Shivam Sharma, a junior doctor working on a geriatrics ward in Birmingham, has kept a diary to reveal what it’s like working on a day when less than half the required number of doctors are on shift. The 26-year-old, in his fourth year as a doctor, has to make life-and-death decisions, as a never-ending to-do list grows. As told to Connie Dimsdale.

8:15am – My shift is not due to begin until 8:30am but I get in early to check on two patients who became very unwell yesterday. Worry about their condition lingered with me through the night.

Patients often pass away on a geriatrics ward. The prospect never becomes any easier to accept.

8:30am – A lot has happened overnight. I need to solve problems by prescribing new drugs or fluids for patients who have run out, and review incorrect prescriptions.

9:00am – Handover begins when members of the team come together to discuss all the patients on the ward. I listen to updates and contribute my own insights and recommendations.

9:30am – I start the ward round where I review each patient’s progress, update their treatment plan, and address any outstanding issues.

Today is going to be particularly busy as we are short-staffed due to sickness and leave. There are three junior doctors when normally there are six or seven.

I write notes for each patient and once I have all the necessary information, it’s time to review them with a full head-to-toe examination.

10:00am – There are a couple of patients who I need to refer to cardiology due to suspected heart failure.
Then my attention turns to one of the two unwell patients from yesterday. He has been hospitalised for several weeks and has developed distressing shortness of breath, and I suspect, contracted hospital-acquired pneumonia, but is improving.

Patients who remain in the hospital for extended periods of time are more susceptible to such infections, showing the importance of discharging medically fit patients as fast as possible. However, the ongoing crisis in social care has resulted in many waiting for extended periods.

10:20am – As I review the condition of the second unwell patient, my heart sinks. Despite being on strong antibiotics, oxygen, and nebulisers for four days, the patient’s condition has got worse.

His oxygen saturation levels are still alarmingly low and he is unable to communicate properly due to his advanced dementia. This is a heart-wrenching.

The patient’s family member is understandably distraught. I have to be honest. I explain that the patient’s condition is very serious and his prognosis is poor. It’s a difficult conversation to have, but we need to decide whether to continue treatment or make the patient comfortable during the end of his life.

It’s moments like this that I question my ability as a doctor, to balance the desire to save lives with the reality of what’s best for the patient. I understand the family’s desire to continue treatment and to hold onto hope for a cure. But as I discuss the situation with my consultant, we both know that prolonging treatment will only bring more suffering.

11:00am – Continuing my rounds, I feel the weight of the day’s tasks piling up. Each patient requires some level of attention and care, whether it’s a simple medication adjustment or a more complex consultation with a specialist from another hospital. The constant need for follow-ups and chasing up on test results is a never-ending cycle that can be exhausting. I can already feel my energy levels dwindling.

12:30 pm – As I go through my to-do list for the rest of the day, I’m interrupted by the nurse in charge who needs a handover of all the patients’ conditions and treatment plans.

1:00pm – I have to take blood from a patient with dementia who is being treated for MRSA (a type of antibiotic-resistant bacteria). It can be tricky when working with dementia patients as they tend to be confused and often have trouble keeping still.

I put on PPE and wash my hands before entering the patient’s room. She is in a side room by herself due to the MRSA infection and understandably anxious. I try my best to reassure her and distract her with some small talk. Thankfully, my charm seems to work and I am able to take the blood first try.

1:30pm – Half an hour lunch break and a quick catch up with colleagues. Our union has just announced strike dates so there is a lot of talk about. We all agree we are worth more than a real terms pay cut of 26 per cent since 2008.

2:00pm – I return to the ward, a growing job list is reminding me of all the tasks I have yet to complete.
I start by changing the catheter of a patient. This is always time-consuming as finding all the necessary equipment can be a challenge. Nothing is labelled, which only adds to the frustration.
Next up, I have to make some phone calls to chase up important investigations and referrals. This is always tricky as phone lines are often busy or the on-call doctor I am trying to reach is tied up.

3:00pm – A nurse alerts me to a patient whose condition seems to have worsened. There are several alarming symptoms – an increased heart rate, low blood pressure, and a need for new oxygen. I rush to the patient’s room.
I suspect they are septic due to a possible infection. A chest x-ray confirms the infection so I adjust the treatment plan and instruct nurses to keep a close eye on them.

4:00pm – It’s always difficult to tell a family that their loved one is still unwell, and despite our best efforts, there is no further treatment we can provide.

5:10pm – Time to head home.

6:00pm – I have dinner then I spend time working on my application for speciality training. It’s a very competitive process and I’ve been dedicating a lot of free time to studying for exams and interviews preparation.

8:30pm – I’m feeling pretty tired, but I have some urgent emails to deal with.

9:30pm – I go to the gym. Yes, I am exhausted, and, yes, it’s late but I don’t know how I would function without the gym. It helps me clear my mind and release tension.

11:00pm – Time for bed. I watch some 20-minute TV shows. I’m glad I’m off this weekend because next weekend I am working 9am to 9:30pm.

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