retrospectre

I have this tired preset response for whenever someone asks me what I'm doing in hospital after hours - which is most days. It's something along the lines of, 'I live here now' or 'I've got nowhere else to go!' and it started out as a cute little quip, grinning ruefully and bouyed by a gust of bravado, but lately I've gotten tired of saying it. It's become less of a joke and more a statement of fact delivered in a flippant manner - and after a long day, sometimes even the flippancy falters.

Why does it feel like my life can be summarised as what happens within the hospital.

Has split in two and the world has moved on, and I'm taking a different path that's leading further and further away from everything I've known. A current that leads away from KL and old friends' birthdays.

A day off, outside the hospital, feels strange. Feels like re-entering the atmosphere after having been isolated in space - or coming out of a 10 year coma with a tom hanks castaway beard, trying to remember what the word 'normal' used to mean

---

I went into preston last night, the streets were alive, the city's spark had returned. there were returners sauntering through the streets, and a bar filled with freshers, hunched over their drinks, warily scanning the crowd for a friendly face or something familiar. The outdoor terrace decorated with fairy lights, a young man holding a guitar and the group surrounding him, feeling a little unsettled by the new-ness of their surroundings. A few years later they will identify the feeling as homesickness, look back fondly at their initiation into a world bursting with potential and bright futures waiting to be claimed or squandered away.

Panacea

But he wanted to justify himself, so he asked Jesus, "And who is my neighbor?" 

---

Yet I hold this against you: You have forsaken the love you had at first.

---


Yesterday I made the other urology FY1 cry. Or rather, I was there when she cried.

We had both finished a mammoth day - neither of us had sat down for a second or had lunch. It was 6.30pm - an hour and a half after work had officially ended and we were in the doctor's office finishing up jobs. For some reason the phlebs hadn't taken any of the post op bloods we'd requested in the morning, which meant during grand round there were a grand round of dirty looks directed our way, with looming registrars telling us, 'these bloods should have been done.' Protesting, 'We ordered them this morning,' and receiving in reply a stern look that said, 'these bloods should have been done.'

By the time grand round had ended it was 3pm. 'Jon - let's go through the list. It doesn't look like there's much to do.' I had a referral that needed to be made by 5pm, because that's when the consultant leaves hospital, two urgent discharge summaries to write so that well patients can go home and we can free up beds, and now urgent bloods that should have been done in the morning. 'There are four patients in EDU to be seen. Let's go down and clerk them and then you can finish up and update the list.'

I knew what this meant. What the reg wants is for me to see patients with him, stay back late and sort out paperwork and add patients to the list so that he can go home at 5pm. Which is fine - I get it - but it wouldn't kill him to see one or two patients on his own.

'Uh, I actually have this urgent referral to do. You know, for Mrs Y.? I can join you in EDU afterwards.'


'You can do that down in EDU, can't you? Just bleep him down in EDU.'

Or I can do it from here, now and join you in EDU afterwards.

'I need one of you to come with me and clerk patients in EDU.'

Why?

Selfish. This has happened before. Don't do it

And if someone takes your cloak, do not withhold your tunic as well.

'Okay, sure.'

Two hours later I'm in the office updating the list and trying to sort out what to do with this referral I missed because I was assisting with a catheter and was told, 'Whoever is bleeping you, just ignore it. You're busy with a patient.'

And whosoever shall compel thee to go a mile, go with him twain.

After we got the catheter in, I washed my hands and scrambled to the nearest telephone.

'Hello dialysis unit.'

'Hi, it's Jon urology FY1, did Dr. X bleep me by any chance?'

'Oh he was here a while ago, but he's gone now.'

Perfect.


By the time I had gotten to the office it was an hour past quitting time and I was in a pretty foul mood.

I texted the other FY1; hey quick q have you ordered bloods over the weekend for ward patients?

Not yet


Which means I'll have to do it.

I quickly checked to see if the urgent bloods had all been done, and some part of me wanted the answer to be no, wanted something concrete to confront her with, and some cruel part of me was perversely glad to find that one of them had indeed been missed.

Normally I wouldn't have mentioned it at all and sorted it out myself. After all, what's a few more minutes when you've already over-stayed two hours. But I reasoned, if I continue to do this, she will a.) not realise that her responsibility includes checking that bloods have been sent off and checking the results and b.) believe that things will continue to magically sort themselves out even if she does forget to order or check blood results.

Plus, it wasn't the first time this had happened. We divide jobs into outliers and ward. I've pretty much been picking up after her every day for the past four days, making sure bloods have been ordered and adding patients that have been missed off the list.

