Under the Microscope

by Dave Spikey

  My fab daughter Jill is joint hero because she is loving, caring, dedicated, kind and funny. She had always wanted to be a teacher and after leaving school she won a place at Lancaster University to study for her BA. Since she qualified, she has worked so hard to become one of the most respected and accomplished teachers you will ever find. She applied for an Assistant Head post a couple of years ago and asked me to check her CV. When I read through the document, I was amazed at how much she’d crammed into her career so far. Extra classes in teaching special needs, organizing the school choir and so many other achievements, too numerous to list. I was both stunned and so proud to discover this ‘hidden’ portfolio and the dedication it must have taken to achieve.

  She got the job and is as enthusiastic as ever in her new role. Jill also has a fantastic sense of humour and could have been a comedian; she has everyone in stitches with her animated stories about school life and life in general. Stephen is also very inventive and very funny. I’m absolutely serious when I say that both of them could have made a career out of comedy, had they wanted.

  Nurse Bramwell

  I’VE SPOKEN ABOUT my father earlier and how much of an influence he was. I want to take a moment now to outline to you just why. He was a remarkable man for many reasons, but mainly, in my eyes, because although he had no academic qualifications, he appreciated, understood and was knowledgeable about all aspects of the arts.

  He had books and books covering the works of his favourite artists, notably the Impressionists with Renoir and Van Gogh amongst his favourites. He had a small but impressive collection of classical music and loved opera, singing along enthusiastically to ‘La Donna è Mobile’ from Rigoletto, ‘Il Mio Tesoro’ from Don Giovanni and ‘Nessun Dorma’, long before it was sadly used (and devalued) as a World Cup anthem. I think he made half the words up – but languages were never his strong suit.

  He also loved literature and was a fan of Tolstoy, Camus, Dostoevsky and contemporary American writers. I have many of his books and I have to admit I struggle to finish many of them. His favourite book, however, The Ragged-Trousered Philanthropist, became one of my favourites too, dealing as it does with working-class painters and decorators ‘subsidizing’ their rich employers and the efforts of a handful of men to try to organize others into a union to gain their rightful rewards.

  My dad wrote short stories and took a creative writing correspondence course for years, and had a couple of poems published. I take his handwritten stories out from time to time and trace the words of his perfect handwriting, trying to feel his presence, his inspiration in the ink.

  He was always interested in religion, psychology and philosophy, and flirted with Buddhism, Quakerism and Methodism. In one famous incident, he spoke at length on the subject of Zen Buddhism to the family and friends of my Chinese accountant during a party at his offices. I emerged from a meeting with the accountant to find my dad holding forth to a large group of Chinese people, a can of beer in one hand, peanuts in the other. I could tell he was a bit drunk because he had the habit of speaking out of the side of his mouth like Robert Mitchum when he’d had a few and he was doing this now, allowing the occasional peanut fragment to escape. The crowd listened to him enthralled, hanging on his every word, and it was only later during a chat with my accountant that I learned the reason for their rapt attention. It turned out that they were all Christian, but found my dad’s depth of knowledge of Buddhism fascinating.

  My dad was a communist and we were possibly one of the only houses in Bolton that had the Morning Star delivered every morning. He was a champion of the working classes and even stood for election to Bolton council as a communist and gained 212 votes, bless him.

  It should have come as no surprise to me that shortly after I started working at the hospital, he became acutely interested in psychiatric nursing. He was a caring person, he was intrigued by philosophy and psychology; the surprise was that it had taken him so long to find this direction. There was one massive stumbling block, and that was that, as I previously mentioned, he had no academic qualifications. There was, however, an entrance exam, which he was allowed to take. He passed impressively and began training to become an SRN (State Registered Nurse).

  It was sort of weird going onto wards to take blood or assist in bone marrow aspirations with my dad attending as senior nurse, giving me the odd smile and wink! He was a painter and decorator by trade, this was completely mad – what was going on? It was brilliant.

