Tag Archives: hospital

The life-changing flying eye hospital treating blindness across the globe

In Kitwe, the second largest city in Zambia, young mother Verah is carrying her one-year-old daughter, Racheal, into the consultation room at the eye annexe. The only dedicated paediatric eyecare centre in the country, the Kitwe annexe also attracts patients from neighbouring Angola and Congo. Racheal is here for surgery to remove the bilateral cataracts that prevent her from seeing.

A few months after Racheal was born, Verah noticed that something didn’t seem right with her vision. “I would move my hands in front of her face but she would not react. I would move things past her eyes but she would not follow them,” she explains.

The team of nurses, anaesthetists and paediatric ophthalmologists treating Racheal have been trained and are being continually supported by peers from some of the world’s most respected eye hospitals, who fly in on a specially adapted plane – the flying eye hospital – thanks to an initiative of Orbis, an international blindness prevention charity.

“Orbis volunteers who come to share their knowledge and give technical support are very good – most of them have been working for a long time so they have very good experience,” says Chineshe Mboni, the paediatric ophthalmologist treating Racheal. “So we have some from the US, Britain and Israel etc. Techniques are different around the world, so we get a mix of everything.”

A volunteer ophthalmic nurse in the recovery room.

A volunteer ophthalmic nurse in the recovery room. Photograph: Geoff Oliver Bugbee/Orbis

Sharing experiences and discussing cases with the visiting Orbis medical volunteers “raises your confidence, to see that what you are doing is what everyone else is doing around the world”, Mboni concludes.

Globally, 285 million people are blind or visually impaired and yet for 80% of them, this could be prevented with access to the right treatment like the surgery Mboni is able to give Racheal. Orbis focuses its efforts in Africa, Asia and Latin America because 90% of the world’s 39 million blind people live in developing countries. Many of the conditions causing blindness – such as cataract and trachoma – can be easily treated. The loss of sight these conditions can cause have a huge impact as it will impede a person’s ability to gain an education, prevent them from finding employment and can plunge families into a life of poverty.

Ann-Marie Ablett, a nurse from the University Hospital of Wales in Cardiff, has been giving up four weeks of her annual leave to volunteer with Orbis since 2003. “You can’t change everything overnight but you can start with one patient and help them,” she says. “If everyone plays their small part together, you can make changes.”

Ablett is speaking in a terminal at Stansted Airport and just outside is the flying eye hospital, here for a short promotional visit. The white MD-10 aircraft on the tarmac looks like a typical passenger plane. In fact, this is a 46-seat classroom complete with audio-visual equipment that transmits live surgeries that can be watched in 3D. The lead surgeon, who is just next door in a state-of-the-art operating theatre, can be asked questions throughout the procedure. The aircraft, donated by FedEx, also features pre- and post-op spaces and a laser suite.

A patient wakes up from surgery.

A patient wakes up from surgery. Photograph: Orbis

Orbis’s main aim is to train eyecare teams and strengthen hospitals in the 92 countries where it works. It’s for this reason that Ablett first chose to volunteer. She says: “We’re not in the developing country just for numbers, we’re there to teach so that means we do less surgeries but when we fly off to the next country, the local doctors have got the skills to treat their own patients because they were trained up.”

Dr Jonathan Lord, global medical director for Orbis, went from being a regular volunteer to giving up his position as a consultant at Moorfields eye hospital in London and becoming a staff member for the charity before being promoted to his current role.

“I was just hooked after my visit trip,” he says. “Seeing the flying eye hospital work in real life, in the field with the patients being treated on the plane and that treatment being part of a really comprehensive training package that is upskilling all the groups of staff that are needed for each surgery, is amazing.

“The need round the world is huge. You realise the magnitude when you look at some of the statistics. In Ethiopia, there is a population of over 80 million, but [until recently] there was little over 80 ophthalmologists practising in the whole country. When I left Moorfields, it had over 150 covering just the catchment area of London.”

