Quick Reads This Is Going to Hurt

by Adam Kay

  I am often the most senior person in clinic these days. Tradition means I now get called Mr Kay rather than Dr Kay – which makes my ten years of studying so far feel like a fucking waste of time.

  I am now in charge of labour ward. There are more senior doctors I can call on in a crisis, but most of the time it’s down to me to keep every mum and baby alive. Sometimes there can be a dozen births happening at once. It is as though I am always having to solve a difficult puzzle involving babies and surgical instruments.

  It sounds horrific, and at times it is. Working long hours doesn’t help. Leaving work at 8 p.m. rather than 10 p.m. means I have put myself before my patients. And when I am home, I’m no fun to be around. Switching off after this kind of work is hard.

  But I still go to work with a spring in my step. It feels like everything at work and home is clicking into place. I hope I can keep it that way.

  Tuesday, 2 October 2007

  I pick up my phone from the locker after a very long day on labour ward. There are seven missed calls from Simon and a bunch of voicemails. I can hardly bear to press play in case it’s already too late. It turns out Simon has simply sat on his phone. The little bastard.

  Monday, 12 November 2007

  All staff have to go to a talk on patient safety. This is because last week a patient had their healthy left kidney taken out, leaving only their useless right kidney. The hospital is very keen that a mistake like this does not happen again. They remind us that in the last three years, British surgeons have drilled holes in the wrong side of patients’ skulls fifteen times. Fifteen times a doctor has been unable to tell left from right while holding a drill to your head. Never again will I say something is ‘hardly brain surgery’.

  The new rule is that any patient going to surgery must have a large arrow drawn in black pen on their left or right leg to show the doctors which side to operate on. I put my hand up and ask what to do if the patient already has a tattoo of an arrow on the wrong leg. Everyone laughs and my boss calls me a fucking clown.

  Tuesday, 13 November 2007

  I get an email from the hospital management to say that if a patient has a tattoo of an arrow on either leg, it should be covered up with tape and a new arrow drawn in pen on the correct leg. This has now been added to the official rules and they thank me very much for my help.

  Saturday, 19 January 2008

  I decided to go into work on my Saturday off. ‘If you’re having an affair you can just tell me, you know,’ said H.

  I did a big operation yesterday and wanted to make sure the patient was OK. Every time my phone went off this morning, I thought it must be the weekend team telling me something had gone wrong. So I went in to check and to stop myself from going mad.

  The patient was fine and had just been seen by another doctor. I didn’t want the doctor to think I didn’t trust him to do his job properly so I pretended I was ‘just passing’. ‘I don’t blame you for coming in,’ the doctor said. He told me he had once been in the same situation after his first ever big operation. He had planned his patient’s care to the last detail and been to check on her several times. Then, on the day she was meant to go home, she choked to death on an egg and cress sandwich.

  I begin the long drive home and think about what H said earlier. Even if I wanted to have an affair, I think I would be too tired to take off my trousers.

  Friday, 29 February 2008

  For some reason, a lot of patients insert unusual objects into their bodies during the holidays.

  At Christmas I have seen a stuck fairy and a patient who burned her vagina after stuffing a string of lights inside and switching them on. ‘I put the Christmas lights up myself’ usually has a different meaning.

  This is my first leap year working as a doctor and the great British public have not held back.

  Patient JB decided to follow tradition and ask her boyfriend to marry her. She bought a ring and put it inside a Kinder Surprise egg. She then put it up her vagina for him to find. The plan was that he would remove it, she would go down on one knee, and then perhaps go down on him too . . .

  Sadly, it got stuck and neither of them could get it out. JB was keen to keep it a surprise and would not tell him what she had done or why. But in the end it seemed a good idea to seek help in the hospital. I met them in room three. It was a very easy delivery.

  JB had not told me what was inside the egg either. Her boyfriend and I both thought it was very strange when she asked him to open it. I gave him a pair of gloves, which made the whole thing even less romantic.

  JB asked her boyfriend to marry her. He said yes, perhaps out of shock or the fear of what she might do if he said no. I wonder where the best man will keep the rings at the wedding?

  Thursday, 17 April 2008

  Sometimes it’s the little things that make a difference on labour ward. The touch on your arm and a quiet thank-you from the new mum too tired to speak. The Diet Coke a nurse buys you because you look so tired. The nod from your boss that says ‘you’ve got this’.

  But sometimes it’s the really big things that make a difference. A patient’s husband takes me to one side after a difficult birth to thank me. He tells me he works for a famous champagne company and wants to take my name so he can send me a gift. I spend a week dreaming about taking a swim in a giant glass of expensive fizz, as if I am a showgirl in Las Vegas.

  Today a parcel arrived for me at work. Inside was a baseball cap and key ring. Not quite what I had in mind . . .

  Tuesday, 13 May 2008

  I go to a pub quiz with Ron and some friends. One of the questions is, ‘How many bones are there in the human body?’ I get it wrong and the team are very cross with me. I try to explain to them that it’s not something you get taught. At no time on the job would you ever need to know this. I wouldn’t expect Ron to know how many types of tax there are . . .

