I’d rather not, of course, but I only have an evening of Emma’s rather poor cooking and repeats of Location, Location, Location to look forward to, so why the hell not? It also means I get to miss the first day on Acute Medicine down the road, which is a joy. There’s nothing worse than watching half a hospital wandering around looking for the toilets. I’ve done it a few times now and, let me tell you, it is painful. The patients’ charts don’t get read, the wrong drugs are shelled out in the wrong amounts, and no one knows the entrance codes to the theatres, the drugs cabinets, or even how you sign on at the computer. I’d much rather sit out that chaos watching Holly and Phillip on This Morning with a lapful of toast and Marmite.
‘I’ll phone through to your consultant and tell him you’ve done an emergency double and to give you tomorrow off,’ says Chris, like he’s reading my mind.
‘Perfect,’ I say.
‘Thank you,’ says Louise, looking grateful. ‘I can’t bear that graveyard shift.’
‘It’s fine,’ I say. ‘It’s August and half the population are on holiday. What’s the worst that can happen?’
There really shouldn’t be any need for me to pull a double shift tonight, and technically I’m not allowed to, but it does still happen. Although the days when we came to work on Friday and didn’t leave till Monday are over, they will stand me in good stead tonight. I will be on call, so to speak, and I’ll be given a bed somewhere in the hospital; whether or not I get to lie down on it is a different matter. I am technically supposed to be on a forty-eight-hour week, which basically means that some doctors have become expert shift workers who watch the clock and walk straight out of the building as soon as their hours are up. Gone are the days when you would catheterize yourself just to get through an operation. Now doctors leave halfway through cases, midway through consultations, which means patients going into an operation only to have someone totally different meet them when they come round. There is no longer any continuity of care. Patients are handed on from one doctor to another, with all the nuances of individual treatment lost in transit.
Consultants now have productivity-related pay. They are paid, like celebrities, per PA, or personal appearance. You can negotiate anything between nine and twelve PAs a week with the hospital, which means that those who are rewarded the most are those who play the system the best.
And still we have to do double shifts, and still locum doctors turn up who have already done eleven hours somewhere else before clocking on here. I used to think some of them were workshy tosspots when I caught them catnapping on the coats in the common room, but then you realize they’ve done eleven hours somewhere else and you forgive them a ten-minute lie-down every so often. I remember being so tired that I used to nod off during my own case presentations. I’d be standing at the whiteboard telling my fellow doctors about how I had managed to spot the signs of malaria, then fall into a snooze, only to come round having drawn a big red line over my chart. But, as I said, at least I am well practised at functioning on fewer than five hours, sleep over a weekend, so tonight won’t be too much of a drag. I only pray that we are busy. It sounds mad, I know, but the busier A&E is, the less time I’ll have to think and the less time I’ll have to realize quite how tired I am.
‘Really, thank you for doing this,’ says Louise, giving my shoulder a squeeze.
I have to admit I was hoping for a slightly more generous gesture. Not quite along the lines of Margaret and Steve this morning, but something a little more expansive. A peck on the cheek?
‘That’s OK,’ I shrug.
‘No, I mean it,’ she says. ‘It’s very kind of you. And good luck for next year.’
She leans in to hug me. Better than nothing I suppose.
‘I’m sure we’ll see each other around.’
‘Yep,’ I say. ‘Good luck to you too.’
Not that she needs it, of course. She is pretty and clever, the sort of woman men like me do double shifts for. She’s not going to run into many difficulties. I am on the verge of asking her for her phone number, but I realize it’s a pointless exercise. I am never going to have the balls to call her, and Louise is never going to call me.
‘See you around,’ I add, lamely.
She smiles lamely back and heads out of the office, off to her sister’s birthday barbecue.
Back out in the hall, the locum has turned up. He has dark curly hair and a winning smile.
‘Hi,’ he says, coming over to shake my hand. ‘Ben. I think I’ve worked with you before.’
‘Oh, right,’ I say, searching through my raddled old hungover memory for his name or face.
‘A couple of months back?’ he says.
