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FRNow 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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SubscribeAn 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).
If only everyone could be as perfect as you so obviously are – wouldn’t that be lovely!
What 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….’
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.
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.
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.
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.
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.
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!