During the day, there are typically at least three junior doctors and one consultant managing each ward. At night, the training wheels go off. My registrar and I are covering eight wards between us. She will manage the most acutely ill patients, and I will take care of the rest. We both carry a bleep, an infernal black box that is clipped to my belt. Whenever someone calls me, it emits a high-pitched noise that sounds like a dolphin being throttled.
2058: I arrive at the hospital thirty minutes early. Friday night is especially busy, so I want to be prepared.
2136: Handover meeting. The day team blitz through a list of the 38 patients who were admitted into hospital today, explaining why each patient is in hospital, and what needs to be done for them overnight. Eight of these patients will require extra attention during the night: some will need repeat blood tests, some will need a full checking over from the registrar, and one, we are warned, is our most critical.
2209: My bleep has already gone off several times during the meeting. I catch eye contact with my registrar, and I walk briskly to the nearest phone. With my fresh A4 sheet of paper and trusty biro - apologies to the nurse from whom I 'borrowed' it - I begin to 'answer my bleep'. This is the equivalent of phoning back all of your missed calls. Typically, they'll be nurses asking about the management of a deteriorating patient, or asking me to prescribe medication for a patient in pain.
Scroll back to a time in your life when you were acutely ill, or when you were visiting someone acutely ill. How much attention did you need in one night? Now, multiply that demand by a factor of 180 - the number of patients I'm responsible for taking care of over the next twelve hours.
2345: BLEEP. BLEEP. One elderly patient has a dramatically increased respiratory rate. He does not look well. At all. He's unresponsive, and it sounds like he may have aspirated. That is to say, a piece of gunky NHS canteen food has found its way down his trachea, possibly settled in one of his lungs, and now it's likely infected. He is losing colour rapidly. His wife is there, panicked.
"Is he dying, doctor?"
I cast a sympathetic glance while explaining the situation, as I attempt to portray calm, while managing the nursing staff and racing through my own tasks at the speed of light.
I give the patient oxygen; lots of oxygen. I perform a quick examination. I retreat to the nearest computer, where I request a chest X-ray. I read the patient's previous history. By this stage of his admission, there are at least one hundred pages of illegible doctor scrawls, which might as well be hieroglyphics.
I prescribe antibiotics and intravenous fluids, but the patient could die before they take hold. I bleep my registrar to let her know that a patient is on the edge.
"I'm also seeing a patient who's about to turn critical. I'll be there as soon as I can..."
In hospital, when someone says they'll be there "as soon as I can," you know to take that with a pinch of salt. A myriad of calamities can happen when you're "on your way."
Meanwhile, I take blood from the patient, in attempt to gather more information about his physiological state. With a vial of blood in my syringe, I leave the ward to run to the blood-analyzing machine, of which there are only two in the entire hospital. Within five minutes, I return to the patient.
From a distance, something doesn't look right. The wife is sat in her chair and tenderly caressing her husband, her back facing me. I halt my step. The nurse looks over to me with a concerned face. I beckon her over.
"He's gone. I don't think the wife knows yet."
Right on cue, my registrar appears.
"How is he?", she asks.
"I think...I think he's gone."
I am zapped from my stunned state by my bleep. Every time it goes off, I feel an impending sense of doom. But, there is precious little time to reflect. This is a military operation. There are people to save. I just need to get on with it.
0314: Has the storm passed? Or is this merely the eye of the hurricane? I trundle to the cardiology ward and muddle through the staff kitchen cabinet. I think I might have a window of a few minutes for a cup of tea. As I let out a deep sigh and take my first sip, the worst-case scenario: a second's worth of ominous static appears on the bleep, a female voice speaks loudly and clearly through the bleep, but with an anxiety so deep and foreboding that you can feel her lip trembling: "CARDIAC ARREST: WARD 33. CARDIAC ARREST: WARD 33."
Gulp.
I'm pretty sure Ward 33 is a maternity ward. A pregnant lady arresting in the middle of the night is a nightmare scenario for all involved. Just to make sure, I jog to the nurses' station to confirm. Yes, it's in a maternity unit, in an entirely different building complex, on the fourth floor. Double-gulp. This is why I wear trainers at night.
During the day, there are always enough doctors in the building to handle a cardiac arrest. During the night, no matter where you are, you drop what you're doing and you get a move on. I sprint down three flights of stairs, accelerate down a long corridor, across a covered walkway, and I'm in the maternity building. In the distance, I hear the pitter-patter of fellow panicked feet. Distressing during the day, frantic company feels reassuring at night.
