Tag: nhs

Some Cat’s Birthday, Somewhere

Oct 20th, 2022

Public Service Announcement: the hospital mission statement has recently changed.

A regular feature of my working day is stealing supplies from around the hospital. This is necessary, because a) our own stuff often don’t turn up and b) it is a larf. To this end, I encourage my fellow NHS cannon fodder to imagine that, instead of carting a patient about the place in a hospital bed, they are instead piloting a Viking longship in the ninth century, and the hospital is a monastery on the Isle of Iona. This initially drew a few blank stares but once I explained what the Isle of Iona is, and the significance of the Viking raids there, they embraced the idea with great enthusiasm and now return from jaunts to A & E or the ‘Big C’ cancer unit with drugs, nephrostomy bags and urine bottles, of which we never have enough. I have suggested we solve this with a grit tray along the centre of our ward like you would have if the patients were all cats but, thanks to the magic of stealing, these days are a thing of the past. As we enter the last weeks of 2022, my unit’s boast is that any mammal of any size can urinate in comfort. Actually, I think this should be the mission statement for the entire hospital, rather than the current one – ‘Our vision is to provide every patient with the care we want for those we love the most’ – which is just annoying.

My personal mission statement is that ‘It’s always some nurses’ cat’s birthday somewhere’ and I frequently remind my gallant team of this, as it means that cake is also up for grabs around the wards. It is usually found on the draining board of the small sink units outside the linen stores which are the impromptu staff room on most of them, along with the ‘I’m Not A People Person’ mugs – another strong contender for the hospital mission statement, now I come to think of it – and endless boxes of fucking Cadbury’s Heroes. This is unless you find yourself in paediatrics, which is all crisps for some reason. I’m not convinced that cholesterol is the evil substance it is made out to be, having read everything and spoken to everyone I can find about it during my current concerns about peripheral arterial disease, and am instead blaming refined sugar and processed foods. Sadly, I love these things very much, so am unable to share in the bounty of birthday cake theft. This is troubling, but now that being a wellness coach has replaced being a primary school teacher as career of choice for young middle class women, there are at least plenty of people to talk to about it.

Such is the plunder available that I have long thought it would be possible to survive at work by just eating cake and Cadbury’s Heroes. Imagine my surprise when I realised that some of the cannon fodder I am seeking to unionise actually do. I’m pretty sure they will be stealing biscuits and whatnot from stuff the patients get bought in by their families and so on, too. I’ve done that, if it’s those mad Christmas seashell chocolates or Ferrero Rochers or whatever although, being a gentleman highwayman, I tell the patient I am stealing stuff while doing it. Also, my motivation is gluttony rather than malnutrition, but I now know there are patients who have food brought in for no reason other than to feed staff. This is insanity. I know staff that order sandwiches and such for fictitious patients so they have something to eat, and that a blind eye is often turned to this, but patients actually feeding their carers is madness. Awful. It would be nice to be as proud of the NHS as people who don’t work in it are, but I’m afraid I am not.

Then again, this sort of thing is why unionising the cannon fodder might be a good idea. Also, I do have the germ of an idea about how to spark this into life, in the form of my personal development review. This is where you bang on about all the stuff you’ve done in the year and set goals and so on. I have spent most of the last year being appalled and horrified, so I don’t have much to say. I could set my goals for next year as being less appalled and horrified, I suppose, but might refuse to take part altogether on the grounds that I have no faith in the management of the NHS, which would lead to some interesting discussions when it gets escalated. My case in point would be the manager who actually writes my personal development review, who caused a member of staff to leave by repeatedly shouting at her, in anger, in front of colleagues, that the only reason she goes to football is because she is racist and homophobic. She was a Norwich fan, too, and they are a lovely bunch. She could’ve complained, but the person she would be complaining to is a close friend of the manager concerned – they go on holiday together and whatnot – so she understandably felt that this was pointless and now works in Pizza Express, where at least there is quite a lot of food about, I should think. Yes, I understand that it is tiniest conceivable spark, but that’s all you need really.

Anyway. The rest, as they say, is histology. In case you are unfamiliar, this is the clinical study of cellular structures and, come to think of it, would’ve been a more appropriate remark while justifying the theft of hospital supplies then going on about Vikings and the Isle of Iona. Hindsight is a wonderful thing.

Picters:

Main: A cannulation trolley of my acquaintance.

