Nine out of nine was a twisted ankle while running for a taxi, p.i.s.sed, number 10 was a head injury after falling over, p.i.s.sed, and numbers 11 and 12 were another fight (over who was looking at whose bird), p.i.s.sed and p.i.s.sed.

Reading this, you may think that I have a Presbyterian view of the new drinking lawsI don't. The 24-hour laws have, in my opinion, and that of a recent government report, not increased or decreased alcohol-related problems coming to us but just spread the workload over from what was originally 11 p.m.1 a.m. to 11 p.m.5 a.m.

The new rules have also done a lot of good. Police and local councils can liaise with the A&E departments about local problem pubs and they have been warned to buck up their ideas or lose their licences. The A&E consultants can also advise police and councils on safety issues. After consultation with one A&E department in Wales, a decision was made to force one pub/club to only sell booze in plastic bottles/gla.s.ses. The incidence of serious injuries decreased ma.s.sively.

After an interval of three non-alcohol related patients I got my 13th booze-related patient: a Latvian builder whom I can only a.s.sume had misread the bottle label after work and drunk vodka instead of water (these mistakes do happen). He came in to ask if I could give him something to stop him vomiting and feeling so dizzy as he had to go and fix someone's roof soon! At least it won't be me who sees him when he comes backit's my last shift for a few days and I am off to the pub now for a fry-up and a pint (the best bit about the new licensing laws).

Upset at work

One case really upset me today. An old lady came in struggling to breathe. She was about 85. We tried all we could but soon her breathing stopped, as did her heart. We started CPR. Occasionally it works, but it was obvious in this case it wasn't going to work either: 15 minutes later, I checked with the team if anybody minded if we stopped. n.o.body did. I went to speak to her husband.

'Is she dead?' he asked without emotion.

I nodded. 'Oh...what do I do now? I haven't been on my own for 64 years. May I see her?'

I tried to explain what had happened but he just wanted to see his wife.

He looked at her. 'I love you', he said, with tears rolling down his face he added. 'See you in Heaven,' and then he left.

It really upset me. However long you have done this job you do get upset. Also, you know that he will be back soon, as invariably widowed men die shortly after their spouses. I tried to get a cup of tea when the red phone went off and another patient came ina chance for reflection was stopped by a multiple trauma.

My last thoughts

Today was my last day at work before a two-week holiday and the break from writing that would ensue. The main thing writing this book has done for me is actually to get me to think about what I do as opposed to just go through the motions.

As I drove home to the sounds of REM (who always put me in contemplative mood), I started to think about my job and day. Yes, I had had a good day. I had seen lots of varied and interesting cases (medical term for patients/people), ranging from a heart attack to a broken finger. I had seen a patient whose condition had really made me upset, but also made me thankful for what I have got. I had an email from a medical student thanking me for a teaching session I gave a couple of weeks ago, and positive feedback from my boss about a patient I had treated. I had flirted with the nurses, and patients over 80, and had had a good bit of banter with my colleagues.

So, all in all, it wasn't so bad a day. To top it off, we hadn't been worried about 4-hour waiting targets as we seemed to be well-staffed today. So, on a good day, I think there is no other job in the world that I would prefer.

On a bad day, well, that is different. The stresses of dealing with such heart-breaking cases can be hard to cope with. The nervousness about making a mistake and the worry that your treatment will do no good, are hard to live with. There is the paranoia of getting a complaint from a patient. Then there is the anxiety of a getting a bad reputation from your bosses for not managing the department efficiently or being thought of as s.h.i.t by your specialist colleagues for not sorting out patients in the manner they deem appropriate. Combine all that with the worry of exams, revalidation and working your way up the career ladder when you now have no idea of what is waiting for you at the top, then it leads to a difficult job. However, I think the good bits outweigh the bad bits.

So, I think to myself, do I want to carry on? Well, yes I do. Hopefully, in a few years I'll be a consultant and, although that means more responsibility and extra challenges, it also means that I will have a voice and perhaps some power in trying to direct changes in an appropriate way as opposed to just being swept along with them.

