It’s that time again. Night shift. I take the slip road off the M8 and see the GRI loom in front of me. It looks so gothic against the moon and black sky. It truly is a place of the night. I am a vampire, coming to life at night, going from patient to patient with empty vials ready to fill with blood. The darkness hangs over the old hospital’s turrets like a black shroud. Lights shine from windows as workers remain unseen beyond. As I drive up alongside, I feel I am entering a dark abyss. It envelopes and sucks me in. Ok I am exaggerating and getting carried away but the place at night does look like its come straight out Mary Shelly’s imagination.
I am sitting waiting for the blood porter to answer his page. I’ve got three bottle of blood that need to be sent off urgently. What makes this blood extra precious is that it has come form a patient with extremely poor access and the senior team have just put a venflon in her neck-an orange one-that’s a big one to you and me. To get blood out otherwise would have had me there for hours. It would have been awful for the patient as I would have continued to have to keep trying to access a vein. The needle is not without pain. Thankfully the senior team where around for me to ask at handover time. So glad the day JHO told me about her at our informal little handover rather than it being a case of the nurses phoning me at midnight to tell me the small blue she had already in her hand had tissued. I am going to try another phone. The porter has not called back. I think gremlins are at work. And its only just 10pm. That’s early.
Apparently when you do night shift you have breakfast at about 4pm or whenever it is you wake up. I still cannot get used to having Crunchy Nut Cornflakes, as I peep from out of the duvet watching the Simpsons. I eat far too much far too early. Dinner time is about midnight for the night staff and that’s when amazing culinary affairs emerge. Or a take away from the local Chinese or curry house is ordered. Today I have brought a salad. But also cakes. I was at the gym today before ‘breakfast’ and found myself walking into Sainbury’s. I figured it was my turn to turn up with the goodies. Over the last few nights, I have been invited to eat all sorts of food laid out in various parts of the hospital. The Surgical High Dependency Unit has got a great thing going on. It looks like an all night buffet, complete with chocolate fountain. I select two cakes, some cheese and crackers. I have thought about cooking but then quickly moved on from that thought. I am getting fatter though.
It’s been a bit like the Lion, the Witch and the Wardrobe here. Remember the bit when the witches spell starts to fail and the good people of Narnia start having little Christmas parties in the woods. It had always been winter and never Christmas, but now they could all get the Christmas crackers out and celebrate. Well that’s what it was like on Christmas Eve here. Every ward I walk into, hushed excited tones gather round tables stacked with food, soft drinks and plenty of nibbles. Presents are being exchanged from various Secret Santas.
I am going over to SHDU to see what’s going on there. Blood is now arranged to be whisked away by the porter. The first call of the night. Besides my first cup of tea of the night is sitting there and has gone cold.
Thursday, 28 December 2006
The Mortuary Visit
Pay day! My first wage packet. Makes it seem all worthwhile somehow. Not the sentiment I was expecting of myself though. My rose tinted specs on feeling great satisfaction from patient care grew wings and flew away a few weeks ago. I should be able to save money for the first time ever due to the sheer reality of not having time to shop. I think a far chunk is going to be spent on pedicures. I’ve already had two.
At last I find the free parking spaces on the side roads around the hospital. After spending two days in the on site multi storey at £12 a day, I needed to find alternatives. The broken glass along frequent stretches of road from previously assaulted cars is somewhat discerning though. They say its just a matter of time before a member of staff is mugged or worse.
I arrive on the ward and notice that Mr Brown is not there. He died during the night. I didn’t realise he was so close to the end yesterday. He was becoming increasingly confused. He associated me with needles and every time I walked by he held his arms close to his body. His kidneys as well as his liver were failing, but I didn’t realise he was dying. I have never come across someone dying before. It just didn’t feature as part of medical school.
I am asked to write my first death certificate. The family are coming by in half an hour to pick it up. It feels somewhat unfitting to be doing it in biro. It should be in black ink. I am after all declaring the death of a man. I make a mistake and start a fresh one, trying to use my best hand writing. I fight against my normal junior doctors ‘no time’ scrawl. He is to be cremated, which requires me to fill another certificate. It was never my forte. The main points to remember here are to use block capitals, check the patient doesn’t have a pace maker as that would cause the furnace to explode and then pop down to the mortuary to see the body. For this final duty we are paid the ‘crem fee.’ I don’t know how much but I am told a cheque will arrive in the post. There is a vast amount of paper work in this job, which is probably why I am struggling.
