Fluid Balance Chart

Dr. Farida Abdel-Aziz twisted the cap off her water bottle, the morning light filtering through the cramped changing room window. Her pager hadn't beeped in ninety seconds—a new record for St. Barnabas Hospital. She closed her eyes, feeling her parched throat constrict as she tilted the bottle upward.

The cool liquid was millimeters from her lips when her pager erupted.

"Christ on a bicycle," she muttered, then crossed herself automatically—her mother's influence lingering like Catholic guilt. The display read: CARDIAC ARREST, WARD 7B.

She bolted out, white coat flapping behind her like surrender flags. As she ran, she passed a bulletin board with the hospital's latest memo: "EFFICIENT DOCTORS DON'T DRINK ON SHIFT - Dehydration Saves Time, Saves Lives."

Another day in the NHS had begun without a single sip of water.

Farida peeled off her gloves. Forty minutes of chest compressions, four rounds of adrenaline, and Mr. Jenkins was gone. His wife clutched his hand, sobbing while Farida's registrar documented the death.

"First day back after Cairo and you caught a crasher. Irish luck's run dry," Dr. Penelope Singh said, scribbling notes.

"I didn't even have time to pee yet," Farida replied, her mouth dry.

"Welcome to medicine." Penelope handed her the clipboard. "Finish this? I've got clinic."

Farida nodded, her headscarf slipping. She readjusted it, thinking of her father who'd encouraged her wear it during Ramadan. "It's about discipline," he'd said. "Like Lent, but with more complaining about thirst." Her mother had rolled her eyes from behind her rosary.

"Dr. Abdel-Aziz!" A nurse called. "Ms. Harrington-Smythe wants to see you. Now."

Farida's stomach dropped. Helen Harrington-Smythe, Director of Optimization and Efficiency, summoning a junior doctor at 7:30 AM. Nothing good ever came from those conversations.

Ms. Harrington-Smythe's office was a monument to minimalist corporate aesthetics—all glass, chrome, and not a single personal photo. The woman herself matched her surroundings: sleek, sharp, seemingly devoid of warmth.

"Dr. Abdel-Aziz, do you know why our Trust outperforms 87% of others in discharge turnaround times?" She didn't wait for an answer. "Because we understand that efficiency isn't just a goal, it's a lifestyle."

Farida stood awkwardly, still wearing her scrub top stained with Mr. Jenkins' bodily fluids.

"I've noticed you spent fourteen minutes in the changing room this morning." Ms. Harrington-Smythe slid a printout across her desk. It showed Farida's staff card swipes.

"I had just arrived—"

"Time is the one resource we cannot bill for, doctor. Every minute spent not treating patients is wasted." She smiled thinly. "Your hourly productivity metrics are concerning."

"I'd just come off a cardiac arrest—"

"And yet, Dr. Singh managed to document the event and proceed to clinic in half the time." Ms. Harrington-Smythe adjusted her glasses. "We've implemented a new Hydration Management Protocol. Research indicates doctors waste up to forty-seven minutes per shift on fluid intake and elimination."

She handed Farida a laminated card titled "Optimal Intake Guidelines."

"One hundred milliliters before shift, two hundred after. Nothing during. The body adapts."

Farida stared at the card. "This can't be safe."

"We've had consultants practicing this way for decades. Dr. Wellington hasn't urinated on shift since 1997." Ms. Harrington-Smythe's smile didn't reach her eyes. "I'm watching your metrics closely, Dr. Abdel-Aziz. St. Barnabas doesn't believe in bottle-feeders."

Back on the ward, Farida's throat felt like she'd swallowed sand. Her head pounded as she tried to decipher Dr. Wellington's handwriting on a patient's chart.

"You look like you need whiskey, not water," came a voice with a thick Dublin accent.

She turned to find Dr. Seamus O'Malley, a locum consultant known for his unique approach to hospital regulations.

"Seamus, what on earth are you wearing?"

He adjusted his turban, royal blue with gold trim. "I've converted to Sikhism for the week. HR can't question my religious headwear." He reached up and pulled a plastic tube from the folds of fabric, taking a long sip. "Camelback water system. Three liters capacity."

"That's... inappropriate on so many levels."

"Aye, but it's efficient." He grinned. "Last month when I was Hasidic, the payot kept getting caught in IV lines."

Farida couldn't help but laugh. "You're going to get fired."

"They need me too much. Plus, I've filled out all seventeen diversity forms." He pulled his loose scrubs away from his body, revealing a catheter tube disappearing into his pants. "Got the full setup. Haven't visited the loo in three days."

