This is Going to Hurt: Now a major BBC comedy-drama

The decision to work in medicine is basically a version of the email you get in early October asking you to choose your menu options for the work Christmas party. No doubt you’ll choose the chicken, to be on the safe side, and it’s more than likely everything will be all right. But what if someone shares a ghastly factory farming video on Facebook the day before and you inadvertently witness a mass debeaking? What if Morrissey dies in November and, out of respect for him, you turn your back on a lifestyle thus far devoted almost exclusively to consuming meat? What if you develop a life-threatening allergy to escalopes? Ultimately, no one knows what they’ll fancy for dinner in sixty dinners’ time.

Every doctor makes their career choice aged sixteen, two years before they’re legally allowed to text a photo of their own genitals. When you sit down and pick your A levels, you’re set off on a trajectory that continues until you either retire or die and, unlike your work Christmas party, Janet from procurement won’t swap your chicken for her halloumi skewers – you’re stuck with it.

At sixteen, your reasons for wanting to pursue a career in medicine are generally along the lines of ‘My mum/dad’s a doctor’, ‘I quite like Holby City’ or ‘I want to cure cancer’. Reasons one and two are ludicrous, and reason three would be perfectly fine – if a little earnest – were it not for the fact that’s what research scientists do, not doctors. Besides, holding anyone to their word at that age seems a bit unfair, on a par with declaring the ‘I want to be an astronaut’ painting you did aged five a legally binding document.

Personally, I don’t remember medicine ever being an active career decision, more just the default setting for my life – the marimba ringtone, the stock photo of a mountain range as your computer background. I grew up in a Jewish family (although they were mostly in it for the food); went to the kind of school that’s essentially a sausage factory designed to churn out medics, lawyers and cabinet members; and my dad was a doctor. It was written on the walls.

Because medical schools are oversubscribed ten-fold, all candidates must be interviewed, with only those who perform best under a grilling being awarded a place. It’s assumed all applicants are on course for straight As at A level, so universities base their decisions on nonacademic criteria. This, of course, makes sense: a doctor must be psychologically fit for the job – able to make decisions under a terrifying amount of pressure, able to break bad news to anguished relatives, able to deal with death on a daily basis. They must have something that cannot be memorized and graded: a great doctor must have a huge heart and a distended aorta through which pumps a vast lake of compassion and human kindness.

At least, that’s what you’d think. 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. Their ideal student is captain of two sports teams, the county swimming champion, leader of the youth orchestra and editor of the school newspaper. It’s basically a Miss Congeniality contest without the sash. Look at the Wikipedia entry for any famous doctor, and you’ll see: ‘He proved himself an accomplished rugby player in youth leagues. He excelled as a distance runner and in his final year at school was vice-captain of the athletics team.’ This particular description is of a certain Dr H. Shipman, so perhaps it’s not a rock-solid system.

Imperial College in London were satisfied that my distinctions in grade eight piano and saxophone, alongside some half-arsed theatre reviews for the school magazine, qualified me perfectly for life on the wards, and so in 1998 I packed my bags and embarked upon the treacherous six-mile journey from Dulwich to South Kensington.

As you might imagine, learning every single aspect of the human body’s anatomy and physiology, plus each possible way it can malfunction, is a fairly gargantuan undertaking. But the buzz of knowing I was going to become a doctor one day – such a big deal you get to literally change your name, like a superhero or an international criminal – propelled me towards my goal through those six long years.

Then there I was, a junior doctor.* I could have gone on Mastermind with the specialist subject ‘the human body’. Everyone at home would be yelling at their TVs that the subject I’d chosen was too vast and wide-ranging, that I should have gone for something like ‘atherosclerosis’ or ‘bunions’, but they’d have been wrong. I’d have nailed it.