Recovery Room

The flying hospital’s recovery room. Photograph: Orbis

Programmes usually last two weeks, and require a lot of pre-planning with a team from Orbis flying in ahead to consult on what would be most helpful to the healthcare professionals in that country. The plane will land at a local airport and the team of local surgeons, nurses and anaesthetists board to join their volunteer counterparts. Meanwhile, another team of volunteers goes to the local hospital to provide training using the equipment in situ. At the end of the week, the teams swap.

Becoming hooked after stepping foot on the plane is a running theme among staff and volunteers, including the pilots, all FedEx employees who volunteer their time. Gary Dyson, who has been involved since 2001, says: “On my first trip, which was to China, I saw a child who couldn’t see on Monday but could see on Wednesday. It’s such a life-changing event for them.”

For Racheal, the short surgery will have undoubtedly had that effect. As Mboni removes the patches, she blinks a few times and waves her hands in front of her eyes, before looking up and seeing her mother for the first time.

News is spreading across Zambia of successes like this, Mboni says. “[People] know we can act fast, so they are telling patients with eye conditions – ‘This problem? Go to Kitwe central hospital’.”

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Mentally ill woman’s treatment in Lismore hospital ‘deeply distressing’, says Greg Hunt

Appalling footage of a mentally ill woman stumbling around a NSW hospital, covered in faeces and falling over at least 25 times before she died of a brain injury, has shocked the public and politicians.

Footage released by the coroner shows the woman, mother-of-two Miriam Merten, locked in a seclusion room for more than five hours at the Lismore Adult Mental Health Inpatient Unit on 1 June 2014.

A nurse unlocks Merten’s room the next morning, before she is left to stumble around the hallway naked, eventually collapsing in a corner before an emergency crash cart is rushed in by staff.

Merten died at Lismore base hospital on 3 June 2014.

A coronial inquest found she died of “traumatic and hypoxic brain injury caused by numerous falls and the self-beating of her head on various surfaces, the latter not done with the intention of taking her own life”.

A senior nurse at the facility was aware Merten had been sedated with psychotropic drugs and fallen on at least one occasion, but failed to take appropriate action, the coroner Jeff Linden found.

A second nurse was also involved.

“The lack of care and compassion showed to the deceased was monumentally disgraceful and appeared to emanate from an: ‘Oh, it’s just Miriam’s mentality,” Linden said in his inquest findings.

“To see a mentally ill person in 2014 at a public hospital in NSW treated in such an appalling manner is really beyond comprehension.

“While this appears not to be a system failure it is clearly a serious human failure.”

The New South Wales Labor party on Friday called for an urgent parliamentary inquiry into the state’s mental health facilities.

Opposition mental health spokeswoman Tania Mihailuk says the incident is a “Don Dale moment” for the NSW mental health system and demonstrates “abhorrent mistreatment and abuse”.

Mihailuk said the government should apologise to Merten’s family and conduct a full and transparent review.

The federal health minister Greg Hunt said the two nurses “are no longer in service”, and the state government had Canberra’s “full support for the strongest possible steps against what was completely unacceptable”.

“I have (seen the footage) … it is deeply distressing,” Mr Hunt said in Sydney on Friday.

The NSW premier Gladys Berejiklian echoed that view.

“We’ll do everything we can to make sure this never happens again,” she told reporters.

Baby boomers warned over alcohol intake as hospital admissions soar

Alcohol-related hospital admissions in England have increased by 64% in a decade and are at their highest ever level, prompting experts to warn that baby boomers are continuing to risk their health through frequent and excessive drinking.

There were an estimated 1.1m admissions where alcohol was the primary or secondary issue in 2015/16, compared with 670,000 in 2005/06, according to NHS Digital data published on Wednesday.

Separate data from the Office for National Statistics (ONS) for England shows people aged 45 and over are frequently drinking at more hazardous levels.

