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To be a good doctor, you have to master a paradoxical art. You need to get close to a patient so that they will tell you things and you will understand what they mean. But you also have to keep distant enough not to get too affected. This distance keeps both parties safe. A doctor can’t afford to faint at the sight of blood or retch on smelling faeces. And the last thing a person wants when they have been told awful news is for their doctor to start crying. But sometimes, you feel the likeness between you and your patient more than the difference. Sometimes, your own body declares its fallibility as if in sympathy for the person you are consulting, or your heart defies you by responding just when you least want it to. One of the most difficult things is learning how to manage sexual matters in hospital life. It’s like going through adolescence all over again.
The first time I ever touched a stranger’s penis, I was lucky enough that it was a patient under general anaesthetic. The old man, who had been wheeled unconscious into the operating theatre from the anaesthetic room, was due for a left hemicolectomy for cancer, a long operation which requires a urinary catheter for monitoring.
I was a house officer. I knew I loved being in theatre but as yet had no useful place in it. I was standing awkwardly in one of the corners when my handsome registrar invited me to initiate myself. I accepted enthusiastically, admitting my ignorance of the procedure, and was grateful when he agreed to show me what to do. A nurse arranged a trolley with all the bits we would need, and Adonis and I approached the patient’s naked groin.
I put on a pair of sterile gloves. ‘Now,’ Adonis instructed, ‘one hand is clean. One hand is dirty. With your dirty hand, swab the penis.’ Struggling to prevent the words ‘dirty’ and ‘penis’ from conjuring certain private fantasies about myself with this surgeon, I began to blush. I washed the man’s glans.
A small coterie of theatre staff were enjoying my clear discomfort, as my registrar continued. ‘Now, with that hand, hold the penis still. And with your clean hand’ — a breeze of relief at not having to keep hearing the word ‘dirty’ lightened my blush here — ‘take the lignocaine jelly and introduce it into the meatus.’ What I now saw as my useless, trembling and woefully clean, never-to-be-meaningfully-dirty hand fumbled with the man’s limp organ and the vial of jelly which I hoped would disappear into his penis poured out all over his groin. Adonis, from his lofty position of experience and romantic obliviousness, began to find my incompetence amusing. ‘Pull back the foreskin and introduce the catheter.’ No penis, all foreskin, the task seemed impossible. The slippery prepuce appeared to have no underlying structure to be retracted on so that the end of the foot-long catheter kept popping out of the baggy eye of the man’s penis, flicking jelly around with every jaunty boing. Nurses and theatre underlings tittered. Adonis woundingly quipped, ‘I thought you might have been better at this. Not your first penis, surely?’ ‘My first floppy one, yes!’ was all I could hotly reply.
Adonis eventually finished the job for me, but for weeks afterwards I was greeted in operating theatres the hospital over with sniggers from senior surgeons, identifying me as the one who had declared herself used to handling firmer members.
Another awkward encounter, which made me feel like I had been cast back to peripuberty, occurred during an on-call. I was asked to see a post-operative orthopaedic patient suffering from what is known as phimosis. This is a painful condition which occurs if the foreskin is pulled back over the head of the penis for any length of time. The band of retracted skin acts like a tourniquet, impeding drainage of blood from the penis and causing it to balloon painfully. In hospital, it may happen when a nurse or doctor has forgotten to pull a foreskin back into position after inserting a catheter.
It was the middle of the night when I arrived on the orthopaedic ward and I was immediately able to make out a low groaning, separate from the ward’s collective groan. Steve, the burly chief nurse, led me to Mr Ashton’s bed, drew the curtain around me and the patient and, with an encouraging wink, left us to it. Leg and cast on a pillow, Mr Ashton’s head was thrown back in disquiet. His swollen, discoloured penis lay like a dark lighthouse against the horizon of the sheet’s edge.
He was a young man. We were contemporaries. I tried to chase from my mind the idea that, in other circumstances, I might have met him at a party. I found myself perversely grateful that his pain left no room for embarrassment between us. He looked wildly at me and whimpered a little. I began to talk to him in a quiet voice, not because it was night-time but because I wanted him to look at me and think me quiet and therefore gentle, since what I began to explain to him was that I was going to put his sore penis into my hand and squeeze it. As soon as I said ‘squeeze’, I added ‘very very gently’, but what I didn’t detail was that I would then start to squeeze it harder and harder until I chased all that pooled blood back up more proximally so I could get the foreskin noose loose and put things back where they belonged.