It was finally time to step out onto the ward armed with all this exhaustive knowledge and turn theory into practice. My spring couldn’t have been coiled any tighter. So it came as quite the blow to discover that I’d spent a quarter of my life at medical school and it hadn’t remotely prepared me for the Jekyll and Hyde existence of a house officer.†

During the day, the job was manageable, if mind-numbing and insanely time-consuming. You turn up every morning for the ‘ward round’, where your whole team of doctors pootles past each of their patients. You trail behind like a hypnotized duckling, your head cocked to one side in a caring manner, noting down every pronouncement from your seniors – book an MRI, refer to rheumatology, arrange an ECG. Then you spend the rest of your working day (plus generally a further unpaid four hours) completing these dozens, sometimes hundreds of tasks – filling in forms, making phone calls. Essentially, you’re a glorified PA. Not really what I’d trained so hard for, but whatever.

The night shifts, on the other hand, made Dante look like Disney – an unrelenting nightmare that made me regret ever thinking my education was being underutilized. At night, the house officer is given a little paging device affectionately called a bleep and responsibility for every patient in the hospital. The fucking lot of them. The night-time SHO and registrar will be down in A&E reviewing and admitting patients while you’re up on the wards, sailing the ship alone. A ship that’s enormous, and on fire, and that no one has really taught you how to sail. You’ve been trained how to examine a patient’s cardiovascular system, you know the physiology of the coronary vasculature, but even when you can recognize every sign and symptom of a heart attack, it’s very different to actually managing one for the first time.

You’re bleeped by ward after ward, nurse after nurse with emergency after emergency – it never stops, all night long. Your senior colleagues are seeing patients in A&E with a specific problem, like pneumonia or a broken leg. Your patients are having similar emergencies, but they’re hospital inpatients, meaning they already had something significantly wrong with them in the first place. It’s a ‘build your own burger’ of symptoms layered on conditions layered on diseases: you see a patient with pneumonia who was admitted with liver failure, or a patient who’s broken their leg falling out of bed after another epileptic fit. You’re a one-man, mobile, essentially untrained A&E department, getting drenched in bodily fluids (not even the fun kind), reviewing an endless stream of worryingly sick patients who, twelve hours earlier, had an entire team of doctors caring for them. You suddenly long for the sixteen-hour admin sessions. (Or, ideally, some kind of compromise job, that’s neither massively beyond nor beneath your abilities.)

It’s sink or swim, and you have to learn how to swim because otherwise a ton of patients sink with you. I actually found it all perversely exhilarating. Sure it was hard work, sure the hours were bordering on inhumane and sure I saw things that have scarred my retinas to this day, but I was a doctor now.

* ‘Junior doctor’ refers to anyone who isn’t a consultant. It’s a bit confusing as a lot of these ‘junior doctors’ are actually pretty senior – some have been working for fifteen years, picking up PhDs and various other postgraduate qualifications. It’s a bit like calling everyone in Westminster apart from the prime minister a ‘junior politician’.

† The hierarchy goes: house officer, senior house officer (SHO), registrar, senior registrar, consultant. They’ve recently renamed the ranks: it’s now F1, F2, ST1–7. Everyone still uses the old terminology though, like when Coco Pops were briefly rebranded as Choco Krispies.

Tuesday, 3 August 2004

Day one. H* has made me a packed lunch. I have a new stethoscope,† a new shirt and a new email address: [email protected]. It’s good to know that no matter what happens today, nobody could accuse me of being the most incompetent person in the hospital. And even if I am, I can blame it on Atom.

I’m enjoying the ice-breaking potential of the story, but in the pub afterwards, my anecdote is rather trumped by my friend Amanda. Amanda’s surname is Saunders-Vest. They have spelled out the hyphen in her name, making her [email protected].

* H is my short-suffering partner of six months. Don’t worry – you’re not going to have to remember huge numbers of characters. It’s not Game of Thrones.

† I’m all for explaining terminology as we go along, but if you don’t know what a stethoscope is, this is probably a book to regift.

