‘Hi, I’m Ben. I’m a doctor and I’m here to help get you home. How are you feeling?” I don’t normally introduce myself to patients by my first name. But Toby Harris has only just turned 18 — and, six days ago, he was on the brink of death.
“I’m okay,” he says, fixing his scared eyes on mine, his voice a whisper. He’s tall and good-looking, with pierced eyebrows, tattoos running up his neck and a tough-guy attitude — but he knows he’s about to cry in front of a complete stranger.
“I just want to go home,” he mumbles as he screws up his face to try to stop the tears. The two Turkish nurses who’ve brought me to his bed don’t speak any English but they’re almost crying, too. When Toby has calmed down, I ask him about his accident.
“I was on a moped,” he begins. I wonder if he has any idea how often my consultations begin with those five words. “We were racing about, chasing some girls, having a laugh. I’d been drinking, but that wasn’t why it happened. It was the gravel — I hit a corner and just lost it.”
The only good news was that he’d been wearing a helmet — the best decision he’d ever made. Now I’ve been flown out to bring him home safely — courtesy of his travel insurance.
That evening, I walk on to my hotel balcony and gaze over the streets of this anonymous Turkish town. There’s that wonderful muffled buzz you hear just after the sun sets on a really hot day. I breathe in deeply. It’s on nights like this that I love my job the most.
Two years ago, I was going slowly mad. I’d been working as a doctor for a few years and I was about to start another set of 1,000-hour-a-week shifts. About that time, I acquired a new flatmate — a nurse who earned extra cash from being sent all over the world to rescue people who’d been ill or injured on holidays or business trips.
When she couldn’t do a job one weekend, I had a quick interview and did it myself. Most of my colleagues said I was crazy, but a few months later I quit the hospital and signed up.
My new boss, Jackie, didn’t attempt to sugar-coat the long hours. But she also talked about the perks: how grateful most of our patients are; how much better it is than chasing targets on a hospital production line. Then she listed some of the things she’d been to lately — concerts in Las Vegas, museum openings in St Petersburg, tennis tournaments in Dubai. She also had premier or gold status in almost every frequent-flyer programme.
“So, do you like the sound of it?” she asked towards the end of my interview. “You had me at the air miles,” I joked. I’ve been jet-lagged ever since. My girlfriend Danielle dumped me because I do up to eight jobs a month and am always away — but I still think it’s the best job in the world.
At our base in Hounslow, west London, we have a handful of full-time doctors and nurses and a few dozen freelancers who do occasional jobs. The variety is astonishing: recent repatriations have included everything from a brain-damage case after a jet-ski accident in the Dominican Republic to a woman who fractured her skull when she walked into a plate-glass window at a hotel in Switzerland.
My Turkish repatriation, I’m happy to say, looks as though it’ll be one of my easier jobs. Toby, who’s from Newbury Park in east London, has a medical record as clean as the hospital’s blindingly white waiting area.
However, his body took quite a battering when it spilt onto a road on Gumbet Bay seven days ago. After a blood transfusion, he had to have skin grafted from the back of his legs to his upper arms. Then he was in theatre for three hours while they pinned his right thigh and shin bones back together with a medical Meccano set. He’d also broken a handful of ribs, one of which punctured his lung, so they had to put in a chest drain to keep him breathing.
His Turkish doctor says he’s been stable for 48 hours: “If he were my son, I’d be happy for him to fly.” I know, however, that there can be a huge temptation to hide just how sick British patients are. Doctors often just want to get them discharged and off their wards. Then the repatriation doctors have to get their hands dirty if it all goes wrong at 35,000ft. Which it often does.
It’s 2.30pm. We’ve pre-boarded through the service lifts into the galley, and Toby and I are having a bit of a laugh in our business-class seats — which on a European charter flight seems to mean economy-class seats with different coloured fabric.
He’s transformed. “I never thought I’d see the f****** sun again,” he says. A few moments ago, he started flirting with one of our flight attendants. It’s safe to say he’s on the mend.
He walks slowly to the loo and lumbers back a few minutes later. But the happy mood has vanished. He’s looking right at me, the way he did that first moment in the hospital. “I just can’t ... just can’t ... breathe.”
