by Adam Kay
The nursing staff’s disappointment is palpable when today’s consultant, Mr Hopkirk, turns up around 10 a.m. wearing chinos and a jumper. Before the cries of ‘Grinch!’ and ‘Ebeneezer!’ get too deafening, he explains that the last time he was on call on Christmas Day, he chucked on the outfit and beard for the ward round and was halfway through when an elderly patient suddenly went into cardiac arrest, so he dashed over and started CPR while a nurse went to fetch the trolley. Unusually, the CPR was successful,‡ and the patient gasped back to life to the sight of a six-foot Santa liplocked with her, his arms on her chest. ‘I can still hear her scream,’ he said.
‘Go on,’ says one of the nurses, like a child failing to hide their distress that their Christmas present is a calligraphy set not a kitten. ‘Maybe just the hat?’
* A lot of individuals (I’m not calling them patients; there’s nothing wrong with them) come to hospital under the misapprehension they’re in any way ill – known as the worried well. If this is because of something they’ve read online, they’re called cyberchondriacs.
† Consultants are generally on call from home outside of normal working hours, giving telephone advice when needed, and only coming in for major emergencies.
‡ If your heart stops, you’re probably going to die. God is fairly strict on that matter. If you collapse on the street and a bystander starts CPR then your chance of survival is around 8 per cent. In hospital, with trained personnel, drugs and defibrillators, it’s only about twice that. People don’t realize quite how horrific resuscitation is – undignified, brutal and with a fairly woeful success rate. When discussing Do Not Resuscitate orders, relatives often want ‘everything to be done’ without really knowing what that means. Really, the form should say, ‘If your mother’s heart stops, would you like us to break all her ribs and electrocute her?’
Wednesday, 17 January 2007
‘In order to encourage use of public transport’ there is no staff car park at the hospital – an admirable sentiment that would land me with a two-hour twenty-minute commute each way. Instead, I’ve opted for a seventy-minute drive, leaving my wheels in the visitors’ car park. The pricing system must have been dreamt up by someone who realized their chances of winning the lottery more than once were pretty skeletal, and thought there must be another way to raise a similar annual revenue. It’s £3 per hour, with no discount for long stays, and is applicable every hour of every day and every night, except for Christmas, which presumably they decided would be greedy.
The only exception is for women in labour, who get a parking voucher valid for three days when signed by the labour ward supervisor. I’m on good terms with the supervisors – not so much for the fact that day in, day out I resolve obstetric emergencies, but because I occasionally bring in a box of Viennese whirls. As a result they’re happy to sign me a parking voucher every few days, and have therefore provided me with a marché-gris parking space for the past few months.
Today, however, the jig is up: my car has a clamp and a £120 fine for removal jammed under the windscreen wiper. I weigh up buying an angle-grinder for fifty quid, but I’ve been at work twelve hours and just want to get to bed as quickly as possible. I grab the notice to find out who to call. The parking attendant has scrawled on the back, ‘Long fucking labour, pal.’
Sunday, 21 January 2007
Just when I was thinking it had been a while since the last episode of ‘unexpected objects stuck in orifices’, today a patient in her twenties presents to A&E unable to retrieve a bottle she’d put up there. Speculum* in – so what’s it going to be this time? Chanel No. 5? Two litres of Tizer? The magic potion I need to drink to take me to the next level of that Dungeons & Dragons game I abandoned twenty-four years ago? As it transpires, it’s a medical sample bottle, filled to the top with urine.
I can’t work out the backstory, so ask her to enlighten me. It turns out she has to provide her probation officer with clean urine samples, and so, rather than choose the simpler option of not taking drugs, she has her mother piss in a pot for her, which she then smuggles in vaginally and decants into the sample pot she gets given by the probation officer. I think about the enormous volume of paperwork I’ll generate for myself if I document this in the notes, so pretend I never asked the question and send her home.