Wednesday, 18 August 2004

Patient OM is a seventy-year-old retired heating engineer from Stoke-on-Trent. But tonight, Matthew, he’s going to be an eccentric German professor with ze unconvinzing agzent. Not just tonight in fact, but this morning, this afternoon and every day of his admission; thanks to his dementia, exacerbated by a urinary tract infection.*

Prof OM’s favourite routine is to follow behind the ward round, his hospital gown on back-to-front, like a white coat (plus or minus underwear, for a bit of morning Bratwurst), and chip in with ‘Yes!’, ‘Zat is correct!’ and the occasional ‘Genius!’ whenever a doctor says something.

On consultant and registrar ward rounds, I escort him back to his bed immediately and make sure the nursing staff keep him tucked in for a couple of hours. On my solo rounds, I let him tag along for a bit. 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.

* In the elderly, urinary tract infections, or any kind of low-grade sepsis, often make them go a bit nuts.

Monday, 30 August 2004

Whatever we lack in free time, we more than make up for in stories about patients. Today in the mess* over lunch we’re trading stories about nonsense ‘symptoms’ that people have presented with. Between us in the last few weeks we’ve seen patients with itchy teeth, sudden improvement in hearing and arm pain during urination. Each one gets a polite ripple of laughter, like a local dignitary’s speech at a graduation ceremony. We go round the table sharing our version of campfire ghost stories until it’s Seamus’s turn. He tells us he saw someone in A&E this morning who thought they were only sweating from half of their face.

He sits back in anticipation of bringing the house down, but there’s merely silence. Until pretty much everyone chimes in with: ‘So, Horner’s syndrome then?’ He’s never heard of it, specifically not the fact that it likely indicates a lung tumour. Seamus scrapes his chair back with an ear-splitting screech and dashes off to make a phone call to get the patient back to the department. I finish his Twix.

* The ‘doctors’ mess’ either refers to our communal area with a few sofas and a knackered pool table or the state of most of my patients in the first few months.

Friday, 10 September 2004

I notice that every patient on the ward has a pulse of 60 recorded in their observation chart so I surreptitiously inspect the healthcare assistant’s measurement technique. He feels the patient’s pulse, looks at his watch and meticulously counts the number of seconds per minute. To give myself a bit of credit, I didn’t panic when the patient I was reviewing on the ward unexpectedly started hosing enormous quantities of blood out of his mouth and onto my shirt.

Sunday, 17 October 2004

To give myself no credit whatsoever, I didn’t know what else to do. I asked the nearest nurse to get Hugo, my registrar, who was on the next ward, and meantime I put in a Venflon* and ran some fluids. Hugo arrived before I could do anything else, which was handy as I was completely out of ideas by that point. Start looking for the patient’s stopcock? Shove loads of kitchen roll down his throat? Float some basil in it and declare it gazpacho?

Hugo diagnosed oesophageal varices,† which made sense as the patient was the colour of Homer Simpson – from the early series, when the contrast was much more extreme and everyone looked like a cave painting – and tried to control the bleeding with a Sengstacken tube.‡ As the patient flailed around, resisting this awful thing going down his throat, the blood jetted everywhere: on me, on Hugo, on the walls, curtains, ceiling. It was like a particularly avant-garde episode of Changing Rooms. The sound was the worst part. With every breath the poor man took you could hear the blood sucking down into his lungs, choking him.

By the time the tube was inserted, he’d stopped bleeding. Bleeding always stops eventually, and this was for the saddest reason. Hugo pronounced the patient’s death, wrote up the notes and asked the nurse to inform the family. I peeled off my blood-soaked clothes and we silently changed into scrubs for the rest of the shift. So there we go, the first death I’ve ever witnessed and every bit as horrific as it could possibly have been. Nothing romantic or beautiful about it. That sound. Hugo took me outside for a cigarette – we both desperately needed one after that. And I’d never smoked before.

