National Harambe Service

A short story on death, memes, and the National Health Service.

I’m Marco, username MedicMarco90. I’m your average junior doctor, more or less, which means you can trust me, even though I’m scrolling through medical memes on Insta, angling my phone away from the nurses, trying to take my mind off the Sisyphean workload on G6 ward as well as the cancerous lesion in my lung that’s meant to send me, in six months’ time, downstairs to palliative care.

My ageing consultant, Dr Shahzad, doesn’t know how sick I am. He emerges onto the ward with the carriage of a Middle Eastern dictator, shoulders winged by invisible epaulettes, chirruping ‘Marco, Marco,’ as if he were Italian. Not far off the mark with his Iranian accent.

‘Where do you see yourself in five years’ time?’ he purrs, registering the crisis of motivation on my face. ‘Where do you see the nhs?’

Like ‘how are you?’ it’s not a question you genuinely answer. Shahzad is doubly removed from junior doctors like me – generations older, and with the apocryphal ‘experience abroad’, in pre-revolution Iran where nurses carried out doctors’ orders without question and top-quality kabobs were served for lunch, for free.

‘The nhs is on its knees,’ I say, lamenting our lack of kabobs.

As he turns, his bald spot glints like a gigantic green olive.

‘Yes, my boy, and what’s your generation going to do once doctors like us are gone?’

‘Work harder than ever before, Dr Shahzad. Work till the day we drop dead.’

***

My dying: I was on call when I found out. I had been scrolling through Insta, chortling at ‘Dicks out for Harambe’ – the greatest possible solidarity with a gorilla shot dead in his pen – when my laugh became a bloodied cough on my fist. (May Harambe keep on giving, may he dance forever in the meme-agerie of my mind!)

Straight to radiology, said the reg, where an X-ray showed a cloud on my lung. ‘Probs just a pneumonia,’ he said. ‘Take some Augmentin.’

As a single focus it looked vague and maybe, at first, reassuring. Then both our eyes swivelled at once over the crack on my ribs and a thoracic vertebra, explaining the months and months of backache.

My being 27 years old made metastatic lung cancer exceedingly rare. Well, I had been angling to publish somewhere big for a while. Perhaps I could write myself up for The Lancet.

***
On Dr Shahzad’s ward, there is a patient with a blocked catheter, which I’m told feels like daggers on your pubis. Someone else hasn’t had a bowel movement for three weeks – I prescribe a ‘fleet enema’, an evacuation effort worthy of Dunkirk. Ward jobs pull me in every direction while the sickest patient in the bay opposite is gasping for air, making a noise like when you unblock a sinkhole with a plunger. Soon, that’ll be me.

Dr Shahzad removes himself from the bay, his stout figure an afterimage against the blue, kitchen-towel grade nhs curtain, and summons me over with an index finger that looks like it’s prostate-massaging the air.

‘Message this meme to my wife,’ he says: a gif of a man wind-milling down an escalator with the title ‘britain leaving the eu’.

Even though he can recite Harrison’s textbook by heart, I remind myself he’s still a boomer, and that for his generation the sending of memes is a fraught affair. He trusts me with his phone, pictures of roses and cherubs and Farsi verse in a private chat with his wife.

‘Sure,’ I say, sending her an emoji of an aubergine and splashing water.

***
Since my bad news I drink the same, I party the same, only with a belly full of Ibuprofen. Hungover the next morning in my apartment ten minutes away from the hospital, I read an article on The Guardian website written by a medic the same year as me at university.

‘As a junior doctor,’ he writes, ‘I call on all my colleagues in Britain to go on strike,’ alongside a picture of his spotless face and Di Caprio quiff.

Fuck that, I think, coughing for ten minutes straight. Could I really leave Shahzad on the ward, alone? The man’s nearly seventy. Won’t patients die without junior doctors like me around? And if not, then are we even necessary?

There are 687 comments in the section below. Some fellow juniors echo my worry, but a great many others say things like what about doctor retention in the long term, and burnout, and our rights?

I follow the drama for two hours, witnessing the entire nhs unravel in a single comments section. Finger-prickling energy bubbles up inside me, willing me to jump in and take a chunk out of someone. MedicMarco90, sliding into a heated argument to join forces with his anti-strike colleagues.

