The Patient (4 page)

The doctor, who spoke with a heavy Greek accent, was a beautiful, fine-featured blonde woman dressed in a bright-red sleeveless short dress that accentuated the golden colour of her hair and the deep blue of her eyes, which must, thought Jonathan, give her an irresistible hold on almost every man who cast his fortunate eyes upon her. He was enthralled and was having trouble dragging his gaze away from her breasts. Her nipples protruded through her dress – she didn't seem to be wearing a bra. She took a sip from a cardboard cup, and a little cappuccino froth stuck to her upper lip. Slowly, she licked it off, as if to tease her male patient into total slave-like submission.

‘So, tell me what happened,' she said.

‘I'm fine, really. My' – he was going to say ‘wife' but changed course – ‘friend, partner, thought I needed to be checked out.' He was trying so hard not to be a patient. He was at a bar, attempting to impress this magnificent creature before him.

To the doctor, he was the fiftieth patient she had seen since starting her shift early yesterday evening. The day
intern, meant to take over from her, had not turned up, so she'd been forced to stay on and do a double shift. So far, she had declared four people dead on arrival, had lost another four and resuscitated more than 16. This man was quickly irritating her.

‘Allow me to judge whether you should be here or not. What is the symptom you have come in with?' Her tone was terse.

‘Well, yesterday I bumped my back on the cupboard in the kitchen. I was on my way out to dinner. We had an award ceremony, and then, after that, I went home. Everything was fine, until this morning I woke up around dawn desperate to pee – urinate, I mean. There was blood in my urine. I urinated a second time, and there was still blood. But during today it's settled, and there's been nothing since.'

‘Has this ever happened before?' She was already writing request forms for a full blood count, a study to make sure his blood was coagulating properly, an ultrasound of his kidneys and bladder, a mid-stream urine test to rule out infection and a test to check if there were cancerous cells in his urine.

‘No. Never,' he said.

‘Any other illness? Heart, lungs, abdomen, et cetera?' She glanced up at the clock – she had another three hours of her 24-hour shift to go and wanted this man out of her way.

‘Fit as a bull,' he quipped.

She looked up at him, a pitying smile on her face. ‘Smoker?' she asked.

‘Very little now. I used to smoke a lot, but I cut down about a year ago.' Tracy was always on at him to stop.

‘OK. We're going to run some tests, and then we'll see what to do. I'll also need to examine you.' She wrote up the last of the forms in silence and stood up. ‘Please, you get into this gown. Take your clothes off first. I will return in a couple of minutes.' She got up and drew the curtains around his cubicle.

He undressed but wasn't sure what to do with his underpants. Should he take them off or keep them on? He always had this dilemma when he was having his occasional massages. If he took his underpants off, the masseuse could misinterpret that action as a request for something more than a platonic massage. However, if he kept his underwear on, then it was inevitably in the way and diminished that deep relaxation he yearned for. He had an image of the blonde doctor and decided to keep his underpants on, and his socks. After slipping the gown on, with the opening to the front, he sat on the edge of the trolley, attempting vainly to keep his front covered. He then remembered an article he had read in a trashy magazine about how keeping socks on was a turn-off for women, so he quickly took them off. He was half-thinking about maybe taking his underpants off as well when the doctor returned.

‘Lie down, please,' she barked.

First, she took his blood pressure and pulse, then she parted his gown and examined his abdomen. She pressed deeply, giving him a strong urge to pass wind. He resisted, but only just.

‘Please roll over. I need to examine your back passage.' She had already turned her back to him and was donning a rubber glove and opening a package of K-Y Jelly.

‘Is that absolutely necessary?' he said.

‘Yes. Roll over.'

Jonathan Brewster reluctantly rolled over and pulled his underpants down gingerly.

The blonde beauty had a long and probing index finger. He winced, more with embarrassment than with pain. It was all over in a matter of seconds.

‘OK. I need to take blood,' she said. There was a distinct smell of faeces in the cubicle now. This added drastically to Jonathan's sense of embarrassment.

After putting on a new pair of rubber gloves, she put a tourniquet on his arm, tapped the skin a few times and decided on the vein from which she would harvest the blood. Seconds later, she had several full vials and was removing the needle from his arm. The curtain was pulled open abruptly. It was the nurse he had seen arguing with the doctor in front of the TV.

‘Corina, cardiac arrest in cubicle four,' she shouted.

‘Please label these tubes for me, Vanessa.' And with that she pushed aside the curtain and left.

Through the open curtains, Jonathan saw sights he had never seen in his entire life. The red beauty who was just at his side was now barking orders to staff at the cubicle directly opposite his. ‘Intracardiac adrenaline. Come on, hurry up. Keep that cardiac massage going!'

There was a woman who looked to be at least in her 90s. Jonathan could see that she had soiled herself. There was an awful stench spreading throughout the Emergency department. More sickening was the sound of her rib bones breaking from the cardiac massage. The grating, horrible sound made Jonathan gag.

A nurse handed the doctor a syringe, and she called out
to the burly intern to stop massage, then plunged the needle into the front of the old woman's chest.

‘Anything?' shouted the doctor.

Silence. Then, the beeping that Jonathan had seen on a multitude of TV shows. The heart stirring to beat once again.

‘Yesss!' The doctor looked immensely satisfied. ‘Keep her on the infusion and get her up to Coronary Care pronto,' she called out to no one in particular yet to everyone in the cubicle.