Married and cohabiting couples are more likely than single people to consume alcohol on five or more days a week, though they are slightly less likely to binge drink.

Surveys found 60% of women aged 45 to 64 and 69% of men of the same age had drunk alcohol in the last week – the highest proportions of any age group.

Prof Sir Ian Gilmore, a liver doctor and chair of the Alcohol Health Alliance UK, said the figures proved the UK continued to have a dysfunctional relationship with alcohol.

He said: “We know that over the long term, rates of binge drinking are falling and more people are choosing to abstain from alcohol. Worryingly, however, these trends do not appear big enough to stop alcohol harm from continuing to rise, and the sharp increase in alcohol-related hospital admissions over the last few years means hundreds of thousands more people each year are experiencing the misery associated with harmful alcohol consumption.”

Dr Tony Rao, co-chair of the Older People’s Substance Misuse working group at the Royal College of Psychiatrists, said: “These figures show that alcohol abuse is not a ‘young person problem’. While the rest of the population reduces its alcohol intake, it is very concerning that baby boomers are drinking at a similar rate as before and are exceeding recommended guidelines.”

Alcohol figures

The ONS data also shows that the proportion of adults who say they drink alcohol is at the lowest level for more than a decade.

The trend has been largely driven by an increase in the proportion of younger people abstaining, but there has been no decline in the proportion of over-65s drinking, and they are the age group most likely to have consumed alcohol on five or more occasions in the week before they were interviewed.

Such regular drinking is more than three time more likely among over-65s than in the 16-24 age group, the data shows.

Alcohol is linked to more than 60 illnesses and diseases including heart disease, liver disease, cancer and dementia. Hospital admissions due to liver disease have gone up 57% over the last decade, and the number of people diagnosed with alcohol-related cancer has risen by 8%, according to the AHA. The World Cancer Research Fund has said that if nobody drank alcohol in the UK, 21,000 cases of cancer could be prevented each year, including nearly 12,000 cases of breast cancer.

NHS Digital cautions that a narrower measure of alcohol-related hospital admissions is more reliable for tracking changes over time than the broad measure – which the 1.1 million figure relates to – because it is less affected by improvements in recording of secondary diagnoses. But even under the narrow measure, hospital admissions have risen by 22% since 2005/06, to 339,000.

The ONS data shows that 7.8 million people admit to binge drinking – defined for men as consuming more than eight units and for women more than six units – on their heaviest drinking day.

Men are more likely to drink than women and to binge drink. Higher earners, on £40,000 and above annually, are more likely to be frequent drinkers and to binge drink than the lowest earners.

Gilmore said: “The data released today should be sobering reading for whoever wins the upcoming general election, and we would urge the next government to make tackling alcohol harm an immediate priority to save lives, reduce harm, and reduce the pressure on the NHS.”

The Alcohol Information Partnership, which is funded by global drinks companies, said binge drinking and harmful drinking had declined by 17% and 23% respectively since 2005.

Labour to propose immediate halt to hospital closures

Labour has promised to immediately stop the proposed closures of A&Es and other health services across England and instead carry out a full-scale review of controversial government plans.

The shadow health secretary, Jonathan Ashworth, revealed that a flagship commitment in his party’s manifesto, to be published later this month, will be a moratorium on so-called sustainability and transformation plans (STPs).

“We have listened to the hundreds of patients and campaigners up and down the country that have been pleading with the government to hear their concerns about their local services,” he said.

“Threats of hospitals being closed, A&E services moved miles up the road, and children’s wards being shut, have caused widespread concern and confusion. What is more, these decisions have been decided behind closed doors, with no genuine involvement of local people. It’s a disgrace.”

He said Labour would ask a new body – called NHS Excellence – to lead a review that would place local people at the heart of decisions.

