SWNOVELS : Chapter 4
I realize everyone moans about their salary and thinks they deserve more, but I’m happy to look back on my time as an SHO with a bit of objectivity and declare I was profoundly underpaid. The money is utterly out of step with the level of responsibility you have – literally life and death decisions – plus there’s the fact you’ve been to medical school for six years, worked as a doctor for three and started to accrue postgraduate qualifications. 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.
Doctors tend not to complain about the money though. It’s not a profession you go into to satisfy the dollar signs behind your eyes, whatever the occasional dead-mouthed politician may say. Besides, even if you’re unhappy with your salary, there’s sod all you can do about it. It’s all determined centrally, and rolled out across the entire profession. Perhaps it’s unhelpful to describe it as a salary – the NHS should call what they pay doctors a ‘stipend’, acknowledge it’s below the prevailing rate but that they’re in the job because it’s their calling, rather than for any financial imperative.*
Nothing about the job plays along with the conventional reward structure for employees. 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. There’s no dazzling your superiors and leapfrogging your peers, or any opportunity for promotion: you progress up the ranks at a regulation rate.
Everyone seems to think doctors get upgraded on planes, but the only way that happens in reality is if they put on a suit – and then apply for a job in the City, earn more money and buy a business-class ticket. I suppose you do have unlimited access to the informal medical opinions of every speciality at work if you begin to malfunction in any way. This is good, but just as well, as there’s little chance you’d get the time off work to go to an outpatient clinic. But I’m not sure it’s worth the flip side of providing medical advice to every friend at every opportunity. You’ll hear ‘Could you just take a quick look?’ more than you’ll ever hear ‘Hey, it’s great to see you.’† My only small consolation was not having to give medical advice to relatives, what with most of my relatives being doctors.
All medics get to grips with the lack of promotion and financial incentives, but 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. Or that I’d made a smart management decision, saved a life, cleverly thought on my feet or stayed at work late for the thirtieth consecutive shift without complaining. Nobody joins the NHS looking for plaudits or expecting a gold star or a biscuit every time they do a good job, but you’d think it might be basic psychology (and common sense) to occasionally acknowledge, if not reward, good behaviour to get the most out of your staff.
Patients tended to get it, though. When one of them said thank you, you knew they meant it – even if it felt like it wasn’t for anything special, just one of the smaller horrors thrown at you that day. I’ve kept every single card a patient has given me. Birthday and Christmas cards from family and friends would always get thrown away, but these guys survived every house move, escaping even my cathartic clear-out of medical paperwork once it was all over. They were little fist-bumps that kept me going, rays of thoughtfulness from my patients that hit the spot when bosses couldn’t, or wouldn’t, oblige.
It took until now, my third job as an SHO, to feel properly recognized by a consultant for the first time. A few months through my contract, my clinical supervisor said that a registrar was leaving the post early for a research job, and asked if I’d be interested in acting up on the rota. She told me she’d been very impressed with my work in the department. I knew this was a lie; she’d met me twice – once at induction and once to bollock me for starting a patient on oral rather than intravenous antibiotics. She’d clearly just looked through everyone’s CVs and clocked that I had worked as an SHO for the longest. But sometimes it doesn’t matter how they spot you as long as they actually do, so I beamed and said I’d be delighted.
I also realized this could make a significant practical difference to me. Three years into our relationship, H and I were taking the next step into adulthood and looking to buy a flat. I’d decided to sacrifice a shorter commute so we could have a permanent base, a place to actually call home, somewhere you can hang a picture on the wall without being docked fifty quid from your rental deposit. Most non-medical friends were clambering onto the second rung of the property ladder by then, and you know what it’s like when your friends are all doing something and you’re not. Whether it’s fingering someone at a party, taking your driving test or dropping hundreds of thousands of pounds on a dungeon with dry rot – nobody wants to be left behind.
Because every penny of salary helps with getting a mortgage, I asked the consultant if I’d be paid on the registrar scale while I was acting up. She laughed so long and so hard I’m pretty sure you could hear it through two sets of double doors over on labour ward.
* Like the way priests get a stipend for their duty to God (or love of choir boys, depending on denomination).
† Tediously, this has morphed into something even worse now I’m a TV writer. I’d take ‘What do you think about this rash?’ over ‘What do you think about this script?’ any day.
Monday, 12 February 2007
Prescribing a morning-after pill in A&E. The patient says, ‘I slept with three guys last night. Will one pill be enough?’
