by Adam Kay
He comes to meet me outside the hospital I’m examining in; neither of us really knows the area. Lonely Planet are yet to release a set of guides to the shithole streets most NHS hospitals seem to find themselves on, so we duck into the first pub we see, a hundred yards from the revolving doors. This is our first mistake: it’s the sort of pub the Krays might swerve because it looks ‘a bit too stabby’. They’ve made the vaguest nod towards the festive season: half a canister of snow-spray applied to a couple of the windows that aren’t boarded up, and some sun-faded Coronation-era paper chains rustling around the top of the bar.
Kevin has absolutely no interest in pep talks or discussing the merits and pitfalls of his momentous decision (stupid, but brave, I guess), so we focus on the more important business of getting drunk.*
‘What white wines do you have?’ I ask, trying to keep my voice as even as possible, so I’m not mistaken for a cop. The barmaid points one of her remaining fingers at a small row of individual plastic bottles of Chardonnay in the fridge and looks at me like I’m Princess Margaret demanding a Brandy Alexander. I’m at the losing end of the beggar–chooser ratio here, so I thank her nervously, grab my Château Sarsons and Kevin’s pint of lager, then ferry them over to the table Kevin has found. I sit down and the glasses make a disconcerting squelch as they settle into the sticky lake on the tabletop.
A few deep swigs of tepid battery acid later and I’m toasting his decision. I get halfway through asking for a mention in his first Oscars speech when a guy wanders over and puts a full pint of lager on our table. He explains that he’s just got a round in, but his mate who’s drinking beer has had to dash home. Would we like it? – he doesn’t drink the stuff. We take a proper look at our mysterious benefactor – Daddy Warbucks he is not. He looks and smells like he’s just been exhumed, and his fashion inspiration seems to come from Stig of the Dump’s charity-shop toss-out pile: mismatched shoes, and a raincoat customized with enough stains to warrant its own CSI franchise. He sees we’re mulling over how to answer, so chirps, ‘Don’t worry, it’s clean!’, which obviously adds considerably to our worry.
Kevin weighs up the odds, then gratefully accepts his free pint, and our evening continues. I sit facing the room, and watch transfixed as, ten minutes later, our friend shambles over to another table, brandishing another pint of lager. I point it out to Kevin immediately. What is this guy’s game? Given the toxic fumes radiating from his hell-coat, it would be understandable if his pals couldn’t stand more than a minute of his company, but surely another friend can’t have just left, unable to start their pint? Are we being filmed for an episode of Secret Millionaire?
Kevin moves his seat round so we can both keep an eye on what this guy is up to and, as a precautionary measure, puts his half-finished pint to one side. The man shuffles over to the bar and buys two pints of lager. He takes them back to his table and drinks a quarter of the first pint, followed by a quarter of the second. Next, he moves both glasses onto the floor, looks around, then bends down as if to tie his shoelace, before returning the first glass back to the table, filled to the brim.
This isn’t the kind of pub in which you particularly want to be caught staring at someone, but we subtly reposition our seats to get a better view. In retrospect, ignorance was absolute bliss. It wasn’t his shoe he was fiddling with, but his trouser leg which, when lifted up, revealed a catheter leg bag.† He was, horror of fucking horrors, opening the tap on the leg bag and allowing the contents to stream into the glass of beer, creating the world’s most grotesque shandy.
I react more calmly than Kevin – unsurprising, given only moments before he’d been knocking back his free piss-beer like Paris Hilton on the Krug. I wonder out loud why the bloke might be doing this. And then whether any infectious diseases are potentially transmissible by drinking tramp urine. Some species of parasite perhaps? Kevin’s response will sadly have to go unrecorded: he was far more concerned with racing to the toilet like Roadrunner on methamphetamine and forcing himself to purge. Not that his gag reflex needed much encouragement.
Guess I’ll need to be more specific next time I tell H I’m going on the piss with Kevin.
