I used to play a game with my children. How many ambulances are going to be waiting outside the emergency department today? I used to play it with my kids as I got a lift in for an early shift.
“No, I think it is going to be two.”
“Well, I reckon there will be five today.”
And we’d cheer when one of us was right – another point to the seven-year-old. But now it is just too hard to guess. The blue and white are parked wherever they can fit, in varied states of preparedness.
Some, having disgorged their patient load, are sneaking just a few feet away, waiting to be cleaned and sanitised. Ambulance officers that have managed to offload their patients stretch, change masks and grab some fresh air.
They tell of stoic gentlemen who didn’t want to be a bother so waited until they could no longer look after themselves before they called for help. They tell of lonely Greek nonnas who had fallen and hadn’t been found for 24 hours – their families unable to visit them at home. They tell of young women, isolated and afraid and unable to see their counsellors and who just couldn’t cope with living in lockdown anymore. And they tell of young men, who thought it was OK to hang out with their friends, despite knowing they had the virus, thinking they were invincible.
As I pass the yellow trolleys and the patients waiting to be seen, I gaze through the plexiglass into the waiting room. It is already full, and it is not even eight in the morning. Some people are wrapped in hospital issue blankets, clearly having had to wait far too long. I know what I’ll be saying to them when I call them in.
“I’m so sorry you have had to wait such a long time … Yes, it is unacceptable … I’m sorry.”
I say this every day now as patients wait longer and longer to be seen. We have nominal targets to meet. The sickest patients should be seen on arrival but the challenge now is finding somewhere to see them.
The department is already full. The emergency department reminds me of a casino – all bright lights and noisy machines. Somewhere that time does not register. Where weekends and evenings cease to exist.
You used to be able to guess the time of the day by the ebb and flow of the patients. Now the only way to tell is when the dulcet tones of the switchboard operator remind visitors that it is time to go home – the recording no longer needed as hardly anyone visits anymore.
Every bed in every cubicle is taken up and the night staff look exhausted. They came on to 20 patients waiting to be seen as the shift before struggled with access block. Hospitals tend to run at near capacity in normal times (whatever those are) and so a patient can only move out of the department when a bed becomes available on the ward. We used to have targets to hit. Every patient had to be seen and sorted within a four-hour time window. They either had to be discharged or moved on. Now they are barely seen in four hours, let alone processed. You can’t see patients in the waiting room or in the corridor so you have to wait.
As the emergency medicine consultant in charge for the morning, I know that I will be playing human Tetris for most of my shift. We’ll shuffle patients from cubicle to cubicle, hoping that we can squeeze just one more in, getting dangerously close to that line at the top of the screen. But there can be no game over for us. Not when it means the loss of life.
I spend my shift on the phone getting impatient inpatient teams to review their patients. They have already been in our department for 20 hours, on hard grey trolleys. Coats and jackets double for pillows that have already gone the same way as most people’s goodwill. How can anyone be expected to get the rest they need in these conditions?
The radio squawks and we have to find somewhere, anywhere, to put the next critically unwell patient. We move someone out of the resuscitation cubicle to make space. We’ll park them in the corridor, just for a little bit, we tell ourselves. The access managers have allocated them a bed, after all. But we know that the bed is not ready, not empty yet. There is still someone in it, waiting for transport to go home.
Hour one of my eight-hour shift done. Seven more to go.
I’m tired. We all are. When we started getting ready for coronavirus 18 months ago we were ready for an onslaught of patients. We had seen friends overseas go through the grinder and come out the other side. And so we prepared. And, nothing happened. Not really.
Some of us felt this anticipatory anxiety, like a surfer paddling out to meet a big wave. But the wave never came. As horrific as it sounds, perhaps it would have been better for the wave to crash down on us then. For us to struggle and splutter, before kicking up to the surface to breathe fresh air again. The human body can only hold the tension for so much time before it breaks.
We, the people that look after you, have been holding it for you for so long now. And we are breaking.