by Adam Kay
‘Well, darling, he made it to hospital in time, but he was so drunk that he whipped out his cock when the doctor was putting the forceps on your head, and they had to call security to boot him out.’
Wednesday, 16 December 2009
H was genuinely surprised I made it to the theatre in good time for the start of A Christmas Carol, probably because overrunning shifts have meant I’ve missed the first half of almost every other play we’ve seen this year. Unfortunately, when we took our seats in the stalls I immediately fell asleep. After eight labour ward shifts on the trot, my brain had clearly declared it an emergency and just powered down.
H prodded me awake the first couple of times I nodded off, before the gentleman to my left took over. I may not be the silent sleeper I’d assumed I was. Sensing the murderous intentions of other paying customers in our immediate radius, we headed home at the interval so as not to cause any more disruption. Still, makes a nice change to miss the second half of a play for once.
Saturday, 19 December 2009
This job is really adding to the ‘other skills’ section of my CV – today, magistrate joins the list alongside social worker and cleaner. I meet midwife Georgette and Prof Pruitt (a nice Australian consultant who works on labour ward with the approximate frequency of Halley’s Comet) in closed session to discuss the case of Patient DH.
The defendant has been on the antenatal ward for the last three weeks with major placenta praevia* and constant vaginal spotting. Fingers crossed she won’t do anything too dramatic for the next five weeks, at which point baby will be near enough fully cooked, and we can perform a caesarean under controlled circumstances. There are four units of crossmatched blood for her on labour ward at all times, in case things kick off and we need to deliver her in a hurry. She’s effectively sitting in a prison cell with an unexploded mine in the corner.
The complainant, Patient TW, has informed me on my ward round that the defendant is running a ‘Christmas card racket’ from her bed, drawing ‘shoddy cards’ and selling them to other hospital residents in aid of ‘some unnamed charity’. ‘It’s not what the NHS is about, is it?’ she asks.
My ‘And . . .?!’ goes down like a turd in her tea, so in the absence of a formal ombudsman system, or – as I suspect the patient would prefer – my immediate dismissal for insubordination, I promise to speak to my consultant.
It’s fair to say that, no, the cards are not of the highest quality, like something a kid might bring home from school that you’d discreetly bung into the recycling rather than display on the Smeg door.
Our supergrass is wrong about the charity being unnamed, however: it is mentioned on the back of the cards, and the defendant has collected all the money she’s raised (£30) in an envelope to pay in once she’s out of hospital. Whether she actually does that or not, we cannot guarantee, but as frauds go, I doubt it would give Rumpole too much of a migraine.
Our verdict is unanimous: the defendant should be acquitted of all charges. She’s locked up in hospital over Christmas and when she’s not bored out of her mind, she’s probably worrying about the ticking time bomb nestled in her uterus, and is doing a nice thing to keep herself busy.
Talk turns to other enterprising inpatients. Prof tells us when he was a junior doctor they found out one of the antenatal patients had been doling out blow jobs in her cubicle to male inpatients – apparently at fairly competitive rates.
‘What did you do?!’ Georgette and I ask in unison.
‘I think we just gave her a side room.’ Registering our mouths hanging open like the back of a bin lorry, he adds, ‘This was back in Australia, of course,’ as if that somehow explained it.
* Placenta praevia means the placenta is lying too low and getting in the way. Major is the most severe type, where it sits right over the neck of the womb, and baby has to be delivered via the emergency exit. Because of the risk of heavy bleeding, patients who have recurrent symptoms are often kept on the ward for their own safety, hopefully having a boringly uneventful time, until baby’s far enough along to be delivered.
Sunday, 20 December 2009
Out for annual Christmas drinks with school friends. Well, annual for them. The fact I’m not on a shift is met not so much with surprise, but like we’re in a horror film and I died in a fire five years earlier.* Everyone seems disproportionately happy to see me. I don’t owe them any money so maybe they’re finally warming to my revolting anecdotes after all these years?
