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We always know that winter is coming; the newspapers tell you so from some point in mid-July.
Now it’s December and the tell-tale signs come thick and fast. Somebody is sticking a flu-jab in your arm, you’ve already had two colds, the ‘could all consultants please attend an emergency meeting’ announcements have started to appear over your crash bleep, you hear Monday morning arguments when intensive care tells a surgeon they have no beds for elective cases and you find yourself more and more stuck in resus with that patient you tubed three hours ago but can’t get onto the unit. Winter is here.
As somebody who works in intensive care there is winter pressure no doubt, but from my point of view I find myself feeling relatively armoured. There is a level of protection in being responsible for the critically ill. Your needs often get put to the top of the pile, your distress calls often carry more weight.
My friend is a medical registrar and works in a busy district general hospital. This week, on her way home from a shift on the medical take, she phoned me. That’s not unusual, you get through training by knowing who the people are that you can phone and exhale your day to.
Her team of three junior doctors saw 64 patients in the first 8 hours of that day. 64 lives.
There was a new diagnosis of a brain tumor, a man with troponin positive chest pain who had to sit in minors, four cardiac arrests, an end of life conversation, three patients who needed neurosurgical referral, multiple who actually needed general surgery, pneumonias, strokes, exacerbations of COPD and the vague histories from patients who just didn’t have the right support at home.
There was a phone call to come and ‘attend’ to a man in reception who apparently didn’t want to leave and another from an outlying hospital who interrupted her to ask if she’d mind finding old angiographies for a patient they had received with chest pain, because ambulances had started to divert patients away from her hospital.
She started off that morning by sending messages to everyone she could think of to find cover for the night registrar who had phoned in sick and midway through the day, an ITU SHO phoned to tell her she had to come and write a discharge letter for a patient she’d never met who was being discharged straight from there.
The medical registrar; wide open for all your needs.
My friend is a good doctor. I’d trust her with my life, I’d trust her with my grandmother’s life. I listen to her story and for large parts of that day she is Sisyphus, rolling a boulder up a hill, enduring the punishment of hopeless labour. Could there be anything more disheartening?
Her actual description of that day was this: ‘They say sometimes you’re just fire-fighting. I wasn’t fighting anything; I was spitting on fires and running away.’
Winter is here; we need more doctors, more social care, more funding and more flow through hospitals. These are the answers, but what can another junior doctor do about that? It reminds me of that Christmas carol ‘In the bleak midwinter… what can I give him, poor as I am?’
In the bleak midwinter, let’s look out for the medical registrar spitting on fires.
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter
Time to hear from Dr. Mark Porter before he leaves his post. As a patient I found his talks to camera clear and reasoned with ,perhaps too kind an analysis of the government's role. However having stood with Junior Doctors on their strike I could see why they were disappointed and angry with their union, the BMA. As a patient I am furious with the entire medical establishment starting with the Royal Colleges which allowed the 2012 Health and Social Security Bill to become law and now are silent as the STP roll out continues apace. I would like a list of all their names to show my grandchildren when they ask why the fairest, cheapest and most admired health care system in the world was destroyed to bring in an American style unfair, expensive system putting profit before patient care.
This system is broken at every level. I empathise with the "catch-all" Med Reg. I am a GP: I spend most of my day trying to reinvent (perhaps questionable) diversions from admitting and referring very unwell patients. They are insightful and accepting of my reasoning (as I too am honest about what I am doing!) and they weigh risks they should not have to consider... yes, Mental Capacity is exercised. Back off CQC.
I am reminded of the quote from the historically accurate 1970s film "Battle of Britain". No there is no Brexit overtone, but an acceptance that the British establishment does not accept facts decades before they explode in a predictable and "gosh what a surprise" way. When asked about radar, Air Chief Marshall Dowding responded to the civil servant by reversing Mr Churchill's suggestion: actually we are "praying for radar and trusting in God". In this situation we are "praying for the NHS leadership/ DOH and trusting in God", as the former is pretty much discredited and has completely failed.
Keep good professional and personal standards: that is the best you can do. I wish you well.
Blessings on your friend who is spit- dehydrating, there are many who would not spare even that Maximum respect to you, your friends, your collegues, the BMA ... and all of us who are spitting furiously .....because even as the flames subside , like a phoenix, another issue rises from the ashes......