by Adam Kay
It turned out her raised pulse wasn’t caused by any surgical complications, but because she was in floods of tears. I asked what was up and she told me her eighteen-year-old son was coming over tomorrow to visit, and she didn’t know what to say to him – how would he react when he found out why she was in hospital? I reassured her that an eighteen-year-old boy would rather peel his testicles and douse them in malt vinegar than ask any questions at all about why his mother is ona gynaecology ward. The phrase ‘women’s problems’ alone – especially if delivered in hushed tones whilestaring straight into his eyes – will have him changing the subject immediately, even if he has to start a small fire as a distraction. Tears over and pulse back down to normal. Although she might want to think up a plausible excuse for that incredible suntan . . .
* Pelvic inflammatory disease, or PID, is when untreated gonorrhoea or chlamydia spreads north and gunks up the pelvic organs – it can be tricky to treat and even result in permanent pelvic pain. It’s also one of the main causes of female infertility. Basically, use condoms, or you might end up not needing them at all.
Monday, 9 April 2007
Results out today. I have somehow passed my MRCOG Part One exam and am celebrating in the pub with Ron. Unfortunately, drinks are strictly non-alcoholic as I have to head straight off afterwards to a night shift, and I gather turning up drunk is frowned upon. Ron recently got through his postgraduate accountancy exams, so we compare notes. While his firm cut down his hours so he could revise, I had to squeeze in as much revision as my bloodshot eyes would allow after work. Ron had a full month of study leave before the exam; I applied for a week off, but rota gaps meant that it ended up getting cancelled at the last minute, without discussion. His firm paid for all exam fees and materials; I had to shell out for £300-worth of textbooks, a £500 course, £100 for online learning resources and £400 on the exam itself, a grand total of £1,300 – a mere two-thirds of my monthly take-home pay.
My carefully considered answers don’t even get seen by a human – it’s a multiple-choice paper and you fill in the answers in pencil on a grid, which then gets scanned and marked by a computer. I show Ron the RCOG pencil I pinched.
He immediately gets a promotion and pay rise for passing his exam; all mine means is that I’m now eligible to enter the Part Two exam.
‘No. All it means,’ says Ron sympathetically, ‘is that you spent £1,300 on a pencil.’
Thursday, 19 April 2007
An email from Infection Control informs all doctors that long-sleeved shirts are now banned in clinical environments. Some study has swabbed a bunch of cuffs and discovered it would be more hygienic for us to wear shirts made out of fresh human faeces and poorly sealed vials of ebola. The same apparently applies to neckties, which dangle down, bobbing in and out of various festering wounds and cross-pollinating bugs across the hospital like polyester honeybees with a death wish.
We are henceforth instructed to wear short-sleeved shirts, so I brush aside any hope of making the cover of Vogue while at work and go shopping to invest my savings in five of the things. These short-sleeved numbers, we are told, may be worn either with no tie or with a bow tie – giving us the option of dressing like an airline steward or a paedophile. I’ll go without, thanks. Tea? Coffee? Hot towel?
Wednesday, 2 May 2007
I finish consenting a couple for caesarean section. ‘Any questions at all?’ I ask the room.
‘Yes,’ chips in their six-year-old. ‘Do you think Jesus was black?’
Saturday, 5 May 2007
In lieu of an incentive scheme at work, I’ve invented my own perks: I take scrubs home for pyjamas and steal the odd patient meal at night. It’s 1 a.m., I’m absolutely starving and it’s my only chance for some food for the next seven hours, so I sidle into the gynae ward kitchen. Clearly I’m not the only one with an eye for a freebie – there’s a new sign up on the fridge warning staff that meals are strictly for patients only. As security systems go it’s not exactly sophisticated – they may struggle to prevent the more determined thief with A4 paper, Blu Tack and Comic Sans alone.
Tonight’s delicacy is ‘Quorn-style Savoury Mince with Sultanas’. It’s like they got Accenture in to come up with the least appealing possible menu options. I think I’ll just take my chances and let nervous energy and Red Bull keep me going.
