day in the life of an emergency department hca

wait what’s going on

well i got a conditional offer to work as a full-time hca in a&e at St Peter’s Hospital.

wait what?

so unis closed in april 2020 because of covid and the outbreak. on the very day i was walking around the library - handed my books in and just thinking what on earth am i gonna do for next four months. helen’s like ‘what about going back for more hca work?’ that very night. straight onto nhs jobs. st peter’s hospital emergency department. did some work experience there in 2016 and 2011 and loved it. deadline for that job was that very night. i had to go for it. to say if i didn’t see helen that day, i may not have had this job.

day in the life

Left my flask in the men’s changing room again. So that means no instant cappucinno for young me today. Instead, it’s a swig of two week-old Innocent juice. Not bad, not great. Into work we go.

7am handover

Nurse X, Nurse Y and me – Green Resus. I’m back in Resus – for the first time since being a supernumerary. Honestly, felt quite nervous but having had a steady routine and a good night sleep – I felt calm in my ability. Having desperately fiddled with a crash trolley for a patient with profuse facial bleeding, held an airway whilst doctors intubated a patient and taken ECGs with patients bathing in their own vomit – I felt confident in my ability to care for today’s events. Looking back, Nurse X and Y, are two of the most hard-working, efficient and judicious nurses I know. I will never forget their commitment these last few months.

7.15am

can you help do a 1 to 1 on a patient? Well, I’m out of the firing line to a young late 20s patient who has been in the department for at least 36h. He looks malnourished, socially withdrawn and is not speaking to anyone. He is taken by secure ambulance under a Section to the Mental Health ward. I hope he gets the support.

9.30am

can you cover the screening out front? Not a problem. Sit on a chair, take people’s temperatures and enjoy the sun. Is this the summer perk of the Healthcare Assistant job? Two young doctors come flying in kitted out in sunglasses and slim jackets. ‘Ohh, you got this job today,’ with a look of sadness. ‘Sun’s out, young doctors in. It’s gonna be a good day.’ Yes, young me, hope for the best. Prepare for the worst.

10am

resus time. Patient comes in. it’s a priority stroke call. So that’s ED consultant, anaesthetics and stroke team. Thrust my kit on and straight to connect the patient to the monitor, take the ECG and let the nurse take bloods. There’s a delay with the ambulance hand-over so we’re stalled from running our blood tests. In the mean-time, he starts vomiting blood and caking his chest with it. Immediately get him onto his side – in the recovery position, change his bed sheets and gown. This is real nursing.

A mild lactic acidosis. CT regardless.

Back from CT, he’s started seizing. This time, he’s at risk of aspiration so suction is on, oxygen is on, the team is on. IV lorazepam is injected along with an infusion of levetiracetam started. It’s a non-ischaemic stroke (a blood clot) so thrombolysis is prepared along with a phone-call to the nearby hospital about they think its surgical and whether he will improve. In the mean-time, he can’t tolerate an oral airway due to the vomiting so the decision is made to intubate. So we’re thrombolysing + intubating at the same time. I’ve never seen such relaxed critical care doctors in a for-me pressured environment. Just ice flowing in their veins. Propofol, rocoronium, cricoid pressure and he’s put to sleep. A second CT angiogram is requested to identify a stroke, potential areas of reversible and salvageable brain tissue in the cerebellum.

All this took place over an hour and 30 minutes. Just keep calm and time will fly. Because if you’re calm, the team’s calm and the team can all make better decisions – or so it should and today it did. This man’s ALT was >1000 and clotting results were pending. Pretty much a highly likely liver failure (likely OD or illicit drugs or drinking or both) + stroke. This man has multiple organs damaged and failing. ITU with no doubt.

In the afternoon, patient comes in with suspected haemothorax. After a CT, her extent of bleeding is localised to the pleural space so a chest drain is performed.

A patient comes in after a road traffic accident. Side collision from parked car into driver’s door at 30mph. Headache and arm pain. Observations, ECG and bloods taken. First VBG – potassium of 5.9 (concerning), let’s repeat, next 7.3 (it looks like a haemolysis surely). Third VBG, 4.6 (a sigh of relief). It was almost definitely a too long left tourniquet by young me. CT head and spine scans are fine and she’s okayed to go home.

And that was today. From psychiatric 1 to 1, a major stroke call, two trauma patients that are now recovering and lots of other odd jobs – taking patients out for a cigarette and mopping up sick, it was just another day in helping to steady the A&E ship. A lot of great learning points for the future. A lot of difficult decisions have been made to provide care over COVID-19 – building a make-shift green resus alongside an existing red resus. From my role as a healthcare assistant providing patient care where needed, it has been incredibly fulfilling to experience the scare and hustle of resus with such an engaging and thorough team.