Back to (Relative) Normality

After 4 months, 75 shifts averaging 10 hours each, no social life and a strange new appreciation for daytime television and solitude, I have finally come to the end of my rotation in the Accident and Emergency (A&E) Department. The cloak of darkness is lifted and once again I will be returning to join Londoners on their daily morning commute; this a far cry from the 3pm, 4pm, or 10pm nocturnal shuffle that I would make towards work to start yet another evening or night shift. Weekends, ah weekends, how I look forward to you as well – no longer dominated by the quandary of how to get to work with the inevitable weekend rail engineering works but by which side shall I lay on as I doze, enjoying a lazy Saturday morning in bed.

I recall looking at my rota, some 4 months ago, and being filled with both horror and confusion. Afterall – surely I am not expected to work 6pm until 2pm Monday to Friday and then 3pm until 3am on Saturday and Sunday with only one day off before starting again?! Oh, no wait, I am. Now, however, I look at the rota with a real sense of pride, puffing my chest from a much diminished frame (I realised I have lost over a stone and a half since working in A&E), for not only have I had a the most fantastic time working in A&E with a wonderful team of people who encapsulate the Commando motto of “cheerfulness in adversity” (thanks Bear Grylls, for that nugget) but I have survived probably the hardest rota that I will encounter on my road to becoming a GP. Now if you didn’t know, I have spoken about life in A&E recently this week in the Independent (http://www.independent.co.uk/life-style/health-and-families/features/life-inside-ae-the-highs-the-lows-and-the-grief-is-something-that-echoes-across-all-hospitals-around-the-world-10132683.html) What I perhaps did not mention though was how humbling a place A&E is. Once you look past the chaos, the shouting, and the stress that, on some shifts more than others, seems to hang in the air, there are acts of kindness and compassion in all direction. Too many to list and perhaps, moments like that should be left in their moment and not revisited.

Last night, there was however, one patient that made me think about the appropriateness of some medical decisions we make. A 90 year old nursing home resident with advanced dementia, bed-bound, requiring all her care needs supported by somebody else, with bed sores, and a DO NOT RESUSCITATE order in place (at the wishes of this patient herself) is rushed into the resuscitation room via a blue light ambulance for a reduced level of consciousness. She had no temperature, was not infected. She had not appeared to have had a huge stroke. Looking at her, with all the information available it was clear that this was an old lady who was quite simply dying. She was in her comfortable nursing home with her own room, nurses that knew her, photos of her family and memories that she had sadly slowed had taken from her as dementia gripped. Why the hell bring her into a packed hospital ward to die. After talking with the family it was clear we all shared the same view – get her back to the nursing home to have a good death. Yes, a ‘good death’ is part of good medical practice as important as the life before it. A good death has comfort, dignity and is free of pain and distress. My point is, we should not treat everything and everyone just because we can. We have a mind, emotions and sense – let’s use it.

In an NHS era where I was supposed to make sure that I have seen and treated my patient within 4 hours (and by the way, referred to a medical or surgical team within 2 hours – tricky if you don’t get to the see the patient because there is nowhere to see them in a full A&E and when you do – they are already on 3 hours and 20 minutes), we, as doctors and health care professionals, are always expected – dare I say it pressured sometimes – to treat patients as a statistic. A statistic that we are desperately trying to keep below that horrible bloody number – 4. If I hear someone mention 4 hours this, 4 hours that, anymore, I may have to defect to Australia – and I don’t do well in the sun. Personally, I am refusing to treat any patient as a statistic – and if that patient breaches the 4 hour mark then so be it. My justification – a guarantee from me that they have received the appropriate care and investigations in a sensibly, safe and timely manner.

Perhaps people need to be reminded of the old Aesop’s fable – the tortoise and the hare.

Have a great weekend everyone,

Nick

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