Contents

About the Book

Christie Watson was a nurse for twenty years. Taking us from birth to death and from A&E to the mortuary, The Language of Kindness is an astonishing account of a profession defined by acts of care, compassion and kindness.

We watch Christie as she nurses a premature baby who has miraculously made it through the night, we stand by her side during her patient’s agonising heart-lung transplant, and we hold our breath as she washes the hair of a child fatally injured in a fire, attempting to remove the toxic smell of smoke before the grieving family arrive.

In our most extreme moments, when life is lived most intensely, Christie is with us. She is a guide, mentor and friend. And in these dark days of division and isolationism, she encourages us all to stretch out a hand.

About the Author

Christie Watson was a registered nurse for twenty years before writing full-time. Her first novel, Tiny Sunbirds Far Away, won the Costa First Novel Award and her second novel, Where Women Are Kings, was also published to international critical acclaim. Her works have been translated into eighteen languages. She lives in London.

ALSO BY CHRISTIE WATSON

Tiny Sunbirds Far Away

Where Women are Kings

Introduction: Worth Risking Life For

Nursing was left to ‘those who were too old, too weak, too drunken, too dirty, too stupid or too bad to do anything else’.

Florence Nightingale

I didn’t always want to be a nurse. I went through a number of career possibilities and continually exasperated the careers advisor at my failing secondary school. ‘Marine biologist’ was one career choice that I listed, having visions of wearing a swimsuit all day in a sunny climate and swimming with dolphins. When I discovered that much of the work of a marine biologist involved studying plankton off the coast of Wales, I had a rethink. During one summer in Swansea I spent time watching my great-great-aunt gutting catfish in the large kitchen sink; and once I went out on a boat with hairy, gruff and burly yellow-booted men who pissed in the sea and swore continually. I’d also eaten cockles and laver bread for breakfast. Marine biology was definitely out.

‘Law,’ a teacher remarked, when my parents, also exasperated with me by then, asked what I might be suited to. ‘She can argue all day long.’ But I had no aptitude for focused study. Instead I looked towards other animals and conservation. I dreamed of doing photography for the National Geographic, leading to travel in hot and exotic locations where the sun would shine and I would wear a swimsuit all day after all, and live in flip-flops. I joined marches and anti-vivisection campaigns, and gave out leaflets in the grey-brick town centre of Stevenage showing pictures of dogs being tortured, rabbits having cosmetics tested on them until their eyes became red, and bloody, skeletal cats. I wore political badges that were outdoor-market cheap and came loose, stabbing me until one evening I found a tiny constellation of pin-prick bruises on my chest. I refused to go into the living room after my mum bought a stuffed chick from a car-boot sale and placed it amongst her ornaments, and instead ate my vegetarian dinner on the stairs in protest, saying, ‘It’s me or the chick. I cannot be associated with murder.’

My mum, with endless patience, constantly forgave my teenage angst, removed the chick, made me another cheese sandwich and gave me a hug. It was she who taught me the language of kindness, though I didn’t appreciate it back then. The next day I stole a rat from school, to save it from dissection by the biology department. I called it Furter, and hoped it would live safely with my existing pet rat, Frank, which used to sit on my shoulder, its long tail swinging around me like a statement necklace. Of course, Frank ate Furter.

Swimmer, jazz trumpeter, travel agent, singer, scientist … Astronomy was a possibility until, at the age of twelve, I discovered that my dad, who had taught me the name of every constellation, had made it all up. I didn’t tell him, though; I still let him point upwards and tell me his stories, with his enthusiasm for narrative bursting into the sky. ‘There – the shape of a hippo? You see it? That’s called Oriel’s Shoulder. And that is the Bluebell. You see the shape? The almost silver-blue colour of those particular stars? Fishermen believe that if you look to the stars hard enough, they will whisper the secrets of the earth. Like hearing the secrets of the sea inside a shell. If you listen hard, you can hear nothing and everything, all at the same time.’

I spent hours and hours looking at the stars to hear the secrets of the earth. At night I pulled out a cardboard box full of treasures from underneath my bed: old letters, a broken key ring, my dead grandfather’s watch, a single drachma; chewing gum that I had retrieved from underneath a desk, and which had been in the mouth of a boy I liked; stones I had collected from various places, and a large shell. I would stand in my bedroom looking up towards the stars, holding the shell to my ear.

One night, burglars came to steal meat from our freezer, which we kept in the garden shed. Those were the days when people bought meat in bulk at car-boot sales, from men on giant lorries with loudspeakers and dirty white aprons. Those were the days when police would come at night to investigate frozen-chicken theft, and my star-watching was interrupted by police shouting. The universe had answered my shell-call: vegetarianism mattered. I am not sure which would have been a more unusual sight that night: a few young men carrying a frozen chicken and a giant packet of lamb chops, or a skinny teenager in a moonlit bedroom, with a large shell pressed against her ear.

