The secret A&E nurse's diary: 'He stands 1cm from my face, saying he will kill me'

http://www.theguardian.com/society/2016/jan/22/casualty-nurse-diary-nhs

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Sunday 7am to 7.30pm

Sundays are notoriously busy in A&E. GPs are closed, and there has been no movement out from the wards so there are no free beds in the hospital. At the start of my shift there are already 83 patients in the department. People are waiting to be treated in the corridors and it’s like sardines. My heart sinks.

I’m in charge of ambulance triage – as soon as the ambulance pulls up outside, I have 15 minutes to get the patient into a cubicle and take over from the paramedic. I have targets to achieve. For every breach, we are fined. It seems unfair, especially when 10 turn up at once.

I hear one of my drunk patients shouting and run to find him ripping off his monitoring, throwing thousands of pounds worth of equipment across the room. I ask what he’s doing and he comes and stands 1cm away from my face, telling me he is going to kill me. He reaches into his pocket but before I know it, one of my colleagues has restrained him up against the wall.

Monday 7am to 7.30pm

Today is a day of stark contrast. I see a 20-year-old woman who describes symptoms of a urinary tract infection. Her GP prescribed her antibiotics five hours ago. She says they’re not working.

A few minutes later, a 79-year-old man walks into A&E. His lips are blue. He says he rolled over in bed last night and has felt short of breath since. I take him into resuscitation and later find out he suffered a collapsed lung. He should have phoned an ambulance.

Tuesday night 7pm to 7.30am

I’m in charge of resuscitation. A 27-year-old male comes in with multiple stab wounds to the chest, neck and head. All of a sudden, it seems there are more police officers than patients. They are concerned it’s a gang-related incident that will cause trouble in the department as the perpetrators may return to finish off the job.

Wednesday night 7pm to 7.30am

I look after a 34-year-old woman who drank three bottles of wine and fell down a flight of stairs. She is visibly intoxicated but starts to become less responsive. Is this due to alcohol or a head injury? One thing I have learned is to never assume someone is just drunk. She falls unconscious and stops breathing. A tube is put down her throat to help her breathe. Scans report various limb fractures, a skull fracture, broken ribs and, more worryingly, a bleed on the brain – a potentially fatal diagnosis.

Thursday night 7pm to 7.30am

The theme for the night seems to be suicide attempts, with three patients coming in. Two go to intensive care. I always wonder how people feel if they wake up. They have felt that life is not worth living, but then we do everything medicine has taught us to bring them back.

Friday

I get three hours’ sleep after finishing work at 7.30am. I need to turn myself round for my next day shift on Monday. I’m exhausted. I’m just thankful I’ve got this weekend off.

Most difficult decision: When I was in charge of resuscitation, it was at capacity. I had to decide which patients were most likely to decline and need help, and which could risk going to an area with less monitoring and no one-on-one care.

Most satisfying result: With the constant rush of A&E, it was nice to be able to sit and take my time suturing the wounds of the 27-year-old man. It’s a therapeutic art.

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