6.38am
My workplace is not a hospital any more. It’s a battlefield. And when I turn up for my ten-hour shift, 20 minutes early, it feels like going over the top of the trenches into an onslaught.
More than 35 people are already crowded into A&E, with several sitting on the floor because all the seats are taken. Most of them are plainly exhausted as well as ill.
I can tell that many have been here all night. There will be more in the corridors too, on trolleys.
Before I can even greet my colleagues, two patients approach me demanding to know when they will be treated. I tell them we’ll get to them as soon as we can.
‘Do you know how many times I’ve heard that since I arrived at ten o’clock last night?’ snaps one woman.
6.40am
The situation in the corridors is worse than I feared. Waves of flu and chest infections are sweeping through Britain this January, causing more cases of pneumonia and other respiratory illnesses than I have ever seen.
Our wards have been at maximum capacity for months and every day the crisis gets worse.
As the doctor stars her ten-hour shift, 35 people are already crowded into A&E, with several sitting on the floor because all the seats are taken
At least four elderly patients on trolleys have signs of chest infections impacting their breathing.
They ought to be in resus [the resuscitation area, where the most seriously ill patients are dealt with], or at least in a high dependency unit, but instead they are in a corridor overseen by a physician assistant.
Many patients might imagine these are qualified doctors, but they are not. It’s madness: apart from anything else, the corridors are unheated and drafty, the worst place for flu patients.
6.50am
As I’m getting to grips with the triage reports that determine which overnight patients will be our highest priority, there’s a commotion at the door. One of the security guys has his arm around a woman, hustling her towards me.
His face is open-mouthed with shock. Hers is frozen in fear, and she’s carrying something that I mistake at first for a bundle of clothes.
It’s a child. I reach automatically under the coat, searching for the side of the neck, but as soon as my fingers touch cold skin, I know I will not find a pulse.
When I lift the child’s body from the mother’s arms, it is stiff. Rigor mortis is setting in. Death must have occurred during the night, but the woman either doesn’t understand or she’s in denial.
Even though there’s no hope, protocol insists we must make an attempt at resuscitation before declaring the child dead. She’s a girl, about four years old, and her mottled face is pitted with dark red spots.
I know these signs: chickenpox, followed by overwhelming sepsis and death from blood poisoning.
As the body is taken to a resus room, I try to learn from the mother what has happened. She’s East European and her English is not good, but she manages to explain in numb words and gestures that she has two other children, and that her husband is away working.
All her children have been off school with chickenpox, but last night the little girl became listless and floppy. The mother took her to an A&E ward on the other side of the city but was told to report to another clinic.
Seriously ill patients are left in a corridor overseen by a physician assistant. Many patients might imagine these are qualified doctors, but they are not. It’s madness: apart from anything else, the corridors are unheated and drafty
Unable to understand where she was meant to go, they went home instead. She tried to watch over the girl but, exhausted, must have fallen asleep. When she woke, her daughter wasn’t breathing. It’s utterly tragic, and so unnecessary. If A&E departments are so unable to cope that they’re sending mothers with very sick children away, Britain no longer has a functioning health service.
7.30am
I want to sit down and cry. The doctors and nurses around me look anguished and shocked. After events like this, we’re supposed to ‘huddle’ – lean on each other for support and talk.
No chance. I barely have time during the average shift to go to the toilet.
8.15am
A man with a head wound is causing disruption in the waiting area. He is pressing a bandage to his scalp and there’s no sign of bleeding. He also smells strongly of drink.
He’s complaining loudly about waiting – he says he’s been here since midnight, but I can’t ascertain the truth and suspect he’s trying to jump the queue. Of course he needs to be seen, but he’s far from the only one.
When I try to explain this, he leaps up and barges me out of the way, swearing furiously. Then, shouting the odds to everyone about Britain’s ‘third world healthcare’, he storms out of the main doors.
A few people applaud, glad to see him go. But our job is to treat everyone, not drive away the impatient ones.
Violence from members of the public, though rare, is a constant worry. We’re all very aware that a nurse was stabbed at a Lancashire hospital earlier this month, and that a man has been charged with attempted murder.
