Twas the Nightshift Before Christmas

by Adam Kay

  Patient HL presents with an episode of post-coital bleeding. Inside, everything looks a bit . . . grazed. There’s clearly a piece of her story missing – perhaps her boyfriend is that big yellow bloke from the Fantastic Four who’s made entirely out of rock.

  The actual answer is that, with no condoms available, she and her fella dipped into a Christmas selection box and improvised with a Mars bar wrapper – really embracing the ‘play’ aspect of ‘work, rest and play’. The human desire to fuck seems to override any of our normal checks and balances. It’s why you get people shagging in aeroplane toilets (a coffin that flushes!) or using a pepper mill in lieu of a dildo.

  Luckily there’s nothing to sew up for Patient HL and it doesn’t need packing.* I advise her to use less abrasive methods of contraception in future and, until it has totally healed, to take a break. By which I don’t mean she should move on to KitKats.

  * As every boy scout knows, in the first instance you put pressure on a wound to stop it bleeding. This applies to vaginal lacerations too (although they tend to leave this part out of the boy scout handbook), and you apply this pressure by ‘packing’ the vagina with a length of gauze.

  Tuesday, 25 December 2007

  Fuck the halls with boughs of holly. It’s four Christmases in a row and the depressing part is how normal it now feels. Routines are forming, like when a tree grows around a railing. The 7 a.m. bleary-eyed exchange of presents and a mince pie wolfed down while H pretends not to notice I’ve got one eye on the clock.

  I didn’t put up a fight when the Christmas rota came out this year. It’s just the job, and someone has to do it. Maybe it appeals to the hero complex all doctors pretend they don’t have: Batman with a bleep. Plus there’s that selfish buzz every member of our species is programmed to get after doing something good, like if you donate to a telethon or reunite a snivelling toddler with the teddy bear they’ve dropped. In the absence of a god tallying my actions on the heaven/hell ledger, it’s something. But selflessness at hospital only serves to heighten my selfishness in other ways. Abandoning H, who has now stopped mentioning it because we have already had every possible permutation of the same discussion. Abandoning my family, who will never stop mentioning it. Even in death, they’ll doubtless find a way via annual scheduled emails or a Ouija board.

  Today’s text from my mum says, ‘Maybe we’ll see you one year’ – guilt, weaponized. I guess these days I’m just one of those people who doesn’t celebrate Christmas, like a Jehovah’s Witness, or a turkey.

  On the drive into work, the biscuity-voiced radio presenter gives a shout-out to everyone working over Christmas, and I almost beep my horn in solidarity, before remembering I’m British. Then back to wondering if the car park will be free of charge today (obviously not).

  I bustle in, look up at the labour ward board and sigh. ‘Has anyone referred room eight to psych yet?’

  Megan, one of the midwives, sighs back at me louder and tells me to take another look at the patient’s info.

  18 years

  Declined vaginal examination throughout labour as claimed to be ‘virgo intacta’

  For psych referral as claims child is ‘son of god’

  Overseas patient: Nazareth

  Excessive number of visitors in room

  Baby male infant delivered at 00.00. Condition: stable

  Ho ho no. It’s only ten past eight and I’m already too tired for this shit.

  Rather less ‘humour’ over on the gynae ward, where Patient HW has had a pretty grim week, the lowlights being emergency surgery for ovarian torsion* and a lingering post-op wound infection. I was desperate for her temperature to stay down so she could make it home at some point, to salvage a bit of Christmas Day and stop December becoming a total write-off. I must have been an unexpectedly good boy this year because Santa has checked his list twice and given me what I asked for. Unfortunately, although Patient HW is now well enough clinically, there are logistical issues to deal with – she can’t find anyone to drive her, and patient transport say there’s no room on the back of their donkey.

  Brook, one of the gynae nurses, goes full Chris Rea – minus the beard and the voice you’d get by accidentally gargling cement – and offers to drive her home. ‘It’s on my way anyway!’ she says brightly, but another nurse quietly mentions that’s not remotely the case. My icy heart thaws at this simple act of kindness.