‘Right, I remember,’ I lie.
‘This is my last locum shift,’ he says. ‘I’m joining a private plastics firm next week. I didn’t get my consultancy – again.’ He rolls his eyes, then moves over to the sterile gel dispenser to clean his hands.
‘That’s annoying,’ I say.
‘It’s more than annoying,’ he asserts. ‘I did a super specialism in rhinology last year so that I could, you know, make myself more attractive, and I was reduced to A&E shifts to make some cash, and now …’ He sighs. ‘Now I’m going to have to listen to people bang on about why they don’t like their noses at a hundred and fifty for a half-hour whine, when I used to do fifteen patients in three hours at Guy’s. But, you know, what doesn’t kill you …’
Ben is one of the growing number of limbo doctors: all qualified but nowhere to go. While many of them earn money doing locum shifts, waiting for a job to come through, others are leaving the NHS to set up in the world of extreme beauty. The world of Botox, collagen and fillers used to be the remit of the beautician with a needle fetish. Rather scarily, anyone with a rudimentary knowledge of eyeliner and Chanel’s new spring/summer colours was allowed to inject anyone else, just so long as they signed a consent form. But these days extremely talented surgeons who were once reconstructing faces after car crashes are now finding themselves washed up on the high street. So the NHS’s loss is the WAG’s gain. Who better to pump your face full of Sculptra than someone who actually knows what goes on below the skin?
‘There are a few perks for pumping carp lips all day though,’ Ben grins. ‘My mate, who owns the practice, says he’s being offered blow jobs all the time.’
‘What?’ Two minutes of talking to Ben and already unemployment is sounding a little rosier.
‘Oh yeah,’ he nods. ‘Blow jobs for Botox. Sex for surgery. It’s all going on. He says it happens at least once a week. It’s mainly the Essex girls and the Russians. They’re twenty-one and they come in and start to rub your cock when you’re standing over them with the needle. Or they rub your hand over their boobs, or run their fingers up and down your thigh.’
‘And does he? You know, shag them?’
‘Sometimes, but you don’t want to get yourself a reputation as a place where you can do that. Otherwise you would be inundated. Imagine how many call-girls get Botox. He’d end up running a knocking shop. But I know he’s done it. Also, you have to be so careful as they can always accuse you of stuff. He has an assistant in there with him, to cover him in case of any difficult behaviour, but the girls always find a way of getting rid of her, asking her for some water, to get their handbag that they have “left” in reception.’ He does the quotation thing in the air with his fingers. ‘There were two girls in a few weeks back, Russian—’
‘He does two patients at a time?’
‘Oh yeah, mothers and daughters, mates on a trip up to town. It’s only Botox and collagen for Chrissake.’
‘True.’
‘Anyway, these Russians came in and started talking between themselves about giving him a blow job and having a threesome with him. Little did they know that he did French and Russian at university before going on to do medicine so he understood every word.’
‘That must have perked up his day no end.’
‘Yes, well, the other day was a little different. He had
this gay bloke in for liposuction. He was doing the gut and the moobs using a local anaesthetic. And while he was sucking away with a probe in one hand, the aspirator in the other, the bloke’s hand crept up underneath the green sheet and grabbed his cock.’
My mouth opens in shock.
‘Yup,’ continues Ben, grinning back at me. ‘So there he is, with both his hands occupied and someone else’s vice-like grip on his genitals. He can’t do anything. If he stops the op the man will just deny it, he’ll lose the six grand for the operation and it will be his word against the patient, and the patient will deny all knowledge, and he’ll probably have to do the op again anyway. Or he can just carry on. The nurses could see what was happening and refused to help him out in any way, shape or form. They just watched his eyes gently water over the mask as he looked longingly at them for help!’
I’m laughing quite loudly now.
‘So my mate had his cock and balls cupped for twenty minutes while he sucked as much fat out of the man’s stomach as possible. It was the quickest op he’s ever done!’
‘I bet, I bet!’ I laugh. ‘So that’s where you’re going after this?’