Top inset: The scrubbed floor of one of our operating theatres. You’d think that a flooring material that retains the slightest splash of iodine with the permanent appearance of a bloodstain would be seen as a design flaw, but it appears not.

Middle inset: The baffling and recently changed hospital mission statement.

Lower inset: Sid larking about in some woodland a couple of years ago.
Up North, Kicking Up Fuss

Oct 7th, 2022

Public Service Announcement: Since writing this post, the Royal College of Surgeons has ruled that Jungle is too mental for a clinical setting, although breakbeat hardcore is OK if it’s not too hectic.

Following on from our last chat, the topic of a Spotify playlist for surgery has been a hot one at work. This stemmed from thoughts about what I would want as the soundtrack to my own vascular surgery, should I ever require it as a result of peripheral arterial disease. It should be stressed that this is an as-yet unconfirmed condition, pending an MRI scan which I’ll pop down to East Block Level 2 for at some point, but my doctor and I are pretty sure I’ve got it. Countering her advice, I suggested that instead of lowering my cholesterol to combat arterial deterioration, I instead increase it so I form a natural immunity, a tactic for which I also lobbied when Nid was diagnosed with a nut allergy, although this was rejected by his mother who feared that if he didn’t have a food intolerance the other mums at yoga would think he was working class.

As I am fond of saying ‘I know we’re supposed to care for the patients – but are we though?’, and this extends to their Spotify choices for surgery, because there are six staff in an operating theatre, and quite often the patient is unconscious or a bit sulky, and anyway it can’t always be about them. The consensus among the medical professionals of my acquaintance is that the playlist should be bangers rather than classics, a banger being defined as a tune that you basically like and everything, but don’t often listen to but, when you do hear it, realise it’s mental. Classics are merely considered to be good, or ground breaking, or otherwise remarkable. This rules out the fresh new sound of my own beloved Beatles, as everything they did was classic, with no

identifiable bangers in sight, although as they were inventing not only popular music as we know it but the cultural landscape it would inhabit until the end of time, they were quite busy. My contributions were Groove Is In The Heart by Dee Lite, Incredible by M Beat ft General Levy, and Original Nuttah by UK Apache and Shy FX. Incidentally, it’s Pheno One Be Lit! on Spotify, ‘Pheno One’ being the primary operating theatre in my unit, in case you fancy it while facing surgery of your own.
I love the diet that contributes to peripheral arterial disease – or peripheral arterial delicious, as I like to call it – so I can’t complain when my blood vessels buckle under the resultant tsunami of cholesterol. Still, my signature dessert – two jam doughnuts in half a pint of double cream – is off the menu for a couple of weeks which, as I understand it, is how long chronic arterial conditions take to sort themselves out. To celebrate my lactose dependency, I also pioneered what my sister-in-law refers to as ‘double dairy’, which is a lot of double cream mixed with a lot of Cornish ice cream – refreshing at any time of day. Remarkably, I’m not fat. It would be easier if I was, because I could sort it out by taking up smoking in order to keep my appetite down. An average working day for me involves walking around 23,000 steps and cycling between 15 and 40 miles, so I am in shape and everything, it’s just that my customary celebration of the striking of each waking hour with four Mars bars and fifteen chocolate Hob Nobs may have to be re-thought before I end up having my legs amputated, which is the endgame of the condition if you aren’t careful.

I was about to say how much I approve of the reference to ‘eggs fried in butter’ that appears in Original Nuttah when I remembered my other playlist contribution: Street Tuff by the Rebel MC and Double Trouble. This was huge at West Ham during my teenage years, mainly I suspect due to the ‘Up North, kicking up fuss’ line. I

suggested this appear on the stickers we plastered upon pub windows, letter boxes and lamp posts on jaunts to the featureless frozen wasteland beyond Waltham Abbey, this being when you could travel cheaply on Inter City services by simply refusing to pay. At the time, they carried the line ‘Out Of Control And Heading Your Way / West Ham ICF Wrekin’ The Second’ and, while I liked ‘Wrekin’ The Second’ for the pleasing half rhyme, culturally colloquial spelling, and reference to what was then the Second Division of the football league, I questioned the plausibility of being out of control and heading towards something. ‘Out Of Control But Heading Your Way’ made more sense, I would explain on long journeys back from Blackburn or Sunderland or Hull, but agreed that the sentiment lacked punch, unlike the people I was talking to. Looking back, I suppose the paradox had a certain ring, and was certainly popular, as I am sure faded shreds of sticker in tiny forgotten corners of the north of England will testify to this day.

