Seven Signs of Life by Aoife Abbey

Author:Aoife Abbey
Language: eng
Format: epub
ISBN: 9781473555839
Publisher: Random House

I believe entirely in this approach. The ability to make appropriate admission assessments is one of an intensivist’s most important and valuable skills. The reality was that there were no beds available on the intensive-care unit itself, but the imperative was that I block it out; it was a distraction that was unfair to the patient in front of me.

The consultant came and we had a long conversation. We went through the history and the X-rays and we spoke to his family. It was decided that the patient would not benefit from escalation to intensive care. This meant that he would go to the ward, with the expectation that he was now in the final days of his life. I agreed it was the right decision for the patient, but I was also genuinely relieved that had been the decision – I don’t know how we would have found space for him. I moved on, hoping all night that the next patient I was asked to see wouldn’t need a bed, and hoping also that I was good enough not to let that detract from my assessment of their needs.

Focus: it is a requirement, even when you are standing in the resus department and it feels like somebody has asked you to make a difficult decision while standing still in the centre of Waterloo Station in the middle of the rush hour. People who work in acute care adapt to become good at not needing peace and quiet to make their decisions. I find that I am learning this and I can manage it, as long as I still have access to a pen.

I am a fan of writing things down, and that clearly won’t come as a shock to you, but perhaps because I am young and of the ‘next generation’ of consultants, you might think I ought to be putting out bunting to celebrate our movement in medicine towards embracing ‘paperless records’. Personally, though, I have never been fond of the online, pro-forma way of recording matters. Of course I see that it has some strengths, but in my experience there is little room for free text and thinking out loud.

Instead, I value the simple tool of a pen, and wonder how I could possibly focus without it. Usually when I have this thought, I am in the resus department or out on the general wards and I have seen a patient who has been referred because the parent team is worried the patient might need a higher level of care. I arrive, go through the patient’s background and admission history, then work my way through the blood results, any radiology or other imaging that is available and the records of vital signs. I speak to the patient, if they are able to communicate, and then I examine them. Next, I take out a pen from the top pocket of my scrubs and I start to put it all together.

Invariably somebody from the patient’s team will approach me,

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