‘Absolutely,’ he smiles. ‘Think how much more you can charge for your acid peel if it’s administered by a doctor.’
‘Double?’ I suggest.
‘And the rest!’ He winks.
I follow Ben towards the computer. I haven’t laughed this much for ages. It makes such a difference who you work with in this business. I have a feeling this shift might fly by.
Suddenly the swing doors slam open and a gurney speeds in with three paramedics steaming along beside it.
‘Stabbing!’ barks one of the green jumpsuits.
‘Stabbing!’ echoes another. ‘Suspected punctured lung, possible punctured heart and left pulmonary artery!’
‘Stabbing!’ Chris shouts up at me. ‘Get yourself down here, now!’
The next five minutes are hellish. Turns out this sixteen-year-old boy was stabbed through the heart as he got off the bus at his stop, on his way back from football practice. He’d looked at someone ‘funny’, or so the story goes. So the other bloke’s mate stuck a six-inch blade through his chest, at least twice, possibly three times. It took about seven minutes for the ambulance to arrive, and in that time he picked up an entourage. With the victim comes his mother, two sisters, an aunt, their mates and about another six or seven interested parties. A&E is packed. There’s shouting, there’s screaming. His mother keeps shoving her head into the cubicle, beseeching us to keep her son alive.
Despite his black skin, the boy is white. Literally all the colour is draining from his face. There is blood on the floor, blood on the table, a trail of blood all the way up the corridor and back through the double doors. It is pouring out of him. Andrea and Margaret have set up IVs of O neg but it seems to be bubbling straight through him and back out on to the floor. We are skidding and slipping in the stuff. Chris cuts open his chest and both of us stare inside, trying to work out what has happened. It is gory and cut up in there; it is impossible to work out where to start. His young heart is madly pumping away, but it’s running out of blood to pump. His blood pressure is plummeting. His mother is screaming, his sisters are wailing, and Chris and I are desperately searching through the pools of blood and severed pipes trying to work out which ones to try and stem.
‘Here,’ says Chris.
‘No, here,’ I suggest.
‘Oh fucking hell,’ he says.
The pumping heart suddenly ceases. The monitor goes monotone and there is a wild scream from the other side of the curtains. I look at Chris. He is covered in sweat and blood; he looks like a slaughterman after a hard day’s cull. He stares back at me. I am up to my elbows in blood. His expression is desperate. His eyes are hollow. But there is nothing we can do. Nothing.
‘Please can you call it?’ he asks.
7–8 p.m.
It was all over in twenty minutes. From the first slam of the double doors to the horrible sound of the heart monitor flat-lining; it took no time at all. He was alive, struggling for his life. And then minutes later he’s dead. I think it’s the chaos, or the fact that your heart is beating nineteen to the dozen, that makes it appear longer, that makes you feel like you are living three lifetimes in those few short minutes.
But of course the fallout is huge. The family are inconsolable. They want responses to questions no one has answers to. Their son/brother was not in a gang. He was on his way back from football. He was two minutes from his own front door. It’s always the nice ones who get it. The ones who were minding their own business. He did not carry and was not carrying a knife. Although you can hardly blame any of them for carrying knives. It is part of the culture. It’s very hard being a teenage boy in the shitty areas of this city. You get picked on on your way to school and again on the way back. You have to carry a knife for your own protection. Or at least that is what they think. The results of which we see time and time again.
I have stitched up so many young men here who have been knifed while attacking someone or who have been wounded in self-defence, I have ceased to judge who was in the right and who was in the wrong. I tell you, the temptation to do a bad job on some psychotic shit who has brought two other victims in here with him is high. But in the end you do a professional job, because you are a professional; though I might just use a little less painkiller or a slightly thicker needle than usual. But it will all look more or less the same.
Chris and Andrea are dealing with the boy’s parents. His mother is wailing so loudly, her grief is so palpable, that they have closed the office door. No number of cups of sweet tea and biscuits from the Fox’s box that are specially reserved for patients’ relatives is going to calm her down. I can see Chris holding her hand, patting it, stroking, trying to calm her down. She eventually collapses sobbing on his shoulder, and Chris pats her arm.