The lock in the door behind me rattled, and she came in looking drained and older by about 10 years.

'Hey, how's it going?'

'Not too bad, do you know if Mr Z had his bloods done?' I asked, already knowing the answer.

'... I asked Zoe (the medical student) to check and she said the nurse was doing them.'

'Because it says on the system, it's been collected but... that was three hours ago.'

'Oh.'

'So it's not been done.'

'I guess not... I asked Zoe though.'

'Yeah but.'

'The rest of them are definitely done though.'

'Yeah but what about Mr Z?'



'I guess he's not getting bloods today then.'

'... So when the reg asks, why haven't bloods been done - what are you going to say?'

'I asked Zoe and she said... the nurse was doing it.'

'So you're going to say "Zoe told me it was being done?"'

She laughs. 'Are you afraid of the reg?'

'No, I'm not - but I just need you to know that... these bloods have to be done. It's not okay to just leave it undone. Do you understand?'

'Alright well I'll do it later then.'

'No - we can handover to surgeon of the week, or ask one of the nurses to do it. That's not the issue, what I'm saying is that Mr Z had an AKI so he needs bloods for today. Do you understand? You can't just leave assuming that that they're done. You have to check... '

Before I knew it there were tears rolling down her cheek. I had not expected this.

I sat there, unsure how to suddenly switch from lecturing to comforting her.

'Hey, what's the matter?' I said at last, trying to sound like a friend.

'It's nothing,' she said, still sobbing furiously.

'... is there... something at home? Something troubling you?'

She shook her head and dabbed at the tears with her wrist.

'... is it the job?'

She gave a small tentative nod.

'It's like... I can't do everything...'

'... As in, we try our best, but people still expect things to be perfect?'

She nods again.

'Yeah, I know... you'd expect them to understand that - there's just two of us... doing a four person job, and it's not like we're sitting around drinking coffee...'

The tears had nearly stopped now, her gasping reduced to a sniffle.

'And I don't know why they still act like it's reasonable to expect us to get everything done. I mean... either they know it's not possible or...'

And then I stopped speaking. Because I realised that I had been doing to her the exact same thing I resented being done to me. Being held accountable without a fair trial - without considering there might be more to the story - something wrong with the system rather than with the individual. She wasn't incompetent. She had sorted out the urgent echo request and another patient's heparin induced thrombocytopenia screen. To have done both by quitting time is no small feat. She simply hadn't gotten round to checking that all the bloods had been done. She was doing her best - and I had somehow convinced myself that her failure to check on Mr Z's blood was due to negligence or some kind of mental laziness.

And I was reminded of something I had already suspected; that cruelty comes from suffering. And that the kind of registrar who abuses their house officer is the kind of registrar who was abused as a house officer - and becomes the kind of house officer who abuses other house officers, and makes nasty private comments about the ward sister's weight and appearance, and gradually loses the ability to understand anybody's suffering beyond his own, and begins to convince himself that any and every minor inconvenience or mishap is part of some grand conspiracy or deliberate, concerted effort to keep him as miserable as he is now.

'Yeah, but I keep making mistakes... keep missing things out.' She says. 'Like yesterday I prescribed blood for that lady - only to find it hadn't been given... and I had to represcribe it, because apparently you can't prescribe 2 units at the same time...' She shook her head. 'I mean... sometimes it's just like... what's the point?'

'Yeah, I know what you mean. Like all that work is for nothing.'

She nods.

'I think maybe you're just tired. It's been a long week and you're only human. Have you been getting enough sleep?'

'I think so.'

'I don't think so - cause you have to wake up early to drive here, and you've been staying pretty late, haven't you?'

'But so has everybody else.'

'... I think what you need is to have a good rest - just spend some time away from work and come back refreshed. I think a lot of it is just stress. And it messes with your sleep too. You know, when you can't get your mind to switch off? I honestly couldn't sleep at all yesterday.'

And then I told her about my delirium dream that consisted of a consultant trying to explain something very basic to me, and me just not understanding at all, and watching as he became more and more frustrated.

And as we talked she managed a laugh, which manifested as a kind of sharp, brittle sound, which I recognised as being the very same one I made just over a month ago and fighting back tears a week later at someone else's house.

---

Above all, love each other deeply, because love covers over a multitude of sins. 

---

Brothers, if someone is caught in a trespass, you who are spiritual should restore him with a spirit of gentleness. But watch yourself, or you also may be tempted. Carry one another’s burdens, and in this way you will fulfill the Law of Christ.