Medical, cultural and sub-cultural points of order aside, there is a new trade union to organise, as a couple of posts ago. The imagined course of action is a thrilling call to the barricades followed by a dramatic and acclaimed victory, but I cannot think of a single historical precedent for this. You could argue that Napoleonic France, Soviet Russia and Nazi Germany achieved it in theory, if you overlook the paranoid industrial slaughterhouses that all three became for the entirety of their existence, but I suppose the Peasants’ Revolt is nearer the mark. However, this tends to be remembered for what it was, rather than what it did, which tells you something. In any case, I am suspicious of the word ‘peasants”, as no group of people has ever referred to themselves thus, suggesting that the events are not being told from the perspective of the people in whose name they allegedly took place – which sounds to me like our old friends the middle class fiddling about with the narrative again.

Incidentally, I am aware of how equating my thoughts about conditions for lower grade staff within the NHS with some of the most important events in European history sounds, and also that it is a conversation that, for now, exists only in my inner dialogue. We are all capable of declaring war upon our circumstances and those of our peers, but I am aware that sooner or later you have to be – here we go again – Gavrilo Princip outside a Sarajevo delicatessen with a pistol in your pocket, watching an Austrian Grand Duke rolling towards you in a large car. I imagine that’s the awkward bit, really.

Picters:

Main: beach at Weybourne, height of the tourist season.

Inset top: Phone which I am supposed to carry at work in case I need to be contacted. I tend not to carry it.

Inset middle: This is not Pheno One, but Q-Artis Three, pretty much the same thing except it doesn’t get used much due to the weight of the machinery pulling the ceiling down.

Inset lower: My scrubs always end up with stuff written all over them by the end of a shift. It’s like the last day of school or something. They are nature’s notebook, as far as I am concerned.
To Pass The Time Along

Sep 21st, 2022

Public Service Announcement: This is a slightly bitty post, as I am experimenting with writing entirely on work time, either while waiting for the East Block lift, which is never in a hurry, or in the cardiovascular outreach office, an airless cupboard which has not seen natural light since 2002.

I was on a train recently when the driver announced via the public address system that we were ‘to prepare ourselves for dreadful news’. As my old friend Rachel pointed out from distant Nebraska, this is not a comforting way to address passengers on a mass transit system but, as we were still in Norwich station waiting to set off, there seemed little immediate cause for alarm. The news was that the Queen had died, and that the moment Smiths fans had been waiting for since 1986 had finally arrived. Well, not me, as I am both a Smiths fan and a monarchist, but still. The lady on the seat next to me immediately turned and said ‘My God! What do we do now?’ and I said there was no point asking me as I couldn’t believe it, even though we had been following the news of her physical deterioration at work all day. The Queen had, in fact, passed away as I was cycling onto Riverside from Barrack Street via the Bishop’s Bridge roundabout on the way to the station. Upon arriving home, I woke Nid to pass on the unhappy news. He had a considerable cry but, after his concerns about ‘what happens to the Spitflier’ (the Spitfire we saw during the Jubilee celebrations which he believed the Queen to be piloting) were addressed he promised to ‘defend the new King’ and went back to sleep. Thus, in our corner of the Realm, the three hundred year reign of lovely old Queen Elizabeth II was consigned to history.

Still, in the midst of life we are in death, as Agatha Christie, who should know because she was murdered on the Orient Express, would doubtless remind us, and my work up the hospital is an unending opportunity to contemplate mortality. Consider, for example, a nephrostomy, which is a surgical procedure whereby a thin tube is inserted percutaneously into your kidney to Lyin’ Eyes by the Eagles. It’s always Lyin’ Eyes by the Eagles, because patients under local anaesthetic can listen to their music of choice, and those with compromised urinary function love the Eagles. Lyin’ Eyes pops up on the ‘This is the Eagles’ Spotify playlist just as the catheter goes in, and during Tequila Sunrise, I will say ‘OK Ray/Joan, I need you to take a deep breath, deep as you can, and hold it till I tell you, OK?’ in my ‘now-pay-attention’ hospital voice.