What I would do – and who I would be – consumed me in a way that didn’t seem to worry my friends. I didn’t understand then that I wanted to live many lives, to experience different ways of living. I didn’t know then that I would find exactly what I searched for (minus the swimsuit and the sun): that both nursing and writing are about stepping into other shoes all the time.

From the age of twelve I always had part-time jobs. I worked in a café cleaning the ovens – a disgusting job, with mean women who used to make the teabags last three cups. I did a milk round, carrying milk during the freezing winter, until I could no longer feel my fingers. I did a paper round, until I was found dumping papers in dog-shit alley. I didn’t make any effort at school; I did no homework. My parents tried to expand my horizons, give me ideas about what I might do and a work ethic: ‘Education is a ticket to anywhere. You have a brilliant brain, but you don’t want to use it.’ I was naturally bright but, despite the tools my parents gave me and their joie de vivre, my poor school-work ethic and my flightiness continued. They always encouraged me to read, and I was consumed by philosophy, looking for answers to my many questions: Sartre, Plato, Aristotle, Camus – I was hooked. A love of books was the best gift they ever gave me. I liked to roam and not be far from reading material; I hid books around the estate: Little Women in the Black Alley; Dostoevsky behind Catweazel’s bins; Dickens under Tinker’s broken-down car.

I left school at sixteen and moved in with my twenty-something boyfriend and his four twenty-something male lodgers. It was unbelievably chaotic, but I was blissfully content working a stint at a video shop, handing out VHS videos to the Chinese takeaway next door in exchange for chicken chow mein, my vegetarianism now beginning to wane, as I concentrated on putting on 18-rated films in the shop and filling the place with my friends. I went to agricultural college to become a farmer and lasted two weeks. A BTEC in travel and tourism lasted a week. To say that I had no direction was an understatement.

I was truly devastated when, after turning up late for an interview, I did not get the job of children’s entertainer at Pizza Hut. It was a shock when my relationship broke down, despite being only sixteen and completely naive. My pride meant that I would never go home. No job, no home. So I worked for Community Service Volunteers, which was the only agency I could find at the time that accepted sixteen-year-olds instead of eighteen-year-olds and provided accommodation. I was sent to a residential centre run by the Spastics Society (now called Scope), earning £20 pocket money a week by looking after adults with severe physical disabilities: helping them to toilet, eat and dress. It was the first time I felt as if I was doing something worthwhile. I had begun eating meat and I had a bigger cause. I shaved my head and lived in charity-shop clothes, spending all my pocket money on cider and tobacco. I had nothing, but I was happy. And it was the first time I’d been around nurses. I watched the qualified nurses with the kind of intensity that a child watches her parents when she’s sick. My eyes didn’t leave them. I had no language for what they were doing, or for their job.

‘You should do nursing,’ one of them said. ‘They give you a bursary and somewhere to live.’

I went to the local library and discovered an entire building full of waifs and strays like me. I had been to my school library, and to the library in Stevenage, many times when I was much younger, but this library was about more than simply learning and borrowing books. It was a place of sanctuary. There was a homeless man asleep, and the librarians left him alone. A woman on a mobility scooter was being helped by a man who had a sign round his neck that said he had autism and was there to help, reaching a book on a top shelf for her. There were children running around freely, and groups of younger teenagers huddled together, laughing.

I found out about Mary Seacole, who – like Florence Nightingale – nursed soldiers during the Crimean War. She began experimenting in nursing by administering medicine to a doll, and then progressed to pets, before helping humans. I hadn’t considered nursing as a profession before, but then I began remembering: my brother and I purposefully ripped the stuffing out of soft toys or pulled the glass eyes from dolls, so that I could fix them. I remembered my primary-school classmates queuing for an anaemia check-up; I must have bragged about my specialist knowledge, before lining them up outside school and pulling down their eyelids, one by one, to see if they needed to eat liver and onions; and the endless friends with sore throats whose necks I would gently press with my fingertips, as if on a clarinet. ‘Lymph node.’

There wasn’t much written about what nursing involved, or how to go about it, so I had no idea whether or not I’d be suitable. I discovered that nursing pre-dates the history books and has long existed in every culture. One of the earliest written texts relating to nursing is the Charaka-saṃhita, which was compiled in India around the first century BC and stated that nurses should be sympathetic towards everyone. And nursing has strong links with Islam. In the early seventh century, faithful Muslims became nurses – the first professional nurse in the history of Islam, Rufaidah bint Sa’ad, was described as an ideal nurse, due to her compassion and empathy.