STPs were meant to be necessary local blueprints designed to keep the NHS afloat in the face of massive pressure and a £22bn financial black hole. But they have caused huge controversy with critics claiming they amount to plans for hospital closures, cutbacks and radical changes to the way that health is delivered.

The health secretary, Jeremy Hunt, hit back by calling Labour’s policy proposal a “nonsensical Jeremy Corbyn idea”. He claimed that Ashworth had supported the policy as recently as December and that Labour had backed the plans in its last manifesto.

“These local plans are developed by local doctors and communities, backed by the top doctors and nurses of the NHS, and will improve patient care. This is all underpinned by an extra £10bn for the NHS, which we can only afford thanks to our strong economy,” he said, claiming Corbyn would put that at risk.

The Liberal Democrat health spokesman, Norman Lamb, said the original purpose behind the STP process of bringing fragmented parts of the service together was a good one. “But it is based on the fantasy that there is enough money to deliver this vision, when the plans are now hundreds of millions of pounds short,” he said.

Lamb argued that only the Lib Dems would take the “tough action” needed to increase investment by making the case for increasing tax to support the NHS.

Critics slam ‘rip off’ 50p-a-minute charge to call patients’ hospital phones

Relatives who call patients in hospital are still being forced to pay “rip off” charges of 50p a minute despite a promised clampdown on the issue.

The firm Hospedia, which runs bedside TV and phone services in NHS hospitals and made £21.2m in revenue last year, makes people call loved ones via costly 070 numbers. The charges vary from hospital to hospital, but many trust websites say they cost about 50p a minute or more.

Callers are also forced to listen to a lengthy recorded message of about 70 seconds – which racks up charges before they are even connected to their loved one.The message contains information already obvious to the caller, such as the fact the patient is in hospital, and tells callers to be “patient”. Critics say patients are being treated as “cash cows” and described the charges as “extortionate”.

Hospedia currently manages TV and bedside phone services in 150 NHS hospitals, installing services for free in return for keeping the money charged to patients and relatives.

The firm said in 2014 it planned to phase out the use of 070 numbers but it has not happened. Ofcom reviewed the high costs in 2006 following complaints from users and recommended a substantial reduction in incoming call charges.

It urged the Department of Health to review all aspects of the system, and the way these costs appear “to be borne disproportionately by friends and family”.

The department looked at the issue and agreed to consider a skip facility at the start of the recorded message, enabling callers to bypass it and reduce the cost of the call. But this never came into effect and high call charges have remained.

A health department report in 2007 concluded that decisions on phones should remain with local hospitals. MPs on the health select committee also recommended a reduction in phone costs and called for a skip facility on the recorded message.

Hospedia refused to answer several questions posed by the Press Association, including how much money it makes from 070 numbers and why it still uses them.

A spokesman said: “Ofcom granted us use of the 070 number range to enable every bedside unit to have its own unique telephone number so that friends and relatives can call patients directly, alleviating pressure on nursing staff having to field calls.

“The patient’s bedside phone number is unique to each patient’s account and can follow them around the hospital if they are moved bed, a frequent occurrence.”

He said Hospedia offers free TV on children’s wards and free channels BBC1, BB2, ITV, Channel 4 and channel 5 from 8am to noon on adult wards. Outbound calls to landlines are also free.

He added: “We believe we offer an excellent service, which would not be provided at all if it weren’t for us taking on the investment and on-going management and support costs.

“Patients can choose to pay for our services, beyond those we offer for free, or not.”

But Liberal Democrat leader Tim Farron said: “These charges are a total rip off. When channels are free at home and people have already paid for their TV licence, it is unfair for them to need to pay it again.

“If someone is to spend four weeks in hospital with a full TV package that is the same price as their yearly fee.

“Hospitals and these businesses are treating the sick as cash cows.

“From hospital parking charges, TV packages to making people call expensive phone services, it seems like they try to eke out every bit of cash they can, it’s frankly unacceptable.”