Saturday, 12 May 2007
My philosophy on flights is to get so hammered that no right-minded air steward would want me anywhere near a sick passenger, which has served me well these past few years.* Karma repaid me tonight, not on the flight itself but twelve hours later, in Glasgow for the weekend and walking back to the hotel after dinner and drinks and drinks and drinksssssss with Ron and his wife Hannah.
Walking down Bath Street at 1 a.m., we see three guys in their late teens hanging around some basement steps, outside a shop door, surrounded by an extraordinary amount of blood. It looked unreal, like a murder scene on a Channel 5 drama. They were all the worse for wear – though probably no worse than any of us – and one was exsanguinating from what looked like a big arterial bleed on his forearm. Impossible to guess how much blood was sprayed and pooled around, but it couldn’t have been less than a litre. He was conscious, though barely, and nothing was being done to stem the blood loss.
I sobered up extremely quickly and told them I was a doctor. The friends were pointing at the smashed glass door and repeatedly telling me he’d tripped and fallen, as if the fact he’d clearly broken into a newsagent was anyone’s main concern here. They’d called an ambulance already, but I had Ron phone 999 to expedite its appearance and asked Hannah to rip up T-shirts to make tourniquets. I held the guy’s arm up high and squeezed hard. His pulse was slow and thready,† and he was drifting in and out of consciousness. I keep talking, talking, talking – telling him the ambulance is really close, I’m a doctor, everything’s going to be fine. It doesn’t matter how many times you say it or whether any of it is true – well, at least the ‘doctor’ part is true – you have to believe it, because they need to believe it.
It felt like he was on the brink of cardiac arrest and I was going through CPR in my head so I didn’t need to think twice when he did. Was this even legal – drunk in charge of an emergency? I was confident I was managing the situation correctly, but it wouldn’t look great if he died with me in this state. Mercifully, the ambulance arrived almost immediately and they whisked him away, filling him with the fluids he needed to save his life. All’s well that ends well, but I had a terrible feeling of impotence waiting for the ambulance to pull up. Back in the hotel I poured myself a £12 miniature from the minibar and realized that even on a plane I’d have had more resources to help him. The whisky would have been cheaper, too.
* My family are much nicer people than me. One Christmas, British Airways sent my dad a pair of return tickets to anywhere in the world as a thank you for answering the ‘Is there a doctor on board?’ call, and handing out some antihistamines from the medicine box. My brother (also a GP) was extremely unimpressed – he’d spent the entire duration of a budget airline flight managing an urgent cardiac situation with extremely limited resources and didn’t even get the words ‘thank you’ as a thank you, let alone a free trip to Bali.
† If you lose blood, then your pulse usually speeds up – your heart needs to work extra hard to get oxygen around the body given there’s less blood to transport it. When the pulse becomes slow in this situation, it generally means the body is getting exhausted and preparing to throw in the towel.
Monday, 14 May 2007
In the doctors’ mess, my friend Zac – currently working in orthopaedics – tells me that he always muddles the words ‘shoulder’ and ‘elbow’ in his mind, and has to really concentrate before using either term. Before I even have time to process this and what it could mean for his next patient, an intensive care registrar joins in from the next sofa: since childhood, she’s always malapropped the words ‘coma’ and ‘cocoon’. The more she tries to rememb
er which is which, the more her mind convinces her she’s got it the wrong way round. She shows us a piece of paper in her wallet that reads,
COCOON = Insect
COMA = Patient.
This, we hear, helps prevent the admittedly hilarious scenario of sitting down an inconsolable relative to break the news that their husband is in a cocoon.
Tuesday, 12 June 2007
It’s five minutes until my shift ends and I need to get away on time to go out for dinner. Naturally, I’m asked to review a patient – she’s got a second-degree tear,* and the midwife looking after her tells me she hasn’t been signed off to repair those yet.†
Me: ‘I haven’t been signed off to do them either.’
Midwife: ‘You don’t need to get signed off to do things – you’re a doctor.’ (Depressing but true.)
