by David Ellis
October 1984
It’s generally assumed that female medical students will take to obstetrics like ducks to water. The reality for Emma was far different. Distant memories of a bustling woman in brown uniform and sensible shoes at her own birth loomed large for her. And as she entered the antenatal clinic, who should loom large but a bustling woman in brown uniform and sensible shoes.
“You!” she said.
“Hello, I’m Emma Jones, a 4 year medical student. Where should I go?”
“Well, not here for a start; we’re far too busy.” And the bustling woman in brown uniform and sensible shoes bustled off.
Emma eventually negotiated her way out of the overcrowded antenatal clinic, only just avoiding being squashed between a Scylla and Charybdis of two very pregnant abdomens.
The students’ introduction to obstetrics took place in a seminar room that doubled up as the ‘birth training centre’ and seemed to be full of obstetric models displaying babies in open abdomens that were crying out for some artist to copy and transform into a twenty-foot piece of art.
Emma and her three colleagues were divided between midwives and they were told that their task was to follow through all the women who presented; from stepping out of the car or ambulance to going home with baby plus bouquets of flowers, helium balloons saying “It’s a girl/boy” and the shell-shocked father. Given that the average duration of labour for a first pregnancy is 16 hours, it rapidly dawned on them that this could mean four weeks of total sleep deprivation.
But the curious thing is that Emma’s experience in that four weeks of obstetrics was one of the most meaningful she had throughout her three years as a clinical student.
And the very best was her first labour.
Emma walked into the labour suite, found the delivery room she’d been allocated to, knocked on, and warily poked her head around the door, not knowing quite what to expect.
The young couple she saw were calmly lying together on the birthing couch and spraying each other with Evian water.
“Oh, hi,” said Emma, “I hope I’m not disturbing you. I’m Emma, a medical student and I’ve been asked to stay with you for your labour.”
“Come in and join the party,” said the very handsome husband. “I’m Tim and this is Jemma plus one. Would you like a spray of Evian water? Sparkling or still?”
And despite that most unorthodox start, Jemma and Tim turned out to be a delightful couple who were also opera singers when they weren’t having babies.
As the labour progressed, the sound of their singing spread around the labour suite and Emma kept on having to close the door on people wanting to find out the source of the singing. By the time the third stage came around, their voices were getting rather ragged, but they managed to retain a sufficient reserve to end the labour with a duet from Puccini’s ‘La Boheme’ as the baby was actually born. And to round it off, they asked for the placenta to be put in a doggy bag as they planned to fry it with shallots and garlic.
June 1987
Emma collected a small package from her pigeon-hole on the way back to her room. She had no idea what it was but her name had a ‘Dr’ in front of it. That surprised her as the Finals results had only just come out. Someone with friends in high places, she thought.
As she came back into her room, Emma realised that she’d miss it, despite its pokiness. She was glad that she’d been able to move back into a college room for her last clinical year as it gave her a stability that she’d found difficult to find when living in lodgings.
Most of her possessions were now in boxes ready to go back to Hindhead until she started her first house job. Emma reflected that putting things in boxes had also been her way of finally making sense of medicine and which had undoubtedly helped her pass her exams. Emma had also learnt a lot from a neurologist who’d asked her what Ockham’s razor was and then proceeded to give her an erudite mini-lecture about William of Ockham and his principle that the simplest solution was usually the best. She’d used Ockham’s razor for her medical long case and had been spot-on with her diagnosis. But she’d also been helped by the telling look in her patient’s eyes which had confirmed what she thought. She was also relieved that Ockham’s razor had pretty much replaced her own.
Emma looked out of the window at the college chapel. Although she still occasionally imagined the steeple turning into a spaceship and taking off into outer space, she didn’t really mind that much if religion stayed behind. Better a belief in something than in nothing, she thought.
She turned her attention to the mysterious packet. The writing on it was in italics and unusually beautiful. She tore off the paper and found a strange, five-inch square, thin plastic case with the title ‘La Boheme’ on it and a cover photo of a handsome young couple whom she immediately recognised as Tim and Jemma, the opera singers. She wasn’t quite sure what to make of the silver disk inside the case but she was mesmerised by the way the surface diffracted light and shimmered like a butterfly’s wings. It suddenly dawned on her that she was holding a compact disc, a replacement for the LP that had only just come on the market. Sadly, she realised that it would probably take months of salary slips before she’d be able to afford the equipment to play it on. In addition to the compact disc, there was also a small photo of Tim and Jemma and their baby. On the back there was the same italic writing and Jemma read:
‘Dear Jemma,
Our first ever compact disc! We’re thinking of you.
Kindest regards,
Tim, Jemma and Sian
P.S. The placentaà la française was heavenly!’
Emma thought that sooner or later she’d be returning to Oxford.
August 1987
The introduction for house officers starting their first surgical job was held in a severely raked lecture theatre in the bowels of the hospital. It looked as if it had been an operating theatre at some point in its past and smelt of carbolic. A tall, distinguished looking man in a Saville Row suit entered, with sleek grey hair and bow tie, followed by a mini-me version, who Emma guessed was his registrar.
