I was expecting bad things from this week of night shifts and I was right. I was based on the Medical Admissions Unit, where patients come to be assessed by the onsite physician (me) after being referred in by a GP or A&E doctor.
One of the paradoxes of working in medical admissions is that most of the patients arrive on the unit after 5pm, which is exactly when the staffing levels of doctors and nurses on the unit fall. This means that if you do an evening or night shift Medical Admissions, you can just about guarantee that you’ll have a busy time.
My first night was no exception. I walked in and there were already eight patients waiting to be seen with another five expected from A&E. I warned the FY1 doctor* that with only the two of us working, tonight was going to be manic. He gad a knowing nod.
And so it began, we spoke to, diagnosed and treated the frail, the sick and the infirm into the early hours of the morning. Some patients were critically ill, some just needed a couple of days in bed and there were lots in between. I don’t know if any of you guys have ever stayed up all night (whilst not on drink or drugs) but I find that after I’ve been awake for about 20 hrs my vision goes a bit weird, simple things like making a cup of tea seem to take ages to do and I get really emotional about just about everything. There’s a point in the night, usually about 4 or 5am when you think “The whole world is in bed. Why am I still awake? I don’t want to be here. I just want to sleeeeeep.”
But the patients keep coming in and they all need to be treated.
At times like this, truly, the last thing you want to here is the emergency pager going off, saying “Medical Emergency, Dr Anderson to A&E resus please. Medical Emergency Dr Anderson to A&E resus”
I hot-foot it down to A&E resus and find the A&E staff performing CPR on this old man. I manage to glean some background story. Apparently, this man found he couldn’t breathe and rang 999. The paramedics arrived at his home and found him dead next to the phone. They rushed him into A&E where, by using drugs and oxygen, we managed to upgrade his status from dead to alive. Problem was his heart kept stopping (i.e. he kept dying). Me and the A&E staff kept having to use drugs and CPR to restart it. This went on for about half an hour until we eventually “brought him back” so he had a pulse again. You must note that I’m using a medical definition of “alive” here, this man never regained consciousness. Although he had a pulse, he was not able to speak or move, he couldn’t feel or see anything, hell, he couldn’t even breathe for himself.
After giving him a cocktail of very powerful drugs, we sent him to the intensive care unit where a machine would breathe for him. I don’t know why this man died at home, my best guess was that he had a pulmonary embolism. What I can be more certain of is that he’ll never wake up. He’ll require increasingly higher doses of powerful drugs in the intensive care until eventually they’ll decide to switch the ventilator off and then he’ll die. For good.
As I wander out of the resus room, another A&E doctor asks me to see this woman who is having a heart attack and I’m reminded of the old saying “it never rains it pours.” Heart attacks are extremely serious in their nature and frequently kill, but fortunately, this lady wasn’t having a big one. I treated her, sent her up to the Coronary Care Unit and 06:45, I trudged back upstairs to the Medical Assessment Unit.
I’d been awake for 24 hours and there were still five patients waiting to be seen. One of whom had been on the unit since 01:30. I felt really bad that this poor old chap had been waiting so long to be seen but what can I do? To quote Whoopi Goldberg, “There’s only one me.”
* FY1 or “Foundation Year 1” doctors are in their first year after medical school are the most junior doctors in the NHS