Newsletter January 2024 – The Sisyphean struggle of the medical records courier
Attainable goals for personal improvement; the big toe or micro penis mix-up; the physics of snow and gradient vs the iron will of the hospital factotum; medical secretaries and their warpaint...
Ever mindful that there are barrel scrapings of happiness to be had simply by lowering one's bruised and battered expectations, my New Year's resolutions for 2024, if you can call them that, consist of a notion that I would like to graduate from a 16kg kettlebell to a 20kg kettlebell by December, and a polite but firm personal reminder to zip up my fly before I exit the bathroom.
These baby steps towards a better me seem to be achievable goals that will improve my own life and the lives of others in tangible ways, if I remain diligent and committed to seeing them to fruition.
As to the former, I believe that, if you pointed a gun in my direction and instructed me to lift a 20kg kettlebell above my head and hold it there for ten seconds, then I would be able to do it. Whether I could exercise with it without fracturing my skull or careening like a wrecking ball into one of the walls of my home is more a matter for debate. There is something intoxicatingly primal about weaving a big lump of blackened iron in some kind of complicted orbit through one's personal space. Once you get a taste for it, the siren call of an even heavier weight is hard to resist.
Speaking to the other matter – the unsavoury business of leaving the bathroom with things left undone, I don't know whether to blame carelessness or maybe my tendency to always be thinking about something else during moments of downtime. Perhaps it is an indicator of early onset of dementia; one of several potential end-stages of an autoimmune disease that is gradually squeezing the life out of me, and which has currently entered one of its unenjoyable waxing phases. All I know is that recent forays into the great outdoors, in temperatures hovering around the 0ºC mark, with my fly yawning open like a mouth of hungry basking shark (thankfully under my coat), have made their frostbitten mark on me, and have convinced me of the urgent need to mend my neglectful ways.
At the end of a year, when I give consideration to my own plans for the future, it is hard not to also reflect upon the state of the world and what might soon come to pass. Things seem particularly dire at present. As someone who enjoys an enviable standard of living in a stable, if somewhat Orwellian, western nation, by the time the ripples of human suffering originating from elsewhere in the world reach my quiet corner of the pond, they generally manifest in some innocuous form, such as five extra pence on the price of a bag of rice, which I will have the temerity to grumble about.
I don't have a sufficient grasp of the geopolitical theatre to pontificate on it at length, nor have I ever been the type to change my avatar, or pin a coloured ribbon to my chest, in support of a cause that is likely more nuanced and unpredictable than I have been led to believe.
Broadly speaking, it does appear that we we have allowed ourselves to drift into an era where battlelines are being drawn across all strata of society, from the international right down to the interpersonal. Unity is rarer than dodo feathers. The freedoms to which we are accustomed have become separated in our minds from the social responsibilities that allow these entitlements to exist and flourish in the first place.
Against this backdrop it is practically revolutionary to hear somebody be asked to consider walking a mile or so in another person's shoes. I recently read a story about a woman in Ohio who threw a bowl of hot food in the face of a worker at Chipotle because she did not like the way that it had been prepared. The judge at her trial presented her with an option: Ninety days in jail or a reduction in her sentence to thirty days with proviso that, for the duration of two months, she work at least twenty hours a week at a fast food restaurant. It was the hope of the judge that the experience would give this women an appreciation of what it is like at the customer-facing end of the service industry.
Periodically in the UK a rabble-rousing attempt will be made to stoke a debate around the reintroduction of national service, as a mean of installing a sense of discipline in young people. This figurative sabre-rattling commonly issues from the mouths of people who have likely never rattled an actual sabre in anger, and who, were national service to be reintroduced, would be too old to be put in a position where they would be the ones compelled to familiarise themselves with the ins and outs of formation marching, or mastering the art of making their bed according to the army's exacting standards.
While I can't get behind the militarisation of the youth, given that we live in a service economy, I would happily entertain the prospect of everyone being required to work six months in one of those roles where you are cannon fodder for any member of the general public who wants to safely let off some steam with minimal, if any, repercussions. We might be a politer, less narcissistic and more empathetic society if that were to occur. I know that I am as a result of my experiences in this area.
A while ago I was employed on the Clerical Bank at Southend hospital where I am also currently (and for life) an outpatient. I was an in-house temp – an aspiring jack of all trades with no training to speak of, who would be called upon at short notice to plug a variety of admin and borderline-medical roles that had been left vacant, either due to sickness, annual leave, or, more often than not, because a department didn't fancy the trouble or the expense of hiring a permanent member of staff, with all the associated rights and benefits.
