Mortuary

Every doctor is used to seeing dead bodies on a regular basis. As one of the group of ICU consultants, I was a particularly frequent visitor to the hospital mortuary. However, I saw my first dead body at the very beginning of my training on day one of week one in the Dissecting Room (DR) at medical school. Actually, I saw twenty dead bodies that day, one for each tutorial group, all lined up in neat rows lying on top of metal trolleys. It was the start of the process of desensitisation to death that all doctors undergo, sad but necessary if they are to continue functioning while their patients are dying like flies around them.

As soon as medical students qualify, they encounter more dead bodies on the wards. Lots of them. Only these bodies have blood rather than formaldehyde in their arteries and veins. It’s usually the house officer’s job to certify hospital patients dead. They also attend them during cardiopulmonary resuscitation while the jury is still out, deliberating on whether a patient is alive or dead. I’m not sure how many dead bodies I saw in total during the course of my medical career, but it certainly ran into hundreds.

Although death and dying are familiar to hospital doctors, seeing a dead body in the mortuary somehow takes things up to a new level of sadness, added to which there is a sense of the macabre. Mortuaries are obviously not everyone’s cup of tea, and I include most doctors. Nevertheless, I always found that the people working in the hospital mortuary, who were on intimate terms with the refrigerated corpses that temporarily resided there, were among the cheeriest people you could ever wish to meet. I suspect a cheery disposition is an absolute prerequisite for working as a mortuary technician or a pathologist. That, and an underdeveloped, preferably genetically absent, sense of smell.

Unless you are a histopathologist performing post-mortem examinations (aka PMs or autopsies), the commonest reason for most doctors to have to visit the mortuary is to confirm that a person really is dead before attesting to that fact on their cremation form. I always found it an unpleasant duty, although the bitter pill was sweetened by the cheque that arrived from the funeral director in due course for signing the authority to cremate the deceased’s body (Ash Cash). It was obscenely good money for ten minutes’ work, too. The geriatric house officer could earn a fortune during their six months in post, and the rest of us envied them.

Dead bodies undergo major physical change in the short interval between dying on the ward and being viewed in the mortuary, a mere 24-48 hours later. A metamorphosis, you might even say. On the ward, dead patients look exactly the same as they did when they were still alive, only a tad less lively. I would have no trouble recognising them. If it weren’t for the fact that they weren’t breathing, they might just have been enjoying an afternoon nap. The recently deceased often looked better dead than they had when their bodies had been fighting desperately to stay alive. However, whenever I went to view an ex-patient in the mortuary, and the technician opened the metal door of their refrigerator, one of many in a large bank making up the back wall of the mortuary, and slid my patient out on their cold, hard, metal bed, they were often unrecognisable. Not in a hideous way. It’s just that they did not have the appearance they’d had in life. Not inhuman, exactly, but lacking the essence of humanity. Corpses in the mortuary had more in common with the wax figures in Madame Tussaud’s than with real people. Their spirits, their souls, the very cores of their being, had well and truly left the building. The only way I could ever be sure that somebody really was the patient I’d come to see was to check their identity wristband.

For the ten years I trained as a junior doctor and during my earlier years as a consultant after that, I often popped down to the mortuary to attend the PM of a recently deceased patient. There were two types of PMs back in the day: coroner’s PMs and hospital PMs. The former were statutory and ordered by HM Coroner if he or she deemed one necessary to establish the cause of death. Consent from the patient’s family was not necessary. Relatives of the deceased could object. However, permission from the next of kin to undertake the other type, a hospital PM, was mandatory. We, the doctors, requested one whenever we thought that examining the internal organs of a loved one might be educational and improve the medical management of similar patients in the future. Although there were occasional refusals by next of kin to consent, the prevailing attitude at the time was to grant the request.

Societal attitudes have changed dramatically in the intervening period following various scandals involving human organs and tissues. Doctors became reluctant to ask for consent for a hospital PM, and relatives were unlikely to agree if asked. Thus, every PM examination performed on one of my ex-patients during the second half of my consultant career was a statutory one ordered by the coroner.

