What have you done to help at the Front?
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7580 (Published 29 November 2011) Cite this as: BMJ 2011;343:d7580
- John Quin, consultant physician, Royal Sussex County Hospital, Brighton, UK
- jdquin{at}aol.com
Abstract
There’s a crisis in casualty, says John Quin
I belonged to the Blank Generation, which meant that I could take it or leave it each time, whatever “it” was. I suspect now that “it” was politics, polemic—all those portentous words beginning with P that point to Pseuds Corner. But times are tough, and I’m now a fully paid up member of the Rank Generation—that’s rank as in less than fragrant, rotting and rotten, ready for the knackers yard, aka admission to an accident and emergency department. And that scares me because the days of the emergency room attracting budding George Clooney types to save the shattered masses are long gone. No one likes the front door any more; recruitment is in crisis, and alarms need sounding. Here are five speculative reasons why this has come to pass and one blinding insight, like a diamond bullet right through the forehead, which should sort all our woes.
1. Smell
Lieutenant Colonel Kilgore in Francis Ford Coppola’s Apocalypse Now (1979) famously equated victory with the smell of napalm in the morning. Defeat in all its ignominy is what we associate with the olfactory nightmare that is midnight in casualty. We imagine Dante’s circles of Hell, the third say, with its inebriated gluttons spewing gouts of soured Jack Daniel’s; the nonpareil hogo from a noisome pan of melaena; the whiff of plastered incontinents in all their ammoniacal glory; the hydrogen sulphide blast from a depressurised smoker’s empyema that renders us temporarily apnoeic.
2. Noise
You might as well blast Wagner’s Ride of the Valkyries from wall mounted microphones while someone is telling you about the guy in resuss with a past history of Carney complex and an international normalised ratio of 9. All around you phones trill, bleeps bleep, intravenous sets alarm, psychiatrically unwell people scream, staff pray.
3. The light
There aren’t any natural shafts, of course, as there are no windows. And when the deadening artificial stuff is eventually switched on it really puts the zap on your head. Not infrequently you find yourself frankly tetanic owing to flatline levels of vitamin D. There you are, Chvostek twitching to yourself in some dreich dunny.
4. Chaos
Things get confused out there. There was a time when everyone was into chaos theory and would gibber on about butterflies and hurricanes, but then we all wised up and realised that knowing stuff about chaos wasn’t going to help us one iota in accident and emergency. See us like ragged claws scuttling across the newly mopped floors then skidding into matron. We could tell patients to present themselves again between 3 and 6 in the morning when things calmed down, but that won’t work.
5. The horror
Horror, we are told, has a face. And that we must make a friend of horror. Well, that’s a bit of an ask these days when violence against NHS staff has become a frighteningly frequent occurrence. Shooters and swordsmen are now common sights. We are the Self Preservation Society, and we gotta get out of this place, if it’s the last thing we ever do.
So there you have it, several reasons why die junge can’t wait to escape from those bits of the hospital where ambulances arrive at.
What is to be done? Throw money at the problem? I know, I know, we don’t have any, but can’t we find it from somewhere—anywhere? No, and again no. It’s all gone. The scramble has begun. Our new graduates are crippled with debt; they live (according to the artist Liam Gillick) in a society where capital has colonised the mind, and so almost all who want to be doctors fancy anything that has a procedure that can earn a few extra bucks.
The new Bank Generation are clean: they want anything that can keep them on a rota that minimises exposure to the unwashed, the unkempt. Medicine in the UK has to face up to the New Snobbery in our broken version of “society,” its new fears, its demonisation of the chav, and so on.
Here’s the solution. Be brave! Ditch the Bank Generation if you can, come back to the front line, and show that you can keep your head when all about you are losing theirs. And OK, I know—that’s a big if.