9.40am
Not everyone is impatient. Some, especially the elderly, are too patient for their own good.
A frail gentleman whose face is as white as his hair emerges from one of the side rooms and stands forlornly by the vending machine. As I’m passing, I ask if he’s OK – he looks as though he might faint at any moment. ‘Do we get anything for breakfast?’ he asks me apologetically.
I tell him a trolley might be round later but that there’s no canteen. ‘Did you not get a chance to eat before you arrived?’ I ask.
It transpires that he has bone cancer, and was booked in for a scan two days ago. The ambulance that was due to bring him was delayed by 22 hours, since 999 demand was high and scans are categorised as a low priority.
That’s true, but it meant he missed his appointment slot by a whole day and since then he has been sitting in an armchair, waiting to be seen for 14 hours.
During that time, he’s had a cheese sandwich and a tuna sandwich, he tells me. He’s 87.
No wonder there are ambulance delays. Half the fleet appears to be parked outside, queued like taxis on a rank. All of them have patients inside
10.15am
No wonder there are ambulance delays. Half the fleet appears to be parked outside, queued like taxis on a rank. All of them have patients inside.
It might seem like lunacy to use a £150,000 state-of-the-art ambulance as a waiting cubicle, but if the hospital has no capacity to treat new admissions, then it isn’t safe for paramedics to offload their patients.
Call handlers will try to divert ambulances to other hospitals, but an A&E department can’t simply close its doors without being subject to a heavy fine.
Meanwhile, many of the overnight patients are still a long way from being seen. A report last year by the Royal College of Emergency Medicine – the body responsible for setting standards of training in emergency medicine – suggested more than 250 patients a week were dying as a consequence, direct or indirect, of very long waits in A&E.
According to those figures, in February last year 44 per cent of A&E patients spent longer than four hours in the department (compared to 5.2 per cent in 2011). It’s going to be even worse this year.
11.30am
A woman in her 20s asks if she can speak with me in private. There’s something in her eyes that makes me break off and take her to an examination room.
She tells me she’s not sure if she should even be here but she thinks she’s been raped.
Four nights ago, she went for a drink after work with friends. She rarely has more than two glasses of wine, but this time she woke up the next day, fully clothed on her sofa, with only patchy memories of what had happened.
Since then she has been suffering flashbacks about going to a club and ending up in a stranger’s apartment. She has no idea who or where this was. All she knows for certain is that she’s bruised and sore, and wants me to tell her whether she’s been sexually assaulted.
I explain that whatever happened that night, the sexual health team has to see her immediately. Until we know for certain that she has not contracted HIV, she will need preventative medication. The side effects of that, I warn her, are not pleasant.
Immediately, the police have to be informed. As she is not on the Pill, she also has to have a pregnancy test and probably a morning-after pill. As I write up her notes, she becomes really distressed. All the emotions she has bottled up for days burst out.
A 39-year-old man is admitted with serious chest pains – he is having a heart attack. He tells me he is a cocaine user. Because of the explosion in coke use since lockdown, we’re seeing much more coronary disease in patients much younger than in typical heart attack victims
12.45pm
A 39-year-old man is admitted with serious chest pains. My first thought is that he may have suffered a heart attack – and I am right.
He tells me frankly that he is a regular cocaine user. This isn’t a confession, just a statement of fact, the way he might explain what his job is.
He would be more embarrassed to tell me he smoked cigarettes than snorted blow. Cocaine can cause symptoms of ischaemia in the heart, narrowing of the arteries that supply blood.
Because of the explosion in coke use since lockdown, we’re seeing much more coronary disease, in patients much younger than the typical heart attack victims of 30 years ago.
Cardiac conditions have also become more common because of Covid itself, and because of a side-effect of the Astra-Zeneca vaccine. It’s comparatively rare, but that’s no comfort to the people we see with internal bleeding and low platelet counts (these stop heavy bleeding by causing the blood to clot).
