i have increasingly found myself adopting something of a clockwatcher attitude to work and also conveying my ethos to the new junior doctors. part of this is because our bosses badger us to make sure we leave on time for fear of reprimand by the government. more, it is because the NHS is such a miserable place to work these days.
to be honest, apart from staying to help the person that becomes acutely unwell at 4.50pm, why would anyone want to stay a minute longer than they have to in the dirty wards, in the company of disinterested staff, performing eight contrived tasks to attain one simple goal?
"thankless" is the wrong word to describe my job for it suggests that i want some kind of kudos, some kind of appreciation, above and beyond my paycheque, for what i do. wrong. i don't want hordes of patients throwing themselves at my feet in gratitude, pawing at my converse hightops, shedding tears of euphoria. "halleluia we have been SAVED."
all i want is not to feel that i am constantly fighting against the system in order to make it work. everyday involves pushing and pushing and pushing to get things done. i feel like a shaven Samson (after a bit of how's your father with Delilah) trying to topple the pillars in the temple. only there is no divine intervention from God. because God has been replaced in the NHS by a protocol driven 4 hour maximum entry pathway into the kingdom of heaven and because divine intervention is not a part of Hospital At Night as it is provided as cross cover by the ENT registrar on call from home. is it a massive demand to want everything to flow a bit more easily, so that we can sit in a coracle and paddle calmly down the hospital river and out into the sea of good patient care without hitting big fuck off rocks.
but back to clockwatching. despite all my efforts, tonight i find myself returning home five hours after i should have. "why Dr D&C?" you lament. "surely you must have been on the beers?" no. i shake my head.
there is a lady who is dying on one of the wards. she was brought to hospital on death's door, nay, looking through death's letterbox asking if anyone was home. she has had a big stroke and her body is also riddled with infection. the bacteria have formed colonies on the valves of her heart and with each contraction of the heart little pieces of these colonies fly off into the blood stream and seed her lungs, her skin and her brain. she has been treated aggressively, perhaps out of scale with her pre admission quality of life (largely chairbound, her family doing EVERYTHING for her) but over the past few days it's been clear that we aren't winning and she is slipping away.
it has fallen to me to speak to the family to tell them what's going on. i've called them several times each day but no response on their home phone. hardly surprising: the patient's daughter has four kids to school and work at the same time. anyway it gets to today - friday. again no response from the daughter's house but the nursing staff inform me that she did pop in at four and would be coming back later in the evening.
the daughter is an intelligent worldly woman and she doesn't need to be a doctor to know that her mother is dying. she knows this and i know that she knows this from talking to her before. i could have just left it, packed my bags at five and taken off. the nurses could tell her that things weren't looking good and that her mum might die this weekend. and when her mum does die the nurses could also tell her that it was to be expected and she would probably have known that too.
but i couldn't just leave it like that. nor could i do it all over a five minute phone call. i wanted to see her again in person and talk to her.
i waited till she came back from picking her daughter up at 8pm, made her a tea and sat down with her. as i expected, she already knew what was going on, that her mother had not responded to treatment and was deteriorating. i told her that she would probably die in the next few days. she cried and cried and i felt like a proper cunt. i spent another half an hour talking to her about her mother, her life and her kids. she is exhausted from rushing to the hospital daily to looking after her kids and trying to work at the same time. she is in the real sense of the word remarkable. we then went to her mother's room and made sure the pillows were in the right position and that the blankets were covering her properly and that she was comfortable. i stopped all the unnecesssary medications and made sure all the drugs that she might need for pain relief, sickness, etc over the weekend were written up. i went and told the nurses three times what was going just so they wouldn't forget or fuck things up even more. i went back to the daughter, said my goodbyes and took myself off home as she cuddled her mum.
so the clockwatching didn't go to plan. and five hours later i am finally home though drained and lacking a third of the weekend. but how could i leave work tonight with a situation like that? i couldn't leave that. you would surely have to have a heart of stone and acid for blood to leave her. and besides no-one else was going to do sit down and talk to her. i wonder whether the nurses would actually do it when faced with thirty other people to look after.
i wonder if someone will do it for me or for my kids when i'm leaving this life. and when this lady dies this weekend i hope her daughter in her utter shitty grief can take maybe an atom of comfort in the knowledge that someone had the decency to tell her what was going on during her last days.
and that's the final and probably most important thing i want. i can do without making the fancy diagnoses and performing the clever surgery. i can do without the stupid exams and the teaching hospital jobs. i just want this system to have a bit of fucking decency.