That’s a job on my list today-’go to mortuary to see Mr Brown.’ The mortuary in Glasgow Royal Infirmary is again my first. I had imagined them as being clinical, white and silver. This one however is not. I press the bell at the locked door and stand there as people inside ignore me. I literally make eye contact with them as they walk past with that awkward ‘pretend you are not there’ look. A nurse in scrubs arrives and lets me in. Maybe only nurses are authorised to open the door. She’s young and cheerful. She somehow knows that I’m a mortuary virgin. Must be my wide eyes and nervous laughter. To get to the bodies, we need to get to the basement. Its like something out of a murder series, complete with an old lift that creaks and shakes as it descends. The doors to the lifts are wooden screens that need to be pulled across. The nurse explains that during the winter the lift and the lower floor flood. The staff wear wellies. Not sure if she is having me on. Suppose I’ll find out soon enough.
I had looked after this man in life. Only the day before I almost knocked myself out with surprise when I got blood gases off him. This involves using a special syringe and needle, and aiming for the radial artery on the wrist. If your in, you are rewarded with a red flash back of blood, which fills up the syringe under the pressure of the blood without any further effort. It’s a sore procedure and there have been many times when I have had to continue stabbing at the wrist trying to get that bit of blood. Its awful for the patient and its awful for me to continue to inflict pain, due to my inexperience of locating the correct area. Its an important test to establish the blood content of oxygen and carbon dioxide. Like all things in medicine there are normal parameters to work with and if the results are outside those we need to know why and try to fix it. All parts of the jigsaw puzzle I still am learning to put together.
We get to the place where the bodies are kept. This bit looks familiar. It could be a scene from Silent Witness. That smell must be formaldehyde. I try using shallow breaths through my mouth. One side of the room is filled with floor to ceiling draws that pull out to reveal corpses wrapped in white sheets. I subconsciously begin to back away until I can go no further when my back reaches the far wall. The nurse smiles and suggests I come closer to be able to see Mr Brown. She unzips the bag. What am I supposed to say? I try not to stare at him with morbid curiosity. My one task firmly fixed in my head is to check for the presence of a pacemaker. I purposefully look in the left chest area. No sign of scars, so no pacemaker. He can be cremated without fear of an explosion. It helps to make me feel my presence there justified even though it’s a legal requirement of writing the ‘crem forms’.
He is leaking brown fluid hence the use of the giant white plastic bag. He had been really puffy from excess fluid in the last few days from liver failure. That was the booze doing its work. It is now seeping out. I had known him as a jaundiced patient, yellow. Now he is grey. I am happy to leave that space and enter the land of the living. I can’t help but take a deep breath of fresh air and feel the urge to shower.
This account was published in The Glasgow Herald.
At last I find the free parking spaces on the side roads around the hospital. After spending two days in the on site multi storey at £12 a day, I needed to find alternatives. The broken glass along frequent stretches of road from previously assaulted cars is somewhat discerning though. They say its just a matter of time before a member of staff is mugged or worse.
I arrive on the ward and notice that Mr Brown is not there. He died during the night. I didn’t realise he was so close to the end yesterday. He was becoming increasingly confused. He associated me with needles and every time I walked by he held his arms close to his body. His kidneys as well as his liver were failing, but I didn’t realise he was dying. I have never come across someone dying before. It just didn’t feature as part of medical school.
I am asked to write my first death certificate. The family are coming by in half an hour to pick it up. It feels somewhat unfitting to be doing it in biro. It should be in black ink. I am after all declaring the death of a man. I make a mistake and start a fresh one, trying to use my best hand writing. I fight against my normal junior doctors ‘no time’ scrawl. He is to be cremated, which requires me to fill another certificate. It was never my forte. The main points to remember here are to use block capitals, check the patient doesn’t have a pace maker as that would cause the furnace to explode and then pop down to the mortuary to see the body. For this final duty we are paid the ‘crem fee.’ I don’t know how much but I am told a cheque will arrive in the post. There is a vast amount of paper work in this job, which is probably why I am struggling.
