Now is not the time to get sick. Buda Mendes/Getty Images
For most people, the festive period conjures up images of twinkling lights, family gatherings, and the warm fuzzy glow of over-indulgence. For the doctors and nurses on my A&E ward, it presents a rather different reality: one defined by constant fatigue, poignant tragedy and, on one occasion, a patient who decided to stick a jar of Marmite up his anus.
The chaos begins at the start of December, as Britain’s party season swiftly takes its toll. And as a physician, it’s the time of the year that I really feel like I’ve earned my stripes. Christmas is tough on the public and staff alike and my A&E will be an absolute fairground of drunken activity. Alcohol-related admissions rocket. I remember one year treating a rather self-important, high-profile barrister who arrived intoxicated and belligerent, treating us with the same contempt he might reserve for his opposing counsel. Fortunately (or not, as it would soon transpire), that quickly changed when, slouching in a three-piece chalk stripe suit, his nostrils enjoying a “white Christmas” of their own, his bowels got the better of him. A&E has a habit of being a great leveller.
Over the festive season, however, it also has a habit of witnessing Christmas in its cruellest incarnations. As any paramedic will tell you, alcohol consumption makes the roads increasingly treacherous; what’s often forgotten is that it can make life at home more dangerous too. According to police data, domestic violence incidents surge during the Christmas period. And frequently that spills over into A&E. Last year, on Boxing Day, a woman presented on our ward with a broken nose and an indentation in her cheek that bore a striking resemblance to a large signet ring.
It’s not just alcohol abuse that takes hold over Christmas; the grim consequences of drug-taking — from cocaine-fuelled acts of violence to accidental and intended overdoses — also increases. One of the worst cases I’ve ever seen took place a few years ago, when a heroin-addicted couple brought their baby into A&E just before Christmas. They were beside themselves with anguish. After injecting themselves the night before, they had come around to find their child rigid, cold and lifeless. An examination revealed that the baby, only a few months old, had choked on his own vomit. The parents could hardly speak; my colleagues and I ended our shifts numb. Nobody felt festive that year.
More often than not, it’s Christmas Day itself when the true essence of emergency medicine reveals itself. The patients who come in on the 25th generally need to be there. And treating their conditions is not for the faint-hearted. I’ve seen everything from massive heart attacks to brain haemorrhages — often in patients who’ve been putting off symptoms for days because they didn’t want to “spoil” the family’s Christmas until it’s too late.
I’ve also seen those who succumb to the rituals of Christmas itself. Burns from hot fat or blistering pans and falls from step ladders while hanging decorations are par for the course, as are small children swallowing Lego bricks. Some years ago, I had a patient who, while preparing the family turkey in flip-flops, slipped on her kitchen floor and sustained a severe ankle fracture. The result: six days in hospital waiting for the swelling to subside before surgery.
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SubscribeWhat an odd article.
The author seems surprised at encountering the ailments that even a lay person might expect to present at an Xmas A&E (and double points for the Marmite anecdote).
My anesthetist mate says pretty much every doctor has encountered a patient with a foreign object in their bum, way before consultant stage.
This author has history of moaning, without suggesting any reasonable alternatives.
With it being the season of goodwill, i’ll give her credit for completing an article without making some banal political point.
It was mildly entertaining, even if those of us who’ve worked in the NHS just roll our eyes at this kind of thing.
I envisage an alternative article in The Guardian article based on A&E at Christmas. In Guardianland the lack of self awareness and irony
‘Since Brexit A&E admissions on Christmas Day have soared as imports of good quality French wine and German beer have dropped to be replaced by cheaper lower quality imports….’
Not quite but close – try this – ‘since Brexit A&Es have been more short staffed and the cost of sorting Visa’s for staff coming from further afield to plug critical gaps time consuming and costly. In addition something psychological seems to have happened post referendum and some of the populace think it’s more acceptable to abuse staff, especially if they aren’t white’.
Or ‘since large-scale immigration from the EU started circa 2000 the proportion of NHS staff from overseas has reached 20%, driving down wages, working conditions and disincentivising potential new recruits resulting in a shortage of suitably trained staff that will take years and substantial investment to address.’
I think you fail to factor in we didn’t have much of a problem until austerity and the cuts to training places, creating more reliance on overseas recruitment. Tories then also cut the Nurse bursary. Doh! And I doubt you’ve been keen and supporting public sector workers, such as Nurses and Doctors, having inflation proof wage settlements. The Right pursued a deliberate Policy and tried to then hide it, almost criminally blaming migrants.