Liz McAnulty, chair of the Patients Association, said: “Phone contact can be hugely valuable and reassuring to people in hospital and their loved ones at home.

“Any facility to provide this must offer a high quality service at a fair price, but Hospedia’s service appears to fail these tests badly.

“It is unacceptable for people calling someone in hospital to be charged heavily for 70 seconds before they even get through.”

Caroline Abrahams, charity director at Age UK, said: “Since older people typically have longer hospital stays and do not always have access to a mobile phone, they and their families are particularly likely to be impacted.”

Lynda Thomas, chief executive for Macmillan Cancer Support, said the cost of calls was “shocking”.

She added: “When you are having cancer treatment, getting a call from a relative can make a huge difference as you can share your worries, seek reassurance, or just hear their voice.

“But if relatives have to pay extortionate amounts to make these calls they may not call, cut it short, or shoulder the burden of these high charges, at a time when the whole family may be struggling financially.”

A spokeswoman for Ofcom said it was “concerned” about 070 costs and wished to hear from customers as part of its ongoing monitoring.

She said there is no requirement on Hospedia to use 070 numbers, adding: “We are concerned about the cost of making calls to and from hospital patients.

“Following an investigation into this, we referred our findings to the Department of Health, which has since changed its rules on mobile phone use in hospitals.

“We are glad that more patients now have the option of using their mobiles when in hospital, but arrangements for bedside phones are managed by the NHS.

“We want to ensure adequate safeguards for consumers so we are examining the use of 070 number ranges, amid concerns that the cost of calling these numbers can be confusing.

“We welcome evidence of any harm so we can further protect consumers.”

A health department spokeswoman said: “Suppliers should always put patients first in the way they provide services.

“Staying connected to friends and family while in hospital is crucial and we expect local hospitals to tackle anything that prevents this.”

Last year, Hospedia doubled its minimum price for a TV package from £2.50 to £5.

Prices for TV packages vary between hospitals, with the Big Bundle TV and internet package costing £17.50 for two days at Newcastle General, but £15 at Ipswich Hospital. Five days can cost £35.

Sky Sports can cost an extra £10 on top each day. Longer-term packages are less costly.

Manchester cancer hospital fire ‘may have destroyed vital research’

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Cancer Research UK institute likely to have lost millions of pounds of life-saving equipment in blaze, says its director

Years of research and millions of pounds of life-saving equipment are feared to have been destroyed in a devastating fire at a cancer hospital in Manchester, its director has said.

Prof Richard Marais, the head of the Cancer Research UK Manchester Institute, said researchers had been able to save 25 years of clinical samples, but other vital work was lost in the “heartrending” blaze at Christie hospital.

Continue reading…

Rise in hospital admissions for infants triggers call for NHS overhaul

The number of infants admitted to hospital for emergency care for conditions such as asthma, bronchitis and jaundice has risen sharply in the past decade.

More young children are also ending up spending time in hospital being treated for tonsillitis, breathing problems, drug poisonings and infections, new NHS figures show.

Experts behind the report into children’s care are demanding that the NHS overhauls services inside and outside hospital to provide better care and avoid young people adding to the pressures on hospitals by spending time unnecessarily as an inpatient.

They have raised concerns about a number of weaknesses they have identified in NHS care of children and young people, including a lack of knowledge among GPs, poor mental health services and paediatricians spending too little time helping patients in community-based settings. Problems with the quality of care children receive helps explain why some need to be admitted in the first place and, in some cases, have to be readmitted soon after their hospital stay.

“We have identified a number of areas of concern, which highlight potential inadequacies in the level of care and support this group is receiving outside the emergency hospital setting”, said co-authors Ellis Keeble and Lucia Kossarova, who work at the Nuffield Trust thinktank.

They undertook the research, alongside the Health Foundation thinktank, by examining official NHS hospital episodes statistics records for admissions to hospital in England by newborns up to those aged 24 between 2006-07 and 2015-16.

