these words mean (and most of those are prepositions), I can’t help wondering how it’s relevant to my baby-delivering abilities. But if it’s what my insane demonic overlords want me to know, who am I to argue?

  Another textbook cheerily info
rms me that ‘It’s quite possible to revise for MRCOG Part One in just six months, with an hour or two’s study every evening.’ It’s one of those phrases that is intended to be reassuring but has the opposite effect, like ‘it’s only a small tumour’ or ‘most of the fire’s been put out already’.

  I’m not entirely sure where these extra couple of hours a day are going to come from – either I need to give up my frivolous hobby of sleeping or cut out my commute by living in a store cupboard at work. Oh, and my exam’s in four months, not six.

  * Member of the Royal College of Obstetricians and Gynaecologists – a necessary hurdle to proceed up the ranks. The exam is in two equally brutal parts, and feels rather like the Labours of Hercules, in that you’re forced to do it to demonstrate your extraordinary dedication to the field more than anything else.

  Monday, 25 December 2006

  I don’t particularly mind working Christmas Day – there are snacks everywhere, people on the whole are in a good mood and there are very few worried well.* Generally nobody rocks up as a patient on Christmas Day unless they’re genuinely sick, genuinely in labour or genuinely hate their family. (In which case, we’ve at least got some common ground.) I’m not convinced H sees it this way, as we exchange gifts at breakneck speed before 7 a.m.

  Tradition at St Agatha’s dictates that the on-call consultant† turns up and does a ward round on Christmas Day, which eases the workload for the juniors. The consultant will also bring a bag of presents for the patients – toiletries, panettone, that sort of thing – because, well, it’s pretty rotten being a hospital inpatient over Christmas, and the little things do make a difference. Best of all, tradition has it that this consultant will be dressed as Santa Claus as they do their round.