A&E

I dreaded A&E. The thought of working there made me a nervous wreck for the last part of summer. How on Earth was I going to be able to work in such a busy environment? Having to face loads of conditions I had maybe only read about before... some years ago. Maybe.

It was with massive trepidation that I started at 4pm on that first day.

And it wasn't that bad. I remember my first patient, an old lady with a urinary tract infection. Not even very ill. But I'll never forget the wry smile of the staff grade as I double-checked she would be safe to go home.... "What's the worst that could happen?" he said, causing me to stutter out a list of reasons why I might be responsible for her imminent death. He, of course, stopped me with a hand on my shoulder... "...she'll be fine. Now, next patient!"
By the end of that shift at midnight, I'd surprised myself with what I knew.

On my second day I was assigned to Children's A&E. Terrified, I wandered over, expecting a rush of clapped out kids. Instead, I spent the afternoon looking at coughs and colds, banged heads and bruised knees. Until about 8pm, when a 9 year old autistic kid came in, his hand bloody following his exploration of a moving lawnmower blade.

Remarkably, he wasn't too upset, and with some help from a patient nurse, I sutured my first hand. It went as well as could be expected for a kid who kept giggling (from the Entonox) and wriggling so he could see what I was doing better!

And so time went on. I think it was 6 weeks in when I first saw a small fracture that I wasn't already looking for from clear physical signs. I stunned myself - I never thought I'd actually be able to interpret an X-ray! On a future X-ray, I later found out that a small scaphoid fracture I'd suspected was actually there but which the consultant didn't feel was evident was confirmed by radiological reporting. Brilliant.

Of course, there were plenty of times the consultants questioned what I had done, which at first was intimidating, but I soon learned to value. I'd never had such great teaching or felt like I had learnt so much before.

As the weeks went on, my fear of the resuscitation room turned to a morbid pleasure - I loved the acute assessment of patients, and was really proud of the first standby arrest call that I led. It was a horrible situation, a young patient with sudden death, that was terribly upsetting, but I really felt I'd done all I could, and tried to help the family in that initial few hours.

About 3 months into the job, I had to consider what to apply for in terms of specialist training. having been a gung-ho psychiatrist-wannabe for 3 years, I was now wracked with confusion. I LOVED coming to work in A&E... should I think about a career in it?
The feeling lasted about two weeks... many advised that the initial excitement would soon boil down to boredom after a few years. And I didn't see myself as an "multiple RTA" or open-thoracotomy type-of-person as a 45 year old.
But after a frank chat with one of the best consultants, I realised I really did enjoy the acute medical patients, the COPDs, the asthmatics and heart attacks.
And so I applied for core medical training, something which still surprise both me and my friends.

If I was born 5 years ago, the medical training system would have meant I could have done a year or so of A&E jobs, and I kind of wish for that system. I don't feel like I've done enough yet, and would love to head back to do some more training there.

And where else do doctors get their goriest, funniest, scariest and most tragic stories from?

So if you ever want to hear about what that man had lodged up his ass, the time I made a mother vomit over her child, dropped my stethoscope on a ripe tampon, or why I almost made the Bolton News, buy me a pint.

If noble moments is what you're after, perhaps I could tell the story of the wife of the patient I cared for over 5 hours as he died in A&E, supporting him unwaveringly until the moment he relaxed? Or the time our patient was found to have a previously unknown lung tumour invading his aorta, leading to him arriving coughing up his entire blood volume? The man beaten in the face whilst protecting his wife. The lovely old man with a clearly visible skull fracture.

Of course, there's the moans. The hundred of coughs and colds I sore. The patient's who'd sprained their ankles but "didn't belive in painkillers". The four-hour breach (incidentally I set a record with a patient leaving the department with 20 seconds to go - something I shouldn't be but am very proud of!). The surgeons. The orthopods. The bloomin' CRISIS team.

And let's never forget the scores of flirtatious old ladies. I've still got it (as did Pete and Adam).

To every patient that had to wait, for whatever reason, I'm sorry. We all worked as hard as possible. It's just unlucky that everyone seems to get ill at the same time. And I know you can never get a GP appointment when you want to. But many of you seemed to agree that Bolton's A&E was fantastic. Cos it bloody well is.

Maybe I couldn't hack working there for the rest of my life. But I'll be damned if I don't defend those that do for the rest of my working life. If it wasn't for the A&E staff, every other health worker's life would be far more miserable.