Yesterday I collapsed in the treatment room in A&E.
I was working my third consecutive 13-hour shift over a bank holiday weekend. I was running a fever of 39 degrees and had the most horrendous head cold. I was probably sicker than at least 20% of the patients I was being asked to admit to hospital. I was the only SHO on shift for medicine, and when I had awoken with blocked sinuses, the inability to stand upright without staggering, and the full knowledge that realistically I should spend the day horizontal, slipping in and out of sleep and having hot ribenas, it did not even cross my mind to call in sick.
I am not writing this for sympathy. I know an overwhelming amount of people who have done the same thing. As medical professionals, we consistently prioritise other people’s needs above our own. It is part of the job. However, yesterday I was unsafe. I could barely walk, let alone be expected to make a legitimate management decision for a patient. I drugged myself up on a combination of co-codamol and nurofen, and wandered the hospital with a box of tissues and a litre of ribena. In my mind, there was no other option. Bank holidays and weekends run on skeleton staff – the number of doctors to patients is dangerous even when everyone is on top of their game. You have to be legitimately dying to justify staying home.
Bank holidays in particular also tend to run on locum staff, particularly locum registrars. Now, whilst some of these are amazing doctors, most aren’t. Even if they are good clinically, they usually don’t know the hospital layout, don’t have access to the reporting systems, don’t know how to request imaging. It makes an already stressful shift unbearable when they don’t even have good clinical skills. My registrar on Friday did not recognize when a patient went into ventricular tachycardia on a monitor, and it was only because I happened to walk behind her that we managed to check if the patient had a pulse, start him on the correct medication and take him to CCU. How could I call in sick when I knew what state I was leaving the on call team in?
Things like updating families about patient’s conditions go by the wayside. Urgent blood tests get handed over from day team to night team and back again. Once you have been clerked in on an acute take you are lucky if you see a doctor at all until the next normal working day – if you are unlucky enough to be admitted on Good Friday then you can usually expect to sit idle, with no further medical assessment until 4 days later.
The only thing that alerts us to a patient’s deterioration is the NEWS call – a call put out when a combination of a patient’s blood pressure, heart rate, temperature and oxygenation reaches dangerous levels. These calls mean we have to come running to the ward, quite often for things that could easily have been avoided if there were enough staff to reassess a patient’s condition on a regular basis.
It is baffling to me that not more people die over long weekends in hospital. If you make it to the end of a shift without an “adverse outcome” it feels like it is more a result of luck than anything else. If we had even one more doctor on shift it would feel less unsafe. I know multiple doctors who would rather work twice the number of on calls with adequate staffing than half the number and feel unsafe. But I know it is all about money. We seem to have an endless pot to fund terrible locum doctors at the drop of a hat, but never enough left over to create a more tenable working rota, which would hopefully decrease the need for the locums in the first place.
And meanwhile, people like me come into work dangerously unwell, and then take up a bed in ED for assessment – further adding to the workload of an already overstretched system.