‘Oh, hello stranger! I can’t believe you made it in,’ declares a round blonde called Margaret, who is one of the few pretty nurses we have in A&E. She squeezes a Sainsbury’s bag in between three Tupperware boxes on the top shelf of the fridge, before turning to look at me.
‘Ha ha,’ I reply, squinting slightly as I stare into the palm of my hand, looking for the correct change for the drinks machine.
‘No, I’m serious,’ she says. ‘You were last seen dancing to “I’m Every Woman” in a pink Afro wig.’
‘Dancing?’ I stop what I’m doing. I seriously don’t remember the wig or the song or the dance. I don’t normally dance. Shit. I must have been extremely drunk.
My heart is now beating a little fast and I am beginning to sweat.
‘Still,’ she shrugs, ‘at least you weren’t discovered in the medical store on all fours giving Mr Mukti a blow job like Lorraine in ICU.’
‘Dr Lorraine?’ I ask, like it makes a difference.
‘No, physio Lorraine,’ replies Margaret.
‘It’s always the physios,’ interjects the head nurse, folding her arms, as she queues up behind me to use the drinks machine. Short and dark with a bosom the size of a sofa, Sister Andrea is not the sort of woman you want to mess with, in every sense of the word. ‘They are quite the party animals.’
‘I must say I didn’t see any of your lot holding back when it came to the drinks,’ I say, remembering trying to elbow my way through the scrum of nurses who were about two to three deep at the bar.
‘Yes, well,’ she says, pursing her lips slightly as she looks up my nose. ‘At least my girls can dance.’
Making a tit of yourself at the annual mess party is de rigueur, especially if you are leaving the place. Every hospital has a few huge piss-ups a year and the plusher the hospital the posher the piss-up; a few of them, like the Chelsea and Westminster and St Mary’s Paddington, even have a couple of black tie or fancy dress balls on top. However, every hospital has a mess that all the doctors and nurses contribute to. Each of us pays a few quid a month into the Mess Fund and in return it keeps us in tea, coffee and toast, and every so often a big fat grand of cash gets put behind a bar and the doctors try to get a few shots in before the nurses steam in and glug back the lot. Although judging by my hangover I appear to have been quite successful last night at kicking those angels into touch.
‘At least he didn’t throw up, grope any nurses or have sex in the Ladies,’ says Louise with a bright white smile, sipping on a Diet Coke at the door. Even dressed in her scrubs Louise is gorgeous. Small and slim, with short dark hair, she is sharp and funny and fantastically clever. This is also her last day in A&E before she goes on to St Thomas’s, where she will eventually specialize in maxillo-facial surgery. She is already being groomed for the top, by the slightly sweaty-lipped consultant on the fourth floor, who seems to have quite a line in sexy young Max Foxes (glamorous maxillo-facial girl students) following him around. ‘They found two condoms and a Dutch cap on the floor of the toilets this morning,’ she declares. Somehow it doesn’t sound that grubby coming out of her mouth. ‘I know everyone’s a bit hot under the collar because it’s the end of term, but I would’ve thought after the dose that went around post the last mess party people might have learnt their lesson.’
‘It’ll be the physios queuing up for penicillin,’ announces Andrea, tapping the side of her nose. ‘Mark my words. By the way,’ she adds, on her way out of the door, ‘the big box of Terry’s All Gold in my office is out of bounds. The parents of that young girl with the broken leg who came in over the weekend brought them in last night and I am regifting to Oncology. They don’t get many gifts in the cancer ward, so hands off!’
‘I am quite happy not to see another chocolate as long as I bloody live,’ says Margaret, her hands very much in the air.
‘You’re safe from me,’ says Louise. ‘I’m not a Terry’s fan.’