Would I recommend being an A&E doctor to school kids, medical students and my own child? Yes...but only if they are mentally strong and can cope with the stress and upset involved in the job, only if they don't take criticism to heart, only if they have 'bouncebackability' (thank you for that word, Iain Dowie) and only if they can rationalize what is important in life and not get so stressed by problems of complaints, difficulties with management, and the uncertainty of their chosen career. If you are like me and possess none of these qualities, would I still recommend A&E as a career? Yes, as long as you have the love, support and compa.s.sion of a partner to help you through it all and support you when it gets rough. Luckily, I have the best possible one: Mrs Edwards, everything I do, you make do-able and worthwhile. Thank you.

Apologies, acknowledgments, thank yous and hopes

It is unusual to start this type of ending with an apologies section. However, I think that it is probably wise. Very rarely have I mentioned the many colleagues (including many managers) who work very hard to help A&E departments function well and help provide good quality of care for patients. This is not because they are rarefar from itthey are the rule, it is just the exceptions that really drive me mad and make me write to vent anger. If a biased view has come across, then I apologise.

I have many thank yous to say. First, to the publishers for agreeing to sign a contract without seeing much of my work and just based on me ranting while having a tired cup of coffee after a set of nights. Second, to my agent for leading me through a process that I know so little about. I would also like to thank my friends for being supportive and listening to my rants down the pub.

I would like to thank all the staff I work with and the thousands of others who keep the NHS going. My particular thanks go to my recent immediate bosses for helping train me and showing how to keep your head when everyone else is moaning and ranting.

I would like to thank my family: my parents for their moral compa.s.s, my brother for his advice and my in-laws for encouraging me to write this book and giving me the idea in the first place. Most importantly, I would like to thank my wife. You have given me so much, including our precious child. This book has only been possible because of your support. Thank you. I love you so much. You have an unlimited shoe and handbag budget this year, I promise.

So that just takes us on to hopes and conclusions. I hope that you have enjoyed the book, and that it has opened your eyes to the reality of the subject material. I have shown you why I love my job and why it also drives me crazy. Generally, I think that things have got better in the NHS and emergency medicine in the last 10 years. The money pumped in has seen improvements. I think that the government's intentions have been right; it's just their actions that have been at fault. The problems have been the unintended consequence of poorly thought-out policies.

The NHS is an inst.i.tution that I care about deeply. Policies have been brought in that tamper with its principles and ethos. I fear that the structural changes that have been brought in may lead to a patchwork privatisation and a consequential degradation in service provision. I hope a post-Blair era proves me wrong. If you too are worried, then try and do something to help save the NHS. We live in a democracy and our voices should count. Go on marches against your local hospital closure, sign pet.i.tions, write to your MP or get involved with pressure groups (such as http://www.keepournhspublic.com). If you have any comments or wish to contact me please do so via The Friday Project or at

Thank you.

Dr Nick Edwards, July 2007

Glossary

ASBOantisocial behavioural order. I believe over 90 percentof people coming to A&E after midnight on a Sat.u.r.day night have or should have one of these.

Blair, Tonyicon of revolutionary socialist ideology or Thatcher's love-child who acts as a tree for George Bush's poodle. You choose.

BMABritish Medical a.s.sociation (the doctors union) but not the type that calls each other comrade and organises meat raffles. A GP's best friend.

BMJBritish Medical Journal (the (the Sun Sun of medical journals). You can understand most of the words, it keeps you vaguely interested and there is often an interesting picture or two. of medical journals). You can understand most of the words, it keeps you vaguely interested and there is often an interesting picture or two.

Brown, Gordonicon of revolutionary Scottish socialism or a boring and impolite version of Tony Blair. I am not sure which one yet.

Cannulaa plastic tube that goes in the back of your hand and from which we can take blood tests and give you fluids and drugs. Not really something to make a joke out of, as it has no amusing properties.

Charge nursenurse in charge. It is what we call male sisters. They object to the term 'brother'.

ChavEnglish equivalent of trailer trash. Spend money on c.r.a.p food, f.a.gs and on Burberry gear.

Choose and bookto make the NHS look good we now let you choose if you want to go to your local hospital or one 50 miles away.

Copperpoliceman; precious metal.

CPRcardiopulmonary resuscitation.

Cross matchingfinding out what batch of donated blood is compatible with the patient's.

Dowie, Iainfootballer (very, very good in his time) and manager (not so good). Like all the best sportsmen he has got a big, ugly bent nose.

