Hospital Babylon

by Imogen Edwards-Jones

  ‘You all right?’ asks Ben, arriving in the next-door stall. ‘That was a bit touch and go.’

  ‘Do you think?’ I say, stifling a yawn. ‘It was pretty textbook to me. We get quite a few of those in a month. They’re normally surrounded by a bit more of an entourage than Timmy.’

  ‘Jerry,’ corrects Ben.

  ‘Whatever his name was or is, I am quite tired,’ I say, finishing up.

  ‘Well, do you want some of this?’ asks Ben, shaking his cock and pulling up his trousers before plucking a white envelope out of his scrubs pocket.

  I obviously look a little shocked.

  ‘What?’ he says. ‘Like he’s going to fancy a line in the next twenty-four hours.’

  ‘True,’ I say.

  ‘Anyway, it’s A&E perks.’

  Drugs, like cocaine, heroin and E, are normally confiscated when they come into A&E. Although quite what happens to the drugs when a patient is relieved of their gram, pills or packets is anyone’s guess. There’s no particular precedent or protocol for patients’ drugs; I think everyone just presumes they are destroyed or thrown away, which of course they are. Sometimes. And sometimes they are not. The good stuff gets pocketed and used up elsewhere; the rubbish gets thrown away. The pills tend not to be pinched, because the patients with pills who end up in A&E are, of course, the ones who are having a bad time and who are clearly in possession of some bad gear. The powder is the stuff that goes walkabout. And who can blame us? A cheeky gram here and there. After all, there’s nowhere else in the department to put the stuff!

  ‘A small one?’ asks Ben, already in the toilet cubicle, chopping one out with his hospital ID card.

  I have to admit I am tempted. I am shattered and I could do with a little something to get me through the next couple of hours. But the idea of going back home and having an argument with the drunken Emma when I’m a little wired means I’d lose all the moral high ground. Quite apart from the fact that I have just had to resuscitate someone who’s been using this very stuff.

  ‘No thanks,’ I say.

  ‘If you’re sure,’ says Ben, taking a biro out of his top pocket and pulling out the ink tube. He puts the hollow plastic case to his nose and snorts a line of white powder off the loo seat. He gags a tiny bit as the coke hits the back of his nose and throat. ‘Urrrh,’ he coughs. His eyes water. ‘That’s good shit.’ He looks at me and licks his finger before running it over the top of the loo seat, picking up any residue and rubbing the same finger over his gums. ‘Have you ever managed to get your hands on any NHS coke?’

  During rhinoplasty, or nose jobs, a substance called Moffat’s solution is used, 6 to 10 per cent of which is cocaine, mixed with adrenalin and sodium bicarbonate. It is put up in the nasal lining before the operation to help stem the amount of bleeding. It comes in a pot with two grams’ worth of paste in it and any of the solution that is not used is either poured down the sink or thrown in the sharps box. During which time the anaesthetist will announce over and over again, ‘I am getting rid of the Moffat’s solution, I am not throwing the Moffat’s solution in …’ It’s all very worthy and we all have to watch as the potent pick-me-up is thrown away.

  ‘Sadly, no, I haven’t.’

  ‘I bet it would blow your head off,’ he says, sniffing. ‘I had to fill in for someone who was caught pinching drugs when I was training, but he was caught taking diamorphine and diazepam.’ He sniffs again as he emerges from the cubicle. ‘He was injecting the stuff. It took them over a year to catch him, and when he was finally caught there was no hand-wringing or any of that shit. He was put on four months’ leave, he got a rap across the knuckles, and that was that.’

  ‘How did he get caught?’

  ‘It was one of the nurses who finally noticed that Trevor, or whatever his name was, was very keen on the drugs key. They didn’t notice when the vials of diamorphine went missing, only that one doc was very helpful when it came to getting supplies for people.’

  ‘I think they are a little tighter here,’ I suggest.

  ‘More’s the pity,’ says Ben. ‘I mean, you use the stuff every day, it would be quite nice to have a shot or two. We know how it works, we’re hardly going to OD or anything, are we? Just a bit of fun.’

  ‘I can’t say I’m too keen on trying that one.’

