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This weekend I came face to face with my own cynicism and I didn't like it.
I was attending a trauma call in A&E resus. The air ambulance had brought us an elderly man who’d had both an accident and a cardiac arrest. It was late in the afternoon on a Saturday. Hospital admissions were pouring in and wards were backing up from all the discharges they couldn't sort out at the weekend.
Our patient arrived packaged up on a stretcher; intubated, ventilated and struggling to maintain his own circulation. Shortly after arrival he had another cardiac arrest; we started CPR and eventually his heart restarted.
Over the next hour or so I kept his circulation going with drugs and supervised his ventilation, we narrowly avoided two further cardiac arrests. When he was stable enough to have a CT scan it became evident this man would not survive his injuries.
He came to us an unknown male. The police were unable to trace any relatives and his pockets only contained a jumble of keys and coins. We put them in a plastic bag with his watch. There was no phone, no wallet. Just a man without a name.
Still intubated and on the ventilator, the A&E SHO and I set about trying to find a place for him to die. Dying was inevitable of course and a bustling resus is no place to pass your final minutes, if it can be helped. The curtains barely went around the cubicle.
The SHO tried to find a side room in A&E, he was told there are none to spare. ‘Best try get him to the acute medical ward,’ we were told. So he phoned the flow manager and begged for an urgent side room. Against the odds, they had one. My heart lifted. But they would not be able to take him ‘just yet’.
My heart sank.
’Typical management‘, I grumbled, and I sat and watched my patient, still hoping we could get him somewhere else before he died. Typical management.
After a very short time the flow manager arrived into resus. She was a nurse. She hurried to the bed and said she was sorry about the delay, that she had wanted to make sure she’d found a member of staff to be with the patient while he died.
She had brought a healthcare attendant and a bed and she asked if I would wait to extubate him until he was cleaned up and off the hard trolley. Then she took him to his room, left her phone there playing Mozart, and left him a hand to hold.
By the Secret Doctor
Read the Secret Doctor blog: https://www.bma.org.uk/connecting-doctors/b/the-secret-doctor
Follow the Secret Doctor on Twitter: https://twitter.com/thesecretdr
At the end of this story, someone arrived to provide patient centred care. The NHS can be the 'altruistic gift to society' * is was meant to be. (*with thanks to Dr Tudor Hart for this descriptor)
This is what NHS is all about.
Maybe, there is hope...
Thanks for this- we all have choices to make about 'going the extra mile' every day and it might be something simple with a big impact.
perhaps time to admit there is a weekend effect after all?
This and incidents like this (and there have been many such) is why I am proud to have worked in the NHS! I hope the NHS survives the political medelling.
What a heartbreaking story
I felt please and proud to be a part of the NHS reading this story. We all have experience of the patients who are too unwell to be saved, for whom the most dignified and most appropriate thing is to help them to comfortably and respectfully die.
The only thing that really made me sad and irritated was the comment below: "perhaps time to admit there is a weekend effect after all? ".
Using this story to score a perceived political point is disgusting. There are many reasons why this story does not support such a statement, but they've been said before and I don't feel it's appropriate to detail them all again here.
Thank you to the staff of that hospital and RIP to the elderly gentleman.
There is so much good and dedication in the NHS- an unreported world. . I hope he had a family. The dedicated staff fought for his life and provided great care and dignity.