I’m anonymous, dressed like this. Androgynous, too. No one’s going to assess the size of my hips, a little wider than I’d like thanks to night shifts when I don’t get a break until after ten and rely on vending machine chocolate or canteen chips. No teenage boy’s going to spy my cleavage when I bend over to examine him on a hospital bed. I’m a doctor, this pyjama-type uniform says, as does the lanyard round my neck. Hello. I’m Dr Trenchard. I’m here to do a job, and to do it well.
Wearing scrubs, like any uniform, also bonds you with your colleagues. We’re all in it together: an army working for a greater good we still believe in – the dysfunctional, fracturing, only-just-about-coping-because-of-the-goodwill-and-professionalism-of-its-staff, free-at-the-point-of-need NHS. And if that sounds sentimental or sanctimonious, I’m neither of those things. It’s just that when it’s your daughter’s tenth birthday and you can’t put her to bed because it’s impossible to swap a Friday night shift, and she’s said, piling on the guilt in a way that only your firstborn can: ‘It’s all right, Mummy. I understand that you need to work.’ When this is the background to your fourth late shift in a row, and you’re exhausted and would really like to be in bed, curled around the husband you only grunt at during the week. When that’s what you’re missing and your reality’s very different: when you know your colleagues are racing to a crash call – hearts pumping as they run, shoes squeaking on the shiny floor, curtains whooshing around a bed; that fierce concentration as they crack ribs or apply paddles to shock a patient back into life . . . When, more prosaically, you haven’t had time for a wee . . . Well, you have to cling onto some belief in what you’re doing; you have to believe there’s a point in being committed to this sort of career. Because otherwise? You’d give up medicine, or emigrate to Australia, New Zealand or Canada, where the weather, hours and pay are all far, far better.
Oh, don’t get me wrong. I love my job. I believe what I’m doing is important. (What could be more worthwhile than making sick children better?) It’s stimulating; and, coming from my background – I’m the child of a single parent who ran a seaside café – I’m immensely proud to have got here at all. But this shift comes at the end of a string of nights preceded by an academic course last weekend and I’m shattered: my brain so befuddled I feel as if I’m seriously jetlagged. Adrenalin will carry me through the next few hours. It always does. But I need to focus. Just ten more hours: that’s all I need to get through.
I’m thinking all of this as I trot along the shiny corridor from the children’s ward to A&E, my mood not enhanced by the art on the walls: a mixture of seascapes and abstracts in bright primary colours that are supposed to soothe patients and distract them from the unpalatable fact that they have to be here. I pass the oncology and radiology departments; and think of the lives being fractured, the hopes and dreams evaporating; for some, the lives ending; then shove the thought aside.
I’m on my way to see a patient. Ten months old: fractious, irritable. She’s vomited, according to A&E, though she hasn’t a fever. She may be no more ill than Sam, my eight-year-old who’s just had a chest infection, though it’s odd to bring in a child who’s not genuinely poorly at this time of night. The junior isn’t happy to discharge and asked me to come down. My heart tips at the thought of a complicated case.
Because I could do without another terrifyingly sick child right now. My shift started with a crash call to the delivery suite to resuscitate a newborn: a full term plus thirteen days overdue baby; blue, with a slow heartbeat, and a cord pulled tight around his neck. I got him back: stimulation, a few breaths – but there was that long moment when you fear that it could all go horribly wrong and the mother who has managed to carry her baby beyond term might end up mourning the child she has dreamed of. As every obstetrician knows, birth is the most dangerous day of your life.
Then a child with an immunosuppressant condition and a virus was brought in by ambulance, and just after he’d been admitted, I had to deal with a three-year-old with croup. The mother’s anxiety made the situation far worse, her panic at his seal-like whooping exacerbating the condition until it became dangerous, the poor boy gasping for breath as she distracted our attention. Often parents are the most difficult part of this job.
So I’ve had enough drama tonight, I think, as I squeak along the corridor and take in the chaos of paediatric A&E, filled with hot, disgruntled parents and exhausted children. A boy in football kit looks nauseous as he leans against his father in a possible case of concussion. A waxen-faced girl peers at a blood-soaked dressing, while her mother explains she was chopping fruit when the knife slipped. From the main A&E, where the aisles are clogged with trolleys, there’s the sound of drunken, tuneless singing: ‘Why are we waiting’ half-shouted increasingly belligerently.
I check with the sister in charge, and glance at the patient’s notes: Betsey Curtis. My heart ricochets. Betsey? Jess’s Betsey? The baby of a friend I know well? Jess was in my antenatal group when I was pregnant with Rosa and she with Kit. Together we navigated early motherhood and stayed close when we had our second babies, though we’ve drifted apart since Jess’s third. Perhaps it’s inevitable: I’ve long since left the trenches of early babyhood, and work, family life and my suddenly vulnerable mother are all-consuming. Still, I’ve only seen her a handful of times since she’s had this baby and I’ve let things slip. She didn’t send Rosa a birthday card and I only noticed because she’s usually so good at remembering. Far better than me, who sometimes forgets her son, Kit’s, a week later. Of course it doesn’t matter – but I had wondered, in a distracted, halfconscious way as I scooped up the cards this morning, if she was irritated with me.
And now she’s brought in Betsey. I look at the notes again: ‘Non-mobile, irritable, drowsy, tearful, has vomited . . .’ they say.
‘Ronan, is this the patient you were concerned about?’ I double-check with the junior doctor.
He nods, relieved at deferring responsibility.
‘I’m not sure what’s wrong,’ he says. ‘No obvious temperature but her mother was concerned enough to bring her in. Wondered if you’d keep her in for observation for twenty-four hours?’
I soften. He’s been a doctor for less than eighteen months. I’ve felt that uncertainty, that embarrassment of asking a senior colleague.
‘Of course – but let’s have a look at her first.’
I pull the curtains aside.
*
‘Hello, Jess,’ I say.
‘Oh, thank God it’s you.’ My friend’s face softens as I enter the bay, tension easing from her forehead. ‘I didn’t think we should come but Ed was adamant. It’s so unlike him to worry, it panicked me into bringing her in.’
I look up sharply. Panicked‘s a strong word from an experienced mother of three.
‘Poor you and poor Betsey.’ Examining a patient I know is really not ideal, but with no other paediatric registrar around, there’s no other option. ‘Let’s see what’s wrong with her.’
Jess’s baby is lying on the bed, tiny legs splayed against the paper towel coating its blue plastic surface; large eyes, watchful, her face a tear-streaked, crumpled red. I’d forgotten how pretty she is. Almost doll-like, with thick dark hair framing a heart-shaped face, a cupid’s bow of a mouth and those vast blue eyes peering at me. A thumb hangs from the corner of her mouth and her other fist clutches a dirty toy rabbit. It’s the toy I bought her when she was born: the same make as Sam’s, an unashamedly tasteful, French, velveteen rabbit. Her bottom lip wobbles but then the thumb sucking resumes and she manages to soothe herself. She is heavy-lidded. Looks utterly exhausted.