  ‘Yeah, well, if you hang around here long enough, it’s enough to turn anyone to drugs.’ He grins. ‘Ever thought of chucking it all in and becoming a GP?’

  ‘A GP? My dad’s a GP.’

  ‘What? One of those hundred-and-seventy-grand-a-year ones, the ones who “earn more than the Prime Minister”?’ he asks, doing the quotation-marks-in-the-air thing.

  ‘Sadly not.’

  ‘I’ve been looking into it,’ announces Ben. ‘You know, if the old blow-jobs-for-Botox thing doesn’t work out I think I could cope with a life of coughs, colds, chicken pox and the odd bit of housewives’ depression. I know it’s a fine line between boredom and a nice life, but I bet I could tread it.’

  ‘My dad always says that being a GP is ninety-five per cent boredom and five per cent sheer panic.’

  ‘I’d be good at that,’ Ben responds. ‘I’m a good listener. Did you know that in the US they’ve worked out that if you let a patient wang on for thirteen minutes they will leave your surgery happy, happy in the knowledge that they have really been listened to. Apparently twelve minutes won’t cut it. Only thirteen.’

  ‘Brilliantly we have only five- to ten-minute slots here in the UK. The patient has to be in and out in a maximum of eight minutes for the system to work at its optimum level.’

  ‘That’s why everyone always feels so hard done by,’ he chuckles. ‘But then, all those guys care about is hitting their quality achievement targets and clocking up some “Quality Operation Framework” points, and trousering a nice big fat Billy bonus.’

  ‘I don’t think all GPs are that mercenary,’ I say.

  ‘Well, they should be,’ says Ben. ‘It’s dog eat dog out there and the government is going to cut through everything like a knife through butter; they’re just softening up the public at the moment. They used to want to save all elements of the NHS, but if there’s enough briefing against doctors, telling everyone how much we earn all the time, talking about bonuses, then everyone will say “Oh fuck ’em, halve their cash, what do we care?” Mark my words,’ he says, tapping the side of his nose. ‘Anyway, where do you want to end up?’

  ‘Royal London,’ I say. ‘Best trauma unit in the country.’

  ‘Yeah,’ he nods. ‘If you have to get run over, do it just outside the Royal London. If you want to set fire to yourself, do it next to the Northwood, best plastic surgery and burns unit in the country.’

  ‘Give birth?’ I ask.

  ‘Oh,’ he says, ‘that’s a hard one. Maybe Tommy’s – best view in the country, over the Thames at the Houses of Parliament?’

  ‘Worst place to have an accident?’

  ‘Oh God,’ he sniffs. ‘So many to choose from. Somewhere shit up north that you’ve never heard of until they start killing people and then everyone pretends that they’re shocked and that they haven’t been fiddling their stats for years? God, I remember working in a hospital where we would cancel all operations because we knew someone was coming to inspect the A&E department. We’d stop all operations so that this sod, who must have been in on it too, would say “Isn’t it great, there’s no waiting for beds, there’s no one in the corridors, everything works really well. Here, have some more money and a little performance-related bonus.” And then they’d bugger off, we’d start operating again, and there’d be trolleys in the corridors. All sorts of shit.’

  ‘If you don’t hit targets, you don’t get your money, and if you don’t get your money, your hospital withers on the vine – so you have to lie,’ I agree.

  ‘Are you sure you don’t want a line?’ Ben says suddenly. ‘I think I fancy another sharpener before going back out there.’

  ‘No, no thanks
. But be my guest. I’d better get back out there now, in fact.’

  I leave Ben in the toilet to rack up another line and talk to his reflection and go to check on Jerry. Stacy is with him, checking the heart monitor.

  ‘How’s the BP?’ I ask, checking his chart.

  ‘Down to one twenty over eighty,’ she says. ‘He seems to be a lot more comfortable.’

  ‘Good. And the girlfriend?’

  ‘She’s wearing out a trench, pacing up and down in the waiting room.’

  ‘You should tell her to go. Jerry will be going up soon so she may as well go home.’

  ‘Sure,’ she says. ‘It’s busy out there.’

