On Call : Dr. Daisy Dashwood writes........

"I'm like the canary in the mines," announced Edward proudly. "I get sick before everyone else."

After his spectacularly splendid moment of personal breakdown in the Doctor's Mess, Edward had gone on to develop a rampant Streptococcal septicaemia which had floored him for a week.

The rest of the doctors groaned and blew their noses/downed Lemsip /crunched Tunes . They had been spared the full impact of the bastard Streps and had instead contracted a rather nasty and debilitating dose of the 'flu. Chuck, who has bronchiectasis, had managed to get onside with the A and E Sister, and procured a fair whack of erythromycin. Only the other day, Microbiology had phoned up to report the growth of some rather atypical Streps. ("You always have to be different," muttered Amos in disgust.) Most of the staff were either off sick or dying in various positions around the hospital.

"I mean, I'm quite happy to fob myself off with some sort of viral illness," said Amos, coughing into a blood chit. "So why can't that be enough for the patients?"

"Is it any wonder I continue to contract these illnesses?" demanded Chuck. "Temperatures are below freezing in the SHO Shanty Town. Last night I was huddled in bed with 3 jumpers, 2 sleeping bags and one of those little exothermic lavender bags."

"Pussy!" muttered Amos.

"I heard that!" said Chuck. "The walls in the SHO Shanty Town are made of spit and twigs. And I'm not even going into what they used for the bathroom! We've got a bit of mushroom growing out of our bathrom floor. It's about so high and has a proper cap on it. I call it Allan."

"Allan?" said Mary incredulously. You had to agree with her, once you got to the stage of naming your bathroom fungi, chances were that you were, not that much of a fun guy yourself anymore.

"It could only have been Allan or Gary," said Chuck reasonably.

"That could be what is exacerbating your asthma," mused Amos. "Steal a space blanket from A and E."

"I'd rather have an epipen," said Chuck.

"Well, at least you've not broken your femur," said Mary. "Just think of some of those little old grannies up on the orthopaedic ward. Then try feeling cold!"

Mary sometimes connects a little too much with the patients. That's why we try to keep her off the Psychiatry Ward.

"What, has another one of your patients noffed?" asked Chuck, picking holes in an investigation sheet.

"I beg your pardon!" said Mary stiffly.

"Have you never heard that one before?" asked Chuck. "The verb, to NOF. As in break your neck of femur."

"Oh," sniffed Mary.

"I say, I'd rather have old dears than ruddy alkies!" said Edward. "What, they are a rum lot!".

"Why, who have you come up against lately?" said Mary, batting her eyelashes. The effect was frightening.

"Ruddy Jasper Harper!" said Edward, viciously.

"Oh, not him again!" said Mary.

"Haven't you noticed all the flies?" asked Edward. "They tend to follow him around."

"Yes, I must admit that the flies do seem to have been particularly plentiful over the past few days," conceded Amos. "I thought we had just lost a patient and was going to ask everyone to make sure that all their patients were accounted for and breathing."

"Gordon finally reached the end of his tether and told him that the next time he came in, we'd not put him through detox," said Chuck. "C'mon, you must know him? Heavy gold jewellery, lots of tattoos, used to be in a pipe band?"

"Then he'll come in with a gastric malignancy," said Edward gloomily.

"I hope so," said Amos.

"How is he anyway?" enquired Angie.

"Oh, I don't know!" said Mary.

Amos made a rude noise.

"He's raving and talking about a 'big, red eye'," said Mary.

"But we think he's just been watching 'Lord of the Rings'," chimed in Chuck. "He does have very hairy feet."

"He's a bit crazy, isn't he?" said John. "I keep on trying to get him to drink water but he won't. However, he'll do a really convincing impression of picking up a glass of imaginary water and drinking it."

"Perhaps he was an ex-mime artist?" suggested Chuck.

"Well, he's been drinking buckets of imaginary water," said John. "Now we just have to get him onto the real stuff."

****************************

"Come on Mrs. Englebert," said Mary encouragingly. "Just swallow these last 24 tablets and that'll be it until lunchtime."

Mrs. Englebert kept her mouth firmly shut, gave Mary the finger and refused to swallow.

"You know," said Amos, sidling enigmatically past, like some shady character out of a 20's black-and-white movie. "They need to start small. Like digoxin. Give her 62.5 micrograms of digoxin and work up to the evening primrose oil."

"But she doesn't need digoxin!" protested Mary, scandalised.

"Well, perhaps she would have a reason to be in hospital if we sent her into an arrhythmia," retorted Amos.

Mrs. Englebert gave him two fingers.

"On the subject of drugs," wheezed Laurence, staggering through the door, guess what Mr. Nicholson just told me.

"He's going to leave you £5,000 in his will?" guessed Mary.

