From our Lead Surgical Contributor, Dr. Paul Sturch.
Flapping and panicking is one of the most contagious conditions seen in hospitals. Those who remain calm in stressful situations are admired; those who do not are often the cause of wider issues. For me, remaining calm did not come naturally, and I can clearly remember situations that brought home the importance of taking a breath and keeping your head.
On a surgical ward during my F1 year we cared for an elderly lady with renal failure secondary to obstructing malignancy. There was nothing more that could be done and she was moving into the palliative phase of her disease. Her family adored her and clearly had not come to terms with the fact that she was dying.
I was on call the night she died. I was bleeped to come to the ward immediately by a nurse who was clearly flustered. I could hear panic in her voice, shouting in the background and what sounded like chaos on the ward.
When I arrived, the family were beside themselves with grief, and didn’t know what to do with themselves. They were crying, and charging up and down the bays – past the nurses station – wailing and shouting at everyone.
This had a contagious effect on all around them: the ward nurses were rattled, the patients and relatives vising the ward were shocked, and nobody knew what to do. I came onto the ward and ended up becoming enveloped in the whole run-away situation. I ended up flapping, too, and found myself calling a registrar that I trusted at home because I didn’t know what else to do
“Hi, I’m not on call though. Right?”
No, I just needed to tell you about the patient we saw this morning. She just died.”Whe
“Ok, that wasn’t unexpected. It’s sad but inevitable. Did you need me for anything else? No? Good.”
While I was speaking to him it felt like the bubble of chaos had been burst. I had been myself so caught up in the panic that I had been swept along, calling him for reassurance and advice. Thinking back, I hadn’t called my registar for any technical advice, and I didn’t know at the time what I was asking for when I called him, but just in the same way the nurses had called me to the ward, I was looking for someone to help provide some logic and calm to the situation. I was able to have a chat with the nurses and relatives and diffuse the situation that evening, and since then have always tried to ensure the first thing I do in any stressful situation is to remind myself to stay calm.
Out of the Ordinary
A couple of years later I was the surgical SHO on call overnight in a small DGH. A 19-year-old man had crashed off a moped and sustained multiple injuries including a fractured hip and open fracture of his lower arm. For the small hospital I worked in, trauma was a fairly infrequent occurrence so seeing bone sticking out of the skin was a source of rare excitement for the A&E staff. I was helping the Orthoapedic registrar work up the patient’s injuries. The Reg was holding the patient’s arm, cleaning and irrigating the wound, and assessing for other injuries while I scribed. Unfortunately, while he remained calm, running through his mental checklists, the rest of the staff in the department were caught up in the excitement of seeing trauma, bone, blood and gore. Nurses and junior doctors were coming in and out of the curtains, making astonished, shocked and disgusted noises and chattering away with the chaos kept spreading and of no help at all to the patient. I could see the ortho reg having to physically exert himself to remain calm with all the flapping going on around him, which he did, focused on the patient and delegating jobs to the people around. We got the patient into theatre that night and fixed his fractures and cleaned up his wounds.
Most of the day-to-day work in hospitals is mundane and can even be boring. The exciting situations usually mean that a patient is in trouble and one of the most important things to remember in any critical situation is to remain calm, even if you’re feeling panic inside. As one of my first consultants said – you look like a duck on a pond, all calm above the water even when the legs are kicking frantically below.