The problem is scope creep. Government services should be limited to what they can do cost effectively to keep society moving along. Not everything to everyone.
Usual winging drivel from this tiresome PoS
“and double points for the Marmite anecdote).”
Seems a strange sort of a**l d***o. What size of Marmite jar, I wonder?
Every emergency department has its story.
The wife’s is a 14 year old and a door knob.
The funniest ‘bum’ story I heard was by a USA emergency room consultant who dealt with a businessman who had put his Nokia mobile telephone in vibrate mode and shoved it up his bum. Not surprisingly he could not retrieve it after the initial pleasure trip; so he ended up in A&E. The funny part was that the medics had to operate on his a**s to recover the telephone. But what should have been a relatively simple, short procedure turned out to take much longer. Why? The medic team was in stitches of laughter as someone kept calling the patient’s mobile and it was constantly ringing in his ring-piece, as it were!
That’s a good one. Usually it’s hamsters.
I’ve worked in mountain rescue and in a war: I could write about tragedy and gallows humour, but it would only be about mountain rescue stuff and war stuff … boring.
The difference, and I was 22yrs RN, is mountain rescue and war are rare experiences for an individual. What the Author describes is fairly standard every day occurrences in an ED. That said that’s in large part why you are drawn to working there.
The Author in sharing her experience over this period didn’t make any overt political or policy points, but would be rude if I didn’t.
What she described was of course fairly standard and nothing unique for anyone close to the Service. The ‘Granny dumping’ (hate that phrase but…) is an increasing issue and of course compounded by an aging population. It then gets worse over the coming couple of weeks as Social services and other support close down for the festive season and discharge is further delayed whilst an assessment backlog accumulates. Usually by first and second week of Jan the vast majority of UK hospitals will be at major incident status with gridlocked throughput (if they weren’t already). More recently the usual January gridlock has become the normalised at other periods too and is a fundamental productivity blocker in the NHS.
And here’s another point – despite this the staff and the service will get to you. They won’t check your insurance details, and later you won’t find there was small-print that meant you’ve a big bill coming.
And just to cheer the cognescenti the alcohol misuse that plagues A&E and our healthcare system is not immigrants, and certainly not Muslim brothers and sisters. It’s us.
Social Services and support don’t close down for the festive period. They work through like any other public service. I’m not convinced you’ve ever worked for the NHS. Certainly not in the Midlands anyway. You’re correct that it’s against the religion for Muslims to drink. However in reality many many do. As do Sikhs. Same for gambling. The local casino near me would have shut down years ago had it not been for the Muslim patronage.
You clearly have never tried to discharge to a Care Home on a Bank Holiday, get a Care Package set up with some Home adjustments or get a social worker assessment at a weekend. Look at the Calendar – there are 3 extra BHs and that’s alot of accumulation, before you even factor in how Leave been managed. Then you have the added issue elderly care demand on hospitals often goes up in this period, at the same time as the social care response tilts down. And hey presto. It’s not complicated.
As regards alcohol and certain ethnic backgrounds – yes there are some but just have a look in any ED and you’ll see it’s overwhelmingly not them.
Quite right. I once calculated (for a rather tedious conference) that 9 1/2 NHS and Social Care doors out of 10 across London closed on the dot of 5pm, come rain or shine, leaving A&E and a few understaffed emergency teams in the only buildings with lights on. I suppose these days you can try WhatsApping the GP, but good luck with that – maybe try the fax??
An interesting article that I enjoyed reading (perhaps because mercifully free of the usual campaigning).
But stepping back, what strikes me is that almost all (perhaps all) the cases cited were the result of human stupidity and irresponsibility. And often the direct result of criminal activity (drug abuse, violent assaults). Dr. Jones seems happy here to accept that it is the responsibility of the NHS to clear up any and all mess here. I just wonder if that is really what the founders of the NHS intended. Or how long as a country we can encourage and subsidise such irresponsible behaviour when we’re constantly told that the NHS is overloaded.
Doubtless an un-Christian and unseasonal message, but questions I think that need to be asked.
As Someone once said, the sick need a physician.
It’s a daily thought all front-line staff have…’if only’ etc. It wasn’t what was intended either. But when one gets into judgments on ‘deserts’ it’s not quite as straightforward – is the car accident through poor driving as bad as an alcohol related illness, or a skiing accident more than some sexual transmission? The load on the system may be the same.
