Tag Archives: This

I was a doctor prone to fainting. This is how I got over it

Like 12% of medical students, the graphic sights of the operating theatre caused me to faint. But slowly, after many queasy incidents, I learned how to cope

Surgeon and medical staff working in an operating theatre


‘I did not want to be the one who distracted the surgeon during a delicate phase by fainting’ Photograph: Alamy

Medicine is great, but it involves pain, pus and blood. For some, seeing those things is a problem. When I started medical school, I was worried. Before applying, I had spent a night in the local casualty department as work experience. I watched a junior doctor try to prise a splinter from a young woman’s hand. It was hurting her, and she kept yelping. The doctor got irritated and said the anaesthetic “should be working by now”. He kept digging into her hand with a scalpel tip; she started to cry. I felt lightheaded, my skin went cold, I moved my legs to keep the blood flowing, but seconds later I fainted.

They put me on a trolley, checked my blood glucose, and the same doctor explained that only “an insulinoma” could explain such low sugar readings. I got home, looked it up (a tumour of the pancreas), and for several months assumed there was something growing within me. There wasn’t. But the experience had planted a doubt. Was I really cut out for this?

Fainting is a common problem for medical students. A study in 2009 showed that of 630 students, 77 (12%) said they had fainted or come close to fainting in an operating theatre. Half of these were interested in becoming surgeons, and a significant proportion were put off from pursuing that specialty by their experience. The students reported being adversely affected by ambient heat, the smell of burning flesh, wearing a mask, having to stand for long periods, and menstruation.

For me, the first two years at med school were filled with lectures. Even the dissecting room, where the nasal punch of formalin rises up from the dull brown tissues of dead bodies, failed to sway me. The fascination with internal structures and cotton-thin nerves seemed to banish any queasiness. It was nothing like real, human life.

My first postmortem however, was a different matter. The professor of pathology, wearing long green rubber gloves, lifted up a series of pre-dissected organs. I glanced past him to the cadaver, and glimpsed the sawn head; I watched green juices drip off the liver, and … down I went. Apparently, when the professor heard the thump he looked into the audience and called out, “Will someone check to see if she’s alright?” I’m a man.

Then the day arrived for us to practise blood tests on each other. My trembling partner inserted a needle into one side of my elbow vein and out the other, causing a swelling the size of a large marble. As I watched it grow I began to sweat, the edges of my visual field closed in and I sat on the floor with my head between my knees until the blood rushed into my head and I recovered. A close one.

Entering the hospital wards for the first time, I didn’t do as well. We met the house officer and were told that it was our job to do the blood rounds each morning. She assembled a needle and blood tube set, and asked me to roll my sleeve up. Pretending to take blood, showing us how to handle the tube, she held the needle just a few millimetres from my skin. The sweat came on, and I fainted.

Repeated exposure to the causes of fainting is recommended. Of the 77 students in the study who fainted in the operating theatre, 10% benefited from making themselves go back. Others made sure they ate and drank well beforehand, requested frequent breaks from assisting the surgeon, and moved their legs.

surgeons


‘The blood poured over the side of the table, down the surgeon’s gown and into the top of his white rubber boots. Yet I remained standing.’ Photograph: Valery Sharifulin/TASS

The Doceatdoc website, written for students considering a career as a doctor, contains similar advice about keeping your blood sugar levels up, avoiding dehydration, and ensuring there is blood flow to the brain. Here though, they recommend avoiding specific situations that you know will cause a problem (patients screaming in pain, infected leg ulcers and bad feet, for me).

So how did it go for me in the operating theatre? I told nobody about my fears, but I walked in for the first time with trepidation. I did not want to be the one who distracted the surgeon during a delicate phase by fainting.

The patient was an emergency case. His abdominal aorta (the largest blood vessel in the body) had ruptured. I moved my toes and flexed my ankles to keep the blood flowing to my brain. He opened the abdomen and the patient’s blood welled up. It poured over the side of the table, down the surgeon’s gown and into the top of his white rubber boots. I heard him curse as he nicked the spleen with his scalpel and was forced to remove it. Blood. Negative emotion. Potential calamity. The unholy trinity of faint-inducing factors. Yet I remained standing.

I have since found myself in many faint-prone situations, but I am glad to report that it is no longer a problem. The connection between eyes and brain has been modified by experience, seniority, confidence … who knows what? Rest assured, if you are a fainter, it tends to get better.

