The First Month of A&E Was Tough

The first month of A&E was tough. It reminded me of the beginning of F1: the sudden rise in responsibility, having to make important decisions, picking apart complex situations.

It was a difficult adjustment from GP. I was stepping away from a job that involved me sitting in an office for several hours with help just an arm stretch away and stepping into a busy Emergency department at the worst time of the year, in the midst of a bed crisis. Adding to all that, I had to quickly become familiar with all the new parts: learning new names, learning to code patients, learning what was OK and not OK.

Suddenly, I was responsible for making difficult decisions. Not that I never made decisions before. I made management plans for patients all the time in GP, but there the patients were rarely very unwell and the issues tended to be chronic. But those same patients would present to hospital, now acutely unwell. They’d come confused and disorientated. I’d find it difficult to understand exactly what was wrong and often I’d start treatment without the luxury of test results and very little to go on. I struggled with deciding who to admit. Who did I think would be safe to discharge back to their homes, where they lived alone, where there was no supervision? And that would weigh on me. It really felt like a judgement call, looking at each person and wondering what would happen if I sent them home. I’m still struggling with this.

The first time I ever cried at work was during that first month. It was a bad combination of a busy shift, an unwell patient and senior doctors I was nervous to approach. I was struggling to look after this elderly lady whose heart rate was over 140, the machine kept beeping, a few times, she’d suddenly slump over  for a few seconds whilst I examined her. My mind went blank. I didn’t know what to do. I felt clueless and I could feel myself panicking. I felt like I wasn’t doing right by this elderly patient who remained sweet and cheerful despite being so sick. It turned out OK in the end and we managed to bring her heart rate down slightly. I calmed down when I realised she wasn’t dying. But that feeling of panic and confusion stayed with me for a long time afterwards.

Christmas brought its own pressures, several bank holidays meant few other places were open and we saw an influx of even more people. The department was overrun: patients in corridors, waiting areas crowded and minimal hospital beds. When I eventually finished the shift and left the chaos, I walked out to a sea of ambulances. Row after row of neon yellow striped vans, waiting sombrely in the cold. And all I could do was be thankful I didn’t have to go back in.

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