“Good morning, doctors. My name is Professor Cuthbertson and I am Head of Surgery. Today is the most important day of your career. You will be taking the first step from clinical virginity to consummate practitioner. You will do this by learning not from books but from patients and the operating theatre. You will discover that surgery is a craft demanding a lifetime of practice and dedication. You can give an amateur a Stradivarius but it will only be a violin; only a virtuoso will make it sing. Surgeons must strive to be both the conductor and virtuoso of their instrument. Although you may be only mere beginners in the art, I will expect nothing less than the highest standards of professionalism. Hard work will be expected and rewarded, but excuses will not be accepted. You have all been allocated to firms and your work starts after this meeting. Now, where is Dr Jones?”
“That’s me, sir,” said Emma.
“Dr Jones, matron has asked that you present yourself to her after this meeting.”
There was a giggle from other house officers. Emma felt singled out for no reason other than him using her to exert his superiority.
“Very well. Please collect your badges, white coats and bleeps. Ward rounds are at 8:00 a.m. sharp and I expect you to know all your patients. Good day to you all.”
“Good day, sir,” the house officers said in perfect synchrony.
Professor Cuthbertson walked out imperiously, his mini-me in tow.
A baptism of fire is what Emma expected and a baptism of fire is what she received. Unfortunately, Prof Cuthbertson was the consultant on her surgical firm.
Emma made her way to Ward A1, which happened to be the main ward for general surgery. Double doors opened onto a cavernous space with beds on both sides and a nurses’ station in the centre. A smell of antiseptic with undertones of urine and anaerobic infection pervaded the space. Patients were male and most seemed to be elderly.
“You!” a voice boomed.
Emma turned suddenly to be confronted by a bloated figure in blue, who was obviously the matron judging by her elaborate headdress. It’s Hattie Jacques, Emma thought.
“Where’s your coat and badge?” she asked.
“I wasn’t told anything about that; just to come and see you before I picked up my bleep,” said Emma.
“Doctor, your professional identity comes first, so I suggest you go to medical staffing and only return to the ward when you are suitably attired.”
Matron retreated into her office, the view of her stern as formidable as her aft. It reminded Emma of her mother in her more pigged-out phase, except that her mother wore hand-crocheted ethnic tents rather than starched blue uniforms.
Several wrong turnings later, and at the end of a rabbit warren of basement tunnels, Emma found medical staffing, although the staff seemed more interested in talking to each other than attending to the queue of new doctors that was building up. Eventually someone waddled up to the counter.
“Oh, I suppose you’re the new doctors,” she said, with body language that reeked of boredom. “You need to fill in these forms – in black ink, mind you, because we have to photocopy them – and then you can get your badges, except they’ll have probably gone off for lunch, so you’ll have to wait.”
Emma glanced at the form. Lots of questions about identity, addresses, medical degree, GMC registration and so on, all of which she thought they already had. She filled these in as best as she could and handed them back. Ms Boredom barely glanced at them and stamped the last page. “Now take this to get your badge,” she said, handing her a chit with her name on it, and then turned to the next doctor in the queue.
More wrong turns, more corridors, and feeling more like a process than a person, Emma wound up at the security desk. The security guard was in the process of finishing something that looked like a burger, the fat oozing out of the sides of his mouth and dripping down his chin.
“Hello love. You here for your badge?” he asked. He continued eating his burger and the fat continued dripping.
“Look, I’m just here to get my badge and bleep. Can we make it quick? I need to get back to the ward as matron is expecting me,” said Emma, feeling a combination of revulsion and panic.
“Okay, okay, keep your hair on,” he said, before putting down the burger and then taking the chit and turning to a box with badges and bleeps. “There, found it. Sign here and you’re ready to go.”
Emma signed the chit and collected her badge and bleep. She felt proud when she saw her name and title on the badge: ‘Dr Emma Jones, House Officer’. She looked at the security guard and, rather unexpectedly, sensed vulnerability beneath his gross exterior. She thought he deserved something better although she had absolutely no idea why the idea had crossed her mind.
The security guard stood with his mouth open in amazement. Emma wasn’t sure what to make of this reaction and turned around, holding on to the badge and bleep in case he decided to ask for them to be returned.
“Best of luck, doctor,” she heard as she walked back down the corridor.
After collecting her white coat, Emma retraced her steps back to the ward. By this time, matron had assembled the other house officers around her and seemed to be going through some sort of handover for the patients on the ward.
“Oh, there you are, Dr Jones. I’m glad to see you’re finally ready to start work,” said matron sarcastically. “Please remember that I run a tight ship on this ward.”
One of Emma’s fellow house officers whispered: “And bursting at the seams.”
Emma giggled just as matron turned her attention to her.
“And I don’t expect any insubordination! Patients go to theatre every day and we expect you to clerk them in, take their bloods, arrange x-rays, prepare the operation list, and then assist in theatre. Names go up on the board every morning. Phone numbers and bleeps are on the list next to the board. Your job this afternoon is to clerk in patients for tomorrow’s list and to review post-operative patients. Is that clear to everyone? Do you have any questions?”