Oh no, it’s not that. Now we’ve hit our late twenties they only care about my professional qualifications – everyone’s starting to procreate and to them I’m a one-man antenatal clinic. They all but form a queue to ask me questions. ‘Is it true walking under power cables can make the umbilical cord get trapped around baby’s neck?’† ‘Is there a vegan alternative to breastfeeding?’‡
Jack asks me what I think about 5D scans – he and his wife are ‘thinking of getting one done privately’ and wonder if they’re worth the money. Typically, if you have to ask whether something medical is ‘worth the money’, the answer is no – unless it’s a pioneering operation to reattach a severed head. But nobody wants to hear me smart-mouth my way out of awkward questions. Instead I say I don’t really know enough about them to answer, but wonder aloud how the private sector are able to offer two entire additional dimensions.
* At the degree ceremony they never mention the huge impact medicine will have on your social life. It’s not simply missing things because of your rota. It’s more that if it’s 5 p.m. and someone starts bleeding out on labour ward, then you stay and sort it out. There’s no one who can take over from you, so you end up leaving a few hours late – this means you’re routinely texting people to cancel on drinks or dinner at the last minute. By the third time you’ve cancelled on the same person, you’ve become the ‘flaky friend’ and you stop getting invited out. Your social circle contracts before your very eyes, like a miserable magic trick.
† What the fuck?
‡ Also, what the fuck? Surely breastfeeding is the single most natural thing in the world? And – chapped nipples aside – no animals are getting harmed. Plus, this baby’s sole source of nutrition in utero was blood, which isn’t an especially vegan start.
Monday, 21 December 2009
Giving my bleep the same hopeful look I give the front door when I’m waiting in for a parcel and need to leave the house. Silence. Today of all days, nothing. Surely labour ward can serve me up one of its usual time-consuming 8 p.m. emergencies to give me an excuse to miss the dreaded Christmas Ball.
‘Ball’ is stretching the word to the very perimeter of its meaning – the Met Gala it is not. This annual St Dominic’s tradition is held in the greasy, windowless basement function room of a local two-star hotel. H has declined to be my escort on the grounds of ‘absolutely no way’, so I will be going alone or, if the stars align (assuming they aren’t too busy pointing the three kings to Bethlehem), detained at work.
But alas, my prayers go unanswered – you’d have thought god might have embraced the novelty of someone desperate for a medical crisis, given most people are begging for the opposite. I plod to the locker room and change into my cobbled-together ‘smart clothes’; an increasingly tight but not yet indecent black suit that has somehow survived since medical school, and a white shirt whose stains are invisible if I don’t take off my jacket. Plus the pièce de disgustance, my trusty Christmas tie. Its edges are tatterdemalion and poor Rudolph looks like he could do with a few weeks at Champneys. I give the button an exploratory press, assuming its battery is long-perished. But while my TV remote needs fresh batteries every other week, this fucker seems to have seen out half a decade. It’s definitely entering death-rattle phase – the noise it makes isn’t instantly recognizable as ‘Jingle Bells’ but more of a low, slow, droning honk, like a tuba being buried at sea. I reach for a stitch-cutter blade and euthanize the bastard thing out of its misery. No such reprieve for me: my obligatory entertainment awaits.
For dinner I receive a starter of what was presumably mozzarella in a previous life, surrounded with limp, geriatric supermarket salad leaves, like liver failure on a plate. Because I’d failed to pre-order the vegetarian main course, I get an ‘I’ll see what I can do’ from the nearest elf, delivered as convincingly as a ‘you look great’ from an ex. What eventually arrives is my starter, again. Then there’s a dessert of chocolate slurry so faeculent that I scan the room looking for the dog responsible.
During coffee-coloured liquid, we are treated to a thirty-minute speech from the medical director, which is only marginally less interesting than the teaching session he gave last month on polypharmacy in the elderly. Finally there’s a ceilidh band. (Why? If we were much further away from Scotland, we’d be in the sea.)
