Several wrong turnings later, and at the end of a rabbit warren of basement tunnels, Emma found medical staffing, although the staff seemed more interested in talking to each other than attending to the queue of new doctors that was building up. Eventually someone waddled up to the counter.
“Oh, I suppose you’re the new doctors,” she said, with body language that reeked of boredom. “You need to fill in these forms – in black ink, mind you, because we have to photocopy them – and then you can get your badges, except they’ll have probably gone off for lunch, so you’ll have to wait.”
Emma glanced at the form. Lots of questions about identity, addresses, medical degree, GMC registration and so on, all of which she thought they already had. She filled these in as best as she could and handed them back. Ms Boredom barely glanced at them and stamped the last page. “Now take this to get your badge,” she said, handing her a chit with her name on it, and then turned to the next doctor in the queue.
More wrong turns, more corridors, and feeling more like a process than a person, Emma wound up at the security desk. The security guard was in the process of finishing something that looked like a burger, the fat oozing out of the sides of his mouth and dripping down his chin.
“Hello love. You here for your badge?” he asked. He continued eating his burger and the fat continued dripping.
“Look, I’m just here to get my badge and bleep. Can we make it quick? I need to get back to the ward as matron is expecting me,” said Emma, feeling a combination of revulsion and panic.
“Okay, okay, keep your hair on,” he said, before putting down the burger and then taking the chit and turning to a box with badges and bleeps. “There, found it. Sign here and you’re ready to go.”
Emma signed the chit and collected her badge and bleep. She felt proud when she saw her name and title on the badge: ‘Dr Emma Jones, House Officer’. She looked at the security guard and, rather unexpectedly, sensed vulnerability beneath his gross exterior. She thought he deserved something better although she had absolutely no idea why the idea had crossed her mind.
The security guard stood with his mouth open in amazement. Emma wasn’t sure what to make of this reaction and turned around, holding on to the badge and bleep in case he decided to ask for them to be returned.
“Best of luck, doctor,” she heard as she walked back down the corridor.
After collecting her white coat, Emma retraced her steps back to the ward. By this time, matron had assembled the other house officers around her and seemed to be going through some sort of handover for the patients on the ward.
“Oh, there you are, Dr Jones. I’m glad to see you’re finally ready to start work,” said matron sarcastically. “Please remember that I run a tight ship on this ward.”
One of Emma’s fellow house officers whispered: “And bursting at the seams.”
Emma giggled just as matron turned her attention to her.
“And I don’t expect any insubordination! Patients go to theatre every day and we expect you to clerk them in, take their bloods, arrange x-rays, prepare the operation list, and then assist in theatre. Names go up on the board every morning. Phone numbers and bleeps are on the list next to the board. Your job this afternoon is to clerk in patients for tomorrow’s list and to review post-operative patients. Is that clear to everyone? Do you have any questions?”
Emma and her colleagues muttered “Yes” and “No.” They gathered around the board to look at the patients they’d be responsible for. Emma’s patients had a ‘Prof C’ next to them and there seemed to be a total of six in all: two post-op and four marked down as ‘TCI’. Two of the latter had ticks by their names, which she took to mean that they’d already arrived, but the other two didn’t. Emma thought she’d better make a start.
Emma went to the trolley to find the notes for the first patient, a Mr Edwards, in bed 6. Glancing through the outpatient letters, he seemed straightforward: gallstones for about a year and he’d come in for a cholecystectomy. She went over to his bed.
“Good afternoon, Mr Edwards.” she said without really looking at him. “I’m Dr Jones, the house officer, and I need to ask you some questions and examine you before your operation tomorrow.”
“Are you really a doctor, miss?” he said. “You don’t look any older than my daughter and she’s still at school.”
Emma felt herself bristling but didn’t rise to the bait. “Well, to be honest with you, Mr Edwards, I’m as new to this hospital as you are, as I’ve just started today,” she said with a smile.
“Out of the frying pan into the fire, is it then?” he said.
