Chapter Two

Eight hours earlier…

‘The National Health Service is not how it once was,’ said Dr Steer. ‘I have been a consultant for nearly thirty years and for the twelve of you sitting here today, your role as a medical registrar has turned into a peculiar one. The modern registrar is burdened with more administrative tasks and higher volumes of patients, not to mention the hundreds of new drugs that have been discovered since my last registrar shift. But no one is going to feel sympathy for you I’m afraid. You’ll just have to show some resilience.’

Dr Steer was wearing a light grey suit that matched her shoulder-length mane and stern rimless glasses. She may have resembled a frail pensioner, as if a child could topple her with ease but she spoke with such assertion and precision that Philippa suspected she was far stronger than she looked.

‘To complicate matters, litigation and patient power means we have ended up first to be on the firing line when an adverse incident occurs. In medicine, hindsight is not a wonderful thing; hindsight haunts us…’

The lecture theatre was more the size of a modest conference room. Dr Steer stood before the group of nervous registrars, illuminated by the enormous screen behind her, which projected the final slide from the previous talk. The microbiologist Dr Cotter had delivered a firm message about prescribing antibiotics; some labelled it stewardship, Philippa thought it was just using common-sense.

The carpet beneath Philippa’s rubber soles felt rough and the scent of fresh paint was at times sleep-inducing let alone when combined with the sedative of the talks themselves.

‘Who here are ST3s?’ Dr Steer asked. ‘Put your hands up. Come on!’

Five of the group revealed they were first year medical registrars in various medical specialties, from cardiology to gastroenterology.

‘At times, you’re going to feel like you have been thrown into the fire pit here. We have a population with an average age of eighty-two. Lots of people with lots of co-morbidities. Still, it’s all character building at the end of the day. Any questions about any of the talks today?’

Standing at the front of the room, Philippa could almost picture the senior doctor leading a cardiac arrest call, delegating tasks as an all-conquering medical registrar; all-conquering, as they were once upon a lifetime…

No one dared to ask.

‘You are contracted to work forty-six hours a week. Of course, there will be some weeks where you just do the bog-standard forty hours and others where you will find yourself doing double that. Either way, we expect you all to be ready for anything that comes your way, just as I used to be back in my day. I was once one of you after all.’

Supportive comments, thought Philippa.

‘You will work an average of three night shifts a month.’

The words brought despair to Philippa’s heart, for she was the unfortunate soul. But someone had to be rostered to do it…

The consultant scanned the loose papers in her hand then faced her muted audience and asked: ‘Who is Philippa?’ She re-read the sheet of paper she was holding, which remained as frozen in fear as the juvenile registrar sitting at the end of the row. ‘Philippa Haven?’

Philippa raised her left hand and immediately felt the weight of Dr Steer’s glare squash her up against the back of her chair. Dr Steer advanced forwards and as Philippa looked up at her, she noticed that the consultant would be much shorter had it not been for the snake-skin stilettos she was wearing.

‘Do you have a question or are you Philippa Haven?’ asked Dr Steer, raising an eyebrow.

‘I’m Philippa.’

‘You are starting on nights, I believe?’

‘I am.’

‘You must have upset medical staffing for that to happen…’

There was a nervous laugh from one of the other registrars, uncertain whether Dr Steer was joking or not.

The way the consultant continued suggested she wasn’t. ‘You do have your rota, don’t you?’

‘Yes; although I was only sent it last week.’

‘A week should be plenty of time to study it! It’s the same everywhere Philippa. You’re quite senior at ST6 level so you should know by now.’

‘It’s not enough time to book leave though. I need to attend an important event in three weeks and I’m scheduled to be on-call then.’

What infuriated Philippa most, was that she had emailed medical staffing regarding this leave, long before the rotas were even dispatched. Doctors were humans and had lives to live too…

The silence that ensued stung Philippa’s ears. Dr Steer’s expression became one of sadistic curiosity, as though she was pondering how to punish the outspoken registrar. She took another intimidating step towards Philippa and the atmosphere became almost claustrophobic.

‘Then in that case Dr Haven, you will have to find a way to swap the on-call with one of your colleagues here and if you can’t, I’m afraid you won’t be able to go.’

Her title was often used as a marker of respect but it felt quite the opposite right now.

‘Well I have to go.’

