"This Is Going to Hurt"

[fiefoe]

Adam Kay is really good at spicing up his grave message to the NHS with hard-to-beat anecdotes. It makes for light reading with a lot of kick to it.

• writing down anything remotely interesting that had happened that day, like a medical Anne Frank (only with worse accommodation).
• In reality, medical schools don’t give the shiniest shit about any of that. They don’t even check you’re OK with the sight of blood. Instead, they fixate on extracurricular activities.
• I don’t particularly know what I’m doing, and I don’t have vast depths of confidence even when I do, so it’s actually quite helpful to have a superannuated German cheerleader behind me shouting out, ‘Zat is brilliant!’ every so often. <> Today he took a dump on the floor next to me so I sadly had to retire him from active duty.
• There’s a plant in my garden where if you simply sat under it for ten minutes then you’d be dead.’ Job done: she bins the tablets.
  I ask him about that plant over a colonoscopy later.
  ‘Water lily.’
• The truth is, although dozens, maybe hundreds, of lives are saved every day on hospital wards, almost every time it happens it’s in a much more low-key, team-based way. Not by a doctor performing a single action, so much as implementing a sensible plan which gets carried out by any number of colleagues, who at every stage check the patient is getting better and modify the plan if they’re not.
• when he asked if the penis could be ‘regloved’. Mr Binns, the consultant, calmly explained that the ‘glove’ was spread evenly up eight foot of lamp post in west London.
• That he thought her father was in fact his own wife. That unfortunately by the time the nurses heard the commotion and attended it was too late, and this patient was straddling her father and had ejaculated onto his face. <> ‘At least it didn’t . . . go any further than that,’ said the daughter, in a world-class demonstration of finding the positive in a situation.
• This time, it’d be a real bonus if he wouldn’t mind laying off the alcogel dispensers. <> He reared back like I’d just accused him of twincest, telling me that of course he would never do that – they’ve changed the recipe recently and now it tastes really bitter. He pulled me closer to whisper in my ear that in this hospital you’re best off sucking on some of the sanitizing wipes, then gave me a conspiratorial tap on the arm
• I spend the entire night shift feeling like water is gushing into the hull of my boat and the only thing on hand to bail it out with is a Sylvanian Family rabbit’s contact lens.
• It’s the third time in a week my boxers have been soaked in someone else’s blood and I’ve had no option but to chuck them away and continue the shift commando. At £15 a pop for CKs I think I’m running my job at a loss. <> This time it had soaked through further than usual and I found myself washing blood off my cock. I’m not sure which is worse: the realization I could have caught HIV or the knowledge that none of my friends would ever believe this is how I got it.
• After twelve weeks of neonatal magic he’s gone from a transparent-skinned shrew attached to a dozen tubes and wires to a proper screaming, vomiting, sleeping little baby,
• Ninety-nine per cent of the time we order the same dozen tests and yet, rather than prioritizing those at the top of the list (even the easyJet website knows to put the UK above Albania and Azerbaijan), they’re scattered throughout a billion tests I’ve never heard of or requested. Who knew there were three different lab tests for serum selenium? As a result, there’s a very narrow window of anaemic patients I will now order Vitamin B12 levels for. If you’re only mildly anaemic I’m not wasting the day with my finger pressing on the down arrow for three minutes.
• And now I’m sitting with a woman who’s asking me if she shouldn’t have her ashes scattered on the Scilly Isles. It’s her favourite spot, but she doesn’t want it to be a sad place for her family once she’s gone. The undiluted selflessness of someone fully aware what her absence will do to those she leaves behind.
• the home insurance people asked a standard question about the number of nights the property is left empty. I realized that if I lived alone, the policy would be invalid as it would technically be considered an ‘unoccupied property’.
• All junior doctors change hospitals on exactly the same day every six or twelve months, which is known as Black Wednesday. You might think it would be a terrible idea to exchange all your Scrabble tiles in one go and expect the hospital to run exactly as it did the day before, and you’d be quite right.