Emergency hospital admissions for all under-25s grew during the decade from 990,903 in 2006-07 to 1,124,863 in 2015-16 – a rise of 14%. However, that was lower than the 20% increase in emergency admissions among the population as a whole over that time.

But they learned that there had been a 30% jump in the number of infants having to be admitted and a 28% rise among those aged one to four. The “concerning” spikes in those younger age groups raised inevitable questions about the availability and quality of maternity and community services, the researchers said.

“The number of infants, children and young people using emergency departments continues to increase – with 30% more emergency admissions for under ones and 28% more for one- to four-year-olds than 10 years ago. This is placing huge pressure on a service already under strain,” said Dr John Criddle, a spokesman for the Royal College of Paediatrics and Child Health.

The number of admissions among infants for jaundice more than doubled from 8,186 to 16,491 per year and cases of acute bronchitis rose 88% from 21,235 to 39,122.

Spells in hospital for “other perinatal conditions”, which includes digestive problems and feeding trouble in babies, also increased sharply, from 14,293 to 24,848. Upper respiratory infections except asthma rose from 17,357 to 20,940; viral infections rose by 116% from 12,730 to 16,826.

Tens of thousands of emergency admissions a year in the nought to 24-year-old range as a whole – each of which costs the NHS about £400 a night – could be avoided with better management and treatment, the report concludes. Four-fifths of the 37,549 admissions seen in 2015-16 for acute and chronic tonsilitis could have been prevented, as could “a proportion” of the 27,727 inpatient stays for epilepsy and 27,325 admissions for asthma, the authors said.

Emergency readmissions rose 12% over the decade, including 17% among 15- to 19-year-olds. “Perhaps most worryingly, compared to other conditions the analysis revealed a larger rise in emergency readmissions following emergency admission for acute and chronic tonsilitis (27%) and poisoning by other medications and drugs (25%) for children and young people”.

Dr Bob Klaber, a paediatrician at St Mary’s hospital in London, said: “There is no one medical explanation for why 30% more young children are now being admitted to hospital than before. So there must be something about how we are supporting these families and a lack of support for mums with newborns who are socially isolated.

“From my experience, the fragmentation of our health and social care system, including antenatal support and help in the child’s first five years of life, has made things really difficult for parents with new babies and young children, and so too often our hospitals become the default place for them to attend.”

A lack of focus on developing joined-up preventative care plans may help explain the growth in admissions for asthma and it could be that the NHS has made the eligibility criteria for children having their tonsils removed too tight so that some with recurrent tonsil problems end up needing hospital care, according to Klaber.

He urged paediatricians to work more closely with GPs, health visitors, school nurses and other primary care health professionals in their area so they can help them identify and manage illness in children.

Klaber said a scheme in which children’s doctors from St Mary’s did that with seven “hubs” showed that approach worked. “As well as extremely positive patient and staff experience, our published evaluation of the first full hub showed that 39% of new patient hospital appointments were avoided altogether and a further 42% of appointments were shifted from hospital to GP practice,” he said.

“In addition, there was a 19% decrease in sub-specialty referrals, a 17% reduction in admissions to hospital and a 22% decrease in A&E attenders.”

The harrowing hospital night shift nothing could have prepared me for

The most important part of every night shift is matching your scrub top to your bottoms. Odd shades, bad luck. Match for the best chance of success.

I’m full of superstition because fate doesn’t follow conventional rules. I sit, cross-legged comparing until I’m satisfied with my choice. I pull my clothes off and my blue scrubs on. Stethoscope, badge and water bottle. Downstairs, grab phone and rush to handover, hoping I’ve remembered my pen.

Back of house, but this is no theatre production. A list of jobs to mop up from the day. Twelve wards, the nurse practitioner and me, “Let’s hope they all behave tonight”.

