I am having the worst shift ever 🙁

I can’t believe it. There’s a blue whale in the ED corridor. I get bleeped by the ED consultant in charge - he tells me we’re getting slammed down here, and he has ambulances coming out of his ass and he’d appreciate my help in seeing it first. 

“A blue whale?”

“Yeah if we leave it too long it’s going to end up being peri-arrest. I’m not really sure how long they can survive outside of water. Would you mind seeing it as a matter of priority, you can probably turn it around relatively quickly. I imagine it just needs a bit of hydration.”

I walk down (never run in a hospital) and am greeted by the familiar bleeps, bells, screams, and bustle of the Emergency Department but also there is a massive blue whale taking up most of the space in the corridor. It’s been placed on a row of a dozen or so bariatric beds strung together. 

I’m accosted by the Nurse-In-Charge with a clipboard. I’m not sure at first if she is talking to me or into her bluetooth headset. 

“...yeah can you can do something about this please, it’s taking up all the space in my corridor. We’re trying to make a bed for it, but it’s going to need half a ward. I’m on the phone to site right now, but they will need to get maintenance to knock down a few walls. Apparently infection control need to have its TB status checked, but that takes 6-8 weeks, so it needs a side room as well. Yeah hello is that site…”

I walk towards the low anguished moaning sounds, but get accosted by a patient. “Hiexcusemesorry, we’ve been waiting here for 6 hours. I know you guys are really busy,” she glances at the whale. “My daughter Elizabeth has broken her foot and she has the sepsis, and she hasn’t been offered any tea, can you…Elizabeth stop jumping near that disgusting thing please.” 

I keep moving. I see a humongous whale lying on its back, writhing and moaning in obvious discomfort, and a small army of nurses and HCAs pouring fluid on it from bags of saline. A paramedic, standing under the whale’s flipper, notices me. 

“Ah, are you the doctor looking after Bailey.” The paramedic strokes the blue whale and shouts into it’s  gill, “It’s okay Bales the doctor’s here now. Do you want to hand over this one.” The paramedic motions over to his junior colleague who pulls out a clipboard. 

“Yeah of course, hi sorry, this is BAILEY. Well we don’t know his name but I think he is Bailey. Bailey is a 65 year old blue whale. We found him on the beach, and we think he is hypothermic. We tugged him here. We don’t have much of a background and unfortunately Bailey’s airway is a little bit obtunded so we tried to put in an airway device but he just swallowed it. I’m not sure if there’s weakness in one of his flippers so may have had a stroke, but we’re not sure if that’s new. He also sounds very chesty. I think he probably has chest sepsis from his lungs.Sorry we could’t find a vein for ages but we finally managed to get a yellow paediatric cannula in. We’ve got a bag of 500ml Saline going, but he looks a bit wet so we weren’t sure about heart failure so we’re giving it very slowly. We’ve also squirted some oral antibiotics into the blowhole. He likes to be called Bales.”

Next comes the nurse: “He’s really cold doctor. I couldn’t really get any other obs. I’m trying to get a bair hugger, but they only come in one human size. Perhaps we can just leave it on top of him? What do you think?” 

I try to assess the whale as best as I can. I try desperately to think of any whale-related simulations that I’ve been involved in, or any guidelines which might be pertinent to whale pathology but my mind draws a blank. Finally I fall down on the familiar A-E. Meanwhile the whale thrashes about wildly. It’s clear that it may die at any minute, and the bags of saline are not doing the trick. 

The nurse turns to me, “doctor I can’t do CPR on a whale. I’m not signed off my BLS for whales. They didn’t have any slots.”

Whilst I’m trying to feel pulses, an extremely well-dressed middle aged lady taps me on the shoulder. 

“Can I have a word in private please?”

We move somewhere within earshot of a different patient who is clearly having a mental breakdown which is the only piece of empty floor real estate in the Emergency Department. 

She does not look at me, but through me. 

“I want to begin by saying how much I respect and value the hard work you do. Thank you. Thank. You. Your selfless dedication to excellent patient care in these difficult times is truly remarkable. On behalf of the entire managerial exec team, I can say you are truly living up to the trust values of Work, Motivation and Love.” She claps for an uncomfortable few minutes and then goes on. “I cannot thank you enough. I am in awe when I see you staff at work. But doctor we must always remember our obligations to the GMC’s good medical practice.”

I’m alarmed, those are three letter no one wants to hear coming out the words of a senior hospital manager. 

“The GMC?”

“That’s right. Again I want to thank you for your incredible hard work. I cannot say that enough. Thank you. Unfortunately the care of the whale is almost certainly going to make it into the news, and therefore place the organisation under scrutiny. As you can appreciate, that can cause reputational damage to Our Beloved NHS. Thank you so much for everything you do, but we have a SOP for this possibility. It means we must conduct an impartial investigation now where we will unfortunately find you guilty of gross patient negligence. For that reason I’m obliged to inform you that we are pre-emptively referring you to the GMC with a recommendation to impose sanctions that you are not to attend any non-humanoid patient without a chaperone. We will also advice that their investigation should take at least 5-7 years to bankrupt you. Thank you for your amazing work.”

She disappears and I am left distraught. I pick myself up and go back to the whale, who by now has arrested, and has gone through the rigours of ALS. It proved impossible to get an ECG tracing (leads not long enough) so it was treated as a Vfib but unfortunately during the defibrillation the water dripping from the body of the whale electrocuted everyone in the vicinity, and caused the whale to explode in the corridor, covering everyone and everything in blubber. 

The cleaning crew wouldn’t go near it (“not signed off for whales”), so a random poor F1 is called to scrub away bits of whale gore from the ED floor. 

A matron finds me. “Doctor you need to fill in a datex. The surge in electricity from the explosion caused a light bulb to go off on the seventh floor. The patients could have fallen over in the darkness.”