You would be amazed by the amount of chocolates that turn up in Andrea’s office. As is obvious from the size of her, she is the one who usually takes care of them. It depends where you are in the hospital as to what sort of gifts come your way. The nurses in Maternity get given chocolates but they also get money, as some cultures believe in tipping the midwife, or whoever is around at the time of the birth. Consultants always get champagne. Lots of champagne. I remember Julian telling me that when he worked in IVF for a few months, he got three bottles of Moët in his first two weeks. The senior old boy consultants who have private practices and efficient Rottweiler secretaries always talk about acceptable and unacceptable presents. Whisky is. Gin is not. Wine is. Vodka is not. And champagne is always, obviously, gratefully received. The lovely consultant I was with last year would joke about his wisest cancer patients waiting five years before turning up with a cheque made out to his favourite charitable foundation to say that he had done a good job.
I watch Louise putting her delicious-looking Marks and Spencer lunch in the fridge, and take out my cold sandwich. I am just about to sink my teeth into the dry white crust when a junior doctor comes running into the room. His face is bright red and he is sweating with panic.
‘You! And you! Who the hell is on duty here? It’s all kicked off in A&E. There’s some bloke in reception having a fucking stroke!’
8–9 a.m.
The panic is over by the time I have put my sandwich down, drained my can of Coke and made it into the A&E waiting room. The flapping junior doctor had managed to get most of the department to drop everything and run to his rescue, and the poor bloke having the stroke is totally surrounded by willing and very able pairs of hands and is being wheeled past me straight into an empty bay to be hooked up to the monitors.
Weirdly, strokes are quite a common early-morning presentation. Normally the stroke has occurred at some point in the night and the person wakes up unable to move an arm or a leg. It is, however, quite unusual, I have to admit, for someone actually to have the stroke in the reception. Then again, I have ceased to be shocked and surprised by anything that goes on here.
I poke my head into Andrea’s office. She has her broad back to me and is typing away at the computer. She senses me behind her and stretches across a plump left hand to protect the large box of Terry’s All Gold on the edge of her desk. I can almost hear her growl. One of the corners is squashed. She clearly hasn’t guarded them that well, I think, as someone’s already dropped the box on the floor.
‘I have eyes in the back of my head,’ she declares.
‘I am not interested in your chocolates,’ I reply.
‘Well it’s not my body you want,’ she says, spinning around in her chair, her hands resting on her round stomach, her short legs crossed at the ankle.
I put on my sweet, vulnerable, butter-wouldn’t-melt face. ‘I was wondering if you have any paracetamol?’
‘That all?’ she asks, swiftly opening her top drawer and fishing out a couple of white pills which she then drops into a nearby white paper cup before handing them over. ‘You’re the third person to ask me this morning.’
‘Thanks,’ I say, knocking them back in one.
‘You need water,’ she says.
‘Mmm,’ I agree, a little too late.
It takes me a couple of eye-watering gagging gulps to get them down.
‘How is it so far today?’ I ask eventually, wiping my eyes and nodding across towards the A&E waiting room.
‘The usual mix,’ she shrugs, her back once again to me. ‘Someone’s already complained that the man with the stroke jumped the queue, so I directed them to the CDU.’
‘That is naughty!’
‘I know!’ She laughs.
The CDU, or clinical decision unit, is where we put people who are cluttering up A&E. We follow what is known as the Manchester Triage system, which is a way of assessing patients as they arrive in the hospital. The administrations nurse or receptionist notes down the symptoms and gives each patient a colour. Red means you will be seen immediately and is u
sually something life-threatening. Yellow is serious, but you won’t die if you have to wait a bit. Green is minor, and if you are given blue you may as well go home because no one is going to give you the time of day this side of Christmas.
After you have been allocated a colour, the long wait begins. However, due to government guidelines no one is allowed to sit in the A&E waiting room for more than four hours, hence the handy use of the CDU. It is just another place to put patients to sit, a place where there are no time limits to their sitting and no other edicts as to what will happen if they sit there too long. They have officially been processed and are no longer in the A&E system. Some patients, mainly the drunks, are put there for the whole night. It is basically a nice warm place for them to snooze and sober up before we kick them back out into the world in the morning. If you are not drunk and asleep, the CDU is a bad place to be.
