Captain Mainwaring’s Casualty

Late April 2016. As hospital consultants and staff doctors across England prepare for the first ever full walk out by junior doctors, similar preparations take place at Walmington-on-Sea…

Scene: The local District General Hospital Casualty Department. Mainwaring and his platoon stand facing each other. All are wearing baggy theatre greens with stethoscopes draped in the modern fashion round their necks, except Wilson who is wearing a Prince of Wales check suit, with a large neurologist’s hat-pin in his lapel. Frazer has on an ENT surgeon’s head mirror, flipped to the up position, and the light reflects off it like a heliograph as he darts glances here and there. Mainwaring has a vintage WWII flare pistol in a holster on a belt, strictly for emergency use only.

MAINWARING: Hurry up and get changed, Wilson.

WILSON: Is that really necessary, sir? I’m not planning on doing any operating. You see, that’s not what we neurologists do.

MAINWARING: Of course it’s necessary. We’re here to show we stand four square behind our junior doctors, and are ready, willing and able to do anything they can do. Who knows, perhaps even better. In fact, casualty patients will never have had it so good.

JONES: That’s right sir! A good job of work as well done as any junior, sir!

MAINWARING: That’s the spirit Jones. Now look here men. We…

WILSON: I’ll just be off to get changed then sir.

MAINWARING: Not so fast Wilson. I’ve got something important to say to you all. You see…

WILSON: But I thought…

MAINWARING: No you didn’t. I do the thinking round here. Now, I just want to set the tone for whole campaign during the strike. There are those who say some of us seniors may be getting on a bit, but when the NHS calls, we’re ready. (pause for dramatic effect) You see, we were all juniors doctors once, every man jack of us. We here to show that, when the government gets all high handed, we doctors, juniors and seniors, are all in this together…

JONES: Permission to speak, sir! You can’t say that, sir! That’s what that devious Mr Cameron keeps on saying, and only last week he was caught with his hand’s down someone else’s bikini, sir, and the whole business went tits up, sir! You see, they don’t like it up ‘em, sir!

WILSON (extra smoothly): I think you’ll find it was the Bahamas, Jones, and it wasn’t about the bottom, but the bottom line.

MAINWARING: Stop beating about the bush, Wlison.

WILSON: If you say so, sir…

(Door flies open, Hodges enters wearing a tin hat with the letters CQC stencilled on it.)

HODGES: You can’t come crashing in here, Mainwaring, pretending you are junior doctors. I’m going to inspect you, right away, here and now.

MAINWARING: Oh no you are not. We don’t need to bother with that sort of nonsense round here. We’ve got work to do. Get out.

WILSON (smiling evenly at Hodges): You heard what the man said.

HODGES (leaving): I’m warning you, Mainwaring. I’m warning you.

MAINWARING: Stupid man. Now, as I was saying…

GODFREY: All this excitement is getting to me. I think I’m feeling rather faint…

MAINWARING: At ease, Godfrey. Pike, get a chair for Godfrey to sit on.

GODFREY: I…I… (collapses)

JONES: Don’t panic! Don’t panic!

FRAZER (rolling eyes): Godfrey’s down, Lord knows who’s next. I warn ‘e one and all, we’re awe doooom’d!

MAINWARING (kneeling beside Godfrey and taking his carotid pulse): No pulse. Stand back, men, I’m going to start CPR. (links hands and places them on Godfrey’s sternum)

WILSON: Are you sure that’s wise, sir. I mean, it’s a while since you did that sort of thing…

MAINWARING: Stop fussing, Wilson. (starts doing compressions, somewhat slowly and mechanically) There’s a man’s life at stake here.

WILSON (drawing his hat pin from his lapel, and fingering the sharp end, as if imagining what he might do with it): I think you’ll find you need to go a bit faster than that. (Opening bars of the Bee Gee’s track start in the background) It’s called ‘Staying Alive’, sir.

