Abstract
The year is 2056 and all is balanced in the world once more. Global warming has resulted in an appreciation that food and water are actually more important than Facebook™ and Twitter™ and all available land is now allocated to the growing of food or purification of water. Genetic engineering has bred cows with webbed feet, water parsnips, and potatoes that grow on seaweed. Giant lily pads have been engineered to tolerate salt water (though salination levels are considerably lower since the melting of the ice caps) and provide platforms for agriculture and amenity. Electric vehicles rule the highways (and waterways), powered by electricity generated from solar panels that adorn every commercial and residential dwelling. Every vehicle must have the capacity to humanely accommodate a live pig (it’s a farming thing), the assumption being that they will humanely accommodate a dead one too. Cyclists are banned due to their high CO2 emissions.
Joey Essex is Prime Minister - deal with it.
The global population has started to diminish due to high concentrations of oestrogens contaminating the water supply and the resulting increase in infertility. Health care is still free at the point of access as long as you are paying tax.
The trial of coin-operated intensive care unit (ICU) technology has failed due to the Royal Mint being unable to keep up with an adequate supply of coins. Prolonging life through the use of invasive organ support has therefore been made illegal and anyone found doing it faces a penalty of life-long imprisonment. All intensive care physicians have been re-trained in palliative care (it didn't take long). Critically ill patients have only one chance of salvation: a single, liberal application of Clinique's™ ‘Total Tissue Oxygenation' cream.
There is no requirement for doctors to do on-call given the impact it has on their health and the health of their patients …
Wood awakens from his utopian dream to the sound of his mobile phone belligerently ringing in his ear. It's Twig. It is 03:00 in the morning and she has been referred a 97-year-old patient in the Emergency Department (ED) who presented with an out of hospital cardiac arrest. “She had 90 minutes of resuscitation and 17mg of adrenaline, after which she developed ROSC” says Twig. “She developed a rash?” “No ROSC” “A rusk?” “Return of spontaneous circulation - ROSC - it means she's alive”. “Well what does she think about going to ICU?” “She's not that alive … ”
It becomes apparent that the ED Middle Grade referred the patient on the grounds that she had been “fit and well” with a “good quality of life” prior to this event, and that ICU admission cannot be refused on the grounds of age alone; he has recently attended an age discrimination course and is happy to refer anyone who disagrees to the General Medical Council. Twig has probed ED Middle Grade's belief of what he thinks ICU can offer in a situation such as this. ED Middle Grade states that Twig is being “obstructive” and contacts the on-call ED consultant (who ran the course on age discrimination); the latter demands that the ICU consultant review the patient immediately (or at least within 4 h of the patient's admission) – hence the phone call from Twig.
Wood asks Twig whether there is a sensible relative on the scene. Twig replies that the patient's 24-h carers are with her, but the patient has outlived their children and has no grand-children; there are no living first-degree relatives. “Twenty-four hour carer “It seems that the patient needs two carers round the clock in order to maintain their ‘Good Quality of Life” replies Twig. “What do the 24-hour carers think?” asks Wood. “They think we should do everything possible to keep her alive for as long as possible” replies Twig. “Apparently they receive full pay while the patient is alive and receiving hospital care, but have only 24 hours to find new work if the patient dies.”
Wood can see no end to this madness without transporting his jaded self to the ED department tout de suite. He jumps into his recently acquired sports car and reaches the hospital in less than 20 min, where he duly parks in the Chief Executive's parking space.
He skulks into the ED to find a maelstrom of activity at the bedside of the 97 year old patient. It seems that she had arrested again, though calm rapidly descends to the sound of “any objections if we stop?” coming from ED Middle Grade. No one objects and the war party disperses. “I see you finally saw sense” says Wood to ED Middle Grade. “Actually, we ran out of adrenaline” he replies.
Military ED Nurse informs Wood that in Bastion it was the norm to do ward rounds wearing a side-arm. Wood isn't entirely sure what she is getting at – but he likes her style anyway.
It is now 04:00 and all the trainees have headed back to their on-call rooms. Wood doesn't have an on-call room; clearly there isn't deemed to be a need for those enduring a week of continuous on-call as opposed to those doing 12-h shifts. When Wood started in this business, the consultant on-call duties were considered ‘restricted leisure'. The senior registrar needed to know which restaurant / theatre / party you would be attending and the relevant phone numbers to contact you in a dire emergency; however, at heart they knew that any contact would be seen as a sign of uncompromising weakness. Consumption of alcohol was only frowned upon if you were too drunk to drive to the hospital. Aah, how things have changed – Wood contemplates.
There is no point in going home, so he proceeds to his office where he falls asleep on the office floor. He is awoken a few hours later with a monumental crack on the head as Trees throws open the door with caffeine-fuelled vigour. “Are you dead?” he asks. “I don't think so” replies Wood. “Busy on-call then?” “Futile on-call” says Wood, feeling decidedly sorry for himself. “Aah – define futile” says Trees "'Futile' is something not worth getting out of bed for” Wood replies; he is struggling to look left due to a cricked neck.
Trees is looking forward to a day of mandatory training. Fire safety followed by lifting and handling, protecting vulnerable adults, equality and diversity and, lastly, breast-feeding awareness. Each session requires a sign-in and the doors are locked after admission so that no-one can leave early. Trees feels that this is a fire risk and says so to the Fire Officer running the first session. Fire Officer disagrees and informs those present that after 25 years in the Fire Service, he could have “that door down in less than 20 seconds in the event of a fire”. Trees and his Cardiothoracic Colleague see an opportunity here. “No way can that door be taken down in less than 20 seconds” they state to Fire Officer. “The secret is the hinges” replies Fire Officer. “Take out the hinges and the rest is a piece of cake." “How do you take out the hinges?” asks Cardiothoracic Colleague. “It could be the most important thing we learn today” reinforces Trees. “I'll show you” states Fire Officer as he opens his briefcase and removes a sturdy crowbar; 20 seconds later, the hinges have been breached and a permanent exit has been formed.
Feeling liberated, Trees decides to stay for the rest of the fire safety session to show solidarity for Fire Officer whose actions have made the rest of the day more tolerable – plus he has managed to log onto an open WiFi network.
Wood finishes the ward round at 10:00. It has taken longer than usually because he has had to position the team, charts and patient results on his right hand side due to his acute torticollis; this has presented a few infection control issues for which he was reprimanded by the microbiology registrar. Fortunately, she left hurriedly when he pointed out that there was a patient with multi-drug resistant tuberculosis receiving nebulisers on the open medical ward. After that, the round went well, thanks largely to Twig taking control and sorting out the plan for the day.
Twig is coming along nicely; unlike the other trainees who moan about how tired they are after their 12-h shifts, Twig seems to rise to the challenge and rarely opts to leave the hospital before the on-call consultant. “She's getting in training” said Trees after his last stint on-call. He and Wood have taken Twig aside to reassure her that her dedication has been noted and that, if she plays her cards right, she would be a welcome addition to the department and may even get to be like Wood and Trees one day. Twig has seemed a little distracted ever since … Wood and Trees