- Feb 3, 2024
- LitBits
- 0
Another Night in A&E (Part 1) by Rachel McCarron The Art of Waiting
Back in March, I regaled you all with tales of the bizarre night time world of the emergency department. And last night, we were back for more.
I was about an hour off finishing my nine-hour shift at the GP surgery. It had been an okay day, and I was tying up loose ends in the Clinical Hub. It’s a bustle of noise and productivity from early morning, but by 6pm, there are just three of us left. I’m dictating my referrals, Tina is dealing with an urgent blood result, and Nikki is messaging a patient who thinks it’s their right to contact us at this time to demand to see a doctor about a sore finger. She politely advises that there are no appointments left today, and they should attend the walk-in centre or contact us tomorrow.
‘I haven’t had to send anyone up to the hospital today,’ I boasted to my colleagues.
‘Good going, Rach,’ says Nikki.
‘Not like you,’ says Tina.
I do most of the home visits, and when people are too unwell to get into surgery, they are often unsafe to stay at home.
Then my phone rings. It’s my husband. He never rings when I’m at work. So, I know there’s something wrong.
‘I’ve been… in the… now I can’t… the cleaning… on the screen the end disappears… I put the records back on the… the thing looks wrong.’
I know this. I’ve encountered it before, although never in my husband. This is what being lost for words is really like. He can’t find the words for kitchen, shelf, words, clock. The lines of text on his computer are disintegrating to the right. When he looks at the clock, there is no number 3. He still knows the records he’s been listening to are by Ralph Towner and Miles Davis. He’s still managed to take them off the turntable and put them away on the thing he doesn’t know the word for.
I ask questions that he knows the answers to but struggles to articulate. I ascertain that he has no limb weakness and he’s still orientated to time, place and person.
“Do you mind if I get off early?” I ask the others. How could they mind?
I talk to him on the hands-free as I drive home. It’s twenty minutes and it crosses my mind that I should have called an ambulance first. But I want to assess the situation myself, even though I know where we need to go.
When I get home, he looks fine. He’s dressed and ready to go. For comfort at home, he tends to wear his pyjamas – a word which is now conspicuously absent from his vocabulary.
Tina had rightly pointed out that I should call an ambulance rather than take him myself in case anything worsens en route. This is the safe advice that I would give my own patients, although everything’s different when it’s personal.
The ambulance service call handler tells me, yes this is a symptom of stroke, and he needs to go to hospital immediately. The current wait time for Cat 2* is between one hour fifteen minutes and two and a half hours. “Can the patient make their own way or arrange alternative transport?”
For a fucking stroke? You’ve got to be kidding me.
In stroke care, there is a concept known as the Golden Hour. It refers to the timeframe to get a patient scanned, diagnosed and treated to give optimum chance of recovery. Go beyond the Golden Hour and the patient’s outlook is poor.
But with the state of the ambulance service in 2025, the Golden Hour falls by the wayside. I’m only glad he can walk, and I can drive.
I keep him talking on the way, asking him to name objects and prompting him to recall the address of the place we stay in Bristol and the name of where I work. He reads out the road signs as we pass. His words are coming back. Maybe we should turn around and go home, see the GP tomorrow and get a referral to the TIA** clinic. But he’s terrified, and so am I, so we stick to the original plan.
On arrival, A&E is packed. I wonder if a Wednesday evening in August is peak time for emergencies, but I suspect it’s just normal these days.
Nevertheless, we are triaged quickly, the stroke team is bleeped, and a specialist nurse arrives with a doctor in tow. She carries out a swift set of neurological observations, and he’s in the CT scanner by 8pm.
I stand outside the scanning room because there are no seats. I check my Litopia app for something to distract me while I wait, and I marvel at the awesome service from our much-maligned NHS.
“Well,” says the specialist nurse as they emerge, “we found a brain.”
I assume this schtick is reserved for patients without any serious pathology, and I breathe a clichéd sigh of relief.
The doctor confirms there is no bleed (a significant risk with being on anticoagulant medication) and no infarct.*** An urgent TIA clinic referral is all that’s needed.
Yay! We can go home.
Nope. We still need to wait for the official CT report and to be reviewed by the A&E doctor before he can be discharged.
And how long will that take?
A Tannoy announcement informs us, “The current wait time in the accident and emergency department is… seven hours.”