* A Venflon, or cannula, is the plastic tube that gets shoved into the back of the hand or the crook of your elbow so we can run drugs or fluids intravenously through a drip. Putting in Venflons is one of the key responsibilities of a house officer, although I got through medical school without ever having tried it. On the night before my first day as a doctor, one of my flatmates in our on-site hospital accommodation stole a box of about eighty of them from a ward and we practised cannulating ourselves for a few hours until we could finally do it. We were covered in track marks for days.

† Varices are a horrible complication of liver cirrhosis, where you essentially get huge varicose veins inside your oesophagus, which can rupture at any point and bleed heavily.

‡ A tube you can wedge down the throat that – when it’s in position – can be inflated like a balloon, to put pressure on the vessels and hopefully stop the bleeding.

Tuesday, 9 November 2004

Bleeped awake at 3 a.m. from my first half-hour’s shuteye in three shifts to prescribe a sleeping pill for a patient, whose sleep is evidently much more important than mine. My powers are greater than I realized – I arrive on the ward to find the patient is asleep.

Friday, 12 November 2004

An inpatient’s blood results show her clotting is all over the shop for no good reason. Hugo eventually cracks it. She has been taking St John’s Wort capsules from a health food shop for anxiety. Hugo points out to her (and, in fairness, me) that it interacts with the metabolism of warfarin, and her clotting will probably settle down if she stops taking it. She is astonished. ‘I thought it was just herbal – how can it be that bad for you?’

At the sound of the words ‘just herbal’, the temperature in the room seems to drop a few degrees and Hugo barely holds in a weary sigh. It’s clearly not his first time at this particular rodeo.

‘Apricot stones contain cyanide,’ he replies drily. ‘The death cap mushroom has a fifty per cent fatality rate. Natural does not equal safe. 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.’

Monday, 6 December 2004

All junior doctors at the hospital have been asked to sign a document opting out of the European Working Time Directive* because our contracts are non-compliant with it. This week I have seen H for under two hours and worked for a grand total of ninety-seven. Non-compliant doesn’t quite seem to cover it. My contract has taken the directive, dragged it screaming from its bed in the dead of night and waterboarded it.

* The European Working Time Directive was brought in to provide some legal measure to stop employers working their staff to their bleary-eyed deaths, by limiting shifts to a ‘mere’ forty-eight hours per week.

Thursday, 20 January 2005

Dear drug-dealing scrote,

Over the last few nights, we’ve had to admit three young men and women – all dry as a husk, basically collapsed through hypotension, and with their electrolytes up the fuck.* The only connection between these individuals is their recent use of cocaine. For all its heart-attacking, septum-shrinking risks, cocaine does not cause this to happen to people. What I’m pretty confident is going on here – and I want a Nobel Prize or at the very least a Pride of Britain Award if I’m right – is that you’ve been bulking out your supply with your nan’s frusemide.†

Aside from the fact you’re wasting my evenings and my unit’s beds, it feels like fairly terrible business practice to be hospitalizing your customers. Kindly use chalk like everyone else.

Yours faithfully, Dr Adam Kay

* Electrolytes are the salts in the blood – mostly sodium, potassium, chloride and calcium. If levels become too high or too low, your body has a way of alerting you, by making your heart stop or putting you in a coma. It’s clever like that.

† Frusemide, or Furosemide, is a diuretic – if you’ve got a build-up of fluid in your lungs or tissues, generally from a malfunctioning heart or kidneys, it will make you pee it out. If you don’t have a build-up of fluid, as here, it will make you pee out the water content of your blood.

Monday, 31 January 2005

Saved a life tonight. I was bleeped to see a sixty-eight-year-old inpatient who was as close to death’s door as it’s possible to be – he’d already pressed the bell and was peering through the frosted glass into the Grim Reaper’s hallway. His oxygen saturation* was 73 per cent – I suspect if the vending machine hadn’t been out of order and I’d bought my Snickers as planned, it would have all been too late.