Me: ‘Isn’t there another midwife who can do it?’
Midwife: ‘She’s on her break.’
Me: ‘I’m on my break.’ (Untrue.)
Midwife: ‘You don’t get breaks.’ (Depressing but true.)
Me: (pleading, in a tone of voice I’ve never managed before, like I’ve unlocked a secret level of my vocal cords) ‘But it’s my birthday.’ (Depressing but true.)
Midwife: ‘It’s labour ward – it’s always someone’s birthday.’
* Having a baby can rip your undercarriage to shreds, there’s no getting away from it, especially if you’re a first-time mum. Durex should take their cue from cigarette manufacturers and show photos of post-partum perineums on their packaging – no woman could look at that and ever risk getting pregnant. A first-degree tear goes through the skin, a second-degree tear goes into the perineal muscles, a third-degree tear involves the anal sphincter and a fourth-degree tear rips your leg off or something.
† Doctors’ and midwives’ roles are fairly well-defined in most aspects of labour ward – midwives are responsible for normal deliveries; doctors are involved when there are worries about mum or baby’s well-being or the progress of labour. Who gets the sewing kit out for first- and second-degree tears is a greyer area than your nan’s vagina.
Tuesday, 19 June 2007
An email to all clinical staff, letting us know a psychiatric inpatient has been transferred to the respiratory ward following a diagnosis of pneumonia. But this wasn’t the kind of ‘say hello if you see him’ notice you’d get if a new kid transferred to your school. Yesterday it was discovered he’d been wandering around the ward minesweeping like the last aunt at a wedding, downing the contents of every sputum pot he found on fellow patients’ bedside tables.
We are advised to send all clinical samples immediately to the lab and not to leave any in easy reach for the time being. Someone has replied-all with ‘Yuck’, which feels rather like watching a nuclear reactor explode and saying ‘Oh dear’.
Tuesday, 26 June 2007
I’ve been in the doghouse for days now. We were at H’s friend Luna’s house – Luna is pregnant, and just before dinner she whipped out a photo album of their recent 3-D scans. I suspected my thoughts on 3-D scans – that they serve no purpose other than keeping 3-D scanning companies rich, and boring the anuses off dinner-party guests – would go down like a cup of cold sick, so I had a polite flick through along with everyone else.
‘Everything seem OK?’ Luna asked me. I wanted to say, ‘Looks the same as they all fucking do,’ but I suspected that might lose the room, so I just smiled sweetly, handed the photos back and said, ‘She looks perfect.’ The temperature in the room dropped about ten degrees and murder flashed discernibly across Luna’s eyes. ‘She? SHE?’
It’s the first time I’ve dropped the ball on this, so to speak, and worst of all with a friend, not a patient. Dinner felt like it took a fortnight; eye contact avoided, plates plomped unceremoniously in front of me.
It didn’t help that tensions were already running high at home. Two weeks ago, our flat purchase fell through. It seems that, with a total disregard for my blood pressure and a relationship slightly fraying at the edges, the owners have decided not to sell it after all. I rather suspect they’ve merely decided not to sell it to us, probably because someone else had offered them a bit more money. Luckily, we’ve only spent a couple of thousand fucking pounds on solicitors and surveys and whatnot. I know more about this flat – that I will now never set foot in again – than I do about any of my closest blood relations. Everyone tells us that these things happen for a reason. In our case, the reason is that the world favours bastards and clearly wants us to spend our every spare moment with estate agents for the next few months.
But life goes on, even if it’s peppered with annoying reminders. The depleted bank account, for one, and the fact that, unless I take a five-minute PTSD-avoiding detour, I drive past the flat that got away every morning on my journey to work. And today – amazingly, just to prove there’s no escape – the couple who screwed us over turned up in antenatal clinic. I’d not met them before, but here was their address in front of me, the exact same address that’s permanently scarring my happiness.
