Saturday 25 June 2016

The Morning After in A&E

The atmosphere in A&E the Friday morning of Brexit was more subdued than normal. Medical, nursing and portering staff busied themselves with administrative tasks at the staff base rather than indulge in the usual noisy banter that acts as a team fist bump for the start of a shift.  Sometimes you get this sort of disconcerting quiet in an A&E when the normal routine exchange of gossip, inappropriate innuendo, informal medical education and war stories of previous shifts is temporarily suspended by a collective unspoken distress.

Usually this arises as a result of a particularly harrowing case: the death of a young patient or a staff member. But this time it was a political event: a democratic decision to leave a seemingly distant political institution. Why did this feel so upsetting and so personal to a bunch of people used to seeing tragedy and some of the worst of human nature? Young people with cancer, abandoned frail elderly, savage beatings, domestic violence, drug punishment stabbings and the ravages of drugs and alcohol are all part of the daily routine here, managed by resilient staff with empathetic yet technical efficient objectivity.

As the morning wore on and disbelief morphed into anger and alarm, the reasons started to crystallise as staff began to discuss the events of the previous evening in small huddles while beginning to attend to the first ambulance arrivals of the day. The common theme was one of a damaged sense of collective purpose and identity. The mirror of the referendum had been held up and we did not like how we were being reflected as a nation. Narrow minded, parochial, fearful, selfish, and most significant of all for A&E workers – not team players.

Some very limited consolation was taken from the Scotland result and the possibility of another Scottish Independence Referendum, but even here in Glasgow, 1 in 3 voted to leave, if they bothered to vote at all. One or two of the team even sheepishly confessed one or other of these sins to the silent incredulity of the others. Others searched for demographic groups to blame for the shame of lurching the country towards its isolationist, xenophobic and right wing future, oblivious to that irony.

But more and more patients rolled in, and as the shift busied up, conversations were replaced by frenetic activity. There were major road accidents resulting in life changing injuries, newly diagnosed lung cancers, a ruptured aorta, and many frail elderly patients with complex needs to care for. A committed team, guided by objective evidence, worked collectively to protect all comers from the misfortune that had befallen them, including those that had made poor life choices with very serious unforeseen long-term consequences.


By the end of the shift, the general mood had shifted somewhat back to normal. As the team changed out of their scrubs and headed for home, there was perhaps the reassurance that, within the walls of the A&E department at least, cooperation remained the best way of doing business.