That’s a job on my list today-’go to mortuary to see Mr Brown.’ The mortuary in Glasgow Royal Infirmary is again my first. I had imagined them as being clinical, white and silver. This one however is not. I press the bell at the locked door and stand there as people inside ignore me. I literally make eye contact with them as they walk past with that awkward ‘pretend you are not there’ look. A nurse in scrubs arrives and lets me in. Maybe only nurses are authorised to open the door. She’s young and cheerful. She somehow knows that I’m a mortuary virgin. Must be my wide eyes and nervous laughter. To get to the bodies, we need to get to the basement. Its like something out of a murder series, complete with an old lift that creaks and shakes as it descends. The doors to the lifts are wooden screens that need to be pulled across. The nurse explains that during the winter the lift and the lower floor flood. The staff wear wellies. Not sure if she is having me on. Suppose I’ll find out soon enough.
I had looked after this man in life. Only the day before I almost knocked myself out with surprise when I got blood gases off him. This involves using a special syringe and needle, and aiming for the radial artery on the wrist. If your in, you are rewarded with a red flash back of blood, which fills up the syringe under the pressure of the blood without any further effort. It’s a sore procedure and there have been many times when I have had to continue stabbing at the wrist trying to get that bit of blood. Its awful for the patient and its awful for me to continue to inflict pain, due to my inexperience of locating the correct area. Its an important test to establish the blood content of oxygen and carbon dioxide. Like all things in medicine there are normal parameters to work with and if the results are outside those we need to know why and try to fix it. All parts of the jigsaw puzzle I still am learning to put together.
We get to the place where the bodies are kept. This bit looks familiar. It could be a scene from Silent Witness. That smell must be formaldehyde. I try using shallow breaths through my mouth. One side of the room is filled with floor to ceiling draws that pull out to reveal corpses wrapped in white sheets. I subconsciously begin to back away until I can go no further when my back reaches the far wall. The nurse smiles and suggests I come closer to be able to see Mr Brown. She unzips the bag. What am I supposed to say? I try not to stare at him with morbid curiosity. My one task firmly fixed in my head is to check for the presence of a pacemaker. I purposefully look in the left chest area. No sign of scars, so no pacemaker. He can be cremated without fear of an explosion. It helps to make me feel my presence there justified even though it’s a legal requirement of writing the ‘crem forms’.
He is leaking brown fluid hence the use of the giant white plastic bag. He had been really puffy from excess fluid in the last few days from liver failure. That was the booze doing its work. It is now seeping out. I had known him as a jaundiced patient, yellow. Now he is grey. I am happy to leave that space and enter the land of the living. I can’t help but take a deep breath of fresh air and feel the urge to shower.
This account was published in The Glasgow Herald.
The first month is done, eleven more to go...
I’ve been here in this hospital in Glasgow a month. Its pay day and my first month’s wage is in the bank. My feet tell me I earned every penny. And there was plenty that wasn’t paid for. The pay slip says 40 hour weeks. Really?
Spoke with the Glasgow Herald health correspondent today, Helen Puttick-had to shout as I had gone for coffee in the Beanscene. Bad idea to go, didn’t relax me at all. I am so shattered the only option is to sleep. But I am at that stage of tiredness where sleep does not come and I feel sick and dizzy. Today in between patients I thought I was going to faint. Maybe there’s a bug going around. The other JHO felt ill too. I had hot flushes.
But there was no time to reflect. The list of jobs was growing and my most treasured asset in the form of my SHO was away with migraine. It was all down to me. Triumph with the venflons, even managed to get one into Mr. H! My heart sink venflon patient. My first. I am actually quite enjoying doing them. Just a couple of weeks ago I was terrified and all fingers and thumbs. The feeling of satisfaction when you see that flashback of blood, as you withdraw the needle is better then any other. And when the saline flush goes through easily without squirting back in your face that’s just the jackpot. Not such a joyous moment though if you see a lump of skin forming just above the venflon sight. It means it’s in the wrong place. There have been occasions when I managed to squirt the patient too, with the saline flush, so I now advice them to look away.
