Maybe it was the six lovely days off, the warm cuddles with my family, the Christmassy glow, the communal feeling of joy and goodwill to mankind. Maybe it was the couple of glasses of red wine and prosecco, and a little too much trifle on Christmas Day.
Maybe it was my daughter waking up for several hours each night for the past week with the combination of manic excitement about Christmas, nightmares about Lego ghosts and a rather annoying cough. Maybe it was an overdose of Christmas songs and saccharine movies. Maybe that’s what made Boxing Day spent working in the Emergency Department feel so tough. Or maybe it was the fact that we had more than twenty people on trolleys in the corridor at all times through the shift, alongside the other fifty patients already in the department. The people in their nineties spending their Boxing Day in a corridor which is freezing cold at the best of times but particularly when the rain is lashing at the windows and the wind whipping up a gale. At one point there were eight people stuck in ambulances on the department forecourt who were unable to even unload into the corridor, one of whom I was trying to urgently treat with sepsis whilst he was still in the van. Maybe the people who had waited thirteen, fourteen, more hours to be found a bed inside the hospital itself, arriving in the dark of the early morning and still there by the time the dark of nighttime arrived. The indignity of trying to examine patients in corridors in front of other patients and their families. Having to apologise to every patient you meet that this just isn’t good enough but I’m afraid there is nothing else I can do. The fact that half the patients I looked after had only been discharged from hospital a few days earlier, almost certainly before they were really ready, and had inevitably bounced back in, more unwell than they had been before. Having to argue with doctors from inpatient specialties that yes, this patient really does need to be admitted. Maybe all of that was what killed off my warm Christmas buzz.
This is my tenth Christmas as a specialty doctor in Emergency Medicine, and over those years I have worked my fair share of Christmas Eves, Days, Boxing Days, New Years Eves and Days. In a funny way I often look forward to them. They tend to come with their fair share of tragedies, patients and families and stories that will stay with you forever. The cases where you go home and cuddle your own family a little tighter and count your Christmas blessings. But they also tend to come with some real Christmas spirit, colleagues in silly hats, songs sung in waiting rooms, donated presents given to the children, a staff room full of food, and an awful lot of Merry Christmas wishes. Some of that has been there this year (there was some phenomenal beard glitter on show!) but it felt a little hollow whilst working in the conditions we faced.
As long as I have worked in Emergency Medicine it has been a challenging job, not for the faint hearted. We have always felt stretched and under staffed at times. The last couple of years have been different though.
The corridor is now a legitimate patient area of our department, often with more patients than any other area, staffed with it’s very own team of nurses and health cares. It’s not a sign of a bad shift if there are patients there, but the sign of a miraculously good one if there aren’t. It’s now normal for patients to wait more than four hours for a bed and scarily common to wait more than four hours to even speak to a doctor for the first time. I keep seeing new firsts, the first evening handover where there are still patients from the night shift, the first time I have to run a trauma call in the decontamination room as it’s the only place we can fit an extra patient, the first time I have to try and treat a patient still in the back of the ambulance. And then those new lows become common place as well. We keep shifting our goal posts of what is normal and expected and acceptable. We keep upping our game and keep adapting as the next new challenge is thrown at us, and keep trying to deliver the very best care we can when it gets more tough than we could have imagined.
I do wonder though where the line will be drawn. When will it finally become too much. Because these conditions are not acceptable for the staff leaving their families at Christmas to care for others, and they absolutely, categorically are not acceptable for our patients.
One patient’s son was saying how unacceptable the situation was and I wholeheartedly agreed with him. He told me I should write to my MP. I smiled politely but didn’t want to say that if my MP was unaware of the crisis that our Emergency Departments are in then they should be sacked, and that it is the MPs who hold such a huge responsibility for having created this situation in the first place.
I am writing this now, tucked up in bed, failing to rest in preparation for the four hard night shifts that I begin tonight. I know that I go into those nights with the hospital in the highest state of alert in terms of overcrowding. I finish my run with New Years Eve, traditionally one of our busiest but one of my favourite nights of the year. I usually volunteer for it whether I’m due to be working or not.
We usually start the night with a quiet department, everyone avoiding us if at all possible. We might get a chance to all toast midnight with some booze free bubbles and a little song. Within half an hour of the new year starting we tend to see then rolling in, those who have celebrated a little too hard. And in they pour through the rest of the night. The night tends to bring its share of vomit bowls, swear words and bashed heads, but also lots of laughs and drunken song and that spirit which was definitely missing this Boxing Day. I am not facing it this year with my usual positivity. I fear the department will already be full and spirit long gone before the clock strikes twelve, so I worry how we will then manage the onslaught the new year always brings.
But I will live in hope. As an emergency doctor I think that’s what we have to do, I think that’s what must bring us back shift after shift. I will hope for a midnight toast and a hug from my colleagues, and a real change ahead of us in 2018. I hope that somehow somebody will come up with a way to make things better, and that line will be drawn at last. Lastly I hope you have all had a merry Christmas add that 2018 has lots of wonderful surprises in store for you!