Sympathy, compassion, empathy: this is what history tells us makes a good nurse. I have often revisited in my head that trip to the library in Buckinghamshire, as those qualities seem to have been lacking all too often during my career – qualities that we’ve now forgotten or no longer value. But, at sixteen, I was full of hopeful energy and idealism. And when I turned seventeen I decided to go for it. No more career choice changes and flitting around; I would become a nurse. Plus, I knew there would be parties.

A few months later, I somehow slipped onto a nursing course, despite being younger by a couple of weeks than the official entry age of seventeen-and-a-half. I moved into nursing halls in Bedford. The halls were at the back of the hospital, a large block of flats filled with the sound of banging doors and occasional screaming laughter. Most of my corridor was made up of first-year nurses, with a few radiographers and physiotherapy students, plus the occasional doctor on rotation. The student nurses were almost all young and wild, and away from home for the first time. There were a significant number of Irish women (‘we had two choices,’ they’d tell me, ‘nurse or nun’); and a small number of men (universally gay at the time). There was a laundry room downstairs, next to a stuffy television room with plastic-coated armchairs which the back of my legs stuck to, in the heat from the radiators on full blast twenty-four hours a day. I met a trainee psychiatrist in that television room, after inadvertently blurting out that I was stuck to the chair, and he became my boyfriend for a few years. My bedroom was next to the toilets and smelled of damp, and one of my friends once grew cress on the carpet. The kitchen was dirty and the fridge was full of out-of-date food, with a note on one cupboard stating: DO NOT STEAL OTHER PEOPLE’S FOOD. WE KNOW WHO YOU ARE.

There was one telephone in an echoing hallway, which rang at all hours of the day and night. There were arguments, and the sound of heels running and of music being played loudly. We all smoked – cigarettes usually, but the smell of weed was like a constant low-level background noise that you didn’t even notice after a while. We went in and out of each other’s rooms in a communal fashion, and our doors were never locked. In my room Leonardo da Vinci’s anatomical drawings of the chambers of the heart were on a poster above my bed; there was a shelf full of nursing textbooks and tatty novels, and a pile of philosophy books next to my bed. Plus a kettle, a radiator that wouldn’t turn down and a window that didn’t open. There was a sink to wash in (bodies and cups), to flick ash in, to vomit in and, for a few weeks when the toilets were continuously blocked, to pee in. To my contemporaries, it wasn’t much; but after sharing a room in the residential centre for so long, and previously a house with a boyfriend and his male lodgers, it was heaven to me.

The first night, though, is always the worst. I had no idea what I would be doing as a nurse, and had begun to regret not asking more questions of the nurses who had encouraged me to apply. I was terrified of failure; of the look on my parents’ faces when I announced yet another change of heart. They had been shocked enough about my decision to become a nurse: my dad actually laughed out loud. Despite my work as a carer, they still saw me as the rebellious teenager who couldn’t care less about anyone. It was a far stretch to imagine me being devoted to kindness.

I lay awake that night and listened to the sound of my immediate neighbour arguing with her boyfriend, a moody, lanky security guard who, against all the rules, appeared to be living with her. Even after they were quiet I couldn’t sleep. My head was dancing with doubt. I knew I’d be classroom-based for a while at least, so I wouldn’t kill anyone by accident, or have to wash an old man’s penis or experience similar horrors. But I was full of anxiety. And when I went that night to the toilet, which was shared by those on the entire floor, I found a used sanitary towel stuck on the bathroom door. I retched. Aside from how vile it was, I remembered then that the sight of blood had always made me feel faint.

My queasy nature was confirmed the following morning when we had our occupational health screening. Blood samples were taken from all of us. ‘To hold on file,’ the phlebotomist announced. ‘In case you get a needle-stick injury and contract HIV. We can then find out if you were HIV-positive already.’ It was 1994, and misinformation and fear about HIV were everywhere. The phlebotomist tied a tourniquet around my arm. ‘Are you a student nurse or a medical student?’ she asked.

I watched the needle, the blood filling the tube, and the room began to blur. Her voice sounded far away.

‘Christie. Christie!’ When I came round, I was lying on the floor with my legs up on the chair, and the phlebotomist above me. She laughed. ‘You okay now?’

I slowly got to my elbows, regaining focus. ‘What happened?’

‘You fainted, dear. Happens. Though you might want to rethink your career.’

Twenty years in nursing has taken so much from me, but has given me back even more. I want to share with you the tragedies and joys of a remarkable career. Come with me on the wards, from birth to death; past the Special-Care Baby Unit and the double doors to the medical ward; run through the corridors to answer the crash bleep, past the pharmacy and staff kitchen, and to Accident and Emergency. We will explore the hospital itself, as well as nursing in many of its aspects. What I thought nursing involved when I started: chemistry, biology, physics, pharmacology and anatomy. And what I now know to be the truth of nursing: philosophy, psychology, art, ethics and politics. We will meet people on the way: patients, relatives and staff – people you may recognise already. Because we are all nursed at some point in our lives. We are all nurses.