Had the added joy of getting blood out of Mr C without the normal problems. Numerous attempts and clotting syringes. He is rather large patient and 30 plus stone. Getting venous access has been my nemesis. If I had all day to do it that’s fine, although the poor man then has to endure multiple needle stabs. But with the central line which basically goes in through the veins in the neck, getting that essential blood is just a question of opening taps and letting it flow. Yes, come to mama.
I managed to pray in the chapel on the way back from radiology, and clerking in ERCP patients in another ward across the way. There was another Muslim worshipper in the Chapel today. So I am not the only one! Certainly different from the little community of Muslims we had at Ninewells Hospital, Dundee. I remember hearing the bleeps of male doctors’ going off as they prayed and then answering the page and discussing patients with nurses. To my inexperienced eye, it looked dead impressive and important. I live in fear of mine going off now I have one. I am growing to hate the stupid little things that we wear attached to belts and waistbands. Those innocuous little black boxes rule our lives. I am going to have to stop. It’s all getting blurry.
Spoke with the Glasgow Herald health correspondent today, Helen Puttick-had to shout as I had gone for coffee in the Beanscene. Bad idea to go, didn’t relax me at all. I am so shattered the only option is to sleep. But I am at that stage of tiredness where sleep does not come and I feel sick and dizzy. Today in between patients I thought I was going to faint. Maybe there’s a bug going around. The other JHO felt ill too. I had hot flushes.
But there was no time to reflect. The list of jobs was growing and my most treasured asset in the form of my SHO was away with migraine. It was all down to me. Triumph with the venflons, even managed to get one into Mr. H! My heart sink venflon patient. My first. I am actually quite enjoying doing them. Just a couple of weeks ago I was terrified and all fingers and thumbs. The feeling of satisfaction when you see that flashback of blood, as you withdraw the needle is better then any other. And when the saline flush goes through easily without squirting back in your face that’s just the jackpot. Not such a joyous moment though if you see a lump of skin forming just above the venflon sight. It means it’s in the wrong place. There have been occasions when I managed to squirt the patient too, with the saline flush, so I now advice them to look away.
Had the added joy of getting blood out of Mr C without the normal problems. Numerous attempts and clotting syringes. He is rather large patient and 30 plus stone. Getting venous access has been my nemesis. If I had all day to do it that’s fine, although the poor man then has to endure multiple needle stabs. But with the central line which basically goes in through the veins in the neck, getting that essential blood is just a question of opening taps and letting it flow. Yes, come to mama.
I managed to pray in the chapel on the way back from radiology, and clerking in ERCP patients in another ward across the way. There was another Muslim worshipper in the Chapel today. So I am not the only one! Certainly different from the little community of Muslims we had at Ninewells Hospital, Dundee. I remember hearing the bleeps of male doctors’ going off as they prayed and then answering the page and discussing patients with nurses. To my inexperienced eye, it looked dead impressive and important. I live in fear of mine going off now I have one. I am growing to hate the stupid little things that we wear attached to belts and waistbands. Those innocuous little black boxes rule our lives. I am going to have to stop. It’s all getting blurry.
One August day
Monday 28 Aug
I am so knackered I can’t be bothered to switch channels even though Celebrity Love Island is blaring out of the TV. Its v. poor. Really dull. I watch it without actually seeing anything. I am in a zombie like state.
I actually ache. Food helps though. Feel much better for having eaten. Sleep is going to be so good.
This morning feels just like a moment ago, but it took a long time to get to this evening. And tomorrow is going to come far too quickly.
I walked onto the ward this morning and it felt different. I’d been away for a few days on a course run by the Media Guardian Television International Festival. It was just fab. Glamorous, intellectual, ego clash heaven and everyone was trying to network like crazy with someone. My brief trip into the real world ended though as I returned to the unreal world of hospital life. That Never Never Land, where normal life stops existing as people become sick and enter as patients. Some need the same help as they required as children, with feeding and toilet. As I say, normal life is left at the door.
Some of the faces on the ward were the same but we’d had new patients in since my few days away. I felt disorientated. Last week I thought I had got it all sorted. I could run a mental list through the ward, but today the nurses had obviously been playing musical beds again, switching patients around the ward. Sicker patients are nearest to the nursing station and when they improve another sicker patient comes and takes the elevated position.