Eventually the police arrive, all four of them with pens poised, trying to work out how it all happened so quickly and so tragically, in broad daylight, on a dull evening in August. Finally the family release Chris, and are taken somewhere more private for the questions, the recriminations and the what-ifs to begin. The blood is mopped up and the boy’s body is wheeled off to the morgue.
Ben comes up to me in the corridor and taps me on the shoulder. ‘Have you seen a nurse?’ he asks. ‘My PFO in here needs stitches.’
I check my watch; it’s not even seven thirty. ‘That’s a bit early for a PFO, isn’t it?’
‘Office party,’ he says.
The pissed-and-fell-over presentations don’t usually start arriving until after nine p.m. You have to give them enough time to get steaming drunk after work, and three hours of solid boozing usually does the trick. Obviously on ‘special occasions’ such as England football matches, during the Christmas party season, on St Patrick’s Day or even just on a plain old bank holiday, they can come in earlier. But more usually people tend to wait until nineish before falling down the stairs and breaking their faces, or tripping off the pavement and breaking their legs. This bloke, according to Ben, has slipped over in a pool of Pimm’s on a lino floor and cut his forehead open. It’s not serious. It requires about six stitches.
Most of the nurses have changed shift now. Andrea is still here, briefing the fresh batch on what’s been going down in here today. I am just about to be a little pissed off that Margaret hasn’t bothered to say goodbye when I spot her coming towards me in her navy blue coat.
‘It’s a little hot for that, isn’t it?’ I say, looking at her coat.
‘It’s practically autumn,’ she smiles. ‘Anyway, you never know what the weather is doing in here. We don’t see daylight for twelve hours at a time.’
‘True,’ I say. ‘You off then?’
‘Yup,’ she says. ‘I’m having dinner with Steve.’
‘Really?’
‘Well, you know, he’s off tomorrow and, you know, he’s got his girlfriend Alicia …’
�
�I see.’
‘Our last chance,’ she says. ‘Bye then.’ She gives me a kiss on the cheek.
She looks much younger out of her sky-blue cotton/polyester-mix tunic. The flowered dress poking out from underneath her coat makes her look much more girlie and sweet. I can only hope that Steve knows what he is doing. I am not sure Margaret is as Teflon-coated as he thinks she is.
‘I’ll come by and see you when I’m over in this neck of the woods,’ I say.
‘Yeah, you won’t,’ she says. ‘Don’t worry, we’re used to you doctors coming and going and leaving us behind.’
‘Well, I hope to see you one day.’ I smile, and kiss her back. ‘Bye, Margaret.’
‘Bye,’ she says, with a little wave. ‘Tell Steve not to be too long. I’m waiting in the Prince of Wales opposite.’
Steve is clocking off at eight tonight, the lucky bastard. Hopefully we will be joined by another SHO at the end of their rotation, plus another senior consultant at least, to join Ian, as Chris is about to leave as well. Things generally kick off from here on until about two a.m., so we usually have a minimum of a couple of consultants on call, to tide us over the tricky bit. But at this time of year, with everyone moving tomorrow, any sort of shit can happen.
‘Great, you!’ says Ian. ‘Come with me. I’ve just been bleeped. We’ve got a heart attack coming in due to anaphylactic shock. Some dental nurse has eaten a peanut.’
‘Resus two?’ I ask, trotting on after him.
‘Good. We want adrenalin, atropine, the whole fucking medicine cabinet. She is twenty-three years old, let’s try not to lose her.’
The whole of A&E springs into action. Andrea’s ample bosom comes undulating towards me beneath her midnight-blue uniform. Stacy, a nurse who I have worked with many times before, rushes over with IV stands, and Connie is whisking all the monitors into place. Chris is standing to attention despite the fact that he was on his way out, and we are all staring at the double door in tense anticipation.
The doors slam open; the trolley comes speeding in, with two paramedics running either side of it.
Hospital Babylon Page 14