I would get a call asking me whether I wanted to do such and such a job for oh so many days or weeks. I learned early on that if you declined an offer of work you got bumped to the bottom of the list, so I said yes to everything. It soon became apparent that, even if I had worked in a similar role, the same job would be completely different in another part of the hospital. Sometimes this was because the emphasis was in a different place; clerking on the Acute Medical Unit or the Surgical Assessment Unit, where everything advances at an accelerated tempo, is different from clerking on one of the long-term inpatient wards. There were other times when it seemed as if the job had moulded itself around the personality, priorities and eccentricities of a long-term incumbant. These strange methodolgies that initially made no sense whatsoever would begin to reveal a certain logic the longer you worked in the role.
It was common for me to turn up at a job with absolutely no clue as to what exactly I was supposed to be doing. I would have no idea where anything was. There was generally no guidance, either in written form from the absent staff member, or from the other staff on duty. I made my best guess and put in a good effort in the hope of being invited back. When you are a temp, you stand or fall on your reputation and good word of mouth. After a while I gained a knowledge of how different parts of the hospital functioned both in isolation and in conjunction with each other. I knew the parts of the organisation where the gears turned fluently along with those sticking points where the cogs would grind against each other. I had contacts all over the site. I established relations; learned people's names; sent thank you emails and Christmas cards. If there was a problem that couldn't be resolved in-house on a particular department or ward, the chances are that I would know who to call.
I did all kinds of different jobs. I booked appointments for hip and knee operations and made sure the appropriate implants were waiting on the shelf for the surgical team. At the Eye Clinic, I settled into the Herculean labour of clearing an enormous backlog of patient notes that had been allowed to build up to extent that the crates filled an entire room and were now spreading along the wall of a corridor. It took me nine weeks, working half-days, to sort it out.
For almost a year, which is disgraceful amount of time for a department to be leaning on a temp, I worked in pathology. I labelled incoming samples (mostly blood). I passed on the results of down syndrome tests to midwives in the field. I read the results of blood tests down the phone to doctors at a nearby mental institution, who, had they been more proactive, could have secured access to the system themselves. I booked home visits for the phlebotomy team. For reasons that are unclear to me, my bank status spared me from having to adopt the unwelcome mantle of 'urine lady' (with the exception of maintenance, portering and medical records delivery – more of which in a moment – the hospital staff was predominantly female) – an unpleasant job that was allotted on a rota system and entailed sorting and labelling urine samples. In every batch there would be one or two where the lid had not been properly screwed on.
An air of terse camaraderie hung over the department: “Another day of fucking shit,” the head phlebotomist cheerfully announced as she dropped-off some urgent samples at the counter. A pair of her peach-coloured satin knickers arrived at the reception via the pneumatic tube system that, in principle, but generally not in practice, allowed the wards to send blood samples to the lab without the need for delivering them by hand. The underwear was an escalation of the sexual banter between her and one of the young male receptionists who had applied for a completely different job at the hospital but had somehow ended up here. He had been mistaken for a doctor by one of the patients and now we all jokingly referred to him by that title.
One afternoon I returned from lunch to find a group of my co-workers holding up a small sample jar to the light. A body part bobbed inside it. Opinion was divided over whether it was a big toe or a penis. I pointed out the nail as an obvious identifier.
“All of you are mothers. How do you not know this?”
A lidded plastic pail was hastily abandoned on the counter by a member of staff. It had been overfilled and a glistening pool of surplus liquid was already forming around it. There was no accompanying paperwork and no indication of whereabouts in the hospital it had come from, or what it contained. Eventually the ‘doctor’ peeled back the lid. It was a foetus. I gazed down upon the tiny sbmerged human being and thought ‘I am one of the few eyewitnesses to your brief time on this earth.’
A junior doctor turned up with a blood sample and asked me whether I thought it had haemolysed. I held it up to the light. It looked okay, but I wasn't qualified to make a call, so I sent it through to the lab. While we were waiting, I took a glance at the blood test form. The patient had been tentatively diagnosed with a suspected case of Creutzfeldt-Jakob disease, colloquially known in the UK as 'mad cow disease'. Even though the infection is generally contracted as a result of the consumption of contaminated cattle products, or less commonly via blood transfusion, I still gave my hands a thorough wash after handling that sample.
At the time when I was working for pathology the department was in the process of phasing out the yellow warning labels that indicated at a glance that a sample was potentially highly infectious and needed to be handled with extra care. The rationale behind this decision was that the presence of such a label on a blood sample might run counter to patient dignity, and that pathology staff should be handling all samples with the same level of care. The reality is that, when dealing with several thousand samples per day, you can only be so careful. You need to know on sight the ones where you need to take extra precautions because the consequences can be dire. I once received an antibody test for hepatitis C, which is highly contagious, where there were drops of blood in the bag containing the sample. I flagged it with one of the virologists, who went absolutely ballistic.