Another seismic shift regarding PMs was introduced around the same time. Our area coroner forbade members of the clinical team who had been looking after a deceased patient to attend their PM. He was concerned that we might alter our witness statements based on the findings at PM. I stopped attending PMs altogether. Good news, perhaps – after all, who really wants to go to a PM if they don’t have to? On the other hand, in my view, it was a shortsighted approach and a great shame. Attending a PM wasn’t the most pleasant duty of a hospital doctor, but it was instructive to correlate the stages of a patient’s final illness with the observed organ damage.

The Hospital Staff Dining Room

(more latterly known simply as The Hospital Dining Room)

The hospital staff dining room, as its name suggests, was once the preserve of hospital staff – doctors, nurses, physios, porters, domestics, even managers. There were also exclusive doctors’ dining rooms at the beginning of my medical career. When I was a medical house officer at Manchester Royal Infirmary, all the juniors would dine together at the end of the day in our exclusive enclave in the doctors’ mess, where we would be served a three-course meal. Sadly (for us), doctors’ dining rooms came to be considered an anachronistic privilege for a profession no longer quite so hallowed. They disappeared. Quite right, too, I hear you cry. Elitism, favouritism and non-inclusivity. I wouldn’t necessarily disagree, although it was most enjoyable while it lasted. Plus, a lot of useful work got done while we were chomping through our steak and kidney puddings, chips, peas and gravy. Difficult cases were discussed at dining table seminars, with different opinions offered on the differential diagnosis and which investigations to order next. A request from the cardiology SHO for the endocrinology SHO to see their patient with heart failure whose blood sugars were high would be reciprocated by a request from the endocrinology SHO for the cardiology SHO to see their diabetic patient who had an undiagnosed heart murmur. Dinner wasn’t just an entertainment, it was an education.

While the loss of doctors-only dining rooms is one thing, the loss of the hospital staff dining room and its replacement with a restaurant open to the general public is quite another. The hospital managers, in their great wisdom, saw a money-making opportunity and decided to open up the catering facilities to all-comers – mobile patients escaping the ward in the search for better food, followed by a post-prandial smoke afterwards; relatives; random members of the public out for a meal, treating the place like a local bistro; the odd feral dog or cat. The hospital dining room was no longer a haven for stressed-out, tired-out doctors and nurses to chill out for half an hour over a hot meal. It no longer afforded the opportunity to moan and complain; to de-stress by enjoying the gallows humour of the NHS frontline; to discuss a tricky case and ask for advice. Now the world and his wife might be sitting at the next table, or even at the same table, earwigging your conversation.

You might find yourself eating lunch, having just come from a difficult conversation on the ward with the family of a critically ill loved one, only to become uncomfortably aware of them sitting at the table to your right. Or worse, you might be unaware they are sitting behind you while you regale your dining companions about said patient’s non-existent chances of survival and that it would be better for all concerned if you could put them out of their misery by shooting them because you wouldn’t treat a dog like that. Or the person sitting beside you, polishing off a double-sized portion of apple crumble and custard, might be the diabetic patient whose high blood sugar you struggled to understand why it was not under control when you saw them in the outpatient clinic earlier.

Apart from never being able to escape pesky patients and their relatives when you’re supposed to be on your break, there were other problems. Sometimes you couldn’t even get into the hospital dining room because it was jam-packed with interlopers. The minute hand on your watch would move quicker than the mile-long queue to be served. By the time you did make it to the serving area, they would have run out of the braised steak and roast potatoes, the fish and chips, and the lamb madras curry with pilau rice. All that would be left would be dried-out baked potatoes with a less-than-interesting mashed potato filling. Not that it would matter because you’d be due back in theatre or on the ward by now and wouldn’t have time to eat it.

Although the hospital staff deliver a 24/7 service every single day of the year (managers excepted, of course), the hospital dining room isn’t open 24/7 to serve hot food. It used to be when I first started out. Extended opening hours were a lifesaver at three in the morning, when you’d been running around all day like a blue-arsed fly, seeing patient after patient, with never a chance to sit down for even five minutes for a bite to eat.

But that was before the bean counters got involved for a second time. Having opened the hospital dining room to anyone who fancied eating there, they now restricted the opening hours to coincide with maximum footfall. The shutters went down at six o’clock, and anyone trying to sustain themselves through a night shift or 24 hours on call had either to bring in their own butties or take their chances on whatever offerings were available in the chilled vending machine.

