For doctors like me working in A&E, crisis is the new normal In the first column in a new i series, our doctor reveals life inside an A&E unit

It’s 2am on a Saturday morning and I’m working a night shift. The site manager walks into the doctor’s office to announce that the hospital is now on “black alert”. That is a not too subtle way of saying: “The hospital has run out of beds.”

This means that anyone who has come into A&E and needs to stay in hospital can’t. Not here at least. We’re told we need to “treat and transfer”, which sounds more like a Formula 1 pitstop than an emergency department to me.

This might all seem very dramatic, but you can tell from the team’s muted reactions that this is just par for the course. I decide that this isn’t the moment to question the point of a traffic-light alert system that uses the colour black more than amber and green.

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The site manager leaves the room having barely raised her weary eyes from a clipboard that holds a bed list littered with frantic annotations. Ready to see my next patient in A&E, I finish writing the plan for an elderly woman with new confusion and a probable chest infection, knowing that I’d just told her family it shouldn’t be too long until she moves to the ward. Now there’s every chance she’ll be moving to a different hospital.

By now, A&E is even busier. The scene looks like it’s been plucked straight from the stock footage Panorama might use to introduce a piece on the NHS winter crisis. There are patients waiting on trolleys everywhere: by the lifts, along the corridor, in front of the nurses’ station, you name it.

I steel myself and begin the age-old quest of attempting to find the patient the A&E doctors have referred to the medical team. I overhear my colleague examining a patient on the now-coveted “trolley by the lift”; their privacy is just about maintained by a fold-out room divider.

“Cubicle eight”, I’m told. “No he’s moved now, try the other side.”

These are the hurried instructions of some of the best nurses I know, but they’re struggling to keep up with the sheer number of jobs being thrown at them from every direction.

‘It’s like the metaphor of a frog boiled alive when the temperature of the water is increased bit by bit’

Eventually, I find my patient in a quiet cubicle at the end of the department. He’s a delightful old man with Parkinson’s who’s been finding it harder to get around over the last few days. His wife is at pains to admit they’re struggling to cope at home, especially since they stopped receiving visits from a Parkinson’s nurse. I pull up a chair. It’s a small gesture but one I hope demonstrates, despite the chaos around us, that we do care and that we are here to listen.

It’s not until I’m sitting down on the train home at 9am that I stop to properly reflect on what had, at the time, seemed like a night when the hospital was in crisis. But I know this isn’t a one-off. It’s the new normal. We’ve been told that the NHS is in crisis for years now. We’ve become desensitised. It’s like the metaphor of a frog being boiled alive when the temperature of the water is increased bit by bit rather than all in one go.

Crisis doesn’t have to mean imminent collapse. Every system has its breaking point and it feels like we’ve been edging closer and closer to it. National A&E performance is now the worst since records began. The resolve of the brilliant nurses I work with can only be taken for granted for so long.

Anyway, it’s bedtime, and my brain can’t be dealing with existential problems like this right now.

The Secret Medic works on the front line at a major acute hospital in the UK. Their columns will appear in i