I made some enduring friends in pathology and had a lot of fun. I wrote and performed a poem about renal week (the week in every month where the dialysis patients are given a suite of blood tests) in the style of a Viking saga. I was there when a colleague rescued a pigeon from the airducts and when a dementia patient, who had wandered off one of the wards followed a member of staff through the code-locked doors and had to be escorted out. I think they would have taken me on as permanent member of staff but I was reluctant. There rumours of privatisation in the air. During a time and motion study, that must have cost the hospital a fortune, and struck me as a formality, a woman walked behind me, counting my steps. It took every last ounce of self-restraint not to break into overly large strides.
When I joined the Clerical Bank, I mentioned on the application form that, because of my illness, I would not be able to work any job that required sustained physical labour. I was struggling with exhaustion. I was in chronic pain and every so often I would blackout and find myself on the ground unable to recall how I got there. I didn't want the latter to occur when I was up a ladder, or in the process of lifting something heavy – either an object or another human being.
The hospital ignored my concerns. I was offered a job working in Medical Records which I accepted assuming that it would comprise data entry and filing. Patient records at the hospital consisted of folders of case notes. The notes of those patients with extensive medical histories would be expanded over several volumes. These were added at the discretion of whoever was filing the most recent paperwork. Some folders were allowed to fill up almost to the point of bursting before a new one was grudgingly opened. I knew a child cancer patient whose notes ran to seventeen bulging volumes. If you had piled them one on top of the other, they would have been taller than she was. That is assuming she had been strong enough to stand.
Patient records were stored off-site and couriered-in as needed. Their location was tracked manually on computer. In theory you could scan the barcode on the front cover of a set, and the database would do part of the job for you. In practice, there were very few scanners and what there were, were often broken or unreliable. The system worked up until the moment when somebody forgot to update the location of a volume, or it got delivered to the wrong location. In that very common scenario it would take detective work to track the notes down. Some patient records went permanently AWOL.
The case notes arrived at the hospital in blue plastic crates that were sealed with zip-ties. They were deposited in the basement where they were unpacked and the folders placed on the relevant section of the shelves, depending on whereabouts in the hospital they were headed. My job was to make the deliveries and to pick up the crates of notes that had been thrown out, and were to be sent back off-site. It remains the hardest and most thankless job I have ever done.
The physicality of the work (added to the exhaustion and the chronic pain I was already dealing with) wiped me out to a point where even a goodnight's sleep was insufficient for me to recover in time for the next shift. The hospital is on a large site and consists of buildings from different eras. It took a long time to get from one end of it to the other. Away from the accessible public areas, the layout is cramped, quirky, and difficult to negotiate, with departments and offices shoehorned into unlikely nooks and crannies.
The Heart and Chest secretaries, for example, occupied a large room on the ground floor that was only accessible via a narrow staircase from the floor above. The secretaries burned through notes faster than anywhere else in the hospital. I would cram the folders into crates and stack them six layers high in one of the tall cages that were capable of holding twenty-four boxes in total.
The code-locked door to the staircase opened onto a confined junction consisting of nubs of corridors that didn't lead anywhere. For unfathomable reasons, the floor sloped by design towards the main corridor. I would put all my weight behind the cage, push it up the incline, then jam on the wheel brakes before it could roll backwards. Given the workload and the pressure to get everything done, it was tempting to try to halve the delivery time by stacking a pair of crates and carrying them down together. In principle it seemed like a good idea. In practice, two full boxes of notes were heavy to the point where they would pull you forward. The staircase was steep and enclosed. There was a significant risk of stumbling and then not being able to catch yourself because your hands were full. I would make the same arduous up and down journey twenty-four times, exchanging a crate of incoming notes for a crate containing records that were to be returned to the library off-site. When I was done, I would make my way back to the basement where I would load up any crates that I hadn't been able to take the first time around. By the time I returned to the secretarial pool there would be more crates of notes for me to take back. It was never ending. You were never on top of it.
I worked mostly in isolation. As time wore on I could feel my mental faculties being bludgeoned by the repetitive labour. It felt as if I was becoming invisible to myself and to others. The natural instinct under such circumstances is to push back. During a week of heavy snow, staff absences were high and the hospital was unusually quiet. I wheeled my trolley of notes the length of the deserted main corridor on the second floor (mostly secretarial; a couple of wards) taking advantage of the superior acoustics that could make anybody sound like Bruce Dickenson, to belt out an a capella version of Iron Maiden's Powerslave.
Having occupied a variety of positions in the hospital, I can say with authority that, in the hierarchy of staff, the on-site Medical Records team were, by a wide margin, the least respected and the most badly treated. I was often spoken to as if it was assumed that I was mentally deficient. I once watched a secretary bully and coerce one of my co-workers – a man in his fifties – speaking to him in the kind of raised condescending tone that one might reserve for a misbehaving five-year old. It was soul destroying.
