Writing Hospital Scenes -- by Elizabeth Kay

 A warning to those of a squeamish disposition – a fair amount of this deals with the vagaries of the alimentary canal…

 I wonder whether, like me, you get most of your present-day information these days from Casualty and similar programmes? Where no member of staff has a trouble-free relationship, and they routinely find themselves involved in/with car crashes/fires/explosions or psychopaths. Or else they’re addicted to alcohol, gambling or prescription meds. And what of writing medical dramas in the past? I can remember the days when I was told to shut up and not to make a fuss in the last stages of labour, and you needed your husband’s signature to have an intrauterine device fitted. When consultants ignored you and just talked rather condescendingly to the nurse. When my mother simply didn’t believe that my female Polish relatives could be proper doctors. Call the Midwife seems a bit cosy, really. I never saw the same one twice, and always had to wait for hours to see anyone at all as they gave twenty people the same appointment time. So, in the midst of all the doom and gloom and drama, here’s what happened to me recently.

Female fossa

A bit of background information. No, actually, quite a lot. On September 6^th husband Bob and I flew off to Madagascar, in an attempt to replace our memories of a holiday twelve years previously with some better ones. On that occasion ten out of the fourteen people in the party went down with salmonella. Two of the group had to be flown to a hospital in South Africa, before they were well enough to be repatriated to Australia. As luck would have it, two of the people who didn’t get sick were doctors. Bit of a busman’s holiday for them, really. But I don’t think I had ever been so ill, and everyone missed at least one walk or visit and often several. So, we thought, let’s give it another go, although this time we did it bespoke, through a wonderful company called Wildlife Worldwide. Just the two of us, not doing the same tourist route as before and taking internal flights as we wanted to see specific things that aren’t that easy to find – in particular, the aye-aye and the fossa.

And we did, so that bit was all right. But the first lodge we stayed at looked suspiciously familiar, although it was hard to be sure as the trees had grown a lot in the intervening twelve years. We congratulated ourselves on still being well twenty-four hours later. But the following night we were ill, and by this time we were absolutely certain it was where we’d all caught salmonella before. It was only a twenty-four hour indisposition this time, so we were fit enough for the next stop which was at a slice of paradise called the Palmarium Forest Lodge. 

Liz with brown lemur

I had another twenty-four hour stomach upset the night before we left, although the night after that was at a lovely hotel by the beach, so I was able to chill out. Then back to Tana (Antananarivo) and a one hour flight the following day to the west, to stay in the Kirindy Forest, the most rural of all our destinations. That was where the fossa, Madagascar’s biggest carnivore, made a surprise appearance behind the kitchen early one morning. Then it was Bob’s turn to get his second dose, but it was much worse than the first one so I put him on the antibiotics I always take with me – Ciprofloxacin, and he was better three days later. That stuff seems to work every single time. Flight back to Tana, and then a two hour flight the following day to the north. Up there everyone seemed to have a hacking cough, which was a bit worrying. But we had a nice time, despite having our return flight cancelled and having to stay there an extra day, which was organised at no extra cost by our holiday company who seem capable of dealing with absolutely anything. After that it was back home.

Male fossa

 Not long after that my sinusitis started, and was seriously unpleasant for a week. That was when Bob’s cough began, and was bad enough for the GP to order a chest x-ray, which was fortunately clear. We did Covid tests, which were negative; we were both very washed out, and sleeping a lot more than usual. On Saturday the 14^th October we had four friends round for a very elaborate meal, which was huge fun and went off very well indeed. But about an hour after they left I started to feel a bit odd, so I went to bed – with a bucket. Just as well, because I was very very sick. After that the abdominal pains started, and grew so bad that I was shaking uncontrollably and practically screaming with them. Eventually Bob called 111, and they called an ambulance after two magic words. One was the AAA I had in 2006 (abdominal aortic aneurism repair), and the other was… Madagascar! Madagascar’s got everything, from rabies to malaria to plague. And now the crux of my story begins…

The two guys who were the ambulance crew were not only very nice, they were very dishy. Or maybe that was the morphine. They had a catheter in me before you could say IV drip, and the pain magically receded into the background. It was midnight by now, and I vaguely remember being transferred from the stretcher to a bed when we reached the hospital, eight and a half miles away, which seemed a bit challenging. Someone asked me if it was my hip that was hurting; it wasn’t, it was just the abdominal pain but I thought, wow, if they know I’ve got a bit of arthritis in my hip they’ve accessed my notes already. Impressive.

I was told I was going to have a CT scan so I could only have sips of water, and at some point I had a top-up of morphine and once I needed a complete change of clothes, even my shoes had something unmentionable in them, and it was done with such gentle good humour that I can even remember laughing about it. It wasn’t until I saw my GP later that week that I realised how many tests they actually did. Temperature, bloods, ECG, BP, a full CT from head to toe, rectal exam, urine test… a complete MOT, really. And the conclusion? Extreme constipation, very nearly fecal impaction, and that can be dangerous. I remember thinking, oh that’s all right then, nothing serious, I can go home now, and told Bob I was ready to leave.

I wasn’t, I hadn’t been discharged, and ten minutes down the road I had a phone-call saying I needed to go back straight away as I still had a catheter in each arm. But what I really recall was the calm of that A&E department, it was like watching a swan travelling gently downstream. But what you need to remember is that the legs are paddling like anything beneath the surface, and things really are getting done. It wasn’t like Casualty at all. It was a really good experience.

It took another six days and industrial amounts of laxatives to start to shift everything, which took a further week. I felt as though I’d been through a wringer, thoroughly exhausted and falling asleep a lot. But the explanation seems to be the two doses of diarrhoea I had in Madagascar, from which I never really recovered. My body went into spasm in retaliation, and I wasn’t quite well enough to notice what was happening.

 A week after my visit I washed the two hospital gowns, the blanket and the slippers they had given me, bought a card, a box of chocolates and a box of biscuits, and took them back to A&E. The scene in the waiting room was very different from the calm organisation behind the scenes, and the queue for the reception desk was long. So I stopped a passing nurse, and handed her the bag with everything in it explaining that I had been there the previous week, and everyone had been so lovely. To my surprise, she gave me a big hug. My sister-in-law is a nurse, and she explained that it’s the staff on the surgical and medical wards who get the presents, because they deal with patients over a period of time. A&E just tends to get abuse. So next time you write a hospital scene, bear in mind that what you see on the box is drama, and not real life. And do your research; nineteen out of twenty AAAs are success stories, not a quick way of killing off a troublesome character.

 We don’t think we’ll give Madagascar a third try.

Bob chilling out on the veranda at Palmarium

Liz feeding a crowned lemur