If you’ve ever struggled to suck a particularly thick milkshake up through a straw, then you have some idea of how the patient on my night shift was feeling. Except he was trying to breathe through airways that were badly diseased after a lifetime of smoking. As I watched him struggle I grew increasingly aware that he needed specialist help, which, as a junior doctor, I was not in a position to provide. When I look back now at that time, reflecting on that shift and that patient, all I remember is how scared I felt.
Night shifts are hard, there’s no particularly eloquent or insightful way to put it, they’re just hard. But this night shift was made harder by the absence of my senior registrar who was off sick and for whom no cover had been provided. Without this senior colleague, I was the only doctor covering all the wards of a major NHS hospital. I had four pagers slung around my waist, dreading the ‘bleeps’ that were coming in every few seconds.
When a pager goes off, it means someone needs you and you have to answer it. You head to the nearest available landline phone and dial the number back. You don’t know who has paged you or how urgent it is. But the upshot of being the only person responsible for all pagers that night was that I was unable to spend any real time with any of the patients who I had been bleeped to care for. It began to feel like I was running around wearing a belt of live grenades.
I was charging about answering bleeps in no considered order of priorities. My nursing colleagues who were working with me that night were so concerned by my inability to spend meaningful time with patients that I was later reported for my lack of attentiveness – a true testament to the million directions in which I was being pulled.
I don’t think that the majority of NHS patients would know how a pager works or how we still rely so heavily on them. I know that I had never seen, let alone used, one before becoming a doctor. We’re technically not supposed to use other tools, such as SMS or WhatsApp, to communicate with our hospital colleagues while on shift and we’re absolutely prohibited from discussing any confidential medical information about patients on them. So on every shift I was a slave to my pager. And on this particularly night shift, it meant being dragged from pillar to post, never knowing what was waiting for me on the end of the call.
There were some small victories that night. A patient who was dealing with homelessness, drug abuse problems and an HIV diagnosis presented with major infection as a result of using dirty needles. He needed a cannula to give him some fast fluids to treat the infection but this required me to find a vein, which was almost impossible until the patient helped me find the one surviving vein in his body (up around his clavicle). He then held the tourniquet in place with his teeth while I located the vein and successfully administered his fluids. It was a brief moment where I felt like I’m being able to do the job I’d train so long for.
Mostly though I just remember experiencing a horrible kaleidoscope of sleep-deprivation, hunger, nausea, anxiety. And the bleeps. The never ending, bleepin’, bleeps.
Like lots of other junior doctors my age, I decided to take a break from medical practice earlier this year. I’m still committed to working in healthcare and I’m passionate about improving the NHS; I don’t think I’ll ever stop seeing myself, first and foremost, as a doctor. Instead, I’m using my experiences to create new technology that allows doctors to ditch the bleeps (and the landlines and fax machines, for that matter) and help them communicate better during their shifts. Doctors desperately need more time to care for their patients and we can’t reasonably expect them to work indefinitely under conditions of extreme stress compounded by technological inefficiency. But even more than that, patients should be able to expect their doctors to have the time to care for them safely, effectively, and compassionately.
I hope that the next generation of junior doctors don’t nod in recognition when they hear about my night shift from hell, but instead can’t believe that it ever had to be that way.