There were secretaries who had spoken to me cordially and professionally over the phone when I had worked in other roles, who were unpleasant and happy to engage in low level bullying in person. I was once loudly chastised for placing a set of hand-delivered notes on the right hand side of a secretary's desk, when apparently I should have put them down on the left side. A man pushing a trolley was regarded as an acceptable/safe target for venting general frustration.
We were treated like beasts of burden. There was a perception that we could be made to work harder, or faster, or give priority to certain departments or individuals if we were threatened with calls to line managers or disciplinary action. The truth was the department was on its knees; barely functional. We had two volunteers working for us, both named Ian; both of whom hated each other. Usually hospital volunteers are given light duties. These two men did exactly the same job that I did, and probably knew their way around the hospital better. Without their assistance there was no way we would have had the time to deliver what needed to be delivered, and to collect what needed to be collected. The department was leaning on the labour of two men working for free and an in-house temp who would frequently have to stop what he was doing was because he was doubled over in pain.
Ironically, the pain clinic was about as far away from the basement as you could go. It wasn't even really on site. The hospital had purchased some of the residential properties on an adjacent road and had converted them to house the clinical overspill. In order to deliver notes there, you had to push your trolley uphill through a busy car park, and then enter the garden via a back gate. One of the receptionists – we'll call her Maria – wore make-up the same way Boudica probably donned warpaint. She was always rude and abrasive towards me and I dreaded going there.
One afternoon, I was pushing an almost full cage of notes through the snow, up the slope of the car park, towards the clinic, when the wheels locked. I leaned into the frame, the soles of my shoes slipping repeatedly on the ice unable to gain traction, moving neither forwards nor backwards. It seemed likely that, if the mechanism remained jammed, and I surrendered the cage to the forces of gravity then it would topple over and I would be crushed underneath. The sensible course of action would probably have been to jump clear, though I don't know whether I would have made it, especially given how slippery the ground was. I instead gave the cage an almighty push and felt the wheels begin to turn. Pressing against it with my shoulder, I forced it the rest of the way up.
As I unpacked the crates into a cupboard under the stairs, still rattled from my near death experience, Maria materialised in her usual accussatory fashion wanting to know whether I had a specific set of notes. I went through what I had brought with me. Ominously, the requested folder was not there.
“It's tracked to you,” she insisted.
“Did you look at the time it was tracked? Because it might still be in transit, or it might have been delivered after I left.”
“Well, can you go back and look for it?”
I reeled-off a list of the various departments and wards who were also expecting deliveries and pick-ups by the end of the day, then told her to send a runner.
The following morning I was pushing a trolley of notes back from one of the older buildings when the front right wheel went through the ice and embedded in a fissure in the service road. I remember the snow coming down in thick flakes. As the basket began to keel over, I attempted to hold it upright with my leg. It occurred to me that there were two likely outcomes: Either the trolley was going to break my leg and then fall over, or I was going to move out the way and allow it to fall. I stood to one side and let it go. Afterwards, I gathered those notes that had been thrown out, removed the remainder from the top and bottom baskets, yanked the trolley out of the fissure, reloaded the baskets and went on my way.
The snow continued to present itself as a serious hazard. The Rheumatism Clinic was located in a small building on the perimeter of the hospital. I arrived with my trolley of notes to discover that the narrow pathway leading to the front door had been cordoned-off for repairs. The only alternative way of reaching the clinic was via the street. There was no option other than to wheel the trolley off the site onto the icy pavement and then around the corner. I shudder to think what the liabilities were in such a situation. I am in absolutely no doubt that, had there been an accident, the same tiers of management who would demand that you make your deliveries, and who would turn a blind eye to how this was achieved, and whether it was safe for you and for others, would have laid the blame at my door. Nobody in the upper echelons of the Trust cared whether Medical Records was safe. Nobody even asked, or wanted to know, or gave even a modicum of consideration for the well-being and the dignity of the staff and the volunteers whose work there propped up the hospital and allowed it to function.
Eventually, in an effort to extricate myself from Medical Records, I raised the issue of my illness with the Bank and asked why I had been placed in a working situation that was likely to exacerbate my condition. A meeting was called where I faced off against a panel of three admin staff who aggressively insinuated, without saying it directly,
that I was the one at fault for my current situation, even after I read out the statement I had made in my job application. They referred me to Occupational Health who concluded that I fell under the protection of the Disability Discrimination Act. There was no apology. There never was at that level. The default positon was that the junior member of staff is always wrong.
A few years later I was visiting New York with my parents. We were walking the High Line – an elevated park founded on the former New York Central Railroad spur. My father, who was tired and irritable from a bad night's sleep, and from having purchased a ticket that entitled him to stand in a line to purchase another ticket, began yelling at a bartender who had committed the grave sin of failing to understand a question he had been asked. As I stood in the background, absolutely mortified, I saw in the poor man, who was likely working for minimum wage, and who had no option other than to accept any abuse thrown his way with good grace, an echo of my former self.