I didn’t even have the spare seconds to run through the bullet points of a management plan in my head – I just started performing action after action on an autopilot mode I didn’t know I possessed. Oxygen on, intravenous access, blood tests, blood gases, diuretics, catheter. He started to perk up pretty much immediately, the bungee rope jerking him back from a millimetre above the concrete. Sorry, Death – you’re one short for your dinner party this evening. By the time Hugo arrived, I felt like Superman.

A strange realization that it’s the first time I’ve actually saved a life in five months as a doctor. Everyone on the outside imagines we roam the wards performing routine acts of heroism; I even assumed that myself when I started. 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.

But sometimes it is down to one person; and today, for the first time, it was me. Hugo seems happy, or at least as happy as he’s capable of being: ‘Well, you’ve bought him another couple of weeks on earth.’ Come on – give a superhero a break here.

* Oxygen saturation is the percentage of oxygen in your blood, and is measured by that little clip they put on the end of your finger. It should be as close to 100 per cent as possible, definitely above 90 per cent, and definitely definitely above 80 per cent.

Monday, 7 February 2005

My move to surgery* has rewarded me with my very first degloving injury.†

Patient WM is eighteen and was out celebrating with friends. After chucking-out time he found himself dancing on the roof of a bus shelter, and then decided to descend to ground level using a handy neighbouring lamp post as a fireman’s pole. He jumped over to the lamp post and slid down, koala-bear style. He unfortunately misjudged the texture of the lamp post – it wasn’t the smooth ride he was expecting at all, but a chafing, agonizing, gritty slump to the bottom. He therefore presented to A&E with severe grazing to both palms and a complete degloving of his penis.

I have seen a lot of penises in my brief time in urology (and beyond) but this was far and away the worst one I have ever seen. Worthy of a rosette, if only there’d been a place to pin it. A couple of inches of urethra, coated with a thin layer of bloody pulp, maybe half a centimetre diameter in total. It brought to mind a remnant of spaghetti stuck to the bottom of the bowl by a smear of tomato sauce. Perhaps not surprisingly, WM was upset. His distress was only made worse 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.

* House officers generally spend six months working in medicine and six months in surgery. The very shortest of straws saw me working in urology.

† A degloving injury is where skin is traumatically torn from the underlying tissues – typically seen in motorcycle accidents, where the rider’s hands drag along the ground. Rats are able to deglove their tails at will to escape capture. Quite why we were taught this at medical school escapes me.

Monday, 21 February 2005

Discharging a patient home after laparoscopy,* I sign her off work for two weeks. She offers me a tenner to sign her off for a month. I laugh, but she’s serious, and ups her offer to fifteen quid. I suggest she sees her GP if she’s not feeling up to work after a fortnight.

I clearly need to dress smarter if that’s the level of bribe I’m attracting. On the way home I wonder how much she’d have needed to offer before I said yes. Depressingly, I put it somewhere around £50.

* Almost any abdominal operation can now be performed laparoscopically, which is Greek for ‘much much slower’, and involves inserting tiny cameras and instruments on long sticks through little holes. It’s fiddly and takes a long time to learn. Recreate the experience for yourself by tying your shoelaces with chopsticks. With your eyes closed. In space.

Monday, 14 March 2005

Out for dinner with H and some mates – a pizza restaurant with exposed brickwork, too much neon, menus on clipboards, an unnecessarily complicated ordering system and the almost total removal of waiting staff. You’re given a device that beeps and vibrates when your order is ready, whereupon you schlep across the artfully mismatched tiles to collect your pizza from a disinterested server who sits there safe in the knowledge that no one ever asks for the 12.5 per cent service charge to be taken off the bill – even when nobody actually serves you.

The device goes off, I say ‘Oh my God’ and reflexively jump to my feet. It’s not that I’m particularly excited about my Fiorentina – it’s just that the fucking thing has the exact same pitch and timbre as my hospital bleep. H takes my pulse: it’s 95. Work has pretty much given me PTSD.

