After years of not darkening the door of A&E, we’ve managed to chew through chunks of that scarce NHS resource twice in a month. I seriously misjudged my step near a flight of stairs in mid-December and still have a limb in plaster. A few days into the New Year, Grenouille’s flu-ridden Papa passed out in the bathroom, bounced his head off about five different hard surfaces, and was blue-lighted in with possible C-spine injuries, in a neck-brace and on a spinal ‘scoop board’.
Both times, our local A&E staff have been superb, but the place is a nightmare. It’s a maze of cramped corridors and cubicles, with people sliding sideways past one another. Windowless, it feels oppressive even at noon, and I’ve never seen it but it’s rammed. I don’t know how crowded it was when G’s Papa was taken in, in the wee small hours; I had to stay with G after the smoothly competent paramedics had assessed P, shot him full of morphine, braced and boarded him, got him round the awkward turn on our stairs and up the steep front path. I know they managed to rustle up six competent pairs of hands to get him off the trolley and under the X-ray machine without jolting his neck and thankfully, after a period of worrying uncertainty when the initial films weren’t clear, he was given the OK. But when I was in there, at ten in the morning, it was appalling.
Areas of the department seem to be under refurbishment. I’m not sure if this is merely planned work to remedy some of the terminal shabbiness or whether they’re having to do emergency replacement of bits that have actually started fall down. Either way, there are apparently random areas sheeted off with dust-coated polythene, behind which can be seen foggy outlines of construction workers; and the doctor treating me – Dr A, young, serious, neatly-pressed shirt starting to wilt – had to push me, on a squeaky-wheeled, brakeless trolley, to a half-demolished area. Here, he brushed sawdust off a computer terminal, in order to show me my X-rays and explain what needed to be done for my broken bones. Back in the main area, en route for the plaster nurse, it was impossibly crowded. The doctor manoeuvred the trolley expertly, gently drifting it between scurrying bodies and round tight corners, without bumping anyone or anything, and parked me in a wider stretch of corridor. Around me eddied my fellow-flotsam: an elderly gentleman, slumped in striped pyjamas, whose only word, uttered dolefully at roughly thirty-second intervals, was ” ‘Ome!”; another woman with a leg injury who had brought in her knitting and her e-reader and was determinedly trying to block out her surroundings, though without much success, judging by her winces every time her neighbour foghorned his desired destination; a rather confused late-middle-aged lady who was having trouble communicating with staff. Parents cradled grizzling children and patiently repeated answers to repeated questions. In the distance, the doctor glided past at speed with another trolley, this one bearing an unconscious old lady, her scalp showing through her sparse hair, the same faded pink as the cellular blanket that covered her. The phone on the nurses’ station rang constantly, but was seldom answered. A nurse seized a water-bottle from behind the computer and gulped several swigs before flitting off. Staff coalesced briefly around the desk and rapidly dispersed again. Unlike the parked patients, they were in constant motion.
Suddenly, there was a buzz of bells and a trundle of trolleys moving from left to right, from the direction of the ambulance entrance towards the operating theatres. Half the staff rose and moved off in a body behind them, as though the trolleys were surfing before a Severn bore of blue scrubs.
The confused lady became tearful and grabbed at a nurse for reassurance, babbling an incoherent account of her troubles, symptoms and worries. “My heart… and I can’t remember which day, it’s… and then the stroke… I think I’m going to have one of my panic attacks, but the palpitations, it’s like when…” The nurse squatted in front of her, talking to her as though she were a dim and rather naughty child. “You’re hyperventilating! Stop it! Come on!” She tapped the lady’s hand. The lady breathed harder. A female doctor came over: “I’ve set up an ECG machine in the the office, I think she’ll be better in the quiet.” “Come on,” said the nurse again. “Let’s get you over there.” She stood up and put her hand under the lady’s arm. “Get off!” shouted the lady, suddenly switching to indignation. “You’ll make me fall!” The nurse rolled her eyes. “I’m just trying to help.” “I have to… the stroke, it’s walking. Take my time.” She heaved unsteadily to her feet and shuffled off unevenly, muttering, between the two younger women.
Eventually, the plaster nurse came to find me. “Sorry about the wait. We’ve had a couple of urgent cases come in so Dr. A wasn’t available – he needs to observe this.” She spun me round and set off for the workmen’s area again, acquiring Dr. A en route. He watched as the nurse moved swiftly through her task, giving him minimal explanation and no opportunity to do anything himself. I thought, fuzzily, that if this was the ‘see’ part of Dr. A’s ‘see one, do one, teach one’ training, I hoped he was a very quick study. I was glad I was his first and not his second patient. The nurse handed me a pair of crutches and helped me to transfer to a folding wheelchair that was even more decrepit than the trolley. “Can you find someone to take her back to the front desk?” she said to Dr. A. “I need to get this trolley back in circulation.” She squeaked off, leaving the door open.
