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‘I’m not sure I can do this anymore.’
Those are the first words I hear from the senior nurse I’m running the Emergency Department with today.
Shortly after that she bursts into tears. She won’t be the only staff member who cries in conversation with me today. I offer the usual platitudes and reassure her we can but my words feel empty. We have arrived to take handover from the night shift to a chaotic start. The department is full to bursting with patients awaiting beds in the hospital. Every cubicle is occupied with patients and trolleys and beds are crammed into spaces that don’t really exist.
There is a queue of patients lining the corridor, most of them have been there nearly all night. Resus is full. I hope that the standby phone stays silent whilst I lead the handover of the department and come up with a plan to make some space. If a critically ill patient arrives now I’m not sure where I’ll put them. I make a quick assessment of ‘who is the least sick’ out of the very sick patients in there that I can pull out of a cubicle and into the middle of the room if I need to. Do I choose the patient who is on treatment for cardiac arrhythmia? Do I choose one of the septic patients with dangerously unstable obs?
Do I choose the patient we have started palliative care treatment on? It’s a hard decision and not one I want to make.
The situation was like this throughout winter. ‘Winter pressures’ it gets called. The problem is it’s now April and it shows no sign of easing up. Whilst the world gets excited that ‘winter is here’ as the final season of Game of Thrones airs, the sentiment that ‘Winter is here to stay’ resonates across emergency departments up and down the country. The ED Twitter community are all saying the same thing. The system is broken. There aren’t enough beds. We are drowning in a sea of chaos and we are struggling to keep patients safe.
I attend capacity meetings throughout my shifts and hear that we have dozens of beds occupied by patients who don’t need hospital care but can’t be discharged as there is nowhere suitable for them to go. Social care is on its knees and there simply aren’t enough care homes or community carers. The hospital is gridlocked. The managers have difficult decisions to make day by day on whether or not to cancel elective theatre cases to free up beds for the endless stream of patients arriving to the emergency department.
I feel terribly selfish as I hope the decisions go in favour of my department and extra beds are made available for those patients marooned on my corridor and I wonder ‘how did it come to this?’
When I chose to specialise in emergency medicine it was incredibly competitive. It was a real privilege gaining a training post. You get to meet patients on the worst day of their lives and you have the opportunity to help them.
The medicine is exciting, diverse and interesting. You get to work in a team of fabulous colleagues and no day is the same. That’s the career I chose. I expected stress as part of the job. The stresses of managing severely unwell patients. The challenges of diagnoses. It’s a stress I used to enjoy. The problem is the career I now have is not the one I picked. It’s not the one I trained for. Corridor medicine didn’t exist when I entered the world of emergency medicine.
I had no idea I’d be spending my days deciding which poorly patients to leave on the corridor and which to prioritise for my next space. The level of risk involved is terrifying.
I keep wondering how I’d feel if it was my relative stuck in that queue in pain, frightened and lacking any sort of privacy or dignity. Many consultants I’ve spoken to around the country have had a death on the corridor.
It should be front page news but it’s overshadowed by Brexit and the never-ending political soap opera that occupies our news channels.
Winter is here to stay. Patients deserve better. We all deserve better. I’m not sure I can do this anymore.
Anonymous emergency department consultant
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