None of the cabin crew is anywhere to be seen — and I have a terrible feeling I’m going to need them. Meanwhile, people are leaning around their seats to see what’s happening. Just when I’m going to need every tiny inch of available space, it’s fast being taken from me.
A clock’s begun to tick in my brain. It’s Toby’s lung. It has to be. And if I’m right, he could die.
“I need to get you on the floor.” We’re one row from the emergency exits, so I half-drag him towards those few precious square feet of space. A woman gives a little scream. Then another. The aisles fill up with people. Where the hell are the cabin crew?
I wrestle with Toby’s T-shirt, trying to rip it off. “Shit. Shit. Shit.” His chest drain has fallen out. The wound between his ribs is gasping like a tiny, angry sea anemone, sucking air into the space between his lungs and his rib cage. I know that his lungs will soon collapse, and his heart will then shift to one side. He could go into cardiac arrest within minutes.
“Buddy, you’re not going to like this,” I say, sticking a finger into the hole in his chest. Another wail from a passenger, inches from my face.
“I need the bag from that locker back there. I need it right now.” But everyone’s frozen in shock. I’m about to ask again when a stewardess arrives.
As she digs out my gloves and tries to find my chest-drain kit, I say: “Can someone put this glove on my hand?” An elderly man, who appears to be crying, rips open the packet and pulls the latex over my left hand.
The clock’s ticking fast. The stewardess has found the drain kit, which looks like a long metal knitting-needle inside a clear plastic tube. My job is to push it into Toby’s chest; then I have to reattach the vacuum bottle at the end of the old drain.
As I grab the tube, I remember what my lecturer at medical school once said: “Inserting a chest drain is a particularly unpleasant procedure for both the operator and the patient.” He certainly wasn’t lying. I don’t think he ever did it in front of a planeful of terrified passengers.
“Toby, be cool, trust me, keep your eyes closed.” Tears squeeze out from his closed eyelids and run towards the cabin floor. I calculate we’ve got less than three minutes. There’s another wail from the lady in seat 8B.
I need to aim right over the top of the nearest rib. Go too close to the one above, and I’ll hit an artery. Every millimetre counts — this would not be a good moment for turbulence.
It looks as though I’m pushing a sword into Toby’s chest. “What’s he doing with that thing? Stop him,” a woman is shouting. “Madam, this is a doctor. Sit down.” My stewardess is a lioness.
Now I need to stitch the new tube to Toby’s body — and it’s going to hurt. While the stewardess is looking for my stitching-pack, I feel a hand on my shoulder. “Doctor, do you want the other glove?” It’s the dear old gentleman from across the aisle. “You’ve been quite wonderful,” he says. Now it’s my turn to feel choked up. The kindness of strangers makes this job worth doing.
Toby’s breathing loudly now; his face is pinched tight, his teeth biting into his lips to stop himself crying out. By the time I’ve made the last stitch, I’m sweating. I note we haven’t spilt a single drop of blood on to the plane’s carpet.
“Can he lie here a moment?” I ask the stewardess. I turn to face her and see she’s crying. “It’s the air-conditioning. Sets me off every time,” she says, wiping tears across her face.
The next day, I’m back at our office in Hounslow to complete my report. It’s dull work, but I’m smiling because I’ve just read an e-mail from Whipps Cross hospital, where Toby was delivered from Gatwick.
“He’s going to be absolutely fine,” the surgical registrar has written. “He wants to say that he is ‘never going on another f****** holiday again as long as I f******, f****** live’.”
My next patient is in St Tropez: a 74-year-old widower who was on a coach tour round the south of France. He fell, hit his head on a pavement and now has pneumonia.
I turn up for a business-class flight, dressed in my usual gear: slightly scruffy black cargo trousers and a dark-blue polo shirt that won’t show too much blood or vomit.
On my way to the hospital in a taxi, I read my patient’s medical history file. I’m surprised that he reckoned he was well enough to travel in the first place. He’s a lifelong chain smoker with chronic lung disease, and he’s told his GP he drinks 40 units of alcohol a week which means the real figure’s probably 80. When I arrive at the hospital, I’m expecting to see a scared, fragile shadow of a man. I’m wrong.