"That's disgusting. And medically concerning."

"It's adapting, Farida. Like your wee lizards back in Egypt."

"I'm from Croydon, Seamus. My dad's Egyptian."

"Same difference. Hot places with pyramids." He shrugged. "Adaptation is how we survive. Like your man Darwin said."

Farida's pager beeped. RESPIRATORY DISTRESS, WARD 4C.

"Speaking of survival," she sighed.

"Wait." Seamus pulled something from his pocket—a tiny water bottle disguised as a hand sanitizer container. "Take this. It's my spare."

"Ms. Harrington-Smythe has me on a watch list."

"All the more reason, love. Dehydration is the first step in brainwashing."

Four hours later, Farida stood at the nurses' station, her vision slightly blurry as she tried to concentrate on a medication chart. Her water bottle—Seamus's contraband sanitizer disguise—was nearly empty.

"Your clinical parameters are concerning," said Dr. Imran Khan, a second-year trainee with perpetually disheveled hair. "I'd estimate your GCS at 14, mucous membranes severely dehydrated, and early signs of orthostatic hypotension. Classic pre-syncope presentation."

Sister Maureen Walsh, the veteran nurse from Glasgow, passed by with a medication trolley and snorted. "In other words, you look like absolute mince, love. Proper rough as badgers."

"Thanks," Farida replied. "I feel worse than I apparently look."

"When did you last drink anything?"

Farida tried to remember. "This morning? Before the cardiac arrest."

"Jesus Christ." Imran reached into his pocket and pulled out what looked like an asthma inhaler. "Here. It's water. I've modified it."

She blinked. "You're carrying fake medical devices filled with water?"

"Necessity is the mother of invention." He grinned. "I've got saline disguised as eyedrops, water in fake glucose gel tubes, and a special compartment in my stethoscope."

"This is insane."

"Insane is expecting humans to function without basic physiological needs." He handed her the inhaler. "Take a hit."

She glanced around nervously before bringing it to her lips and pressing the canister. Cool water sprayed into her mouth.

"The inhalers are best," Imran said. "You can claim it's for stress-induced asthma. Harrington-Smythe can't argue with that."

Farida took another spray. "Why does everyone act like it's normal to not drink water for twelve hours?"

"Stockholm syndrome on an institutional level." Imran lowered his voice. "But some of us are fighting back. Interested in joining the ISH?"

"The what?"

"Internal Sustenance Hydration group. We meet weekly."

"ISH?" Farida frowned. "You know that sounds like—"

"ISIS, yes, we're aware." Imran rolled his eyes. "Seamus pointed that out after our first meeting. We're changing it to OASIS."

"Organized... Aquatic..."

"Alliance for Sensible Internal Sustenance." Imran shrugged. "Seamus insisted. Something about 'Wonderwall' being the song of resistance."

"When's the next meeting?"

"Tonight. Room B14 in the old psychiatric wing. After handover." He smirked. "Come if you don't want your cognition to decline by twenty percent while making life-or-death decisions."

By mid-afternoon, Farida was covering three wards simultaneously. She'd managed half of Seamus's contraband water and stolen sips from a patient's water jug when no one was looking. Her pager hadn't stopped.

She hurried down the corridor, nearly colliding with Dr. Wellington.

"Dr. Abdel-Aziz! Just the woman I wanted to see." The elderly consultant adjusted his bow tie. "How are you finding your first day back?"

"Busy, sir."

"Splendid, splendid. Nothing builds character like unrelenting pressure." He thrust a stack of papers into her arms. "Discharge summaries. Need completing before your shift ends."

Farida stared at the mountain of paperwork. "But there must be thirty here."

"Thirty-seven, to be precise." He smiled, revealing teeth stained from decades of NHS coffee. "When I was a junior, I once did eighty-seven discharge summaries in a single sitting. Didn't even need the loo."

"So I've heard."

"Ms. Harrington-Smythe mentioned you might need extra supervision. Something about time-wasting tendencies."

Farida felt her cheeks burn. "I was attending a cardiac arrest."

"We all attend cardiac arrests, my dear. The difference is, some of us don't use them as excuses." He tapped the papers. "I expect these by seven PM. Sharp."

As he walked away, Farida flipped through the stack. Most were for patients she'd never even seen.

Her pager beeped again. FAMILY MEETING, WARD 6A.

"Wallahi, give me strength," she muttered, a phrase she'd picked up from her father.

The family meeting was brutal. Terminal diagnosis, family in denial, consultant leaving halfway for a fundraising dinner.