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

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

I was a doctor prone to fainting. This is how I got over it

Like 12% of medical students, the graphic sights of the operating theatre caused me to faint. But slowly, after many queasy incidents, I learned how to cope

Surgeon and medical staff working in an operating theatre


‘I did not want to be the one who distracted the surgeon during a delicate phase by fainting’ Photograph: Alamy

Medicine is great, but it involves pain, pus and blood. For some, seeing those things is a problem. When I started medical school, I was worried. Before applying, I had spent a night in the local casualty department as work experience. I watched a junior doctor try to prise a splinter from a young woman’s hand. It was hurting her, and she kept yelping. The doctor got irritated and said the anaesthetic “should be working by now”. He kept digging into her hand with a scalpel tip; she started to cry. I felt lightheaded, my skin went cold, I moved my legs to keep the blood flowing, but seconds later I fainted.

They put me on a trolley, checked my blood glucose, and the same doctor explained that only “an insulinoma” could explain such low sugar readings. I got home, looked it up (a tumour of the pancreas), and for several months assumed there was something growing within me. There wasn’t. But the experience had planted a doubt. Was I really cut out for this?

Fainting is a common problem for medical students. A study in 2009 showed that of 630 students, 77 (12%) said they had fainted or come close to fainting in an operating theatre. Half of these were interested in becoming surgeons, and a significant proportion were put off from pursuing that specialty by their experience. The students reported being adversely affected by ambient heat, the smell of burning flesh, wearing a mask, having to stand for long periods, and menstruation.

For me, the first two years at med school were filled with lectures. Even the dissecting room, where the nasal punch of formalin rises up from the dull brown tissues of dead bodies, failed to sway me. The fascination with internal structures and cotton-thin nerves seemed to banish any queasiness. It was nothing like real, human life.

My first postmortem however, was a different matter. The professor of pathology, wearing long green rubber gloves, lifted up a series of pre-dissected organs. I glanced past him to the cadaver, and glimpsed the sawn head; I watched green juices drip off the liver, and … down I went. Apparently, when the professor heard the thump he looked into the audience and called out, “Will someone check to see if she’s alright?” I’m a man.

Then the day arrived for us to practise blood tests on each other. My trembling partner inserted a needle into one side of my elbow vein and out the other, causing a swelling the size of a large marble. As I watched it grow I began to sweat, the edges of my visual field closed in and I sat on the floor with my head between my knees until the blood rushed into my head and I recovered. A close one.

Entering the hospital wards for the first time, I didn’t do as well. We met the house officer and were told that it was our job to do the blood rounds each morning. She assembled a needle and blood tube set, and asked me to roll my sleeve up. Pretending to take blood, showing us how to handle the tube, she held the needle just a few millimetres from my skin. The sweat came on, and I fainted.

Repeated exposure to the causes of fainting is recommended. Of the 77 students in the study who fainted in the operating theatre, 10% benefited from making themselves go back. Others made sure they ate and drank well beforehand, requested frequent breaks from assisting the surgeon, and moved their legs.

surgeons


‘The blood poured over the side of the table, down the surgeon’s gown and into the top of his white rubber boots. Yet I remained standing.’ Photograph: Valery Sharifulin/TASS

The Doceatdoc website, written for students considering a career as a doctor, contains similar advice about keeping your blood sugar levels up, avoiding dehydration, and ensuring there is blood flow to the brain. Here though, they recommend avoiding specific situations that you know will cause a problem (patients screaming in pain, infected leg ulcers and bad feet, for me).

So how did it go for me in the operating theatre? I told nobody about my fears, but I walked in for the first time with trepidation. I did not want to be the one who distracted the surgeon during a delicate phase by fainting.

The patient was an emergency case. His abdominal aorta (the largest blood vessel in the body) had ruptured. I moved my toes and flexed my ankles to keep the blood flowing to my brain. He opened the abdomen and the patient’s blood welled up. It poured over the side of the table, down the surgeon’s gown and into the top of his white rubber boots. I heard him curse as he nicked the spleen with his scalpel and was forced to remove it. Blood. Negative emotion. Potential calamity. The unholy trinity of faint-inducing factors. Yet I remained standing.

I have since found myself in many faint-prone situations, but I am glad to report that it is no longer a problem. The connection between eyes and brain has been modified by experience, seniority, confidence … who knows what? Rest assured, if you are a fainter, it tends to get better.

