First day At 8am, I arrive at the emergency department fully armed for my first shift: A&E scrubs donned and ‘NHS’ proudly branded above my left chest pocket. Melody Redman on her first day at Scunthorpe General Hospital My fob watch, a hand-me-down from my mum, a former nurse, is clipped on, a selection of pens and a pen-torch are on hand, my name badge is visible and my stethoscope hangs neatly around my neck. I pick up the file for my first patient. The department is busy and Mr Smith has been waiting in a cubicle for an hour, which means I only have three hours until he breaches. ‘What if my very first patient breaches?’ The triage nurse tells me that he had a fall. I step into the cubicle and introduce myself. He immediately makes me feel at ease as I listen to his explanation, ask questions and examine him. While waiting for Mr Smith’s x-ray and blood tests, I go to see my next patient. As I pop out to start the paperwork, a senior nurse approaches me and asks: ‘What’s happening with Mr Smith? He’s back from x-ray and we need to decide before he ‘breaches’ in 50 minutes.’ Despite knowing the nurse is just doing her job (effectively), I immediately feel under pressure: what if my very first patient breaches? Melody's badge and fob watch handed down from her mum, a former nurse While juggling jobs that need doing for my second patient, I review the x-ray and ask for a senior’s opinion. We discuss Mr Smith’s case and agree that he is fit to go home. With plenty of time to spare, he’s discharged and does not breach the four-hour limit. Phew! As I continue with the care for my second patient, two colleagues walk toward me, waving around a mysterious piece of paper. I worry that I have done something wrong, until I notice their wild grins. ‘A thank you can go a long way’ Before he left, they tell me, Mr Smith completed a ‘Friends and Family Test’, and had thanked me by name on the card. I am so touched and encouraged to have this palpable representation of my first patient as a junior doctor. A thank you can go a long way. You can't fix every problem August 2014 When Mr Brown arrived in A&E as a result of chest pain, my heart slowly sank as he expressed his frustration with his numerous health problems. I find it difficult to not treat patients’ long-term health problems that are not directly related to why they’ve been admitted. ‘I would like to have done more for him’ I have been trained throughout medical school to see the patient as a whole, but to do this a doctor needs time and resources – the two things that we have limited supply of in the NHS. Once the chest pain was dealt with appropriately, Mr Brown had to be discharged and was advised to visit his GP and seek advice and treatment there for his other health issues. I know I dealt with the cause for admission, but I would like to have done more for him. Some of the challenges of working in A&E are ones that I had expected, others are a surprise, and some are a total shock. Despite this, I am reminded of the Hippocratic Oath: ‘I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.’ The hospital never sleeps Doctors have their own health challenges, one of which is maintaining the right work-life balance. In my case, half of my rota consists of late shifts, which generally means that I finish at midnight, when all of my colleagues have either gone to bed, or are still at work. I currently work one in four weekends, which compared to a lot of other A&E doctors, is fairly easy going. ‘You need to be hydrated, fed and not sleep-deprived’ A lot of my colleagues on the wards don’t get a break or eat their sandwich while writing discharge letters, so that patients can be sent home from the hospital and more can be admitted. The hospital never sleeps. To be at your most effective though, you need to be hydrated, fed and not sleep-deprived - no matter what your career stage. This is sometimes difficult, but the team in A&E have been wonderfully supportive, with senior doctors often demanding: ‘Melody, go for your break now!’ He passed away during the night December 2014 There was a moment of silence as my colleague and I leaned backwards, glimpsed each other’s eyes across the room, and shared a sad acknowledgement that our patient had died. Mr Black had many health problems, and his death was somewhat expected by both the staff and the family. ‘When death happens, it affects everyone’ However, even as a doctor who experiences death frequently, I feel saddened by the news that a patient has passed away. For doctors, our approach to death is a delicate balance. There is some extent to which it must be normalised; it is a normal process and must be considered and prepared for with some of our patients. But it is also important that we don’t become hardened to it. When death happens, it affects everyone around