  I might sometimes go the extra mile at work, but – unlike Brook – I draw the line at going an extra seventeen on my way home. Brook tells the patient she’ll be knocking off at 2 p.m. if she’s OK to wait that long. ‘Fine,’ replies the patient. ‘But I hope you’re not expecting any money for the petrol.’ That’s the spirit.

  * Please see footnote on page 44 of the paperback edition of This is Going to Hurt. OK, fine, just this once: ovarian torsion is when an ovary twists on its ligaments like a maypole, cutting off its blood supply.

  Thursday, 27 December 2007

  It’s 4 a.m. and I crumple into a chair in the doctors’ mess and make a noise like a deflating dinghy. Burton, one of the house officers, is curled up like a croissant on the sofa opposite me. ‘How’s your shift?’ I ask.

  He unfurls slightly and looks up at me – his body exhausted, his face puffy. He starts to speak but the effort is too much and he shakes his head and returns to his imaginary cocoon. Oh god. I was rather hoping to stare dead-eyed at the telly for half an hour, not counsel a traumatized colleague.

  ‘Mate . . . are you OK?’

  His head re-emerges, like the world’s most lethargic meerkat.

  ‘The vending machine’s broken.’

  Friday, 28 December 2007

  ‘Insufficient sample’ – the bane of a junior doctor’s life. I get this weird dread when I look up a patient’s blood result – like watching someone undress for the first time, or being in a McDonald’s queue at 10.28 a.m. and praying you make it to the counter before the breakfast menu finishes.

  It’s always an urgent blood test – one that came from a patient with atom-thin veins, that took you fifteen attempts and left the patient looking like they’d just given a porcupine a hand-job. You cradle the precious test tube of blood like a white-gloved museum curator handling a first edition of the Old Testament, and with a quiet prayer you send it on its journey to the lab. And then it comes back as ‘insufficient sample’. You can’t shake the feeling that the lab technicians are gaslighting you – you know the hallowed ampoule was full to the brim. And even if it wasn’t, murderers can be convicted on DNA evidence from a decades-old micro-fleck of spittle; can’t the lab just live dangerously and have a bash at telling me a patient’s clotting from 2.9 ml of blood rather than 3? But all you can do is bitch and moan at whoever’s standing next to you, then go back to the patient for round two. A few more minutes’ work for me, yet more track marks for the patient, but ultimately no real harm done.

  It was much more irritating today when, reviewing a couple’s results in infertility clinic, the semen analysis report showed ‘insufficient sample’. Unlike a repeat blood test, there’s nothing I can do for him here that wouldn’t get me struck off. Instead the guy will have to book another appointment with the jizz deposit clinic, which – because there’s no such thing as a semen emergency – will now be in the new year. Then, of course, he’ll have to wait a month or so before seeing us back here in clinic – we can’t discuss next steps until we have a complete set of results.

  I’m about to break the news to them when my eyes drift a little further down the screen. Context! ‘Scant sample, mixed with dirt, fluff, detritus. Please repeat.’ Did he . . . wank into a hoover bag?

  The patient seemed genuinely surprised he hadn’t got away with it, but quietly admitted he had overshot the container. No doubt with his grandmother’s ‘waste not want not’ battle-cry ringing in his ears, he’d tried his best to scoop his issue back into the pot, bringing with it all the dust and DNA of whoever and whatever had gone before him.

  �
��He does go a long way,’ says his wife in a proud voice, like she was boasting about her child’s grade three piano.*

  I can’t blame the guy for not having Olympic-archer accuracy – our lab doesn’t have dedicated ‘production rooms’ as they’re coyly described, so patients have to knock one out in the cubicles of the gents toilets. It can’t be easy to bring yourself to the point of erotic ecstasy to the soundtrack of squeezing and straining from the cubicle next door. It’s also fairly distracting for the hospital staff trying to get some ‘me time’ with their digestive system, knowing full well what the other cubicles moonlight as.†

  As part of my BSc in Reproductive Medicine, I spent a couple of days working in a seminology lab, processing and testing the samples that came in. I meticulously followed the instructions the lab technician had given me: measuring the volume of the sample; transferring it to a new container; spinning it in the centrifuge to separate off the sperm from the unneeded fluid; chucking the fluid down the sink . . .