MAINWARING (still not quite in time to the music): Stop mumbling, Wilson. Of course it’s about staying alive.

WALKER (aside to Pike): Get with the beat, baggy. (Pike sniggers)

WALKER (to the room at large): I’ll just get the defib…

MAINWARING (between breaths): Hurry up, man, we’ve no time to loose. (Walker leaves; soundtrack fades)

JONES (kneeling down beside Godfrey, opposite Mainwaring): Permission to speak, sir! I should like to volunteer, sir, to do some compressions!

MAINWARING: That’s the spirit. Carry on, Jones. (Mainwaring staggers to a standing position as Jones takes over)

WILSON: Are you quite sure you are all right sir? You seem, well, rather redder in the face than usual, sir. I do hope you haven’t strained anything important (Mainwaring glares back. Walker returns wheeling a crate with the letters ‘NHS Property: Not for Resale” stencilled on it)

MAINWARING (drawing himself up to full height): Where did you get that, Walker?

WALKER: Round the back sir. I’ve been keeping an eye on it.

MAINWARING: I see. Now get to work. We’ve not a moment to lose. (Walker opens crate and takes two paddles on leads and places them on Godfrey’s chest)

WALKER: Stand clear!

JONES: Permission to stop compressions, sir! (steps back)

MAINWARING: Get on with it man!

(Walker fires defibrillator, Godfrey jolts)

PIKE (smirking): Shocking…

MAINWARING: You stupid boy. Try again, Walker.

(Walker fires defibrillator a second time. Godfrey jolts, stirs and then sits up looking dazed)

FRAZER: Raising yon dead! I warn ye, no good will e’er come of it!

WILSON (ultra smoothly): Well, I suppose you would say that, wouldn’t you, given your line.

MAINWARING: Be quiet. Godfrey, how are you feeling?

GODFREY: Can’t complain sir, I think I must have just nodded off. One does, you see, as one gets older. When’s tea?

MAINWARING: There was a bit more to it than that. Now, lets get you off to the ward. We’ll come round and see you later. Now men, what was I saying about tomorrow’s strike? That’s right, we were all junior doctors once. We may have worked longer hours back then, (beginning to wax nostalgic) but our hospitals looked after us better back then. We all felt we belonged, every one of use. Today’s juniors aren’t so lucky. We owe it to them, and above all else to our patients, to stand shoulder to shoulder with…

WILSON: I’m not sure that’s really what you mean sir. After all the juniors are going to be outside, on the picket lines, and we’re going to be on the inside, doing what the juniors normally do. If we stand shoulder to shoulder with them…

MAINWARING: Stop trying to be clever, Wilson. It won’t get you anywhere.

WILSON: I was only trying to help, sir.

MAINWARING: Well, don’t. I give the speeches round here, see, and you listen. Now, as I was saying, men….

Opening bars of ‘Who do you think you are kidding Mr Health Sec’ kick in as closing credits start to roll…

Of course, if one or more junior doctors’ full walk outs do go ahead later this month, it won’t be a ‘Dads Army’ of past-their-best doctors manning A&E, but doctors at the top of the game. If anything, the clinical care delivered may even improve, as more patients will be seen by more senior doctors, though that won’t stop the scurrilous and the disingenuous – we know who they are – from claiming otherwise. But, even if there are any ‘unexpected deaths’, it will be well nigh impossible to attribute the death directly or indirectly to the strike. No doctor, or indeed coroner, is going to enter ‘Cause of death: Junior Doctors’ Strike’ on a death certificate.

Instead, the main effect will be on routine care: more elective operations and regular clinics cancelled, as consultants and staff doctors switch from providing routine care to emergency care. No doctor wants further disruption to routine care, but given the imposition of a deeply and profoundly flawed contract predicated on the bizarre notion of magicking a quart out of a pint pot, combined with a government that refuses to talk, what other realistic options do juniors have?