  ‘It’s always busy out there,’ I say. ‘I suppose I should help Sanjay, Alex and the others out.’

  ‘The two juniors are looking very stressed,’ she smiles.

  I go over to the computer and pick up another case.

  ‘Mr Richards,’ I call. ‘Mr Richards?’

  Two men, one middle-aged and the other quite elderly, come towards me. The older man, wearing split working-men’s boots and an overcoat tied with string, looks a little disoriented. It looks like he’s been sleeping rough. The younger man is much better dressed. I sit them both down together in a cubicle and start to take notes. It transpires that the older man is the younger man’s father and has been missing for two years. The father has a history of mental health problems and has just turned up out of the blue at his son’s house. I nod and listen to the story. I ask the old boy all the requisite questions to see if he is on the ball. What day is it today? The date? His name? The name of the Prime Minister? He gets them all correct except the name of the Prime Minister, but I have to say that flummoxes quite a few people these days. He doesn’t appear to be suicidal. I check him over briefly, and he’s not ill either. So I share the good news with the son that his father is fine and can go home.

  The son starts to get cross. He wants me to admit his father.

  ‘I’m afraid I can’t,’ I say. ‘I have no grounds to admit him. He is well.’

  ‘But he has mental health problems,’ says the son, beginning to raise his voice.

  ‘Not at the moment.’

  ‘He’s had them before.’

  ‘Not now he hasn’t.’

  ‘But he’s crazy!’

  ‘Not now he isn’t,’ I insist.

  ‘OK, well, we don’t want him at home with us!’ he shouts. ‘The man’s got nits. I don’t want him to give them to my kids.’

  ‘I’m sorry, sir, but this is not a drop-in centre for the elderly, nor is it a place for you to dump members of your family because it is inconvenient for you to look after them. If you want to dump your father, then I’m afraid you need to take him to Social Services in the morning and perhaps they can arrange for him to be housed elsewhere. We can’t look after him here. This is a place for accidents and emergencies, and your father is neither.’

  Perhaps I should have been a little more tactful, but I found his callousness in front of his own father rather shocking.

  ‘You fucking racist!’ he shouts at me. ‘Just because I’m black.’

  ‘It has got nothing to do with the fact that you are black, Mr Richards. Black or white, I am not admitting somebody into hospital unless they are ill.’

  ‘YOU! ARE! A FUCKING RACIST!’ He is really shouting now, jabbing his finger at me, and I can feel my heart pounding. It is not a pleasant experience. ‘I want your name! Give me your name! Give me your name! I am going to report you!’

  I am not obliged to give him my name, and the last thing I want is him coming after me. So I refuse. This, of course, pisses him off even more.

  Finally, Sandra arrives to try to defuse the situation. Mr Richards Jr fills her in on my supposed racism and the fact that I refused to give my name.

  ‘I’m sorry, sir, but you need to calm down,’ Sandra says. ‘Or I will have to call security.’

  Unlike some hospitals, where emergency staff wear ripcord alarms around their waists that they can pull in the event of their being threatened, we have nothing here. And even when security does arrive they can’t do anything; they can’t touch a member of the public unless that person has actually been physically abusive towards us. Punters can stand there and verbally abuse you for fifteen, twenty, thirty minutes at a time, indeed as long as they like, and no one can do anything about it.

  Mr Richards does not calm down, and it takes about five minutes for the two sleepy security officers to arrive. They are about as effective as a fart in a wind tunnel. Mr Richards carries on shouting at me for the next quarter of an hour while a concerned crowd gathers. Some try to reason with him, others just keep telling him to calm down, but he is not listening. He keeps on shouting and I just stand there and take it. Eventually, when I realize that he is not going to stop and the security guards are not going to do anything for fear of being sued, I give up.

  ‘Here,’ I say, ‘here’s my name.’ I write it down on a piece of paper. ‘And now, can you please leave me alone!’

  1–2 a.m.

  I have to say, now is about the time I wish I had a hip flask in the changing room. After being on the end of an aggressive finger-jabbing tirade like that, you kind of want a few minutes on your own and a shot or two to calm your nerves. Not that Mr Richards is the worst I’ve ever had. I have been hit with a clipboard, punched in the back, and kicked in the stomach as I tried to restrain a drug addict who was chucking stuff around and threatening members of staff.