“I’ll take you myself,” said Dr. A, shoogling the chair’s handles until the wonky wheels were lined up enough to move. “I haven’t seen a porter at all this morning. Still, you picked a good time to come in. Earlier, it was really busy, and it’ll get worse again later on.”
I looked out at the heaving chaos in the main area and wondered aloud how much worse ‘worse’ would be. Dr. A sounded amused. “We’re jammy just now. We’ve still got a spare operating theatre,” he said, turning down a corridor leading away from A&E, propping a door open with a crutch and deftly retrieving it as we passed through. “No-one’s bleeding uncontrollably, or having a heart attack, or trying to take a swing at a member of staff. And if you’ll kindly shift onto one of these banquettes in the foyer – if we prop your leg like this, is that comfortable? – I’ll have another seat for a patient who’s still waiting to be treated.” He smiled, tiredly, wished me well and disappeared briskly, the wheelchair wobbling in front of him.
I called Eldest to come and pick me up, and tried to imagine what it must be like after fourteen hours of too few staff, in too small a space, juggling too many patients, including bleeders, vomiters, screamers, about-to-croakers. If, as I believe, the quality of care depends on the nature of the relationship between carer and caree, how can you really care in those circumstances? If you really care, how do you cope with having to do half a job much of the time: the bare minimum with no time for relationship, or even kindness? How do you steer between the Scylla of callousness and the Charybdis of collapse? How do you keep sane, knowing you have to do it all again tomorrow?
When E was in his final year at school, one of his friends was knocked down in the road. A group of them had all been at an after-school ‘revision club’, and had stopped off at the local pizza place afterwards; it was winter, and dark, and the car came fast around a blind bend. Milo went up on the car’s bonnet and was then hurled several yards down the road when the driver stood on the brakes. E, who had completed St. John Ambulance emergency first-aid training, did all the right things. He immediately ‘set a perimeter’, flagging down a couple of other cars and getting them to park with their hazard lights on so that Milo – and anybody helping him – was protected from the traffic flow. He stopped a well-meaning passer-by from trying to move Milo. He delegated calling the ambulance to someone else while he checked Milo’s ABC, kept him covered, kept him talking. When the ambulance arrived, E was able to give the paramedics a comprehensive account of the number, nature and possible severity of Milo’s injuries. His other friends agreed to wait for the police; E went with Milo in the ambulance. He called me from there to explain why he was going to be late, and to ask me to phone Milo’s parents and tell them which hospital to go to. No answer on the landline. E didn’t have their mobile numbers, and Milo’s phone had got smashed in the accident. I called E back and told him I’d keep trying. He said that Milo needed to go into theatre immediately, could I speak to one of the doctors to explain. E stayed with Milo right up until he was under anaesthesia, and then he went down to the main entrance so that when Milo’s parents finally arrived, they didn’t have to ask anyone where their son was; he could take them straight to the right place. The surgeons were still operating. E sat with Mr. and Mrs. Milo for another two hours. Milo was still in theatre. At 11.30, E got a cab home.
It was a long night. Although E’s training had clicked in perfectly, and I was able to tell him, repeatedly, with absolute confidence, that what he had done had given Milo the best possible chance of surviving (given that he couldn’t make the car un-hit him), E knew that the injuries Milo had sustained were life-threatening. He was in shock, shaking and unable to sleep. I called the hospital. No information. At some point after midnight, Milo was transferred to the regional trauma centre. They were still more reluctant to say anything, even that he was a patient, but I managed to find out at 2 am that he was undergoing further surgery and was not expected to be out until 6 am. At 6.30, Milo’s father called me to say that Milo had just been moved to recovery. As E had suspected, there had been serious internal injuries and bleeding to sort out, but Milo was expected to make a full recovery*. E fell asleep as though poleaxed; and I got Grenouille up and into the taxi, phoned E’s school to let them know why he wouldn’t be in that day, and retired for a kip myself.
It wasn’t the end of E’s difficulties, though. He had nightmares and trouble sleeping for several days and I had to coax him to keep telling his story over until he had made his peace with it. And so I am troubled about what we are asking of our A&E professionals at present.
Now, I know that there is a huge difference between a seventeen-year-old having to deal with an accident to a friend, and a healthcare professional dealing with patients as part of their job. The HCP has far more training, more experience, more detachment, more formalised support. But they also have more incidents, a closer view of the consequences of injuries, more people to deal with every day, more responsibility. As long as E hadn’t actively made things worse for Milo, he would have done well enough; that he did considerably better than that was just icing. A health professional’s first duty may be to do no harm, but they have to go a lot further, every working day, with every patient. And then they have to complete the paperwork. No chance for a proper debrief, let alone an extended one. Just eat, sleep and repeat.
Expecting them to do so, without breaks, on shifts that are nearly twice as long as the typical working day, in emergency departments that are under-staffed and over-crowded because the entire health system is deliberately underfunded for politico-ideological reasons, is diabolical.
*Milo returned to school, in a jangle of supportive ironmongery, about 6 weeks later; got top grades in his A2s and, fully recovered as predicted, is currently doing very well indeed at university.