"No," said Laurence.

"He's going to sue you?" suggested Amos. The hospital hadn't been sued for at least 6 months and it always added a bit of character to the daily grind.

"No," said Laurence.

"He's a closet junkie?" said John.

"No!" snapped Laurence. "He's 92! Anyway," recovering his characteristic good humour. "He was telling me about his chest pain and I was asking about exacerbating and relieving factors."

"Oh Doctor," said the old man, reaching out and grabbing Laurence's hand. "I don't let it bother me. Whenever I feel the old angina coming on, I just take a couple of puffs of my TNT spray."

"Shame about the marked GI side effects," remarked Amos.

"What do you mean?!" asked all the Junior Doctors in chorus, their hands straying reflexively to their BNFs.

"The sad risk of explosive diarrhoea when using TNT cream on anal fissures," said Amos gravely.

"Ick!" said Angie.

"I'd give all smokers TNT spray!" said Amos decisively. "A couple of puffs, and then another couple of puffs and then bang! Great!"

"Daisy, have you pissed off the Ward 1 Sister again?" demanded Darren, striding sexily into the Doctor's Room.

"Er……" I said, my 'flu-fogged brain not being able to think of an excuse in time. "How can you tell?"

Darren thrust a typed piece of A4 paper under my nose.

"There will be no weekend phlebotomy service this weekend," it read. "Will Junior Doctors please assist with taking the bloods."

"There's going to be no bloody time to do anything else!" snapped Darren angrily. "No troponins, no ECGs, no lactulose. I'm telling you, somebody's bowels are going to suffer!"

***************************

"What's that, Gordon?" asked John.

Gordon was muttering something that sounded suspiciously like "f***ingmidwivesf***ingmidwivesf***ingmidwives."

"Another run in with Obs and Gobs, eh old chap?" said Edward sympathetically. "Dashed little blighters, those midwives."

"Fecking midwives!" hissed Gordon. "If it's not alcoholics then it's overdoses, if it's not overdoses then it's midwives."

It looked like Gordon was maybe teetering on the brink. Having been so close to the brink on more than one occasion, some lucky event had always pulled him back, be it the Geriatric Harvey's Bristol Cream or the promise of after-hours shenanigans up at Raigmore.

"At least they're not your patients," pointed out Janey.

"What I wouldn't give to have 5 minutes alone in theatre with some of them!" said Gordon, his hands becoming more and more tense around the piece of paper he was twisting.

"Did you do the Ward 5 sign?" said Amos sympathetically.

"Over and over!" said Gordon emphatically.

"What's the Ward 5 sign?" I enquired, imagining Amos and Gordon repeatedly battering Ward 5 with a huge neon sign in the effigy of a midwife.

"Well, it's more of a gesture than a sign, really," said Amos. "It's what you do when you walk past the Obs and Gynae ward."

"You just have to hope that there's no patients near the door," said Gordon.

"Maybe that's why Mrs. Englebert hates me," mused Amos, thoughtfully.

*****************************

"We had the most marvellous patient come in today!" said John, bouncing in from on-call.

"Was it Philip Schofield? said Mary, eagerly.

Mary had a bit of thing for Philip Schofield. She still ritually played "Any dream will do," before she was able to sleep at night.

"No, it was a 90 year old guy wearing a stetson!" said John.

"Unfortunately, we can't cure that medically," said Amos, pondering.

"I had a really batty patient once," said Poppy. "He was also about 90-odd and as well as having the regulation get-well cards, he had this massive lifesize black-and-white cut-out of Jimmy Shand beside him."

"We think he was missing the tea dances," said Amos.

"And those smokers!" said Mary.

Amos ground a small fly into the carpet.

"Ah yes, we knew it was time to discontinue her IV antibiotics when she went outside for a smoke," said Chuck.

"Some incredible things you see in here," said Amos.

"Take that joker that was smoking on Ward 9 yesterday," said Janey. "Oxygen masks all around him."

"Yes, it's wonder all the old biddies haven't' been blown to kingdom come yet," agreed Amos.

"When I used to work in Glasgow," reminisced Amos, "I once came across a man who had cut holes in his oxygen mask so as he could smoke and still inspire at the same time. I was almost tempted to leave him and watch his beard ignite."

He had that look on his face that said "If only everyone could be as good as me."

"If only everyone could be as good as me," said Amos.

"Huh?" I said.

"I should write an article for the BMJ," said Amos decisively. "How to be a really excellent Registrar, by Amos Maradonna, Registrar."

"Physician, heal thyself," muttered Poppy.

******************************

"You need to get more compliant, you crazy kids!" said Dr. Berkeley, jumping from foot to foot.

