I’ve come on duty for my 8am shift in A&E. Before I even walk through the door, I see five ambulances outside the emergency entrance, and my heart sinks. This usually means the A&E department is completely full and there’s no space to offload new cases. Sure enough, as I walk the draughty corridor into A&E, it is lined with patients on ambulance stretchers, eleven of them in total, most of them elderly.
At the head of this line is Winnie, a fragile lady of 83, wrapped in a colourful crocheted blanket, dozing fitfully in spite of the noise and bright lights around her. Sister in charge greets me with a grim look; Winnie has already spent more than four hours on the ambulance stretcher. Thankfully the A&E doctors and nurses have already examined her, diagnosed a chest infection and started antibiotics via a drip, but there is still no room in the inn. All cubicles in the department are filled with patients who are waiting for beds on the wards, but news from the early morning bed-meeting is that there are no empty beds anywhere around the house.
Until ward rounds begin and discharges occur, we must continue to care for all the patients in our overcrowded department and continue to accept more. “We just can’t keep all of these patients safe in such conditions”, sister says, and I’m genuinely shocked to see tears in her eyes. She’s worked in A&E for thirty-four years and is as tough as they come.
As A&E nurses and doctors, we tend to be a resilient lot; we thrive on the high pressure, the fast pace, the variety of patients and cases. I have a moment to reflect on how the relentless nature of working in A&E is “turning and burning” (turning off and burning out) so many colleagues, before the emergency doors slide open again, and another ambulance stretcher is wheeled in to take our queue up to an even dozen.
In numbers: the NHS crisis
It’s another elderly patient, who had a “funny turn” over his breakfast this morning. His carer called NHS 111, who advised calling for an ambulance and attending A&E. (In fact, 1 in 6 calls made to NHS 111 results in a visit to A&E). This poor old chap suffers from advanced dementia. He is clearly distressed, shouting and trying to get off his stretcher. There’s no way that I can leave him like that for what may be hours, so I quickly get the history from the ambulance crew, examine him, get an ECG (in the corridor-there’s no place else) make a phone call to his carer and decide to send him home. If only such patients had access to better care plans in the community. His visit to hospital has done him no favours whatsoever.
I finally make it into the main part of the department. The registrar who has been on duty overnight is waiting to hand over a department with filled with 68 patients. Our normal capacity is for just 32.
He looks weary. The shift has been short a doctor overnight (in spite of being advertised at premium locum rates) and the overcrowding in the department has been unbearable. For him it’s the last of a set of nights he says have been “the worst of my career”. I might take this with a pinch of salt if I didn’t know that this chap is also an army medic, and has literally practised in war zones.
I take handover from him, tell him to be careful driving home and get ready to see the next patient in the queue. As I do, Winnie is finally moved from her ambulance stretcher to a hospital trolley. She now joins a new queue for a bed on the ward. It’s only taken her five hours.
Dr Bernadette Garrihy is an A&E consultant in the West MidlandsReuse content