  It’s too late. I can see the look on their faces. They are clearly thinking about all the times they have asked for medical advice from a doctor who doesn’t even know how many bones there are in the body. Three other teams get the answer right. (It’s 206, by the way.)

  Monday, 2 June 2008

  Today I was called in by a midwife. Her patient was a healthy woman near the end of her pregnancy. The midwife had been unable to hear the baby’s heartbeat. This happens quite often and most of the time everything turns out to be OK.

  But I can tell as soon as I walk into the room that something is wrong. The midwife is very pale. The patient and her husband are both doctors and seem to have guessed it won’t be good news. Sadly, when we look at the screen we can all see that the baby’s heart is no longer beating.

  The woman is very calm. She goes into work mode, just like I have to. Her husband is in tears. ‘You shouldn’t have to bury your child.’

  Thursday, 5 June 2008

  The rota has been sending me to every corner of the hospital lately. I’ve given up hope of seeing someone I recognize unless they are handing me a coffee in Costa.

  It is very rare to see the same patient more than once, but on labour ward this afternoon I see the doctor from Monday whose baby’s heart had stopped. Today, she has to give birth on labour ward.

  She and her husband seem strangely pleased to see me. I guess it’s because I am a familiar face and I already know what has happened, so they don’t have to explain it all again. This must be such a sad and scary time for them.

  What the hell can you say? It feels like an awful gap in our training. No one has ever taught us how to speak to couples who have lost a child. Will I make it better or worse if I say something hopeful about ‘next time’? Do I say how sad I feel for them? How about a hug?

  Stick to what you know. I just talk to them about what is going to happen next. They have a lot of questions which I do my best to answer.

  I pop back every hour or so to see how they are doing. It goes past 8 p.m. and I decide to stay until it has happened.

  H is waiting for me at home, but I lie
in a text and say there has been an emergency and I need to stay. I don’t know why I can’t just tell the truth. I lie to the patient too when she asks why I am still here after 11 p.m. ‘I have to cover for someone,’ I say. It does feel like my being here is helping them a bit.

  The baby is born soon after midnight. I talk through the tests we can do to find the cause of death. They want me to do them all, which means I have to take skin and blood samples from the baby. This is the worst thing I have to do in this job. I used to get so upset that I couldn’t look as I did it. Now I can look, but I still find it extremely sad. We expect babies to look beautiful and perfect, but often they don’t. I think he must have been dead for a couple of weeks. ‘I’m sorry,’ I say to him as I take the samples I need. ‘There we go. All done now.’

  I dress him. Then I look up to a God I don’t believe in and say, ‘Look after him.’

  Tuesday, 10 June 2008

  The police stop me on my drive home. ‘Did you know you just went through a red light there, sir?’ I had no idea. It was a very tough night shift and I’d had no sleep. I hope I was paying more attention to my patients than I was to the road.

  I explain that I have been working on a labour ward for the past thirteen hours. They don’t seem to give a shit. They give me a £60 fine and three points on my licence. Bastards.

  Monday, 7 July 2008

  An urgent call to a room on labour ward. The husband was messing around on a birthing ball and fell off, cracking his head on the floor.

  Tuesday, 8 July 2008

  There are always highs and lows in this job, but I’ve never seen things take such a sudden turn. I am called to the Early Pregnancy Unit to confirm the loss of a baby at eight weeks. The doctor on duty has not done many scans before and wants a second pair of eyes. I remember that feeling very well, so I rush over. He has clearly made the couple aware that it does not look good. They are sad and silent as I walk in.

  It turns out that the doctor may as well have been doing a scan of the back of his hand or a packet of crisps. Not only is the baby fine, but so is the twin he didn’t spot. I’m not sure I’ve ever had to break good news before.

  Thursday, 10 July 2008

  Next week H and I will head off for a two-week holiday to celebrate five years together. I can’t wait to be on a beach on the other side of the world from labour ward. I just hope I haven’t forgotten how to be in a relationship that isn’t kept alive by text messages that say ‘sorry’.

  Today, I get an email that tells me I have to work the middle weekend of our holiday. No one else can swap with me, and I don’t know how to deliver a baby over Skype.

  I know other doctors who have had to come home early from their honeymoon, or miss a family funeral, so I know they won’t change the rota for my holiday. Their best suggestion is I just pop 6,000 miles back to England for the weekend.

  Thursday, 11 September 2008

  I almost cry at the end of a tough night shift when I open a lovely card from a patient. I remember her well. I gave her some stitches down below after she had her baby a few weeks ago.

  Dear Adam,

  I just wanted to say thank you. You did a great job. My GP checked my stitches and said you could hardly tell I’d had a baby! Thank you so much again.

  I am very touched. It’s the kind of thing that makes the whole job feel worth it. She has even made the card herself. It’s a beautiful white card with her baby’s footprint in gold paint on the front. Though perhaps she didn’t have much choice. There can’t be many cards in Sainsbury’s that say, ‘Thanks for mending my arsehole!’