By the time she escaped, her head pounded, mouth desert-dry, thirty-seven summaries waiting.

She ducked into a supply closet. Five minutes. That's all she needed.

The door opened. Farida jumped, nearly knocking over catheters.

"Cozy." Seamus grinned, turban askew. "Mind company?"

"Taking a moment."

"We all need moments." He closed the door, flicked on his phone torch. "Prefer rooms with fewer bedpans, though."

"Harrington-Smythe has me doing Wellington's discharges."

"Ah, the dynamic duo of dehydration. Wellington's had three strokes on shift. Blames 'migraine auras.'"

"How do you know?"

"People tell locums things. I'm like a priest without guilt trips." He offered a protein bar. "You're about to keel over."

Farida took it gratefully. "Haven't eaten since... whenever."

"NHS tradition. Starvation and martyrdom." He pulled a water bottle from his turban. "Topped up in Pediatrics. They still believe in hydration."

As she drank, Seamus watched thoughtfully.

"Your father called me once."

She nearly choked. "What?"

"After your interview. Said you're too stubborn to ask for help, like your mother." He chuckled. "Told me to watch you. Between Jesus and Muhammad, we'd have your bases covered."

"That's Baba." Farida smiled. "Always hedging religious bets."

"The Quran says 'you never know.'" Seamus winked. "Or so he claimed."

Her pager interrupted.

CODE BLUE, A&E RESUS.

"Duty calls," she sighed, returning his bottle.

"Keep it. Got backups." Seamus opened the door. "Come to OASIS tonight. Planning a little... intervention."

By 7 PM, Farida had completed thirty-two discharge summaries. Her hand cramped, brain foggy.

She was packing up when Ms. Harrington-Smythe appeared.

"Dr. Abdel-Aziz. A word."

Farida followed to a quiet corner, fatigue making her unsteady.

"Your metrics today are... concerning." Ms. Harrington-Smythe consulted her tablet. "4.3 minutes per patient. Trust target is 2.8."

"I had complex cases—"

"And three bathroom breaks."

Farida blinked. "You're monitoring bathroom breaks?"

"Resource utilization is my responsibility." Her voice was cool. "Reports say you were drinking water repeatedly."

"You make it sound like vodka."

"Attitude noted." She tapped her tablet. "Efficiency Improvement Program for you. Daily monitoring until metrics align."

"What you're asking isn't just unreasonable—it's dangerous."

"Dangerous is prioritizing comfort over care." Her eyes hardened. "QEC metrics are down 17%, and the board wants heads. Mine first if we don't improve before CQC inspection."

She lowered her voice. "London North went into special measures last month. Their Director was replaced with McKinsey consultants who implemented 14-hour shifts."

Farida noticed shadows under Harrington-Smythe's eyes, tremor in her hands.

"The Secretary himself is watching our numbers. Post-Brexit reorganization has five Trusts on the closure list." A muscle twitched in her jaw. "Forgive me if hydration seems trivial."

For a second, something flashed in her eyes—not regret, but fear.

"I have my own bosses. They don't accept excuses." She straightened her blazer. "One week to bring your metrics in line. Otherwise, more... drastic measures."

Alarms blared.

CODE BLUE, THEATRE 3.

Theatre 3 was chaos when Farida arrived. A patient in anaphylactic shock, an anesthetist frantically preparing adrenaline, and Dr. Wellington swaying as he attempted to intubate.

"Need... a moment," Wellington slurred, stepping back. His face was ashen, movements uncoordinated.

"Sir?" Farida moved closer.

Wellington's eyes rolled back, and he collapsed, bow tie finally askew.

"Doctor down!" someone called.

Farida checked his pulse—rapid and thready. His skin dry and hot.

"Severe dehydration," she announced. "Get a liter of normal saline."

As the team split—half continuing with the patient, half attending to Wellington—Farida caught sight of Ms. Harrington-Smythe watching through the observation window, her face unreadable.

Room B14 was crowded. Farida counted twelve doctors, three nurses, and Seamus, whose turban now sported a small antenna.

"Welcome to OASIS," announced a woman with cropped silver hair. "I'm Dr. Lola Greenberg, nephrology consultant and founding member."

"What's with the antenna?" Farida whispered to Seamus.

"Hydration monitor. Measures fluid levels through skin conductivity." He tapped it proudly. "Built it myself."

"That's not how skin conductivity works."

"Placebo effect, love. Powerful medicine."

Dr. Greenberg cleared her throat. "For our new members: OASIS stands for Organized Alliance for Sensible Internal Sustenance. We used to be ISH, but—"

"—it sounded like we were planning to blow up the water coolers," Seamus interrupted. "Bit extreme, even for the NHS."