Despite my initial Scroogings, it’s actually an enjoyable evening, entirely out of step with the sum of its parts. I get to talk to my doctor, nurse and midwife colleagues – and not just to impart medical information. They’re all so different tonight, and it’s not only the tuxes and evening dresses. They’re duplicates of their normal selves – only more animated, more fun, more human. Once we put our scrubs on, it’s clearly all role-play. I realize I hadn’t really thought of them as people before – with lives and interests and a sense of humour – and feel bad for assuming I was the only one with a personality (such as it is). Especially as that’s precisely what frustrates me about the other players in this game – the patients and the politicians, forgetting that we’re human.
‘We should hang out more often,’ I say to one of the gynae nurses and we clink glasses. I really mean it, but we both know the truth: we won’t have the time. Work will make sure of it.
Wednesday, 23 December 2009
At this time of year the hospital is always Locum Central. With so many new faces on labour ward, it’s a bit of a game of Russian roulette, with the barrel of the gun pressed against the clammy temples of the patients’ heads. Will they have overstated their experience by five years in the hope of blagging it and getting maximum Christmas spending money, while I end up doing two people’s jobs to keep a floor full of mothers and babies alive? Or will I get a ludicrously experienced gynae consultant,* and spend my shift drinking tea and reading trashy magazines in the coffee room, the ones with headlines like ‘Slay Ride: Santa murdered my husband!’ and ‘My daughter’s a minotaur!’
Heather, the SHO about to depart for the evening and hand over to a locum, nudges me as she spies a figure walking down the corridor. ‘That’s a bad sign.’
‘What is?’ I ask.
She points at the guy loping towards us, wearing a locum agency lanyard. ‘Velcro shoes . . . can’t tie knots.’
* This is actually not as unusual as you might think, thanks to the UK system’s treatment of foreign-trained doctors and the endless hoops they have to jump through to get a substantive job here. It’s at best zealous and at worst xenophobic.
Friday, 25 December 2009
There are busy shifts, there are very busy shifts, and then there are apocalyptic, balls-to-the-wall shifts where you’d gladly swap places with the turkey crisping away at gas mark 4.
It’s not until we’re nearing the end and I meet Patient GA in her Christmas jumper that I even remember what day it is, like when you get out of the cinema and it’s still light, or come round from a thirty-year coma.
‘Where do you work?’ I ask, seeing from her notes she’s a paediatric nurse. She tells me and it turns out I’d done an attachment there as a medical student, so we swap stories about the mad ‘Paternoster’ lift system.*
She’s come in with abdominal pain at twenty-eight weeks, and is accompanied by her mother. I examine her and strap her onto the CTG machine, while mum goes outside to do what I probably should have done four hours ago – phone home and check in on everyone’s Christmas Day. Once the prospective grandmother is out of sight, Patient GA leans in and whispers conspiratorially, as if she’s about to tell me she isn’t actually pregnant.
‘I’ve not worked there since July,’ she says. I raise an eyebrow. ‘It just got too busy, too stressful, too horrible. I haven’t worked as a nurse at all since then, but I can’t face telling my parents.’ I can totally understand – a combination of shame, a feeling of failure, a dereliction of duty; letting down the people who invested so much in your career.
‘It’s not why I got pregnant, but it gives me a while to work out what I’m going to do next . . .’ She cocks an ear as she hears familiar footsteps trooping over. ‘I’m just going to tell them I decided not to go back after maternity leave.’
Her mum bounds back into the cubicle with news of who won Monopoly and the terrible traffic Brian ran into on the M4 – we clam up as though teacher has just walked in. The pain has settled and her CTG is normal, so I send her home.