1

A Tree of Veins

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care.

Article 25 of the Universal Declaration of Human Rights

I walk across the bridge towards its jagged-edged shadow, watch the pale-blue, almost green, grey light dancing on the water below: it is dawn. Everything is quiet. A full moon. A couple of women swerve past me, wearing party clothes and smudged mascara; a man in a sleeping bag is slumped against the wall, a coffee cup beside his head containing a few coins. There is hardly any traffic, but for a few black cabs and the occasional night bus. But there are other people like me heading to the hospital: a uniform of scuffed flat shoes, rucksack, pale face, bad posture.

I turn into the hospital grounds and walk past the small church in the courtyard, which is always open. Inside, it is dark and lit by dull lighting and candles, with a book full of messages and prayer requests on the altar. The saddest book you will ever read.

The staff are rushing in through the main entrance; some pushing bikes, others walking with purpose, trying not to catch the eye of anyone anxiously searching for information, carrying a letter and an overnight bag, holding the hand of a crying child or pushing an elderly relative in a wheelchair, a blanket tucked over their knees. At 9 a.m. there will be a volunteer to help the lost, wearing a banner that reads: ‘How Can I Help You?’ This is Ken, who is seventy and whose granddaughter was treated at the hospital for sepsis, following treatment for ovarian cancer; ‘I want to help people like me. It’s the little things.’ He gives out maps of the hospital layout, directions and a smile. The map of the hospital is colour-coded, and there are coloured stripes on the floor for people to follow. At least once a day someone will sing and skip as they follow the yellow stripe: ‘We’re off to see the wizard …’

I walk past the reception seating area, where even more people are huddled together: rich and poor, disabled and able-bodied, people of all races and cultures and ages. Often I see the same woman – wearing slippers and reeking of urine, sitting next to a trolley filled with plastic bags – muttering to herself. Sometimes she shouts out as if she’s in pain, and a security guard’s face will pop up at the hatch to check for disturbances, before disappearing again. But today she’s not there. Instead I see an elderly woman wearing a thick red coat, despite the hospital heating. She looks up at me for a few seconds with frightened, sad eyes. She seems completely lost and alone despite the dozen or so people around her. Her hair, once curled, is now unwashed and half-flat; it reminds me of my nan’s hair when she got sick, and how she hated not having a perfect blow-dry. She closes her eyes and rests her forehead on her hands.

I love walking through the hospital. Hospitals have always been places of sanctuary. King Pandukabhaya of Sri Lanka (who lived from 437 to 367 BC) built lying-in homes in various parts of his kingdom – the earliest evidence anywhere in the world of institutions dedicated specifically to the care of the sick. A psychiatric hospital was built in Baghdad in 805 AD. These early hospitals were forbidden by law to turn away patients who were unable to pay for care. The Qalawun Hospital in thirteenth-century Egypt stated: ‘All costs are to be borne by the hospital, whether the people come from afar or near, whether they are residents or foreigners, strong or weak, low or high, rich or poor, employed or unemployed, blind or sighted, physically or mentally ill, learned or illiterate.’

I walk on, past the gift shop where ‘Congratulations’ and ‘With Sympathy’ cards are separated by ‘Get Well Soon’. I pass the tiny clothes shop where nobody ever buys clothes, but the shopkeeper tells good stories and knows everything that is happening in the hospital; on to the public toilets where patients collapse, inject heroin and, occasionally, are attacked – once even raped. Opposite the toilets are the newsagent’s and the twenty-four-hour café, where sour milk from the broken coffee machine once flooded onto the lifesaving defibrillators stored in the basement below.

I turn the corner and glance back at the woman in the thick red coat, nearly colliding with a kitchen assistant pushing a giant metal trolley which smells of bleach, mould and aeroplane food. Left of the coffee shop are the lifts where there is always a cluster of people waiting. The hospital is built on expensive land and grows vertically; most of the wards are above the main veins and arteries of the ever-expanding hospital buildings. But the long wards with their many windows are still recognisable as having the same architectural layout that Florence Nightingale suggested, recognising the role of good architecture and hospital design in improving patients’ health. She recommended that ward layouts comprised of long, narrow blocks with tall windows, maximising the fresh air and sunlight. In her correspondence between 1865 and 1868 with the Manchester architect Thomas Worthington, Nightingale also highlighted the practical needs of the nurses: ‘Will the Scullery be sufficient accommodation for a nurse to sleep in, if necessary?’