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

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

I survived sepsis eight times. But can care workers spot this deadly illness?

Care staff are increasingly likely to see sepsis, but there is no standard training to make them aware of the symptoms to look out for in clients

Sepsis


There is a golden hour for the treatment of sepsis, when someone can be saved by basic steps known as the ‘sepsis six’. Illustration: Christophe Gowans

I am a survivor of sepsis. Not once, not twice, but eight times.

Sepsis – also known as blood poisoning – kills more people than bowel cancer, breast cancer and prostate cancer combined. It affects more than 260,000 people and claims 44,000 lives every year in the UK. But it is not spoken about in training for social care workers, even though they are increasingly likely to see it.

Sepsis is triggered when the body tries to overcompensate for an underlying infection and too many white blood cells are released into the bloodstream. An example you may see in the social care context is kidney and chest infections. It looks like common flu in the early stages, but it can lead to life-threatening septic shock.

There is a golden hour for the treatment of sepsis, when someone can be saved by basic steps known as the “sepsis six”. Although there is no standard training, there are some symptoms care professionals can look for in a client:

  • Are they sleepy?
  • Is their breathing rapid or shallow?
  • Do they have a raised temperature?
  • Is their complexion mottled?
  • Do they seem confused, distracted or agitated?
  • Have they spoken of feeling the worst they have ever felt?

Taking their temperature at home may be the best indication of whether someone has sepsis until a medical professional is available, but you should try to get the person to a medic as soon as possible after identifying the symptoms.

Most importantly, when you speak to the medic, follow the “just ask” protocol; ask if they think it could be sepsis and give a good, rounded history of the individual. If you are not familiar with the patient, a synopsis of their medical condition should be placed at the front of their care plan.

One of the occasions when I had sepsis offers a pertinent example of why care workers should be aware of the condition’s symptoms. I had been feeling ill for a couple of hours and had told my care workers. They said we should see how it goes – and went back to their mobile phones. This continued until my husband returned from work and, within minutes, he noticed that I was pale and flushed and that my head was nodding. He touched my cheeks and realised I had a temperature – 39.9 degrees at that point. Paul called for an ambulance and asked the paramedics if it could be sepsis; they immediately started to check for the signs using the “sepsis six”.

I spent four weeks in hospital, with a stay in intensive care on high impact antibiotics. I was told that if Paul had not acted so decisively and asked the correct questions, that I may not have received the correct treatment that saved my life. Coincidentally, Paul and I met in hospital when we were both being treated for sepsis.

Please do not underestimate the importance of recognising sepsis and simply asking medics: “Could it be sepsis?” And if you’ve had sepsis before, tell those caring for you about your history – sepsis can and does come back often.

Damian Bridgeman is a social entrepreneur, disability rights activist, and board member of Social Care Wales. He is speaking at an event on this topic in London on 18 January. For more information on sepsis, visit the Sepsis Trust

Join the Social Care Network for comment, analysis and job opportunities, direct to your inbox. Follow us on Twitter (@GdnSocialCare) and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to us at socialcare@theguardian.com

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs

I survived sepsis eight times. But can care workers spot this deadly illness?

Care staff are increasingly likely to see sepsis, but there is no standard training to make them aware of the symptoms to look out for in clients

Sepsis


There is a golden hour for the treatment of sepsis, when someone can be saved by basic steps known as the ‘sepsis six’. Illustration: Christophe Gowans

I am a survivor of sepsis. Not once, not twice, but eight times.

Sepsis – also known as blood poisoning – kills more people than bowel cancer, breast cancer and prostate cancer combined. It affects more than 260,000 people and claims 44,000 lives every year in the UK. But it is not spoken about in training for social care workers, even though they are increasingly likely to see it.

Sepsis is triggered when the body tries to overcompensate for an underlying infection and too many white blood cells are released into the bloodstream. An example you may see in the social care context is kidney and chest infections. It looks like common flu in the early stages, but it can lead to life-threatening septic shock.

There is a golden hour for the treatment of sepsis, when someone can be saved by basic steps known as the “sepsis six”. Although there is no standard training, there are some symptoms care professionals can look for in a client:

  • Are they sleepy?
  • Is their breathing rapid or shallow?
  • Do they have a raised temperature?
  • Is their complexion mottled?
  • Do they seem confused, distracted or agitated?
  • Have they spoken of feeling the worst they have ever felt?