Typically, you would be tempted by cheese and tomato pizza (plastic cheese, tasteless tomatoes, rubbery base), baked potato and more plastic cheese, a cheese and tomato sandwich (same as the pizza, but with white, sliced bread) or spaghetti bolognese (any Italian nurses unlucky enough to give this dish a try would be on the next plane back to Bologna). A far tastier and infinitely more nutritious alternative, if you didn’t have a Pot Noodle to hand, was to go back to the doctors’ mess, where there were loaves of sliced white bread, mountains of butter and a toaster. Thickly buttered toast was the fuel that kept acute medical services running during the night and saved many a life. All NHS toasters should be awarded an OBE.

The WRVS shop

An alternative to the hospital dining room was the WRVS shop (Women’s Royal Voluntary Service, rebadged as the more inclusive RVS since 2013). There was one in every hospital I trained in back in the day. Although their opening hours were often more limited than even the hospital dining room, the WRVS shop was an alternative outlet for obtaining something to eat and drink. This could be useful in a fluid balance or blood sugar emergency, but was otherwise best avoided for several reasons.

Firstly, the WRVS shop specialised in trademark sandwiches. Whether they were boiled, flavourless ham on white, the mildest of mild cheddar cheese on white, sulphurous egg mayo on white or their signature fishy-but-not-from-the-sea tuna mayo on white, the flour their bakers used to make the bread was sawdust. The only thing you could truly taste was the one-inch-thick coating of axle-grease flavoured margarine on the slices of bread.

Secondly, it always took forever to reach the front of the queue. When you were finally served, it took even longer to close the deal on your choice of lunch. Let’s say you’d foolishly ordered a cheese sandwich and a coffee. Gladys would put the kettle on, take two slices of bread and spread them with margarine. Then, she’d search here, there and everywhere for the cheese. ‘Dot, where’s the cheddar?’ Dot, who would be round the back stocktaking or hard-boiling eggs to make egg mayonnaise, would pipe up, ‘At the back of the fridge, bottom shelf.’ Gladys would spend forever looking up and down the fridge for the cheese until suddenly remembering it was still on the counter where she’d left it after making a previous cheese sandwich. At long last, your sandwich would be ready for you. Now to pour the boiling water onto the instant coffee, only to discover the wall switch to which the electric lead of the kettle was connected was in the off position.

Three minutes later, you would be handed your sandwich and coffee. But that had been the easy bit. Now it was time to tot up the bill. The combined mathematical talents of Gladys and Dot would be needed for this task, along with several sheets of paper and a pencil. A blunt one, which first needed sharpening. Figures would be jotted down and calculations made. ‘That will be £35.10, please. No, that can’t be right.’ The previous calculations would be scrubbed out with Dot castigating Gladys for making a schoolgirl error in her adding up. Something to do with the decimal point being in the wrong place. ‘That will be twenty pence, please. No, that can’t be right.’

‘It’s £2.76,’ you offer, trying to be helpful. Gladys and Dot smile at you with a knowing look which proclaims, ‘Why don’t you leave this to the professionals?’

Just when you’re considering doing a runner, assessing (correctly) that neither Gladys nor Dot is up for the chase, Gladys announces, ‘It’s £2.76, please.’ You attempt to pay up, but sadly, you only have a £5 note and the change has to be calculated. Several pages of calculus and quadratic equations are required, only to discover that the till is empty of change. The starving hungry people in the queue behind you, which by now stretches out of the shop and halfway down the long main hospital corridor, have a whip-round to pay for your lunch. You thank them all profusely before suddenly remembering your patient who’s been admitted with a massive heart attack. Ah well, they can hang on a while longer while you have your lunch, can’t they?

Hospital Car Parks

Aka the chief exec’s cash cow

Don’t get me started on hospital car parks. There is no topic more likely to transform normally docile, amenable hospital workers into frenzied maniacs on the rampage, incandescent with rage and baying for the blood of the first hospital manager they clap their eyes on. Okay, I will tell you about hospital car parks but only as a fairy tale so I don’t become apoplectic while writing it all down and have a heart attack or a stroke on account of my blood pressure being somewhere north of 200/150.