Thursday, 22 February 2007
Spent the morning going through three months of bank statements with the mortgage broker so he can assess my expenditure. ‘You don’t . . . go out much, do you?’ he says, totting it up. For once I’m grateful for my job – we wouldn’t have saved up enough for a deposit if I was allowed the normal social life of someone in their late twenties.
It’s reasonably depressing looking at where the money goes: a lot of coffee, a lot of petrol, a lot of takeaway pizza – necessities and practicalities. Not much in the way of fun or extracurricular frippery – no pubs, restaurants, cinemas or holidays. Hang on, what’s that? There we go – theatre tickets! Shortly followed by a payment to a florist, after bailing on H at the last minute. Depressingly, it happens frequently enough that I can’t even remember the particular emergency or staffing crisis on that occasion.
Wednesday, 28 February 2007
In gynae clinic, I go online to look up some management guidelines for a patient. The trust’s IT department has blocked the Royal College of Obstetrics and Gynaecology website and classified it as ‘pornography’.
Monday, 12 March 2007
Pretty sure that if obs and gynae goes arse over tit I could retrain in psychiatry in about fifteen minutes – I’ve basically taught myself how to do it over the course of a dozen conversations with Simon. Tonight I was pretty stressed when he called and had a bit of a moan about work. Unexpectedly, this really seemed to help him. Either he’s a horrible sadist and likes the idea of me having an awful day or it’s comforting for him to know that everyone else has shit going on in their lives too. Misery loves company, after all – you only have to look in the doctors’ mess to know that.
Maybe it’s like when you’re in a proper relationship for the first time and you meet their family – and you see it’s not just your family that’s a miserable fucked-up mess with dozens of dark secrets and grotesque dinner-table habits. We finished today’s call with Simon in hysterics after I told him a lump of placenta flew into my mouth during a manual removal and I had to go to occupational health about it. He may well be a sadist, come to think of it.
Thursday, 15 March 2007
I ask a patient in antenatal clinic how many weeks she is now. There’s a long pause. Cogs turn. A camera slowly pans across a wasteland. Maths isn’t everyone’s strong point, but I’m after the number between six and forty that people must constantly ask her about. Finally:
‘In total?’
Yes, in total.
‘God, I couldn’t even tell you in months . . .’
Has she got amnesia? Is she a clone of another woman currently being held prisoner in an evil sci-fi villain’s lair? I start to ask when her last period was, and she interrupts.
‘Well, I’m thirty-two in June, so that’s got to be more than a thousand weeks . . .’
Christ.
Thursday, 22 March 2007
Idea for Dragons’ Den: a bleep with a snooze button.
Thursday, 5 April 2007
Revenge is a dish best served cold – so long as it doesn’t end up poisoning the wrong person. I was called to review a patient on the ward: she’d had a laparoscopic drainage of a pelvic abscess in the morning and her pulse had been raised all evening. Looking through her notes, this lady was in her mid-fifties and had discovered on her wedding anniversary that she wasn’t the only person to have received a pearl necklace from her husband. Her reaction was seemingly straight out of niche porn – she took herself, and her husband’s credit card, off to Trinidad and Tobago and had sex with as many men as she could over the course of a fortnight, expanding her bedroom (and beach) repertoire to include anal sex.
Back home, bow-legged but unbowed, she soon found she was having terrible abdominal pain, plus producing purulent monsoons from both her Trinidad and her Tobago. She was diagnosed with pelvic inflammatory disease,* and even IV antibiotics couldn’t persuade it to sod off – seemingly there’s some pretty weapons-grade gonorrhoea going round the Caribbean. Today’s procedure would hopefully get her back on the road.
It turned out her raised pulse wasn’t caused by any surgical complications, but because she was in floods of tears. I asked what was up and she told me her eighteen-year-old son was coming over tomorrow to visit, and she didn’t know what to say to him – how would he react when he found out why she was in hospital? I reassured her that an eighteen-year-old boy would rather peel his testicles and douse them in malt vinegar than ask any questions at all about why his mother is on a gynaecology ward. The phrase ‘women’s problems’ alone – especially if delivered in hushed tones while staring straight into his eyes – will have him changing the subject immediately, even if he has to start a small fire as a distraction. Tears over and pulse back down to normal. Although she might want to think up a plausible excuse for that incredible suntan . . .
* Pelvic inflammatory disease, or PID, is when untreated gonorrhoea or chlamydia spreads north and gunks up the pelvic organs – it can be tricky to treat and even result in permanent pelvic pain. It’s also one of the main causes of female infertility. Basically, use condoms, or you might end up not needing them at all.