* The speculum is a great clanking duckbill of a device used for looking inside the vagina. The first speculum was invented by an American surgeon called Sims back in 1845. He later wrote in his autobiography, ‘If there was anything I hated, it was investigating the organs of the female pelvis’, which goes some way to explain why he devised such a hideous instrument.
Monday, 29 January 2007
My favourite patient died a couple of weeks ago, and it rather knocked the stuffing out of me. It was far from unexpected: KL was eighty in the shade, with metastatic ovarian cancer, and she’d been on the ward as long as I’ve worked on this unit, minus a couple of short-lived discharges home. Five foot nothing of Polish sass, with bright, twinkling eyes, she loved to tell long, meandering stories from back home that she would invariably lose interest in the moment they got interesting – almost all of them ended with ‘blah blah blah’ and a vague wave of the hand.
Best of all, she despised my consultant, Prof Fletcher. She called him ‘old man’ every time she saw him even though she had a good fifteen years on him, regularly prodded her finger into his chest when making a point, and once asked to see his line manager. I’d genuinely look forward to her stop on the ward round – we’d always have a good natter and I really felt like I’d got to know her.
She immediately clocked I was Polish, despite three generations of my family living in England, breeding with Brits and sending their offspring to expensive schools. She asks my original family name – I tell her it’s Strykowski. She thinks it’s sad a good Polish name like that is out of commission; I should be proud of my heritage and change it back.*
Over the months I’d met all of her children, as well as numerous friends and neighbours who came to visit. ‘Now they like me!’ she would say. Despite the joke, you could see why everyone did; she had a magnetic personality.
I was really upset when I heard she’d died. I decided I should go to the funeral – it felt like the right thing to do. I swapped out of clinic this afternoon so I could make it, and let Prof Fletcher know I’d be attending, as a courtesy.
He told me I couldn’t – doctors don’t go to their patients’ funerals, it’s unprofessional. I didn’t quite understand why. His argument hinged on drawing a personal and professional line, which I agree with to an extent, but his tone seemed to suggest I was going along in order to seduce her grandchildren or get myself written into the will. I suspect that underpinning it is actually an old-fashioned sense that doctors have ‘lost’ or ‘failed’ if a patient dies; there’s an element of blame or shame. Not really a sustainable attitude in gynae oncology, where there’s always going to be quite a high patient turnover. I was disappointed – partly because I’d had a suit dry-cleaned specially – but he’s my boss and those were his very clear instructions.
Of course, I went to the funeral all the same – not least because that’s exactly the kind of ‘fuck you’ she’d have wanted to give him. It was a beautiful service, and I’m certain it was the right thing to do – for me, and for the friends and family I’d met on the ward. Plus I was able to sleep with one of her grandchildren.†
* Strykowski is pronounced Strike-Offski, so I’m not convinced it’s a great name for a doctor.
† ‘I think you should point out that this is a joke,’ recommended one of the lawyers.
4
Senior House Officer – Post Three
I realize everyone moans about their salary and thinks they deserve more, but I’m happy to look back on my time as an SHO with a bit of objectivity and declare I was profoundly underpaid. The money is utterly out of step with the level of responsibility you have – literally life and death decisions – plus there’s th
e fact you’ve been to medical school for six years, worked as a doctor for three and started to accrue postgraduate qualifications. Even if you think it’s appropriate that you take home less money per week than a train driver, there’s still the fact that these working weeks can involve over a hundred hours of unremitting slog, meaning the parking meters outside the hospital are on a better hourly rate.
Doctors tend not to complain about the money though. It’s not a profession you go into to satisfy the dollar signs behind your eyes, whatever the occasional dead-mouthed politician may say. Besides, even if you’re unhappy with your salary, there’s sod all you can do about it. It’s all determined centrally, and rolled out across the entire profession. Perhaps it’s unhelpful to describe it as a salary – the NHS should call what they pay doctors a ‘stipend’, acknowledge it’s below the prevailing rate but that they’re in the job because it’s their calling, rather than for any financial imperative.*
Nothing about the job plays along with the conventional reward structure for employees. There’s no opportunity for a bonus – the closest that exists is ‘ash cash’, where juniors get £40 a pop for signing a form for the funeral directors to confirm the patient about to be cremated doesn’t have a pacemaker fitted. (Pacemakers explode during the process, taking with them entire crematoria and congregations, as one family presumably found out during a particularly stressful funeral.) Thinking about it, that’s pretty much the opposite of performance-related pay. There’s no dazzling your superiors and leapfrogging your peers, or any opportunity for promotion: you progress up the ranks at a regulation rate.
