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At the heart of general practice since 1960

The patient journey

They arrived early and waited in the car park. The hospital had been built in the early 1900’s in an Edwardian baroque style. When it was first built it was used as a TB sanatorium and then as a private health spa funded by wealthy patrons.

They arrived early and waited in the car park. The hospital had been built in the early 1900's in an Edwardian baroque style. When it was first built it was used as a TB sanatorium and then as a private health spa funded by wealthy patrons.

The building had been bought by the NHS in the 1970s. There had been many eccentric owners over the years who had converted, renovated and extended the buildings, they hadn't paid much attention to architectural harmony though and the different wings budded off haphazardly. In the centre, weighty, austere and un-moving was the gothic clock tower.

A set of revolving doors led them into the main waiting area. There was a chequered marble floor and wooden panelling, it was tiled, airy and there were pleasant murals on the walls. The couple were nervous. After speaking with her GP she had booked on-line for her outpatient appointment. It was an urgent assessment and their family doctor had looked concerned, she had known him long enough to read his body language. He had spoken professionally and reassuringly but the unspoken word is often the loudest.

The receptionist typed in her details, checked her date of birth, her address and then checked the spelling, she checked her surname and then her maiden name and then began the process all over again. There was no booking, nothing on the system, but sometimes that happened. There had been a lot of software crashes since the new system came on line, so not to worry, if she could have a seat in a smaller waiting room down the corridor she would ask the bookings receptionist to chase it up for them.

They walked down a carpeted corridor, there was narrow strip lighting over-head and the acoustics suddenly changed, the atmosphere was a little stuffier and the clip of her heels became muted. They waited on soft upholstery, a hospital clock ticking out the seconds. After three-quarters of an hour a receptionist appeared from the back room and apologised for the delay, there was something wrong with the system and she would have to speak with one of the nurses to see if her paper notes could be found and to see if there was an appointment slot available. Her breath smelt of coffee and cigarettes. The couple were asked to move upstairs and once again the receptionist apologised for the delay.

They wandered through a network of passageways and found the back stairs which took them up a flight. They followed the plastic blue signs to nursing and pre-op assessment out-patients, clutching their appointment slip. They took a seat again and waited. Around them there were gloomy faces, some of them jaundiced, glancing at watches, muttering, rifling through last weeks' newspapers, talking in hushed tones. No-one was called in and everyone waited. There was a brass reception bell which tinged, but no-one ever came. The only external reference came from the clock tower which beat out the pulse of the hospital.

Hours later a nurse came out, looking flustered, she apologised but she had looked in all the usual places for their notes but they seemed to have gone missing. The clinic hadn't received their referral and she was still waiting for the GP to get back to them. She was a bank nurse and the usual nurse was away on holiday and she wasn't sure what the routine was. She asked for their documents and hurriedly scanned them, flipping from front to back and then front again. She had a faint tremor. She went off with them into a back room to speak with her colleague and there was more silence, more waiting.

They shifted uncomfortably, the plastic seats warming under them, a water cooler bubbling like a modern cauldron in the corner. When she reappeared, several hours later, she asked them to take a wait further up, up the narrow passageway and she indicated where they should go. She wasn't sure what had happened but she hoped they would be seen today and added that one of the junior doctors would be with them. At least she would be able to get her bloods taken today even if she wouldn't be seen by the consultant. She would bleep the junior for them but she advised them that there would be a considerable delay because the hospital was very busy and they were short staffed at the moment because of the holidays.

The couple moved up a very narrow flight of stairs, they had to dip their heads to pass through the doorways and the air was becoming hotter and mustier. Whole sections of the hospital snaked and mazed out from the central corridors and twisted back on themselves and all was now lit with an eerie purple light. They passed rooms which were boarded over and locked, rooms that were full of debris and ancient fittings.

They squeezed into the waiting room. There were only a couple of other people now and it was cramped and airless. Time stagnated and her disease raced on. The hours ached by and eventually a doctor came and took bloods. He didn't know the patient or why she was there or really why he had been asked to take bloods but he took them anyway and asked her to press down on the cotton wool. She had already had bloods taken by her GP but she didn't want to argue, she just wanted to be seen by the surgeon, maybe the bloods had been lost. The young doctor couldn't tell them how long they would have to wait, the consultant had been called to theatre so they would just have to be patient.

They were asked to go upstairs and wait, the consultant would be with them soon.

They mounted a very narrow set of wooden stairs, vertiginous and brittle and by the growing sound they realised they were snaking up the interior of the clock tower. They reached the top and found themselves in the bell room. The clock's mechanism clicked forwards and enormous wooden and brass cogs pushed over the time. There were pulleys and networks of dusty leather straps, the bell was motionless but threatened its purpose.

There was only one other person waiting, he was a stooped elderly gentleman who helped her change into a white gown. She assumed it must be NHS regulation. The voluminous white folds swept the floor as she moved and it had a hood which she pulled over her head. She was invited through a small door way, she said goodbye to her husband and to her surprise she stepped out onto a boat which rocked gently under her weight. Water lapped at the sides. She felt stable, strangely calm and knew what to do.

Across the black water was an islet and lining the shore were the black fronds of cypresses that pressed up to the warm sky. Vertiginous cliffs of pale red clay were fenestrated and filled with strange architectural pieces, a forest of pinnacles mingled in with the rock. The old man began to row, they moved silently, glissading over the surface of the water. She looked back but both the hospital and her husband were gone. The clock chimed gently in the distance as she made her way to the island of the dead.

Dr Kevin Hinkley is a GP in Aberdeen.

Through the K hole

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