The Night of the Long Stockings

Hail,
Well, back from a weekend shift and a lot going on.

I started at seven in the morning today. I dragged myself out of bed (not entirely hungover, but neurons still crackling from the glorious football) and hunched my way through the rain to the ED. I sortof shuffled past the waiting room (only a few people waiting), grabbed one of those coffees I advise other people to cut down on and sat down next to Dr Longstocking.

"Screen looks good" I said. "How's it been?"

And she burst into tears. And the next half an hour (I wasn't there for all of it) she explained to the senior consultant Dr Van (via sobbing, and gesturing, and wringing of hands around imaginary necks), what overnight had been like.

She'd been on with three others. One was a GP trainee. General practice trainees are good at seeing everyday problems ("This lump on my ear..."), and that's often all they do overnight in the ED. This one didn't do a lot of that, because he was basically disinclined to work. And I can understand him being nervous about his capabilities to do what must have been a very challenging job, but presumably he was less nervous spenidng the money.

One of the others was Wmbesa, a doctor who appears to have evolved on another world where the gravity is much weaker. He moves with almost treacle-like slowness. The first night he was on I remember watching him flow from one cubicle to another like the Blob. In ten hours he sees two ro three patients. He does buggerall.

And lastly she had Dr Rookswen. Dr Rookswen is not like the others - it cannot be said that he does not see patients that he should see. Rather he sees ones that he should not, because he is dangerously, frighteningly, almost "slapstick comedy if it wasn't real life" bad.

No words, no hyperbole, can adequately illustrate this. One example - he's the guy who saw a kid having a seizure and turned out the light to help it relax. So it could choke and convulse in the dark.

No, none of us believed it either.

He is meant to be working under one-on-one supervision. He has been sent down here because he is too fucked (my boss's term) for any other branch of medicine. He keeps trying to escape and see people independently, but normally we can track him down and stop him.

But last night Pippi's there with three imbeciles and more than ten priority twos (really sick people who have to be seen within ten minutes) and a priority one (someone who is dying and has to be seen now) and a waiting room full of people and basically did 90% of it herself.

And first she was seeing them because they were human beings in pain and then she was seeing thembecause they had to be seen and by four in the morning she was seeing them out of fear of them dying (all nobler feelings having fled) and by seven thirty she was seeing them out of whatever spinal reflexes move you around when compassion and fear and conscious thought are gone, but still not far enough gone to let Rookswen moved about unobserved - she sent a nurse to watch over him, much to his chagrin. And nobody died on Pippi's shift, but by God it was a near run thing.

Anyway, this morning Pippi melted, and said she will not be here in a few months if significant changes are not made, and that she does not believe they will be, so she's looking around now for other jobs.

And she is the best doctors we have amongst the juniors.

I don't know. Sometimes I feel my whole profession is imploding.

That sounds stupid, but emergency medicine - I don't know. I believe at some level that we have to do it, that a society or a community or whatever the fuck we are meant to be has some duty to do this. Provide basic medical care for those who cannot provide it themselves.

But in the last few years it's gone horribly awry. The local GPs (that's the family doctors), they all charge now. Twnety five dollars minimum to see a doctor. A lot of people in the greater Mordor-Slytheryn area can't pay that. And I don't give a rats arse whether it's "can't" or "won't", in the end if you're old or you're a baby and you have pneumonia and you don't go get antibiotics, you die.

So the sick, in increasing numbers, come here, where there are decreasing numbers of us to look after them. And it's starting to show - we have more junior doctors, more foreign trained doctors... I worry that we have more questionable doctors. Because we're desperate, and if you're desperate, you'll take anyone.

I don't know. Of the junior registrars I started out with, several have gone. One is definitely still in the training programme, she's that kind of person, emergency medicine material. Another is deeply unhappy, looking to transfer to cardiology or something - and smart enough to. Dr Maad is not really in training. Dr Iskandar has resigned and gone to Queensland and will never return. Pippi has children who want to see her and a husband who almost left last year - she knows there are other positions, places that offer forty thousand dollars a year more for easier work.

And me. I'm part time. I'm not one of the common ED personality types - my boss did a bit of research, got the consultants and seniors to do that Myers Briggs personality test. A disproportionate number of ED doctors are thinkers rather than feelers, extraverts rather than introverts, sensers rather than intuitors, judgers rather than perceivers. When they did the study they published the results on the ED noticeboard. I went and looked it up and my personality type (I think it's INFP) is represented by a smallish proportion of the general population but precisely no other ED doctors.

And I have a wife and children too, and stuff I want to do.

I know it's stupid, but that baby still gets to me. You know, the one that wouldn't breathe, the one I thought was a doll. And I don't know what I'm doing, typing all of this out to a doubtless rapidly diminishing number of readers, maintaining an online record of what is likely to be some kind of breakdown, but I keep thinking about it.

I am a thirty eight year old Australian man, I have more degrees than a thermometer, a father and a doctor and allegedly one of life's winners, and I am ALWAYS at some level afraid.

Is this what it's like for everyone else?

Anyhow. No-one has died yet on "my" shift, no-one has died who wasn't going to die. And no complaints against me personally, and no legal action.

Deep breath, calm down. Truth is, I don't know how much longer I will do this. I feel selfish saying it, but I don't know if I am going to keep doing this. I love doing the job, a few days ago I saw this guy brought in with acute heart failure, pale, labouring, so sweaty we couldn't get an ECG on him... and it all went bloody well. We kept him out of ICU, he ended up being able to talk and eat instead of being intubated or resuscitated... and it felt good and it worked well.

And I love the staff, nurses, doctors, everyone. I love the community, the cameraderie, the sense that we share a common understanding, that despite ER and Chicago Hope and all that we are a closed circle. And I really love seeing patients, and I love it more as I get better at it.

But I don't know. I have to do a year non-ED, that's next year. Maybe it's for the best. Next year will be Hogarth House and Something Else - psych, paeds, drugs-and-alcohol. Nine to five, good pay, easy money. And an option to stay as long as I like.

It's hard now to imagine not doing ED. But I reckon next year it'll be hard to go back.

Thanks for listening, too.

John