But I log out instead, because doctors are calling other doctors dickheads, and I don’t fancy getting dogpiled on a website before I die.

***
I get a call from the medical manager saying the night junior is off sick, could I cover after my day shift (that might not end before the night shift begins?)

‘The admission list is longer than ever.’

‘What’s wrong with them?’ I ask, imagining myself shitting all over this junior who’s pulled a sickie and fucked us.

‘Don’t know, Marco.’

Then comes a stream of coughs like a train thudding on a track. ‘You don’t sound so good yourself,’ the manager says.

‘I’ll do it.’

‘You sure?’

‘Yeah, I mean, who else will?’

There is a sense of rejuvenation walking into hospital, like dead leaves stirring up in a gust. The first A&E referral I see is eighty-something and too jolly for someone with a gastrointestinal bleed. She flirts with me and her middle-aged daughters look humiliated. I bend over as she lies in recovery position and prang a cancerous deposit in my back, wincing as if my chest has suddenly stretched itself thin over a barbed lampshade.

I insert a gloved finger into her rectum to check for signs of bleeding.

‘Ooh,’ she says, her eyebrows taking flight. ‘No one’s touched me like that since my husband died!’

I imagine writing an article in response to the one I read in The Guardian, titled ‘Junior Doctors – What Do You Hope to Achieve?’ In it I would say the following ‘To be effective doctors, we must do all we can do prevent suffering; but to partake in an effective strike, our patients must suffer, or even die.’

Maybe a different title: ‘I Will Never Walk Out On My Patients.’

‘Dickhead!’ My colleagues would shout, then doubtless accuse me of not setting my mind on the nhs long-term, wherein we should tolerate a little suffering now to prevent much more of it in the future.

But I would ask them all, somewhere deep in the comment section of this admittedly fanciful, click-bait article: ‘What, dear friends, were you expecting when you took this job up? Where did you think we were all headed?’

When Harambe died, we were supposed to hang our heads in sadness forever. But there is no point ruminating about his death, or its exploitation, is there? We’re here for the memes (said with a gif of popcorn-eating Michael Jackson). Let the lols pave over our sorrows, let them blind us to what else might be on the brink of death, to the generations pulling out of view, to the new generation the old have screwed.

***

After midnight, I am at the nurse’s station, scrolling through news about a new gorilla born in China who might be called, after a landmark vote, Harambe McHarambe-face. One look at my sunken cheeks and the lovely matron places a plate of custard creams and a glass of milk beside me.

‘You alright?’ she asks.

Like all good art, Harambe the meme will outlive me. But I don’t let this thought stop me scrolling. My pager bleeps. I need to review someone on the respiratory ward. Sometimes it’s nice to break up the day with work.

Back home, I facebook-stalk the junior who shanked us over these shifts. I find pictures of her painting on a canvas the size of a garage door, which makes me cough evilly. Something on a theme of Kandinsky melded with mental health mumbo-jumbo. Rubbing my nose in her life outside medicine.

‘You should not be so judgemental,’ says Dr Shahzad when I get this off my chest. ‘There’s no telling what she’s been through.’

He insists on a trip to the hospital Starbucks even though we are about two days behind on ward jobs. His obliviousness to my enormous workload triggers me. It makes me want to pull his ears clean off.

‘The nhs needs martyrs to keep going,’ I say.

‘But it can’t be like that forever. Everyone must be honest with their limitations; only then will we know the extent of the staffing problem. You cannot force men and women to work. Support your patients and your colleagues, Marco. What will be will be.’

But if we’re all honest, I want to say, if we bring all our problems to work, if we all say exactly what we want to one another, won’t everything fall apart?

‘Oh, Marco, I don’t want to have coffee with someone so miserable. Do you mind not being so miserable?’

And then it hits me: I am a dickhead. I’m sanctimonious. I’m crabby. Behind my friendly, junior doctor’s facade lie the cracks of the insufferable martyr.

But I’ve decided. When the time comes, I’m not calling in sick. I won’t tell a soul, not even medic friends who share the woes of the job. The manager will call me on my ward phone, my mobile phone, my flat phone, and there will be no answer. On the day I join Harambe, when there are no longer the good locum rates or the compensatory leave, there will be no one to replace me, or others like me. All there’ll be is a meme of the cartoon dog saying ‘this is fine’, surrounded by the burning house of the nhs.