`After 12 hours, I'm like a zombie'
It's 7.45am, and Catherine Bateman has arrived for work at the Royal Sussex County Hospital in Brighton. The next 24 hours will stretch her to the limit - leaving her exhausted, but still having to make critical decisions. It's a typical day for a junior doctor. ino
Tuesday 21 September 1999
07.45: I arrive at Royal Sussex County Hospital in Brighton to meet Catherine Bateman, a 26-year- old house surgeon who is in her second job since qualifying. Right now she looks fresh-faced and alert, having had last night off. She is coming to the end of a 12-day rota in which she has been on duty every day, including one 40-hour shift with no break.
08.00: It is the start of 's ward round on the vascular surgery ward. We join up with Catherine's fellow house officer James Simpkin; Mark Morgan, the registrar; and Mike Lemon the SHO (senior house officer) - all three of whom are classified as junior doctors. The head of the "firm", the consultant and vascular surgeon Mr Hurst, is also there.
08.15: For the last 15 minutes Catherine and James have been running round getting the patients' notes. The ward round seems rushed, but there's still time for a little jollity. When one elderly lady complains of a distended stomach, Mr Hurst asks: "Now, when was your tummy last flat - 1920?"
08.25: I keep losing Catherine somewhere between wards, nurses' stations and storerooms. She nearly gets left behind while filling out a form for a computer tomography (CT) scan. Then to intensive care where there is a man with a liver tumour, who has had a stormy time post-op.
08.40: Brisk walk to A&E, where a man with a stab wound needs examining. Luckily, the blade missed his lung cavity.
08.49: Off to organise a CT scan for a woman with liver problems. In an overcrowded hospital with overworked staff, getting the system to work for you requires tact and tenacity. "Much of my work is about negotiation; I've learnt how to say things in words people just can't refuse," says Catherine.
08.50: Up to the renal ward, to visit a 63-year-old diabetic woman who's had her leg amputated. Then a quick visit to a 30-year-old man who fell off his bike, sustaining massive head injuries. The hospital is negotiating a permanent home for him but in the meantime he's developed a chest infection.
09.55: We stop for breakfast. Catherine has baked beans and bacon and a cup of strong coffee. She confesses that though she's working with a surgical team she doesn't intend to be a surgeon, because of the "particularly gruelling hours".
10.05: We go with Mark to brief the radiologist about two patients. Then back to A&E. On average a junior doctor walks between five and 10 miles a day.
10.15: James bleeps her to ask for a patient's CT scan results. We race up to level 9 and 15 minutes later she realises she's been looking under the wrong name. A nurse looks at me and says sympathetically, "that's because they're worked too hard". Catherine confesses that it's the nurses who have kept her going during the last few months, particularly in the middle of the night when she's been exhausted and tearful.
10.45: Back to A&E, this time to see a 39-year-old woman with severe abdominal pains. She is vomiting and in extreme discomfort. After examinations, Catherine reckons it could be appendicitis.
10.55: Andy bleeps Catherine to ask if she's spoken to the radiologist about the lost notes. James bleeps to discuss a woman's increasing abdominal pain. Mike bleeps wanting to know about an X-ray result. I ask Catherine whether she still feels fresh. "I haven't felt fresh for months, though people say I still look OK," she says.
12.10: There is a bleep from the ward as a post-op patient has a leaking aneurysm (swelling on the artery). This is now an emergency and he'll need surgery. We meet him in the CT suite. Further blood tests are needed. He is understandably upset. Catherine's bleep goes again and in the midst of all this she loses the papers she's been clutching all morning.
12.50: Back to A&E to ring labs and sort out blood tests. Then two calls from GPs about patients coming in with abdominal pains.
13.23: Mike briefs Catherine on a woman whose leg is badly swollen. Blood is taken, and then there's the paperwork. In the next 10 minutes her bleep goes three times.
13.40: Catherine has to go up to level 8, where a patient's line has come out. "How thin can a vein be?" she says desperately, having tried to get a line in both arms. We haven't sat down or had a drink since 9.55am.
13.50: The lab says important blood results aren't ready and Catherine is beginning to get edgy. A&E bleep her about another admission. As we wait for the lift, she confesses that she likes doing this: "it's a rare moment of calm when I can't be doing anything else."
14.10: To my relief Catherine says that it's time to grab a sandwich. "You forget functional feelings like hunger or needing to go to the loo," she says. Eating a prawn sandwich and drinking a cup of tea lasts all of four minutes.
14.17: Back to A&E to see another man with suspected appendicitis. Twice Catherine is bleeped and has to interrupt the consultation. More forms to be filled in, and there is news of another GP referral. An elderly patient is waiting to see her. Catherine drags a wheelchair to the side of the bed and sits there asking the questions.
