On my husband’s birthday I spent the night stretched out across three chairs in A&E, barely coping with the pain from an infection in my thumb.
At 3am a trolley was finally located in a consulting room where I was hooked up to a drip. It was a real, live NHS nightmare, bringing home to me the patience and dedication of the doctors and nurses who care for the constant stream of patients. It made me wonder: who does this for a living, and why?
Rachel Landau is at the sharp end of NHS emergency care. A consultant in emergency medicine at the Whittington Hospital since 2001, the calm, measured Australian grew up in Melbourne in a traditional Jewish home. At school she was encouraged to become either a lawyer or a doctor.
A week in casualty in her fourth year and an eight week placement at Hadassah Hospital got her hooked on emergency medicine.
“When I qualified I toyed with the idea of going into obstetrics and gynaecology but decided to train in emergency medicine. I enjoyed the variety, the team interaction, talking to people, understanding who they are.”
Landau feels the challenges have grown substantially since she started, citing the rising demand for emergency services due to an elderly and frail population, increasing drug and alcohol abuse, mental health issues and chronic and complex health conditions.
“We are the people who mop up when other parts of the NHS aren’t working. We have a 24 hour service when people cannot find care elsewhere.
"In our department in 2001 we treated 60,000 patients a year, now it’s 108,000. We are very stretched. It’s not the medicine that is stressful, it’s managing resources, organisational demands and performance.”
During the eight to nine hour, shifts, there is no downtime. Yet there is a lot of talk about staff wellness and burnout.
“We need a sustainable workplace,” says Landau. “We need to be able to take breaks. We try to have lunch.
"In my department we have an afternoon tea once a week that all department staff are invited to. It’s a rare few minutes down time and an opportunity to get to know other staff members better. I’m lucky as I find it easy to switch off at the end of the day.”
Landau believes that working in emergency medicine may particularly suit women. “The ER is the front door of the hospital. We interact with people across all departments and we are good multi- taskers. I also think my Jewish ethical and moral code and the impetus around saving life impacts how I interact with people.”
Sharon Taylor was told that she would struggle to get into medical school. Her teachers at North London Collegiate thought her dyslexia would hold her back. But with the support of her English teacher, Taylor followed her vocation and got offers from five medical schools. She’s now a psychiatrist for the Central and North West London NHS Foundation Trust.
“I believe my background has brought me more in touch with people’s suffering,” says Taylor.
“My grandfather lost seven siblings in the Holocaust. It makes you feel fortunate, instils a sense of responsibility and a fundamental desire to do something useful. I felt I came from relative privilege. I was determined to give back.”
Taylor co-directs the Child and Adolescent Psychiatry Programme for North West London for higher trainees. She works on the interface of pediatrics and psychiatry treating young people who present with physical health symptoms such as trauma, chronic illness, locked-in syndrome, encephalitis or injuries that require amputations.
She also helps young people who present with physical symptoms such as paralysis but for whom no known organic cause can be identified and the underlying problem may have psychological components.
Her work is both distressing and rewarding, working with very sick children and supporting families. “Each day is unpredictable,” she says. “There are crises and emergencies. Disasters such as Grenfell. Doctors volunteered their time, as did I. That’s why we did medicine.”
The deep-rooted challenges felt across the NHS are Taylor’s main stresses — lack of funding and understaffing, along with a heavier workload and dealing with issues arising from poverty, gangs and patients at risk.
Nevertheless she feels the flexibility and sensible maternity packages make the NHS a good place to work for women. She splits her work between the NHS and teaching, training and supervising — she provides the pastoral care for up to 30 medical students at Imperial College School of Medicine.
Off duty, her door remains open. “People call you. You definitely work beyond your hours. I make a conscious effort to timetable in ‘me time’— I exercise and have access to a potting-wheel. I prioritise family and friends.”
Consultant academic nephrologist Professor Liz Lightstone remembers when it was rare to see a woman in her specialism.
“Renal was male heavy when I started. In 1988 there were no consultant women nephrologists in England, one in Ireland and I think two in Scotland. When I chose renal as a speciality, I was warned that I wouldn’t be able to do it part time.
"It’s completely changed now. I call myself an ‘accidental nephrologist’ as I didn’t set out thinking I would specialise in this field.”
She started out as a Senior House Officer (SHO) at the Hammersmith Hospital in general medicine. “My consultant would swan in once a week, do a ward round and return to his research. The SHO would run everything. Nowadays consultant nephrologists are the main point of continuity yet have much less administrative support.”
The strain on consultants and doctors can take its toll. Lightstone had a serious acute illness in 2001, forcing her to take a break of several weeks and reduce her workload.
She admits that going part-time to focus on her family and health slowed her career progression. She still has had to fight to ensure women are better represented.
Lightstone, 60, now works nearly full time and does full weeks on call. “The workload is pretty relentless — my clinical outpatient work focuses on patients with complex conditions plus when I’m on the wards, it’s routine to be looking after patients with very rapidly changing clinical conditions.
"For me, the patient always takes priority. Yet I also need to maintain my academic work — undertaking research, publishing or applying for grants.”
She relaxes by tuning into TV medical dramas such as ER and Call the Midwife, as well as prioritising holidays and trips to the theatre.
As the incumbent President of the Jewish Medical Association (London) Lightstone hopes to invigorate the programme and bring younger people on board. She believes that her Judaism has a huge influence on her work.
“I won’t go to social gatherings on Friday nights. I keep kosher. On Yom Tov I am off. I didn’t do ward rounds in the three months leading up to my son’s barmitzvah which caused some bemusement among colleagues. I was asked, ‘This barmitzvah thing — is it a big deal?’
“Being Jewish helps me understand my patients who come from very diverse and often religious backgrounds.
“I am used to worried, sometimes slightly intrusive relatives. I get it!"