Sunday, 20 March 2005

There’s more to breaking bad news than ‘I’m afraid it’s cancer’ and ‘We did everything we could’. Nothing can prepare you for sitting down a patient’s daughter to explain that something rather upsetting happened to her frail, elderly father overnight.

I had to tell her that the patient in the bed next to her dad’s became extremely agitated and confused last night. 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.

Monday, 11 April 2005

About to take a ten-year-old straight from A&E to theatre for a ruptured appendix. Colin, a charming registrar, has been conducting a masterclass in dealing with a worried mum – explaining everything that’s going on in her son’s tummy, what we’re going to do to fix it, how long it’ll take, when he’ll be allowed home. I try to absorb his method. It’s about telling her just the right amount – keeping her informed but not overwhelmed – and delivering everything at the right level; not too much jargon, but never patronizing. Above all, it’s about being professional and kind.

Her expression becomes less uneasy by the second and I can feel the angst leave her body like an evil spirit, or trapped wind. It’s time to take the kid upstairs, so Colin nods to the mum and says, ‘Quick kiss before he goes off to theatre?’ She leans over and pecks Colin on the cheek. Her pride and joy is wheeled away, his own cheek sadly dry.

Tuesday, 31 May 2005

Three nights ago, I admitted patient MJ, a homeless guy in his fifties, with acute pancreatitis. This was the third time we’d admitted him with acute pancreatitis since I started this job. We got him comfortable with pain relief and started him on IV fluids – he was sore and miserable.

‘At least you get a warm bed for a few nights,’ I said.

‘Are you joking?’ he replied. ‘I’ll get bloody MRSA in here.’ It’s come to something when the streets outside a hospital have a better reputation for cleanliness than the corridors within.

I don’t like to preach, but I’m a doctor and not wanting him to die is kind of in the job description, so I reminded him he’s in here because of alcohol,* and even if I can’t persuade him to stop drinking (I can’t), could I at least ask him to stay off it until we’ve got him out of hospital, as that will really help. 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 as if to say, ‘that one’s on me’. Tonight he discharged himself ‘home’, but will doubtless be back with us in the coming weeks.

As per tradition, I celebrate the end of our run of night shifts with my SHO, and go for a slap-up breakfast and a bottle of white wine at Vingt-Quatre. Night shifts are essentially a different time zone to the rest of the country, so even though it’s 9 a.m., you can hardly call it an eye-opener – it’s practically a nightcap. As I’m refilling our glasses, there’s a knock on the window. It’s MJ, who laughs uproariously before shooting me his best ‘I knew it!’ look. I resolve to sit further from the window next time. Or to just have a quick suck on an alcohol wipe in the changing rooms.

* Pancreatitis is extremely painful, often very severe, and is generally caused by either alcohol or gallstones. There are a number of other causes, and the mnemonic for remembering them, pleasingly, is GET SMASHED. (The second ‘S’ stands for scorpion venom.)

Sunday, 5 June 2005

It would be unfair to label every single orthopaedic surgeon as a bone-crunching Neanderthal simply on the basis of the 99 per cent of them it applies to, but my heart does seem to sink with every night-time bleep to their ward.

So far this weekend I’ve reviewed two of their patients. Yesterday: a man in atrial fibrillation* following surgery for a #NOF.† I note from his admission ECG he was in AF at that point too – a fact completely unnoticed by his admitting team, even though it would almost certainly explain why he ended up sprawled across the floor in Debenhams in the first place. I feel like running a teaching session for the orthopaedic department entitled, ‘Sometimes people fall over for a reason’.

Today, I’m asked to review a twenty-year-old patient whose blood tests show abnormal renal function. Both his arms are in full plaster casts, like a Scooby Doo villain. He’s got no drip for fluids and an untouched glass of water on his bedside table that – despite all the will in the world, I’m sure – physics has prevented him from touching for the past couple of days. I prescribe IV fluids for the patient, though it would be more efficient to prescribe common sense for some of my colleagues.