I imagine her footsteps, and watch my own as I pass the patient transport area, where there is an entire room full of people waiting to go home, too sick to travel by public transport and too poor to go by taxi; none of them have relatives to collect them. The patients are sitting in wheelchairs and plastic chairs, wearing coats or dressing gowns and blankets, looking at the automatic doors for the face of a stranger; looking past the automatic doors at the sky outside, its emptiness. The vending machine whirrs, untouched, behind the row of chairs. I wonder if these people – most of them elderly and frail – are hungry, or in pain, or frightened. I already know the answer. The waiting room to leave the hospital seems fuller than the waiting room to get in. Everything is relative. Patients may not feel lucky to suffer a serious injury and be fighting for their life in Accident and Emergency (A&E), but if they have family and friends with them, then maybe they are lucky.

The porters’ lodge door opens and slams continually into a line of empty oxygen cylinders, looking like giant skittles. A woman with frizzy hair and drawn-on eyebrows has a Madonna-esque earpiece and microphone and a switchboard pad in front of her. She is someone I spend time trying to befriend. But despite my efforts she barks, ‘Can I help you?’ every time I say hello, as if I am a stranger. Still, I persist.

The pharmacy is next door: a giant sweet shop for adults. There are trays that pull out, and miles of lines of different tablets. The inside of the pharmacy is like a trading floor on Wall Street, down a low-lit staircase to the basement, where certain drugs are organised into emergency boxes, labelled whenever they are opened, to ensure they’re not tampered with, then restocked and sealed. Many of the drugs are used in the UK without NICE (the National Institute for Health and Care Excellence) approval. This is not uncommon. In paediatric use in America, for example, only 20 to 30 per cent of drugs are FDA-approved.

Drug reps are salespeople, and they used to be a source of excitement in hospital. They are easy to spot; like the pharmacists, they are better dressed than the doctors. A uniform of designer clothing and the manner of a car salesman, plus the ability to get the attention of a busy consultant (and past the consultants’ secretaries), mean that a good-looking undercover army of twenty- and thirty-year-old graduates, who didn’t quite get the grades for medical school, regularly visit hospitals. A visit on the wards from the drug rep used to mean pizzas, pens, notebooks and other gifts. ‘Transparency’ means that the drug-rep lunches are now less luxurious, and doctors are not allowed to be bribed to stock or prescribe one particular drug over another. The reps still give out promotional material, though (all doctors and nurses have mugs and pens in their houses with the name of drugs on them, and for a long time my baby daughter had a favourite teddy bear that wore a T-shirt advertising an antidepressant).

There is a small hatch and a constant stream of student nurses waiting for TTO (To Take Out – a drug prescription that a patient is taking home, like a takeaway from a restaurant); and a door where you have to get buzzed in, for certain drugs or fluids.

My office is three floors above the pharmacy. It is an over-hot, over-stuffed, carpeted room with exposed pipes and rat-traps outside the door, but we’re not in here much. I look around the room for a few seconds, my eyes sweeping the table, on which rest out-of-date endotracheal tubes and faulty defibrillator pads (‘They were sparking, but it’s anecdotal, so we don’t need to panic yet!’). There are sachets of stolen brown sauce from the hospital canteen, where we stop occasionally for toast or fried breakfast, after receiving a handover from the site nurse practitioners (SNPs) – the senior nurses who manage the hospital overnight and deal with all manner of hospital issues, from bed management to critical incidents, security and terrorist attacks. Also on the table are the thick medical notes of a patient who died, waiting to go back to the bereavement office; plus a large tub of decaffeinated coffee, which I was told on my first day had been there, unused, for years.

My job as a resuscitation officer is a strange hybrid role – a specialist nurse expert at resuscitation. Our team is mostly staffed by experienced former intensive-care nurses (like me) or Accident and Emergency nurses, but sometimes by paramedics or operating department practitioners (highly trained operating-theatre assistants). We teach nurses and doctors and other healthcare professionals about resuscitation, and carry crash bleeps (or pagers) that take us to all areas of the hospital: the wards, theatres, coffee shop, stairwell, psychiatry outpatients, the car park and wards for the elderly; and we work with a team and help the staff manage medical emergencies and cardiac arrests.

I change behind a makeshift screen. There is no other place to change in our office, and no time to go to the toilets; the makeshift screens have been a feature for years. The crash bleep goes off, flashing and emitting an alarm: ‘Adult Crash Call, Main Canteen’. The crash bleep can be silent all day. On other days it can go off five or six times. Staff put out the call by ringing 2222 and specifying the type of emergency: adult, paediatric, obstetric, neonatal or trauma. Even in hospital, medical emergencies can be rare, but may be also horrific, although most of the calls are what we quietly consider a load of nonsense: a patient who has fainted or is faking a seizure or, once, had been stung by a wasp.

‘My advice,’ a colleague tells me on my first day, ‘is to run very, very slowly. You do not know what you will find, and you certainly don’t want to be first on the scene until you know what you’re doing.’