“Well, it’s a bit like that until we find our feet. I see in your notes that some tummy pain was the first thing you noticed. Can you tell me about that?”
“Well, it was just after having an Indian meal for my birthday last year. I probably ate too much and also had too much beer, but I got a digging pain here – he pointed to just under his ribs on the right – and it wouldn’t go away. I thought it must be indigestion. Anyhow, it went a bit but then kept on coming back. I like my fry-ups and they really made it bad. So I thought I should see my GP – that was about two months after it started - and she got me seen by the professor. And that’s the whole story really, doctor.”
“And I see that Professor Cuthbertson then arranged for you to have an ultrasound scan, which showed that you’ve got stones in your gall bladder,” she said, glancing through the investigations section of his notes. “What’s been happening since then? Has the pain been getting worse? Have you had any other symptoms?”
“Well, if the truth be told, I’ve been drinking more to cope with the pain. I know I shouldn’t, but you know what it’s like. It’s only beer, mind you. I never touch spirits.”
“When did you last drink any alcohol?” asked Emma.
Mr Edwards seemed embarrassed and he looked down at his feet. “Well, to be honest, doctor, I had a few pints first thing just to get going, you know.”
Emma leant closer to her patient. The smell of alcohol on his breath was very obvious. “Mr Edwards, I’ll need to examine you, but I’ll also need to take some blood for tests and we’ll need to check your liver.” She pulled the curtain around his bed.
She reached for the sphygmomanometer attached to the wall above his bed. “Let’s check your blood pressure first.” She inflated the cuff and applied the diaphragm of the stethoscope over the brachial artery. She listened as the cuff deflated and heard the sound of the systolic which then faded away when she reached the diastolic. His blood pressure was elevated at 160 over 110.
“Now could you lean forwards and take some deep breaths.” She listened intently and heard a few wheezes but put that down to him being a smoker.
“Very good, let’s examine your tummy.” Mr Edwards was very obese. He winced a bit when she palpated below his ribs and she thought she could feel the liver edge. Not a good sign, she thought. She finished the rest of the examination, thanked him and went off to get a tray to take his bloods.
Emma mulled over what she’d found so far. He was a classic case of gallstones but his high blood pressure was a concern and the alcohol even more so. He certainly needed liver function tests and might need to be on an alcohol detox. He might even have memory problems. So hardly that straightforward and she wondered what the Professor would say.
She returned to Mr Edwards’s bedside with the bloods tray. “Is it alright if I go out for a cigarette, doctor?” he asked.
“After I’ve taken some blood, Mr Edwards, but you’ll have to promise me that you won’t be away for long in case we need to do other tests. And you really shouldn’t smoke, you know.”
He rolled up his sleeve and she swabbed his arm and efficiently took some specimens, squirting the contents of the syringe into various bottles which she labelled.
“I’ll see you later.” She left his bedside, drawing back the curtain.
Just at that moment, she heard matron call out “Crash call, nurse!” whilst simultaneously pulling the curtain around a patient a few beds down. Emma stood rooted to the spot, not sure what to do. Medical emergencies had never figured that highly at medical school, and anyway she had always been somewhat avoidant, preferring a slower pace where everything was more in control.
“You!” called matron. “Don’t just stand there! Fetch the crash trolley!” Emma glanced towards where matron was pointing and ran to the other end of the ward, dropping off the blood tray at the nurses’ station on her way.
The crash trolley was painted red and had a sign above it saying ‘Crash Trolley’, so it was impossible to miss it. Emma grabbed it and manoeuvred it to the curtained-off bed. The patient in question was elderly and unresponsive. Matron was bent over him, performing chest compressions, with her considerable bulk all but obliterating his tiny frame. “You do the breaths!” she ordered.
Cardiopulmonary resuscitation was also something that Emma had little practical experience of, although she remembered watching a grainy video of how it should be done. She went to the other end of the bed and stared down at the man’s grey, cadaverous face. She saw far too much suffering and now the poor man was having his ribs broken by matron.
