First impressions

After having spent two and a half days in the A&E (accidents and emergencies) I am ready to summarize my first impressions. It is all so new to me that I try to just take it all in without judgement or criticism. I realize that might sound impossible to anyone who knows me, but even I am humbled by the very special circumstances here.

The first time I went into the A&E I was surprised by how calm it was. A few people were sitting in the waiting room, a man was lying on a mattress on the floor. Although the walls would definitely benefit from being repainted, it all appeared clean and spacious. Inside there was a separate resuscitation room and a small corridor where patients who had been seen and treated would wait for test results, leaving room for new patients. The rest was just one large room with ten cubicles, or bays as they are called here, seperated by closed drapes so I couldn’t see any patients.

I was a bit envious of the drapes since the ones we had at Sodersjukhuset were taken down and replaced by mobile screens on wheels that you have to drag around in order to keep your patient from being exposed to everyone walking by. There aren’t enough screens so unless you need to undress the patient completely you mostly don’t bother. There is of course a reason for this nuisance. The drapes were not deemed hygienic. Hygiene has a very high priority in Sweden. We have a low prevalence of multiresistant bacteria and intend to keep it that way. The doctors have had to give up their white coats since only short sleeves are allowed. Scrubs are provided and washed by the hospital and have to be changed daily. Hands must be disinfected before and after every patient encounter and if we need to touch the patient or the stretcher we should wear a plastic apron to protect our cloths. I am not sure how evidence based this is, the short-sleeves were questioned in a recent study, but to prevent harm to our patients is definitely my top priority. I still miss the drapes, though.

In the A&E all doctors were wearing private clothing. Some even had jackets on! I was introduced to everyone, but since almost no one carried a name tag their names bounced off my brain before hitting the memory center. There were several nurses, most of them in uniforms. I didn’t really grasp what their responsibilities were. All needle work was done by doctors, unlike in Sweden where most doctors don’t pierce any veins after leaving medical school. My impression was that the nurses more or less performed the orders given by doctors using oneway communication, but since I couldn’t even figure out who was a doctor I might be wrong.

At the end of the room there were a few desks and chairs. There was a whiteboard on the wall showing all patients, stating their chief complaints and what priority they had been given at triage. I was amazed that there weren’t more patients. It was actually possible to get an overview of all patients in the A&E! The waiting times were also much shorter than I am used to. I don’t know why we have so many people hanging around in the ED back home. We are about to expand to accommodate them, but I have a feeling they just shouldn’t be there at all.

Something I wasn’t expecting in the A&E was the lack of basic necessities. I had read about how they would run out of iv fluids and certain medicines, but I don’t think I believed it a the time. On my first day we ran out of test tubes and wouldn’t have been able to send blood blood samples if we hadn’t found an additional pack stacked away. How can there be expensive monitors in every bay, but no proper dressing to secure the iv lines? Why aren’t things that break being mended? The CT scanner has been broken for months and patients have had to be sent to other hospitals to be examined. It doesn’t seem to be a lack of money, but rather a lack of responsibility and coordination. I will try my best to understand this conundrum.

So, I don’t know what to think about the A&E. Maybe that it has great potential? Getting the basic things right is essential. That applies everywhere. I do know that my learning curve here will be steep and I am definitely looking forward to the ascent.