How to be a FALCON

Or How to Stare Down the Apocalypse

By now you may have twigged that in my institution we have an unholy obsession with role-delineating acronyms. We have the EPIC (Emergency Physician in Charge), an OWL (Observation Ward Leader), and a CAT (Clinical Something-starting-with-A Teacher), as though we are all in some delightful Edward Lear fancy about to set sail with a runcible spoon. We are, most assuredly, not.

The latest addition to our menagerie is the FALCON. A role of necessity. Like most emergency departments the world over, we are imploding. The inn is full, the system bust. Ambulances line up in dirgeful, funereal queues, trying to offload their human cargo to us. Every part of our previously functional system has ground to a halt. Cue our newest role: Front of House Clinician. The bandaidiest job imaginable. The dyke finger. The person with a bowtie and ‘would you mind arranging the deckchairs’ as their job description.

We needed a name for the position. Most of the suggestions made by a jaded consultant workforce are not printable in civilised company. To be honest, I can’t recall what made us come up with FALCON, but I can’t blame previous us. If it gave us a laugh for a few precious seconds, then so be it. Possibly it was Front Access Liaison Consultant (or Not). I don’t know. But FALCON we are.

We were promised an RMO and a nurse to help us. We have neither. Mostly we are a lone consultant slightly past their prime – like incorrectly stored perishables – trying to assess a roiling ocean of undifferentiated patients who cannot get their foot into the emergency department door. Wave after wave over which to fly and somehow sort.

I am not a very good FALCON.

I start my shifts having mantra’d the s&*t out of myself. ‘Just do the best you can for the patient in front of you’, ‘Don’t sweat the small stuff’, ‘I AM KING CANUTE’, which deteriorates through the day into ‘if you survive the day you can have chocolate’, and ‘is it OK to drink wine on a tea break?’

Out on the ‘ramp’ trolleys are stacked so close together their metal sides generate sparks. I suck in my stomach to squeeze between them in the hope of getting an IV line in. I am happy I can still do this (suck in my stomach, that is. Let’s admit it. I am vain). The joy is short-lived. I try to put an IV in at an angle Euclid would disapprove of. I miss. The paramedics make a face. I am suitably embarrassed and slink off, muttering something about dehydration or valves or the patient moving at an inopportune moment. There is no room for hubris in this job. Transparency keeps even the mighty humble. Eventually I get another in, and I celebrate these small victories, as if they were somehow vital to the future of humanity.

Falcons are majestic birds. Magnificent raptors. Swooping kings of the plains. I am less resplendent, more a spluttering ground-dweller, hell-bent on some sort of survival if not for myself, at least the patients.

The noise out on the ramp is an affront to delicate ears.  It cannot be measured in decibels. I try to take a history of a deeply intimate problem within earshot of the entire world and their iPhones. I want to put in a femoral nerve block, give some analgesia, reduce a misplaced joint, but am hamstrung by the inhumanity of the ramp. I try and refer a patient directly to their expecting team but the only phone that remains after most have been lost in the Congo of scrub pockets has a flat battery.

In an attempt to optimise what is a clearly unsatisfactory architectural footprint for this unique challenge – to provide some sort of space for these antechamber patients – we have renovated. Multiple times. So many times, in fact, that the ceiling has grown transparent. Recently it collapsed on one of the RMOs, causing him to spend his entire shift in spinal precautions. With no sick cover. I deeply wish I was joking in the services of a minimally amusing anecdote here, but sadly I am not.

I continue my FALCON shift. I write reams of forms, hoping someone will do a blood test, perform an Xray. I tell the EPIC this particular patient needs to come into the department immediately. They smile patronisingly at me.

The obvious question is, why. Why are so many patients stuck outside the emergency department, when they should be warming their toes by the clinical fires inside? How can we walk this ridiculous line of one patient out, one patient in?

The most accurate answer is, the crumbling fabric of society. Every deterioration in societal standards, no matter how subtle, how fleeting, wherever in the chain it is, more people end up needing the services of the emergency department. Every failure, both concrete and abstract, contributes to more patients needing unplanned care. To list them, to outline them like red wool in a TV serial killer episode, needs many more pages than we have available here.

I say this without even referencing the pandemic.

One might noddingly agree that these are, indeed, apocalyptic times.

Have we ever, in the history of humanity felt so close to a definitive apocalypse? Of course, humans have always felt an apocalypse is nigh. For most of our past the apocalypse has been a religious concept. Now it is secular. Because who needs God when humans can create end times all by themselves?

By the time a meal break comes, I sit in the socially distanced tea-room eating a tuna and bean abomination extracted from a mournful hole in the vending machine where the chocolate ought to be.

I get back to the ramp just in time to see a patient attempting to re-enact the final scene in White Lotus with Armond and the suitcase in the Pineapple Suite. More patients have arrived. Few have left. I wonder whether we could hire one of those Japanese Train guards who manages to push more passengers into a departing train that physics would ordinarily permit.

Is this Dante-esque scene simply the first taste of some cataclysmic finale? Climate change, mismanaged pandemics, the crumbling fabric of society. I then recall that of course the apocalypse is nigh. We are always going to end. In several billion years our glorious sun will flame out into a red giant, broiling our miniscule planet. In several trillion years the universe will have spent all of its nuclear power, and it will return to a void. These thoughts are somehow comforting, and I shrug, clocking off for another day.

‘How to…’ An Instruction manual for those in Critical Care

• How to be EPIC
• How to be The Shop Floor Clinician
• How to Read an ECG
• How to be Kind
• How to be EPIC (in the time of COVID)
• How to be a FALCON