The Patient (7 page)

A couple of times during those weeks of waiting, his urine was pinkish. He missed several more meetings at work, and the pile in his in-tray grew. People were starting to get irritated at his inefficiency, and Paul asked weekly what date he would be going to hospital to get his operation done.

Frustrated that Jonathan couldn't give him a definite answer, he said, ‘Well, for the time being, make sure you hand those big projects to Jake. We really want you to get well, and I don't want any added pressure on you right now.' How kind his boss was being.

It was seven weeks later when the call finally came from the Admissions department, and by the end of that week, at 6.30 am, he presented himself at the Victoria Hospital.

The admissions procedure made him feel much like he was in a mob of cattle at a sale yard. Instead of his skin being
branded, he had plastic bracelets fitted to his wrist and to his ankle.
Is there a chance of my arm and my leg being separated?
he thought. He answered the same questions several times on a multitude of coloured forms. Each time, a different clerk, nurse or intern went through the same routine. Why are you here? What operation are you having? When did you first notice the blood in your urine? Are you allergic to anything? Are you on any medications? Jonathan became irritated. Why did they need the same information a thousand times? He hadn't seen Derek Johnson since the consultation in his rooms, and he needed to ask him some questions about the operation and about his recovery afterwards. Derek was nowhere to be seen. In fact, he wasn't even in the hospital yet; he was still doing his ward rounds at one of the three private hospitals where he also had patients admitted.

Tracy was getting the girls ready for school. Her mother would come over in the afternoon to look after them so Tracy could come and visit him, but for now he was all on his own and could merely fume inwardly.

A nurse who had a manner that made her seem better suited to working for the Gestapo told Jonathan to remove his clothes and handed him an antiseptic wash. She instructed him to wash himself with it, then get into a white gown and come back and wait to be called. Jonathan obliged, walking into the bathroom and locking the door behind him. Immediately, he noticed the brown stains on the shower curtain, the streaks of faeces in the toilet and the tap dripping into the sink, forming a green stain. The floor was slippery, and he noticed a clump of hair stuck to the tiles in the corner, as if a mop had been used to paint the floor with grime rather than to clean it.

He was glad he hadn't eaten since last night or had any coffee that morning, on orders from the doctor's bitch secretary, because he now felt nauseous. He dry-retched into the toilet, took his clothes off and placed them in the paper shopping bag he had been handed, and stepped naked into the shower. Adjusting the temperature proved almost impossible as the slightest movement of the tap made the water alternate between scalding hot and freezing cold. The antiseptic cream was difficult to lather, but he spread it around himself as best he could. He placed a large amount of it in his palm and spread it over his genitals and into his buttocks, around his anus, as the nurse had told him to. Once he'd rinsed and dried himself with the hand towel he'd been given, he donned the gown and an elasticised hat and went back to the Urology waiting room.

The nurse came back soon afterwards. ‘OK, so you're having a gall-bladder operation today –'

‘No. I'm having a cystoscopy,' he cut in quickly. If only Tracy were here to share his disbelief.

‘Oh, the ward clerks have typed up the wrong operation on the sheet. Hang on, and I'll get it corrected. You had a shower for nothing. But it won't do you any harm.' With that, she bustled off.

The anxiety Jonathan was already feeling about going under the knife had rapidly escalated. How could they get his operation details so wrong? How could they make an error of this magnitude? He even started to worry about whether he smelt. Otherwise, why would she say the shower wouldn't do him any harm? What an odd thing to say. He sniffed under his arms, but all he could smell was antiseptic soap.

Just then, he saw Derek appear at the reception desk. ‘How are the troops, sister?' he asked one of the nurses sitting doing her paperwork.

‘Sorry, are you talking to me?' she asked.

‘Yes. How were my patients overnight?' he said, frustrated.

‘Do you mind asking someone else? I'm in a hurry to finish my shift. Who are you, by the way?'

She was one of the agency staff that public hospitals relied on. With a worldwide nursing shortage, there weren't always enough nurses to stand in for those who were away on sick leave or holidays. Private agencies had been established that would, at a moment's notice, send a nurse to cover a shift. The problem was that the agencies paid far more per shift than the hospitals could afford to pay their full-time nursing staff, so a large number of nurses resigned from their hospital jobs and joined agencies, to earn better salaries. The hospital system had been plunged into a downward spiral of inefficiency and escalating costs due to their larger and larger nursing bills.

It was impossible to maintain
esprit de corps
on the wards because there was only a small group of permanent staff. As more of the staff became disheartened, more would leave. Administration would appoint some of the nurses as managers and task them with trying to work out why there was a problem with understaffing, which of course added to the problem of understaffing.

Exasperated, Derek reached for the notes trolley and started wheeling it around the ward. The team's junior resident, Damian, was in the second room.

‘Hello, doctor. I've just finished seeing your patients.
Everyone's fine,' said Damian assuredly, aiming to please.

‘Where is Mohamed? Did he see the cystectomy from yesterday? Is there much in the drains?' he asked.

‘Three hundred and fifty mls in the right one and about two hundred and eighty in the left. He said to leave the drains in. Is that OK by you?'

Derek nodded and asked, ‘How about the prostate in bed three, the old man?'

‘Do you mean Mr Frederick?' Damian said, reaching for the notes.

‘Yeah, I think that's his name. The old fellow that was admitted over the weekend in retention.' Derek was becoming impatient with having to deal with the junior.