But now I’ve been doing the job for a while, so I respond into the bleep, ‘Resus Officer’, and run down the stairs two at a time, past the central area of the hospital, which is dominated by a giant statue of Queen Victoria. I run past the grand hallway, with the piano that is played by people who will surprise you. Today there is a builder in a high-visibility jacket playing Mozart. Past a slow-walking woman and a beaming man, pushing a dot of a baby in an immaculately new pushchair, balloons attached: ‘Congratulations: a Boy!’ I have to slow down as the people get thicker near the post room, where the sounds of swearing and a radio burst through the cubby-hole and an occasional arm flings mail to the queue waiting outside. I walk quickly towards the cash machine that never works, and the hospital canteen where staff with hangovers are eating their fried breakfast.

The woman with the sad eyes wearing the red coat is tiny and frail-looking. She is even smaller when the coat comes off. She’s wearing a floral shirt underneath that has the buttons done up wrong. Her skin is crinkled and dry, her hair white and patchy. Her eyes are rheumy and her lips cracked; her half-flat hair smells sour. A wedding ring hangs on a silver necklace just above her collarbone. Her eyes flick from person to person and she is shaking. She is in the canteen, conscious and sitting on a chair, already surrounded by some of the crash team: a senior doctor, a junior doctor, an anaesthetist and an SNP. They do not look worried. The SNP, Tife, is a friend. She was an A&E nurse for many years. It is always reassuring to see her: she is as calm as ever. She has somehow found a blanket, which you would imagine is easy but never is, and is kneeling in front of the patient attaching a small sensor to her finger to record her oxygen levels.

‘Morning!’ Tife says.

‘Hi. Sorry – I was just getting changed.’

The crash trolley arrives with a porter. It is called for as soon as a crash bleep goes off, and generally arrives at the same time as the team. On it rests an enormous amount of kit – an entire ward on wheels. There’s oxygen, suction, a defibrillator, emergency drugs, and large bags containing everything under the sun from glucose monitoring kits to breathing equipment.

‘Betty here has a bit of chest pain. All the obs are fine. She’s very cold. Can you get a Tempa-Dot?’ She turns to the doctors. ‘We’ll get her to A&E, if you need to go.’

‘She needs a twelve-lead ECG,’ the doctor says, and leaves before she notices the junior doctor rolling his eyes and muttering, ‘You think?’ under his breath.

‘Can I hand over to you?’ he asks me as he runs. They have busy jobs as well as being on the crash team, and have to drop everything when the bleep goes off, sometimes leaving patients in theatre with only junior staff.

I nod. ‘Hi, Betty.’ I reach for her hand. It is ice-cold. ‘I’m Christie. I’ll get you sitting up on the trolley and we’ll go across to A&E. Nothing to worry about, but best to get you checked over. I think I saw you on my way in? In reception?’

‘Betty came in to see Patient Liaison this morning, but was early, so she came for a coffee and had a bit of a tight chest. All her obs are fine, but she’s had a rough time, haven’t you, Betty?’

I notice her expression. Terrified.

‘Betty lost her husband to a heart attack recently.’

‘I’m very sorry to hear that,’ I say, pulling the blanket closer around her. Her temperature is dangerously low. ‘How’s the pain now?’

She shakes her head. ‘I don’t want to cause any fuss,’ she says. ‘It’s not bad. Probably something I ate.’

Betty does not look like a patient having a heart attack (myocardial infarction), though older women do not always exhibit the classic signs that you’d expect – chest pain, numbness, tightness, tingling, pins and needles – and occasionally feel no pain at all. Ischaemic heart disease is the most common cause of death in most Western countries, and a major cause of hospital admissions. We see lots of patients suffering heart attacks in hospitals, and many of them are not initially in hospital for that reason. They come for dental appointments or to visit a relative, or to have bloods taken, and the stress of the hospital environment seems to be enough to tip people over the edge. A heart attack is different from a cardiac arrest. A heart attack is caused by atherosclerosis, or hardening of the arteries – a restriction in blood supply to the tissues, and a shortage of oxygen and glucose needed to keep the tissue alive. A cardiac arrest results from the heart stopping entirely, from any cause. But Betty is not sweating or grey, and although her pulse is thready (thin), it feels regular and is palpable.

With help from me and the porter, Betty slowly climbs onto the trolley and I sit her up, wrap as much of the blanket as I can around her thin shoulders, and over her face I put a non-rebreathing oxygen mask – a mask with a pillowy bag at the bottom, which keeps the oxygen concentration levels high. Oxygen is potentially dangerous in the treatment of heart attacks, as it can constrict already-constricted blood vessels. But in medical emergencies where a patient might be critically ill, oxygen is essential. It is also good if you are hungover. But it smells disgusting, it is drying, and having a face-mask placed over you means that you can’t see properly and the fear escalates.