Monday, 9 April 2007
Results out today. I have somehow passed my MRCOG Part One exam and am celebrating in the pub with Ron. Unfortunately, drinks are strictly non-alcoholic as I have to head straight off afterwards to a night shift, and I gather turning up drunk is frowned upon. Ron recently got through his postgraduate accountancy exams, so we compare notes. While his firm cut down his hours so he could revise, I had to squeeze in as much revision as my bloodshot eyes would allow after work. Ron had a full month of study leave before the exam; I applied for a week off, but rota gaps meant that it ended up getting cancelled at the last minute, without discussion. His firm paid for all exam fees and materials; I had to shell out for £300-worth of textbooks, a £500 course, £100 for online learning resources and £400 on the exam itself, a grand total of £1,300 – a mere two-thirds of my monthly take-home pay.
My carefully considered answers don’t even get seen by a human – it’s a multiple-choice paper and you fill in the answers in pencil on a grid, which then gets scanned and marked by a computer. I show Ron the RCOG pencil I pinched.
He immediately gets a promotion and pay rise for passing his exam; all mine means is that I’m now eligible to enter the Part Two exam.
‘No. All it means,’ says Ron sympathetically, ‘is that you spent £1,300 on a pencil.’
Thursday, 19 April 2007
An email from Infection Control informs all doctors that long-sleeved shirts are now banned in clinical environments. Some study has swabbed a bunch of cuffs and discovered it would be more hygienic for us to wear shirts made out of fresh human faeces and poorly sealed vials of ebola. The same apparently applies to neckties, which dangle down, bobbing in and out of various festering wounds and cross-pollinating bugs across the hospital like polyester honeybees with a death wish.
We are henceforth instructed to wear short-sleeved shirts, so I brush aside any hope of making the cover of Vogue while at work and go shopping to invest my savings in five of the things. These short-sleeved numbers, we are told, may be worn either with no tie or with a bow tie – giving us the option of dressing like an airline steward or a paedophile. I’ll go without, thanks. Tea? Coffee? Hot towel?
Wednesday, 2 May 2007
I finish consenting a couple for caesarean section. ‘Any questions at all?’ I ask the room.
‘Yes,’ chips in their six-year-old. ‘Do you think Jesus was black?’
Saturday, 5 May 2007
In lieu of an incentive scheme at work, I’ve invented my own perks: I take scrubs home for pyjamas and steal the odd patient meal at night. It’s 1 a.m., I’m absolutely starving and it’s my only chance for some food for the next seven hours, so I sidle into the gynae ward kitchen. Clearly I’m not the only one with an eye for a freebie – there’s a new sign up on the fridge warning staff that meals are strictly for patients only. As security systems go it’s not exactly sophisticated – they may struggle to prevent the more determined thief with A4 paper, Blu Tack and Comic Sans alone.
Tonight’s delicacy is ‘Quorn-style Savoury Mince with Sultanas’. It’s like they got Accenture in to come up with the least appealing possible menu options. I think I’ll just take my chances and let nervous energy and Red Bull keep me going.
Saturday, 12 May 2007
My philosophy on flights is to get so hammered that no right-minded air steward would want me anywhere near a sick passenger, which has served me well these past few years.* Karma repaid me tonight, not on the flight itself but twelve hours later, in Glasgow for the weekend and walking back to the hotel after dinner and drinks and drinks and drinksssssss with Ron and his wife Hannah.
Walking down Bath Street at 1 a.m., we see three guys in their late teens hanging around some basement steps, outside a shop door, surrounded by an extraordinary amount of blood. It looked unreal, like a murder scene on a Channel 5 drama. They were all the worse for wear – though probably no worse than any of us – and one was exsanguinating from what looked like a big arterial bleed on his forearm. Impossible to guess how much blood was sprayed and pooled around, but it couldn’t have been less than a litre. He was conscious, though barely, and nothing was being done to stem the blood loss.
I sobered up extremely quickly and told them I was a doctor. The friends were pointing at the smashed glass door and repeatedly telling me he’d tripped and fallen, as if the fact he’d clearly broken into a newsagent was anyone’s main concern here. They’d called an ambulance already, but I had Ron phone 999 to expedite its appearance and asked Hannah to rip up T-shirts to make tourniquets. I held the guy’s arm up high and squeezed hard. His pulse was slow and thready,† and he was drifting in and out of consciousness. I keep talking, talking, talking – telling him the ambulance is really close, I’m a doctor, everything’s going to be fine. It doesn’t matter how many times you say it or whether any of it is true – well, at least the ‘doctor’ part is true – you have to believe it, because they need to believe it.
