Winter in the NHS has always been tough. I moved to Scotland 5 years ago, and each winter I’ve been here we’ve talked about it being the toughest winter the NHS has seen. But this year we know it’s going to be a whole other level of tough, with so much of our beloved NHS at (or even past in some places) the point of collapse.
Christmas has always been a time that shines a brighter light on the highs and lows of working in healthcare. The joys of getting someone home to their family for Christmas, overshadowed by how much more emotionally taxing it is to deliver bad news in the midst of the festive season.
My first Christmas in Scotland I worked most of the festive season. As an FY1 I was covering the wards and also the critical care unit of a small district general. Being a small hospital meant everyone knew each other even just a few months into the job which made it feel even more festive. Christmas day fell on a Monday – the first of my 7 day stretch. The day started with lots of festivities – morning handover had one of the medical registrars in a Santa outfit, another dressed as Rudolph, and festive snacks were at every corner.
Santa helped deliver small gifts to each and every patient and I was tasked with completing the phlebotomy round. I was wearing a Santa hat (of course) and the nurses told me I must go see this one particular patient first. This elderly lady was overjoyed with her gift of slippers, and very enthusiastically told me about Santa delivering it, and the Christmas lunch that was coming later. She’d spent the last few Christmases alone, without presents, and so was incredibly grateful to be able to share this Christmas with others despite being unwell. Visitors arrived after lunch, and we were able to discharge a handful of patients home and the whole hospital felt like a joyful festive place.
I worked a 12 and a half hour shift that day, boxing day and then ended the week with 3 consecutive long shifts. By the time the weekend came some of the festive spirit had faded and tiredness was taking over. Bed pressures were being felt, patients were sicker and it felt like we were all struggling through until our next day off.
One gentleman came into critical care really quite unwell but still so full of festive cheer. He told me about how he was glad he’d got to spend Christmas at home but was sad he’d miss seeing the bells in with his family. He explained to me that I had to have a “wee dram” to see in the bells else it wasn’t a proper Hogmanay. I explained I wouldn’t finish work until late and after a nearly 80 hour week I was mostly looking forward to getting into bed and a long lie in to start the new year. He made me promise to see the bells, and to toast a gin and tonic to him. I did. Just. Before promptly falling asleep on the sofa and having to take myself to bed in the early hours. I spent most of New Years Day in bed, so totally exhausted, before going back to work for another long shift the next day. I went to proudly tell that patient that I’d made it to the bells and done as he’d said, but he wasn’t there. He’d died. That death certificate felt more difficult to write than the countless others I’d done at that point.
After that shift we got back into the normal rhythm in the hospital, or that of winter anyhow. I remember being told there was “nae room in the inn” because we had no beds, and pressures were being felt across the whole hospital. That feels like nothing compared to what we’re seeing now. Ambulances waiting hours outside our emergency departments because there’s simply no capacity inside the hospital. Patients waiting days at some points for urgent care – whether that be at home awaiting ambulances, or in A&Es waiting for beds or horrifically dangerous combinations of both together. Patients coming to harm simply because the system is broken.
The system is beyond broken at this point, and I know many are feeling that burden – moral injury and burnout are so high it’s hard to be optimistic for the new year as we’re all fed up of saying farewell to colleagues leaving for better working conditions elsewhere. What has been a joy however is getting to celebrate Christmas like we haven’t been able to in previous years – Christmas parties for the first time since 2019, and friends and colleagues being able to enjoy festive family gatherings on their days off between chaotic shifts.
The festive season for me is a joyous time of year, the season of goodwill and a time of reflection on the year that’s been. This year I see even more how amazing my colleagues are, just how hard they’ve all been working to try and desperately combat the pressures mounting high on us across health and social care. The NHS is full of goodwill – and not just the boxes of chocolates at every nurses station (obligatory at this time of year), but the fantastic people that make it what it is. Going above and beyond to look out for each other. I am proud to work for the NHS, and of my friends and colleagues throughout the many parts of it. Proud to represent my profession in the work we do within BMA Scotland. We will keep working hard year round to do all we can to advocate for you – locally, regionally and nationally. For better working conditions across the NHS, for a functioning system once again, and here’s hoping that this time next year things will be better, for all of us – staff and patients. Thank you for all that you do. I’ll be seeing in the bells with a wee dram and toasting to all of you, and to hopefully better times ahead.
NOTE: . If you are finding it tough, please do use our wellbeing services. We have a range of services and information to help support you. Our counselling service is open 24/7 to all doctors and medical students – by telephone and in person. It’s confidential and free of charge.
Dr Lailah Peel is Deputy Chair or BMA Scotland
Thank you for such a lovely but tragic story. Best wishes for Christmas.