I try and reassure Betty. ‘This will make you more comfortable.’ I walk beside her as the porter pushes the trolley, thinking about how the hospital arteries are much like our own, as the smallest blockage causes us to stop and start until people move aside to let us through.

Arteries and veins have been misunderstood throughout history. In the second century AD, Galen, a Greek biologist and philosopher who practised medicine (he was a surgeon to gladiators), said that ‘Throughout the body the animal arteries are mingled with veins, and veins with arteries.’ There was a belief that veins contained natural spirits, and arteries contained animal spirits. During medieval times, arteries were thought to contain spiritual blood – the vital spirit. But although our understanding has clearly advanced beyond belief, there is always some truth in history. In studying the arteries, Galen further identified what remains true of arteries (and can be applied metaphorically to hospitals) today: ‘It is a useful thing for all parts of the animal to be nourished’.

Tucked down the corridor to the right of us is the hospital cinema, showing the latest films for patients and relatives (and apparently staff, though I’ve never known any staff member with the time to go there), with a special chair for the nurse, paid for by a charity, who is on hand for reassurance or to deal with emergencies. Next to that is the sexual-health clinic (always busy, standing room only). Betty and I carry on, past the ambulatory medical unit, where a crowd is gathered around a man using a wheelchair who has an unlit cigarette in his mouth and another behind his ear, and is swearing loudly. There is a drip-stand with a large cylinder of frothy clear fluid hanging behind him, running into a thin white tube that eventually burrows into the top of his chest like a misplaced umbilical cord.

‘Nearly there,’ I say.

These people, the chaos: the spiritual blood of the hospital. The branch- and twig-like arteries and veins leading towards the centre: A&E.

A&E is frightening. It reminds us that life is fragile – and what could be more frightening than that? A&E teaches us that we are vulnerable and, despite our best efforts, we can’t predict who will trip on a pavement, causing a catastrophic bleed to the brain; whose roof will collapse, leading to the traumatic amputation of a limb, a broken neck, a broken back, bleeding to death; who will be part of a couple married for sixty years until the wife’s dementia results in her injuring her husband. Or who will be in the wrong place at the wrong time: a man with a knife plunged into his heart by a teenage gang member; or a woman beaten and kicked in her pregnant stomach.

There is beauty in A&E, too: a togetherness, where all conflict is forgotten. There is no sleepwalking through the day, as an A&E nurse. Every day is intensely felt and examined, and truly lived. But my hand always shakes when I push open the door – even now, after many years as a nurse. I’ve never worked solely in A&E, although I spend a lot of time there, in my job as a resuscitation officer. Nursing requires fluidity, being able to adapt and push energy in the direction where patients and colleagues need you, even if it is unfamiliar. Still, A&E scares me. Unlike the staff in the canteen who put out the call for Betty, the staff in A&E only put out a 2222 crash call to the resuscitation team if things are desperate, or if a trauma arrives that requires specialist doctors.

A&E is unpredictable. There are some traffic patterns though. During the week, the mornings are for mothers who have nursed their babies all night and, in the cold light of day, realise they are worse, not better. Daytimes are for accidents and injuries, and the evenings are for office workers who can’t get a GP appointment and don’t want to take time off work. Anything can happen on weekday nights, and people tend to come to A&E at night only if they are truly sick. Yet from Thursday evening through to Monday morning party-people fill the corridors, wild-eyed and twitching; there is a steady stream on Sunday mornings, and the later in the day they arrive, the sicker they are: young men and women who have been taking all manner of amphetamines, their pupils as big as the moon, or the alcoholic heroin users with eyes as small as pinpricks, not seeing, not letting in light.

A&E is full of police, shouting relatives, patients lined up with flimsy curtains separating them; an elderly person having a stroke next to an alcoholic, next to a pregnant woman with high blood pressure, next to a carpenter with a hand injury, next to a patient with first-presentation multiple sclerosis, next to a young person suffering from sickle-cell crisis or a child with sepsis. Heart attacks, brain aneurisms, strokes, pneumonia, diabetic ketoacidosis, encephalitis, malaria, asthma, liver failure, kidney stones, ectopic pregnancies, burns, assaults and mental-health crises … dog-bitten, broken-boned, respiratory-failing, seizing, drug-overdosing, horse-kicked, mentally ill, impaled, shot and stabbed. Once, a head half-sawn off.