The ward round was long. I couldn’t help but dream of having that coffee. Tomorrow it’s the consultant ward round and so today was in prep for that. Crossing all the t’s, dotting all the i’s. That kind of thing. It means making sure all the results of tests are at hand and necessary jobs requested have been carried out. For me that’s a day running around like a blue 'arsed' fly, but hey its no different from any other day really.
Today was definitely venflon day-I had to put in four. I must be improving. I managed them all. I failed on getting bloods through. Some tricky patients.
By 3.30pm and not having had a chance to stop I was beginning to feel dizzy. I was having problems seeing properly. It was time to eat before I became a heap on the floor. By 6.30pm I still had a pile of jobs to do. I had worked flat out and still was way over the cut off working day time laid out by European Working Directives. I couldn’t hold back the tears. I am not entirely sure why I cried, but I just did.
I am way too tired to tell you anymore. Its time to sleep. My feet actually throb. I am already dreading the morning coming round.
I am so knackered I can’t be bothered to switch channels even though Celebrity Love Island is blaring out of the TV. Its v. poor. Really dull. I watch it without actually seeing anything. I am in a zombie like state.
I actually ache. Food helps though. Feel much better for having eaten. Sleep is going to be so good.
This morning feels just like a moment ago, but it took a long time to get to this evening. And tomorrow is going to come far too quickly.
I walked onto the ward this morning and it felt different. I’d been away for a few days on a course run by the Media Guardian Television International Festival. It was just fab. Glamorous, intellectual, ego clash heaven and everyone was trying to network like crazy with someone. My brief trip into the real world ended though as I returned to the unreal world of hospital life. That Never Never Land, where normal life stops existing as people become sick and enter as patients. Some need the same help as they required as children, with feeding and toilet. As I say, normal life is left at the door.
Some of the faces on the ward were the same but we’d had new patients in since my few days away. I felt disorientated. Last week I thought I had got it all sorted. I could run a mental list through the ward, but today the nurses had obviously been playing musical beds again, switching patients around the ward. Sicker patients are nearest to the nursing station and when they improve another sicker patient comes and takes the elevated position.
The ward round was long. I couldn’t help but dream of having that coffee. Tomorrow it’s the consultant ward round and so today was in prep for that. Crossing all the t’s, dotting all the i’s. That kind of thing. It means making sure all the results of tests are at hand and necessary jobs requested have been carried out. For me that’s a day running around like a blue 'arsed' fly, but hey its no different from any other day really.
Today was definitely venflon day-I had to put in four. I must be improving. I managed them all. I failed on getting bloods through. Some tricky patients.
By 3.30pm and not having had a chance to stop I was beginning to feel dizzy. I was having problems seeing properly. It was time to eat before I became a heap on the floor. By 6.30pm I still had a pile of jobs to do. I had worked flat out and still was way over the cut off working day time laid out by European Working Directives. I couldn’t hold back the tears. I am not entirely sure why I cried, but I just did.
I am way too tired to tell you anymore. Its time to sleep. My feet actually throb. I am already dreading the morning coming round.
Step this way
This about a journey into the unknown. Five years of preparing, sweating it out, the adrenalin rush of failure being one exam away. Its all over and we are here. At the start of what is going to be a very long, slippery, wobbly ladder. Some of the rungs may be missing on the way up making it even more precarious. This is about being a junior doctor.
Every day is a mystery. Every morning a heart flutter experienced as the nerves set in. Will I be able to survive this day? That is all it is about right now. Survival. One day at a time. One night at a time. And as the shifts roll into weekends and nights are spent tiptoeing across wards answering that page that will not stop calling you, the mystery increases. The way gets cloudier and the frustration and self doubt mounts. But I am told that at some point a peak is reached and a plateau enjoyed. When that will be I do not know. Its five months in and yes I am better than I was but not as good as I will be one day.
Every day is a mystery. Every morning a heart flutter experienced as the nerves set in. Will I be able to survive this day? That is all it is about right now. Survival. One day at a time. One night at a time. And as the shifts roll into weekends and nights are spent tiptoeing across wards answering that page that will not stop calling you, the mystery increases. The way gets cloudier and the frustration and self doubt mounts. But I am told that at some point a peak is reached and a plateau enjoyed. When that will be I do not know. Its five months in and yes I am better than I was but not as good as I will be one day.
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