Hospital Babylon, by Imogen Edwards-Jones: 2011, Bantam Press, London. Pages 1-319. Price: $A32.95 (pb).
Reviewed by Ian Freckelton SC
Hospital Babylon is an archetypal airport book. It can be read on a flight between Brisbane and Melbourne, as long as there isn’t a distraction on the television screens or too much turbulence. It is written by Imogen Edwards-Jones (author of, among other books, Hotel Babylon, Fashion Babylon, Beach Babylon, Pop Babylon and Wedding Babylon) and she acknowledges unnamed others as having provided information for the book. In short, it is written to a formula, amalgamating the stories told to her by a series of anonymous persons in the “industry” about what is said to be the reality of life for a young doctor in an accident and emergency department that is part of an unidentified hospital somewhere in England. As such, it retails multiple stories, generally the most salacious, and cannot in fairness be said to be representative of its subject-matter.
The book is written in the words of a young male intern over a 24-hour period of his last rotation through an accident and emergency department. The subject asserts (p 16) that:
A & E is universally acknowledged to be the worst department to work in in the whole hospital … It is viewed as the worst mainly because it is hard to do a good job. A & E is still about waiting times and getting people in and out as quickly as possible. All you can do is just enough either to patch them up and send them home or move them through the system to somewhere else.
He identifies with frustration the kickbacks given to some doctors by specialists for making referrals to them and the easier life of practitioners who have nothing to do with the hurly-burly of the A & E provision of medical services. He observes the incidence of errors among A & E doctors whose concentration wavers, as well as the level of protection afforded to them from within hospitals, protection which is not related either to the seriousness of their mistakes and the risk that they continue to pose or to the extent of their insight into what has gone wrong or what has caused their errors. By contrast, he notes the way in which breaches of bureaucratic regulations can be dealt with in a heavy-handed and unfair manner by “the system”.
A moving part of the book relates to an elderly lady who is left unattended while awaiting radiology for a significant period of time, during which she deteriorates without anyone being aware of the worsening in her condition until it is too late. The subject doctor is responsible for some of what occurs, although he cannot admit it. He is unable to face the daughter who attends later to see her mother who she quite reasonably expects is at no particular risk and will still be subject to investigation for her presenting condition.
An issue which arises on more than one occasion throughout Hospital Babylon is the disorganisation which can result in young doctors undertaking shifts that can extend for up to 24 hours or multiple shifts in very few days. Concomitant with this is a level of exhaustion which can only conduce to errors and poor exercise of judgment, both professional and personal. Such overloading of shifts is asserted still to be prevalent in spite of attempts to deal with the issue throughout the NHS. In addition, there is a radiating impact on their families and those with whom they endeavour to have relationships. He comments (p 228):
Working here really affects your personal life in ways you could not possibly imagine. Quite apart from the long hours, the high stress, and the matter-of-fact attitude you have to things like cannulating yourself and popping extremely strong cocktails of drugs to make you sleep, keep awake or just plain feel a little bit better, we also become inured to a lot of things. After you have seen life and death at its most raw, visceral and gruesome, you become cauterized, so much so that it is often quite hard to get emotional about anything.
A useful part of the book relates to the doctors’ and nurses’ sexual behaviours, the usage of alcohol and drugs and the detachment which the A & E workers need to develop in all aspects of their lives to try to survive the demands of not just the environment but the system which places so much pressure upon inexperienced doctors whose learning curve has to be very fast but who nonetheless shoulder heavy burdens in relation to their patients. Although the book relates a variety of entertaining episodes in which sexual transgressions take place, amusing interactions with patients and scenarios in which, for instance, various objects are lost in a variety of orifices, the distress of all concerned when their best efforts fail to treat a patient effectively or to succeed in a resuscitation is authentically conveyed.
Another component of A & E life which is effectively depicted by Edwards-Jones is the myriad of difficulties posed by those with mental illnesses and/or substance dependencies who take up a great deal of time in emergency departments and who cause so much difficulty and risk for staff. He recites what he was told by an experienced consultant when he started work in the A & E department and complained to him about drug-addicted patients (p 95):
He told me they weren’t trouble, they were a challenge. He also reminded me they were victims of life, that what we should do is turn back the clock and see how it all started. We should try to understand rather than sit in judgment. Some were born victims, there was no question of that. But some were also weaker than others. They were simply not able to cope with what life had thrown at them. Some had fallen to the bottom of the pile because they didn’t have the discipline or the strength of character to keep standing, keep fighting. They were just not capable of sorting themselves out.
Such a characterisation aptly captures a well-intentioned attitude on the part of many medical practitioners. In terms of the values and assumptions of the doctors, much also is communicated by the many (judgmental and dismissive) acronyms that the principal characters identify as regularly used in the workplace.
All in all, Hospital Babylon is a surprisingly engrossing book. It is accessible and entertaining. It captures aspects of the life which it seeks to depict and at times it is moving, memorable and plausible in the stories and experiences which it relates. It is well researched. It also provides something of a perspective into elements of what takes place for good and ill in the complex and demanding environment of the A & E department. That is not to say that it isn’t sensationalised for the sake of a good story: of course, it is. Disappointingly, it deals particularly poorly with the female perspective of those who comprise a majority of young doctors and the race and ethnic issues which are part of modern medicine in England, as well as in Australia, Canada, New Zealand and Australia.
However, should readers of the JLM find themselves without the latest copy, and without work to which they must apply themselves on a plane flight, they could do worse than be diverted by the pages of Hospital Babylon.
The citation for this review is (2012) 20 JLM 470 at 472.