* Unthinkable then, but just two years later I’d be out of the profession myself, and not even a naked, begging Chris Hemsworth could have persuaded me to change my mind.
† A discreet way to collect urine if you use a catheter is a thick plastic bag strapped to your leg. At the bottom of the bag is a valve (much like on a box of wine) to empty the contents into the toilet. Or a pint glass.
Wednesday, 17 December 2008
I’ve been unlucky enough to have drawn Mr Ribbons in the gynae Secret Santa. It’s annoying to be forced to spend a tenner on someone who despises every aspect of my existence, from my handwriting to my knot-tying, and who I, as an entirely reasonable result, despise in return. I could get him something shit that he hates, but he’ll only throw it away immediately and that’s no victory at all.
H, presumably high on tinsel fumes, suggests I buy something thoughtful and nice, to try and build bridges. I explain that the only bridge I’d like to build has Ribbons’ concrete-encased corpse in its foundations. I want to get something that will piss him off and inconvenience him so hard that it results in some kind of public breakdown.
‘OK then. Buy him a guinea pig.’*
* I bought him a set of sandalwood styling wax and hair pomade. He is bald.
Monday, 22 December 2008
A couple of paediatric nurses are running around, recruiting volunteers to be Santa for an hour or two in the grotto they’re running in outpatients. I’m shocked to even be asked – surely I’m far too young and slim to pass for Santa. I’d sooner work as a flambé chef on a Zeppelin, so I make my excuses. ‘But . . . I’m Jewish!’ If it’s going to lumber me with extra Christmas shifts, it might as well get me out of this.
‘The kids won’t know!’ the nurse replies, then pauses. ‘Assuming you’re not planning on showing them your penis?’
Tuesday, 23 December 2008
‘And how frequently are you managing to have sex?’ I ask the couple in infertility clinic.*
‘About once a week,’ the husband replies. ‘It would be more but I work nights and I’ve been having a bit of trouble with the old downstairs neighbour.’
I always admire the talent for wordplay a patient will suddenly acquire when referring to their own body and its functions. This is definitely a new one. Not the bog-standard John Thomas, the nauseating
‘Well, you needn’t worry about your . . . neighbour,’ I say, praying for a thesaurus to drop out of mid-air so we can all start speaking English again. ‘Shift work can upset the body’s natural rhythm and cause difficulties with sustaining erections.’
It turns out he meant his actual downstairs neighbour, who’s been having noisy building work done during the day, so they’re staying with his parents and sleeping on the sofa, limiting their romantic opportunities.
* Not an unreasonable question – some people seem to think a monthly fumble will cut it. (The answer is ideally every day or two during the woman’s fertile window.)
Thursday, 25 December 2008
Christmas number five – I think we’re getting into Norris McWhirter territory here. H is with family: plans made before my rota was even announced.
Mr O’Hare is on call for labour ward so, as tradition holds, he appears at lunchtime to cut the turkey in his casual wear. To him it may well be ‘this old thing’, but to me it’s the kind of get-up I’d wear to accept a knighthood. He does it with great ceremony in the staff room and insists the scrub nurse stands opposite him and passes each utensil as he needs it (‘Fork please, sister’). It’s funny and rather sweet, bringing a much-needed home-from-home atmosphere.
‘See,’ I say to Karen, an SHO doing her first Christmas Day on call, ‘it’s fun here at Christmas – we�
��re like a work family!’ She’s unconvinced, preferring the idea of her family family, and asks me if there’s a blood test for Stockholm syndrome.
The turkey ritual manages to briefly circumvent the usually immovable barrier between consultants and the rest of us. Well, to a certain extent; we’re not going to start texting each other jokes and braiding one another’s hair. This is the season of goodwill, yes, but there are boundaries: we still call him ‘Mr O’Hare’ – calling him Gerry would be like calling the Queen ‘Liz’.
