Hospitals are vast places. District generals are large, often with multiple floors and endless corridors. But large teaching hospitals are gargantuan spaces, three-dimensional mazes extending over literally miles of passages, sprouting wards, clinics and theatres. Even after working in one for a month, you might not come to know much about the extended geography of the place.
It’s August 2012, and I am working my first shift in a major city hospital. I had never much wanted to do orthopaedics, but having decided I wanted to spend as little time in theatre as possible, I was now working the hospital rotations a GP trainee has to complete before absconding to the relative peace of primary care.
These rotations are billed as “important learning opportunities”, which is code for “making sure the ward patients don’t die while the surgical trainees are in theatre”.
I had drawn the short straw in terms of the complex rota – my name was right at the start, with the word NIGHT printed across it in large letters. Worse still, I had a lengthy induction from 9am-4pm. That meant four hours to rest before starting my 12-hour nightshift. I had duly booked one of the on-call rooms to get an hour or two of sleep before work.
At 4pm, I head for the on-call room, which is in a basement that looks like a post-industrial version of the set of Labyrinth and takes 40 minutes to find. I settle down to rest, but end up staring at a suspicious yellow stain on the ceiling for three hours.
At 7.40pm I make my way to the handover room. I meet the senior house officer who had been on call during the day, and who gaily informs me there are “only five” really sick patients to worry about and pushes three bleeps into my hands.
The SHO disappears and my first long, jumbled, panicky orthopaedic night shift begins. I ask endlessly which wards I’m meant to be on and where I can find them.
In total, I’m covering five wards plus paediatrics. This is more complicated than it sounds due in part to the strange architecture of the hospital – the designer presumably thought it was perfectly reasonable to put ward 16 between 18 and 32, and to put ward 33 in another building entirely.
Then there are the IT problems. Case study: a frail old lady is dry – she needs fluids. No problem, you think – prescribe fluids. But to do this, you have to log on to the computer. That means you need the password you were given at induction, which doesn’t work. This means that you have to phone the emergency IT line who give you a log number – which would be helpful if you didn’t have to be logged on to a computer to use it.
Once logged on, you have to check the patient’s recent bloods to determine what fluid to give. That means you need your NHS smartcard, but this crashes the computer as soon as it is inserted. After a reboot, you move on to the final stage: prescribing the fluids.
But the drug charts are not physical things anymore, they’re electronic. This is meant to be wonderful, because you can log on from anywhere in the hospital. In reality, you can’t prescribe anything because some unknown person has accessed the drug chart from another computer and forgotten to log off. So you have to find one of the nurses to countersign and unlock the e-chart – which they would be very happy to do if they weren’t all on the phone to the IT department because their own passwords have stopped working.
The night rolls on. Gradually, I begin to feel I am getting the hang of things. I see a patient in A&E and admit them. I send another home. By the time the registrar arrives at 7am to check on me, I’m feeling pretty good.
“Great!” he tells me. “Let’s have a look at the overnights before the x-ray meeting.” I stare at him blankly.
“The overnights,” he repeats, a hint of worry in his voice. My face says it all. “Oh dear,” he says. He explains: A&E keeps a box with records of patients the department has sent home overnight. “You need to get the box,” he tells me. “We look up all the x-rays at the meeting. All the consultants will be there.”
The next 30 minutes are a blur. There are endless stairs, corridors, and well-meaning people sending me in the wrong direction. Every few minutes a bleep goes off. Presumably it’s the registrar asking where the hell I’d gone.
Eventually I locate the right desk in the A&E department and spend three excruciating minutes listening to the receptionist as she extolls the virtues of her new mobile contract. At last, clutching the fabled overnight box, I race up the stairs and stumble into the x-ray meeting. Five consultants regard me coldly. I hand over the box, and slink off to a corner and try to look small.
The meeting ends, and I emerge into the bright sunlight of the real world, the shambling insanity of the hospital behind me. I drive home, crawl into bed, and get ready to do it all over again.
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