The Hospital

Channel 4 have just shown a brilliantly accurate documentary set in the A&E department of a British hospital - called 'The Hospital'. I was a little reluctant to actually watch it, as I thought it would just be showing the drunken masses puking and wetting themselves in A&E (and I think I see enough of that), but it was fantastic and it really showed you just how much pressure A&E staff are put under.

I must apologise for this long post, but bare with me - I have a lot to say!

The bulk of it was displaying drunken youths, and I can't deny that every once and a while I am one of them. The difference is, I make sure I have a taxi booked to go home in so I can sleep it off and some paracetamol for the morning. This is much more than I can say for many others, and I am often shocked by those youths who are older than me, yet have so much less common sense. A phrase caught my attention, said from a drunken girl to a doctor; 'Why are you seeing the people that are sick and not the drunk people?'. That just about sums up the poor attitude of far too many people.

'The Hospital' showed some trauma jobs, which had me glued to my seat. I felt the adrenaline going, it was as if I was at work watching a trauma come into our own resus. A young girl of 19 was brought in after being trapped under a car for a while. Her leg was up by her face and she had suffered crush injuries and burns to both of her legs. She was accidentally given an overdose of Ketamine, and went into cardiac arrest twice. The team managed to 'get her back', and I was so proud to watch it. I think it renewed my faith in the NHS, which has took a battering since I started my job. It has given me something to aspire towards, and maybe one day I will be part of a team whose efforts have brought someone back to life. It's just putting up with the other, less deserving (but deserving none the less - after all everyone should be entitled to care), members of our dysfunctional society.

The drunken patients featured in the documentary looked all too familiar, I didn't see anything new there. I thought about how distracting these patients are, how much time A&E staff have spent holding up a patients head, making sure their hair doesn't fall down as they vomit, and how all of that time could be spent on a patient with serious and possibly life threatening injuries and/or illnesses. I was talking to one of the sister nurses today, she told me about a couple of patients who had called ambulances but were not in need of one. I have to say, considering ambulances are meant for EMERGENCIES, in my opinion only about half of the patients that come in by ambulance are actually an emergency. I think I'm being generous with my estimate. I want to mention one in particular that she told me about...

The man was roughly 24 years old, and had hurt his ankle. He was just 5 minutes away, around the corner from the hospital, and decided he couldn't get to A&E other than in an ambulance. He'd just got off the bus, and didn't want to walk the rest of the way. This nurse definitely shares my frustration at the misuse of the ambulance service, and told him (or tried to tell him) what ambulances are for.

'If you felt that you were having difficulty walking, then you could have called a taxi'

The reply went something like this;

'No I didn't want to have to get a taxi out, besides, I might as well get my money's worth out of the NHS and use the ambulance service - after all, it keeps people in their jobs'

He also wanted an ambulance to take him home.

I felt white hot with anger.

I have been in situations where we've been thrust 5 or more patients with chest pain, who will all of course be prioritised, and when I wheel them into the bay before the drunks I am shouted at for putting the chest pains first. The more time I spend trying to explain that we are all doing our best and that some patients are critical and need to be seen first, the more time and care is diverted away from those that truly need it. I sometimes wonder why I bother to explain, it's lost on some people.

On The Hospital, an unconscious young lad was brought in, and for the first time I felt a horrible tingling sensation that told me to expect the worst. It was described as a swelling in his head, and when they said 'He has unequal pupils', my heart skipped a beat. I closed my eyes and thought to myself; 'He's dead'. I was right, he was in hospital for a few days before they turned off the machine that was keeping him alive.