* Atrial fibrillation (AF) means the heart is beating fast, erratically and inefficiently – this isn’t ideal.

† #NOF means fractured Neck of Femur. If you thought # was a hashtag, you’re banned from reading the rest of the book.

Tuesday, 7 June 2005

Assisting in theatres on the emergency list, removing a ‘foreign object’ from a patient’s rectum. Less than a year as a doctor and this is the fourth object I have removed from a rectum – professionally, at least.

My first encounter was a handsome young Italian man who attended hospital with the majority of a toilet brush inside of him (bristles first), and went home with a colostomy bag. His big Italian mother was grateful in ways that Brits never are, lavishing thanks and praise on every member of staff she met for saving her son’s life. She put her arm round the equally handsome young man who attended hospital with her son. ‘And thank God his friend Philip was staying in the spare room at the time to call the ambulance!’

Most of these patients suffer from Eiffel Syndrome – ‘I fell, doctor! I fell!’ – and the tales of how things get where can be skyscraper tall (come to think of it, it’s only a matter of time before someone tries to sit on the Gherkin), but today is the first time I’ve actually believed the patient’s story. It’s a credible and painful sounding incident with a sofa and a remote control that at the very least had me furrowing my brow and thinking, ‘Well, I suppose it could happen.’ Upon removal of the remote control in theatre, however, we notice it has a condom on it, so maybe it wasn’t a complete accident.

Thursday, 16 June 2005

I told a patient that his MRI wouldn’t be until next week and he threatened to break both my legs. My first thought was, ‘Well, it’ll be a couple of weeks off work.’ I was this close to offering to find him a baseball bat.

Saturday, 25 June 2005

Called to pronounce death* on an elderly patient – he’d been extremely sick, wasn’t for resuscitation, and this wasn’t unexpected. The staff nurse takes me to the cubicle, points out the slate-grey former patient and introduces me to the wife, who you could say isn’t technically a widow until I make the call that he’s officially dead. Nature may do all the heavy lifting, but you still need me on hand to sign the form.

I extend condolences to the patient’s wife, and suggest she might want to wait outside while I perform some formalities, but she says she’d rather stay. I’m not sure why; I don’t think she is either. Perhaps every moment with him matters, even if he’s no longer with us, or maybe she wants to check I’m not one of those doctors she’s read about in the Mail who does unspeakable things to the deceased. Anyway, she’s settling down in her front-row seat whether I like it or not.

I’ve pronounced three deaths before, but this is the first time I’ve had a captive audience. I feel I should have laid on refreshments. She clearly doesn’t realize quite how tense, silent and drawn-out this evening’s performance is going to be – more Pinter than Priscilla, Queen of the Desert.

I confirm the patient’s identity from his hospital wristband, check visually for respiratory effort, check there’s no response to verbal or physical stimuli. Feel for a carotid pulse, check with a torch that pupils are fixed and dilated. Check watch and listen with stethoscope for heart sounds for two minutes. Then listen for lung sounds for another three minutes. Overkill feels like an inappropriate word, but five minutes is an extraordinarily long time when you’re standing motionless under brilliant white light, your stethoscope pressed against a definitely dead man’s chest, observed by his grieving wife. This is why we try and get them out of the room for this bit.

I understand why we take the time to make sure – it’s kind of a deal-breaker with death.† The almost-widow keeps asking if I am OK – I don’t know whether she thinks I’m too upset to move or have just forgotten what to do next in the death-pronouncing – but every time she says something I leap up like . . . well, like a doctor hearing a noise while listening carefully to the chest of a corpse.

Once I peel myself off the ceiling and compose myself, I confirm the sad news to her and document my findings. It was certainly an agonizing five minutes, but if the whole medicine thing goes tits-up, I’m only a tin of silver Dulux and an old crate away from a gig in Covent Garden as a ‘living statue’.

* Doctors are legally obliged to fill out death certificates for their patients, detailing causes of death. In hospital settings they will generally also be asked to formally pronounce (confirm) death.