Both elevators in front of me are on Level 3. As the most junior doctor in the hospital, I would feel faintly embarrassed to rock up to an arrest walking out of an elevator. In any case, I decide to sprint up four flights of stairs. At about Level 2, I start to feel like this might have been a mistake. Months of Chicken Delight's artery-clogging £3.99 pizza and a distinct lack of exercise have both taken their toll. I use the rail to drag myself up the remaining two flights, keeping in mind how embarrassing it would be to be breathless by the time I reach the patient.
I stride into the ward confidently, stumbling aimlessly down another long corridor, before a nurse helpfully points me to the open door on the right-hand side that I had missed.as I had entered. You know, the one with all of the commotion and bodies? Oh, that one, yes.
There are already four nurses and three doctors at the scene. How did they get there so quickly? I don't recognize them and they don't recognize me, but it's the middle of the night and we're all wearing stethoscopes and hospital-appointed lanyards, so we're all pretty much best friends. Even if nobody's smiling.
The patient is a young-looking lady with a big bump in her tummy. She is on the floor and she looks dazed, but awake. Phew. I have no idea what to do, so I do what any other young doctor does in this situation: try to subtly catch my breath, while moving to one side, furrowing eyebrows and folding arms with an air of "Oh, one of these - I've seen this a thousand times before! She'll be OK as long as you keep doing what you're doing. Anything I do would clearly be a hindrance..."
I scan the room for anything obvious I can do to help out. Nope. Guess I'll just stand here and look busy, then. She is slowly coming around, but her head is bleeding and it looks like she's had a bad fall. "Has anyone taken a blood gas?", I ask, into a vacuum of low-frequency chatter. I am superfluous. I am a third nipple. I am completely and utterly useless.
I try to palpate a radial pulse. There's often a lot of pressure in these situations, as it's time-sensitive and there are now other people watching, as opposed to during the day, when you would always perform this task behind a closed curtain. The difficulty of this task lies in your dexterity, experience, and gut. "Sharp scratch," I whisper, as I expertly slide a needle into her wrist. I fish the needle around manfully, but no blood, no luck. Well, I've clearly been useful here.
The patient is now speaking and stable, so I look for my registrar's please-leave-you're-needed-elsewhere nod of approval, and I stride off through the double-doors...
0315: "Doctor, I have a patient here...he has only passed 50ml of urine in the past 24 hours."
"Well, that's more than me," I tell her with a straight face, before realizing that my bladder is now feeling the strain of six hours without even having the time to take a leak.
"I'm sorry, what did you say, doctor?"
"I said...I'm coming."
0456: Sleep deprivation is kicking in, hard. I am groggy. Even in front of patients, I rub my eyes and yawn. I can't help it. If a doctor turned up to work drunk, he would instantly be sacked. So why is it deemed acceptable for me to work in this condition?
0552: As time goes on, I am definitely making more mistakes.I'm making sloppy errors that I would never make during the day. Minor prescribing errors are now routine, and taking bloods from patients - a skill that requires supreme hand-eye coordination and a sixth sense - is literally a stab in the dark. It's pitch black outside, and half the patient's bedside lamps are non-functioning, or so weak as to be functionally homeopathic for my needs. If there's a friendly nurse around, I ask her to hold a torch so I can get a better view. And at this time of night, some human contact and reassurance.
0740: A patient has spiked a temperature. I examine him, take blood cultures and give him some paracetamol. I start to document this in his notes...and a few minutes later, I wake up having face-planted onto the desk and completely conked out. I scan around the office to see if any passing nurses have seen me. By this point, I really don't care. I need a rest.
0823: Clad in white, with angelic blonde hair, a nurse wakes me up, taps me on the shoulder, and presents a hot cup of tea. "You're nearly finished, doc." BLEEP, BLEEP! So far, I have been bleeped 45 times.
0930: Morning handover complete. I am now fantasizing about returning to a warm bed and never waking up again. Returning my bleep to its station, I hold it like I'm trying to dispose of a live grenade. On my way, I see a Scottish patient on the ward who I'd seen a few days before. He'd been especially rude to me. In fairness, he had a good reason to be in a bad mood: lung cancer. For reasons unknown, even though in my mind I'm already in bed, I'm drawn into his orbit. I half-reluctantly step into his cubicle.
"Hello sir, how are you feeling today?"
"Not too bad, doc. You came and saw me before, didn't ya? I just wanted to apologize for the other day -"
"No problem, sir. I understand how you must be feeling. Do you have any questions for me?"
I had my bag strapped around my shoulder and rain-jacket on, ready to go home. He began to ask me in detail about his latest scans, his results and possible prognosis. I drew the curtains, sat down next to him on his bed, and regaled him of his maladies. For the next hour, we discussed his life in the army and the tragedies that he had encountered. We could relate to one another. Even though he had belittled me not two days before, by the end of this chat, he asked me for a selfie.
"We have a lot in common, doc."
"What's that, sir?"
"We're both shattered, and both of us want to get the hell out of here!"