It felt like he was on the brink of cardiac arrest and I was going through CPR in my head so I didn’t need to think twice when he did. Was this even legal – drunk in charge of an emergency? I was confident I was managing the situation correctly, but it wouldn’t look great if he died with me in this state. Mercifully, the ambulance arrived almost immediately and they whisked him away, filling him with the fluids he needed to save his life. All’s well that ends well, but I had a terrible feeling of impotence waiting for the ambulance to pull up. Back in the hotel I poured myself a £12 miniature from the minibar and realized that even on a plane I’d have had more resources to help him. The whisky would have been cheaper, too.
* My family are much nicer people than me. One Christmas, British Airways sent my dad a pair of return tickets to anywhere in the world as a thank you for answering the ‘Is there a doctor on board?’ call, and handing out some antihistamines from the medicine box. My brother (also a GP) was extremely unimpressed – he’d spent the entire duration of a budget airline flight managing an urgent cardiac situation with extremely limited resources and didn’t even get the words ‘thank you’ as a thank you, let alone a free trip to Bali.
† If you lose blood, then your pulse usually speeds up – your heart needs to work extra hard to get oxygen around the body given there’s less blood to transport it. When the pulse becomes slow in this situation, it generally means the body is getting exhausted and preparing to throw in the towel.
Monday, 14 May 2007
In the doctors’ mess, my friend Zac – currently working in orthopaedics – tells me that he always muddles the words ‘shoulder’ and ‘elbow’ in his mind, and has to really concentrate before using either term. Before I even have time to process this and what it could mean for his next patient, an intensive care registrar joins in from the next sofa: since childhood, she’s always malapropped the words ‘coma’ and ‘cocoon’. The more she tries to remember which is which, the more her mind convinces her she’s got it the wrong way round. She shows us a piece of paper in her wallet that reads,
COCOON = Insect
COMA = Patient.
This, we hear, helps prevent the admittedly hilarious scenario of sitting down an inconsolable relative to break the news that their husband is in a cocoon.
Tuesday, 12 June 2007
It’s five minutes until my shift ends and I need to get away on time to go out for dinner. Naturally, I’m asked to review a patient – she’s got a second-degree tear,* and the midwife looking after her tells me she hasn’t been signed off to repair those yet.†
Me: ‘I haven’t been signed off to do them either.’
Midwife: ‘You don’t need to get signed off to do things – you’re a doctor.’ (Depressing but true.)
Me: ‘Isn’t there another midwife who can do it?’
Midwife: ‘She’s on her break.’
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.’
* Having a baby can rip your undercarriage to shreds, there’s no getting away from it, especially if you’re a first-time mum. Durex should take their cue from cigarette manufacturers and show photos of post-partum perineums on their packaging – no woman could look at that and ever risk getting pregnant. A first-degree tear goes through the skin, a second-degree tear goes into the perineal muscles, a third-degree tear involves the anal sphincter and a fourth-degree tear rips your leg off or something.
† Doctors’ and midwives’ roles are fairly well-defined in most aspects of labour ward – midwives are responsible for normal deliveries; doctors are involved when there are worries about mum or baby’s well-being or the progress of labour. Who gets the sewing kit out for first- and second-degree tears is a greyer area than your nan’s vagina.
Tuesday, 19 June 2007
An email to all clinical staff, letting us know a psychiatric inpatient has been transferred to the respiratory ward following a diagnosis of pneumonia. But this wasn’t the kind of ‘say hello if you see him’ notice you’d get if a new kid transferred to your school. Yesterday it was discovered he’d been wandering around the ward minesweeping like the last aunt at a wedding, downing the contents of every sputum pot he found on fellow patients’ bedside tables.
We are advised to send all clinical samples immediately to the lab and not to leave any in easy reach for the time being. Someone has replied-all with ‘Yuck’, which feels rather like watching a nuclear reactor explode and saying ‘Oh dear’.
Tuesday, 26 June 2007
I’ve been in the doghouse for days now. We were at H’s friend Luna’s house – Luna is pregnant, and just before dinner she whipped out a photo album of their recent 3-D scans. I suspected my thoughts on 3-D scans – that they serve no purpose other than keeping 3-D scanning companies rich, and boring the anuses off dinner-party guests – would go down like a cup of cold sick, so I had a polite flick through along with everyone else.
‘Everything seem OK?’ Luna asked me. I wanted to say, ‘Looks the same as they all fucking do,’ but I suspected that might lose the room, so I just smiled sweetly, handed the photos back and said, ‘She looks perfect.’ The temperature in the room dropped about ten degrees and murder flashed discernibly across Luna’s eyes. ‘She? SHE?’
