Accident and Emergency Diary: Saturday Night Shift

A&E wards can be frightening, stressful and downright unpleasant place to visit. They often seem close to bursting point with patients who range from car crash victims to the walking wounded, crying children to drunken adults. But these wards can be equally traumatic for the staff – who must not only deal with life and death decisions, but also cope with abusive patients, inadequate facilities and bundles of red tape.

Hannah, 29, is a junior doctor working in a busy Accident and Emergency department in a hospital outside London. Despite the long hours and the constant stresses of dealing with sick and injured patients, she loves her job and wants to become an A&E consultant. Here, in the second part of a diary that spans two ten-hour shifts over the same weekend, she describes the highs and lows of life at the sharp end of medicine.

Saturday night shift: 10pm-8am

 10pm

I arrive at the hospital to find that I am the only regular doctor in the A&E department tonight. The other five doctors are locums, which means that they are freelance doctors who work shifts wherever they are needed. I recognise some of the faces and say hello, but my heart sinks. It means more work for me because the others will be finding their feet. Things get pretty exciting very quickly in A&E. A big ‘bleeder’ has come in and the place is soon covered with blood. The patient is a man aged about 50 and he is vomiting blood by the bucket load. We put him on a trolley and try and get him to calm down. There is blood all over the curtains and the walls. He has chronic liver disease and has developed varicose veins in his oesophagus. One has burst, and this is causing the massive bleeding. He needs five litres of blood before he is stabilised. We call for more blood from the blood banks. Luckily the man belongs to a common blood group so there is plenty to spare. Less common blood groups may be harder to find. If the hospital runs out, we have to chase up blood supplies all over the country.

11pm

I am pulling my hair out because patients keep coming. Some of the locums are struggling. We won’t ask two of them back because they are clearly not up to the job. There is a real shortage of doctors and medical staff in the NHS, and standards are slipping. Ambulance drivers are now queuing up in the corridors waiting to check in their patients. The clock does not start ticking until they hand over to us. Some hospitals fiddle the waiting times by keeping patients waiting in ambulances for up to an hour. I am a bit worried that we might have to go to red alert. This is when we have to shut to new patients because we are completely overwhelmed. When this happens, ambulances are diverted to other hospitals. It tends to happen in the winter when we have lots of pneumonia and hypothermia cases.

12 midnight

Some women on a hen weekend stagger into the A&E. They are bringing in the bride to be, who is clearly the worse for wear and has cut her hand on some broken glass. They sit in the waiting area, still wearing their bridal veils and joke glasses. A nurse takes a look at the injured hand and sends the woman off to minor injuries. This clinic, for cuts and grazes, closes at 1am. We see quite a few young women who are very drunk. Occasionally, they may be more than drunk. We are always on the look out for possible victims of Rohypnol, the date rape drug.

1am

The place has calmed down again. The pubs have long closed and the clubs will stay open for several more hours. The waiting room is nearly deserted, apart from a couple of men who appear to be asleep. The cleaning team pass through and make an attempt to tidy the place up. The neon lights seem very harsh. Three doctors go home and there are only two of us left. I don’t feel anxious. I am reasonably experienced and I can handle myself. If there is a serious problem, I can always ring 999. I could go to sleep for a bit but I am a night person and I am not tired. I catch up with some of the nurses. They always know every bit of gossip about the hospital.

2am

The ambulance drivers bring in a steady trickle of old people with breathing difficulties. The colder weather signals the start of the flu season, which can be life threatening in older people. More casualties from the bars appear, some under their own steam, others on trolleys. A young man has cut his head. He has been hit by a broken bottle. We patch him up and send him on his way.

3am

A patient comes in suffering from a serious asthma attack. I recognise her immediately beneath the oxygen mask that is clamped to her face. She comes into the A&E department at least once a month. She is blue and gasping. I can see that she is terrified and it is horrible to watch. She has oxygen and nebulisers at home, but sometimes the medication fails to work. I give her an injection of magnesium sulphate, which is a smooth muscle relaxant. Quite soon afterwards, the colour returns to her face and she starts to breathe more easily. We wheel her into a side room where she can slowly recover.

5am

The only other doctor goes home and I am left completely on my own. I don’t like this at all but our regional health authority has decided that one doctor in A&E is enough at this time of the morning. It is fine if nothing happens, but everything gets seriously stressful,  if two seriously ill patients arrive at the same time. It can be Bedlam or it can be like a graveyard. It all depends. I keep my fingers crossed that the patients will come in one by one. The hours tick by and luckily, it is quiet. Patients continue to arrive in dribs and drabs and I deal with the problems easily.

6am

An elderly patient is brought in who has been found lifeless in bed. The ambulance drivers are obliged to bring in patients like this, in case there is the smallest chance that they can be resuscitated. There is no pulse and the patient has clearly passed away. I issue a death certificate and the body is taken away to the morgue.

8am

The A&E unit is bustling again as a new shift of doctors and nurses arrive. I am absolutely knackered and I want to go to bed. I hang up my stethoscope and brief the new team about what has happened overnight. Then I head home. There is no one waiting for me. I don’t have time to find a boyfriend right now. Romance rarely blossoms in A&E.