Emma and her colleagues muttered “Yes” and “No.” They gathered around the board to look at the patients they’d be responsible for. Emma’s patients had a ‘Prof C’ next to them and there seemed to be a total of six in all: two post-op and four marked down as ‘TCI’. Two of the latter had ticks by their names, which she took to mean that they’d already arrived, but the other two didn’t. Emma thought she’d better make a start.
Emma went to the trolley to find the notes for the first patient, a Mr Edwards, in bed 6. Glancing through the outpatient letters, he seemed straightforward: gallstones for about a year and he’d come in for a cholecystectomy. She went over to his bed.
“Good afternoon, Mr Edwards.” she said without really looking at him. “I’m Dr Jones, the house officer, and I need to ask you some questions and examine you before your operation tomorrow.”
“Are you really a doctor, miss?” he said. “You don’t look any older than my daughter and she’s still at school.”
Emma felt herself bristling but didn’t rise to the bait. “Well, to be honest with you, Mr Edwards, I’m as new to this hospital as you are, as I’ve just started today,” she said with a smile.
“Out of the frying pan into the fire, is it then?” he said.
“Well, it’s a bit like that until we find our feet. I see in your notes that some tummy pain was the first thing you noticed. Can you tell me about that?”
“Well, it was just after having an Indian meal for my birthday last year. I probably ate too much and also had too much beer, but I got a digging pain here – he pointed to just under his ribs on the right – and it wouldn’t go away. I thought it must be indigestion. Anyhow, it went a bit but then kept on coming back. I like my fry-ups and they really made it bad. So I thought I should see my GP – that was about two months after it started - and she got me seen by the professor. And that’s the whole story really, doctor.”
“And I see that Professor Cuthbertson then arranged for you to have an ultrasound scan, which showed that you’ve got stones in your gall bladder,” she said, glancing through the investigations section of his notes. “What’s been happening since then? Has the pain been getting worse? Have you had any other symptoms?”
“Well, if the truth be told, I’ve been drinking more to cope with the pain. I know I shouldn’t, but you know what it’s like. It’s only beer, mind you. I never touch spirits.”
“When did you last drink any alcohol?” asked Emma.
Mr Edwards seemed embarrassed and he looked down at his feet. “Well, to be honest, doctor, I had a few pints first thing just to get going, you know.”
Emma leant closer to her patient. The smell of alcohol on his breath was very obvious. “Mr Edwards, I’ll need to examine you, but I’ll also need to take some blood for tests and we’ll need to check your liver.” She pulled the curtain around his bed.
She reached for the sphygmomanometer attached to the wall above his bed. “Let’s check your blood pressure first.” She inflated the cuff and applied the diaphragm of the stethoscope over the brachial artery. She listened as the cuff deflated and heard the sound of the systolic which then faded away when she reached the diastolic. His blood pressure was elevated at 160 over 110.
“Now could you lean forwards and take some deep breaths.” She listened intently and heard a few wheezes but put that down to him being a smoker.
“Very good, let’s examine your tummy.” Mr Edwards was very obese. He winced a bit when she palpated below his ribs and she thought she could feel the liver edge. Not a good sign, she thought. She finished the rest of the examination, thanked him and went off to get a tray to take his bloods.
Emma mulled over what she’d found so far. He was a classic case of gallstones but his high blood pressure was a concern and the alcohol even more so. He certainly needed liver function tests and might need to be on an alcohol detox. He might even have memory problems. So hardly th
at straightforward and she wondered what the Professor would say.
She returned to Mr Edwards’s bedside with the bloods tray. “Is it alright if I go out for a cigarette, doctor?” he asked.
“After I’ve taken some blood, Mr Edwards, but you’ll have to promise me that you won’t be away for long in case we need to do other tests. And you really shouldn’t smoke, you know.”
He rolled up his sleeve and she swabbed his arm and efficiently took some specimens, squirting the contents of the syringe into various bottles which she labelled.
“I’ll see you later.” She left his bedside, drawing back the curtain.
Just at that moment, she heard matron call out “Crash call, nurse!” whilst simultaneously pulling the curtain around a patient a few beds down. Emma stood rooted to the spot, not sure what to do. Medical emergencies had never figured that highly at medical school, and anyway she had always been somewhat avoidant, preferring a slower pace where everything was more in control.
“You!” called matron. “Don’t just stand there! Fetch the crash trolley!” Emma glanced towards where matron was pointing and ran to the other end of the ward, dropping off the blood tray at the nurses’ station on her way.
The crash trolley was painted red and had a sign above it saying ‘Crash Trolley’, so it was impossible to miss it. Emma grabbed it and manoeuvred it to the curtained-off bed. The patient in question was elderly and unresponsive. Matron was bent over him, performing chest compressions, with her considerable bulk all but obliterating his tiny frame. “You do the breaths!” she ordered.
Cardiopulmonary resuscitation was also something that Emma had little practical experience of, although she remembered watching a grainy video of how it should be done. She went to the other end of the bed and stared down at the man’s grey, cadaverous face. She saw far too much suffering and now the poor man was having his ribs broken by matron.