Betty’s face is grimacing. She reaches out for my hand as we walk through the large waiting area, the patients sitting on plastic chairs or standing lined up against the walls, leaning on the posters. Nobody looks at her. It’s as if they see right through her. She is invisible. I read the posters as we pass:

There’s a sink next to the posters. Two containers screwed onto the wall. One contains hand-wash. The other is empty: the alcohol gel has long since been removed. Alcoholics would come into the hospital and drink the hand-gel to get to its alcohol content. Those desperate enough to do that obviously need help but, at bursting point, the only strategy often available is to remove the gel. Nobody has time to scoop up a homeless alcoholic from underneath a sink and deliver treatment for whatever damage they have already done to their system. Bleeding oesophageal varices, as a result of cirrhosis of the liver, is one of the most distressing things I’ve ever seen – the bursting of blood veins inside the throat, until blood is spewing out. And, as with all complications of alcohol dependency, it can be a consequence of less alcohol than you’d imagine.

Most of the patients sitting on the small chairs at the side of us have someone with them. Arguments have been forgotten; hands are being held, hair stroked. A few patients are crying. I think of Hogarth’s portrayal of London in the painting Gin Lane when looking at the hospital waiting area. The poverty is palpable. There are drunk mothers and skeletal fathers. The room smells of body odour and of the metal of old blood. Accident and Emergency may not have changed as much as you might initially think since 1215, when the nuns and monks running a London hospital saw it as a place to provide shelter for the poor, sick and homeless. The first nurses at one such hospital began training on 9th July 1860 and, upon graduation, would be given a chance to visit Florence Nightingale in her own home – an exciting occasion for a few people to meet her in person, but also terrifying: Nightingale kept notes on the students in the school, including their ‘character’. What would she make of me?

The hospital remained a place for the poor throughout the nineteenth century, though nursing was becoming formalised by then. Nursing carries with it the echoes of history: nurses would have lost their jobs, had they married. There are, of course, plenty of married nurses now; and, as a junior nurse, I knew a large group of unmarried matrons in the profession, some of whom were living in Spencer House nurses’ home, a place we referred to as ‘Spinster House’, as we failed to imagine how much of a person good nursing requires. Nursing is a career that demands a chunk of your soul on a daily basis. The emotional energy needed to care for people at their most vulnerable is not limitless and there have been many days when, like most nurses, I have felt spent, devoid of any further capacity to give. I feel lucky that my family and friends are forgiving.

Betty coughs, puts her hand over her mouth. Her thin shoulders shake. She reaches for the handbag that I’ve put at the end of the bed. I lift it higher onto her lap and she gets out a crumpled tissue, wipes her mouth and puts it back in the bag. She keeps hold of the bag, clutching it as if it’s a child. I put my hand on her arm, ‘Nearly there.’

We pass the door to the outside area, where there’s a queue of ambulances: a doctor nips in and out to treat people who are waiting, while they still lie on the hard ambulance trolleys, and apologises for the lack of beds. There is a cleaner constantly mopping the floors, and occasionally she shouts into the air above her head: she has a long-standing mental illness, and the NHS is a non-judgemental employer. The staff come from every possible country, every background, and completely reflect the patients they serve. I’ve worked with nurses from all corners of the world; nurses who’ve been homeless themselves; one who worked as an escort to support her studies; nurses who have family members who are dying or who are themselves going through cancer; those who are caring, outside the work environment, for young children and elderly relatives; nurses who are gay, straight, non-binary, transgendered; who are refugees; who are from incredibly wealthy backgrounds or from the kind of council estates where police only travel in groups. Surely there are very few professions with such a diverse cast of characters.

There is movement in nursing, between wards and specialities, and in London there’s a high turnover of staff moving between hospitals, but in other parts of the UK nurses tend to stay longer and put down permanent roots. ‘I’ll have to wait for someone to retire or die, if I want a promotion,’ a friend moving to rural Cumbria tells me. But regardless of where the hospital is located, there is an army of people staffing the NHS to meet the needs of the masses: such as the women who make clothes for babies or work in the shop; the kitchen staff; the women from the linen room; the pharmacy assistants; the biomedical engineers.

Dozens of different languages and accents are spoken in A&E, and the list of translators behind the receptionist’s desk is ever-growing. It rarely gets used. People often have a young relative with them, or there is a porter or cleaner from that particular part of the world. There are arguments against translation from non-experts; a suspicion, on the part of the nurses and doctors, that the words are being softened and not translated precisely, but it’s quicker than finding a translator.

I wheel Betty on, past the separate children’s A&E, the line of beds where there is a long rectangular desk, at the side of which lie piles of paperwork: Do Not Resuscitate forms, observation charts, admission notes. There are shelves and glass doors behind which are cupboards full of equipment, laid out on large pull-out trays; and in front of the doors there are crash trolleys equipped with everything that might be needed, if someone has a cardiac arrest. Betty looks all around her, her head flicking from side to side. She holds her bag tight to her chest. Still, everyone we pass looks at me, and not at Betty. She remains invisible.