I think I've gone native. Three weeks ago I'd have ducked for cover if a patient sneezed on me: today I almost forgot to wash my hands after a rectal examination on a constipated diabetic, and my generally jovial manner took a bit of a bashing when the rota coordinator called me up to tell me about a little error they had made before we arrived, which somehow involves me working next Saturday at less than a week's notice. There was, needless to say, a brief moment of self-righteousness on my part (one day I even went home before six), but I've been struggling to keep cynicism and bitterness at bay. They don't make it easy for you.
To my astonishment, after six weeks I've started to get a feel for who is ill, and who is not, and the first thing to realise is that there are plenty of people in hospital who are an awful lot healthier than you or I. They stay here because there is apparently a vast army of patients, relatives, and social workers who all labour under the delusion that hospital is a safe place to be if you are old and well. It's not.
Once you're here we give you all the horrible infections that the patient two beds away came in with, many of which can only be treated by the antibiotics that they will invent in the year 2007: then you get diarrhoea from the antibiotics, which throws off your mental function, and before you know it you can't make it to the loo on your own any more and you're on the month long waiting list for a nursing home. I do my bit by washing my hands between patients, but as far as I can tell these bugs have wings. For God's sake, get your parents out of hospital.
The other thing they tend not to mention in the textbooks is that nothing works like they say in the textbooks. For example: there are 50-year-olds who cycle to work every day, and then there are 50-year-olds who smoke in front of the telly. Despite it all, I go through my (painfully) thorough routine on every patient I see in casualty, but for anything other than the barn-door classics the patterns of symptom and sign bear no relation to anything from medical school, and whatever the cause, you can generally see the ones that are going to be fine and the ones that are in for the distance from the moment you walk into the cubicle.
The strange thing is, despite my crippling lack of confidence (but you should see me exuding the stuff), the more I am left alone the more competent I seem to become. My consultant is away at a conference. My SHO is on nights. I do ward rounds on my own, I make management decisions that even my monster of a research registrar (the nice one is on holiday) manages not to publicly ridicule, and sometimes I do a bit of good. Even the stroppiest nurses have stopped treating my requests for a quick set of patient observations as a class war issue.
Ah, stroppiness: sometimes it feels like it's everywhere around me, and the worst of it is that I have become a purveyor of the stuff myself, despite my better judgement. It's the inescapability of the work. What were previously isolated little puddles of labour seem to be joining up into vast oceans of drudgery, and I never seem to be away from the hospital for more than four hours at a time. I live in a small concrete bunker 15 yards away from my ward, and whenever I return home from an evening out, my route takes me right past the main doors of the casualty department.
With this, together with the all-nighters in casualty every five days, and the time-warp effect of spending your every moment on and off the job in a hospital that never sleeps, the days are melting into one another. I used to pride myself on being pretty good at sleep deprivation, but that was when I was a student, and I could award myself a day off to recover after a heavy revision session. This is relentless and inescapable exhaustion, made worse by my churlish refusal to dispense with my social life.
Whenever I do manage to get out into the real world, I can't get over how young and healthy you all look. I bet most of you can even make it to the toilet on your own. It just makes me want to be one of you again. So be kind to me, please, and remember what I said about the bugs: keep yourself out of hospital, and don't go after a doctor in the queue for the canteen salad bar.
