Overheard in a hospital: The worst part of taking my son to A&E

OPINION:

It was midnight and our infant son had woken up vomiting. After a call to the Plunket helpline we bundled him into the car and headed to Waitākere hospital's emergency department.

The March lockdown had just begun, so while my partner waited in reception, I was ushered with our little one into the paediatrics unit. As a caring nurse and kind, smiling doctor diagnosed gastritis and set us up with a syringe of electrolytes, my attention turned to what was going on on the other side of the curtain: a toddler wailed in distress as a nurse explained to the woman holding the child that they would need to try a feeding tube. As the nurse left, I heard the woman say: "Shut the f*** up." The child cried louder. It was heart-breaking and I wish I'd said something.

Meanwhile, out in the waiting room my partner had sent me a video of a cat mincing about on the reception desk. Then, more concerning, a message about a couple who had come in. They were angry at a boy trailing behind them. He sobbed as blood streamed down his arm and pooled on the side of his T-shirt. At no time did the adults who brought him in show him any affection, not even a consolatory arm around his little shoulders, just shouting and arguing over who would take him through to be seen.

As we left the hospital early the following morning, our son deemed well enough to go home, my partner and I agreed we both felt sick about what we'd seen. In fact, observing how those unwell and injured children were treated by their primary carers was the worst thing about our whole ordeal. We were left wondering how the kind, calm staff who deal with this every day cope.

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A New Zealand Nurses Organisation (NZNO) delegate based in the Auckland region agreed to speak to me anonymously about the issue, explaining how they handle these sorts of incidents and the emotional toll it takes.

Comfortingly, she tells me what we witnessed in one night isn't common in her experience as a nurse. But there are instances where staff have to intervene.

"We work a lot on gut instinct. We see patient interaction every day. We see how people should normally react to their family. So we react on what we see, what we hear, and also what we feel. If we're hearing stuff, we're going to have to report it or go through the right channels. Or if we have a gut instinct, we have an escalation process where multiple people will ask in different ways about violence and that sort of stuff as well."

In situations where frontline staff do decide something needs to be escalated, she says there are "lots of other services and agencies we can use to get the family the help they might need".

The process often begins with a call to a social worker and a report of concern filed with Oranga Tamariki. The agency then follows up to see if there have been any other instances with the family in question or if a file needs to be opened.

"If we did find there was something going on, we'd do everything we could to help that family. We wouldn't just ignore it," she says.

In a time where staff burnout is at an all-time high, the emotional toll of witnessing concerning behaviour is pronounced.

But she says huge support is found in colleagues and charge nurses. "The best coping mechanism is to debrief about distressing situations and work on constructive ways we can help prevent or assist if these situations were to arise in the future."

Carer stress is also considered: whereby the person looking after a sick child may also be suffering from fatigue and stress.

"Say you'd been up for 10 days straight because your kid has been unwell and you couldn't get them to sleep, you're beyond the point of fatigue - we might admit you if it's deemed necessary so you guys could get support."

In addition to reports earlier this year of increased pressure on emergency departments, she says there has "definitely been an increase in patients presenting to hospital due to RSV".

And she sees it being further compounded by the pressure on doctors' clinics: "Because GPs are so busy, more and more families are unable to get appointments so they turn to emergency departments to get care for generalised illness which used to be managed by GPs."