To be continued…
*Cat 2: blue flashing lights for someone still breathing and not having a heart attack
** TIA: Transient Ischaemic Attack, aka mini-stroke, stroke symptoms which resolve within 24 hours.
*** infarct: an area which has been deprived of blood flow due to obstruction by a thrombus (clot)
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I was about an hour off finishing my nine-hour shift at the GP surgery. It had been an okay day, and I was tying up loose ends in the Clinical Hub. It’s a bustle of noise and productivity from early morning, but by 6pm, there are just three of us left. I’m dictating my referrals, Tina is dealing with an urgent blood result, and Nikki is messaging a patient who thinks it’s their right to contact us at this time to demand to see a doctor about a sore finger. She politely advises that there are no appointments left today, and they should attend the walk-in centre or contact us tomorrow.
‘I haven’t had to send anyone up to the hospital today,’ I boasted to my colleagues.
‘Good going, Rach,’ says Nikki.
‘Not like you,’ says Tina.
I do most of the home visits, and when people are too unwell to get into surgery, they are often unsafe to stay at home.
Then my phone rings. It’s my husband. He never rings when I’m at work. So, I know there’s something wrong.
‘I’ve been… in the… now I can’t… the cleaning… on the screen the end disappears… I put the records back on the… the thing looks wrong.’
I know this. I’ve encountered it before, although never in my husband. This is what being lost for words is really like. He can’t find the words for kitchen, shelf, words, clock. The lines of text on his computer are disintegrating to the right. When he looks at the clock, there is no number 3. He still knows the records he’s been listening to are by Ralph Towner and Miles Davis. He’s still managed to take them off the turntable and put them away on the thing he doesn’t know the word for.
I ask questions that he knows the answers to but struggles to articulate. I ascertain that he has no limb weakness and he’s still orientated to time, place and person.
“Do you mind if I get off early?” I ask the others. How could they mind?
I talk to him on the hands-free as I drive home. It’s twenty minutes and it crosses my mind that I should have called an ambulance first. But I want to assess the situation myself, even though I know where we need to go.
When I get home, he looks fine. He’s dressed and ready to go. For comfort at home, he tends to wear his pyjamas – a word which is now conspicuously absent from his vocabulary.
Tina had rightly pointed out that I should call an ambulance rather than take him myself in case anything worsens en route. This is the safe advice that I would give my own patients, although everything’s different when it’s personal.
The ambulance service call handler tells me, yes this is a symptom of stroke, and he needs to go to hospital immediately. The current wait time for Cat 2* is between one hour fifteen minutes and two and a half hours. “Can the patient make their own way or arrange alternative transport?”
For a fucking stroke? You’ve got to be kidding me.
In stroke care, there is a concept known as the Golden Hour. It refers to the timeframe to get a patient scanned, diagnosed and treated to give optimum chance of recovery. Go beyond the Golden Hour and the patient’s outlook is poor.
But with the state of the ambulance service in 2025, the Golden Hour falls by the wayside. I’m only glad he can walk, and I can drive.
I keep him talking on the way, asking him to name objects and prompting him to recall the address of the place we stay in Bristol and the name of where I work. He reads out the road signs as we pass. His words are coming back. Maybe we should turn around and go home, see the GP tomorrow and get a referral to the TIA** clinic. But he’s terrified, and so am I, so we stick to the original plan.
On arrival, A&E is packed. I wonder if a Wednesday evening in August is peak time for emergencies, but I suspect it’s just normal these days.
Nevertheless, we are triaged quickly, the stroke team is bleeped, and a specialist nurse arrives with a doctor in tow. She carries out a swift set of neurological observations, and he’s in the CT scanner by 8pm.
I stand outside the scanning room because there are no seats. I check my Litopia app for something to distract me while I wait, and I marvel at the awesome service from our much-maligned NHS.
“Well,” says the specialist nurse as they emerge, “we found a brain.”
I assume this schtick is reserved for patients without any serious pathology, and I breathe a clichéd sigh of relief.
The doctor confirms there is no bleed (a significant risk with being on anticoagulant medication) and no infarct.*** An urgent TIA clinic referral is all that’s needed.
Yay! We can go home.
Nope. We still need to wait for the official CT report and to be reviewed by the A&E doctor before he can be discharged.
And how long will that take?
A Tannoy announcement informs us, “The current wait time in the accident and emergency department is… seven hours.”
To be continued…
*Cat 2: blue flashing lights for someone still breathing and not having a heart attack
** TIA: Transient Ischaemic Attack, aka mini-stroke, stroke symptoms which resolve within 24 hours.
*** infarct: an area which has been deprived of blood flow due to obstruction by a thrombus (clot)
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