To end the day

This morning I jokingly commented to my Intern (in his first ever job out of Medical School) that I keep forgetting how to pronounce the word spelled 'N' 'O'. As this was in the context of things happening on the Unit that in fact I have no capacity to do other than accept and then do the work, my comment exemplified my frustration with working hard to be rewarded by more new work to do.

By the time I finish and then get back to the apartment, I am worn out. Is it just that I am somewhat older than the last time I worked full time in the inpatient ward (almost 15 years ago)? Or is my decreased fitness a factor? Or maybe it's actually harder than it used to be. 

The latter is certainly an aspect that cannot be ignored. There are fewer inpatient beds available now, and the population we serve has grown considerably. There are almost no other reasonable options for safely housing some of the people we admit; one person was admitted a few months ago on the day he was evicted from his accommodation even though he was not acutely unwell. There was quite literally no other option that was humane.

Since then the nursing staff have come under immense pressure through being asked to do extra shifts due to nursing shortages. It got to a point of industrial action, and to avoid a strike management reduced the number of occupied beds. Initially the system coped, offering some support to the belief of an old classmate of mine who as a Professor in California, England Italy and Auckland, asserted that beds get filled if they exist and we cope if they don't.

Latterly, community staff were struggling; my job was easier in that while there was more pressure to discharge quickly, there were significantly fewer patients to assess and treat. In two stages the beds have been re -opened (minus one! so the ratio of 5 patients per nurse is not exceeded). Almost instantly all these extra beds have been filled, and the rate of new admissions is higher than it was when there were fewer beds.

As well as ending today with a dram of a lovely straight malt whisky, I am looking forward to ending this locum on Friday next week. There are people I will miss (patients and staff), but I won't miss the stress and frustration.