  Over the years that followed, my dad passed all his exams, qualified as an SRN, then an RMN (Registered Mental Nurse), then became a deputy charge nurse (staff nurse), and then finally a charge nurse (sister). There were hiccups along the way; one of his patients once ate all the tropical fish because the dinners were late. Dad found him sitting by the fish tank, buttering slices of bread then diving in for another couple of guppies. Later, he prevented a murder when a patient, irritated by the bloke in the next bed’s snoring, went to the kitchens across the road and returned with a meat cleaver with which to decapitate said snorer. Luckily, Dad popped into the side ward to check up on things in time to see the patient raise the cleaver ready to strike.

  And what else? Oh yes, my dad bathed a visitor. Yes, he did. He was working nights on Vickers 1 ward with another male nurse called Brian, a big bruising bloke who liked a drink and a laugh, when they received a phone call to say that, although it was approaching midnight, they should expect a new patient called Mr Richards for admission. Mr Richards was schizophrenic. As it was late and he was more than a little agitated, they were advised to bathe him, as he smelled rather badly, and put him to bed.

  Half an hour later, a man with a suitcase wandered onto the ward. Seeing my dad, he explained that he was a little disorientated and asked if he could please be shown the way out.

  My dad said, ‘Of course. Mr Richards, is it?’

  ‘Yes,’ the little man replied. ‘Which is the way to the car park?’

  My dad shouted for Brian and introduced him. Brian asked him where he was off to and the man said, ‘I’m going home,’ and Dad and Brian got hold of him gently and said, ‘You can go home after you’ve had a bath.’

  ‘I don’t want a bath!’ said the little man.

  ‘Yes, you do,’ said big scary Brian, and he and my dad took the man into the bathroom, stripped him, threatened him when he started shouting, and then bathed him, put him in pyjamas and sat him in bed.

  About an hour later, the senior nurse on his rounds popped in to see if everything was under control. He apologized to my dad for not letting him know earlier that Mr Richards had been admitted to Vickers 2, where he’d been a patient before. My dad and Brian looked at one another before my dad said, ‘No, he’s here. We admitted him an hour ago.’

  ‘You can’t have,’ said the Senior Nurse, ‘I’ve just seen him on Vickers 2.’

  ‘So who’s that, then?’ said my dad, throwing his head back to indicate the bed in the corner. They approached the little man, who was sat up in bed, face grim and arms tightly folded.

  ‘Hello, Mr Richards,’ said the Senior Nurse. The little man sat stony-faced as the Senior Nurse turned back to Dad and Brian. ‘That’s his brother. He accompanied him into the hospital and he was taking his clothes home in the suitcase.’

  D’oh!

  My dad loved working there, but, by and by, his interest in sociology increased. He applied for and won a scholarship to Leeds University to read sociology, in preparation for another change of career into social work.

  And that decision led to a happy meeting with him later in my own career. Despite our scam with the rat DNA test, I passed my HNC in Haematology and Serology in 1972 – at the first attempt – and immediately embarked on what was called at the time the ‘Special Exam’, which is now equivalent to a Masters degree. No one at Bolton had ever taken this two-year advanced course, but I was so gripped by the ever-expanding science that I had to progress. As well as completing a tough, three-paper written exam, I also ha
d to endure an oral exam with an interviewing panel, comprising two consultant haematologists and a senior biomedical scientist.

  Mine happened to take place at Leeds University. And so it was that on the day I passed my Haematology Special Oral Exam, I met my dad, who was studying at the adjacent university, for a couple of celebratory pints. How great is that?

  Senior Service

  NOW I WAS fully qualified, three big things happened. The first was a promotion to Senior Biomedical Scientist. The second was that I was asked to become an occasional lecturer on the ‘Special’ Haematology course, which was a great honour and achievement. I started off doing a couple of lectures a term, but after a few years I was giving around ten in total upon a variety of topics (although no blood coagulation, obviously).