And collecting money from the alcoholic in an A&E not straightforward if we were to make such judgments and insist some monetary contribution for one’s own stupidity needed. Nonetheless one would welcome a greater debate about the responsibilities that go with rights so long as it could be conducted in a productive way.
I agree it’s not simple. But that’s no reason not to look for improvements.
And remember, every person who turns up at A&E with some self-inflicted condition is pushing someone else further back down the queue.
Well, let’s take the skiing accident example. It’s a fair bet your skiing accident will occur outside the UK. And it’s generally accepted that you should take out travel insurance to cover your medical risks to cover any costs from such accidents (whether self-inflicted or from third parties). If you have an off-piste accident and a helicopter is called, you’re certainly not getting that free.
So the model exists and is working. We’re simply debating whether or not it’s scalable.
Similarly, if you turn up at A&E in Poland, your papers will be checked. It takes around 5 minutes (admittedly my sample size is 1 here). And could doubtless be reduced further. Again, it can be done.
It’s no good complaining about A&E crises if you aren’t prepared to limit the “optional” (I know, it’s not quite the right work) demand (which appears to be a fairly large percentage of the total demand) – or raise more resources from those who cause it. Whether that’s small excess charges (normal with insurance) or something else. My NHS dentist doesn’t seem to have any difficulty at all billing me whenever I show up (and indeed, this is the most efficient part of their operation).
Certainly we could claim more from Insurers for road accidents, and sporting injuries such as skiiing. The dilemma has tended to be whether the costs of capturing the details and chasing payment outweigh the potential income, at least in an emergency scenario. You’d need to do it at scale to justify the investment in more admin, and any increase in NHS admin tends to send some into apoplexy. It’s not straightforward but it is something that is often considered.
Perhaps we extend taxes on providers of road insurance, junk food and alcohol etc as these sectors can increase pressure on healthcare and as the ‘next best’? It’s not the same as a tax/payment related to behaviour which we might prefer but administratively it’s simpler. The ease of administration is sometimes why we have what we have.
There may be some merit in looking at offloading some cost where possible.
In Ireland the ambulance service is part of the fire service, not health. In serious road accidents they seek to recover costs from the insurance of the party at fault.
If only everyone could be as perfect as you so obviously are – wouldn’t that be lovely!
Sounds a bit of a Victorian attitude to me. You know, the deserving and undeserving poor type approach.
Medicine is there to help and if possible cure the sick. I don’t remember a caveat which said only those who couldn’t possibly be blamed for getting sick.
When you’ve got a toddler having seizures who can’t get seen by a doctor in the ER (as we Canadians call your A&E) because of all the drug abusers and drunks who fill up the waiting room, you may feel less altruistic.
Yup, chop their budgets in half and see what’s left over.
I didn’t get the impression that Emma Jones was ‘happy to accept that it is the responsibility of the NHS to clear up any and all mess’. When people get ill or injured either we (as a society) give them the help we can, or we leave them to die in the street. Where do you stand on this question? And if you’d prefer the NHS not to treat people who have contributed to their own demise, who gets to decide (in 2 minutes maximum) who gets to be treated and who gets to be turfed out? The receptionist at A&E? The triage nurse? The doctor? And how will you decide? You see a tiny snapshot of an injured person. How will you incorporate all the events and circumstances that have moulded their life and brought them to the front door of your A&E? Should we carry an app on our phones that keeps a running total of our ‘social credit’ and only treat people who score higher than a cut-off point?
You see the problem. Either we have to help everybody who needs A&E or we help only those who deserve to be helped.
I don’t feel that I have to fix society, nor responsible for the NHS when I’m working in my Emergency Department. I don’t feel that by treating a patient I am condoning or perpetuating the shocking education that they may have had, or the atrocious parenting; nor the lack of a moral framework that smug philosophers promote from their safe academic ivory towers; the criminal county-lines drug dealers whose greed and selfishness wreck millions of lives; the poorly-led and over-politicised police force with its skewed priorities; the creators of addictive television and media programs that create dissatisfaction and emptiness; nor a culture where the elderly are regarded not with gratitude but as a burdensome irritation.
Thank God. All I have to do is try my best to fix the patient in front of me, mindful of all the others waiting to be treated. There’s little point in wasting energy on why they have got themselves into trouble or whether it’s their fault. One learns that after a few months of work. Some newcomers may rant and rave about it for a bit, then they soon settle down and get on with the job. Sufficient unto the day…
When a patient has been an obvious idiot he or she will generally be aware of that. They don’t need a lecture from me, particularly not on what may be the worst day of their life. Signposting people towards help (like addiction centres) can be useful. Some will follow these suggestions, some won’t.