Taking their temperature at home may be the best indication of whether someone has sepsis until a medical professional is available, but you should try to get the person to a medic as soon as possible after identifying the symptoms.

Most importantly, when you speak to the medic, follow the “just ask” protocol; ask if they think it could be sepsis and give a good, rounded history of the individual. If you are not familiar with the patient, a synopsis of their medical condition should be placed at the front of their care plan.

One of the occasions when I had sepsis offers a pertinent example of why care workers should be aware of the condition’s symptoms. I had been feeling ill for a couple of hours and had told my care workers. They said we should see how it goes – and went back to their mobile phones. This continued until my husband returned from work and, within minutes, he noticed that I was pale and flushed and that my head was nodding. He touched my cheeks and realised I had a temperature – 39.9 degrees at that point. Paul called for an ambulance and asked the paramedics if it could be sepsis; they immediately started to check for the signs using the “sepsis six”.

I spent four weeks in hospital, with a stay in intensive care on high impact antibiotics. I was told that if Paul had not acted so decisively and asked the correct questions, that I may not have received the correct treatment that saved my life. Coincidentally, Paul and I met in hospital when we were both being treated for sepsis.

Please do not underestimate the importance of recognising sepsis and simply asking medics: “Could it be sepsis?” And if you’ve had sepsis before, tell those caring for you about your history – sepsis can and does come back often.

Damian Bridgeman is a social entrepreneur, disability rights activist, and board member of Social Care Wales. He is speaking at an event on this topic in London on 18 January. For more information on sepsis, visit the Sepsis Trust

Join the Social Care Network for comment, analysis and job opportunities, direct to your inbox. Follow us on Twitter (@GdnSocialCare) and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to us at socialcare@theguardian.com

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs

I survived sepsis eight times. But can care workers spot this deadly illness?

Care staff are increasingly likely to see sepsis, but there is no standard training to make them aware of the symptoms to look out for in clients

Sepsis


There is a golden hour for the treatment of sepsis, when someone can be saved by basic steps known as the ‘sepsis six’. Illustration: Christophe Gowans

I am a survivor of sepsis. Not once, not twice, but eight times.

Sepsis – also known as blood poisoning – kills more people than bowel cancer, breast cancer and prostate cancer combined. It affects more than 260,000 people and claims 44,000 lives every year in the UK. But it is not spoken about in training for social care workers, even though they are increasingly likely to see it.

Sepsis is triggered when the body tries to overcompensate for an underlying infection and too many white blood cells are released into the bloodstream. An example you may see in the social care context is kidney and chest infections. It looks like common flu in the early stages, but it can lead to life-threatening septic shock.

There is a golden hour for the treatment of sepsis, when someone can be saved by basic steps known as the “sepsis six”. Although there is no standard training, there are some symptoms care professionals can look for in a client:

  • Are they sleepy?
  • Is their breathing rapid or shallow?
  • Do they have a raised temperature?
  • Is their complexion mottled?
  • Do they seem confused, distracted or agitated?
  • Have they spoken of feeling the worst they have ever felt?

Taking their temperature at home may be the best indication of whether someone has sepsis until a medical professional is available, but you should try to get the person to a medic as soon as possible after identifying the symptoms.

Most importantly, when you speak to the medic, follow the “just ask” protocol; ask if they think it could be sepsis and give a good, rounded history of the individual. If you are not familiar with the patient, a synopsis of their medical condition should be placed at the front of their care plan.

One of the occasions when I had sepsis offers a pertinent example of why care workers should be aware of the condition’s symptoms. I had been feeling ill for a couple of hours and had told my care workers. They said we should see how it goes – and went back to their mobile phones. This continued until my husband returned from work and, within minutes, he noticed that I was pale and flushed and that my head was nodding. He touched my cheeks and realised I had a temperature – 39.9 degrees at that point. Paul called for an ambulance and asked the paramedics if it could be sepsis; they immediately started to check for the signs using the “sepsis six”.

I spent four weeks in hospital, with a stay in intensive care on high impact antibiotics. I was told that if Paul had not acted so decisively and asked the correct questions, that I may not have received the correct treatment that saved my life. Coincidentally, Paul and I met in hospital when we were both being treated for sepsis.

Please do not underestimate the importance of recognising sepsis and simply asking medics: “Could it be sepsis?” And if you’ve had sepsis before, tell those caring for you about your history – sepsis can and does come back often.

