Image: NHS Choices
A few years ago, I well and truly lost the junior doctor rota lottery and was allocated 7 night shifts in a row over Christmas week.
It was my most memorable Christmas ever.
I was orthopaedic Senior House Officer at a district general hospital outside of London, covering any inpatients who became unwell on the orthopaedic wards overnight, and seeing any complicated or particularly serious A&E admissions. I had an orthopaedic registrar and consultant off site who I could call for assistance. Toward the end of the night, it would then be my job to book urgent operations onto the emergency operating list the following morning.
This was my first set of night shifts since starting the job earlier that month, but I’d been assured by the team that as we were not a major trauma centre, it was unlikely that I would be particularly busy. How wrong they were.
Over the first couple of nights, I saw a number of simple hip and ankle fractures, and the occasional broken wrist courtesy of some excess festive spirit. The wards kept me busy with a few poorly post-operative patients, but none of this was all that new to me, having worked 6 months in general medicine previously.
The pace picked up on Christmas eve. A few more Christmas eve slips and trips kept me busy in A&E until about midnight. I was then called back to the ward to review a woman who was struggling to breathe. I assessed her thoroughly and ran a blood test. She was a few days post hip replacement and I started to worry that she might have developed a pulmonary embolism - a blood clot in the lung, which is more likely to happen when someone is unwell and not mobile, as she had been after her operation. I phoned up the consultant radiologist on call who agreed that an urgent scan and treatment were necessary. We made the arrangements for the on call radiographer to come in and do the scan in the next hour. Sure enough, the scan confirmed my fears, and the patient was diagnosed with an embolism. I contacted a senior doctor and continued her treatment. Throughout the night, she thankfully stabilised, and I was able to tend to the other patients on the ward.
I was kept busy on the ward for a few more hours, eventually stopping for a toilet break and a cup of tea at about 4:30am. As I finally settled into the comfy sofa in the doctors’ mess, the intrusive ‘BLEEP BLEEP BLEEP’ of my pager and a voice from switchboard sounded; ‘Trauma call, A&E Resus’.
Cup of tea down the kitchen sink. I made my way over to A&E where I introduced myself to the team.
‘This is the first patient’, the A&E nurse told me as he gestured towards a young man on a stretcher, blood dripping down his face and incoherently moaning as he clutched his left forearm.
‘First patient?’ I asked, perplexed. Yes. This was the first of 5 patients involved in a single vehicle road traffic accident, just yards from the hospital. It was at this point that I called in my registrar, who also called our consultant.
The following four patients were extracted from the wreckage of the car they had been travelling in and brought to A&E by paramedics in dribs and drabs over the next half an hour. During that time, that first patient I’d seen had become very unwell as a result of a serious head injury. He was soon anaesthetised by the intensive care doctors, with support from the skilled team of nurses in A&E, and transferred to an intensive care unit at a larger hospital. Meanwhile, the second patient, another young man, was being treated for a femoral (thigh bone) fracture. He had been given strong pain killers and gas & air while a team of doctors and nurses, including myself, pulled on his leg, to encourage his bones back into alignment before he went for surgery.
The next young man was lucky and escaped with nothing more than a small scratch. However, once discharged from our care, he stayed in the department to be near his friends. Unfortunately, his behaviour was very disruptive, as was his friend’s with the broken leg which led me to ask what drugs they may have been using that night. Sure enough, they had been out partying and had been drinking alcohol and taking cocaine before driving around town at high speed.
The last two patients were young girls in their late teens. They had been in the back seat. One girl had broken her arm. The bone had pierced her skin and she and needed an urgent operation. The other sustained a serious head injury. She had sadly not been wearing a seatbelt, and bumped her head on the back of the driver’s seat. On arrival she had been alert and even refused to lie down on the stretcher, opting to come in on a wheelchair. She was sent for a head scan, during which she lost consciousness. She, like the driver was then quickly anaesthetised, ventilated and sent to the intensive care unit at a larger hospital. I don’t know what happened to her, and I will always wonder.
It was a hive of activity. Everyone was there. The on call radiographer was present and carried out bedside X-rays on the patients. The administrators in A&E were there, trying to collect identification information for all these patients and get them registered on our system. The ITU and A&E consultants and junior doctors were huddled in teams around their various patients. The nursing staff kept the whole system moving; attaching wires and tubes, measuring patient’s vitals, and administering medication and fluids. The porters delivered patients to and from the radiology department and couriered life-saving blood transfusions and blood tests across the hospital. The health care assistants sat with the worried parents and offered them cups of tea as they waited for news of their children.
As I left my shift that morning and headed home for Christmas breakfast with my family, 14 hours after I’d started my shift, my head was buzzing. I wondered what might happen to the two patients with the head injuries. The young man did come back to us a while later, having had a month of neurorehabilitation. He was now severely mentally disabled and had lost much of his ability to inhibit his actions or behaviour. I never heard anything more about the young girl.
I did however find myself filled with hope when I reflected on the incredible teamwork and dedication of everyone involved. It was 5am on Christmas morning, and only a skeleton of staff were rostered on to work, yet when a complicated emergency came in, everyone stepped up and went above and beyond to provide the best care possible.
And so, if I want you to take anything from this article, it’s this: If you need urgent or emergency medical care over Christmas, just go to A&E. You will be seen, assessed and treated to a high standard by a full complement of dedicated NHS staff. Same goes for any weekend or bank holiday. Don’t let the government or the misguided media tell you you’re more likely to die if you attend hospital at these times - you’re not. We have an incredible thing in the NHS. A cohesive machine of hard working, caring professionals, dedicated to providing high quality care to everyone, no matter what your background or bank balance is, and not for any personal gain or profit. Please support your NHS this Christmas and in 2016.