Jamie is 29 years old and a junior doctor in an A&E department of a Yorkshire hospital. With an NHS strike still looming large, he kept a diary of what it’s really like on the frontline of medicine.
It’s 7.30pm and I arrived home about 30 minutes ago after my shift. In the previous nine hours I saw 11 patients. Some were seriously ill, suffering from heart attacks or severe infections, while others had minor conditions from urinary tract infections to sprained wrists. There were also lovely elderly patients who could no longer cope at home and a few had abdominal pain and broken bones requiring urgent surgery. I wouldn’t call it a ‘normal’ day as there is no such thing when working in A&E, (ever tried to convince a kid to let you look at their sore leg by moonwalking towards them? Neither had I until today), but it was a typical shift.
I hate it when people compare A&E to a ‘warzone’, but there are days when you can see why people draw the comparison. Today was one of them. It was relentless.
From the start of the shift to the finish there was a continual flow of patients in various degrees of distress. At one point our resus area, where we bring all of our sickest patients, was full. So was the waiting room, every patient wondering why the wait was so long. At times like this it feels as if the department is minutes from falling apart. As always the team moved into a gear we didn’t even know existed.
We got through it. Patients were stabilised, moved onto wards and by the time I left the hospital at 6.30pm the backlog of minor injuries had been cleared. I worked an hour and a half over my normal hours and had just one 15-minute break in an 11 and a half hour shift. I can’t complain, it was the same for everyone and I know many more people who have worked for longer and without any breaks at all.
When I talk to my family and friends, and tell them that I’ve chosen a career in A&E, they smile sympathetically and wonder why I put myself through it.
But there are very good reasons why I do Emergency Medicine. When I wake up in the morning (or afternoon) I have no idea whether my first patient might be someone with a severe infection or be a child with a pea up their nose. I like the unpredictability. But the main reason I love this job is the difference you can make.
Today a lady came in with fluid on her lungs. She was struggling to breathe and unable to talk. Within 20 minutes we had given her treatment, she was breathing normally and desperate for a cup of tea. It’s in moments like these that I can’t imagine a more rewarding occupation.
Don’t believe the headlines, today is a weekend and we had a full complement of junior doctors working in the department. The term junior doctor relates to anyone under the level of consultant. That could be anyone from the age of 23 to 53, with one year of medical experience to 20 or more.
In A&E junior doctors will make decisions about what investigations to do, what tests to order and what treatment to give. If you come into A&E, or are admitted to hospital, it is quite likely that the first person you meet, the one who will be responsible for your care while you’re in, and the last person to wave you off when you leave, will be a junior doctor.
Early in the evening we got a pre-alert call about a cardiac arrest; a man had collapsed at work and had no pulse. The ambulance crew had gotten there quickly, found some amazing people at the scene already doing CPR, and were on their way to A&E.
It was too late. After more than an hour of continual CPR and multiple resuscitation attempts, we knew we weren’t going to be able to bring him back. As always when the decision is made to stop CPR the room went quiet, the clamour of controlled, intense activity replaced with silence. Although we all knew there was nothing more that we could have done, we still felt beaten. Then we had to collect ourselves to tell the family the news that changed their life forever.
Minutes later, life in A&E has moved on and I am trying to entertain a nervous child by making a blow-up animal out of a latex glove.
It’s after the shift, in the wee hours of the morning that thoughts turn again to that poor man and his family. Death doesn’t get easier and no doctor is immune to the suffering of their patients. We are human too.
Tonight I saw a lovely older gentleman. He’d been admitted with abdominal pain, but within a couple of hours he was ready to be discharged. On the way out he said that he wished the Government would realise the true worth of doctors and nurses and give us all of big pay rise. I laughed and thanked him for his support, but what he said worried me. This debate is not about pay. This debate is about having a service that is already stretched to absolute breaking point, stretched further.
The only thing that stops it from breaking is the work done on a daily basis by the staff of the NHS. We are working to the absolute limit and we can’t continue to ‘do more, with less’. We all want a seven-day NHS, but it isn’t possible without increasing funding and workforce development.
Tomorrow I start the first of five night shifts. Despite having already worked seven shifts, I still feel relatively fresh. But I know that by the end of this stretch I’ll be exhausted, the kind of tiredness that leads you to fall asleep at traffic lights on the way home.
There are a few things about A & E that make the job particularly draining. As well as the sheer number of shifts, there is the continual switching between day, twilight, afternoon and night shifts. It’s a bit like switching time zones every few days.
On an average day I’ll see a new patient every 30 minutes, I’ll walk around four miles between them, but the hardest part of the job however is the continual decision-making. Decisions about how to best to manage a patient’s care, which tests to order, what treatment to give, how to break bad news to them and their families, about whether they are safe for discharge or need further inpatient care.
Many people also work long shifts, antisocial hours and have to make hundreds of decisions, but if I get something wrong the consequences can be devastating.
In recent month the integrity of junior doctors has been questioned and trust in our profession undermined. Please remember we are not the enemy, we are the ones that will be there for you whenever you need us, 24 hours a day, seven days a week, 365 days a year. We care about our patients, and their safety is paramount.
We don’t want public sympathy, we don’t even need gratitude, we just want to know that we are all on the same side.