(Tone of voice is more important than you might think. In common with people dealing with children or dogs, I have to use my ‘now-pay-attention’ voice, because if they don’t take a deep breath, they will enter cardiac arrest as New Kid In Town starts. If this was to happen, I assume the background music would return to Chaka Demus and Pliers’, cover of Twist and then Shout, which gets more airtime than you would otherwise expect in a clinical environment, because younger patients usually want ‘stuff from the 90s’. This, then, is the soundtrack to interventional surgery in the Norwich and Norfolk University Hospital in the second decade of the twenty-first century. Abba also feature regularly and, as an after thought, we will all have to get used to them singing about the ‘Dancing King’ now. It’ll be an adjustment but we’ll get used to it I expect.)

Anyway. I never tell Eagles fans they are a breath away from cardiac arrest during a nephrostomy. This raises an ethical point, as the information is clearly relevant and, assuming they have the capacity to understand, should they not know? I would argue that to do so could worry the patient out of a procedure which, equally clearly, it is in their best interest to have. Conversely, if I was too jocular, they might not take it seriously and inhale their way to the mortuary which, as the person who would have to wheel them there, only adds to my workload. My work is full of dilemmas like this.

Then again, I have learned that no good songs have ever been written about being on a highway in your mid-forties, thinking about some stoner you had a go on twenty years previously, which seems to be pretty much all the Eagles’ lyrical content concerns itself with, apart from the unforgettable Hotel In California, which is presumably about doing the same thing but drunk. The pleased-with-itself music of American baby boomers is fucking insufferable. Actually, I shall revise that, as I once sold a load of t shirts to the Doobie Brothers, most famous for Listen To A Bit Of Music, at Camden Market and they were a right larf. At around the same time, I sold stuff to Jon Squire of the Stone Roses, either Cagney or Lacey from Cagney and Lacey, the Blue Man Group and the lady responsible for shredding and burning Taylor Swift’s underwear after her two shows at the Shepherd’s Bush Empire. What halcyon days they were.

If I ever find myself having a procedure – not beyond the realms of possibility, as I appear to be presenting symptoms of peripheral arterial disease – I want twenty five minutes of white noise played as my music of choice, the same as at my funeral. At my funeral, I’ve always wanted to have a list of names of a) the people in the congregation I never really liked and b) why I never really liked them read out as I am gathered unto God, so there is a running order to be worked out there. Maybe white noise, then the names of a) the people in the congregation I never really liked and b) why I never really liked them, then a minutes’ applause (as is the modern way), then the national anthem, then speed dating among the single members of the congregation to lighten the mood. Yes, that sounds lovely.

So there we are.

Photards:

Main: Northrepps church.

Inset top: An operating theatre, aka procedure room or suite or lab. I’m lobbying to get a pool table put in to make it less formal.

Inset middle: The ‘box’. If you are ‘running’ for a theatre you sit here and prepare anything that might plausibly be required during a procedure in case someone in the room asks for it. It’s relatively simple to run for a specialised room like this, but in main theatres it is extremely complicated and requires skill, speed, and detailed knowledge.

Inset lower: Scrub room with trough-style urinal.
The Things You Won’t Allow Us, Part 2

Aug 12th, 2022

Public Service Announcement: we finished last time declaring an intention to form a trade union and save the working class. It wasn’t a terribly dramatic declaration, as it took place silently, in my head, during someone else’s liver biopsy. Still, there we are. I’ve discussed it with my current girlfriend and my dog, who both like the idea.

The founding of a trade union and resultant socio-political shift away from the middle class is not a usual train of thought to pursue while assisting with surgery. However, as our patient had no short term memory, and needed no conversation other than constant reassurance that he wasn’t being kidnapped, I was able to think the whole thing through in some detail. He was, in fact, admirably calm for someone who considers themselves a kidnap victim, and was happy enough with me saying, in my hospital voice, ‘Hospital, Ray. You’re in a hospital in Norwich. Yes. Myself and this gentleman are just doing a quick liver biopsy on you. Biopsy. No, your liver. Hospital, Ray. You’re in a hospital and myself and this gentleman are just going to do a biopsy on your liver. Liver. Your liver. Yes. Norwich. No, you’re in hospital, Ray. You and your liver are in a hospital in Norwich’ for forty five minutes until a tiny bit of Ray was in a small pot and away for analysis with those dorks in Pathology.