I could have so easily been wrong, and of course I wish I was, but I was right. I think what set off my tingling feeling was that I had experienced a similar event before, with one of my friends. I was 16 at the time, Jay (not real name!) was only 15. This was before I had any medical training, or even first aid training, and is quite possibly the reason I even became interested in a career in healthcare. He was at his house with two friends and his brother, they'd had a couple of drinks, vodka and red bull, and he was smoking his trademark marlboro lights. He was complaining of a headache, of course no-one suspected anything out of the ordinary. He sat down, and started to feel a little tired. Gradually he lost his motor functions, tried to speak but it was slurred, and had difficulty getting up out of his chair. Obviously they started laughing, thinking he'd just had a bit too much to drink. They sat him next to Kyle, a close friend of mine and Jay's best friend at the time, where he 'fell asleep' on his shoulder. They noticed he wasn't breathing shortly after. His dad was called outside, where he initiated CPR. His brother screamed; 'I gave him too much to drink, I've killed my brother'. The ambulance took him to A&E, where I work now, he had some shocks on the way and they managed to get a pulse back, but after a CT scan at the hospital it became clear that he'd suffered an intracerebral haemorrhage that was so severe his brain had been crushed to half its normal size. They turned the machine off 24 hours later.

Jay was a great friend, and it completely tore our once close friendship group apart. I don't see many of them anymore, I think everyone seems different now. It changed everyone. And everything.

A real emergency, masked by alcohol consumption. Jay wasn't hit on the head, it was a blood vessel waiting to burst. I have to say I'm glad he was with friends and family at home, after all it could have been at school. On The Hospital, the nurse said how it was upsetting that they'd put in so much effort to keep their patient alive and try to do everything they could, but it just didn't work out. She said how scary it is that it could happen to anyone, and you could never have predicted Jay, at 15 years old, could have died so suddenly without warning.

Some patients that attend the A&E department that I work in, don't have to be there. To put it bluntly, they are time wasters. This tends to be the younger generation, but the are exceptions. These are the people that demand to be seen first, that complain about the care they recieve and sometimes abuse staff. Then at the other end of the spectrum, usually the older generation, apologise to me for wasting my time. Some who have put up with agony for days but could no longer bear it, some who didn't want to come in but were forced by a relative and sometimes just people who were a bit worried and wanted to make sure they were ok. In my experience, about 99% of the patients that say to me 'I'm so sorry, I really don't want to waste your time' are not wasting anyone's time and have a serious health complaint, and I had the best example of that today;

A 63 year old male, I'll call him James, came in because he'd collapsed 4 times over the past 4 days. He said he'd just felt a short period of dizzyness, then fainted, and had experienced intermittent chest pain today. I was talking to him and he was very coherant, knew where he was, why he'd came, everything seemed fine. His wife made him come in to us, and rightly so. I did his ECG, (staying at the top as ECG queen), which showed tachycardia. Upon discussing him with a consultant, it was decided that if his BP was low that he should go into resus. His BP was quite normal, but none the less I kept a close eye on him. As I went to take his temperature he started coughing, he has known COPD so I waited for him to stop coughing and get his breath back. But he didn't. His eyes suddenly glazed over and he started fitting. I put him straight onto O2 and we very quickly wheeled him round into resus. I was so glad I was there to witness that, his seizure was over in about 20 seconds. When he'd came out of it he asked 'Where am I?' and looked at me as if he'd never seen me before. A minute ago I was having a laugh with him at how rubbish our home football team are. In those few seconds he'd completely lost the memory of how he'd got to hospital and why he came in.

When James first got to A&E and I'd introduced myself to him, the first thing he said to me was 'I am so sorry I know I'm wasting your time so please don't let me get in your way'. I replied 'No not at all, you've been having chest pain and you have been collapsing, you were absolutely right to call an ambulance and you are definitely in the best place that you can be'. I have all the time in the world for a patient like James, and he was lucky that it wasn't the early hours of a Saturday morning where he would have been 10th in the queue with the drunken head injuries and assaults and other inconveniences that being so close to the city centre spills into our 'Emergency' department. Where his seizure would have probably gone unwitnessed, where he would not have got the care he so desperately needed.

I love my job. It's the best thing I have ever done with my life and I am so grateful for the opportunity to work with so many dedicated and hard working staff both within A&E and the ambulance service, but sometimes these things get to me. I have already been the victim of unprovoked verbal and physical abuse, which I will probably write about at a later date (and if you've read this far you can have a drink on me) - oh the irony.