Everyone seems to think doctors get upgraded on planes, but the only way that happens in reality is if they put on a suit – and then apply for a job in the city, earn more money and buy a business-class ticket. I suppose you do have unlimited access to the informal medical opinions of every speciality at work if you begin to malfunction in any way. This is good, but just as well, as there’s little chance you’d get the time off work to go to an outpatient clinic. But I’m not sure it’s worth the flip side of providing medical advice to every friend at every opportunity. You’ll hear ‘Could you just take a quick look?’ more than you’ll ever hear ‘Hey, it’s great to see you’.† My only small consolation was not having to give medical advice to relatives, what with most of my relatives being doctors.
All medics get to grips with the lack of promotion and financial incentives, but it’s harder to accept the fact that it’s rare to get a ‘well done’. The butlers at Buckingham Palace, under orders to float out of rooms backwards and never to make eye contact with the Queen, probably get more recognition. It didn’t strike me for years, until the fifth or sixth time I’d had my knuckles rapped for some trivial fuck-up when a degree of human error had kicked in, that none of my consultants had ever taken me aside to say I was doing a good job. Or that I’d made a smart management decision, saved a life, cleverly thought on my feet or stayed at work late for the thirtieth consecutive shift without complaining. Nobody joins the NHS looking for plaudits or expecting a gold star or a biscuit every time they do a good job, but you’d think it might be basic psychology (and common sense) to occasionally acknowledge, if not reward, good behaviour to get the most out of your staff.
Patients tended to get it, though. When one of them said thank you, you knew they meant it – even if it felt like it wasn’t for anything special, just one of the smaller horrors thrown at you that day. I’ve kept every single card a patient has given me. Birthday and Christmas cards from family and friends would always get thrown away, but these guys survived every house move, escaping even my cathartic clear-out of medical paperwork once it was all over. They were little fist-bumps that kept me going, rays of thoughtfulness from my patients that hit the spot when bosses couldn’t, or wouldn’t, oblige.
It took until now, my third job as an SHO, to feel properly recognized by a consultant for the first time. A few months through my contract, my clinical supervisor said that a registrar was leaving the post early for a research job, and asked if I’d be interested in acting up on the rota. She told me she’d been very impressed with my work in the department. I knew this was a lie; she’d met me twice – once at induction and once to bollock me for starting a patient on oral rather than intravenous antibiotics. She’d clearly just looked through everyone’s CVs and clocked that I had worked as an SHO for the longest. But sometimes it doesn’t matter how they spot you as long as they actually do, so I beamed and said I’d be delighted.
I also realized this could make a significant practical difference to me. Three years into our relationship, H and I were taking the next step into adulthood and looking to buy a flat. I’d decided to sacrifice a shorter commute so we could have a permanent base, a place to actually call home, somewhere you can hang a picture on the wall without being docked fifty quid from your rental deposit. Most non-medical friends were clambering onto the second rung of the property ladder by then, and you know what it’s like when your friends are all doing something and you’re not. Whether it’s fingering someone at a party, taking your driving test or dropping hundreds of thousands of pounds on a dungeon with dry rot – nobody wants to be left behind.
Because every penny of salary helps with getting a mortgage, I asked the consultant if I’d be paid on the registrar scale while I was acting up. She laughed so long and so hard I’m pretty sure you could hear it through two sets of double doors over on labour ward.
* Like the way priests get a stipend for their duty to God (or love of choir boys, depending on denomination).
