Almost two weeks since I started working at Winchester Accident and Emergency (A&E) aka Emergency Room/Department and it has been a whirlwind. I am still working on processing everything I am learning. The onslaught of information has been exhausting.
Walking down the corridor I was brought back to my time in Haiti when it was so hot and humid with no way of cooling down. This time it is not the heat, it is the surplus of information that I have to process. I often want to run into the break room, take off my mask and drink another cup of tea, even though I just had one.
Information overload…
I am processing a combination of information- English hospital policies and procedures, written and observed. Deciphering the many accents of colleagues and patients and different medical vernacular. And to top it off, differentiating between sincere British kindnesses versus them politely attempting to tell me it is done differently here. While the people from the southern United States are good at passive aggressive comments, the British invented and perfected it.
Florence Nightingale worked at Winchester Hospital and it is surreal to know I walk the same halls. The A&E was broken apart due to COVID then loosely pieced back together back. Prior to COVID it has three major areas, minors, majors, and pediatric. Now it is subdivided into roughly twelve areas that fall into two categories of hot or cold. Hot for high probability or confirmed COVID patients and cold for low probability or negative COVID patient. And in the sideline there is also an Amber section for all the “maybe” and a completely separate pediatric area. And each hot/cold section has its own section of chairs “sit to fit” (mid acuity patient, a healthy chest pain vs chest contusion), trolleys aka gurneys (same as chairs but unable to sit), and resuscitation.
Now I am the one with the accent
The vernacular has my ears sticking out. I have learned it is not dry heaving, it is retching. Giving report is “handover” as in “did you handover to the floor?” Transporting to xray you would “shift” the patient to xray. Vital signs are observations, so you getting a set of obs. And when I ask if they want me to complete an EKG (electrocardiogram: a quick Polaroid of the electrical activity of a heart) they look at me with a contorted face, till I correct myself by saying ECG. But maybe my favorite is “do you bleed?” It is how they ask if you are able to do venipunctures (blood draw) or cannulas (IVs). I keep wanting to say, yes I do bleed don’t we all, but I don’t want to cause unnecessary wrinkling of the eyebrows.
I have never seen these before and they work great!
Certain things are the same, short staffing, lack of breaks, and making sure patients take off their brassiere before x-rays. But other things have my jaw on the ground. First there are no discharge instructions or paperwork, a note is sent to their general practitioner. The provider evaluates the patient; casually mention the patient is discharge well after the patient has left. But if the patient requires antibiotics prior to discharge you obtain it from the TTO cupboard (To Take Out) and just give it to the patient.
Oh medications, all medications are in cupboards (cabinets) with locks. No pharmacy verification or Pyxis machines (Pyxis: automated medication dispensing system supporting decentralized medication management. It helps clinicians safely and efficiently dispense the right medications, for the right patients at the right time.) You do require all IV medications including Normal Saline or NCl as it is written here to be double signed by another registered nurse. A bit of a nuisance but quicker than waiting on pharmacy as my fellow Washington nurses will related
The reality of the NHS
A revelation I could have learned through Google prior to my arrival is that the National Health System (NHS) does not really communicate with each other. I imagine a country wide EPIC (electronic medical record system used in majority of Washington State hospitals) system but in reality it is broken up into different little branches “trusts” that do not really talk to one another because as my mentor stated “they are competing for the same funding and staff.” One Trust might be more advanced and better off than another.
Another shocker, children do not have annual visits to their primary care provider/general practitioner like in the states. Therefore, after immunizations are complete, the child can go the majority of their childhood without seeing a provider. Hence the importance of the A&E.
This is the tip of the iceberg. I have already written pages and pages of things I want to share. I just need to get them typed up. Things that have left me pondering for hours, a different way of practicing medicine in the A&E (ED) and funny stories all intertwined. I hope to have them ready to share soon but first I must continue to process all the information.
The last couple of days off have been a balance decompressing, life, and parenting. Decompression consists of numbing my brain watching bad rom-coms or playing games on my phone. Life is walks into town or through the local fields, runs, and of course laundry and dishes. Through parenting I am reminded that this will ultimately have the biggest effect on the world.