• The MRI checklist asks if they’ve got a metal heart valve (it would tear out of their now-dead chest at 80 mph and splat onto the machine) or worked in a metal factory (tiny bits of metal would have found their way into their eyes, making both eyeballs explode upon opening the door to the MRI suite).
• As it happens, it was an altogether stealthier assassin – a portion of noxious homemade moussaka from a labouring patient’s mother. I can be fairly sure that was the culprit: it was the only thing I’d managed to eat all day. There should be a saying about Greeks bearing gifts, I thought, shitting through the eye of a hypodermic needle, the taste of bile and faint tinge of aubergine in my throat.
• 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.
• 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.
• 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.
• Me: ‘I’m on my break.’ (Untrue.)
  Midwife: ‘You don’t get breaks.’ (Depressing but true.)
  Me: (pleading, in a tone of voice I’ve never managed before, like I’ve unlocked a secret level of my vocal cords) ‘But it’s my birthday.’ (Depressing but true.)
  Midwife: ‘It’s labour ward – it’s always someone’s birthday.’
• And today – amazingly, just to prove there’s no escape – the couple who screwed us over turned up in antenatal clinic. I’d not met them before, but here was their address in front of me, the exact same address that’s permanently scarring my happiness. <> In a Tarantino movie, this would be the part where I produce two samurai swords and unleash a ten-minute tirade about honour, vengeance and respect, before decapitating them. In reality I just said, ‘Hi, I’m Adam – one of the doctors,’ and they had no idea. Issues of morality, probity and legality sadly restrict revenge opportunities to near enough zero,
• I doubt we’d have got so much as an email if she’d died. I’m pretty unshockable, but I’ll never cease to be amazed by hospitals’ wilful ineptitude when it comes to caring for their own staff.
• You become amazing at prioritizing. It’s like you’re living in a constant logic puzzle; the one with the boat, the fox, the chicken and the bag of grain. Except there are a dozen chickens, they’re all delivering triplets and the boat’s made of sugar.
• Not since the day I qualified had I felt so optimistic – I was practically shitting confetti.
• ‘Isn’t this the placenta?’ she asks, blood dribbling out of the corner of her mouth like the disgusting progeny of Dracula and the Cookie Monster. I explain that it’s just some clots I left in a bowl after delivering baby. She turns ashen, then green. Clearly blood isn’t the delicious post-delivery snack she imagines placenta might be.
• With the possible exception of diathermy,* which smells deliciously like frying bacon, the sights and smells of labour ward theatres aren’t great for the morning after. Take a look at the ingredients: there’s over half a litre of blood spilled, plus a tidal wave of amniotic fluid when you cut through the uterus, the baby’s covered in more gunk than you’d find in the plughole of a cattery and the placenta always smells like stale semen
• A ring pessary is a doughnut of stiff plastic that goes up your vagina and keeps your internal organs, well, internal. Pessaries have existed as long as pelvic organ prolapse, which is to say a couple of years after the first woman gave birth. Historically, a popular type of pessary was the potato – shove it up there and everything stays put nicely. Horrifyingly, the warm and moist environment is an ideal sprouting environment for root vegetables, so they would have to trim the green shoots as soon as they started bristling against their underwear.
• Among the liver’s many and confusing functions, it produces a whole load of clotting factors, meaning that liver failure causes defective clotting.
• Lee unseals the case, opens it out in front of me like a dodgy market trader and asks me if I have what I need to sew Terry back up. He clearly splashed out on the deluxe package – there’s probably enough kit in there to take out a lung. After a short while cooing over it like an auntie trying to find the hazelnut swirl in a box of Milk Tray, I select suture material, scissors, needle-holders, swabs and cleaning solution – the only thing missing is some local anaesthetic.
• The patient tells me she prefers having sex with her left vagina, as it’s bigger (as I’d noted during examination – the right needed a smaller speculum), although she says it’s nice to have an option for ‘different sizes of guys’. I suggest that if she forgets which way round it is, the mnemonic ‘righty tighty, lefty loosey’ would apply – though in truth she’s probably very unlikely to forget which way round her vaginas are.
