It’s a cliché, but A&E’s in meltdown.
Except meltdown doesn’t quite do it. Meltdown suggests movement, fluidity, a change from one form to another. Obstruction is more like it. Log Jam. The volume of patients coming through the automatic doors overwhelming the channels established to deal with them. With no beds further up the chain, nowhere for the current cubicle occupants to move up to, nowhere for the new ones coming in the door to go, it’s a logistical puzzle with no solution. A simple question of numbers – although as is often the case, the simplest questions are the most difficult to answer. No one round here has any time to debate. Coping has shrunk to a few centimetres of space, a cup of coffee, a clear view of the wipe clean board and the A&E clock.
The staff in A&E – the nurses, consultants, HCAs, cleaners, porters – everyone is doing whatever they can to alleviate the situation. No-one has the psychic or emotional room to do anything else, to see or believe in any kind of long-term plan. Home has retreated to the realm of fairytale. The best anyone can hope for is a chair and a cup of coffee, something to eat and a place to rest their eyes that isn’t occupied and doesn’t demand action.
I’m waiting with our patient, a young guy with a deep abscess on his left buttock that the consultant has just packed out with super-absorbent gauze in the humane but brisk manner of a field-surgeon under fire. The patient is on his back at least, on a trolley, the pressure of his body helping to staunch the blood loss. His wife is with him, wiping his forehead and kissing him now and again. The whole scene only needs straw on the floor to qualify for a Crimean certificate of tragedy, but everyone’s doing their best, the shift is nearly at an end (theoretically), and the pharmacy has antibiotics, for a few more seasons at least.
I’m chatting to the patient about this and that, keeping him distracted from the general scene of woe, when I feel a tug on my elbow. An elderly woman, peering up at me.
‘You look like the person to ask,’ she says.
‘Oh, really? Okay. How can I help?’
‘I’ve been told my taxi is out where the ambulances are parked, but I don’t know where that is. Could you tell me?’
‘Of course. Head for those doors in the far right corner. See them? Just where that guy in the yellow jacket is waving his arms about? Once you make it past him, you’ll see a couple of automatic doors, and about a thousand ambulances nose to tail in the car park just outside. That’s where your taxi will be. Okay? Do you want me to help you through, or are you all right?’
‘I’ll be fine, thank you. I can see you’re busy. I just got a little lost, that’s all.’
‘It’s all very confusing, that’s for sure.’
‘Well – thank you for your help.’
She starts excusing her way through the melee; I turn my attention back to my patient.
About a minute later, I feel another tap on my shoulder.
It’s the old woman again.
‘Happy Christmas!’ she says.
‘Oh! Happy Christmas!’ I tell her.
She holds out her hand for me to shake.
‘And a very Happy New Year!’ she says.
Then with a neat little shake of her shoulders, a gracious nod to the patient, the patient’s wife, she releases my hand, turns, and with her head up and beak out, she addresses herself to the task of swimming upstream, and the heavenly prospect of a taxi, waiting with its lights on, somewhere out in the dark.