‘You on with me today?’ asks the lovely Louise as she breezes past me.
‘Yup.’
‘D’you know which consultant?’
‘Let’s hope it’s not Rob,’ I reply.
Louise raises her eyebrows and gives me a small nod to show that she understands exactly what I mean.
Rob is charming and nice and great company but he is an old-school surgeon with a bit of a coke problem. In his early fifties, he was once brilliant and now isn’t. He is great to work with, or rather safe to work with, until about lunchtime, then he gets too wired to make much sense and usually has to disappear or be disappeared for the rest of his shift. If he has been up all night, which does happen fairly regularly, he thankfully doesn’t come into work at all. He calls in sick, or just doesn’t bother to show. In any other walk of life he would have been dismissed long ago, but because he is a consultant and because he was once really rather good, everyone covers for him and he gets paid not to turn up when what he really needs is a kick in the pants and a stint in rehab. But hospitals are littered with people who don’t pull their weight. The rarefied world of the consultant means that they answer to few, and just so long as you don’t kill anyone and are seen a few days a week walking through the wards with a clipboard and a concerned look on your face, then you’re still in business.
I follow Louise into the consultation area. Ours is one of those old Victorian hospitals that really needs knocking down and rebuilding instead of being added to and made over every decade, which is what every successive government has done for the past forty years. We are a big old teaching hospital with such a fine and distinguished reputation that nobody can bear to close or relocate us. So when we need some more space for another department with some more beds, we expand into neighbouring houses or office blocks. What we would all really like is a huge great purpose-built place like the Chelsea and Westminster with an atrium and a carpet and a sexy café meet-and-greet facility, which feels more like a shopping centre than a place for the sick. But, sadly, we are old and buggered and short of space, light, equipment and adequate ventilation. Everything is a bit crap and run down and has seen better days, including A&E. We have ten cordoned-off bays with pale-green curtain divides, and another six to eight private rooms where you can actually close the door. There doesn’t seem to be any particular logic to where each patient is put. You would think the more serious the case, the more private the room, but these private rooms are quite hard to get big groups in and out of, so if you are at death’s door and awaiting the crash team, the best place to be is a bay. It’s quicker to get more hands on the deck and there is significantly more room for people to jump up and down on your chest.
I walk over and check the computer to see who is next in line. Your work rate, or ability to get through the list of incoming patients, is monitored, so a high and quick turnover is the order of the day. There are some doctors who cheat the system and deliberately choose patients who have been referred to A&E by their GP. They are known as ‘medically’ or ‘clinically expected’ and are much easier to deal with than the morass that is the unfiltered general public. Their cases have already been ‘worked up’ and gone through, which means they slide through the system so much more easily. They do not really qualify as an A&E admission, but once clicked on on the computer system they count as your patient and make you look super-fast and efficient. You can admit them and send them on to the relevant department before your next-door neighbour has even got round to taking his patient’s blood pressure.
‘This is June,’ says Margaret, as I look up from the computer. She takes me by the elbow, hands me a clipboard and ushers me towards an old lady lying on a trolley. ‘She is seventy-six years old and fell on a slippery wet pavement this morning on her way to post a letter. She’s hurt her hip.’
‘Oh, right, thanks.’ I look down at the notes and then down at the patient, a rather sweet-looking old lady with a tight grey perm. ‘Hello, June,’ I say, leaning over and using my special slow and loud old-lady voice. ‘I am—’
‘I may have fallen over,’ she interjects, ‘but it hasn’t affected my hearing.’
‘Oh, I am sorry,’ I say, taking a step back and smiling. There’s life in the old bird yet, I had better cut the crap. ‘Where does it hurt?’
‘In my hip.’ She winces, shifting on the bed.
I start to feel around the top of her leg as gently as possible. The last thing I want to do is make her feel more uncomfortable than she is. ‘How long ago did you do this?’
‘About half an hour ago, I think. My neighbour found me in the street. I live on my own, you see.’
‘I see.’ The joint is already quite swollen, the feeling of a break unmistakable. ‘On a scale of one to ten, how bad is the pain?’