Emma bent down, grasping and closing his nose with one hand and pulling his jaw down and forward with the other. She tentatively applied her mouth to his. Something solid moved beneath her lips. She realised with revulsion that he had dentures. She’d been told that dentures were always the first thing to check for before doing mouth-to-mouth resuscitation and she’d failed at her first attempt. She inserted a couple of fingers into his mouth and removed the dentures which came out with a sucking, squelching sound. She deposited them in a pot handed to her by a nurse. Emma reapplied her mouth to his, taking a deep breath and then blowing into his edentulous mouth, turning her head to check that his chest was inflating. It wasn’t. She tried again and saw his sunken cheeks inflate but not his chest.
“Come on, doctor, put some effort into it,” demanded matron, whose pumping was vibrating the bed and much of the ward. Just as she started again, the curtains parted and the crash team appeared, out of breath after running down numerous corridors.
The team stared in amazement at the site of matron appearing to be virtually in flagrante delicto on top of the patient. “Glad to see you,” said matron, “and relieved to see some true professionals to take over the CPR.” Emma blushed.
“This is an 84-year-old four days post-op with a perforated DU and no complications until now,” matron announced to the crash team.
The crash team registrar turned to Emma: “Have you anything to add - he looked at her badge - Dr Jones?”
“Sorry, I’ve never met the patient,” said Emma, mainly addressing the floor.
The crash team took over and Emma left the bed area, feeling as deflated as the patient’s chest. She returned to where she’d left the blood specimens and checked that she’d completed the labelling correctly. She marked the forms ‘urgent’, added her bleep number, and put them in the out-tray for the porter to collect. She found the porter’s number and asked him to make an urgent collection for the labs. This was greeted with the usual lack of enthusiasm.
She thought she should write up an alcohol detox for Mr Edwards to be on the safe side and consulted the hospital formulary. Chlormethiazole four times a day sounded about right and she wrote this up on Mr Edwards’s drug chart. He didn’t seem to be on any other medication, but she thought the anaesthetist might want to start him on something for his high blood pressure.
The rest of the afternoon passed relatively uneventfully. Mr Edwards was off the ward for a suspiciously long time. The patient with the dentures didn’t make it and the curtain remained around his bed. She wasn’t sure of the protocol but imagined that someone would whisk him away without other patients seeing anything. She clerked the other three patients, who turned out to be straightforward without anything unexpected in their histories or examinations. She found a blank operation list and completed it for her four patients. She wasn’t sure whether the Professor or anyone else in the team would be coming to the ward this afternoon but thought that they’d probably leave consent for their patients until the morning. She wondered about bleeping the senior registrar to let him know about Mr Edwards but thought better of this as she hadn’t got his blood tests back yet.
Just before 5:00 p.m., Emma phoned the labs for results. As expected, everything was normal until they got to the results for Mr Edwards. His red cell volume was well above the normal range and two of the liver enzymes were elevated. And his gamma GT liver enzyme, which she remembered was an indication of heavy drinking, was sky high. This confirmed that he was a chronic drinker and heading for liver damage. She was relieved that she’d started him on the detox.
As she was walking around the corner to her flat in the nurses’ home, she tried to sum up her experiences from the first day of being a junior doctor. Overbearing personalities loomed large and she felt something like loss when thinking about the patient with the cardiac arrest, but she felt she’d done something good and clinically intelligent when it came to Mr Edwards.
August 1987, the following morning
Emma made sure she got to the hospital well on time for the ward round and she went through all her patients’ notes before the team arrived. She noted that the registrar had been in after she’d left yesterday to do the consenting for the operations.
The team arrived precisely at 8:00 a.m. Matron made it abundantly clear where she saw herself in the pecking order of the ward and almost retied the Professor’s bowtie for him. The bustle on the ward was electric and Emma wondered how patients avoided choking on their cornflakes.
“Good morning, Dr Jones. I hope matron here has been helping you settle in,” said the Professor.
“Yes, Professor,” said Emma. “I’m finding my feet, but I’m afraid we had a death yesterday.”