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

Sometime during my early years as an SHO, I remember watching a documentary about Shaolin grandmasters. They train for a decade or more in a remote temple, waking up at 5 a.m. and only stopping at midnight, submitting themselves to a life of celibacy, devoid of material possessions. I couldn’t help but feel it didn’t sound that bad – at least they didn’t have to uproot their lives every year to a completely different temple.

NHS deaneries, who are responsible for postgraduate medical training, move doctors to different hospitals every six or twelve months to ensure they learn from a broad range of consultants, which I guess makes sense. Unfortunately, each deanery covers a fairly large geographical area, and you get randomly allocated to units throughout that region. For example, one such deanery is Kent, Surrey and Sussex: which I (and indeed the Ordnance Survey) had always considered to be three enormous, separate areas. Another deanery is Scotland. You know Scotland, that – what would you call it, oh yes – entire country measuring over 30,000 square miles. If you’re deciding where to buy your first house, it’s rather difficult to choose a location that’s handy for all of Scotland. Even if you were insane enough to put yourself through a property transaction once or twice a year, it would be fairly tricky as the deaneries limit relocation costs to a princely zero pounds.

So while all my friends in sensible careers were getting mortgages and puppies, H and I were taking on year-long rental contracts and living somewhere mutually inconvenient roughly halfway between our two workplaces. It was yet another item on the list of ways my job was inflicting collateral damage on H – medical widow, post-shift counsellor and now nomad.

I remember once phoning round all the various utilities and DVLA and so on about our change of address (I think as penance because I couldn’t take the day off work to help with the move) and 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’.

Despite the hours, I’d really enjoyed my first year in obs and gynae – I’d made the right choice. I’d gone from a tottering Bambi, terrified every time the bleep went off, to, if not a graceful roebuck, then at least someone who could do a decent impression of one. I now had a bit of self-belief that I could deal with the emergency behind each delivery-room door; mostly thanks to working in a hospital with seniors who were invested in my development as a doctor.

When the deanery rolled their dice for the second time, however, I found myself in a much more old-fashioned hospital. If you describe a grandparent as being ‘old-fashioned’, it’s a euphemism for ‘talks about ordering a Chinky’. In a hospital setting, it means ‘unsupportive’. You’re on your own.

I’d gone from a nursery slope straight to a Schumacher-splattering black run, where they took the now largely extinct approach of ‘see one, do one, teach one’. You’ve watched someone remove a fallopian tube or scan an ovary, so that’s you fully trained up. You’d be forgiven for thinking this was a horrible nightmare. As it turned out at this hospital, it was often the best-case scenario, ‘see one’ frequently getting skipped over, like foreplay in a nightclub toilet tryst.

Nowadays, YouTube instructional videos can show you anything from how to repair an ingrown toenail to separating conjoined twins.* Back in 2006, you had to follow a list of printed instructions in a textbook. To add to the fun, you’d have to memorize these generally quite complicated steps (think kit car rather than IKEA wardrobe) before you saw the patient. How much confidence would you have in someone staring into your genitals with a scalpel in one hand and a manual in the other? I rapidly learned to maintain an air of absolute confidence, no matter how frantically my legs were paddling under the water. In summary, never play poker with me. Although do bear me in mind if you’re struggling with your flat-pack furniture.

Because I spent the vast proportion of my waking hours at work and because the deep end was so very deep, I learned a lot during my second SHO post and did so very quickly. The ‘old-fashioned’ method might not be any fun, but it definitely works. Those Shaolin bastards were basically at holiday camp.

* Please don’t attempt either.

Wednesday, 2 August 2006

It’s Black Wednesday* and I have started at St Agatha’s. It is an established fact that death rates go up on Black Wednesday. Knowing this really takes the pressure off, so I’m not trying very hard.

* 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.

Thursday, 10 August 2006

Reviewing a mother in clinic, six weeks after a traumatic delivery. All is now well, but something is clearly troubling her. I ask her what’s up and she breaks down in tears – she thinks the baby has a brain tumour and asks me to have a look. It’s very much not my department* but one look at the mother’s collapsed face tells me that now perhaps wouldn’t be the best time to play the unhelpful station assistant at a ticket window and advise she should see her GP. I examine the child and hope that whatever she’s concerned about is within the limited parameters of my paediatric knowledge.