First up, fluids. Ward 50 needs a cannula, or two, or three – while I’m there. A couple of bags of normal saline go up and it’s time for me to go down to ward 20 where a lovely woman has slipped off the commode. She’s ever so embarrassed. A check from head to toe, some reassuring words and an offer of a gingernut. Then back to the desk to scribble down the story.

The phone rings, again and again, sore foot, chest pain – blood pressures through the floor and in the clouds. A woman sobers up and wants to leave – listening, persuading, assessing and eventually letting her sign the papers to walk out the door, no doubt next week we’ll meet again for the same dance.

A warm hand on my shoulder and cup of tea beside my hand. “Do you want some cake doc?” – I want nothing more. The 3am slump is here and sugar is my drug of choice. I sit, and chat – and melt into the ward for a few minutes.

An unfamiliar sound from round my neck – I answer, crash call. I drop everything and run. Down two flights of stairs, along the corridor. Turn right. I see a set of anaesthetic greens in front of me. “Bay four, bed six” a voice shouts, we pile in.

A man lies on the floor, breathing hard. Oxygen on. Pulse felt. No response to voice, grumbling to pain. Eyes deviating to the left. I grab the notes and start piecing together the history. Mild upper body weakness, query stroke, a head scan showed nothing much. Back to airway, gurgling noises from his throat. A tube down the nose to help get air into the lungs. We take an arm each, one for arterial blood and one for venous. My hands don’t shake.

Stabilised, we need imaging and fast. I ring the radiologist, ready to plead my case. “Send him down” she says. The ease of the phonecall doesn’t fill me with hope. My senior house officer grabs the emergency drugs from the crash trolley and a fresh faced nurse clutches the oxygen ready to transport. They follow him down. The ward becomes quiet.

I flick through a thin set of notes to try and build a picture. Lives with a loving wife. Walks his dog every day. Gave up smoking years ago – drinks a couple of pints on a Friday. Not too bad for a man in his 70s. Children and grandchildren.

A bed slides through the doors and he returns, the report is back. Large bleed. Blood pushing the brain against the skull. Neurosurgical opinion advised. My registrar arrives, talking fast to someone. I hear “grave”, I hear “imminent”. The bleed is too big and his brain is crushed. There is nothing we can do. Keep him conscious, keep him comfortable, next of kin.

The newly qualified nurse goes white. The notes are in my hand. “I’ll call,” the words leave my mouth before my lips move. A 4am phonecall to a telephone number. A quiet voice answers. She only left at 11pm, the nurses say. “I’m calling from the ward, about your husband, things have changed and I think you need to be here”. She’ll be here as soon as she can. Panic seeps through the phone and into my hand. “Will I make it?” her voice cracks. “Will I see him before he dies?”.

“Call me as soon as she arrives” my registrar says. I nod. She leaves. I stay, breathe in, walk around the corner, shut myself in the clean utility and put two hands up to my wet face. These aren’t my tears to cry but they still come. I push them all back in. Professional.

Years of training do not prepare you for this. Nothing prepares you for your role in someone else’s tragedy. I will leave the hospital in four hours and his wife will still be clinging to his hand. I will come back in 16 hours and they will both be gone. A new name earmarked for his bed. Another story that might end a different way.

The phone rings, and someone needs something. A temperature, a catheter and some laxatives. I glance down at my trousers. They were a perfect match.

Some details have been changed to protect patient confidentiality.

If you would like to contribute to our Blood, sweat and tears series about memorable moments in a healthcare career, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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NHS doctors: how are rota gaps affecting your hospital?

Doctors feel they are spread to thinly to provide good care to patients, a survey found last month. The poll of more than 2,100 members of the Royal College of Physicians found 84% had experienced staffing shortages across their team, while 82% believed the workforce was demoralised. Many believed patient safety has deteriorated over the 12 months.

It comes after The Royal College of Physicians annual census of British consultants showed the pressure NHS staff were under. Doctors who were polled said they worried there were not enough medics to keep patients safe. A quarter of those who responded expressed concern about rota gaps, when a hospital or department is unable to cover the working shift pattern due to a lack of staff.