2.10pm
The other major consequence of the pandemic is a spike in anxiety among teenagers who missed months of schooling. Tens of thousands of children have come out of lockdown with mental health problems. They are preparing to take GCSEs and A-levels and many are not coping well.
A 17-year-old girl is brought in by her mother, with both wrists bandaged. When I ask her what she’s done, she refuses to talk. Her mum tries to pretend it was an accident – ‘she was carrying two bottles, one in each hand, and she tripped’.
The woman seems more concerned that I shouldn’t inform social services than with her daughter’s injuries, which fortunately are superficial.
4.20pm
Throughout my shift, I’ve had management pressuring me to move patients around to make it look as though we’re meeting targets for waiting times.
The bureaucrats don’t care if it’s appropriate for people to be shunted from one department to another, or whether we have bed space – their only concern is missing deadlines, or ‘breaching’ in management speak.
Too many ‘breaches’ and they’ll get fined. Their prime concern is money. The phone rings, and once again it’s a manager.
I want to tell them that I don’t care about the fines, I only care about what’s best for my patients. Actually, what I really want to say is: ‘Why don’t we sack the armies of managers and spend their salaries on more nurses, more doctors and more beds?’
We don’t need to spend billions of pounds on pen-pushers and paper-shufflers with no medical training, who think they can run our departments for us. This isn’t Sainsbury’s or some other corporate giant. It’s the National Health Service and it was founded on principles, not for privatisation and profit. But I don’t have time to waste on useless arguments. I just get off the phone as quickly as I can.
I started at 6.40 this morning and it’s now 5.35pm. I should have gone home half an hour ago
5.35pm
I have not had a proper break since I came on shift. A standard medic joke is that we should all be on a drip, because we never have time to grab a drink. But if I don’t have a cup of coffee now I think I’ll fall down.
Before I’ve taken two sips, a woman marches up to me, her face red with indignation. ‘Excuse me,’ she hisses. ‘Can’t you see how many people are waiting? And you’re on a break? We pay your wages, you know!’
I should have gone home half an hour ago.
6.25pm
A man is brought through the doors on a stretcher. He is unconscious, with a head wound, and he looks familiar. When the paramedic tells me the patient was here earlier today, I recognise him – it’s the guy who barged me aside and swaggered off swearing.
He’s gone home and suffered a seizure. Probably his bad behaviour was influenced by a brain injury, as much as by drink. So much could have been avoided if we’d been able to treat him more promptly. I’m running on empty.
I recognise an elderly; she attends A&E several times a week, sometimes returning hours after being seen. The underlying problem is dementia and so she complains of everything from kidney pain to migraines to asthma. But this time she has a real infection in her chest
7.20pm
For the third or fourth time today, I go to check the corridors. The thought that people could be dying on the other side of the swing doors haunts me.
One elderly woman is sitting up in her gown. I recognise her as one of our regulars – she attends A&E several times a week, sometimes returning hours after being seen.
The underlying problem is dementia: she knows something is terribly wrong with her but she isn’t sure what, so she complains of everything from kidney pain to migraines to asthma.
I listen to her chest. This time, she has a real infection. Once I’ve seen her, she thinks it’s time to go, but she really needs to be kept in. I ask her to wait on the trolley until a bed is available, and once again I can’t believe I’m having to say those words.
If she gets a place on a ward she’ll be part of the bed-blocking problem: until social services find her a place in a care home, she won’t be discharged.
9.20pm
That’s it, I need to clock off. This hasn’t been my longest shift, by several hours, but it has left me mentally and physically exhausted. I know I won’t sleep well – I’ll be thinking about that poor dead child.
As I’m walking out, a woman comes running after me, calling, ‘Doctor! Doctor?’
I want to ignore her, but I can’t. So I turn around and, before I can explain that I’m off-duty now, she says: ‘I just wanted to say thank you. I’ve been here all day with my dad, waiting to be seen, and we couldn’t believe what long hours you work. Lots of us really do appreciate the work you do.’
How unexpected. How lovely. I go home smiling but still wanting to cry.
The writer is an A&E doctor in the South of England.