She shows me a hard swelling on the back of baby’s head. My ship has somehow come in and I can confidently announce that this is baby’s occipital protuberance, which is a completely normal part of the skull. Look, there it is on your other kid’s head! There it is on your head!

‘Oh my God,’ she cries, the tears still streaking her face, eyes darting from her baby to her three-year-old and back again, like she’s watching Wimbledon. ‘It’s hereditary.’

* Parents seem to think obstetricians are wise owls with expert knowledge of infants, but this couldn’t be further from the truth. We know the square root of fuck all about them, save for a few half-remembered semi-facts from medical school. Once a baby’s no longer umbilically attached to its mother, we hand them over and never deal with them again until they’re old enough to procreate.

Monday, 14 August 2006

My rota involves scanning in the Early Pregnancy Unit once a fortnight. Today, having never so much as seen a scan like this performed before, I had to single-shaking-handedly run a clinic of twenty patients, peering at 4 mm lumps of cells using a trans-vaginal probe.*

I asked (begged) a registrar to give me a quick demo, and he had time to see one patient with me before he dashed off to theatre. My SHO colleague on the afternoon shift had never done it before either, so I passed on my new skill by scanning her first patient for her. See one, do twenty, teach one.

* This sounds like a high-speed train service in the Caucasus but is considerably less sophisticated. You look inside with an ultrasound stick to decide if a pregnancy is viable, miscarrying or ectopic. Misdiagnosis can see you the wrong side of a negligence/manslaughter charge.

Wednesday, 16 August 2006

Just out of a delivery, my slickest ventouse yet. The midwife told me afterwards she assumed I was a registrar (although she is known as Dangerous Dawn, so I’m not going to put vast quantities of stock in that).

A phone call from Mum to say my sister Sophie’s got into med school. I send Soph a text with huge congratulations, then a picture of me thumbs-upping in scrubs (cropped above the splatter-zone) and ‘You in six years’ time!’

Had the call come at the end of the shift, my text would have read, ‘RUN LIKE THE FUCKING WIND.’

Monday, 21 August 2006

I’ve been carrying a Post Office ‘Sorry you were out’ card around with me for over a fortnight. I keep taking it out and looking at it meaningfully like it’s a photograph of my firstborn or some long-dead childhood sweetheart, pathetically rereading the collection office’s opening times in the hope they will magically alter before my eyes. They do not.

I wouldn’t have time to get to the Post Office and back in my lunch hour, even if I had a lunch hour, which of course I don’t, but I’ve been holding on to a glimmer of hope that I might knock off work early one day – if the hospital burnt down, say, or nuclear war was declared. Today I start a week of nights so nip off to collect the parcel. Unfortunately, it turns out the Post Office only hold on to items for eighteen days, every one of which I’ve been at work, so it’s been returned to sender.

Long story short, H won’t be getting a birthday present tomorrow.

Thursday, 14 September 2006

Patient CW on the antenatal ward needs some imaging done of her lungs, so I book her in for an MRI and go through the checklist.* She is in fact ineligible for an MRI, having had a small but powerful magnet implanted in the pulp of her right index finger a few years ago. Apparently there had been a limited trend for this, performed by tattoo artists and intended to give the recipient an ‘extra sense’ – an other-worldly awareness of metal objects around them, like a kind of vibrating aura (her words) or a slightly low-rent X-Man (my words).

Her sales pitch needs work, to be honest. It turned out not to be the mystical, ethereal experience she had been looking for, but a regal pain in the arse – she tells me it’s become infected a number of times and going through airport security is now a living hell. I briefly toy with asking her to brush past my colleague Cormac to either confirm or refute the rumour that he has a Prince Albert,† but she says the implant has recently become either dislodged or demagnetized and she now barely feels a thing, except for a lump in her finger. She wants to have the magnet removed, in fact, but the scar tissue that will have formed around it makes it a slightly involved operation, and one not covered on the NHS. I book her in for a CT scan – she can wear a lead apron and there’ll be very little radiation exposure for the baby. Although if I’d only gone ahead and booked her an MRI, I’d have saved her the cost of that private operation.