• Eventually there comes a point where you have to decide what kind of doctor to be. Not the technical stuff, like whether you’re into urology or neurology, but the more important matter of your bedside manner. Your stage persona evolves throughout your training but you generally settle on a way of dealing with patients a couple of years in, and carry it through into your consultant career. Are you smiley, charming and positive? Quiet, contemplative and scientific? I presume it’s the same decision policemen make when they decide if they’re good cop or bad cop (or racist cop).
• a request for the midwife to say ‘surges’ rather than ‘contractions’. The whole thing was doomed from the start – having a birth plan always strikes me as akin to having a ‘what I want the weather to be’ plan or a ‘winning the lottery’ plan. Two centuries of obstetricians have found no way of predicting the course of a labour, but a certain denomination of floaty-dressed mother seems to think she can manage it easily.
• Placenta praevia is a placenta that is attached at the lower part of the uterus. The implications of this are that the baby needs to be delivered by caesarean because the placenta’s in the way for delivering vaginally. It also means that if mum goes into labour, it’s a bit of an emergency as the placenta is liable to shear off, with profound consequences for both baby and mother (700 ml of blood goes through the placenta every minute – her entire blood volume in five minutes).
• Truly indescribable – other than to say that I retch, and the nurse chaperone has to immediately leave the cubicle. I imagine every bunch of flowers in the hospital suddenly wilted. I hardly want to ask, but I need to know the culprit. <> The short answer is it was the head of a Fireman Sam bath sponge. But of course!
• The retired engineer in him is fascinated by the mechanism of the stent, a self-expanding metallic mesh, strong enough to push back the tumour and open up his gullet. ‘Wouldn’t have been possible twenty years ago,’ he says, and we talk about being lucky to live in this current blink of civilization’s eye.
• Isn’t there a way he can still be the person who touches her first? If he lifts her out at the end of the caesarean maybe? <> He would definitely faint, vomit or both at what it looks like inside an abdomen: a casserole of flesh and giblets cooked up by someone irrevocably insane. Besides, it takes most trainees a good few sections before they can get a baby out by the head – unless he can quickly practise by scooping cantaloupe melons out of a swamp one-handed?
• as I start to remove the skin staples a midwife runs into theatre telling us to stop because the swab has been found: the baby was holding it. Much relief all round, except from the scrub nurse who has been subjected to half an hour of unnecessary stress and binsearching. ‘The thieving little cunt,’ she says – not seeing that directly behind the midwife is the swab in question, held by the baby in question, held by its father.
• Shouldn’t we feel sorry for someone who has so little else in their lives that they can be so totally floored by the death of their pet? Grief is grief – there’s no right way and no normal. Mumblings of ‘maybe’ all round, and I wander off, having thoroughly suffocated that conversation with the pillow of my compassion.
• But. If the patient had a dolphin tattoo on her right groin, would it be so bad if my skin incision was slightly wider than usual and I had no choice but to decapitate the dolphin?
• The escape plan unfortunately failed just as she was getting over the railings, when she slipped and one of the metal spikes slid up her vagina and penetrated through the front of her abdomen. <> She’d had the presence of mind to get off her face on cocaine earlier in the evening, which anaesthetized her sufficiently until the Fire Brigade arrived on the scene and were able to cut off the railing just below vagina level (while presumably saying ‘holy shit’ quite a lot). She arrived here haemodynamically stable and remarkably well, all things considered, so we arranged an urgent CT to delineate precisely which cuts of meat were skewered on this particular kebab.
• Technically this job ended at midnight, a fact that occurs to me on the stairwell at 12.10 a.m. when my swipe card refuses to let me back onto the ward and I realize it’s been automatically deactivated. I’m Cinderella in scrubs. <> If you ask the hospital to adequately staff a department, provide an effective computer system or even supply enough chairs for clinic, you’ll get a shrug and a display of colossal incompetence. And yet when it comes to being able to get in and out of doors, they somehow take on the organizational skills of a cyborg librarian. If swipe cards suddenly start developing cancer, a cure will be found immediately.
• As we wait for the cry that may or may not come, I remember an old phrase in the textbooks that describes a successful shoulder dystocia delivery as ‘greater strength of muscle or some infernal juggle’ and totally get what the author was on about.