  ‘What are you doing?!’ yelped the lab tech. ‘You’ve just thrown away the sperm!’ I turned printer-paper white and scrabbled around the sink with my fingers.

  She shrugged and toddled off to the computer to deliver the verdict: ‘Insufficient sample’.‡

  * The long cumshot can be a useful diagnostic tool. (Is this the first time the word cumshot has appeared in a Christmas gift book?) A med school friend, now literally a brain surgeon, managed to shoot himself in the eye one evening, and when what he initially thought was just minor irritation hadn’t gone down a couple of weeks later, he popped to the doctor and was diagnosed with a strain of ocular chlamydia that hadn’t given him symptoms in the usual postcode.

  † A nurse who previously worked at an infertility clinic in the States told me they used to have a TV screen and DVD player. No word on the doubtless sub-motel-level pornographic delights available, but there was the chilling detail that the remote control was kept in a ziplock bag.

  Back home, some units, including one I worked at, give you the requisite kit so you can collect the sample in the comfort of your own bedroom and bring in the specimen pot within an hour. Our instruction booklet said to ‘keep the bottle at body temperature, for example in a trouser pocket, under your armpit or between your legs’. One man became the stuff of revolting legend and the headline act of many a doctor’s dinner-party repertoire by interpreting this to mean ‘inside your anus’, which, in fairness, is undoubtedly body temperature.

  ‡ As I was compiling this book, news came from China that could eradicate the ‘insufficient sample’ – although at perhaps a higher price to a patient’s dignity. One hospital has announced the sperm-collecting machine, an object that looks a little like a customized water cooler with a hole for penile insertion. The machine will, using anatomically accurate vibrations and some frantic suction and thrusting, wank the patient off and collect anything they eject. The patient can then head back to work, complete with the psychological after-effects that come from having sex with a horny wastepaper basket.

  Saturday, 29 December 2007

  History hasn’t recorded for us which Palaeolithic painter first mixed blue and yellow to make green, or blue and red to make purple. But it was Patient HC who discovered that if you bring a cinnamon and mulled wine plug-in air freshener into your delivery room for a bit of festive fragrance, rather than masking the unavoidable potpourri of blood, placenta, amniotic fluid and faeces, all forces somehow combine to create the most rancidly noxious stench imaginable. It hangs in the air like some kind of acrid death-gas in a James Bond film, its putrid cloud choking every airway, blunting every nerve ending. We’re having the room deep cleaned, but they may well have to knock down the entire hospital.

  Monday, 31 December 2007

  My brother and I are both working in hospitals this New Year’s Eve, so I call him for some sibling solidarity. We talk about our resolutions – I’m not sure why I even bother, I don’t think I’ve ever managed a lifestyle change that’s seen out the Christmas decorations. I don’t blame myself, I blame January. Everyone’s wandering round like poorly reanimated corpses and the weather would make Ernie Shackleton think twice about popping down the shops for a pint of milk; yet we choose this month for a bizarre act of self-flagellation.

  But once again, optimism triumphs over objectivity and I’ve decided I’m going to have a pop at losing a few pounds. How hard can it be? I barely have time to eat anyway.

  ‘Yeah, you probably should,’ he replies. I was rather hoping for a ‘Don’t be silly, you look great!’ but with a doctor’s honesty added to a sibling’s bluntness, this was clearly unrealistic. He tells me he has some important advice and my ears prick up. Perhaps he went to some lecture at med school that I bunked off? I’m already imagining myself svelter and am looking forward to the little dopamine fist-bump any time someone asks me if I’ve lost weight. (‘Oh, I dunno, maybe a bit?’ I’ll reply, while getting a paper-cut off my own cheekbone.)

  ‘Don’t do what I did last year,’ he says. ‘You know the “Taste the Difference” ready meals at Sainsbury’s?’

  I am aware of them, yes.

  ‘Well, they’re the fancy range, not the diet range. Took me until March to work out why I wasn’t losing anything.’