* Ordinarily you’d do a CT scan, but we try to avoid those in pregnancy as they involve a large quantity of X-ray exposure; and anyone who’s stayed up for the late-night horror can tell you that radiation plus baby is not a good idea. I’ve had the mechanism of MRIs explained to me any number of times and I’m still none the wiser, but no X-rays are involved: images are obtained using a combination of protons, magic and an enormous fucking magnet. And I mean enormous; the size and weight of a one-bedroom flat. 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).

† The already close-to-zero appeal of a genital piercing instantly evaporated as a house officer when I saw a patient present with a ring that had ripped out during sex. This happens frequently enough that urologists have a term for it: ‘Prince Albert’s revenge’.

Sunday, 17 September 2006

Either the printer has gone insane or one of the receptionists has – huge quantities of paper have engulfed the nursing station. Everyone in sight has collected around to try and fix it, all doing exactly the same thing – jabbing random buttons to absolutely zero effect.

Pages are cascading out of the printer and onto the labour ward floor. I pick one up – they’re patient identification stickers for a neonate, to go on notes, wristbands, etc. For the rest of the day, everyone checks their shoes and backs in paranoia, just in case a stray one has become attached – this is one label nobody wants to be walking around with. A slightly unfortunate surname means that every sticker says BABY RAPER.

Monday, 25 September 2006

How the other half live. In antenatal clinic, an extremely posh patient attends for a routine appointment. All is well with her extremely posh fetus. Her extremely posh eight-year-old asks her a question about the economy (!), and before she answers she asks her extremely posh five-year-old, ‘Do you know what the economy is, darling?’

‘Yes, Mummy. It’s the part of the plane that’s terrible.’

You can see how revolutions start.

Wednesday, 27 September 2006

I’m off sick for the first time since qualifying. Work weren’t exactly sympathetic.

‘Oh, for fuck’s sake,’ spat my registrar when I rang in. ‘Can’t you just come in for the morning?’ I explained I had quite bad food poisoning and was in some kind of gastrointestinal meltdown. ‘Fine,’ he said with the kind of weary, simmering passive-aggression I normally only get at home. ‘But phone around and find someone who’s on leave to cover you.’

I’m pretty sure this isn’t the protocol at Google or GlaxoSmithKline or even Ginsters. Is there a single other workplace where you’d conceivably be asked to arrange your own sickness cover? The North Korean army maybe? I wonder what level of illness would stop it from being my responsibility. Broken pelvis? Lymphoma? Or just when I was intubated on ITU and denied the power of speech?

Luckily, I could manage to force out a few words in between bouts of vomiting (if not in between bouts of diarrhoea), so I was able to organize a stand-in. I didn’t explain what I was doing during the call – it probably sounded like I’d gone paintballing. And I now owe her a shift in return, so it’s not even sick leave.

I’d always suspected if I ended up off sick it would be work that caused it. My money would have been on some form of emotional collapse, maybe renal failure from dehydration, getting beaten up by an angry relative or smashing my car into a tree after a sleep-deprived night shift. 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.

Saturday, 30 September 2006

Review a woman in triage, who just arrived huffing and puffing away in labour. I ask how frequently the contractions are coming and the husband tells me they’re three to four times every ten minutes, lasting up to a minute each. I explain I’ll need to do an internal examination to assess how far dilated* she is.

The husband tells me he checked before they left home and she was 6 cm. Most dads-to-be don’t peek under the hood so I ask him if he’s a medic. No, he tells me, he’s a plasterer, but ‘I know what a centimetre is, mate’. I examine the patient and agree with his findings, making him more competent than most of my colleagues.

* The contractions of the womb make its neck, or cervix, go from closed before labour to full (10 cm) dilatation at the end of labour, at which point baby can make its grand entrance. The first few centimetres can take an extremely long time, so women aren’t generally admitted to labour ward until they’re at least 3 cm dilated – like a strange nightclub you can’t get into until you’ve had two gloved fingers in your vagina. Actually, there’s probably one of those in Soho already.