† When a Pope dies, zero chances are taken. According to the Vatican’s rules, clearly drawn up by someone who thought The Exorcist was on the tame side, the doctor has to call out the Pope’s name three times, check the body’s breath doesn’t blow out a candle, then, just to be certain, bop him on the head with a hammer. At least she didn’t have to watch me do that.

Tuesday, 5 July 2005

Trying to work out a seventy-year-old lady’s alcohol consumption to record in the notes. I’ve established that wine is her poison.

Me: ‘And how much wine do you drink per day, would you say?’

Patient: ‘About three bottles on a good day.’

Me: ‘OK . . . And on a bad day?’

Patient: ‘On a bad day I only manage one.’

Thursday, 7 July 2005

Terrorist atrocities across London, major incident declared, all doctors told to report to A&E.

My responsibility was to go round the surgical wards and discharge any patient whose life or limb wasn’t in immediate danger, to clear the decks for new arrivals from the bombings. I was like a snowplough with a stethoscope – booting out anyone who got to the third syllable of ‘malingerer’ without passing out or coughing up blood. Got rid of hundreds of the bed-blocking fuckers.

Wednesday, 13 July 2005

The hospital didn’t receive any casualties, and with no patients I’ve basically done no work for a week.

Saturday, 23 July 2005

This weekend is my best mate Ron’s stag do, and I’ve had to bail out with barely four hours’ notice. It’s annoying for a million reasons, from the fact it was just a close selection of pals with only eight of us making the cut, to the personalized T-shirts, to the now-uneven paintballing teams, to the fact I spent four hundred fucking pounds on it.

I was originally due to be working, but arranged a four-way swap (A doing my shift, B doing A’s shift, C doing B’s shift and me doing C’s shift) – so it was always slightly precarious, like a house purchase in a massive chain. And now C (who I’ve barely met before) has real or imaginary childcare issues for one of her real or imaginary children, so I’m here on the ward instead of Zorbing, off my tits on tequila.

Non-medics* struggle to understand it doesn’t actually help having loads of notice for this kind of thing: more than two months’ notice means we don’t have the rota yet. I order a bottle of whisky I can’t afford – I can virtually hear Elton John saying ‘Steady on, let’s not go crazy here’ – and arrange to have it delivered to Ron’s flat on his return, alongside my grovelling apologies. We arrange a stag-do postscript for just the two of us in a fortnight’s time – after my run of nights, and after the three locum shifts I booked in to cover the cost of the weekend I’m now missing.

* There should be a term for non-medics, the medical equivalent of ‘lay person’ or ‘civilian’. Patients, maybe?

Friday, 29 July 2005

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.

Everything I’m bleeped about takes at least fifteen minutes to firefight, and I’m getting called about a new blaze every five minutes, so the sums don’t quite add up. My SHO and registrar are tied up in a busy A&E, so I prioritize the sickest-sounding patients and manage the expectations of the nurses who call me about anything else.

‘I’m really sorry but I’ve got a load of patients who are much more urgent,’ I say. ‘Realistically, it’ll be about six hours.’ Some understand and some react like I’ve just said, ‘Fuck off, I’m in the middle of an Ally McBeal box-set binge.’ I run from chest pain to sepsis to atrial fibrillation to acute asthma all night, like some kind of medical decathlon, and somehow everyone gets through it alive.

At 8 a.m. one of the night sisters bleeps to tell me I did really well tonight and she thinks I’m a good little doctor. I’m willing to overlook the fact that ‘good little doctor’ sounds like an Enid Blyton character, because I’m pretty sure it’s the first time I’ve had anything approaching a compliment since I qualified. I don’t really know what to say but stutter my thanks. In my confusion, I accidentally sign off with, ‘Love you, bye.’ It’s partly out of exhaustion, partly my brain misfiring because H is normally the only person who says nice things to me, and partly because, in that moment, I genuinely loved her for saying that.