  Monday, 7 January 2008

  Five weeks after meeting my accountant for my annual bollocking about record-keeping (‘You’d do very badly in prison, Adam’), I’m still being diligent about holding on to receipts. This will all go to fuck at some point in February, but for now I’m a receipt-keeping poster boy for HMRC: the dry cleaning from when a patient accidentally pissed on my trousers in antenatal clinic; the £300 advanced life support course that is somehow mandatory for my job but for which the hospital provides neither the money nor the study leave (you can have that riddle for nothing, Rumpelstiltskin); a new stethoscope after my last one got slightly . . . blood-logged.

  Labour ward isn’t throwing too many dramas at me today, so I slope up to the on-call room for a bit of shut-eye. This is optimistic at the best of times, but today the bed – which has always erred on the Wormwood Scrubs side of luxurious – has been denuded of not just its bedding but also, mystifyingly, its mattress. I wonder where it’s gone. Maybe it’s being deloused? Maybe it blew away – it was certainly thin enough. Or maybe it’s been sold to help with the hospital’s deepening financial Mariana Trench. Given they replaced the canteen with a vending machine, nothing would surprise me now.

  I’m not to be deterred – I’d probably accept the icy embrace of death if it was the only way I’d get a lie-down – so I have an exploratory rest on its wooden slats. I quickly realize this is incompatible with anything other than a chronic back injury, begrudgingly admit defeat and make my way back downstairs.

  Before I leave, I stop off in what a London estate agent might describe as the en-suite, but which is quite clearly a broom cupboard that has been persuaded to masquerade as a toilet. As I’m sitting there, I notice the hand towel is gone too. Perhaps budget tightenings have also identified dry hands as a frivolous level of comfort – I fully expect to turn up one day and discover other luxuries have been removed, like light bulbs and walls.

  I then realize, slightly too late, that there’s no toilet roll either. Fuck. But invention is the daughter of necessity – I guess I’ll just have to explain to my accountant why I’ve gone yet another year with no receipts.

  Fifth Christmas

  I hang up my stocking, I lay down to sleep

  Then shout ‘fucking hell’ at the sound of my bleep

  Monday, 15 December 2008

  I’ve spent the day in a distant hospital, examining students for their medical school finals, as a favour for an academic professor I’ve only met once. It’s a non-optional favour, in the same way you’d be doing a speeding train a favour by jumping out of its path. Plus I’ve had to take the time from my precious supply of annual leave (something I don’t mention to H). Still, I get to sit down all day and, for
a nice change, nothing bad will happen if I take my eye off the ball. Well, maybe a dangerously negligent student qualifies as a doctor – no biggie.

  My role in this low-budget gynaecology-themed version of The Crystal Maze is an assessment of the students’ ability to perform a vaginal examination. Lying on the bed is a chunk of dismembered mannequin, from belly button down to thigh stumps. It’s like a magician’s ‘sawing the lady in half’ trick gone hideously wrong, or Thing from The Addams Family’s randy aunt. I have a checklist of twenty actions the students have to perform, and I tick them off on my clipboard like a factory supervisor. My hapless charges are meant to treat the dummy like an actual patient, so among the fifteen ticks they need, they must introduce themselves, explain what they’d like to do, obtain consent, alcogel their hands and put on gloves.

  I only failed one student, who missed out all the preliminary steps, instead marching into the room and wordlessly jamming his hand inside. Bareback.

  Another student said to the dummy, ‘Let me know if this is uncomfortable, sir,’ and I very nearly burst out laughing. I put it down to his nervousness rather than ineptitude, as he immediately apologized about thirty times and asked me if he’d failed. He hadn’t – there wasn’t a box to tick for managing to identify the patient’s gender.

  Fifty or so students, a couple of litres of coffee, and a plate of custard creams later, I’m sitting in the pub with Kevin.

  Kevin is a friend from university who texted me last week to say he’d handed in his notice and was leaving his job as a medical registrar at the end of the year to pursue his first love of acting. I responded as if the message said he was booked in to get an enormous spider’s web tattooed across his face, and arranged to meet him in order to stage an intervention. ‘It would be great to catch up before Christmas!’ I replied – code for ‘No! Don’t go! Job before happiness, remember . . .’