Anyway. Our current nursing unions seem hopeless. In fact, if there is one thing that contemporary socio-industrial history has taught us, it’s that nurses will put up with anything. Nursing unions can’t even protect nurses, heroically settling for whatever pay rises the government tell them to, and so forth. So what of we non-clinical staff, with our thirteen hour, minimum wage, no-paid-breaks shifts and routine undertaking of tasks for which we are neither qualified nor paid because there is simply no one else to do them? I imagine that we are a long way down their list of priorities. One of the reasons I imagine this is the sheer number of times we are referred to as Heroes on sundry NHS social media outlets – any employer who constantly tells you how heroic you are is not paying you enough, and no amount of rainbow lettering and applause emojis can hide this. In fact, the only tangible use of union resource I can ascertain is stickers all over the East Block bike shelter with ‘She Was Just Walking Home’ on them, as a reminder that assaulting middle class women is bad. I am always tempted to write ‘What? On her bike?’ underneath, but have thus far thought better of it.

I should very much like to make things better for my fellow workers. Incidentally, I don’t mean ‘workers’ in some fanciful, middle class Socialist sense. I am a right-leaning free market pragmatist, so I mean ‘workers’ in the sense of actual people in actual employment, in the actual world that actually exists. I should probably just say ‘employees’ to clear all that up, come to think of it. Anyway. I think the Non-Clinical Workers’ Union, which is what I shall call it, could not only provide a lesson in the correct placement of an apostrophe in conjunction with a plural possessive noun, but valuable representation for low grade staff such as myself and my A Team, who keep every hospital in the country ticking over. If the NHS is saveable, it is us who will save it. Indeed – If there was hope, it must lie in the proles…in those swarming, disregarded masses, to quote George Orwell in his famous book ‘It’s 1984!’

We needn’t be as flimsy as the existing nursing unions, either. For a start, we don’t have a twenty five year career tied up in the NHS, so we have no vested interest in maintaining the status quo. Also, because we are not bound by Hippocratic or any other codes, we do not need to be squeamish about strike action. I envisage this consisting of sitting calmly and cheerfully in the staff room for three hours every Wednesday afternoon offering people tea and biscuits, rather than shouting in a donkey jacket in a car park like it’s the nineteen seventies. Above all, I want my union to be quiet, dignified, and relentless. We’ve all been listening to shouty people for far too long and, in the interests of balance, it might be nice to let calm, rational people have a go for once.

To do this, I would need to disentangle it from the middle class Left. This is important as, throughout my lifetime, their purpose has been to take politics away from those who need it, via a concerted socio-economic campaign of marginalisation, demonisation and ungovernable personal politics. This confiscation of power has been catastrophic for the working class and therefore society as a whole, and must be challenged. However, we must remain a specific group of employees striving against specific circumstances of our employment, rather than acting for or against undefinable notions of class because, although the usual outcome when identifying societal groups as your problem is that you end up very boring and very embarrassing, there is the occasional capacity for thousands of people to get killed. Above all, we must remember that when you stare into an abyss, it also stares into you, to quote Frederick Nietzsche in his famous book Calm Down A Bit, Before You Get Carried Away.

I finished formulating all this as Ray’s biopsy ended. It concluded amid a lot of ‘Finished, Ray. We’re done now. We’ll just sort out some paperwork for your doctor and send you back to your ward. Ward. Doctor. Hospital, Ray. You’re in hospital, Ray. Biopsy. No, we’ve done it. Just then. You have a little doze and then we’ll take you back to your ward. Ward. Hospital, Ray. You’re in a hospital, Ray’, and so on.

As I pushed Ray and his bed out to Recovery, I said ‘That’s the trouble with hospital, Ray, isn’t it? No one tells you anything’, as a little chuckle for me and the surgeon.

‘About what?’ he replied, neatly putting me back in my box.

Photards

Main: Cows in a field. These things are massive and, if startled, can jump twenty feet vertically.

Top inset: That time a trampoline ended up wedged between our house and the garden wall after a ferocious coastal storm. It’s my son’s trampoline. He refers to it as a jumpoline, and we are lucky it didn’t smash the kitchen off.

Middle inset: I am already a union rep, and enjoy it, although I don’t represent anyone at the hospital. Well, yet, anyway.