  Tuesday, 16 September 2008

  A woman is very cross that three or four people who arrived on the ward after her have been seen before her. ‘If I ever have to go to hospital, madam,’ one of the midwives calmly tells her, ‘I want to be seen last. Because that means everyone else is sicker than me.’

  Thursday, 18 September 2008

  My phone rings at 8 p.m. I try to guess if it’s because I forgot to turn up for a night shift or because someone else did and they need me to cover. I’m happy to hear it is just my friend Lee, though he does sound rather worried. This is unusual for Lee. He is usually very calm. He works as a lawyer, and I have heard him on the phone talking to the police, saying things like ‘Was the whole body destroyed by the acid or just the skull?’

  He asks if I am free to come over. His flatmate, Terry, has hurt himself and Lee thinks he should go to hospital, but he would like my advice. It’s not far away so I pop round.

  Terry has indeed hurt himself. He cut his thumb opening a can of beans. There is blood all over the floor and the top of his thumb is flapping open like a Muppet’s mouth. I can even see the bone.

  My advice is to get to hospital as fast as possible. I don’t think many people in the world would disagree with me on this point. But, sadly, Terry is one of them.

  Lee takes me into the kitchen for a chat. Terry really does not want to go to hospital. He drinks a lot and is worried that any blood tests will show problems with his liver.

  I spend some time trying to talk Terry into going to hospital. I tell him the doctors will only focus on the fact that half his thumb is hanging off. But Terry still says no. He won’t even let me call an ambulance so they can come to the flat and take a look.

  Lee and I come up with a new plan while Terry ruins some more tea towels. Lee has a first-aid kit left over from a trip to Africa. He opens it and asks if I have what I need to sew Terry back up. He clearly spent a lot of money on that kit. It contains all the equipment I would need to take out a lung.

  After a short time going through the kit, like an auntie trying to find the coffee cream in a box of Milk Tray, I find what I need. The only thing missing is something to take the pain away. Lee jokes that Terry can just bite down on a wooden spoon.

  Five minutes later I find myself fixing Terry’s wound at the kitchen table. Terry is oddly happy about it. I clean the cut and put in some big stitches to try to stop the bleeding. When the pain gets too much for Terry, he starts to scream. We really don’t want to have to explain it all to the people next door. Lee hands Terry the wooden spoon.

  I am quite pleased with how the thumb looks when the job is done. I don’t know if Terry will listen to my advice on keeping it clean and taking out the stitches. But I tell him anyway. Terry thanks me and gets himself a drink. He says he will never eat beans again.

  Thursday, 16 October 2008

  It’s time to go home. The doctor on the night shift has come from a different hospital to fill a gap in the rota. We have not had a break all day, and it won’t be a quiet night either. I tell the new doctor how sorry I am. Busy shifts are even more difficult when you aren’t used to the hospital. I can see panic behind his eyes, but he says nothing.

  I explain a few things and tell him it will be fine, but he still looks scared. He asks if he will have to do any c-sections. He says he has never done one before.

  I wait for him to tell me this is a joke. Maybe he has turned up on the wrong ward and the doctor who actually knows how to work on a labour ward is about to walk in. But no. This guy said yes to taking this job, but no one bothered to ask him if he had worked on a labour ward before.

  I send him home and call my boss to ask what to do. I can already guess that the answer will mean me working another twelve hours for free.

  Tuesday, 18 November 2008

  Ron called to ask me for some advice this evening. His dad has lost a lot of weight and is in terrible pain. He gives me some other details and asks what I think is going on.

  If I was being asked on an exam paper, I would say it was a form of cancer with little chance of a cure. If I was being asked by a patient, I would say it was very serious and we needed to do more tests quickly.

  But it’s different when I am asked by someone close to me. I said it sounded like his GP was doing all the right things (true). I said it still could be nothing (sadly, not true). I knew it was going to be bad news, bu
t really wanted everything to be OK. Ron is my best friend and I have known his dad since I was eleven. You never lie to your patients to give them false hope. But there I was, telling my mate that it would all be fine.

  Doctors are always told not to give medical advice to friends and family. But I have always ignored that and given them a private helpline. My job makes me such a useless friend in many ways, so I feel like I have to offer something so as to stay on their Christmas card list. And this is exactly why they tell us not to.

  Thursday, 20 November 2008

  In no other job would you be expected to share shoes on a ‘first come, first served’ basis. It is like being at a Megabowl where people get blood everywhere and no one cleans up afterwards.

  If you want your own white leather hospital shoes, they cost around £80. So it used to be only the bosses who had them. They would glide around the hospital like they had two giant paracetamols on their feet.

  But now there is a new kind of shoe called Crocs. They come in bright colours, they do the same job and they cost less than £20. They also have holes in them, so you can lock your shoes together with a padlock and no one else will get their hands on them.

  Today there is a sign in the changing rooms. It says: ‘Staff must not wear Crocs shoes as the holes will not protect feet from falling needles.’ Someone has added a note in pen: ‘And they make you look like a dick.’