Damian Bridgeman is a social entrepreneur, disability rights activist, and board member of Social Care Wales. He is speaking at an event on this topic in London on 18 January. For more information on sepsis, visit the Sepsis Trust

Join the Social Care Network for comment, analysis and job opportunities, direct to your inbox. Follow us on Twitter (@GdnSocialCare) and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to us at socialcare@theguardian.com

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs

I’m an A&E doctor. This is how we’re forced to let our patients down | Anonymous

I’ve arrived five minutes early for my shift in a hospital A&E department. I walk through the corridor behind the department, already crammed with hospital trolleys. I shut them out of my mind. I’ve still got five minutes of breathing space before they become my immediate reality.

The trolleys are staffed by paramedics. They brought the patients in, there’s nowhere for them to go, and there are no hospital staff to look after them. So the paramedics wait with the patients, checking on their pain and repeating their vital signs – instead of being out there responding to the soaring number of emergency calls.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Most of the patients in the corridor today are elderly. Some clearly have dementia, and are confused as to where they are. There’s no dignity, no warmth and a very long wait ahead before the hospital starts seeing and treating them. It turns out that I didn’t manage to shut them out of my mind at all.

As I walk into the changing rooms there is chaos everywhere. A crisis has hit all the staff. The cleaners have needed to help with getting cubicles and bed areas turned around faster and faster, so the staff areas have moved to the bottom of their list. There are literally no clean scrubs or uniforms left for any of us to wear. “Don’t worry, whatever you’ve got on is fine, just start seeing patients.” The bosses are as stretched and as desperate as anyone else.

I am allocated to the “minors” area. This area was designed for ambulatory patients who could be walked into a room, seen and walked back out to the waiting room to wait for results. It is already full of patients on hospital beds, pushed two together in three out of the five consultation rooms. Some are elderly, confused, alone. Some are young, injured or very unwell. One is a mental health patient with severe anxiety. This is not the place to make her feel better. Far from it.

Over the PA system, pre-alerts for ambulances carrying critically unwell patients are announced – the ones whose condition is life-threatening. In 11 minutes, four ambulances carrying patients who need immediate resuscitation arrive. This would saturate the system on a good day. Today they have nowhere else to go.


The inadequate care we are providing is the inevitable reality of the government’s funding decisions

I hear a call for “security urgently” over the PA system. The call is repeated two minutes later. We all know it’s for show. The security team are stretched and scattered all over the hospital, and can rarely answer those calls. This time a staff member had been attacked by an intoxicated patient.

As I walk back down the jammed corridor, increasing numbers of screaming and crying patients line the lanes, creating an emotional and physical obstacle course that every staff member walks down. It’s truly sickening.

What’s worse is that this situation was entirely predictable. The inadequate care we are providing is the inevitable reality of the government’s funding decisions. If you strip back funding, force hospitals to make savings they can’t afford, devastate primary and social care, and fail to invest in staffing or resources to match demand, we are forced to tell our patients: “I’m so sorry, we can’t look after you safely today.”

And for many of us, we’re tired of apologising on behalf of the ministers who have made these decisions. It’s just too much. We are too tired to keep trying to smile. We are struggling to try to make it work. We’re sorry we’ve let you down, but we’re broken and we need your help.

The anonymous writer is an A&E doctor who works in a hospital in south-east England

I’m an A&E doctor. This is how we’re forced to let our patients down | Anonymous

I’ve arrived five minutes early for my shift in a hospital A&E department. I walk through the corridor behind the department, already crammed with hospital trolleys. I shut them out of my mind. I’ve still got five minutes of breathing space before they become my immediate reality.

The trolleys are staffed by paramedics. They brought the patients in, there’s nowhere for them to go, and there are no hospital staff to look after them. So the paramedics wait with the patients, checking on their pain and repeating their vital signs – instead of being out there responding to the soaring number of emergency calls.

Most of the patients in the corridor today are elderly. Some clearly have dementia, and are confused as to where they are. There’s no dignity, no warmth and a very long wait ahead before the hospital starts seeing and treating them. It turns out that I didn’t manage to shut them out of my mind at all.

As I walk into the changing rooms there is chaos everywhere. A crisis has hit all the staff. The cleaners have needed to help with getting cubicles and bed areas turned around faster and faster, so the staff areas have moved to the bottom of their list. There are literally no clean scrubs or uniforms left for any of us to wear. “Don’t worry, whatever you’ve got on is fine, just start seeing patients.” The bosses are as stretched and as desperate as anyone else.