† Tediously, this has morphed into something even worse now I’m a TV writer. I’d take ‘What do you think about this rash?’ over ‘What do you think about this script?’ any day.
Monday, 12 February 2007
Prescribing a morning-after pill in A&E. The patient says, ‘I slept with three guys last night. Will one pill be enough?’
Thursday, 22 February 2007
Spent the morning going through three months of bank statements with the mortgage broker so he can assess my expenditure. ‘You don’t . . . go out much, do you?’ he says, totting it up. For once I’m grateful for my job – we wouldn’t have saved up enough for a deposit if I was allowed the normal social life of someone in their late twenties.
It’s reasonably depressing looking at where the money goes: a lot of coffee, a lot of petrol, a lot of takeaway pizza – necessities and practicalities. Not much in the way of fun or extracurricular frippery – no pubs, restaurants, cinemas or holidays. Hang on, what’s that? There we go – theatre tickets! Shortly followed by a payment to a florist, after bailing on H at the last minute. Depressingly, it happens frequently enough that I can’t even remember the particular emergency or staffing crisis on that occasion.
Wednesday, 28 February 2007
In gynae clinic, I go online to look up some management guidelines for a patient. The trust’s IT department has blocked the Royal College of Obstetrics and Gynaecology website and classified it as ‘pornography’.
Monday, 12 March 2007
Pretty sure that if obs and gynae goes arse over tit I could retrain in psychiatry in about fifteen minutes – I’ve basically taught myself how to do it over the course of a dozen conversations with Simon. Tonight I was pretty stressed when he called and had a bit of a moan about work. Unexpectedly, this really seemed to help him. Either he’s a horrible sadist and likes the idea of me having an awful day or it’s comforting for him to know that everyone else has shit going on in their lives too. Misery loves company, after all – you only have to look in the doctors’ mess to know that.
Maybe it’s like when you’re in a proper relationship for the first time and you meet their family – and you see it’s not just your family that’s a miserable fucked-up mess with dozens of dark secrets and grotesque dinner-table habits. We finished today’s call with Simon in hysterics after I told him a lump of placenta flew into my mouth during a manual removal and I had to go to oc
cupational health about it. He may well be a sadist, come to think of it.
Thursday, 15 March 2007
I ask a patient in antenatal clinic how many weeks she is now. There’s a long pause. Cogs turn. A camera slowly pans across a wasteland. Maths isn’t everyone’s strong point, but I’m after the number between six and forty that people must constantly ask her about. Finally:
‘In total?’
Yes, in total.
‘God, I couldn’t even tell you in months . . .’
Has she got amnesia? Is she a clone of another woman currently being held prisoner in an evil sci-fi villain’s lair? I start to ask when her last period was, and she interrupts.
‘Well, I’m thirty-two in June, so that’s got to be more than a thousand weeks . . .’
Christ.
Thursday, 22 March 2007
Idea for Dragons’ Den: a bleep with a snooze button.
Thursday, 5 April 2007
Revenge is a dish best served cold – so long as it doesn’t end up poisoning the wrong person. I was called to review a patient on the ward: she’d had a laparoscopic drainage of a pelvic abscess in the morning and her pulse had been raised all evening. Looking through her notes, this lady was in her mid-fifties and had discovered on her wedding anniversary that she wasn’t the only person to have received a pearl necklace from her husband. Her reaction was seemingly straight out of niche porn – she took herself, and her husband’s credit card, off to Trinidad and Tobago and had sex with as many men as she could over the course of a fortnight, expanding her bedroom (and beach) repertoire to include anal sex.
Back home, bow-legged but unbowed, she soon found she was having terrible abdominal pain, plus producing purulent monsoons from both her Trinidad and her Tobago. She was diagnosed with pelvic inflammatory disease,* and even IV antibiotics couldn’t persuade it to sod off – seemingly there’s some pretty weapons-grade gonorrhoea going round the Caribbean. Today’s procedure would hopefully get her back on the road.