There's a patient I'll never forget. Their burns and screams still haunt me
The night shift in A&E started off as normal: routine heart attacks, head injuries, road traffic accidents, an array of minor injuries. It was what happened next that has stayed with me for 25 years, long after I left my job as a doctor in the NHS.
I can’t remember exactly when the unmistakably shrill sound of the trauma bleep went off, but I do recall feeling a familiar churning in my stomach. Was it excitement? Or was it a sense of foreboding, a warning that something bad was about to happen, something hard to stomach and impossible to erase?
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I looked up at the arrivals screen: “Trauma, patient moribund, ETA three minutes” were the only clues I had as I walked quickly to the resus room to set up my tray of equipment. One by one, my colleagues arrived; there were no “how are you’s?” or pleasantries, no banter or gossip. There was just an eerie silence as we rushed to prepare so that we could be ready to jump into action as soon as the patient arrived.
The anaesthetist arrived and, amid the continuous bleeping of ECG machines, we were quickly given our roles and instructions. The anaesthetist would take head, neck and airway, I was to take IV access and pain relief, the orthopaedics were ready to assess limbs and spine, the surgeon was to assess the abdomen, and so on.
I listened carefully as I gowned and gloved up, my hands trembling.
What seemed like several long moments later, the paramedics rushed in with the patient on a trolley. The loud, firm, pressured voice of the paramedic said: “Twenty-nine-year old Caucasian male, severe burns to entire body from a house fire, past medical history includes mental health ...”
His voice faded as I took in the screaming, writhing body that was attached to a spinal board and covered in head-to-toe burns. The acrid smell of charred flesh and burnt hair still haunted me for several weeks afterwards, and I will never be able to stop hearing the screaming.
A familiar feeling descended over me – a calm, determined autopilot where somehow, after repeated exams, courses and emergency experience, I knew exactly what to do. “We need access, morphine and fluids …” I heard the anaesthetist’s firm instructions over the screaming and thrashing as he held oxygen over the patient’s face.
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The nurse restrained the patient’s arm as I applied a tourniquet above the elbow; the burnt skin came away under my thumb but underneath I felt the familiar give of what I hoped was a vein. I was handed a grey cannula and on a wing and a prayer plunged it into the skin. A flashback of blood showed that access was secured and within seconds his rigid, desperate, clasping limbs suddenly softened and relaxed as the opiates took effect.
My colleagues jumped into action to sedate him, secure an airway, carry out limb and abdominal assessments, ventilation and cardiorespiratory monitoring, and place lines and tubes. We worked to stabilise the patient so he could be transferred to intensive care.
As the trolley was loaded with equipment and carefully wheeled out of resus, I prayed a silent hopeless prayer. I couldn’t see how he could survive.
The debriefing was filled with a stunned silence, as the consultant asked if we were OK. We looked at the floor in what could only have been a mixture of horror and bravado and replied: “Yes.” He spoke but I remember very little of what was said and after a few minutes our trauma team disbanded to go about the rest of our night shift, a part of each of us also scarred and changed forever.
I’m not sure why this patient has lived on in my memory. Perhaps it was the fact we were a similar age; at a time when I felt invincible, his life was taken from him. He fought for his life for several weeks, but survived only in my thoughts and the hearts of his loved ones. Years later I was again reminded of him and my own mortality as I myself recovered from mental health issues.
My thoughts turn to my friends and colleagues on the frontline of a global pandemic, and I fear for their wellbeing. They are also dealing with trauma, but don’t have the time to process it. In more recent times, debriefing and counselling of healthcare workers has become available but it is by no means routine.
My hope is that immediate funding for a national framework of in-house support and counselling will stem the tsunami of mental ill health among frontline workers that I envisage coming, and shed light on the ultimate medical taboo that is the mental health of our healthcare staff.
Some details have been changed
If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare during the coronavirus outbreak, get in touch by emailing sarah.johnson@theguardian.com
In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.