....'that doctor with the costa in her hand...' And the weird and wonderful world of 'Ash cash'

10 September 2017

Hello all, Laura here again. I'm afraid to say that it's happened. I've become a costa addict. I've gone from not being able to stand the stuff to having at least three coffees a day. I've have gone through several loyalty cards, and with Grimsby hospital hardly being massive, the café staff, Angela in particular, knows which coffee I have each time I go. I swore never to be one of those doctors... Oops. I heard a nurse chatting to a patient, and the patients response was 'it was the doctor with the Costa cup her hand...' I'm going to wean myself off it. It's not good for you, and neither for my bank balance. I have a pricey wedding to save for next year. Imagine it now - 'sorry numerous wedding guests, you're eating a ham sandwich and crisps for your dinner because LAURA spent all her money in Costa! Honest to god! Don't get bitten guys!

On a serious note... Today I was sitting in the office doing VTE forms (the bane of my actual life) and a lady in scrubs came in on a mission looking for 'Dr Cunliffe, GMC number blah blah' I quickly wondered what on earth I had done, as this all sounded very official....

She was from the morgue (not a dead body obviously) and was looking for me to complete a death certificate and also a crem form for a lady I had sadly certified the previous evening when I was on call. (Further post to follow!!) I trotted down to the morgue, rather sceptical I must admit - I've avoided them for 5 years at med school successfully and now had to go into the deepest darkest depths of the hospital. Only kidding, it's right next to the canteen!! Upon arrival I was met by a very pleasant man called Nick. What a nice guy Nick is! He threw his gloved hand out for me to shake it. I hesitated as he had just zipped up a body bag and wheeled the draw back into the fridge, and he must have noticed my rather un-keen face! He removed his glove and I happily shook his hand! He then proceeded to ask me 'the most important question .... Do I have sugar in my tea?' Well I was sold. I love the morgue now! Anyway I then preceded to fill out the death certificate for this very poor 70-odd year old who had died the previous evening. To be perfectly honest I knew grossly her history and I knew that she was on end of life care with lots of input from the brilliant Macmillan nurses for the past week or so, so I hadn't gotten that involved in her care, but I had to fill out this cause of a death on the certificate. Something which is much harder than you would imagine it to be, even with the he help from the HYMS Friday afternoon sessions in 5th year (which I highly recommend you attend!) I sifted through her notes and realised that she had had two surgeries during her hospital stay. Oh god. Coroner needed to be involved. Great. There goes my lunch! This lady had been admitted with a strangulated hernia which was repaired as an emergency case. Post op she deteriorated and CT showed she had an ischaemic portion of bowel. She was then re-operated on to remove the dead bit of bowel, and then really unfortunately suffered an anastomotic leak of the two ends of bowel. The team had a discussion with the family and the patient and she decided that she didn't want any more surgery, and she died approximately one week later of multi organ failure from intra abdominal sepsis. Which I'm sure you all know is an unfortunate but not unheard of complication of bowel surgery. People with poor vascularise often get leaks and it's down to lots of contributing factors, all of contributing factors, all of which this lady had. TRY WRITING THAT ON A DEATH CERTIFICATE. What I learnt was .... Ask the consultant in charge of the care for help in what to write. They will be more than willing to help you as they know it's a difficult job. Second of all, I realised that speaking to the coroner isn't as scary as I initially thought it would be. He was a really nice fella and really helpful. He decided that in this incidence the death didn't require any further investigation and so I could sign for the body to be cremated (after I made sure she didn't have a pacemaker etc! - imagine the bill if I managed to blow up the crematorium machine!)

I did the job and as I stood up to leave, Nick shouted for me to give him my bank details. I turned around and asked what he was on about! It was for the payment, the distasteful but widely used term, 'Ash Cash'. What a strange feeling to be paid for that! But it's all to do with the fact that I have to sign to say that everything on that form is correct and that that body can be disposed of, as we cannot get it back once it's been cremated obviously! Also I take the responsibility to say that the body doesn't have anything in it which could damage the machinery or any people in the process such as radioactive implants So yes, it was a very valuable lesson, and one which I don't want to do too many of either!

Laura C

Dr Laura Cunliffe is a Hull York Medical School graduate (Class of 2017) and a foundation year 1 doctor in Grimsby hospital currently working in general surgery.

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