I am allocated to the “minors” area. This area was designed for ambulatory patients who could be walked into a room, seen and walked back out to the waiting room to wait for results. It is already full of patients on hospital beds, pushed two together in three out of the five consultation rooms. Some are elderly, confused, alone. Some are young, injured or very unwell. One is a mental health patient with severe anxiety. This is not the place to make her feel better. Far from it.

Over the PA system, pre-alerts for ambulances carrying critically unwell patients are announced – the ones whose condition is life-threatening. In 11 minutes, four ambulances carrying patients who need immediate resuscitation arrive. This would saturate the system on a good day. Today they have nowhere else to go.


The inadequate care we are providing is the inevitable reality of the government’s funding decisions

I hear a call for “security urgently” over the PA system. The call is repeated two minutes later. We all know it’s for show. The security team are stretched and scattered all over the hospital, and can rarely answer those calls. This time a staff member had been attacked by an intoxicated patient.

As I walk back down the jammed corridor, increasing numbers of screaming and crying patients line the lanes, creating an emotional and physical obstacle course that every staff member walks down. It’s truly sickening.

What’s worse is that this situation was entirely predictable. The inadequate care we are providing is the inevitable reality of the government’s funding decisions. If you strip back funding, force hospitals to make savings they can’t afford, devastate primary and social care, and fail to invest in staffing or resources to match demand, we are forced to tell our patients: “I’m so sorry, we can’t look after you safely today.”

And for many of us, we’re tired of apologising on behalf of the ministers who have made these decisions. It’s just too much. We are too tired to keep trying to smile. We are struggling to try to make it work. We’re sorry we’ve let you down, but we’re broken and we need your help.

The anonymous writer is an A&E doctor who works in a hospital in south-east England

Need something explained?

Pick a question: We’ll answer the one that generates the most interest shortly

What are your experiences of the NHS this winter? Tell us here

This winter the NHS has been under pressure, with the situation escalating rapidly over festive period, according to a leading doctor.

Dr Nick Scriven, president of the Society for Acute Medicine (SAM), said many hospitals reported more than 99% capacity in the week before Christmas. He said there was significant strain on service as they enter 2018, and called for non-urgent operations to be postponed until at least the end of January.

Share your experiences

We will be monitoring the situation in hospitals over the next few months and want to hear your experiences of the NHS this winter. We are keen to hear from healthcare professionals as well as patients about the situation. Have operations been cancelled? Has pressure led to certain wards being closed? How are staff coping? Help us document what is going on across the UK.

Giving Toby Young this job shows that the Tories care only for their own | Faiza Shaheen

The curtains open on 2018 with a reminder of not just how much but who needs to change. Former journalist and free school campaigner Toby Young’s appointment to the newly created Office for Students shocked many, but is really just the tip of the iceberg. Yes we may rage that Young – anti-inclusion and teacher deriding – has been given a job on a university watchdog, but we also have a health secretary who co-wrote a book on how the NHS should be privatised; a foreign secretary who thinks it’s OK to make a joke about dead Libyans; a Conservative MP having the whip restored despite having used the N-word; a Brexit secretary who can blatantly contradict himself with no consequences. Look wider and you see that the public inquiry on the Grenfell Tower fire is being led by an unrepresentative panel, and a leader has been appointed to Kensington and Chelsea council who had never been inside one of the borough’s tower blocks. This is beyond irony; it’s corruption and it stinks.


The Tories are using the few friends they have left – no matter how unqualified or sullied – to rig the system

When it comes to policy we can only understand what is being done by looking at who is doing it. Those who have experienced hardship, for example by overcoming huge hurdles to get into institutions such as Oxford University, rather than being let in because their dad called the tutor, are more likely to understand and empathise, to introduce policies that don’t punish people for being poor. And it matters because of trust. In a country knee deep in class, gender and race prejudice, many don’t trust bodies and institutions to do the right thing when they do not see and hear people like themselves being represented on them.

Young’s appointment remind us of the Conservatives’ ultimate loyalties and priorities. Gone are those who disagree or criticise – Alan Milburn and his whole social mobility team and infrastructure adviser Andrew Adonis – instead our government and bodies are increasingly led by Tory caricatures. And they’re everywhere – just look at the new appointment of Elisabeth Murdoch to the Arts Council. The Conservatives are using the few friends they have left – no matter how unqualified or sullied – to rig the system and ensure their interests are paramount, with little regard to how it hurts the integrity of our institutions.

