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The Globe and Mail

Doctors face punishing pace in the ER every day

Dr. Graham Cleghorn is seen in the emergency department at Sunnybrook Health Sciences centre in Toronto, Ontario Tuesday, November 19, 2013.

Kevin Van Paassen/The Globe and Mail

This is part of The Globe's months-long series on the challenges facing Canadian hospitals. All of our published material has been reported with permission from staff.

It's 11 a.m. on Tuesday. Elsewhere, people are starting to think about what they'll have for lunch. In the emergency department at Sunnybrook Health Sciences Centre, Dr. Graham Cleghorn is busy trying to figure out how to return a 90-year-old woman's heart rate to normal. She arrived with her son earlier that morning with a heart rate so low it sent the entire department into a flurry of activity.

Dr. Cleghorn is on the phone with poison control, making sure the woman's current medications won't interfere with their proposed remedy. He hangs up and discusses the course of treatment with the health care team, who immediately get it started. He's hopeful that she'll be stabilized in a few hours. Although she's being admitted, it's difficult to say when a bed will become available on one of the patient floors.

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This case is just one of many that will require urgent attention and careful action throughout the day.

"It's very rarely not busy," says Dr. Cleghorn. "Most of the time, it's like, how do you get the flow through because you're at a critical tipping point about when we start to become overcrowded."

Dr. Cleghorn leaves the woman's bedside and hurries into the "green zone", one of the four separate pods that makes up the emergency department. There, he checks on a woman in her 60s who woke up in the middle of the night with chest pains. Dr. Cleghorn asks the resident physician if blood work, X-rays and other tests have been ordered. The woman is no longer experiencing much pain and appears to feel okay, so Dr. Cleghorn moves on to address more urgent cases.

One man has arrived with a scrotal abscess that Dr. Cleghorn must drain. Another patient with suspected tuberculosis has been isolated in a "negative pressure" room that uses a special ventilation system to prevent contaminated air spreading the infection. A male patient is lying on a spinal board in a neck brace because he fell and hit his head on a table.

Dr. Cleghorn can only take a few steps before he is interrupted to answer a question or drop everything to see a new patient. His eight hour shifts regularly extend into 10 and while they fly by, the workload has a punishing pace. He and many others who work in the department sneak bites of food when they can; the idea of going out to eat in the cafeteria seems laughable.

"The hardest thing, I think personally for me, is probably just the shift work. I always tell my friends that working shift work is a little bit like having a full-time job here and then having a full-time job in Australia and what you do is you work here and you fly to Australia and you work days in Australia. You're jet lagged a lot of the time," he said.

Every day, there's a new crop of sick patients who show up at the department. Some of them will need to be admitted, which will cause a scramble among staff to find a free bed in the ever-busy hospital. Many will have to wait for hours to be seen.

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It's just another day in the emergency department.

Follow me on Twitter: @carlyweeks

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