Lower inset: There was an amusing couple of months in my son’s life when, if I set the hands on this thing to ten o’clock, and said ‘Look at the time!’, he would put himself away in it.
The Things You Won’t Allow Us, Part 1

Aug 8th, 2022

Public Service Announcement: This was an extremely long entry which I split in two in order to get a bit of a cliff hanger going. It’s not much of a nail biter to be honest, unless your definition of tension includes absent mindedness and socio-politics. It takes all sorts though, so if this is your definition of tension, move to the edge of your seat now or, if you’re standing up, start chain smoking and pacing about in an agitated manner.

I am fond of saying that a hospital is one bunch of fat depressed people looking after another bunch of fat depressed people, and that the only way to tell staff from patients is that the patients are lying down. There is more to it than this, of course: consultants are generally called James or Ben, whereas matrons, charge nurses and ward sisters are called Laura and Lucy and Ellie. Everyone else is called Lauren and Ellie-Mae. Patients are called Ray or Phillip or Mary or Liz. You get the occasional Kirsty and Helen among both staff and patients, but I am to date the only Paul who has ever been in a hospital, and as such I am a medical pioneer.

As mentioned last time, my pioneering spirit has seen me become de facto supervisor of a little band of trainee trainee nurses. We are like the A Team, except that we don’t have any useful skills, we don’t have a van, and no one but the NHS would hire us to do anything whatsover. A dog could do most of our work, but we are cheaper because we bring our own lunch in. Then again, it is cannon fodder such as we who run the hospital, and everyone acknowledges this. Myself, I do everything from setting up operating theatres with all the drugs and what not to working directly with surgeons and scrub nurses during operations to wheeling patients, most alive but some very much the opposite of that, around the hospital, to proofreading and editing hospital literature – which gives me an opportunity to remove awkward phrases such as ‘medical doctor’, and replace them with ‘doctor’, and take the chance that people won’t assume their liver biopsy will be carried out by a time traveller in a phone box.

I enjoy a day of assisting with liver biopsies. Essentially, you’re a scrub nurse, working intimately with both the surgeon and the patient. I like to relax patients beforehand by saying I’m a bit of a fainter when it comes to needles, so can you hold my hand and tell the surgeon if you see me keeling over, etc. Fortunately, I’m not a fainter when it comes to anything at all or I’d have a hundred reasons to pass out every working day but, rather pleasingly, I do sometimes have patients saying ‘You alright, Paul?’ to me, mid-procedure. I also sometimes ask if they’re OK with Labradors because the surgeon is blind, or do they mind if we have a kebab before we start because we’re very drunk, and so forth. I mean, obviously, you have to read the room before this sort of thing but, as I am fond of saying – ‘If you can’t muck about during surgery, when can you muck about?’.

While I do not yet perform such a prominent role in our hospital’s main theatres, they are also often surprisingly light-hearted places. This is good, because it shows that the theatre team is confident and relaxed. You wouldn’t want your operation carried out by people who were anxious and nervy, after all. The first time I was in main theatre to, I think, assist with some kind of urology expedition I spent the entire time discussing childbirth with the anaesthetist, explaining that at the moment of my son’s birth all I could think of was Kit Kats, as they had those mad chunky single digit ones in the vending machine down the corridor and I was very peckish at the time. He sympathised, because there was a Full English deal on at the canteen – any nine items for 99p – when his daughter was born and, despite her being successfully delivered two and a half hours before the offer ran out, he still only just made it. He went for maximum variety, including fried tomatoes, probably I suspect as a celebration of the earth’s wondrous bounty. I’d have had six soft poached eggs and three slices of light granary toast myself, but becoming a father is quite tiring and each new dad needs to regain his strength as he sees fit.

All in all, the ability to be not quite in the moment is a valuable asset for anyone working in a hospital, and if you’re thinking of working in one yourself – perhaps to fulfill a lifelong ambition of being tired and poor – I strongly recommend you learn how to do it. I mean, pay attention and all that, obviously, but also try and think about something else quite often or you won’t get through your first week. The results can surprise you. For example, during a recent routine liver biopsy, I realised that I needed to start a trade union, and save the working class. It was quite a remarkable moment, although obviously under the circumstances I had to keep it to myself.

Photards:

Main: The biscuit tin in A & E. As usual, it doesn’t have any custard creams in it, because I routinely steal them on behalf of the Radiology team.

Inset top: It will never not be the Jubilee in our staff room.

Inset middle: The scrubs cupboard. XL and XXL usually run out first. The NHS is so fat.

Inset lower: This used to be part of an airfield during World War Two. I let my dog run around and go nuts here now. The arrow is pointing towards Germany.