I finish dictating the letter of the last patient in my afternoon clinic. It’s a quarter to five and tonight I’m on emergency call. The first thing I do is call the medical registrar on call.
I walk over to the A&E department. All rooms are full and all beds occupied, mostly by patients who were admitted the day before. In the waiting room, patients and relatives sit listlessly on metal chairs, some standing. The junior doctor identifies cases that need review. The first is an old woman. She’s slumped in her chair and clearly confused. The junior explains that she is dehydrated and septic; she has started antibiotics.
He’ll be in that chair all night. The hospital is full. It can take a few hours or several days to find a bed. It depends on who goes home (or dies). It is unlikely that he will be home within a month, although he will recover within a few days. There is nowhere to examine her with dignity. I can’t find a nurse to help me, they are too busy.
I continue my round. All cases are over the age of 80, often with chronic illnesses and disabilities. Most are not capable of taking care of themselves. Often no treatment is needed, they just need food and bedding and care at home, but this can take weeks to sort out. Because of this, they will not be able to return home easily.
I go back to my office. There is a backlog of 100 new GP referrals. Most need an endoscopy, clinic appointment, or both. I judge who is most at risk and assign accordingly. The patients in question should be tested in a few weeks. The others could wait years.
One of my colleagues is sick. It means I have to cancel endoscopy schedules to cover his ward work. We have all been out with Covid in the last two years, some of us repeatedly.
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My practice is out of control. An error with the letter verification could result in a cancer patient being missed. I stay up at night worried about this risk that my patients are exposed to. If I’m wrong in one case, someone could die. It is a heavy load.
This continue. The pressure has been continuous since the release of the blockade. A “winter crisis” now lasts 12 months. We used to have a respite in the summer, that’s gone. It’s too much to take.
At home, I withdraw to myself. I am withdrawn, irritable. I feel tired all day. The world is dark.
It is my wife who tells me that I need help. Of course she is. So I call my clinical director. She is understanding and clear. I think she herself has been there. “You need at least a month off,” she says. “Take it easy. Look at a boxed set. I don’t want to see you until October.”
She is right. I spend two weeks doing nothing. The depth of my exhaustion amazes me. I can barely get out of bed in the morning. But little by little my energy returns. I start walking longer. To enjoy the sun.
I’ll have to protect myself when I get back. To take a step back. Do my job to the best of my ability. I can’t do this again. I consider changing jobs, but I know it’s the same everywhere. I have to learn to separate myself. I have to. This is not my fault.
[See also: The truth about the worst NHS crisis]