Criminal activity, indeed.
The punishment for possession of cocaine, a Class A drug, is ‘up to 7 years in prison, an unlimited fine, or both’, according to the UK,gov website.
Strangely, this didn’t seem to unsettle, perturb or temper the behaviour of the ‘high profile barrister’ who went to A & E, dressed in what appeared to be his workwear.
Repeat after me, everyone is equal under the law.
Class is still alive & well in some parts of England.
No doubt had the hospital staff rang the police about said barrister, he’d have informed the hapless constable that he was about to call the Superintendent
This article misses the point. This is all due to mass immigration, two tier Kier and general woke nonsense…..
I’m very unwoke but I have to disagree. I can remember taking a friend into A and E with his finger literally hanging by a thread. The wait was interminable and then an RTA came in. It took forever. This was early nineties. And yes, it was a drink induced accident – got his fingers caught in a deck chair whilst knocking back the beer.
I suspect your name means you are fairly young still MD, but I make a prediction I’d like you to remember – when you need healthcare support, inevitable as you age, you will be v grateful for the immigrant or child of an immigrant highly likely to be delivering it.
Does not mean our current level of immigration can or should be sustained. But you will come to appreciate it’s a little more complicated.
In Italy I recentky visited a hospital for an xray
I had a choice of 6 or 7 but chose the nearest. I paid in advance for the procedure: 36 euros. There were many ambulances awaiting calls and several paramedics. The A and E was empty of patients, yes empty. This was the Italian NHS.
And if you’d not had the 36 euros, or it had been an emergency and you didn’t have time to shop around?
Things can work as you describe in certain situations. Sounds like you were able to access private provision.
And to add – did you know if the X-Ray was really needed? Or did you have to trust them not to suggest needed because you’d be paying?
I think it’s getting simpler to do something like, have people donate money and the medical facility don’t get it until they have patients sign off on it. Maybe make it competitive between facilities.
The dichotomy of the grannies caught my attention. The people refusing to take the woman home is such an indictment of the modern mindset in which elders are often treated as disposable.
It’s not an especially new phenomena. It’s just more frequent because more elderly. There was no rose tinted past where this rarely happened.
Our parents are living longer than prior generations, so be ready for the same dilemma. And if you’ve been exhausted by trying to care for someone who struggles to dress and wash themselves you’ll understand why it can sometimes be the breaking point too for a Carer and they use the hospitalisation as a chance to cry for help.
I’d be surprised if it’s not the standard operating procedure now.
Just like laws protect children laws for elder care may be in the pipeline. Elder care payments as it may be.
Original government intrusion begets the next step.
I’ve known hospitals where the discharge team would have just put the old gal in a taxi, and one occasion where the patient was discharged home in her nightie, drugs and kit to follow….. But that was in the bad old days (2009 I think). Not all NHS staff are angelic, and angels can sprout devils’ horns under the pressure of political ‘process’ targets.
“The first patient was surrounded by her grandchildren, from a nearby council estate, who were eager to take her home for Christmas dinner. Despite their limited means, there was warmth and genuine care. In the next bed lay a woman from a wealthier area, whose well-heeled daughters adamantly refused to take her home, despite her being medically fit for discharge. The contrast in the patients’ expressions said everything — one beaming with pride, the other bearing the weight of shame and rejection at her adult children’s callousness.”
Right, right. It’s always the poor who are saints and the people from a “wealthier area” who are heartless, uncaring b*stards. And yet somehow it is always the poorer areas where crime and other forms of victimization far outpace anything found in “well-heeled” neighborhoods. I suppose the rich people form up mugging convoys to drive to public estates and go on crime rampages.
Yeah, I felt the author was a bit classist there!
I’m both surprised and impressed that no-one has asked what size Marmite jar.
And if the lid was left off?
May have been trying for a refill.
God bless you Doctor! Please share our gratitude with your co-workers and all who are here for us during the Christmas Season. As to the one lady, if you run into the same situation, please wish her a Merry Christmas from me!
A well written and enjoyable piece. But unlike many other contributors here, I ask if it has to be like this? It is high time that the sacred cow of the NHS to be examined from head to toe – and the funding part taking a major role. Similar to the unsustainable NI pension scandal. Britain looks like a country where nothing is managed properly.
I find the sight of Dr. Jones’ icon disturbing.