Saturday, 7 October 2006

I’ve now spent six months being Simon’s on-call mental health helpline since that first Facebook post – any time he’s having worrying thoughts, I’ve told him he can ring me, and he does. I’ve also told him repeatedly to engage more formally with mental health services, but he’s not so keen on listening to that bit. Aside from the fact it’s a bit overwhelming to now have a second bleep threatening to go off with bad news any minute, I suspect he can get better help from someone who didn’t have to panic-google ‘What to say to someone who’s suicidal?’ But it seems I’m better than nothing – at the very least, he’s still alive.

The most stressful part is discovering I’ve missed a call from him – if I call back too late and he’s done himself in, does that make it my fault, like I’m the one who kicked away the chair? I suppose it doesn’t, but that’s how you feel as a doctor, and probably why I’m in this situation to begin with. If you’re the first to notice someone else’s patient is breathing strangely or has abnormal blood tests, it’s your responsibility to deal with it, or at least ensure someone else does. I’m pretty sure heating engineers don’t feel the same way about every kaput boiler they encounter. The difference is obviously the whole ‘life and death’ thing, which is what separates this job from all others, and makes it so unfathomable to people on the outside.

I call Simon back after a caesarean this evening. I’ve got my counselling sessions down to about twenty minutes – it’s just a case of listening, being sympathetic and reassuring him the feelings will pass. He must realize we have the same chat every time, but it clearly doesn’t matter – he just wants to know there’s someone out there who cares. And actually, that’s a very large part of what being a doctor is.

Monday, 9 October 2006

Today crossed the line from everyday patient idiocy to me checking around the room for hidden cameras. After a lengthy discussion with a patient’s husband about how absolutely no condoms fit him, I establish he’s pulling them right down over his balls.

Tuesday, 10 October 2006

I missed what the argument was about, but a woman storms out of gynae outpatients screaming at the clinic sister, ‘I pay your salary! I pay your salary!’ The sister yells back, ‘Can I have a raise then?’

Thursday, 19 October 2006

My poker face has served me well over the years. It’s seen me through an eighty-year-old telling me about his use of a colossal butt-plug called The Assmaster and gently explaining to a couple in infertility clinic that massaging semen into her navel isn’t quite going to cut it, conception-wise. I sit there nodding along blankly like the dog from the Churchill advert. ‘And which size of Assmaster, sir?’

Today, however, my poker face cracked. On this morning’s ward round, a medical student presented Mrs Ringford – a seventy-year-old gynae patient, recovering on the ward after a posterior repair for a large prolapse.* Unfortunately, he called her ‘Mrs Ringpiece’ and, much like the patient, I unexpectedly lost my shit.

* When you reach a certain age, your body attempts to turn itself inside out via your vagina, but you can avoid all this by performing pelvic floor exercises. There are leaflets that describe these exercises in confusing detail, but I always just used to tell patients, ‘Imagine you’re sitting in a bath full of eels and you don’t want any of them getting in.’

Monday, 23 October 2006

Called to A&E to review a gentleman in his seventies. I check with the A&E officer that he realizes he’s bleeped gynaecology: reviewing a man would be rather pushing my remit. It’s complicated, apparently; he’ll explain when I get down there.

I meet patient NS, a Sikh gentleman who speaks no English at all. He is on holiday, visiting family, and has been unhelpfully accompanied to the hospital by a relative who also speaks no English. His history is therefore taken with the assistance of a telephone interpreter service – in this instance, a Punjabi translator is on the line and the phone is passed back and forth. This particular interpreter may have rather fudged his CV – he seems to be able to speak only slightly more Punjabi than someone who can’t speak any Punjabi whatsoever.

The stoic A&E staff have been making glacial progress using the interpreter, and relay what they’ve established: the patient is bleeding from ‘down below’, has been doing so for the past week and – crucially to my attendance – is a hermaphrodite.* I tell the A&E officer that I sincerely doubt this elderly bearded man is part of the intersex community, and ask to speak to the interpreter.

