Three days in the life of an emergency registrar
Friday Night Shift: Reminders of Dead Colleagues
As I walked towards our A&E entrance, my heart sank. All ambulance bays were full. Then I saw that the waiting room was also full. I knew it was going to be a busy night.
He had taken an extra shift tonight. Normally that means I’m not in charge, but it turned out that I was in charge of the department. I started by looking at how many patients were waiting, how long they were waiting, and the number of staff on duty.
I was relieved to find out that there was only a four hour wait for patients to be seen by a doctor. Clearly that is too long and years ago it would have been very abnormal. But given what the new normal is, that’s not bad.
In general, we get by just fine. If there are a lot of people waiting in ambulances, more areas are opened up for people to enter (a hallway is effectively turned into a ward, or an outpatient department is opened that is normally closed overnight), but luckily I didn’t have to do that.
Many problems at A&E are now due to “bed blocking”, and I saw a perfect example of that during my shift.
Many older people have recently come because they have fallen and social care cannot help them immediately with more home visits or more equipment. Tonight it was a man in his 80s, who lived alone, who had waited four hours to be seen. It was a real heartbreaking moment because he knew he would have to keep him here overnight, even though medically he had nothing wrong.
She should have been using a frame or a stick to get around her house, but instead she had leaned against the furniture and tripped. He wasn’t hurt, but he couldn’t get up and had to wait on the ground for a couple of hours until an ambulance showed up.
If he hadn’t been waiting so long, the paramedics probably could have picked him up, checked him out, and left him home. But for older people, lying on the floor for a while has risks like muscle collapse and kidney problems; Furthermore, this man had a history of high blood pressure and heart disease, for which he needed blood tests.
During the day we have a team that can do a quick assessment at the hospital, arrange a physio, get people home and make sure they get help. But when they come at night, we can’t do that. They will have to be seen in the Duty shiftwill have to wait a care package to start and to physios Y occupational therapists to see them, and when it’s the weekend, often that won’t happen until Monday, so they may be there for 48 hours or more.
When someone is lying in a hospital bed that long, the lack of movement means they’re losing muscle mass, plus they’re at higher risk of getting an infection here. Meanwhile, another bed is full, increasing our workload and potentially keeping someone stuck in an ambulance outside, while also delaying paramedics from responding to more calls.
The lack of provision of social care it’s everyone’s problem.
For me personally, the most difficult event of the night was that one of our colleagues was brought in as a patient. I went into the resuscitation unit where the sickest patients are sent, we call it resus, and there he was. He’s just young, so he was a bit of a shocker. He has a chronic illness that was probably aggravated by an infection and required him to go to intensive care.
It clouded my night because it brought back memories of taking care of friends when the the pandemic was at its worst. In the first year of Covid, I had to treat a couple of coworkers who were sick and other colleagues in our department passed away. When a colleague comes in sick now, you have horrible thoughts. He also reminds you: that could have been me.
It was a terrifying moment. In most cases, people were more concerned about their families than about themselves. Some colleagues moved from their homes to hospital accommodation and didn’t see their children, didn’t see their partners. I didn’t do that, I couldn’t imagine dealing with work stress and pandemic and not having any kind of support network.
There are many reminders of colleagues who have passed away in our department (old photos of them and policies they wrote) and events are still organized in their names. It means that there is always that presence; you can’t get away from the memory of them and what happened, it stays in people’s minds.
that’s why watching Matt Hancock continues I’m a celebrity get me out of here it felt so irritating. Some of the blame people placed on him is probably not fair, not all of it was due to the decisions he made. Knowing that his political life is over, he is just trying to earn as much money as he can. In a way, he doesn’t blame him. But he is still insulting to everyone like us? Yes, of course.
I was worried about my colleague, but just like with Covid, tonight I had to get on with my job anyway.
My last patient of the night was a guy who had advanced cancer and was too frail for treatment, so he was sent home with an end-of-life hospice plan, but then he got a serious infection that had cleared up. septic. We treated him with antibiotics and fluids, knowing that he was unlikely to help. I had to call his brother to tell him that he was probably going to die and that they had to go inside.
If the ambulance service had a little more power to make decisions, perhaps this gentleman could have stayed at home. His family could have visited him there and he could have died peacefully in his bed, instead of enduring an ambulance and being pricked with needles for treatment that probably wouldn’t make any difference anyway.
We have quite a few patients like this, where the ambulance service calls us and says, ‘I think this person is dying.’ Ok, but is it convenient for you to bring them? For some people, the hospital is the right place, but for many it is not. Unfortunately, often the situation has not been discussed, which means your home is not prepared for end-of-life care with the proper medications, etc.
The gentleman was still alive when I left this morning, but things were not looking good. When I come back tonight, I’ll see what happened to him. In some cases I look for patients before I started my shift or during my break, especially if they looked like they were going to die, or in medically interesting cases where I didn’t know what was wrong and wanted to learn for the next time. .
I bought a hot chocolate on my way home and came home around 9am. I treat the mornings after night shifts as my night, so sometimes I have an alcoholic drink. I sit and relax with my pets and watch some trashy tv to wind down, and then go to bed around 10 or 11.
I’ve been doing night shifts since I was 18 so now I’m used to sleeping during the day. My partner and I have blackout blinds in the bedroom and I also use a blindfold. Sometimes I have problems after the first turn, but I’m usually fine after that.