I took his next whimper for assent and, like someone on slow spool, finger by finger, enclosed as much of the head of his penis as I could in my hand. It felt as if the two of us were hardly touching. Mr Ashton drew breath at this point, his worst fears of vengeful womanhood perhaps allayed. Then, gradually, I began to apply more pressure, first just enough for the small muscles of my hand to relax their still semi-extended position, then more. In a curious inversion of other similar contacts, I felt rewarded as the contents of my grip began to shrink. I carried on applying pressure bit by bit. After about five minutes, I was clenching Mr Ashton’s penis with all my might. As all the remaining trapped blood migrated northwards from the end of his organ, the young man’s discomfort eased and what had previously looked like agony gave way now to nude shame. In the artificial dusk of the ward, we were suddenly just two young strangers, one holding the other’s penis.
Mr Ashton said thanks and clearly couldn’t wait for me to leave. I felt satisfied with a job well done but also wanted to make myself scarce. Steve made some obvious joke or other on my way off the ward and another task called me elsewhere.
The penis also makes its presence felt more subtly in the medical workplace. Before I had even thought of becoming a doctor, while studying English up north, one of my tutors sought the help of his surgeon brother to refurbish his kitchen. The evening this constructive individual arrived in town, I was at a small student dinner party at this tutor’s house. We were eating meat and his brother ate a lot of it. We were telling young person’s stories about our gap years, about the only adventures we had ever had, postcard-sized. His tales of cutting and thrusting in the operating room made ours seem small and silly. This Mr Silk had a few photo albums in his car, which he showed us over coffee. They were full of before-and-after pictures of tumours followed by smooth expanses of flesh; compound fractures followed by straightened limbs with neatly stitched skin. At the end of the meal, Mr Silk peeled an apple in front of us all, and we watched as a regular ribbon of skin eased its way from the fruit in a perfect, unbroken coil.
At twenty-two, I was amazed, so when a full evening of my attention was rewarded with a singular invitation to visit my tutor’s brother in his operating theatre whenever I might next be in London, I accepted without hesitation.
Less than a month later, I took the train south one weekend to stay with an aunt. On the Saturday, I arose at dawn and caught the first tube to Mr Silk’s private operating suite. I felt a great sense of excitement as I was shown to the women’s changing room and handed my first ever surgical scrubs and cap. I remember as new the oddly industrial smell of the fabric, like hard dusty tarmac. And the feeling of being almost undressed, with only the starchy top and bottoms to brush against skin and underwear.
When he saw me, Mr Silk hugged me to his chest, then welcomed me into his theatre with exquisite grace. I was introduced to his urbane anaesthetist and his various helpers. He showed me what everything was. I mistook this for courteous surgical convention. It would take me fifteen years from this point to reacquire the feeling of being ‘someone’ in theatre, for more authentic reasons.
He then performed an athletic and dramatic hip replacement. I don’t recall much of the procedural detail, complete neophyte as I then was. What has remained is a more sensate memory. The music of the anaesthetic equipment, heard for the first time with its hums and peeps and sighs. The mixed aroma of clean hard surfaces and the loam of the body’s upturned soils. The migrainous glare of the theatre lights. The pared-down gestural language between the players.
When the operation was over, the patient wheeled out, the orderlies gone, Mr Silk produced a bottle of champagne from the anaesthetic fridge, and he and I and the anaesthetist stood in theatre and drank it all from those small slush-white beakers that have corrugated sides and usually hold children’s squash. Knowing nothing of the mores of private medicine, I took this for surgical commonplace, a kind of post-sacrificial bonding.
Afterwards, my tutor’s brother took me out for lunch, and a sense of wonder and excitement and exhilaration at what I had seen poured from me limitlessly throughout the meal, so that all potentially awkward moments were smoothed by its unction; so that any opportunity to realise that it was a little odd to be sitting with this strange man in this restaurant in this way was lost in the sparkle of a surgical world newly seen, compared to which the normal world appeared foxed like an old photograph.
As we left the restaurant, he ushered me with his large all-doing hand upon my elbow, a hand which still gave off a faint scent of Betadine, between the two heavy wooden doors leading out of the restaurant to London and its usual traffic. He stopped me. He stood very close and said, ‘It was a wonderful morning.’ And then, ‘My wife doesn’t know about this.’ Which seemed an odd preamble to a sudden sense I had that he might be about to put his large 55-year-old mouth on mine. I took a step back, and quickly opened the door leading to the street. After a stilted thanksgiving, I was walking to the Tube, and thence to my aunt’s house. I was never given such special treatment again.