After a few minutes of turkey and semi-forced chatter, he pulls me aside to run through the labour ward board. There’s a patient at 7 cm dilation going for a vaginal breech delivery.*
‘You confident with those?’ he asks, and I reflexively blurt out that I am, so he nods and strides off home. I’m not remotely confident. I’ve only delivered one vaginal breech before, and that was an uncomplicated birth that didn’t require forceps. If I’m bleeped to do a breech forceps delivery, I’ll be doing it for the first time and unsupervised.
My mind goes straight to the worst-case scenario, then plays it all forwards: the family for whom Christmas becomes the day on the calendar they dread forevermore – every carol they hear, every cutesy festive film and stodgy mince pie a reminder of the time a registrar blagged it rather than admitted he wasn’t experienced enough.
Maybe if it wasn’t today I’d have answered Mr O’Hare differently. I’m not even allowed to use his first name – it’s going to go down like a semen soufflé if I’m the one who takes him away from his family at Christmas. And that’s exactly what will stick in his mind when I’m applying for consultant jobs and someone taps him up for a reference. ‘Kay – I remember the chap. Couldn’t deliver breeches.’ Not the thousand days I stayed late, or the thousand emergencies I handled on my own, but the one time I admitted I was out of my depth and asked for help.
I hide in the toilet, looking up on my phone how to deliver an aftercoming head with forceps – not the first time I’ve been in a cubicle with a phone in one hand looking for videos, but the first time quite like this. Unsurprisingly there is no such thing on YouTube, but I do find a useful PowerPoint presentation – it was designed to compare techniques, but comes in handy as the medical equivalent of a York Notes crammer.
I feel a bit more prepared . . . but not enough. I spend an hour seeing patients in triage, feeling like I’m about to vomit up everything I’ve eaten in the last five years. The midwife supervisor gives me fair warning: the breech patient will start pushing in half an hour. It’s all getting slightly too real now. After a few agonizing minutes weighing up the relative horror of each scenario, I bottle it and call Mr O’Hare. As his mobile rings, I’m extremely aware that if I’d just told him in the first place, he’d have been far less irritated than he will be now that I’ve let him get all the way home, his fork doubtless poised over its first pig-in-blanket.
I’m halfway through my stuttering apology when Mr O’Hare hushes me to say he’s just downstairs in his office. Did I really think he was going to go home with an undelivered breech on labour ward? I don’t know whether to feel relieved or insulted, but relieved edges it.
The mum starts pushing and I’m sitting at the nursing station with Mr O’Hare, waiting for either the midwife to call us in to help or for a baby’s cry. Happily it’s the latter – though it does mean I needn’t have fucking called him in the first place. I apologize for wasting his time but he says he’d much rather be called a thousand times for something that was fine in the end than not be phoned once about something that went wrong.
‘I’ve done the job thirty years and it still scares me sometimes,’ he confides, and it’s the first time I’ve ever heard a consultant say something like that. I feel reassured hearing it from the safest pair of hands on labour ward. Maybe we’re not so different after all (Aston Martin aside). I respect him for showing his vulnerability and I like to think it’s been a significant moment for us both.
He stands up to leave.
‘Merry Christmas, Adam.’
I pause.
‘Merry Christmas, Gerry.’
He looks at me like I’ve just announced I have sex with household pets, and walks off. Bollocks.
* The majority of breech (bottom-first) babies are born by caesarean section, which is generally thought to be the safest method of delivery for the baby. In a patient with no other risk factors and a unit with suitably experienced midwifery and obstetric staff, vaginal breech should always be offered as an option. In a minority of vaginal breech births, the body will deliver but the head gets stuck, at which point forceps are needed to deliver the head fairly smartish.
Sunday, 28 December 2008
Normal rules don’t seem to apply in hospital. The clothes are different, the food is different, the language is different and, gallingly for Brits, queuing is out. Watching someone else get wheeled off while you’ve been waiting longer must be frustrating, but that’s just how it goes.
