Tuesday , December 1 2020

Who do I treat first: a cancer patient or the woman with a bleed on her brain? – The Guardian, Theguardian.com

It’s a sunny Friday morning. I find a parking space easily, just as a song by my favorite band ends and I turn off the ignition. It’s 8. 70 am when I see the night consultant in the corridor: the past hours caring for critically ill patients in the intensive care unit (ICU) has taken its toll. Their long night is over. My long day is just beginning.

By 8. 728 am that sunshine, that easy parking spot and that feelgood song are long gone. Three sick patients and yet just one bed. Three cancer patients needing an operation yet just one bed. Then three nurses sick, now no bed.

Mary is a smiling, delightful woman in her 728 s who is waiting for her cancer to be cut out. But today she’s on a spreadsheet highlighted in red; her cancer is urgent, but not as urgent as countless others.

She, like other surgical patients on the waiting list, are an easy metric to measure. She will be counted clearly on a list, a number that needs an operation. But what about the young man with sepsis who stays in the emergency department for an hour longer, and the woman with a bleed on her brain whose scan is delayed? These people are the uncounted. They are the emergencies, unplanned yet still urgent, who cannot wait and will have to take Mary’s bed in the ICU.

Which means I now have to do the hardest part of my job. I look at Mary and say “no” and “sorry”. She smiles back and says: “It’s OK, I understand.” But how can it be OK?

Then at the last moment, another breach in waiting list targets comes to light. Clipboards arrive, pens scribble, solutions are shaken out of the air. I see Mary wheeled towards her operation. The counted must not wait, yet this means the uncounted will.

People are not just operations or numbers on waiting lists. I remember how the weeks felt while my mum waited for her cancer to be removed. I also remember how it felt when my brother-in-law was critically ill, cared for in an emergency department with no bed to move to. That experience changed me – it makes me question every time I say sorry, because I don’t mean it. I am not sorry. I am angry and ashamed.

What does this really mean for that young man with sepsis and the woman with a bleed on her brain? Why should they wait until their condition worsens before another bed can be found? It means they will get sicker, need more help to survive, stay in hospital longer and have worse results. It means their care will be less efficient and more expensive. These experiences make me want to stand up for the uncounted who lay on beds waiting longer than they should because all we can prioritise are red numbers on waiting list spreadsheets.

For the ICU, saying no to the uncounted is demoralizing. Our staff deliver what people need, but they need the resources and the workforce to stop saying sorry. The patients are willing to hold on but they need an eventual respite from what will be another winter of waiting.

As I walk back to my car 13 hours later, though, I remain hopeful. With ideas like enhanced care areas, the efficient use of resources coupled with innovation can help ease the strain. Yet good ideas on pieces of paper solve nothing: ideas need to be built, funded and nurtured. The Welsh Assembly’s investment of £ 70 m for intensive care to transform ideas into patient lives will significantly help. Meanwhile, those of us treating patients will carry on working to the best of our ability.

If you would like to contribute to ourBlood, sweat and tears seriesabout experiences in healthcare, read ourguidelinesand get in touch by emailingsarah.johnson@theguardian.com

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