  In a foreshadowing of my later career, I tried to introduce an element of comedy into the lectures, hopefully to make them more memorable and less tedious. I remember tackling the subject of haemoglobin breakdown and using a series of slides to illustrate the molecular progression from haemoglobin to biliverdin to bilirubin, and then I slipped in a slide of Leeds United legend and captain Billy Bremner as being the final breakdown product. It got a laugh, trust me! In later years, I stopped lecturing when I became too busy with stand-up and when the students got more and more anal – and actually started drawing Billy Bremner in their lab books, believing he was a haemoglobin breakdown product. Honestly.

  The third big event was that I was deemed qualified to undertake emergency out-of-hours on-call work, which was a massive boost, not only in professional achievement, but also financial terms. I saw myself as that SAS operative I’d aspired to be when I chose Haematology as my specialist subject; a one-man SWAT team called in to work alone, under pressure, with lives at stake.

  On my first night, a Sunday, I waited anxiously by the phone, which rang as early as 7 p.m. – it was promising to be a baptism of fire! The hospital sent transport to pick me up (as I didn’t have a car at the time) and we hurtled in to do a full blood count on a lady who’d had a PPH – a post-partum haemorrhage. If the haemoglobin was low, I might have to cross-match blood for an emergency transfusion!

  As it turned out, it wasn’t low, so I came home – and the phone didn’t ring again that night. No matter, I’m £2.50 up and I’m officially an experienced on-call technician.

  Ah, but the glamour soon wears off … Within a couple of years, you absolutely dread that phone ringing – and now, of course, it’s always ringing. We’re on ten calls a night, maybe two sessions a week, not getting any sleep and still having to turn up for work at 8.45 in the morning.

  And driving in from home is such a bloody pain, especially at three o’clock in the morning when you’ve only been in bed for ten minutes after returning from the last call. It’s February, it’s pitch black, and you’re battling through the snow and sleet; your windscreen wipers aren’t working properly and the heater’s on the blink and you’re dashing in to do a six-pint cross-match for a ninety-three-yearold with an aortic aneurysm and you know that that’s only the start of it. If they attempt a repair of the aorta, which they will, he’s going to need far more than six pints of blood cross-matching and you can say goodbye to any more sleep tonight because he’ll also need his blood counts and platelet count checking regularly and his blood coagulation monitoring and chances are that that woman who was bleeding on maternity and the bloke with oesophageal varices on C2 are going to want more blood and God knows who else will be admitted; and the only thing that keeps you going on that cold drive in, the one thing that gives you hope as you batter through the wind and snow and hail, is the thought that by the time you get to the hospital, he could be dead. Oh yes – sorry, but it’s true, and he was ninety-three so he’d had a good innings and I NEED TO GET SOME SLEEP!

  And you get in and he has died and you say a prayer of thanks and head for bed, but then the phone rings and a woman on the gynae ward has had a bleed and can you check her haemoglobin level please? That’s not a problem, that’s a two-minute job – but then the doctor hits me with a gem. He tells me that if the haemoglobin level is less than 10 g/dl, I’ll need to cross-match two units of blood.

  ‘Right,’ I say, thinking, ‘Less than 10 g/dl at three o’clock in the morning? What are the chances of that happening?’

  I run the test, the haemoglobin is 9.6 g/dl. Mmm, what to do now? Phone it through and confirm that the doctor still wants to transfuse two units of blood … or let the sample stand on the bench for ten minutes until the red blood cells settle out and become a bit more concentrated? Yes, I’ll do that. Test it again in ten minutes and the Hgb is 10.2 g/dl – result. Off to bed.

  By the way, this is one of the mad laws of medicine. Junior doctors will always request a transfusion if the haemoglobin is less than 10 g/ dl, which is nonsense – who came up with that rule? An idiot, that’s who. Consider that a pregnant woman’s normal haemoglobin could be, say, 11 g/dl, so that if she has a bit of a bleed and let’s say loses around a pint of blood, this level could drop to below 10 g/dl. According to this ‘rule’, she will be transfused two units of blood. This is patently rubbish – I regularly lose a pint of blood when I donate at the blood transfusion donor sessions and all I get is a cup of tea and a couple of biscuits.

