Sunday, 5 December 2010


In the middle grade rota in Raigmore Hospital, there is a one month block in every four where you either do nightshift or are off, and that is my last month in the hospital. You are the most senior medical doctor present in the hospital (surgical, anaesthetic and A&E middle graders are also in). So it's been a while since I've seen most of my colleagues. You're based on ward 6a, the Acute Medical Admissions Unit where the new medical patients are admitted to, but going wherever else in the hospital problems arise. Medical HDU, the wards, CCU, A&E, always working alongside the nurses caring for each patient but going alone to the next. Prowling the darkened corridors, it actually becomes a lonely job. The staff I know well are all on AMAU, but elsewhere in the hospital generally the people you work alongside are strangers, more or less.
But it is all a single team. The staff members come and go but the team never changes, night or day, any day.
Final nightshift.
Final shift.It goes well; not too many admissions. Those we admit are not unstable. Diagnoses seems straightforward, and my junior is efficient and astute. Each one gets seen, diagnosed, treatment, and then moved into a bay and allowed to sleep. It's rare to have such a slick and unflustered night, and it feels wonderful to be so free of pressure.
There is one extremely ill patient who I spend most of my time with, who has already been in a critical care area for several days. Those who are very unwell frequently develop new and equally severe problems in other organ systems that have been just about coping until one finally gives in, and then one after another a cascade of failures can occur. Just fix and fix and support and support, hope the original insult can be recovered, and the patient will usually recover and go back to their unwitting walk along a knife edge. This complication is really serious. The nurses, I and my surgical colleague work hard to resuscitate them. It's a very long and tense night, but we get the patient through it.Lights are switched on, eight o'clock and the day staff come in. Familiar faces flood in to the hospital. Colleagues come in and I hand over care of all the AMAU admissions. I get lucky; they don't want me to come on the ward round. I go to check my unwell patient. Still perfusing. The nurses I worked through the night with have already left and fresh staff have replaced them. The closeness of the night's team is gone, replaced with the bustle of new people taking over.And I sit at the front desk, discussing on the phone the next steps for my patient. All the hospital's resources available, only a phone call away. The surgical ward round; consultant, juniors, students troops in. We relate to the consultant what has occurred through the night, discuss, a decision is made. Plans, details worked out. Three team members on the phone simultaneously, arranging, informing, contingency planning. And then as abruptly as they came in, they troop off somewhere else. The day SHO for the unit arrives, shakes off his coat and finally I am done. It's time to hand on the night's responsibilities, and leave.The staff changes, but the team will remain the same, 24 hours a day, 365 days a year. I can't tell you how sad I am to give up my part in that team.I sit back in my chair, alone again somehow, as staff buzz efficiently backwards and forward around me. It's very difficult to get up and leave. The staff have little time for goodbyes, but everyone gives me a cheery wave or a hug and warm wishes.
I can't really see the future right now. I really don't want to leave this place that I have worked so hard in, and so many people I like so much, with whom I have shared such high highs, and such low lows.But I do leave. And as I walk out the front door it gets easier, just as it always has done, moving from one hospital to the next. Into the sunshine, and the night's cares fall away a bit.

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