  Despite all the last government initiatives and clampdowns and £1,000 fines, the level of violence inflicted on us is increasing. One in ten NHS workers has been physically abused on the job; nearly one in five of us has been verbally harassed or bullied. Nurses and doctors have had knives pulled on them; they’ve been punched in the face, seriously beaten up, even sexually assaulted. And no amount of training, or courses, or talks can prepare you for someone who is suddenly going to lash out or get violent. Ambulance crew and staff working with mental health patients or those with severe learning disabilities are obviously more at risk, but a drunk schoolteacher is just as likely to hit you in the face as a crackhead who’s been picked up off the street. There are no standards any more. I have to say it’s one of the most unpleasant aspects of the job. If anything is going to make me pack it all in and open a beach bar in Thailand, or indeed go into the private sector, it’s that.

  Without a shot of vodka to calm my slightly jangled system, I decide to go outside and have a cigarette. As I walk out of the department, Sandra catches my eye. I half expect her to call me back, but she doesn’t. I suspect she would like to come along too, if only she smoked. It was quite intense in that cubicle, and it was actually thanks to her that Mr Richards finally left, taking his poor, confused, tired old dad with him. What sort of welcome home is that, I wonder as I walk down the stairs to the car park. Poor bloke. He’s been two years on the streets and has finally found his way home, only for his son to try to dump him on us.

  We do get quite a bit of Granny Dumping, as it is called in A&E, but more usually towards Christmas. Carers who have had enough and want to go out on the razzle turn up with an old girl, explain that she’s had a fall, or a turn, or a tumble, and we are obliged to take her in for the night for observation. Even if the old person denies what has happened, the carer will argue that they are suffering some sort of dementia and the old person can’t remember what has happened to them in the last three minutes let alone in the last three hours. The carer then runs for the hills or the nearest bar, only to come back the next day to collect the elderly person, nursing a rather rough hangover. And those are the nice ones. We get some who dump and run. They take their poor unsuspecting parent by the hand, lead them into A&E and walk straight out. These are the really bad cases, where the old person does actually have dementia and doesn’t even know their own name, their address or the phone number of their nearest but perhaps not so dearest. We usually manage to trace these people through some route o
r another, but it’s depressing and it’s hard work. There is something deeply callous about dumping someone so old and frail and vulnerable. What these people don’t seem to realize is that they will be the same one day. Let’s hope their own children will be a little more forgiving.

  Standing outside smoking my cigarette, I suddenly shiver with cold, like someone has walked over my grave. I must be tired. It’s all these morbid thoughts I’m having. It’s enough to make anyone miserable.

  I can hear the click-clack of heels coming towards me out of the darkness. I watch as an attractive thirtysomething woman comes towards me. She’s not walking in a particularly straight line; she is certainly out of it. She pauses in the car park and looks around. Although I am quite close by, she doesn’t appear to see me. She stops between two cars and starts to take her clothes off. She whips off her top and short skirt and then rummages around in an orange Sainsbury’s bag. As she takes her bra off and puts on a patient’s gown that she pulls out of the bag, it suddenly dawns on me who she is.

  ‘Nadine?’ I shout.

  She turns around, looking confused, unsure of where the sound came from.

  ‘Nadine?’

  She squints over at me. ‘Who wants to know?’

  ‘Are you Nadine? From Hepworth Ward?’

  ‘I might be,’ she says.

  ‘Well, they’re looking for you.’

  ‘They are?’ She sounds slightly alarmed. ‘Who is?’

  ‘One of the nurses.’

  ‘Oh,’ she replies, looking completely nonplussed. ‘Well, I’m here now, aren’t I?’

  She walks towards me in her high heels and patient’s gown. It’s a rather incongruous combination to say the least. ‘Have you got a fag?’ she asks, looking at me intently. Her pupils are like tiny pinpricks. She’s high as a kite.

  I pull a Silk Cut out of my packet and give to her.

  ‘Got anything stronger than that?’ she asks.

  ‘No.’

  ‘Oh.’