It’s the first time I’ve dropped the ball on this, so to speak, and worst of all with a friend, not a patient. Dinner felt like it took a fortnight; eye contact avoided, plates plomped unceremoniously in front of me.
It didn’t help that tensions were already running high at home. Two weeks ago, our flat purchase fell through. It seems that, with a total disregard for my blood pressure and a relationship slightly fraying at the edges, the owners have decided not to sell it after all. I rather suspect they’ve merely decided not to sell it to us, probably because someone else had offered them a bit more money. Luckily, we’ve only spent a couple of thousand fucking pounds on solicitors and surveys and whatnot. I know more about this flat – that I will now never set foot in again – than I do about any of my closest blood relations. Everyone tells us that these things happen for a reason. In our case, the reason is that the world favours bastards and clearly wants us to spend our every spare moment with estate agents for the next few months.
But life goes on, even if it’s peppered with annoying reminders. The depleted bank account, for one, and the fact that, unless I take a five-minute PTSD-avoiding detour, I drive past the flat that got away every morning on my journey to work. 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, so I conducted their appointment to the best of my abilities, albeit through gritted teeth. I wasn’t 100 per cent sure that the baby was cephalic,* so I quickly ran the scanner over the mother. Baby was the right way up and all was well. ‘Do you want to see the heart beating?’ I asked them. ‘There it is – all looks normal there. There’s an arm, another arm, that’s a leg, that’s his penis . . . Oh, didn’t you know?’
* Cephalic means baby is head down – this is normal. The opposite is breech, meaning bum first. Breech presentation occurs in 3 per cent of pregnancies, and famous examples include Emperor Nero, Kaiser Wilhelm, Frank Sinatra and Billy Joel. If you win a pub quiz off the back of this, you owe me a pint.
Saturday, 30 June 2007
A news story in the paper about a hospital porter who’s been jailed for pretending to be a doctor for the last few years. Just finished one of those shifts where I wondered if I could get away with pretending to be a porter.
Tuesday, 10 July 2007
I clearly need to change my patter. It usually goes something like: ‘I couldn’t see anything on the ultrasound just by looking with a probe on the tummy – doesn’t mean there’s anything to worry about, early pregnancies can often be very difficult to see this way. Would it be OK if I did an ultrasound using an internal probe to get a better view?’
After today’s incident, should my licence to practise remain intact, my new spiel will be: ‘I couldn’t see anything on the ultrasound just by looking with a probe on the tummy – doesn’t mean there’s anything to worry about, early pregnancies can often be very difficult to see this way. Would it be OK if I did an ultrasound using an internal probe to get a better view? In a few seconds’ time I’m going to rummage in a drawer and pull out a condom and a sachet of KY jelly. Just to be clear: the condom is a cover for the ultrasound probe and the KY jelly is to lubricate it. When you see what’s in my hands, please do not scream so loudly that three members of staff come rushing into the room.’
Monday, 23 July 2007
Sending a patient home from the day surgery unit following laparoscopic sterilization. I tell her she can have sex again as soon as she feels ready, but to use alternative contraception until her next period. I nod at her husband and say, ‘That means he has to wear a condom.’ I can’t quite work out why their faces are a picture of horror, melting like the Nazis at the end of Raiders of the Lost Ark. What have I said? It’s perfectly good advice, right? I look at them both again, and realize the man is actually her father.
Tuesday, 31 July 2007
One of the house officers turned up in A&E last night, having attempted suicide with an overdose of antidepressants. There’s a shared sense of numbness amongst the doctors. The only surprise is it doesn’t happen more often – you’re given huge responsibility, minimal supervision and absolutely no pastoral support.* You work yourself to exhaustion, pushing yourself beyond what could be reasonably expected of you, and end up constantly feeling like you don’t know what you’re doing. Sometimes it just feels that way, and you’re actually doing fine – and sometimes you really don’t know what you’re doing.
Happily, this occasion is the latter, and she has taken a completely harmless dose of antidepressants. In any other profession, if someone’s job drove them to attempt suicide, you’d expect some kind of inquiry into what happened and a concerted effort to make sure it never happened again. Yet nobody said anything – we all just heard from friends, like we were in the school playground. 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.
* A 2015 study by the Medical Protection Society showed that 85 per cent of doctors have experienced mental health issues, and 13 per cent admitted to suicidal feelings. A 2009 paper in the British Journal of Psychiatry showed that young female doctors in the UK are two and a half times more likely than other women to kill themselves.