Dr Steer’s lip curled upwards and her eyes narrowed. ‘What event is this exactly? Philippa, when I was a medical registrar, I frequently had to miss events; weddings, study days – it’s part and parcel of the career you have and one aspect of the job that hasn’t changed since my –’

‘It’s to commemorate the death of my sister actually. She died last year. My application for compassionate leave at my previous hospital was already declined so I was forced to miss her funeral. I can’t – won’t miss this.’

There was a gasp from the audience and although Dr Steer appeared in no way moved, Philippa sensed that her response had sprinkled some sand over the roaring flame inside the consultant’s belly – perhaps an emotion she was unfamiliar with.

‘I can swap with you,’ a voice said suddenly.

Philippa traced the offer back to a timid girl sat at the end of her row. ‘I’m on the ward all day so I should be okay to swap.’

‘Or me,’ another voice said from the back of the room.

The group of registrars turned in one orchestrated move.

‘Thank you, Tim,’ muttered Dr Steer with her arms crossed. ‘Well, we no longer seem to have a problem.’

‘Tim,’ Philippa whispered gladly. ‘I didn’t know you were working here.’

He gave her a thumbs up and replied: ‘We’ll catch up in Costa by the front entrance after?’

‘I see you did manage to make induction.’

Philippa spotted the hint – just maybe – of a grin from Dr Steer and for the first time, it became apparent that she was missing a few teeth from her lower jaw.

‘Only just finished my infection round.’

‘Tim is one of our more senior registrars who was working here last year and has the pleasure of staying here for another. Do you have any other words of wisdom for the group that you would like to share?’

Tim accepted her invite and jogged to the front, his gelled hair resisting his momentum.

‘I’m Tim,’ he began, raising a hand, ‘one of the ID registrars so whichever ward you’ll be working on, I’m sure our paths will meet… that’s if you survive the year ahead.’

‘It’s not that bad is it?’

Tim smiled before continuing. ‘As Dr Steer may have mentioned already, it’s an elderly population here and we’re left to pick up the pieces from the lack of social care funding. If there’s one thing she taught me last year, it’s: make sure you get those resuscitation discussions in early. People aren’t allowed to die anymore, unless you communicate it properly.’

The consultant nodded her head gently to the tune of his words.

‘The on-call shifts are very busy. In my opinion, and me and Dr Steer have agreed to disagree on this, A&E have too much power in this hospital. They will just send people our way if they’re about to breach with absolutely nothing done for these patients… even if someone doesn’t need admitting and looks well. The curse of the four-hour wait hits us hard but who knows it might be scrapped someday.

But the biggest challenge working here is, the staff shortages. Normally there are three juniors with you overnight; generally, one to cover the ward patients and two to help you with the Take but it’s not uncommon to have just one or two juniors.’

Dr Steer marched back to her original position, as if Tim was spilling too many beans and was dwarfed by his near six-foot-frame. ‘Tim is right and Philippa, you are one junior short tonight. It is not ideal but I’m afraid you will just have to use your experience and manage.’

Even if it makes the hospital unsafe, thought Philippa angrily. How can a total of three doctors cover the whole hospital for medicine overnight? Perhaps the surgeons would help, she thought sarcastically.

‘In fairness to Dr Steer, she has fought time again to try and fill the rota gaps but it’s not the easiest hospital to get to so it’s hardly desirable for other locums to come here for the hourly rate.’

‘I have attempted to ask the senior management for cover tonight, particularly with the influx of new registrars, but they will not lift the caps on how much we can offer locums.’

There were some audible groans of dismay and sympathy directed towards Philippa.

‘There aren’t many beds left. Summer has come and gone but there was no lull, as seems to be the case every year now. More people than ever are presenting through the doors of A&E so we need to be extra vigilant about who absolutely needs to be admitted. Our A&E is supposed to be quite good with helping us sieve out those that don’t actually need to come in. I am on-call overnight. Contact me via switchboard if you absolutely must, otherwise I will expect to see you in the morning with all the new admissions ready for presentation and blood results firmly in here,’ she said, tapping her grey-lined scalp.

Philippa gritted her teeth to prevent her from asking the consultant whether she had ever been an inpatient here herself, given her ancient appearance. Dr Steer’s expectations seemed rather unrealistic and only served to add unnecessary pressure to her workload tonight.

‘This hospital can get extremely busy; you’ll need a lot of initiative and organisation to survive here. When the going gets tough, please… just try and keep everyone alive as the bare minimum.’ Then Dr Steer turned to the screen where the time was showing in the bottom right corner. ‘Philippa, your shift starts at eight-thirty. That means you have four hours. If I were you, I would try and get some rest. Welcome to the Princess Royal Hospital.’