Further protests ensued. The man was not safe to get a taxi on his own but was still well enough to go back to his nursing home. There was a willing crew who were free at the time and I couldn’t see the problem. I tried to intervene and told control about how the man was confused and distressed about coming into hospital. I explained that staying in hospital until 9 a.m. the next morning would make him worse. However, I was told that the 3 percent funding shift resource allocation caused by the contract change had meant that they could no longer do goodwill gestures such as I had requested.
It was ridiculous. For no good reason beyond disjointed management decisions – made introspectively, without thinking about the consequence for the whole NHS – this man had to stay in an A&E ward for 10 hours. He became very upset and distressed. A&E later became much busier and our nurses didn’t have time to take him to the toilet and so he soiled himself. He screamed all night because he was confused and disorientated in this strange place and the patients in the bed next to him slept very poorly. I was then asked to prescribe sedatives for the patients in the A&E ward, and for him!
I just don’t understand what is happening in management; I don’t think that management understands what is happening on the A&E ‘shop floor’. I found out from one of the senior A&E nurses that the contract decision was changed to save a very small amount of money. Managers would have slapped themselves on their backs for their ‘efficiency’ savings to the transport budget, but not realised that it would not have saved the hospital, or the NHS as a whole, a single penny (the patient still needed to go back in the morning!).
I was annoyed with our managers, but why did the ambulance control man act in the way he did? A few years ago, the crews would have taken these patients back if they were quiet – contract or no contract – for the good for the patient. I suppose nowadays people are instructed to do stuff only if it is for the good of the targets and common sense has flown out of the window.
I got very stressed and angry about this. After a while the junior doctor working with me asked why I was so irate. I explained that, apart from an irate personality disorder and the fact that ranting is my form of therapy, I was genuinely upset. Apart from my lovely family and useless football team, the things I care most about are my patients’ care and the state of the NHS. It upsets me that crappy management decisions done in the name of ‘efficiency’ bugger up both.
P.S. If there are any politicians/managers wanting to see the actual effect of NHS policies (both good and bad) on patient care, please ask your local A&E department if you can spend a night working alongside the doctors and nurses. You will learn more about the problems in that one night, than you ever will from looking at a balance sheet or ‘throughput’ data that A&E departments send their hospital managers.
P.P.S. If you think I will ever talk about how awful things are, please be assured that some things have improved dramatically over the last few years, it is just that I want them to continue improving and not get worse again. Also, when there are no problems, I do not get angry and so do not feel the need to write. So, if you think everything I say is biased, then, yes, you are right. But biased for the right reason: to try and get things changed for the better … and to help with my stress relief.
It is a well-known fact that you should not be a doctor for your family. This is true. I certainly found out how true last night …
It was the quietest night we had had for a long time. A&E was empty when my wife’s grandpa arrived. He is in his 90s, demented, and spending the last few years of his life in a confused state in a nursing home. The staff at his nursing home had called an ambulance as he was more short of breath than usual.
I got the other doctor to see him and told them all his problems. I explained that on his previous admission, the consultant had declared him ‘Not for Resus’ (i.e. if his heart were to stop, then it would not be appropriate to try to restart it with cardiopulmonary resuscitation – CPR). This was the right thing because his quality of life was so poor. In all honesty, I just hoped for his sake that he would pass away peacefully in his sleep. I had a chat with him and then, when he fell asleep, I left to get a drink. It was very quiet in A&E and he was the only one left in the department.
I was dozing in the coffee room, when the alarm call came through the intercom. ‘Cardiac arrest, Resus’. I ran there past where Grandpa was meant to be. He wasn’t there. For Christ’s sake! Why had they moved him into the Resus room, and why were they doing something futile and cruel? I was livid.
I ran into the Resus room. Everything went into slow motion. There was a nurse jumping up and down on an elderly man’s chest and the doctor ventilating his lungs. I was furious. ‘Let him die in a dignified way and not with broken ribs,’ I thought.
‘STOP. STOP. BLOODY HELL, STOP’, I screamed.
‘It’s not your grandpa, Nick. He has gone for an X-ray. This bloke just collapsed in reception about twenty seconds ago.’
‘CONTINUE, CONTINUE’, I screamed back. ‘BLOODY HELL, CONTINUE.’
Ridiculously embarrassed, I managed to regain my composure and lead a successful cardiac resuscitation. We got back a pulse and called the anaesthetists to take over his breathing. He went to ICU (the intensive care unit) and three weeks later was discharged to lead a normal life. Thank God everyone ignored my advice to stop.
Meanwhile, my wife’s grandpa was sent back to his home the next day and is still in the same sorry way.
Dealing with threatening patients
I get scared sometimes at work. I work in a rather tough town – even the muggers go round in pairs. Consequently, we get some rather tough patients. Give them some alcohol and they become a little hostile. Add the stress of waiting 3 hours and 59 minutes and they become aggressive. The fact that they are often in A&E because they lost a fight sometimes results in them looking for revenge – and A&E staff are often the target.
I am a not a ‘weed’ but I am not sure that I could handle myself if I ever got into a proper fight. With a lack of any training in self-defence, and an A&E security guard that my Nan could ‘have’, you sometimes feel a little vulnerable. I have never been assaulted but I know a number of colleagues who have. The BBC programme Panorama investigated this violence and reported that a NHS worker gets attacked every 7 minutes (for more information see: http://news.bbc.co.uk/1/hi/programmes/panorama/6383781.stm). However, much of the ‘violence’ results from the confusion caused by medical problems. I have been bitten by a lady in her 80s who was short of oxygen. It wasn’t her fault – it was probably mine – I should have been more careful. When she was better she was the most beautifully placid person in the world. These are not the type of ‘violent’ patients that upset me. It is the aggressive, bullying types who know all their rights but have no sense of respect that irk me and make my job scary at times.
Last night I was at the desk, writing my notes, when a drunk and aggressive man came up to me and was forcibly complaining that I was delaying his treatment because I was being anti-Moldovan. (Maybe I need to go on a cultural awareness course, because I didn’t even realise he was Moldovan or, more to the point, where in fact Moldovia is.) All I knew was that he was a man who did not need to be seen before the bloke who need 15 sutures for a bottling injury and who was bleeding profusely.
The patient became very aggressive and angry. As he started to walk menacing towards me, I started to apologise profusely (as well as sweat profusely). Experience has taught me that this often stops aggressive people in their tracks as they are frequently expecting a fight back. Worth a try, I thought …
‘I am very sorry sir, but we are very busy tonight.