Why women doctors are the solution to the NHS workforce crisis
Dr Anupriya George Pandeth, Highly Commended Entry for the Junior Doctor Prize
To the uninitiated, this would be yet another warm, humid night in August. But as I prepare to enter the belly of the beast, I am a mess of thoughts and feelings. I am almost ready to turn around, to give in to my fear and leave. Oblivious to my struggle, the beast stands before me, ready to swallow me whole.
In the discomforting calm of the night, I can almost be forgiven for perceiving the hospital in such a nightmarish way. The main entrance – usually friendly and inviting – looms over me like the maw of a terrifying monster; the lights shining through many windows like blinking bright eyes that follow my every move.
But I persevere.
I make my way to our Paediatric ward where the nurses have already started their night rounds. “Let’s hope it’s not too bad tonight!” they say as they cheerfully wave at me.
My Registrar is already in the handover room when I arrive. She smiles when I reveal it is my first ever night shift and that I am nervous. “Don’t worry,” she says reassuringly, “I’ll look after you!” She has good reason to be so cheerful; this is her last set of nights as she won’t have to do them once she starts her Consultant post.
There is irony in this.
Together, we make our way to the ward to check on our patients. Once we are satisfied, we go our separate ways. “Let me know if you get bleeped about anything,” she says as she closes the door to the night room.
I make my way to the doctors’ office, cup of tea in hand, ready to tackle some administrative tasks; I am determined to make this a productive night. I have scarcely sat down when the alert bleep goes off. My heart immediately begins to race as the cool, clipped tones of the switchboard operator comes through the bleep.
“Paediatric cardiac arrest team to ED Resus.”
I grab my stethoscope and break into a sprint as I race out of the office.
As I run, my mind races with different possibilities and I desperately try to recall my life support training.
As I run, I am acutely aware of the heavy thudding of my footsteps in the quietness of the corridor – am I always this heavy-footed? I find myself belatedly wishing I had made more use of my gym membership; I am secretly grateful there are no witnesses to observe my ungainly form through the corridors.
As I run, I realise it is… quiet. There is peace within these walls. And yet I know there is a child in the Emergency Department who is extremely unwell, whose parents are probably beside themselves with worry.
I continue to race through the empty corridors and full wards with peaceful, unsuspecting, sleeping patients.
The Emergency Department never sleeps.
As I arrive, I am greeted with life, noise, and bright, fluorescent lighting that briefly hurts my eyes after having adjusted to the quiet dimness of the hospital corridors.
To my relief, I am not the first at the scene. My Registrar has won this race with nary a hair out of place as she directs the staff swarming around her, exuding calm confidence. I look at each of their faces and see my own worry and anxiety reflected at me. None of us know what to expect when this child arrives in ED and we are bracing ourselves for the worst. So, despite the hustle and bustle of ED around us, there is complete silence whilst we listen to the handover from the ED sister who has spoken to the ambulance crew.
We only have minutes to prepare.
It is never long enough.
Seizing an opportunity, I make my way over to my Registrar, determined to find shelter under her guiding wing. She introduces me as her SHO and asks me to scribe; I am only too happy to do this.
Armed with pen and paper, I pick a corner of the room and observe the situation unfolding in front of me.
More people have begun to join us. With her bright pink theatre cap and yellow operating theatre gown worn like a coat, I spot the Anaesthetist casually making her way towards us. She will manage the airway, she says, but will let my Registrar lead the situation. Her tone is light, and regardless of how she may feel internally, she exudes confidence and effortlessness. She is the epitome of cool, I quickly decide. Behind her are more members of staff: I recognise the Outreach nurse and ITU sister.
The ED Consultant arrives. Despite her warm smile and kind eyes, I am momentarily convinced she has a built-in radar as those eyes immediately lock onto mine and my repressed fear and apprehension come bubbling to the surface. She asks if I need help and I quickly shake my head, eager to avoid causing any disappointment.