Once upon a time, there was a district general hospital in a town on the edge of the countryside. It was a happy hospital, and everyone loved working there. The main hospital buildings were centrally located on an enormous campus, surrounded by acres of green fields and car parks. There was so much space, in fact, that the car parks were never more than half full, even on the busiest of busy days. Parking your car was free, whether you were a member of staff, a patient, or a visitor. Nobody would have dreamed of making the heroic hospital staff pay to come to work, not even the big, bad chief exec who ran the hospital.

Until one day, the big bad chief exec had a brainwave and decided to build an enormous new pharmacy on one of the fields. Two years later, another field was concreted over to make way for an education centre. A year after that, another field disappeared, replaced by a new day case unit. Before long, the hospital was all out of fields, and when the patients, visitors and hospital staff looked out of the windows, everything was dull and grey. It made them feel sad.

The big bad chief exec was far from finished, however, and it became his mission to put a new building on every scrap of land the hospital owned. A new theatre block, a new critical care unit, a new ED, a new paediatric block, a new maternity block, a new management block, and so the list went on. The doctors’ mess was bulldozed to make way for a new surgical assessment unit.

By now, almost all the hospital car parks had been built over, and the poor hospital workers were finding it difficult to park when they came to work. The big bad chief exec noticed what was happening and came up with a solution. He would charge patients, visitors and staff to park. That would force many of them to make other arrangements to get to work, such as public transport, cycling, and walking. Pressure on the car parks would reduce, and his staff would become fitter and healthier into the bargain, needing less time off work due to illness. Yes, it was a good, green solution. As a bonus, his new scheme would generate additional revenue.

The hospital staff didn’t quite see it that way. Lots of them worked shifts and were coming into work before the buses started running or leaving after they’d stopped. Most of them lived too far away to cycle or walk to work and, anyway, you would be taking your life in your hands riding along the A6 during rush hour. Fights would often break out as a consultant surgeon argued the toss with a nurse from the ED over who’d seen the only available space first. Everyone became even sadder.

As more new buildings went up and more and more car parking real estate was lost, the big bad chief exec had to come up with wilder schemes. The car parking charges went up and up, year on year. He said the money was needed to maintain the car parks and pay for the security staff to hand out penalty car parking charges to anyone breaking the ever more complex car parking rules. He was lying, of course, and eventually admitted that the profits were siphoned off to plug the ever-increasing black hole in the hospital’s balance sheet.

Eventually, even the big, bad chief exec recognised that charging a hospital porter or a student nurse nearly a day’s pay to come into work each week was a bit much. He came up with a new brainwave to solve all his problems. He would introduce differential pricing. Student nurses and porters would pay less because they would be subsidised by the fat-cat medical consultants, who could afford to pay more. A lot more. That was only fair, surely. He had high hopes that if his new scheme was successful, he would introduce differential pricing in the hospital dining room. Fish and chips, that will be £2.50, Mr Hospital Porter. Fish and chips, that will be £10.50, Mr Consultant Surgeon.

But the charges were still too costly for most people, and hospital staff voted with their feet. Everybody handed back their car parking permits and parked in neighbouring streets, on grass verges and in children’s play areas instead. The big bad chief exec wasn’t best pleased. He had to deal with hordes of angry local residents, and the hospital was losing money. It was a lose-lose situation.

Then along came the COVID pandemic. That was very sad indeed because rather a lot of people died. NHS workers were suddenly elevated to the status of national heroes, and the health secretary, in his immense gratitude,  abolished car parking charges for hospital staff – and everyone else. Hurray! And all the car park users lived happily ever after. Well, for two years, actually, until car parking charges were reintroduced.

The VIP Visit Storage Room

Aka The room of requirement

I never discovered the whereabouts of one of these in any of the hospitals I worked in because their precise location within a hospital is always a closely guarded secret. However, I am reliably informed they do exist. The room of requirement is always well stocked with all the necessary paraphernalia to ensure that any VIP visit to the hospital goes swimmingly. There are shelves stacked up to the ceiling with pots of paint in every shade, rolls of silver ribbon, gold scissors, plaques, fresh flowers (replaced daily), garden planters and red carpets. There are also banks of syringes pre-loaded with sedative drugs to inject into the doctors and nurses who will form part of the reception committee to ensure they behave in a calm, docile and dignified manner. Slagging off the local MP on live TV, whose only interest in visiting the hospital is the photo-opportunity it affords, is verboten. So is any criticism of the chief exec.