Thursday, 8 January 2015

The Secret Doctor: A&E is run on pure fear – how much more can we take?

New year means new pressures on hospital emergency departments – we soldier on, but something has got to give.
A patient is rushed into A&E. ‘Patients fill the cubicles and when they are full the trollies line the corridors in every conceivable place.’ Photograph: Mike Goldwater/Alamy

Happy new year to the poor patients filling the waiting room. Some are still merrily inebriated from the night before. Some are not so merry because they realise, as the hangover sets in, that punching a wall during their revelling was not a good idea. And, unlike in the Verve song, the drugs do work – but only for a certain amount of time and then the pain is back because they’ve been waiting so long to be seen in A&E that the effects are wearing off.
Over the Christmas and new year period, the doctors and nurses here have been whispering to each other that the department must be cursed. But it turns out that this curse is nationwide. It’s unbelievably busy everywhere, and waiting times are the worst since records began.
An announcement goes out halfway through the afternoon: “Ladies and gentlemen, there is a four-hour wait to be seen. If you are feeling better, please can we ask you to leave.” I do not notice a stampede for the door. It brings a smile – I’m sorry, I can’t help it. I have been on my feet since 8am without so much as a loo break or time to rehydrate, so small things bring brief moments of respite. You grab them when you can.
I stop to wonder why the out-of-hours setup has scaled down instead of up today. The GP helping triage patients before they even arrive in our hospital greets me like a comrade: “It’s busy, isn’t it?” Yes, I concur. He continues: “It didn’t help that we were on skeleton staff today. There was only one GP on shift to do home visits – and she had 40.”
So who had the clever idea to scale back to skeleton staff on one of the most notoriously busy days? Traditionally, the GP continued, such services were fully staffed, with extra doctors brought in, in anticipation of heavy numbers. But more recently, this appears to have fallen away because of cost-cutting, putting extreme pressure on staff. One doctor, 40 home visits: how can that be right or safe?
Happy new year to the staff I work with. It’s a dynamic and focused team – but even the steeliest members of the team are beginning to crack. The lead consultant is flushed red in the face as he carries the responsibility of the entire department on his shoulders. He sees patients, offers advice on management to junior colleagues and then runs off to the “bed meetings” to fight our corner against the rest of the hospital so we can move patients on to create space to see more.
The role of board nurse has got to be one of the most challenging jobs in A&E. They are the maestro conducting the flow of patients in and out – or more commonly these days the flow in and no flow out because the hospital is full and there are no beds to move them to. So the patients fill the cubicles in majors, the place where we see the unwell patients; and when they are full, the trolleys line the corridors until there are rows of them in every conceivable place.
The lack of privacy and dignity the patients endure is a sad thing to witness. One nurse is concerned about her elderly female patient in the corridor because she is short of breath and her oxygen saturations are lower than preferred. I spot a “safe swap” opportunity and move my stabilised patient out and hers in. And that is how the shift continues. In majors people are unwell; the majority of them need to be here. We just don’t have capacity to fit them all in, given the numbers that are arriving.
Happy new year to myself. I try to remember that doing this job is a privilege but sometimes I feel trapped, overwhelmed, often anxious to the point of experiencing real palpitations. Going to work is like no other experience. It is a rollercoaster, a white-knuckle ride off a giant waterfall, a stomach-churning bungee jump – it is all these things and so much more. It is pure fear.
But it can also be pure joy. There are days when I leave and the feeling of satisfaction is so immense that it magically soothes my aching feet. And then there’s the strange, tremulous feeling you get walking back to the car as the adrenaline begins to ebb away. To work in A&E means to be part of a team of kindred spirits. To stay away is the easier, maybe healthier and saner option. But at the same time, you know you can’t. You are not programmed that way.
But equally, we are not robots working like machines – we are human, and we have our limits. How much longer can we keep this battle up? It was bad last year, and apparently problems with A&E are now worse than ever. And what about next year?
It is in the interest of everyone to stop this spiralling “crisis” – because, unlike any other service out there, A&E is something we will all need at some point in our lives. And right now, the prognosis is not good.

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