15.19: More forms to be filled in, and a nurse bleeps about another GP referral, an 95-year-old man with a head injury. At this point Catherine decides to put on her greens, as the rest of her team are now in theatre and she may need their advice.
15.33: She sees the old man with a head injury. There are many neurological tests to do.
16.27: Two more patients are waiting for Catherine in A&E. "God, where did they come from?" she asks despondently. The senior staff nurse shrugs. Catherine admits she is flagging. "I'm getting to the point that I'm all right as long as no one talks to me." After 5pm all junior doctors are officially on call and on half pay. Brighton Health Care Trust is more generous and gives them 70 per cent.
17.48: Back to A&E to see a diabetic man with a high temperature. He's a very big man and she struggles to hold him up. When the bleep goes I notice her voice is a monotone. The daughter of the man with a head injury asks where she can get a cup of tea. Catherine stares blankly. "At this time of day I can't cope with people asking for cups of tea," she admits.
18.12: Another GP referral of a 50-year-old woman who may have an obstructed bowel. The atmosphere down here in A&E, a windowless department with strip lighting, is now getting oppressive. To background music of Sixties pop, someone, as a nurse puts it, is "belching like a buffalo". Every cubicle is full.
18.19: Mr Hurst reappears from the operating theatre. Catherine should be having her break now but James has called to say he hasn't had time to eat. While she tells Mr Hurst and Mark about the new patients, for a moment two of them get mixed up in her mind.
19.30: Up to level 9 for blood results. In the background, desperate cries from a baby whose mother cannot breastfeed because of her medication.
20.15: A relative asks something and gets a lacklustre response. "People see a white coat and want to know about their sick relatives, but they don't realise I'm now on call, which means I should only be dealing with emergencies".
20.28: Finally we leave the building, but what should have been a five- hour break will now be only three. Normally Catherine has a hamburger in her room, in the accommodation block 200 yards away. We talk about the state of the health service. Catherine is a third-generation female doctor; the hours may have been even worse when her parents were junior doctors, but she feels that the work and the responsibility are now greater. She confesses to being bad at coping with sleep deprivation and says her social life has gone out of the window.
20.30: We sleep until her bleep goes at 11.30. She's due back at midnight but is to meet James early so he can brief her. She walks briskly up to the hospital: "I'm programmed to walk fast. Like a zombie." James hands over a list of jobs. He's due off at midnight but won't be able to leave for another hour.
00.15: Mark bleeps to tell Catherine she may be needed in theatre. Then 15 minutes speaking to the haematologist, getting advice about the blood samples of a very sick patient. A nurse makes us a cup of tea. "OK! Time to wake up now," says Catherine.
00.40: Catherine has to wake a very old woman to put a line in. Someone else has a high temperature. Then, another call to the lab to try to work out why a patient's blood isn't coagulating properly (which could block off the blood supply to her legs). "I'll just go check she's got nice warm feet, or we're in trouble," she says.
01.30: Visit two patients in far-away wards which are Catherine's responsibility during the night. She's not walking so briskly now. More forms to be completed.
02.45: Another bleep, and we rush to intensive care to check on the man who was operated on earlier in the day, who has an infection in his blood. Mark bleeps Catherine to tell her that she's needed in theatre.
03.15: Coffee break in the small restroom. There's rubbish on TV, but still we stare blankly at it and drink more tea. Mike and Mark are still around. They've been operating since morning with no break. It's not unknown for them to work for more than forty-eight hours continuously.
03.55: The operation is a laparotomy to sort out a twisted bowel. The operation lasts for one hour and 50 minutes. For all of that time Catherine is standing at Mike's side assisting. I'm sitting down, feeling footsore and jaded.
05.50: Catherine is bleeped to go to Accident & Emergency where there has been another GP referral. She bleeps Mike to brief him on the new arrival. The next 40 minutes are spent on levels 8 and 9 checking through patients' notes for the morning ward round and looking at a patient with a head injury.
07.00: I finally say good-bye to Catherine, who looks washed out. She's going back to her room to get an hour's sleep before the ward round at 8am and another day's work. Her bleep may go off but, at this stage, any sleep is worth snatching. I leave Brighton more shattered and physically exhausted than I can remember - more so than after sleepless nights following a tricky Caesarean birth. But at least in a day or two I'll be fine, whereas Catherine won't. She says she carries on because she loves the patients and she believes passionately in the National Health Service. What brings her to her knees are the weekends, when if it's busy she can be on her feet for 36 hours. She's to work on millennium night and, like all junior doctors, once she's on call she'll only get half pay. "I find that insulting to patients," she says. "What other profession would do that? At night I become like a zombie. Frank Dobson should come with me on millennium night and see what it's like."
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