  I believe that we should implement this in the NHS. Furthermore, if someone loses two pints: cup of strong coffee and a few chocolate HobNobs. Three-pint bleed? Here’s a pot of Darjeeling and a packet of Garibaldis. Much cheaper, much more efficient and a damn sight safer.

  There are small unexpected moments of joy that surprise you during the long endless nights on call – and one is when you test a haemoglobin and it’s as low as 3 g/dl and no hot-beverage-and-biscuit combo is going to help, and you phone it through to the ward and then this happens.

  Me: I’ve got the haemoglobin result for Mr Dawson.

  Nurse: Okay, let me write it down. What is it?

  Me: (Resignedly.) It’s three grams.

  Nurse: Oh wow! That is low.

  Me: I know.

  Nurse: What a shame! He’s a Jehovah’s Witness.

  Me: Oh no, is he? Well, thanks then. (I hang up.) GET IN!!!!

  (Run round the lab with shirt pulled over my head in celebration.)

  TATT

  OVER TIME, the amount of test requests received in the lab skyrocketed. I think this was due to two things – firstly, clinical judgement seemed to be a fading art; and secondly, the world now seems to be populated with hundreds, nay, thousands of time-wasting hypochondriacs.

  We began to see more and more requests with the Clinical Details as ‘Tired all the time. ? Anaemia’. Only about 10 per cent would be anaemic; the rest were tired. Go to bed earlier, exercise more, adopt a healthy diet and stop skiving! We got tired of typing the details into the system and so we invented acronyms. TATT = Tired All The Time. The doctors soon picked up on this and started to use it routinely themselves on requests, in addition to TATTD (‘Tired all the time, doctor’ – said in a wimpy, whiny voice).

  As time went by and requests continued to rise, we invented more and adopted established acronyms to amuse ourselves and other hospital staff. These included:

  NFB

  Normal, For Bolton

  FORD

  Found On Road Drunk

  FLK / FLP

  Funny-Looking Kid / Funny-Looking Parents

  TFTB

  Too Fat To Breathe

  PFO

  Pissed, Fell Over

  FTF

  Failure To Fly (suicide jumpers)

  WOFTAM

  Waste Of F***ing Time And Money

  LTBB

  Lucky To Be Breathing

  CTD

  Circling The Drain (for patients who just will not die)

  GFPO

  Good For Parts Only

  And from the wards:

  TUBE

  Totally Unnecessary Breast Examination

  CODE BROWN

  loose-bowel-related incident />
  Patients with TATT also usually had a variety of accompanying vague symptoms. Backache, sore feet, mee-graines [sic]and very often ‘depression’, said in a pathetically weak voice over the phone. I’m sure that you have worked with or known some wimpy, work-shy, pathetic excuse for a human being who has been off for months and months with ‘depression’. I get incredibly annoyed with staff who phone in sick with ‘depression’.

  Them: I won’t be in work for a while. I’ve got depression again.

  Me: Oh, again? Have you? That’s three times this year, isn’t it?

  Them: Yes.

  Me: Look, that’s not depression, that’s fed up, that’s down-in-the dumps.

  Them: No. I can’t get out of bed in the morning.

  Me: Neither can I! Make a bloody effort, you lazy git.

  Don’t get me wrong here: clinical depression is a very serious and tragic disorder, and so I find it outrageous that these contemptible people belittle the condition by adopting it as their ‘sickie’. The government are introducing means-testing for people on long-term sick and I put forward a test for people with ‘depression’.

  You get them in a room and sit them on a chair and ask them to be clear about the nature of their illness. When they say ‘depression’, you get a monkey on a bike to ride across the room in front of them. If they don’t laugh, then they really are f***ing depressed because a monkey on a bike is the funniest thing in the world. Imagine a smiley monkey, wearing a red-and-white tank top, waving its funny little arms about and making monkey noises as it peddles furiously … it’s double funny. If they don’t laugh, they are depressed; but if they do, which they will, it’s ‘Get back to work, you malingering sod! And give me that walking stick! You don’t need it, never have!’