Scattered laughter rippled through the room.

"Today's events with Dr. Wellington prove what we've been saying for years," Dr. Greenberg continued. "Dehydration isn't just uncomfortable—it's dangerous."

"He's stable now," Farida reported. "His sodium was 156. Kidney function compromised."

"And yet, tomorrow he'll be back preaching the gospel of fluid restriction." Dr. Greenberg shook her head. "The cycle continues."

"Unless we break it," said Imran, stepping forward. "That's why we've developed Phase Two."

"Phase Two?" Farida asked.

Seamus grinned. "Remember I mentioned an intervention?"

Imran pulled out a chart showing the hospital's patient mortality rates correlated against staff hydration levels.

"We've been secretly monitoring this for months," he explained. "The data is clear: dehydrated doctors make more mistakes."

"We're taking this to the Board," Dr. Greenberg said. "Along with our ultimatum."

"Ultimatum sounds like terrorism," Seamus interjected. "Let's call it a 'collaborative suggestion with consequences.'"

"What consequences?" Farida asked.

"If they don't implement a humane hydration policy, we release the data to the press, the CQC, and the GMC." Dr. Greenberg's eyes gleamed. "And we all start wearing Seamus's turban system."

The room erupted in cheers.

"So," Imran said, turning to Farida. "Are you in?"

"Wait," Farida said. "I've seen this before. Wasn't there already a DRIP committee last year?"

Dr. Greenberg shifted uncomfortably. "That was different."

"And SPLASH the year before?" Farida continued. "And didn't we have FLUID about six months ago?"

"Different circumstances," Imran muttered. "Different political climate."

"All of which accomplished... what exactly?" Farida asked.

Before anyone could answer, the door burst open. Ms. Harrington-Smythe stood in the doorway, tablet in hand.

"Well," she said, surveying the room. "This explains the unusual water cooler usage patterns in Section 4B."

A heavy silence fell.

"Ms. Harrington-Smythe," Dr. Greenberg began, "we can explain—"

"Dr. Greenberg. This is what—the fourth such group you've organized?" Ms. Harrington-Smythe scrolled through her tablet. "After the DRIP committee was disbanded for unauthorized use of hospital letterhead, and the SPLASH initiative flooded the radiology department with your poorly installed water coolers."

She stepped inside, closing the door behind her. "Did you really think I wasn't tracking these rebellions?"

"Dr. Wellington collapsed today," Farida interjected. "His sodium was 156. Directly related to your hydration protocols."

Something flickered across Ms. Harrington-Smythe's face—too brief to be remorse, too sharp to be indifference.

"I'm aware of Dr. Wellington's condition," she said coolly. "He's been counseled about proper self-care numerous times. His stubborn adherence to outdated practices is his own choice."

She scanned the room, her gaze calculating. "As for this... OASIS? This meeting is now terminated. Return to your duties immediately."

"We have data," Dr. Greenberg said, stepping forward with the charts. "Showing direct correlation between—"

"I've seen your 'data,' doctor." Ms. Harrington-Smythe's voice was steel. "Gathered without ethics approval, without proper controls, and without authorization to access staff medical records. The GMC might find that interesting, wouldn't they?"

Dr. Greenberg paled.

"You can't stop doctors from drinking water," Farida said.

"No," Ms. Harrington-Smythe agreed, surprising them. "But I can implement a formal Trust-wide Hydration Optimization Protocol that precisely quantifies appropriate fluid intake based on shift length, ambient temperature, and clinical responsibilities." She tapped her tablet. "Which I've just submitted to the Executive Committee."

She smiled thinly. "Congratulations. You've achieved your goal of official hydration recognition, but now it will be monitored, documented, and added to your quarterly performance metrics."

Seamus groaned. "You've bureaucratized drinking water."

"That's my job, Dr. O'Malley." She turned to leave, then paused. "Oh, and nice turban. HR will be contacting you about appropriate religious accommodations paperwork. I believe it's a seventeen-page form."

She glanced at her watch. "Your shift ended four minutes ago, Dr. Abdel-Aziz. That's overtime I can't authorize. Good evening."

Farida's pager beeped. NEW ADMISSION, A&E.

Some things never changed. She checked her water bottle—still half full—and stood up.

"Duty calls," she said.

As she left, she heard Seamus explaining his catheter system to a horrified Ms. Harrington-Smythe.

The NHS would never love her back, but maybe, just maybe, it could be nudged toward sanity, one sip at a time.