Everyone was suddenly aware of a very old man standing at the doctors' desk in the centre of Emergency.

‘Today was our sixtieth wedding anniversary. Is she going to be OK?' He was distraught but understood that his wife had been given a reprieve. The Greek doctor had worked a Lazarus miracle.

‘Would you like to see your wife, sir?' The intern, Charlie, was doing his best, but he had little experience himself of grief. During their intern year, medical students were transformed by their sudden confrontation with human suffering. It did one of two things to them: either filled them with intense compassion – the minority – or it hardened them so that they stood aloof to pain. Charlie was on the way to becoming one of the latter, who formed the majority of the health profession. The rhetoric was that you needed to be objective if you were to deal with the loss, grief, unfairness, sadness and pain that illness dished out daily, without fear or favour. The Emergency department was the feeder tube into the hospital and hence was a place of concentrated despair. He knew that, while the man's wife was alive now, her
cardiac arrest meant that she would probably be dead within a year.

An orderly came to see Jonathan. ‘I'm here to take you up to the X-ray department. You're having an ultrasound of your kidney and bladder. Lie down, and I'll wheel you.'

‘Thanks.' Jonathan did as he was told, and the orderly elevated the sides of the bed and wheeled him out of Emergency down a long corridor to the lift, which took him up to the X-ray department. There, he was parked in a corner for an hour. Finally, a young adolescent – or so she seemed to Jonathan – came by and wheeled him into the ultrasound room.

‘Can you take your gown off, please? And your underpants?' said the young woman. Jonathan appreciated the unambiguous instructions, which left no room for conjecture. ‘We need to do an ultrasound of your bladder. When was the last time you passed urine?'

It had been a few hours, which she said was good as it would make the pictures of his bladder more distinct. She spread copious amounts of sticky jelly over his flanks and his lower abdomen; the jelly was very cold and made Jonathan shudder momentarily. The young radiographer adjusted a few settings on her machine and then commenced, gliding the ultrasound instrument across his skin.

Jonathan lay there as the machine sent sound waves through his body and captured them again to form images of his internal organs – he remembered having it explained to him when Tracy was pregnant. It was really quite clever machinery, he thought. But why were they looking at his
bladder when it was his kidney he'd bumped? The darkness of the room and the quiet noises of the machine were soporific. His mind floated back to his home, the award ceremony last night, his mother-and father-in-law, who were minding the girls. He recalled giving his speech and wondered whether he had done well. The radiographer pushed some knobs on the front of the ultrasound machine. Then, with her left hand she moved the ultrasound gadget directly over his pubic bone while twirling knobs on the machine with her right. It was like watching a conductor controlling an orchestra.

The door to the room was flung open, snapping Jonathan out of his reverie. He quickly tried to find something to cover himself with, as an old man wearing spectacles entered the room. He ignored Jonathan and directed his gaze straight to the ultrasound monitor.

‘What have you got so far?' the man asked.

‘His kidneys seem to be OK, doctor. I'm just doing the bladder now. Uh-oh. What do you think that is?'

‘Go back over the right lateral area again for me,' the doctor directed.

‘Over here?' she said.

‘Yeah, that's the interesting bit. Yes, it's definite. Take a picture of that. Make sure there's nothing else on the left as well.' The doctor turned to leave.

Jonathan could stand it no longer. ‘What can you see?' he asked. ‘Is there something I should know?'

‘Don't worry. We'll send the report down to the doctor in Emergency, and they can sort it out there. Just relax. Enjoy the attention.' The old man was gone.

‘Who was that?' Jonathan asked.

‘Chief radiologist on duty,' said the young woman, her eyes still firmly on the screen. Every now and then, she would press a switch with her foot and he would hear a high-pitched ping. Each ping signalled the capture of a picture, a small part of the overall jigsaw.

About an hour later, Jonathan was back in the Emergency department; he asked a nurse if Tracy could come in and sit with him. When the nurse returned from the waiting room, she said, ‘There's no one out there called Tracy.'

‘She must have gone home to the kids. Can I use a phone, please? Tracy has my wallet, and I don't have any change for the phone.'

‘Yeah. Just wait a moment and I'll see if I can bring you the cordless.'

An hour later, there was still no phone, but the doctor in red reappeared. ‘Look, we have all your results now. You have something in the bladder. Maybe tumour, maybe stone. I spoke to the Urology registrar, Dr Khadra. He's going to come down and see you. He's just finishing a case in theatres and will be here after that.' With that, she was out of the cubicle.

It had been over 30 hours since I had arrived at the hospital to begin my shift, and Jonathan was my last patient before I could go home, assuming no others came in. The old aphorism of ‘knife before wife before life' had been drilled into me well. There was no question of my asking for time off on the grounds that I hadn't slept for a couple of days. My super vising specialist would have simply laughed as my career disappeared down the plughole.

One of the surgeons had visited the British Surgical Meeting earlier that year and had come back with news of a growing push in the UK for safe working hours among doctors. The surgeon was brave enough to report this to the main weekly meeting of doctors at the hospital, Grand Rounds. The meeting had erupted with laughter and derision. The pain in my back and legs was suddenly telling me that maybe safe working hours were not such a bad idea. However, I would never have voiced that to anyone lest I lose my job or be thought of as lazy or soft. General practitioners and dermatologists can opt for lifestyle, not surgeons. Surgeons surge and physicians fizz. Safe working hours, what a joke. They will never implement or allow it, I thought. I turned my attention back to the patient at hand.