The night shift in A&E: a hellish blur where my best is never enough

It’s the start of my night shift in the district general hospital as the medical registrar. I’m on my own and I know it.

Like every night shift, I have no idea how I’m going to function effectively and people’s lives are in my hands. These thoughts are not new – I expect them – but each time they feel painfully new and unwelcome. I push down feelings of panic and remind myself that I have experience and training. I have done this, I can do this.

There is a long line of people waiting in A&E. They must experience only one thing: reassurance. It isn’t a convenient time to feel the anxiety that threatens to overwhelm me, so I ignore it. These people are sick and worried, and they deserve the best.

After putting on scrubs, I sit down with the team of doctors and nurses who’ve been on the day shift and listen to their handover. Half them haven’t eaten that day. It’s been a busy one. Things started to go wrong after 5pm so at least 10 people have not yet seen a doctor and two of them are so ill they are being monitored in resuscitation. Someone jokes: “It’s OK though, A&E is closed now”. If only.

I need to prioritise but there are distractions. A family member is kicking off on the acute medical ward about their mother not getting appropriate feeding time that evening. Important but not life threatening, they will have to wait.

The surgical team wants the medical team to take over a patient who, they’ve found, “doesn’t have appendicitis”. This patient, too, is de-prioritised – I have two adults about to die in the resuscitation bay. It’s 10pm and we have already spent far too long talking about the patients from the day – I need to crack on.

I’m told there are no critical care beds available, so if one of my patients needs intensive care, we’ll need to send a patient in an ambulance to another hospital to create space. This is not a new scenario. I tell the bed managers this is “exactly what I want to hear”. Another joke. Without this attitude, we wouldn’t be able to get through the night.

A lot of people will be unhappy with how long they’ve spent waiting by the time I get to see them. Although I won’t rest, it will never be enough. I thank the stars for the nurses. They are masters of everything and seem to be everywhere in the hospital at night, roaming the wards, expertly identifying sick patients. They can put in cannulas blindfolded, and support you with tea and banter.

All six beds in resuscitation are full. Two patients require machines to breathe: one is alert, the other is already anaesthetised. Anyone who can’t talk, as a general rule, needs to be seen immediately. However, these sick people cannot be moved from their temporary beds in A&E – there are no beds free in the hospital.

It’s going to be a long night. I see the exasperated paramedics in a queue; they can’t drop patients off. My juniors, just two of them for 150 patients, get to work, but it is hard. There is nowhere private to see people. They are reduced to clerking patients on trolleys and chairs – it’s not dignified. The unsung heroes of A&E – the technicians – efficiently take blood and perform basic but critical investigations such as urine dipstick and electrical heart traces.

In a moment of clarity, at 1am after I have barely stopped to breathe and an elderly lady has died in my arms, I ask myself: “Is this not supposed to be a developed country? Do we not care for our people? Do we really accept that this is the way it needs to be? Doesn’t anyone out there care that there are no beds?”

The night starts to blur. At 4am I anticipate a huge drop in my performance as my mind sleeps while my eyes remain open. I attempt and fail to get 20 minutes’ sleep – the bleeper doesn’t stop. But before I know it the porters, domestics and secretaries start turning up in the corridors, usually the earliest to start, and I know that this hellish night shift is almost done.

I hand over my patients to the day team and the consultants. I get changed. I leave. For a moment it feels like I am a kid again, carefree, outside, letting a warm downpour wash over me, soaking my clothes, removing the things that happened overnight. Relief.

I have a brief, pointless cry in the driver’s seat. And then it’s forgotten. It has to be, because in in a few hours, I’ll do it all over again.

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The night shift in A&E: a hellish blur where my best is never enough

Sugar lobby paid scientists to blur sugar"s role in heart disease – report

Influential research that downplayed the role of sugar in heart disease in the 1960s was paid for by the sugar industry, according to a report released on Monday.

With backing from a sugar lobby, scientists promoted dietary fat as the cause of coronary heart disease instead of sugar, according to a historical document review published in JAMA Internal Medicine.

Though the review is nearly 50 years old, it also showcases a decades-long battle by the sugar industry to counter the product’s negative health effects.

The findings come from documents recently found by a researcher at the University of San Francisco, which show that scientists at the Sugar Research Foundation (SRF), known today as the Sugar Association, paid scientists to do a 1967 literature review that overlooked the role of sugar in heart disease.

SRF set an objective for the review, funded it and reviewed drafts before it was published in the New England Journal of Medicine, which did not require conflict of interest disclosure until 1984. The three Harvard scientists who wrote the review made what would be $ 50,000 in today’s dollars from the review.

Marion Nestle, a nutrition, food studies and public health professor at New York University, said the food industry continues to influence nutrition science, in an editorial published alongside the JAMA report.

“Today, it is almost impossible to keep up with the range of food companies sponsoring research – from makers of the most highly processed foods, drinks, and supplements to producers of dairy foods, meats, fruits, and nuts – typically yielding results favorable to the sponsor’s interests,” Nestle said. “Food company sponsorship, whether or not intentionally manipulative, undermines public trust in nutrition science, contributes to public confusion about what to eat, and compromises Dietary Guidelines in ways that are not in the best interest of public health.”

The cushy relationship between food companies and researcher has been captured in recent investigations by the Associated Press and New York Times. The AP revealed in June that candy trade groups were funding research into sweets. And in 2015, the New York Times showed how Coca-Cola has funded millions in research to downplay the link between sugary beverages and obesity.

The Sugar Association said in a statement that SRF “should have exercised greater transparency” in its research, but also accused the study authors of having an “anti-sugar narrative”.

“We question this author’s continued attempts to reframe historical occurrences to conveniently align with the currently trending anti-sugar narrative, particularly when the last several decades of research have concluded that sugar does not have a unique role in heart disease,” the Sugar Association said. “Most concerning is the growing use of headline-baiting articles to trump quality scientific research – we’re disappointed to see a journal of JAMA’s stature being drawn into this trend.”

The findings were based on documents found by Cristin Kearns, a postdoctoral fellow at UCSF, in library archives.

The scientists and executives involved are no longer alive.

In recent years, the link between fat and heart disease has become a more contentious topic – a 2010 review of scientific studies of fat in the American Journal of Clinical Nutrition found that “there is no convincing evidence that saturated fat causes heart disease”. The role of sugar in heart disease is still being debated.

Sugar lobby paid scientists to blur sugar"s role in heart disease – report