In a Tarantino movie, this would be the part where I produce two samurai swords and unleash a ten-minute tirade about honour, vengeance and respect, before decapitating them. In reality I just said, ‘Hi, I’m Adam – one of the doctors,’ and they had no idea. Issues of morality, probity and legality sadly restrict revenge opportunities to near enough zero, so I conducted their appointment to the best of my abilities, albeit through gritted teeth. I wasn’t 100 per cent sure that the baby was cephalic,* so I quickly ran the scanner over the mother. Baby was the right way up and all was well. ‘Do you want to see the heart beating?’ I asked them. ‘There it is – all looks normal there. There’s an arm, another arm, that’s a leg, that’s his penis . . . Oh, didn’t you know?’
* Cephalic means baby is head down – this is normal. The opposite is breech, meaning bum first. Breech presentation occurs in 3 per cent of pregnancies, and famous examples include Emperor Nero, Kaiser Wilhelm, Frank Sinatra and Billy Joel. If you win a pub quiz off the back of this, you owe me a pint.
Saturday, 30 June 2007
A news story in the paper about a hospital porter who’s been jailed for pretending to be a doctor for the last few years. Just finished one of those shifts where I wondered if I could get away with pretending to be a porter.
Tuesday, 10 July 2007
I clearly need to change my patter. It usually goes something like: ‘I couldn’t see anything on the ultrasound just by looking with a probe on the tummy – doesn’t mean there’s anything to worry about, early pregnancies can often be very difficult to see this way. Would it be OK if I did an ultrasound using an internal probe to get a better view?’
After today’s incident, should my licence to practise remain intact, my new spiel will be: ‘I couldn’t see anything on the ultrasound just by looking with a probe on the tummy – doesn’t mean there’s anything to worry about, early pregnancies can often be very difficult to see this way. Would it be OK if I did an ultrasound using an internal probe to get a better view? In a few seconds’ time I’m going to rummage in a drawer and pull out a condom and a sachet of KY jelly. Just to be clear: the condom is a cover for the ultrasound probe and the KY jelly is to lubricate it. When you see what’s in my hands, please do not scream so loudly that three members of staff come rushing into the room.’
Monday, 23 July 2007
Sending a patient home from the day surgery unit following laparoscopic sterilization. I tell her she can have sex again as soon as she feels ready, but to use alternative contraception until her next period. I nod at her husband and say, ‘That means he has to wear a condom.’ I can’t quite work out why their faces are a picture of horror, melting like the Nazis at the end of Raiders of the Lost Ark. What have I said? It’s perfectly good advice, right? I look at them both again, and realize the man is actually her father.
Tuesday, 31 July 2007
One of the house officers turned up in A&E last night, having at
tempted suicide with an overdose of antidepressants. There’s a shared sense of numbness amongst the doctors. The only surprise is it doesn’t happen more often – you’re given huge responsibility, minimal supervision and absolutely no pastoral support.* You work yourself to exhaustion, pushing yourself beyond what could be reasonably expected of you, and end up constantly feeling like you don’t know what you’re doing. Sometimes it just feels that way, and you’re actually doing fine – and sometimes you really don’t know what you’re doing.
Happily, this occasion is the latter, and she has taken a completely harmless dose of antidepressants. In any other profession, if someone’s job drove them to attempt suicide, you’d expect some kind of inquiry into what happened and a concerted effort to make sure it never happened again. Yet nobody said anything – we all just heard from friends, like we were in the school playground. I doubt we’d have got so much as an email if she’d died. I’m pretty unshockable, but I’ll never cease to be amazed by hospitals’ wilful ineptitude when it comes to caring for their own staff.
* A 2015 study by the Medical Protection Society showed that 85 per cent of doctors have experienced mental health issues, and 13 per cent admitted to suicidal feelings. A 2009 paper in the British Journal of Psychiatry showed that young female doctors in the UK are two and a half times more likely than other women to kill themselves.
5
Registrar – Post One
As a house officer you think your registrar is unimpeachably correct and clever, like God maybe, or Google, and you try not to bother them under almost any circumstance. As an SHO, they’re your port of call whenever you get stuck and need an answer: the safety net of some wise words just a quick bleep away. And then, before you know it, the registrar is you.
