There’s nothing like sitting on the loo in a big busy tertiary hospital.
The moment you take your first steps through those half-working automatic doors and cross the threshold into your first clinical environment as a medical/nursing/physiotherapy/whatever student, you begin to realise how much of the day-to-day functioning rests on what goes on in these toilets. A hospital’s flow, so to speak, depends equally on what is flushed down its S-bends as what comes limping into the ED. Patients’ poo will keep a clinician up all night on occasion, and it will keep patients in hospitals for days or sometimes weeks. The lack of it. Too much of it. The colour of it – extra handwringing if it’s red or black. As the days go by – three, four maybe – before you think about upping the Movicol or introducing an enema to the regime, like a general in wartime, shifting infantry around a map. The dreaded manual disimpaction as a chance to reflect on the life you signed up for, and the one you used to enjoy. But it’s not just the patients dropping their pants on the daily.
As a medical student on clinical placement, I used to spend a fair chunk of my days in these toilets. Often, they would be hidden around a corner, next to an old supply closet or opposite a set of elevators. The more remote and obscure the better. Extra points for multiple cubicles for the picking (given there was always one door which had a broken lock), or even a view of the carpark. I often had little to no clue what I was supposed to be doing as very junior medical student. Days would be spent roaming the corridors of the hospital, lost or simply drifting from one sensation of inadequacy to the next humiliating episode. Ward rounds were either incomprehensibly fast, or eye-wateringly slow. At the end, the actual salaried members of the team would run off in different directions like a bag of marbles dropped on to paving. I would be left cut loose, spinning in the trail of dust left behind as the sound of their RM Williams boots squelching on linoleum got fainter and fainter. Occasionally I would be asked to do a procedure, probably one I had never done before – sometimes ones I had never even heard of before. It became almost ritualistic to go to the toilet before embarking on these things. It served a dual purpose. One: I was able to let out a little nervous shit. Two: I could hurriedly look up a video on my phone of what the hell they were on about, so I didn’t look like such a huge idiot. I was not always successful in the second endeavour, but it was worth a shot anyway. Sometimes I would go to the toilet to just sit. It might be the only part of the day I was afforded a chair (most rotations would be with teams in offices that had so few chairs, I regularly saw at least one intern sitting on an upturned bin – so engrained is this image, I now often look at completely empty correct-side-up bins and think what a missed opportunity for a chair). I would sit and breathe and enjoy my retreat from the coalface of constantly introducing myself to disinterested strangers, having them look down on me, or simply ignore me. Constantly not knowing what my role was within the unit or my purpose in the greater service as a whole. Minutes would pass. I would scroll the socials on my phone, letting my haemorrhoids prolapse more and more until my anal cushions could feed a colorectal surgeon’s family for twelve months. (Not directly).
It was far from my intention to have the first entry on a Substack called ‘Keeping Up Aperients’ be about sitting on the can, but I’ve been thinking more about toilets recently because, since I became a registrar this week, I’ve been spending more time with them again. I have started to embark on the steepest learning curve, in a job that I don’t know I particularly like anymore, with even more awkward encounters than medical school. It has become, once again, one of the few times in a day I might be able to sit down. I don’t have as long to spend in there as I once did, but it is still a relative shrine of worship here and then – a place to meditate (read: ruminate on my imposter syndrome and feelings of total inadequacy) and honour those who came before us (judging by the stains on side the toilet bowl, they were feeling pretty nervous too). And I think about how many medical students and registrars alike have sat on that toilet seat that day, thinking exactly what I’m thinking: “Oh shit, oh shit, oh shit…”
Just binge read every single one of your Substacks and have been genuinely laughing out loud and also feeling so many things based on the depth of your introspection. Can’t wait to see future posts.
I have shit exactly once at a hospital in 15 years, on a night shift as a JHO following several days of constipation due to an absence of water intake. I’d rather be bullied by that obese orthopaedic registrar as an intern again, or linger on the geris ward after a particularly repulsive pad change, than sit on a hospital loo again.