DGHdistrict general hospital. Your local hospital. Apparently our affection for them is the problem for the NHS and they must be destroyed. Personally, I think they do a good job for the populations they serve.

Diagnostic and treatment centresNew Labour term for hospitals. So we close down NHS DGHs and open these 'for profit' diagnostic and treatment centres instead. Makes sense to me. Same as independent treatment centres/private treatment centres.

DVTdeep vein thrombosis.

ECHOechocardiogram. Takes an ultrasound picture of your heart. It looks like a fuzzy black and white TV screen. I have no idea how people can actually interpret these things.

Fast bleepedcalled quickly. Response is often variable.

Frusemidea drug that makes you pa.s.s urine. The Americans keep trying to get us to change the way we spell it, but I won't succ.u.mb to the pressure.

Fractureexactly the same as a break.

Glomerulonephritis and and cANCA cANCAsomething to do with the kidneys but the subject went way over my head at medical school. Only properly understood by renal specialists and perhaps Einstein.

GMCGeneral Medical Council. They make sure that doctors are being good boys and girls and investigate when the public/colleagues complain. There is no truth whatsoever to the rumours that they have trained CIA agents working for them as undercover investigators.

GP (general pract.i.tioner)your family doctor. They tend to come in two types: partners (good businessmen, who happen to be doctors) and salaried GPs who work for the former but don't have a financial interest in the practice (they don't own as expensive a car or do as much paper work). (general pract.i.tioner)your family doctor. They tend to come in two types: partners (good businessmen, who happen to be doctors) and salaried GPs who work for the former but don't have a financial interest in the practice (they don't own as expensive a car or do as much paper work).

GTNa drug to help with angina.

Haemoglobinthe oxygen-carrying part of your red blood cells/blood. Not enough and you become anaemic.

Hewitt, Patricia (Secretary of State for Health)the doctor's and nurse's best friend. Bastion of keeping the NHS public. A great moral thinker of our time. Highly respected among all that work in the NHS. I would personally walk for miles barefoot over broken gla.s.s, just to hear her wise words... (Secretary of State for Health)the doctor's and nurse's best friend. Bastion of keeping the NHS public. A great moral thinker of our time. Highly respected among all that work in the NHS. I would personally walk for miles barefoot over broken gla.s.s, just to hear her wise words...

Hoodiea naughty boy or girl who is worried about the rain damaging their new hair-do.

ICUintensive care unit. Also known as ITUintensive treatment unit. The area of the hospital where the sickest patients receive specialised and life saving treatment. Nicknamed 'expensive scare unit'.

Lancetanother medical journal that gets itself into hot water a bit. Fewer pictures than the BMJ BMJ and longer words. Hence, has a slightly higher brow readership ( and longer words. Hence, has a slightly higher brow readership (P. S The MMR jab is a good thing).

MAUmedical admissions unit.

NHSNational Health Service. The greatest achievement of a socialist Labour government. Set up in the late 1940s to provide free care to all who need it from the cradle to the grave. Was once the envy of the world.

Naloxonedrug that reverses the effects of heroin. Helps drug users to breathe; also gets them off their high rather abruptly.

PCTprimary care trust. Holds the purse strings and power in the NHS.

PFIprivate finance initiative. Another name for a very, very expensive loan that doesn't appear on the Chancellor's ledger.

ReconfigurationNew Labour speak for closing departments, wards and hospitals.

Red phonethe ambulance service use it to tell us about emergencies. Called the red phone no matter what colour it actually is.

Resusresuscitation department. Where we take the sickest patients and where we don't get bothered about 4-hour rules (usually).

Revalidationthe GMC word for the idea to retest doctors' skills and knowledge every so often to make sure we are not like Harold Shipman.

Socialist principlessomething that New Labour has very little experience of. As opposed to PFI and for-profit independent treatment centres, which it knows all about.

SHOSenior House Officer, old term for a junior doctor in training. Now replaced by foundation doctors, specialty training doctors or unemployment.

SMINTsenior minor injury nurse triage.

Staph./Staph. aureusa bacterium of some strength and power. Known for MRSA (methicillin resistant Staphylococcus aureus Staphylococcus aureus) and the new deadly killer MSSA (methicillin sensitive Staph. aureus Staph. aureus)otherwise known as bog standard Staph. aureus. Staph. aureus.

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