‘Ten.’ She’s looking me straight in the eye and I can see she isn’t kidding. ‘And I have had three children.’
‘I am afraid to say that it is a break. I’m not sure how bad just yet but we’ll send you up to X-ray and have a look at it.’
She nods.
‘Do you have anyone you can call? Someone who can be with you?’
‘I think my neighbour is calling my youngest,’ she says.
‘That’s good.’ I smile. ‘And we’ll get you something for the pain.’
I tap the back of her cold, dank, thin hand and her other hand grabs hold of mine.
‘Thank you,’ she says, both her voice and hands shaking.
I have to say, of all the orthopaedic injuries, a hip fracture is my least favourite, mainly because the outcomes are so poor. There is the terrible statistic that 70 per cent of patients who fracture or break their hip die within two years – something like 1,150 people every month in the UK. This is mainly down to the obvious fact that if you fall and break your hip, your balance and therefore your health cannot be very good. And neither, of course, can your bone density. The other reason hip injuries are so often fatal is that the pain of the fracture means the patient stays in bed, and doesn’t move. It hurts too much even to cough, so they don’t. The lungs fill with mucus, the mucus breeds bacteria, because bacteria love that sort of shit, and before you know it you have pneumonia. And from there, the only way is down.
I look at June and think about her three children and hope that she is one of the lucky 30 per cent who make it. She looks quite sprightly and with it. Perhaps it was just this shit August drizzle that got her, and not her lack of balance at all.
Margaret disappears off to call the orthopods, or orthopaedic surgeons, to get one of them down for a second look while I fill out an X-ray request form. I am tempted to write down JFDI on the form – just fucking do it – to see if I can get them back any quicker than the usual two hours, but I think perhaps it’s a bit early in the morning to start bullying people. I’ve a long shift ahead of me and I don’t know when I might need to call in a favour.
‘Broken hip?’ asks Louise as she stands behind me waiting to use the computer.
‘Yep,’ I say. ‘Poor old thing.’ I find it quite hard to concentrate when she stands this close to me.
‘Christ, we used
to get three or four of those a day in Eastbourne.’
‘That’s OAPs for you.’
‘We had nine in one night once.’
‘Nine?’
‘It was icy and windy. Some old biddy was blown over on the promenade and another was chased by seagulls and fell over.’
‘Either that or she had been at the sauce.’
‘They’re dangerous things, seagulls.’ She smiles at me. ‘I was attacked by one once, pecked me on the head. I think it was after my fish and chips.’
‘How long were you in Eastbourne?’
‘Six miserable months in Orthopaedics.’
‘Oh yeah.’ I nod. ‘I remember you saying.’
‘I was fresh out of medical school. They were a bunch of tossers in Orthopaedics. I’ll never forget one of the surgeons asking who was assisting him in theatre that day, and I put my hand up. He sighed and rolled his eyes and said, “God, I may as well be on my own then.”’
‘The sexist!’ I say.
She looks at me, confused. ‘Sexist? No, it was nothing to do with that. It was because I was fresh out of college,’ she snaps, picking up her clipboard and bustling past me.
Oh. I stare at her swinging hips as she sashays through A&E. I was just about to tell her about my time in Bognor, at the Bognor Regis War Memorial hospital, when I was also a shiny new junior. All hospitals, despite their specialisms, and the roaming nature of the doctors that populate them, are only ever really a reflection of the community they serve. So, for example, Coventry hospital, because it is at the intersection of the M40, M1, M42, M5 and M6 motorways, was always full of patients who’d had road accidents. Barts and the Royal London, because it’s in Whitechapel, is always full of stabbings and shootings. Bognor, as we had Butlins down the road, was constantly having to deal with the fallout from fights between Redcoats and big East End families who’d come in gangs of fifty on holiday. The police had to be called several times to A&E to break up brawls, and on particularly heavy nights we used to have to have security guards keeping the two groups apart.
Hospital Babylon Page 2