Kay reveals that by the time he reached his sixth year as a doctor, he often felt disillusioned. However, he continued to believe that his job allowed him to make a positive difference to people’s lives. For this reason, in his fourth posting as a registrar, he agreed to attend a career fair at his old school. Kay told the students the truth about becoming a doctor, describing the long hours, poor pay and conditions, and lack of support and appreciation. However, he also stated there was “no better job in the world” than helping couples struggling with infertility and delivering babies (198).

Tuesday, 9 February 2010 - Thursday, 25 February 2010

Kay was surprised when a patient refused permission to give her baby a Vitamin K injection post-delivery. When the patient asserted that vaccines caused arthritis, a midwife explained that Vitamin K was not a vaccine, and it helped a baby’s blood clot. The patient still declined, asserting she was “not taking any chances with [her] baby’s health” (203).

Kay went out to dinner with H on Valentine’s Day for the first time in four years. After eating one of the heart-shaped chocolates they received at the end of the meal, he realized it was a candle.

A patient’s husband was upset to learn his wife must have an emergency cesarean, insisting he wanted to be the first person to touch the baby. Kay did not have time to explain that the husband would most likely faint or vomit if he saw inside his wife’s abdomen, nor that removing a baby this way requires considerable medical training. He satisfied the husband by offering to hand the baby straight to him after delivery, convincing the man that a doctor’s surgical gloves do not count as touching.

When an emergency buzzer went off in the labor ward, the staff paraded the corridor but were unable to locate a flashing light. After checking in with each patient, they concluded the alarm was faulty. However, as medical staff are trained to react to emergency buzzers, they found the continued noise distracting. When an engineer declared they must tolerate the noise until the next day, they contacted Prof. Carrow, the on-call consultant. Furious at being called out, Prof. Carrow directed his anger at the engineer, telling him that the situation was life-threatening and must be fixed immediately. When the engineer pointed out that women had babies long before emergency buzzers were invented, Prof. Carrow replied that, in those days, “One in twenty women died in childbirth” (204).

Wednesday, 3 March 2010 - Saturday, 5 June 2010

Kay had closed a patient’s wound after a cesarean when a scrub nurse observed that a swab was missing. A consultant, Mr. Fortescue, decided they should re-open the patient to find the swab. Mr. Fortescue told Kay that, a few years earlier, an X-ray of an elderly woman had shown a dessert spoon in her abdomen stamped as the property of St. Theodore’s Hospital. Further investigation revealed that the surgeon who performed a cesarean on the patient decades earlier used a sterilized dessert spoon as a surgical tool. Just as Kay was about to remove the patient’s skin staples, the swab was found in the baby’s hand.

Kay was called to A&E to see a woman who claimed to be in labor, but her baby’s heartbeat could not be detected. Kay could find no medical records for the patient, and a scan revealed she was not pregnant. Kay referred the patient to the psychiatry department while she screamed that her baby had disappeared. Shortly afterward, he was called to the labor ward, where the same woman was again pretending to be in labor.

Patient AB needed an emergency cesarean. However, AB had received a warning for racially abusing the Black midwives who initially attended her. The patient was also abusive toward the Indian SHO assisting Kay. Kay went ahead with the surgery but extended his incision to “decapitate” the patient’s dolphin tattoo.

Monday, 24 May 2010 - Tuesday, 27 July 2010

Kay had a prepared speech when patients asked his opinion on home births. He said that while home deliveries were more relaxing if all went well, he had witnessed incidents where babies had almost died when complications arose, and the mother was rushed to hospital. He had also observed hospital births where the mother or the child would have died if they had chosen a home delivery. When short of time, he simply stated, “Home delivery is for pizzas” (217).

Kay unexpectedly fell asleep twice in one day: once on a theater stool, and the second time at traffic lights. The hospital’s management frequently emphasized that doctors must stay awake for their entire shift and not use empty rooms to catch up on their sleep.

Kay was astonished by a rare sighting of Prof. Carrow on the labor ward until he realized the consultant was being filmed for a documentary. Approaching Kay, Carrow gave instructions to call him if there were any problems during the night. When the crew stopped filming, he retracted the offer.

Kay faced a dilemma when the emergency buzzer went off while he was stitching a patient after an emergency forceps delivery. If he left the patient, her moderate blood loss could turn into a serious postpartum hemorrhage. However, the other emergency could be more life-threatening. Leaving his patient with a midwife, Kay rushed to the emergency, finding a midwife performing a CPR drill with a mannequin. Kay pushed the mannequin off the bed, accused the midwife of compromising patient safety, and then ran back to his patient. Afterward, Kay was asked to apologize to the midwife. He responded by filling in a clinical incident form reporting the midwife for dangerous conduct. The next day, an email reminded staff that drills were a vital part of staff training. However, the new hospital policy required staff to ensure that no genuine emergencies were occurring at the same time.

Kay was asked to cover the endocrinology clinic when the consultant, Mr. Bryce, was on holiday. He immediately recognized one of the patients as the same woman he saw a month earlier in Miss Burbage’s gynecology clinic. Suspecting the patient had symptoms of premature ovarian failure (early menopause), he confessed his lack of expertise in the area and referred her to the endocrinology clinic. Confronted with the patient again, Kay booked her a further appointment on a date when he knew he was on the night shift.

Kay’s friendship with Ron faced a crisis when Ron suggested that Kay’s excuses for missing social occasions—including Ron’s wedding, his dad’s funeral, and his daughter’s christening—were not credible. Kay assured Ron that he loved him, that his excuses were genuine, and that his job really was “unimaginably busy.”