All workplaces are full of this. But in a career where the body is the common currency, it feels odd to have one’s own body be at all the issue. However, if this kind of experience makes one self-conscious, far more disturbing is the situation where one’s own romantic feelings about a patient get in the way.
As I was shaking out a new white coat from its flatpack, to do my first on-call as a qualified doctor, on the other side of London, a perfect young bricklayer was accelerating his 750 cc motorbike to 60 mph on a seemingly empty city road. As the first hours of my on-call disappeared in little tasks and chats, he saw too late the van which pulled out from a side street and knocked him off his bike. While I wondered if the night had any excitement in store for me, Mark hit the ground, bounced several times onto all sorts of different bones, which broke, and then skated noisily across the gravelly surface of the road. He covered a hundred metres of this surface in ten seconds. He then lay silently in a heap for five minutes while the ambulance called by the man in the van came to fetch him. Soon afterwards, he reached A&E, where a trauma team was waiting. The primary survey of airway, breathing and circulation pronounced him alive; the secondary survey, where a quick run-through of every part of the body is performed, concluded that this man would be admitted to hospital as an orthopaedic patient, and that all other injuries would have to wait until the life-threatening bone ones were sorted out.
Mark had thirty-six fractures. Some of these were large single breaks, others accounted for by a single bone having shattered in several places. Amazingly, his skull and face had not been squashed and his internal organs had received no major injuries. His crash helmet and bones had served their purpose.
Two consultant orthopaedic surgeons, each with a registrar, took him to theatre and began to put things back in place. One I didn’t know. The other was called Santa for his gut and facial hair and ho-hoing manner. He always called himself a carpenter and he certainly had his work cut out here. A big man, he began to straighten crooked limbs in order to stem the bleeding in and outside the bones that was threatening the young man’s life.
I was summoned as the underling whose job it was to remove as much as I could of the gravel that had got stuck to Mark’s grazed body and face when he came off his bike. For this, I was given a large plastic bowl of soapy water and several scrubbing brushes, the ones we use to clean our hands before operating. They have hard, densely packed plastic bristles and I felt quite sick as I was encouraged by Santa to rub ever harder, until several brushes had to be replaced by new ones, until the already so damaged man bled in response to my personal assault. Santa reassured me that I was doing my patient a favour, reducing his risk of infection and of the skin scarring that gravel causes, known as tattooing. So as I scrubbed, he bled and it seemed as if, within this room, we were exchanging deformity for deformity. The twisted limbs were straightening to calm the eye but the whole body was now looking veiled with the blood that my work had drawn from it. After a few hours, I left. I had worn four scrubbing brushes flat and my night on call was over.
The next time I saw Mark was on the intensive care unit the following day. His extremities were covered in plaster. External fixators stuck from various aspects of these casts like outsize Meccano scaffolds. Only stripes of skin were visible against the white and these looked swollen, their surface scuffed by my efforts. The young man’s head was round with oedema. Round like a child’s picture of a head. Not round like a head really is.
I was feeling a bit queasy. It was my first time on an ITU. I was still getting used to my white coat, which I wore awkwardly like someone trying to suit the wrong fashion. I was thinking I couldn’t believe I was a doctor now and that I really didn’t know what I was meant to be doing. I had a clipboard with all my consultant’s patient names on the front piece of paper. There was a stout box next to each name in which I was meant to write the jobs that would need doing that day for each patient. I held my pen above Mark’s box, waiting for instruction or inspiration, and I peered at the man’s face with what I hoped would pass for clinical scrutiny. His black, heavy-lidded eyes were open a little, like a turtle’s, and I saw the globes within them turn in my direction. The half-dead man looked at me and he winked. My heart contracted slightly and my palms prickled. I looked at my colleagues but they were all involved in constructive decision-making. When I glanced back, Mark had looked away.
For the next six weeks, I saw Mark every day and during many nights. I talked to him more than to anyone else. This was my first house job, back at a time when the hospital gave you a bedroom for twelve months on the assumption that you’d be working too many hours a week for it to be worth going home. I saw very little of my friends outside medicine during this time. And Mark’s friends visited him for a week or two until the thrill of his accident gave way to the mundanity of watching him heal.
So, we became friends. He was the one to give me reassuring looks when I was being humiliated with difficult consultant’s questions on the ward round. He was the one who often encouraged me, at three in the morning, to stop working for ten minutes to have a cup of tea. He who asked me how trying to become the doctor I was, was feeling. Who told me I was good.