I feel sorry for the patient doing the whole ‘I was here first’ routine to Linnie, a Welsh terrier of a midwife supervisor who takes absolutely zero shit from anyone.
‘Oh, I’m so sorry, madam,’ Linnie replies. ‘But I think you’re confusing my labour ward with a deli counter.’
Wednesday, 31 December 2008
Last nightshift of the run. I phone the SHO to check he’s not drowning in a sea of patients in A&E. There’s only one left, so I offer to review her and clear the department. ‘It’s just a six-weeker with bleeding,’ he tells me.
As soon as I’ve hung up I’m annoyed with myself for not pulling him up on that – no one’s just anything. It’s no less of a pregnancy for this patient than for anyone else, however many weeks advanced. I’m about to call him back when a patient taps me on the arm.
‘That applies to you too.’ Excuse me?! She points to a ‘No Mobile Phones’ notice on the wall, its laminate edges looking as tired and frayed as I do, informing us that phones interfere with sensitive medical equipment. From the abject disgust on her face, you’d think I had a tourniquet round my arm and a syringe full of heroin dangling out. (Though I’m not ruling that out by the end of the shift.)
I want to tell her the truth, that mobile phones interfere with fuck all, and we only have the signs up so patients aren’t sitting around crowing into them all day, driving the rest of us mad with their inane conversations. But that would rather give the game away, and would also mean this conversation lasting much longer than my nerves can stand, so instead I paint on my best meek face, mutter an inaudible apology and head down to A&E.
Patient EN definitely isn’t ‘just’ a six-weeker. I can tell from their raddled faces and raw eyes that she and her husband have been crying. They’ve only stopped because they’ve run out of tears and energy. They’re in their early thirties, this is their fourth cycle of IVF and the one that’s got the furthest. I want to say they’re lucky to be in an area that offers three rounds of IVF on the NHS – edge a few miles south, and it’s one try then bye – but if three have failed then all it means is three times the agony. They’ve ploughed every penny they’d saved for a deposit on a house into this fourth cycle. All their chips on the same square, both financial and emotional, and here I come, the croupier who’s going to sweep them away.
I scan her and tell them the uterus is empty, that the bleeding very sadly does mean the end of the pregnancy.
Their desperation is heartbreaking. ‘But we had a normal scan a week ago. Can you have another look? Maybe you missed it?’ I know I haven’t missed anything but the patient is right there, begging for a final ray of hope. Her eyes searching mine, the husband stock-still next to her, frightened to speak in case it makes the unthinkable true. I repeat the scan, have a second look, pass her some paper towel to clean off the ultrasound gel, and shake my head.
Amid the grief, she searches for answers and explanations. She asks if there’s any way the scan she had last week could have caused this? I know she wants me
to say yes – she needs there to have been a reason, something they could do differently if there were to be a next time. I’ve got nothing for her.
I talk about next steps. It’s a speech I’ve given so many times that I fail to stop myself before saying, ‘There’s no reason you can’t try again.’ But there is, isn’t there? Unless they win the lottery. We live in a world of lotteries, of being in the right place at the right time, of all kinds of sheer luck – and theirs has probably just run out.
There’s a sudden racket from the other side of the blue curtain – crowd noises, general chaos – someone’s put the volume up on the TV. I realize before my patient what’s about to happen and steel myself in an emotional brace position. Five! screams the TV. Four! Everyone in A&E joins in. Louder now. Three! Two! One! Cheering, whooping, party poppers, stamping feet, Auld Lang Syne.
‘I’m sorry,’ I say. About the noise, about their baby, about the IVF, about other people being happy. ‘I’m so sorry.’
Sixth Christmas
Security break up their fifty-eighth fight
Happy Christmas to all, and to all a good night
Tuesday, 15 December 2009
‘Was Daddy there when I was born, Mummy?’
‘No, he wasn’t, baby-who-Adam-has-just-delivered. You see, Mummy went into labour while Daddy was out at a Christmas party.’
‘So he didn’t make it to hospital in time?’