"There's just too much stuff to do, Dr. B!" said Mary, despairingly. Mary had spent the morning trying to bleed an obese 30 year old woman with vitamin K depletion and still had 54 troponins to take.

"I've been noticing this," said Amos, thoughtfully, "and I think I've found a way to overcome this problem."

The JHOs sat up and listened attentively.

"The reason you're non-compliant is that you have to take breaks and then you have to work late," said Amos. "So, if we found a way to eliminate the breaks, we could force the issue of compliance and make the job legal."

The JHOs all snorted derisively.

"No, listen!" said Amos, fishing behind his desk and extracting a large piece of paper, covered with lurid and child-like drawings of people in various stages of torture.

"What," said Chuck, "is that? What are you planning to do to them now, you sick bastard?"

"Well, I had a look at it and breaks are composed of eating and toilet trips," said Amos. "Voila! My new plan."

"It looks like he's catheterised," said Darren, peering at the 2 dimensional JHO on the paper.

"Exactly!" said Amos.

"Is that an NG tube?" asked John incredulously.

"It sure is!" said Amos. "See, we get you guys to swallow an NG tube and then you carry the feed bags around on your backs. And you can have the catheter bags around your waist."

"It would eliminate the need for a belt," said John thoughtfully.

"Anyone tries to do that to me, I'm going to do it them first. Only I'll connect the catheter to the NG tube!" said Chuck firmly. "Try that for a 24 hour feeding cycle. And Amos, if YOU try it, I'll connect the NG feed bag to your catheter and jump on it. Sort of a non-euphemistic wet dream in reverse."

"Honestly, it's a wonder you JHOs don't go into urinary retention!" said Amos.

"I don't even bother going to the loo anymore," I said ruefully. "I just run around and wait until I dehydrate enough. You should see the colour of my urine after a weekend on call."

Everyone took several paces backwards.

"Did you hear about the medical student that they managed to catheterise?" asked Poppy.

"Fool!" said Chuck.

"Apparently they took him through to the back of the theatre suite and told him that it would be a particularly long operation and that in the interests of the patient's welfare, everybody attending would have to be catheterised so as they wouldn't have to take any toilet trips," said Poppy.

"He deserved to be catheterised!" said Amos, emphatically.

"He was shivering a bit, the day after," said Poppy. "The nursing staff always felt a bit bad about that."

"That wasn't a rigor!" said Chuck. "Not in this place! That was just the cold! I went into the canteen yesterday and some twit had turned the ventilation down to arctic. Two blue grannies shivered into their cappuccinos. 'Defrost us another chunk of that coffee, love' I called to the receptionist."

"Hey, chirpy chaps and chapesses," said Dr. Berkely, smiling broadly. He must have gotten through at least 2 packs of Pro-Plus a day. As Gordon used to say, Dr. Berkely was 'scopetastic' and would scope anything with a pulse and possibly once or twice, something without one. "Guess what? We're having a new addition to the family?"

The reactions were immediate and mixed.

"Is it a lady Consultant?" begged Edward.

"Perhaps," said Dr. Berkely, enigmatically.

"What's their name?" asked Chuck, ever Practical.

"Dr. Whou," said Dr. Berkely simply.

"Dr. Whou?" said Amos incredulously. "What kind of a stupid name is that?"

"Amos!" chided Angie. "Surely you must have been alive in the seventies."

"Well, anyway," scolded Dr. Berkely, fussing like some kind of hypo-manic mother hen. "I just want you to make sure that you're nice to Dr. Whou when the time comes. OK?"

"OK," agreed everyone, secretly intrigued by the promise of the Tardis. After all, as Poppy explained, just think how many run-ins with Radiology could be avoided if we were able to travel back in time and re-write the chits properly.

*******************************

"One of the porters tried to get into medicine," said Amos. "I thought that was great."

"Did he get in?" asked Chuck.

"Er, no," said Amos. "But it was still a good effort. You've got to hand it to all those non-medics in the hospital. They add a bit of colour, a bit of je ne sais quoi to the place."

Amos liked to show off his cultured side. Chuck would take advantage of this the following week when he would let slip impressive french phrases to be nonchalantly slipped into conversation, which were, in fact, extremely rude piss-takes on the Consultants.

"Does anyone remember the Spirigel Rep?" asked Angie.

A combination of late nights and debauched booze-ups meant that the JHOs has very poor short-term memories.¹

"He was given a licence for 200 Spirigel containers and by the time they tracked him down, he'd already got to 362. It was like one of those computer games where you go around and collect Spirigel."

"Let's hear it for the Spirigel Police!" said Amos.

"It's also led to a really fun game, called 'Which direction will it go?'" said John. "You squirt it like so and see which direction the Spirigel goes. Like so!"

Here, he brought his fist down upon the Spirigel container which promptly ejected 10ml of liquid alcohol which hit Janey square in they eye.