I watch in quiet awe as everyone organises themselves, ready for the arrival of this sick child. Under the guidance of the ED Sister and Outreach, the ED nurses quickly ready equipment and prepare various vials and syringes of fluids and drugs.
Silence descends upon the room, and I continue to throw anxious glances at the clock, certain that time has somehow ground to a half. An instant later, however, it has sped up again as we’re thrust back into the chaos when an ambulance trolley arrives bearing a ghastly-looking child. Trailing behind him is his distraught mother; her face is blotchy with tears. She looks dishevelled and tired. She is having one of the worst nights of her life.
“Right, so we’ve got JH, who is an 8-year-old boy with no past medical history,” the paramedic begins. We listen with rapt attention. “Mum reports he began feeling unwell two days ago so she kept him from school. Today he’s had temperatures of up to 39°C, and has vomited several times…” I continue to listen but divide my attention between JH’s mother, my Registrar, the ED Consultant, and the Anaesthetist. They have already smoothly swung into action before the paramedic has completed her handover, but the ED Consultant makes it a point to thank them warmly before they leave.
They run through the initial assessment like a well-oiled machine, anticipating each other’s steps and working accordingly. It is an elaborate, intricate dance. Everyone is simultaneously aware of their own actions and the actions of everyone else within the room.
I am in awe.
With one ear, I listen to the history provided by JH’s mum as my Registrar simultaneously reassures her and ekes out the history. With the other, I listen to the Anaesthetist as she continues to maintain control of JH’s airway and breathing, and works with the ED Consultant to complete the initial assessment. The ED sister continues to efficiently direct her nurses based on their assessment, showing them where equipment is kept and answering any questions they may have.
I am almost led to believe that my Registrar is not paying attention to the situation as she speaks to JH’s mother, but then I realise that she has not taken her eyes off him since he has arrived. I am forcibly reminded of a lioness stalking prey by the keenness of her gaze.
It’s all going so well until we all realise that JH needs intravenous access. I move to help but pause as the Anaesthetist and my Registrar exchange the briefest of glances; in this split second, an entire unspoken conversation has taken place between them. My Registrar quickly excuses herself from JH’s mother and moves towards him. I can scarcely hear her soothing tones as she attempts to reassure the child who, perhaps terrifyingly so, is the calmest of us all. He is pale and exhausted; his eyes are heavy, and he looks ready to drift asleep.
Within seconds, a cannula is placed.
Within minutes, he has received antibiotics and some fluids.
All of us are eagerly watching the monitor to see if there is any change. There is nothing dramatic, but we watch as his heart rate slowly climbs down. He still looks exhausted but there is some colour to him now.
We breathe a collective sigh of relief.
“Let’s admit him to the ward, shall we?” my Registrar says brightly.
We all agree.
As I recount my tale to the nurses on the ward, I can scarcely contain my admiration for the fantastic work done by all the staff downstairs. The nurses smile knowingly; this isn’t their first rodeo.
I excuse myself and make my way to the Doctors’ Mess where I am in desperate need of a snack. It is deserted except for one other person. I have found another listener.
“That sounds terrifying,” says the surgical SHO as she gently rubs her belly. “I don’t know what I would do if that was me.”
I suddenly realise she isn’t talking about what she would do in a professional capacity. She has only just started to show, so we were all unaware of the happy news until recently
The rota coordinator has agreed that this will be her last set of nights, she excitedly tells me, although she will still have to do daytime and weekend on-calls. “It’ll be hard,” she acknowledges. She hasn’t quite figured out how she will juggle her new maternal responsibilities, and her existing professional ones, once her little one has arrived.
“But I’m sure I’ll figure it out,” she says a little uncertainly.
She expresses doubts about which surgical field she would like to do, and we talk about this at length. She loves General Surgery but is worried she might find it difficult to do this. I am silent; I want to tell her that it is possible and I’m certain of it, but the words remain unsaid and the truth hangs in the air between us.
It’s hard being a woman in the NHS. But as I do my final round of the patients on the ward and head back to the doctors’ office to lie down for the night, I feel secure knowing that the hospital is in capable hands. At least for tonight.