‘Can you ask if the patient has a womb?’ The phone gets passed back, and the patient starts to repeat a word to us very loudly and angrily in Punjabi. The patient furiously unbuttons his shirt to reveal a Port-a-Cath† – our eureka moment. In unison we all say, ‘Haemophiliac!’ and I leave them to deal with his rectal bleed.

* Hermaphroditism is a very rare intersex disorder where the patient possesses both testicular and ovarian tissue. It’s named after the Greek legend of Hermaphroditus, who was said to be both male and female. He/she was the son/daughter of Hermes and Aphrodite, who it must be said had a pretty lazy system for naming their children.

† A Port-a-Cath is a device that sits under the skin to allow easy injection of drugs and taking of blood, for people who need it done frequently.

Tuesday, 31 October 2006

Moral maze. In the labour ward dressing rooms after a long shift. I’m leaving at 10 p.m. rather than 8 p.m. thanks to a major obstetric haemorrhage ending up back in theatre. I’m meant to be going to a Halloween party, but now I don’t have time to go home and pick up my costume. However, I am currently dressed in scrubs and splattered head to toe in blood. Would it be so wrong?

Saturday, 4 November 2006

Get bleeped to see a postnatal patient at 1 a.m. The ODP* relays to the bleeping midwife that I’m in the middle of a caesarean. I get bleeped again at 1.15 a.m. (still doing the section) and 1.30 a.m. (writing up my operation notes). Eventually, I head off to review the patient. The big emergency? She’s going home in the morning and wants to have her passport application countersigned by a doctor while she’s still in here.

* An Operating Department Practitioner (ODP) is Muttley to the anaesthetist’s Dick Dastardly.

Wednesday, 15 November 2006

I have entered the MRCOG* Part One exam. A textbook advises me to try a past paper before I start revising – ‘You might be pleasantly surprised how much you already know!’ I attempt one.

March 1997, Paper 1, Question 1.

True or false? Chromaffin cells:

A. Are innervated by pre-ganglionic sympathetic nerve fibres

B. Are present in the adrenal cortex

C. Are derived from neuro-ectoderm

D. Can decarboxylate amino acids

E. Are present in coeliac ganglia

Aside from the fact I know what less than half of these words mean (and most of those are prepositions), I can’t help wondering how it’s relevant to my baby-delivering abilities. But if it’s what my insane demonic overlords want me to know, who am I to argue?

Another textbook cheerily informs me that ‘It’s quite possible to revise for MRCOG Part One in just six months, with an hour or two’s study every evening.’ It’s one of those phrases that is intended to be reassuring but has the opposite effect, like ‘it’s only a small tumour’ or ‘most of the fire’s been put out already’.

I’m not entirely sure where these extra couple of hours a day are going to come from – either I need to give up my frivolous hobby of sleeping or cut out my commute by living in a store cupboard at work. Oh, and my exam’s in four months, not six.

* Member of the Royal College of Obstetricians and Gynaecologists – a necessary hurdle to proceed up the ranks. The exam is in two equally brutal parts, and feels rather like the Labours of Hercules, in that you’re forced to do it to demonstrate your extraordinary dedication to the field more than anything else.

Monday, 25 December 2006

I don’t particularly mind working Christmas Day – there are snacks everywhere, people on the whole are in a good mood and there are very few worried well.* Generally nobody rocks up as a patient on Christmas Day unless they’re genuinely sick, genuinely in labour or genuinely hate their family. (In which case, we’ve at least got some common ground.) I’m not convinced H sees it this way, as we exchange gifts at breakneck speed before 7 a.m.

Tradition at St Agatha’s dictates that the on-call consultant† turns up and does a ward round on Christmas Day, which eases the workload for the juniors. The consultant will also bring a bag of presents for the patients – toiletries, panettone, that sort of thing – because, well, it’s pretty rotten being a hospital inpatient over Christmas, and the little things do make a difference. Best of all, tradition has it that this consultant will be dressed as Santa Claus as they do their round.

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 marchégris 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.