‘Yes, sir. He's voiding well and is continent. We were going to send him home today. Do you want to see him?' Damian knew the answer before he asked the question. Derek rarely saw the public patients; it was left to the registrars to manage them. His definition of training and teaching was to let the registrars do the work and learn by experience. Public patients, as far he was concerned, needed to accept that the trainees had to perform their operations on them to gain vital first-hand experience. He only stepped in if there was something that the registrars couldn't handle.

‘No. If you're happy, then I'm happy.' He smiled, turned and headed for theatres.

Surgeons are often criticised for their habit of referring to patients by their disease: ‘the prostate in bed three', as Derek said, or, as a doctor in another ward might say, ‘the liver in bed eight' or ‘the spleen in bed 16'. It is sometimes held up as a failure of compassion or a coldness on the part of the medical profession. The alternative is to refer to Mr
Jones who is worried sick about dying from lung cancer and has three children, a sister and a wife depending on him. For most doctors, it was far preferable to keep a distance and refer to him as ‘the lung cancer in bed five'. Derek was a firm believer in this system. He believed it meant his treatment was not hampered by the soppy and weakening effects of being reminded that his patients were human beings after all.

The male change rooms were the usual mess, with bloodstained theatre garb overflowing from the laundry baskets. Derek found a spare clothes hanger and started to change. There was a knock at the door. It was Elizabeth, the anaesthetist.

‘Are you dressed, Derek?' she asked from behind the door, which was ajar.

‘Yes, Elizabeth. What can I do for you? Have you decided you can't resist my body any longer?' He was always taking his bantering to the edge.

‘Your patient, Jonathan Brewster – he wants to speak to you before the operation. He has some questions. What do you want me to tell him?' She knew that Derek hated talking with patients before their operations. He believed that by the time they got to theatres, they should have asked all the questions they wanted to ask.

‘Which one is he? Is he the bladder cancer?' he shouted through the door.

‘Yes. The youngish man.'

‘OK, I'll come and speak to him. He's one for the registrar to do, though. I was hoping Khadra would do him, but it looks like I'm stuck with Damian.'

She was gone down the corridor to see Jonathan and
reassure him that his surgeon was coming to speak with him. Derek walked in shortly after her.

‘Hello. You had questions?' he asked, curtly.

‘Hello, doctor. Yes. Um … will you be in to see me after the operation to tell me what you found?' Jonathan's nervousness was apparent in his voice. He had been lying on the trolley in the anaesthetic anteroom for over an hour waiting his turn. So far, all that had happened was that the anaesthetist had placed a cannula (the plastic tube used to keep a passage into the blood supply open) in the back of his hand and had flushed it with some sterile saline. His heart was racing, and his mouth felt like the bottom of a parrot cage.

‘Look, I'll try and see you, but sometimes they send you home before I have a chance. My resident will definitely come and see you. I'll get the result of the biopsy within a week, and I would like you to make an appointment and come and see me then, if you don't mind. OK?' And, with that, he placed his mask on his face and passed through the door to the operating theatre.

Elizabeth injected Jonathan with midazolam, a sedative with amnesic properties, and thereafter he would remember nothing else. He was wheeled into the operating theatre, where Don McLean was blaring from the CD player in the corner. Derek was on the computer checking the New York closing prices. Damian was scrubbing. The nurses were preparing the instruments. The orderlies moved Jonathan onto the operating table. Soon after, he was connected to a number of monitors, then Elizabeth worked one of the miracles of modern medicine by injecting him with drugs that would render him unconscious
for just the right amount of time needed to perform the lesser miracle of surgery.

Jonathan was now exposed from the waist down. The orderlies raised his legs up in the air and attached them to stirrups. Thankfully, he was asleep.

Damian walked in drying his hands, then donned a sterile gown. He reached unconsciously for the iodine disinfectant and slopped the liquid over Jonathan's exposed skin.

‘How was your birthday party on the weekend, Lisa?' He was addressing the scrub nurse.

‘It was a hoot, Damian. You should have been there. We waited for you,' she said.

‘I was in here all bloody weekend. Torsion after retention after stone. It was just never-ending.'

He placed sterile drapes around Jonathan's legs and abdomen, leaving his genitals exposed, then connected the cystoscope to a supply of clean water.

‘Ready to start, Elizabeth?'

‘Go ahead. Thank you for asking.' She gave him a smile. Anaesthetists loved to be asked whether it was OK for the surgeon to start. It was a sign of respect and allowed them to be prepared.

Damian inserted the long metallic scope through the meatus – the eye – of Jonathan's penis. Images from the tiny television camera attached to the end of the scope were shown on a screen visible to everyone in the theatre. First the urethra, the long tube through which urine comes down the penis, could be seen. Then the prostate, a little bit obstructive, and then the big dark chasm that was the bladder came into view. Damian drained it of urine and then expanded it again with water. He examined first the
left side. There was a bright stain on the wall, like a patch of red carpet. Next he looked at the right side. Here a large cauliflower-like growth bobbed in the fluid.

‘He's got a bloody big tumour here, doctor,' he called out to his boss.

‘Yes, the ultrasound and the CT scan he had confirmed quite a nasty one. It looked to me like it might be invasive,' he said as he left the computer and came to look over his resident's shoulder at the television screen. ‘Has he got any carcinoma
in situ
as well?'

‘Yes, over on the left, I think.' He moved the camera to show his boss the red carpet-like lesion. The red patch was made up of sheets of aggressive cancer cells that had not yet formed into clumps or masses but were just as dangerous.

‘Resect the tumour right down to the muscle, and then take biopsies from the left lateral and from the prostate as well. This guy might end up losing his bladder.' He turned and left the theatre to go to the tearoom. That was all he needed to do there; Damian could finish the case, then start on the next one and call him in for that.