Young’s CV doesn’t scream higher education regulator – in fact his appointment has made the organisation an affront to the teachers he told don’t work that hard, and to those pushing to increase representation, such as David Lammy, whom he criticised for talking about the ludicrously small number of black students at Oxbridge. Free schools have been found lacking, especially in terms of value for money. How is it possible that he has been given this honour, especially when we know more qualified people applied? Is universities minister Jo Johnson that keen to find someone to squash those snowflake millennials? The new Office for Students is already doomed to fail – as are most organisations that make chummy appointments on criteria other than talent.

What message does this all send? It tells teachers and lecturers – we know your pay and rights are dwindling but here’s someone to lead you who doesn’t value you. To students, your growing debt is not a priority, and to those seeking genuine representation in our education institutions – put a lid on it. Yes, black people we care about tackling racial prejudice but the use of the N-word isn’t really a big deal. Grenfell victims – we know you’re hurting and lost loved ones, but we’ve got friends who we think would do a great job at getting you justice. The message is: we don’t care. We don’t hear you. Two fingers up to all of you.

Faiza Shaheen is the director of the Centre of Labour and Social Studies. She specialises in economic and spatial inequalities, employment, regeneration and child poverty

NHS hospitals made £174m from car park charges this year

NHS hospitals made a record £174m from charging patients, visitors and staff to park in 2016/17, up 6% on the previous year.

Data from 111 hospital trusts across England shows that as many as two-thirds are making more than £1m a year. More than half of trusts now charge disabled people to park.

Some trusts defended the charges, saying they were essential to pay for patient care. But opposition parties and patient support groups were critical, with one group saying they were “cynical” but blaming the state of NHS finances rather than the trusts themselves.

The Liberal Democrats condemned the charges as a “tax on sickness” while Labour said it was committed to ending them.

The government condemned “complex and unfair” parking charges and called for reform, but a Department of Health spokesman said they were a matter for local NHS organisations rather than central regulation.

Parking remains largely free at hospitals in Scotland and Wales.

The 40 trusts in England that provided data on parking penalties made £947,568 in 2016/17 from fining patients, visitors and staff on hospital grounds, up 32% on the £716,385 taken by the same trusts the previous year.

A total of 120 NHS trusts across England were asked to provide data on charges and fines, in requests under the Freedom of Information Act by the Press Association, and 111 responded.

Some were giving private firms hundreds of thousands of pounds to run their car parks.

The Heart of England NHS foundation trust took in the most in parking income across the year (£4,865,000). Royal Surrey County hospital, in Guildford, charged the most at £4 per hour.

If a patient required a day’s worth of treatment then they would have to pay £32 for an eight-hour day. Longer-term concessions were available at some hospitals, such as for people having regular chemotherapy.

Some hospitals defended the charges, saying some or all of the money was put back into patient care or was spent on site maintenance.

Rachel Power, chief executive of the Patients Association, said the current state of NHS finances meant it was sometimes difficult to blame hospitals for trying to find money, although this did not make the current situation acceptable.

“For patients, parking charges amount to an extra charge for being ill,” she said. “The increase in the number of trusts who are charging for disabled parking is particularly concerning.

“Patients who require disabled parking may have little choice but to access their care by car, and may need to do so often. Targeting them in this way feels rather cynical.”

Jonathan Ashworth, the shadow health secretary, said: “Hospital parking charges are an entirely unfair and unnecessary burden, which disproportionately affect the most vulnerable people using our health service.

“Even Jeremy Hunt has described this outrageous practice as a ‘stealth tax’, and yet Tory underfunding of our NHS has resulted in hospitals and private companies extracting record fees from patients and staff. Labour will abolish car parking charges and scrap this needless strain on already worried families.”

The Lib Dem health spokesman, Norman Lamb, said: “The vast sums of money that hospitals are making from parking charges reveal the hidden cost of healthcare faced by many patients and their families. All hospitals should be following the national guidelines to make sure that patients, relatives, and NHS staff are not unfairly penalised.”

A Department of Health spokesman said: “Patients and families should not have to deal with the added stress of complex and unfair parking charges. NHS organisations are locally responsible for the methods used to charge, and we want to see them coming up with flexible options that put patients and their families first.”