I really do admire patients that sit and wait for hours in A&E with symptoms like diarrhoea and abdominal cramps. I mean sit for literally hours until the early hours of the morning. And there is nothing else wrong at all. They seem happy when you tell them they have caught a tummy bug and that the bacon roll they ate earlier from an outside catering van just might have something to do with it. No they haven;t vomited and no they have not gone more than three times in the last five hours and yes they can drink lots of fluids fine. As the answers flow to my initial questions I do try and remain straight-faced and not reveal my disbelief at 2 am in the morning but its hard, especially when you are running between minors and paediatric A&E because there is a shortage of doctors on a Saturday night.
It’s that week – maybe unkindly called ‘death week’ amongst the more cynical, darkly humoured members of my profession, when all the new doctors arrive from medical school. It’s also change over time and we are loosing the junior doctors who have spent six months in A&E honing skills down to a fine art and being able to see patients safely, competently and thus reducing the number of near seizure moments for sister, as their patient breach score reduces with an increase in experience. They seem relieved to be going. Its time to reclaim lives and break out of the six days on three days off cycle of A&E shift life. The days on are ten-hour shifts and its an endless repetitive cycle of days, turning into nights and nights turning into days. When they leave for different speciality attachments new people arrive and with that comes chaos at least for the first week, as the learning process starts all over again, en masse. It was painful last night and all of us were running on our feet. It’s Ramadhan, I was fasting and at about 8.39pm got to grab a quick coffee to break my fast with, but that was about it. My consultant appeared to have done a honorary fast too. She had been in the department since 9am, had hardly eaten or drunk or gone to the loo. It was almost midnight when she told me that. You admit patients for less!
It also seemed to be the night when all the parents in paediatric A&E(affectionately known as paeds or kids) were shouting, screaming and kicking louder than their children. I expect the children to be fed up scared and irritable but when the parents make more noise than the patients I just sometimes wonder. Surely they can see that there is just one of me-yes I was the only doctor in paeds A&E called in from minors at 8pm because there were no other doctors. I walked in and the hail of abuse began. I had been asked to see alternate patients-one in paeds and one in minors but when I had arrived in paeds I thought leaving the nurses alone with a very hostile crowd of parents who seemed to be feeding off each other’s anger might end up in a riot so I stayed. We did not want a mini Tottenham kicking off here tonight as well. Yes this was also the night that people were going wild north from us. Is it the weather, the heat? Everyone seemed to be carrying an aggressive streak tonight. The minors patients would have to wait for a natural lull. That’s how my lady with diarrhoea in minors ended up being seen at 2am. But there you are…diarrhoea.
I got totally abused, shouted at and threatened by a father of a boy with a dislocated shoulder, because of the delay in being seen. He was also angry that I wanted observations done before giving any more morphine based analgesia and that I wanted to try to the gas and air method of analgesia as well. ‘ I wish I had gone to Whipps Cross instead.’ But then again, had he done that he may have had to wait for hours to be seen as the injured rioters from Tottenham were being taken between there and to the Royal London for treatment. I smiled to myself because most of the staff working in my hospital have either worked in Whipps previously or are still doing so. The chances are he could have seen the same people there on a different night. And not to mention I have a brother who is a consultant there. I will pass on the ‘angry dad’ commendation for Whipps. The patient himself was fine, a little tearful and not happy to try to entonox. Totally accepatve as there are other options to try. But the louder the dad shouted the more tearful the boy got. No shoulders were about to be reduced at this rate. Thankfully the sister in charge ran in to ask for an assessment on a query meningitis in paeds A&E immediately. Someone else was being sent in to deal with the shoulder. That kind of did the trick with the dad. He had to wait until another doctor was free to do to the job. I felt sorry for the young boy having to sit with a dislocated shoulder for that long. But the dad was not letting us reduce the shoulder at all. Nothing was going to happen until he clamed down.
As I rushed back to paeds A&E for the meningitis query another parent stopped me to ask me how long before their turn. I replied honestly that I did not know. The father was outraged. How was it that I did not know? He had seen me just walk in and he could see that I was almost running on my way to another cubicle. In truth I could have gone over to the desk, waited for a computor to become available, thus taking another five minutes to work out the further waiting time out. This same family had asked the same question half an hour ago too. It’s not that I do not respect the needs of families and parents, but repetitive time checking only delays me in getting to see them. My colleagues and I want to care for our patients, treat them and send them on their way-that is what we do and its the best thing ever. It’s why we come back, day after day, night after night. But I have no idea what comes over people when they see a reduced group of maybe one doctor and two nurses flying between cubicles and patients solidly for three hours, working as fast as possible. They appear oblivious tto the effort and our attempts to do our best. Waiting to be seen is awful I know, but at that stage all patients are triaged for an idea of severity of illness and will be seen in priority order. When parents become agitated it further distresses the child and adds further delays. Time spent in angry parent negotiation and delay explanation is time ill-spent in an overstretched, busy A&E.
I compare that to the quiet, patient refugee Libyan men,women and children I saw when they were queuing up to be seen in 54 degrees heat in Ramada camp in Tunisia and just wonder-which group are really from the ‘developed’ world and which group have just regressed to a level of selfishness, insensitive to the needs of other around them – and in this case I mean the other patients also requiring attention and sometimes more urgently.