I drive back home myself, five hours later and two hours late, covered in fluids that would give the most specialist fetish clubs in Berlin a run for their money, and wishing I had some suture material to secure my eyelids open. But I’ve still got a smile on my face – I delivered six healthy babies today to six healthy mothers. The job still gives a lot back, despite all it takes from you: the Christmases, the social life, the family life. I wonder what I’d tell my parents if I ever left. Probably nothing – how else could I hang on to my cast-iron excuse for skipping Christmas at their house? Join the army?†
* This is a bizarre, antiquated, open-fronted lift that moves constantly between floors on a wire like a ski lift, or a toaster in a hotel breakfast buffet. When it gets to your floor, if you don’t leap off in time, you’re doomed to stay on it, eventually finding yourself travelling through an eerie, pitch-dark, terrifying roof space that seems to exist outside of linear time, before the lift continues its journey and goes back down again. When up in the void, you generally feel the need to mutter a quick prayer that you’ll make it back safely: ‘Our father . . .’ – or ‘pater noster’ in Latin.
† When I left medicine, I did tell my parents – not immediately, but within a couple of weeks. In fairness, I don’t generally speak to them much more often than that (I’m not a Kardashian). But I didn’t tell them why I’d left – that I couldn’t hack the job. I gave the impression I was doing really well after the break-up of my relationship and using this change of circumstances as a catalyst to finally follow my dream of becoming a writer. They reacted as if I’d just announced I was moving to Alpha Centauri to knit scarves out of space dust.
They only found out my real reasons seven years later, when my first book came out.
Wednesday, 30 December 2009
‘And what’s your name?’ I ask the ten-year-old accompanying his mum to antenatal clinic.
‘Coyle,’ he says.
‘That’s a nice name,’ I reply, my child-communicating skills still second-to-none. I’ll be asking who his favourite member of ABBA is next, or whether he got a spinning top for Christmas.
‘It’s because I got pregnant with him when I had a coil in,’ his mum informs the room, loud enough to induce labour in a Serengeti elephant.
Thursday, 31 December 2009
I’m not a huge fan of forced fun and, at those rare parties my rota allows me to attend, I’ll always look for an excuse to leave early. Not much really cuts it when it comes to escaping before midnight on New Year’s Eve, but Patient CW has just about aced it with the fairly rock-solid excuse of going into labour. She’s got twins on the way and is booked in for a caesarean next week, but it seems her babies are anxious to put in an appearance before the last glass of champagne has gone flat.
She’s huffing and puffing away, but she’s only a couple of centimetres dilated, so I explain there’s no great hurry – we’ll do the
caesarean at some point tonight.
‘So it could be any time tonight?’ asks her husband.
I say it depends on what else might be happening on labour ward and making sure it’s safe and convenient for the paediatrics team and anaesthetist – but at time of press, labour ward isn’t madly busy. He looks at me furtively, as if he’s about to offer to sell me some weed outside Camden Town tube station, and asks if the babies might be delivered at midnight. It’s a couple of hours away so I tell him it’s not unfeasible. He gets that conspiratorial look about him again – is he planning to eat these children?
‘So . . . technically,’ he says, ‘you could deliver one just before midnight and the other just after, so they’d be born in different years?’
He looks at his wife for her take, and she agrees it’s the best idea ever. This is because it is the best idea ever. How can I not be in on it? Rewarding as the job may be, I’m not immune to the thrilling prospect of featuring in a local paper as the obstetrician who transcended the accepted workings of time. This is as close to fame as I’m likely to get: I’m never going to appear on Big Brother – if I wanted to share a sweaty dorm with people whose mental age was twelve I’d have become a scoutmaster.
Also, why not? Both babies’ CTGs are totally normal and she’s not contracting away too dramatically, so I can’t see any negative implications for the patient, the babies or my GMC registration – only the best anecdote in the history of the world, and a set of twins who spend the rest of their lives explaining why they were born in different years.
I liaise with the anaesthetist and theatre staff about getting mum round to theatre for half eleven – enough time for her spinal block, and then I can deliver the babies right on cue. There’s enough of a buffer zone in the timings; I can rush a baby out in under a minute for a crash section, or equally well take the fifteen-minute scenic route, cauterizing every tiny blood vessel so I barely spill a drop.