Share your experiences

The Guardian wants your stories about this. How often do shifts go unfilled where you work? What pressure does this put on remaining staff members? Are some medical specialties more affected than others? Have you found yourself working long hours to fill gaps? Are you concerned that this is affecting patient safety?

Share your stories and experiences, anonymously if you prefer in our encrypted form, only the Guardian has access to your contributions. We will do our best to keep you anonymous.

I was ready to quit nursing until I went to work in a Laos hospital

I didn’t go into nursing ignorant of the challenges ahead. I’d witnessed the enormous toll it can take emotionally and physically, and was exposed to the seemingly constant negative press surrounding the NHS about overworked staff and a broken system. Yet I wanted to be a nurse. And I wasn’t going to let the NHS break me.

After three years of training, I started my first job as a children’s nurse on a busy surgical ward. I sat in my first handover, listening to the nurses complain about not getting breaks until, eventually, one turned to me and said dryly, “Welcome to the NHS!” These weren’t bad people. They were exhausted from giving so much to a system that relies on the good nature of its staff. But I was still optimistic. I wanted to be a good nurse. I wasn’t bitter. Yet.

My enthusiasm very quickly waned. My optimism and energy were worn down by the patient load, 14-hour days with just a cup of coffee to see me through, and the crushing responsibility of being a newly-qualified nurse. I made an agreement with myself: I’d get through one full year before I quit, just to prove to people I’d tried.

As the months passed I found myself actually enjoying the job. Yes, I still worked long days without a real break. And yes, I did still worry about my patients on my days off. But I’d somehow adapted to the gruelling schedule of a nurse. And so I continued.

But gradually, over the years, my list of grievances with nursing grew. It started to affect my home life and I noticed that I was getting sick more often. My resilience had been weakened and I felt like I was running on empty.

My partner and I had been talking about living abroad for a while and we came to the conclusion that now was as good a time as any. We were both ready for a break. Many of our friends were buying houses and climbing career ladders, and would often comment that we were brave to quit it all. But for me taking a break seemed selfish and indulgent rather than brave. I didn’t even consider whether it would harm my career progression. At that point I yearned for less, rather than more responsibility.

And so we packed our bags and headed for Asia. On long bus journeys or during quiet moments I would sometimes question whether I could go back to nursing. With the luxury of distance and time I saw myself as the bitter, overworked nurse I’d been sure I wouldn’t become. I was ashamed. I’d lost sight of why I wanted to be nurse.

After six months away from nursing, I heard that the Lao friends hospital for children in Luang Prabang was looking for nursing volunteers. Re-energised by our time away so far, I felt ready for a new challenge and so, with a mixture of apprehension and excitement, we headed to Laos.

The hospital is well equipped thanks to the generosity of the charity that funds and runs it. Yet compared with NHS hospitals it lacks the equipment, medicines and expertise that we take for granted. In the UK I never saw a child go without a blood transfusion because the blood bank was empty, or watched a terminally ill child be discharged home with only an apology that we could do no more. It reminds me how lucky we are to have the NHS. The limitations we worked with in Laos encouraged innovation and teamwork, which can sometimes be lacking or forgotten about in the vastness of the NHS.

Being part of a team that responds innovatively and tirelessly to the challenges these limitations provide, combined with spending my days (and nights) with children and their families and the joy of seeing these children get better, has reignited my enthusiasm for nursing.

I’m extending my stay here in Luang Prabang. Hopefully when I return to the UK, I’ll be a better nurse for my time spent here. But I certainly wouldn’t rule out another career break. It’s been difficult financially, and yes, it’s a luxury, but a break from my normal has made me remember why I’m proud to be a nurse.

If you would like to contribute to our Blood, sweat and tears series about memorable moments in a healthcare career, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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