Benjamin Daniels - Further Confessions of a GP

The evening wore on and it was just how I like it: a constant stream of patients coming in and out but none of the frantic chaos that so often accompanies working in the emergency department. A couple of hours into my shift I was asked to see Bill, an elderly gent who was confused and agitated. Clara, his worried daughter, was trying to calm him down, but in his confusion he was just mumbling a few words and continually trying to pull off his oxygen mask. Clara had been trying to persuade her dad to see a doctor for months but he had steadfastly refused. He had been stoically ignoring a horrible-looking infected ulcer on his foot. But it had got so bad that the infection had taken hold and he was now too unwell to object to being brought to hospital by the paramedics.

Bill was dehydrated; I needed to put in a drip so that we could give him some fluid, but every time I thought I had calmed him down enough to put in the needle, he would jerk his arm away at the vital moment causing the needle to burst his vein. Searching his arms, I realised I was running out of good veins. I was going to need some help.

‘Sian, could you just give me a quick hand?’

‘Sorry, Ben, my shift finished 10 minutes ago and I really need to get away on time tonight.’

I quickly scanned the area, but there was no one else free.

‘I just need you for two minutes. I can’t get a cannula in this patient. Could you just hold his hand and keep his arm still?’

‘Two minutes!’ Sian repeated sternly before she reluctantly followed me into Bill’s cubicle.

Ten minutes later I was still trying to find a decent vein to cannulate. Thankfully, Sian was doing a sterling job keeping Bill calm and, most importantly from my point of view, holding his arm still. She was even chatting away warmly to his daughter Clara and helping to distract her from how poorly her father was. To all of our relief, I finally got the needle into the vein and gently slid the cannula in place.

‘Thank you so much, Sian. Just keep his arm still for 10 seconds longer while I find some tape to really secure this cannula – I don’t want him to pull it straight out.’

Just as I began to turn round, Sian grabbed my arm. I twisted back to find Bill had suddenly slumped forward and let out a gasp. His eyes, which had previously been shut, were now open.

‘BILL!’ I shouted, grabbing his wrist, but there was no response and no pulse. Within a moment Sian had shouted to the ward clerk to put out a crash call and lowered the bed flat so she could start chest compressions. When the rest of the doctors came running, Sian let someone else take over and gently shepherded Clara out of the cubicle and into the relatives’ room. I stayed with Bill and we carried on doing our best to resuscitate him.

I wish Clara hadn’t had to witness that first stage of CPR. However many times I’m involved with a resuscitation attempt, the brutality of chest compressions is never lost on me. The force needed almost always cracks ribs, and I would hate to witness it being carried out one of my loved ones.

The anaesthetist skilfully intubated Bill while I was still doing chest compressions. After each two-minute cycle we stopped to see if there were signs of life or a rhythm on the monitor that could respond to a shock from the defibrillator. Neither occurred and after 20 minutes it became very clear that Bill wasn’t going to make it. When we agreed to stop, I knew it would be my job to break the bad news to his daughter.

As I walked into the relatives’ room, Sian was sitting holding Clara’s hand, a cup of tea in front of each of them. Bill’s daughter was distraught when I told her the news; as she collapsed in floods of tears, Sian put an arm around her shoulders. Clara thanked us for everything we had tried to do for her dad and I went back out to write up my notes and see some more patients. It was another hour before I walked past the relatives’ room again and to my surprise Sian was still in there with Clara. They were talking and I could see that they’d had at least two further cups of tea.

When my shift ended at 9 p.m., Sian was only just leaving too.

‘I’m so sorry you’ve finished so late, Sian. If I hadn’t called you in to help me with the cannula, you wouldn’t be going home three hours late.’

‘Clara asked me to stay. Her brother lived a long way away and was stuck in traffic coming over. She didn’t want to be on her own, so I promised that I wouldn’t leave her until he got here.’

‘Won’t your daughter be upset with you?’

‘Yes, but she’s used to it by now. It goes with the territory if your mum’s a nurse.’

‘Will you at least be able to claim some overtime?’

‘Fat chance,’ Sian snorted. ‘The managers would just crucify me for working too many hours and breaking the health and safety rules. Clara really appreciated the time I spent with her and that’s enough for me.’

Personally, I think nurses like Sian are among the unsung heroes of this country. An average salary for a UK nurse is around £24,000 per year, which is less money than some Premier League footballers earn in a day. Despite this, nurses are regularly demonised by the media and government alike.

In a speech given in March 2013, the then Health Secretary accused nurses of ‘coasting’, and stated that too much of the NHS is focused on reaching minimum targets, ‘at any cost’. He suggested that NHS staff were striving only to not come last, rather than achieving world class levels of excellence – the gold medals of health care. As the UK still basked in the proud glow that followed the 2012 Olympics, a comparison between athletes and nurses seems an effective way to suggest that hospital medics should strive to achieve better.

Perhaps the most obvious difference between the 2012 Olympians and NHS hospital staff is the funding the government provided for them. When the London 2012 bid was announced as successful, the government provided careful planning, support and money to our athletes, and in the summer of 2012 the results were there for all to see. The vast majority of nurses and doctors actually do start their training aspiring to achieve ‘world class levels of excellence’, in much the same way that an athlete might in the early stages of his or her career. For medics, though, the ability to achieve these goals is often then compromised when we are told that we need to care for more patients with less staff. We are also expected to complete increasing piles of paperwork, which keep us away from our patients.

When this causes standards of patient care to slip, we are vilified for lacking in compassion. It’s the equivalent of criticising an Olympic rowing team for not winning gold even though their boat was broken and two out of four rowers had been replaced with extra coxes shouting opposing instructions. It’s no surprise really that nurses and doctors are too often simply relieved to reach the finish line intact, rather than struggling on to win the gold medals that would give the Health Secretary his glory.

I do agree with the Olympian/nurse analogy on one level. You could throw as much money, coaching and facilities at me and I could never become an Olympic athlete. However hard I trained and ‘strived for excellence’, I would never win an 800-metre Olympic gold medal. I’m just not designed for it, in much the same way that Mo Farah might make an awful nurse. Health care is not the career for everyone; there are doctors and nurses who perform poorly not because of facilities or funding but because they are in the wrong profession. I think we need to accept this early on in the training stage of medical careers and make sure we don’t let people work in the NHS who will never be able to offer patients the compassion and expertise they deserve.