“If you’re here to take me back to Britain, then don’t bother,” are his first words. There’s a twinkle in his eye but I’m unsure how to take this. “Have you seen the food they’re giving me? Cordon-bloody-bleu. Better than anything I got on the holiday. I don’t think this is a hospital at all. It’s more like the Ritz!”
The French attending physician is smiling broadly. “Mr Jamieson is a very satisfied customer. He’s been very popular with our nursing staff.”
The patient calls me closer. “It’s like Carry On Nurse in here. Sexiest women I’ve ever seen. Young man like you, you should get yourself a job here.”
“Well, I think we do have to work out how to get you home all the same,” I say.
“Can’t I just have another week? There’s someone very special I’m hoping will give me a bed-bath soon. I’m planning on giving her quite a surprise when she gets down south, if you know what I mean.”
He gives me a large wink and I know I shouldn’t, but I laugh. There’s more chat about how much he wants to stay, but there’s something else in his eyes. He’s an old man in a foreign country. Bravado lasts only so long. However much he goes on about “bloody gruel and battleaxes” in NHS hospitals, that’s where he needs to be.
“What about my bed-bath?” he wails. “I’ll find an old-fashioned matron to give you one back in Britain,” I say.
Why on earth did I use the words “give you one”? He’s laughing so much that he might actually bring on an attack.
The fun continues at Nice airport. I think we’re going to get arrested at security when he tries to get a petite brunette to pat him down, rather than the male officer he was originally allocated. On the plane, he swaps phone numbers with one of the flight attendants while I go to the loo.
‘The number’s yours for a tenner,” he tells me, with another theatrical wink and a tap of his big, red cauliflower nose.
“Mr Jamieson, you’re a very sick man, and I mean that in every possible sense of the word,” I tell him.
Fortunately, his condition remains stable all the way across the Channel. But the suggestion he makes when our flight attendant checks his seatbelt could cost him dearly in a sexual harassment lawsuit.
At Gatwick, he informs me: “We need to stop at duty free.” It’s pretty obvious what he has in mind. “You’re still unwell, Mr Jamieson. We’re taking you to hospital, so you won’t be able to drink or smoke. Why don’t you take this opportunity to . . .” I’m unable to finish.
“Don’t you dare patronise me — and if you don’t take me to duty free, I’ll have you struck off the medical register.”
I give up and wheel him silently into the last-chance duty free shop. Then I watch him: a seriously ill 74-year-old with lung disease, asthma, pneumonia — and God knows what else — buying 800 Benson & Hedges and two enormous bottles of gin.
The last I see of Mr Jamieson, as the ambulance crew take over outside the airport, he’s asking the young female paramedic a question. He’s clearly whispering, because she has to lean in close. It looks like another potential lawsuit in the making.
Shaking my head, I head back to Hounslow to dump my medical bag. I certainly won’t miss it — it’s heavy and bright orange with big white, reflective crosses on both sides. As usual, I feel like I’ve got a giant arrow over my head saying: “Prescription drugs! Syringes! Funky kit you can sell on eBay or use in some bizarre sex game! Roll up and grab it while the doctor’s not looking.”
It’s one of the many reasons I reckon we should get danger money. That, and a few of the patients themselves.
Recently, I was sent to San Francisco to fly home a man of 62. He’d been admitted to hospital after collapsing in tears at a diner and throwing all his china onto the floor. The hospital reported that he was suffering from extreme confusion — and it wanted to get rid of him fast.
I managed to get him on a plane, but when I tried to fasten his seat-belt, he started shouting: “Rape! Rape! This man is trying to rape me! Help me! Somebody get him off me.”
Even a sedative didn’t stop him telling every passenger who walked past on the way to the loo that I was trying to rape him.
I’ve never been so glad to land at Heathrow. But there was one last bit of embarrassment ahead. A lady came up to me as we prepared to leave the plane, and gave me a sympathetic smile.
“You’ve had a very difficult flight,” she said. “I do hope your father gets better soon.”
©Ben MacFarlane 2009 Holiday SOS: Sun, Sea and Surgery by Dr Ben MacFarlane is published by Hodder & Stoughton on July 9 priced £12.99. Copies can be ordered for £11.69, including postage, from The Sunday Times BooksFirst on 0845 271 2135