And I filled a gap for him too, the line between my clinical and personal questions blurring daily. I only realised how odd things had become when a nurse asked me one day if I could check Mark’s catheter since he had been experiencing some discomfort in his penis and I confessed, to my shame, that I couldn’t do the job. I just knew him too well. Luckily, the nurse understood and asked someone else.
As a healthy woman in my twenties, I could not help but notice that, as Mark got better day by day, he was transforming from the swollen-headed broken thing I had first observed into a guy who was the spit of the young Marlon Brando. With his facial swelling down, Mark was beautiful and, when I remembered that early wink in the ITU in the context of the man who was now in front of me, I felt confused. I started thinking romantically about him, despite myself. I began to dread and long for the time when our ortho round would stop at his bedside. I felt unduly self-conscious if Santa asked me a medical question in front of him that I couldn’t answer. I spent one horrible afternoon hovering on the ward trying to work out who exactly his young female visitor was, and what relationship he had with her.
Things reached a climax one night when I was covering all the ortho wards on call. It had been a busy night and I had spent much of it in A&E helping out with two trauma patients. The last of these had come in fresh from a road traffic accident and had died soon after arriving in hospital, despite our efforts. It was about five in the morning and my bleep had mercifully stopped bleeping. Usually, I would have gone up to my room, chased the cockroaches out and lain down for an hour or so’s sleep. On this day, though, I was feeling jangled by the night so I decided to go to the ward to see if Mark was awake.
I found him sitting up in bed leafing through a motorcycle magazine with his spare, uncasted arm, though so little light was penetrating the dirty window by his bed that I wondered how he could see the pictures, let alone read the print. ‘You look shagged out,’ he said, addressing my by my nickname, which he had now been using for a couple of weeks when we were alone.
I sat down and told him the bare bones of what I’d spent my last hour doing. Pumping a man’s chest. Feeling his ribs break beneath my hands. Knowing that this didn’t really matter because he was dead. Seeing the colour of his skin turn grey amidst the medic-ripped clothes.
Handsome, Mark faced me with such affection. In the semi-darkness, he did nothing to attenuate the feelings in his face. I looked at his eyes and the thing that usually buffers people’s glances when they look at one another fell away and a warmth spread through my chest and made me feel my heart inside me.
Mark’s arm and hand, resting on the pillow and then the motorcycle magazine, looked strong. A real workman’s hand, not like Santa’s. Lovely fingers, proper veins. Muscles still there despite the long bed rest. He lifted his hand from where it lay on the magazine and with a movement that didn’t require him to shift much at all, he lifted up the bedclothes and held them about six inches above the mattress. He held my glance, and his eyes and his gesture invited me into his bed.
The gesture was so in tune with everything that had gone before, so welcome after the night I had had, that I actually felt my quadriceps muscles tense with the intention my legs had of lifting me from my chair and into the narrow bed alongside him, to feel him all along me. As my body leaned momentarily towards him, everything seemed to dilate. Then, when instinct halted me and I relaxed back in my seat, a disappointment lay between us.
We both looked away. I heard one of us sigh and when we looked at each other again, it was with a slight smiling sadness. I reached for the hand of his that had made that wonderful opportunity and I squeezed it like I knew a doctor could, hoping that the squeeze would convey all my most undoctorly feelings. Then I got up and went to my room. There I cried. Then I slept for a bit before getting up for the next ward round that morning.
We were both different after that. Mark was getting better and I stopped by to see him less often than before. For his part, he engaged me less, too. Seldom looked at me when I walked through the ward, drew me in less when I had reason to see him for something.
On the morning that he left the hospital, I was helping in clinic and when I went up at lunchtime to write blood results in the patients’ notes, he was gone. I felt the anger of a jilted one before castigating myself. The next day, a crackly bag with a mother of pearl-coloured surface arrived on the ward with my name on it. Inside was a nest of pink shredded tissue paper and within this some luxury bath products. What you might give to an old lady, but sweeter. As if he were saying, this is an acceptable present but, between you and me, I am thinking of you in the bath. I still have an unopened soap from this set at home.
This is a hospital season. Things don’t stay like this for long. You get used to handling patients’ genitals so that the only mental shift you have to make is at home, to remind yourself in your personal life that your own private dealings are not meant to be practical. With time, your elders seek you out less often for their own romantic distraction. With fewer hours at work, you don’t have the same intense relationships with patients. But, this initiation into hospital adulthood is useful to have. It brings you down, and makes a fool of you if you try and stand above those you are treating.