"Er, sorry Janey!" said John, backing quickly out of the door. He was still slightly scared of all the women.

****************************

"How was on call? asked John. Mary looked slightly frazzled. I could tell by the tense expression on her face that she was bursting to tell us something.

"Jim Jenkins and Patrick Christie got drunk tonight!" she said, slamming her fist down on the chest-of-drawers.

"How?" I said incredulously. Jim Jenkins was a bed-bound recovering alcoholic and Patrick Christie was a social admission whom we were trying to get up and about and who was currently successfully mobilising around the ward with the assistance of one.

"It turns out he's been lying to us all along!" said Mary, disbelievingly.

"Well, it's not the first time and it certainly won't be the last that a patient hoodwinks you," said Amos. "Take it from an old dog. They're a bunch of lying bastards."

"When did you get so cynical, Amos," I said, gazing up at him with quiet awe.

"Well, I used to be like you, Daisy," said Amos. "That was before I trained in Glasgow and got all the fluffiness knocked out of me."

"I'm never going to become cynical!" I said decisively.

"Hah!" snorted Chuck.

Since the previous week's encounter with John in the Doctor's Mess, which had seen him and myself locked in a soon-to-be passionate embrace, I had been too embarrassed to spend any meaningful periods of time with John. However, I knew that sooner or later, I would have to spend some "quality time" with him, which would invariably involve all the Junior Staff getting horribly drunk (aside from Mary) and vomiting throughout the Ward Round. A loud squeal from Janey made us all turn around. Perhaps one of the lab rats was on the loose again? It wouldn't be the first time and it certainly wouldn't be the last. As we turned around, there, leaning against the wall, his hand hovering suspiciously in the region of Janey's pert bottom, was the world's horniest drug rep, Sparky Richards-Hedde (you can guess what his friends called him). His real name was Clive, but he figured that he had less than a coeliac sufferer's chance in the hospital canteen if he kept that name up, and had so switched to more enigmatic, more people-friendly 'Sparky'.

"Sparky!" hissed Janey, protective if her posterior.

"'ello, lads and laddettes, how's you all doing?" enquired Sparky. He was looking very oily today. His Drug Company must have had shares in Brylcreem.

Everyone mumbled something along the lines of "Good, thanks," which left the floor open to Sparky.

"I was in the area, and I thought, maybe it's time to get together with a few of my good friends up North. We could do a little dance, make a little love. Get down tonight?" He arched an eyebrow at Janey.

"Ah, the ubiquitous Drug Rep night out," remarked Edward. "I have heard that they are quite quaint. Chaps go out for a few brandies to wet their whiskers and then, when they're nicely tanked up, they go on for a jolly ripping nosh-up. I say!"

"Bugger the meal!" expostulated Sparky. "Let's just get pished! More money for booze!"

There was a stony silence around the room. The current staff quotient was mainly composed of women, and so this proposition did not go down well.

"Nup? Well, guess we can get a sly one in at the old Indian," said Sparky, defeated.

"Sounds promising," said Poppy, visions of food playing across her mind.

"And then we can booze it up?" said Sparky, hopefully.

"Yeah, why not," said Janey, from behind a mammoth pile of dictation. Dr. Park did not share his colleagues' reluctance to part with patients. Once they were well, he felt that his job was done and they could both go out into the world with a clear conscience. Plus, he did have Amos Maradonna working for him as a registrar. Consequently, his pile of dictation towered over the other 3 Consultants piles. Already it was twice as tall as Janey and almost as broad.

"What drug are you promoting anyway?" asked Amos.

"Stifimax," said Sparky proudly. "The newest anti-impotence drug on the market.

"Why does that not surprise me?" said Amos, rolling his eyes but looking secretly interested.

"Guaranteed to improve erectile dysfunction by up to 80%. Selling like hot cakes on the black market! Not that I'd know," Sparky added hastily.

"We'll recommend it to all our patients," promised Janey.

"Even Dr. Sinclair?" said Sparky eagerly.

Dr. Sinclair specialised in female endocrine problems so Janey looked slightly sceptical.

"OK," she said.

"Well then," said Sparky, overjoyed now that his mission was complete. "I'll be on my way now. Unless," he added as an afterthought, "any of you young things wants to hook up for a drink?"

"It's a hospital, Clive," said Mary firmly. "And it's only 2pm."

"Course," he said quickly. "Anyway. Here's a little something for the ladies," producing 3 boxes of Stifimax tissues with a flourish "and I shall book seats for us all for next week."

And with that, he danced a little two step, birled into the wall and twirled off into the endless buzz of hectic mayhem that was the Hospital.

1 : This would also explain the universal JHO inability to successfully prescribe warfarin.

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