it and causes a cascade of pain and problems for those left behind. ‘Our approach to death is a delicate balance’ Despite facing death frequently, like most people, doctors can find it difficult to talk about it. At medical school we were taught about the importance of using clear terminology, so we don’t say ambiguous statements such as, ‘Last night, Mrs Jones moved on’, which could leave people thinking their relative was simply moved to another ward. However, death is often a taboo and when you want to gently break the bad news to a patient’s family, it can be very hard to find the right words. ‘It is important that we don't become hardened’ Although doctors can often do things to repair mechanically broken hearts, we are unable to fix the broken-hearted. We can’t defeat death, but one lesson I will carry with me throughout my career is that we must continue to provide compassionate and effective care for patients and their families, up to the very moment of their death and beyond. Christmas eve 'The Christmas presents were all neatly wrapped, but I was still stuck at work' The clock struck five on Christmas Eve. My train was due in 19 minutes. My bags were all packed, I’d got my ticket, and the Christmas presents were all neatly wrapped, but I was still stuck at work. If I left right then I would make it home for our family tradition of a Christmas Eve Chinese takeaway, but with the number of patients who had been admitted overnight, there was no way I would finish in time to make it home. This made my heart sink: ‘If only I had a job where I could just work my hours.’ Melody, top left, with her sisters and parents at Christmas I appreciate that many people have to work over-shift, and I am generally happy to stay late as it can make a huge difference to my patients, but relying on staff to work over-shift is not a sustainable way of running the NHS. Although I was disappointed I wouldn’t make it home for our family dinner, thoughts about my own situation soon vanished when I met my next patient Mrs Long. She had three young children who were expecting her home, but we found that she had a dangerously low amount of neutrophils and she would have to stay in hospital for Christmas. ‘Relying on staff to work over-shift is not a sustainable way of running the NHS’ Thankfully, the hospital came together to ensure many other patients were able to go home to celebrate with their families. In fact, in the run up to Christmas Day, it seemed as though some of our patients had even more hope, and improved more quickly. She's had a boy March 2015 I felt a lump in my throat as I began to hear deep irregular gasps behind me. I turned around quickly, and the outline of a man and woman was visible. I took a few hurried steps towards them and asked if the lady was OK. ‘It’s just contractions, love.’ The gentleman was re-assuring and as I looked closer the woman was clearly heavily pregnant. Two evenings later, as I was about to start another night shift, I saw a bright beaming grin at the hospital entrance. I recognised the face. ‘It’s a peculiar mixture of emotions as you build more and more rapport with patients’ ‘She’s had a boy, I’ve been tidying the house all day and preparing things for when she comes home,’ the proud father told me. The cartoon-like smile remained intact as we shared a brief conversation, and his infectious smile lifted my spirits as I went to get changed into scrubs. Later that night, I had been looking after a sick gentleman in a six-bed bay. As I rolled back his curtains, the next patient’s face lit up with a smile and he said: ‘I’ve met you before.’ He was right: when I worked on A&E, Mr Wright had come in very unwell with sepsis. 'The next patient's face lit up with a smile and he said: "I've met you before"' As I now kneeled to cannulate him, we quietly reminisced about our previous meeting. It’s a peculiar mixture of emotions as you build more rapport with patients. Though I do my best to treat each patient as equal, there are some patients and their visitors who you can tell are trying their best to bring some joy into the often stressful hospital environment – this was Mr Wright and his wife. Later that night, while two senior doctors and I were seeing a very breathless lady upstairs on another ward, a healthcare assistant thoughtfully made me a cup of tea - particularly welcome as I didn’t have time to eat until 10 hours into my shift. Despite having intermittent daytime sleep between night shifts, those three events helped me smile and encouraged me, despite disillusionment with many aspects of the NHS, to be the best doctor I can be. April 2015 'I write in capital letters at the bottom, "Medically fit for discharge"' Seventeen days of being well enough to be discharged but nowhere for you to go; 17 days of waiting in the hospital, exposed to an increased risk of infections; 17 days of a bed being unavailable to another patient who needs it; 17 days of bed block. Every day on ward rounds, I write in capital letters at the bottom of Mrs Johnson’s notes "Medically fit for discharge" and add the number of days she’s been waiting. Being in hospital is no longer what’s best for Mrs Johnson but bed block means there is simply nowhere appropriate for her to go. We see many patients like Mrs Johnson; well enough for home, but because social care is delayed, she is just waiting in hospital, just waiting to pick up an infection. ‘Why do we see this problem in hospitals more often than we should?’ As a child I was rather inquisitive, as my Dad so often reminds me. A short explanation or pseudo-answer was never enough; I wanted full and truthful answers. I wanted to know intricacies and detail, as far as a child could understand. Often, working in the NHS, I feel like that child again, asking the adults around me: ‘But why?’ Part of a team June 2015 It takes a great amount of teamwork to provide care for a patient’s stay in hospital. Many people have to pull together, from ward clerks to healthcare assistants, dietitians to physiotherapists and surgeons to lab staff… the list goes on and on. Melody, second from right, with the A&E team at Scunthorpe General Hospital Our ward clerk, Ben, is the hospital's answer to Google. He solves problems I didn’t even know existed and finds answers I didn’t know were available. Last week he was about to go home and asked me to do a non-urgent job. I sighed and snapped, ‘It’ll just have to wait until tomorrow because I’ve got ‘X, Y and Z’ to do.’ I immediately hung my head, sighed and apologised, explaining I hadn’t had a chance to eat all day. ‘Moments like this truly make you feel part of a team’ I carried on with my work, but within five minutes there was a pack of biscuits beside me and a firm command to ‘devour them immediately’. I might not have been part of this unit for long, but moments like this truly make you feel a part of the team. In fact, I probably would have cried, had I not developed the ability to suppress tears so well this year. My future in the NHS? September 2015 ‘Y’know, I really love the NHS. It does work when you need it, doesn’t it, doc?’ I had rung Mr Collins to discuss some blood test results. His heart-warming reply reminded me why it is so crucial to defend the health service we have. ‘The proposed contract is unsafe for patients, unfair for doctors and will undermine the future of the NHS’ I can confidently say I love being a junior doctor; it’s a privilege to spend my day (or night!) providing patients with the care they deserve. A time has come however, when we need to make a stand: a stand to protect our NHS, our patients and our junior doctors. 'I can confidently say I love being a junior doctor' The proposed contract is unsafe for patients, unfair for doctors and will undermine the future of the NHS. It will remove vital protections on safe working patterns, devalue evening and weekend work, and could have a real impact on the quality of patient care if we return to the days of over-exhausted junior doctors working dangerously long hours. A colleague told me last night how tiring his current job is and the impact it’s having on his ability to be a good doctor. ‘There is no give left. If the Government pulls us any further, we will break’ We want to do the best for our patients, but under already gruelling pressures it is no surprise that levels of stress and burnout are already high among doctors. There is no give left. If the Government pulls us any further, we will break. The new contract will extend junior doctors’ standard working hours from 7am to 7pm Monday to Friday, to 7am to 10pm Monday to Saturday. Those working in parts of the NHS that involve lots of evening and weekend work, such as emergency medicine, will be left worse off - disastrous for our A&Es - which are already facing staff shortages. ‘We must send a clear message: Jeremy Hunt, this cannot continue’ In a few weeks, applications open for jobs for the next stage of my junior doctor career; many of my colleagues have already declared they will not be applying. Can we really afford this cost? Scotland and Wales have assured junior doctors that they will not impose this contract. Yet, our own Government will not listen to our pleas for reassurance and our persistent reminders of the detrimental effect this will have on our healthcare system. ‘The BMA has been left no option but to ballot junior doctor members for industrial action’ My heart sinks that the Government has placed us in a position where the BMA has been left no option but to ballot junior doctor members for industrial action. We must send a clear message: Jeremy Hunt, this cannot continue. Source
