Eight years ago I wrote about the ‘Igglepiggle moments’ of my clinical practice. The quick fixes in paediatric ED that punctuate my week and lighten the load, reminding me why I love my job, grounding me in what really matters. I was reminded again this week of my Igglepiggle story; the satisfaction of manipulating a pulled elbow in an inquisitive toddler who a few minutes later will have totally forgotten the experience as they get on with the serious work of playing. The look of amazement on their parents faces when their fears of a broken bone and weeks in plaster are dissipated in moments. 

The specialty I work in, and my role in it, has changed in so many ways over these eight years. Demand in Emergency Medicine has rocketed, departments have expanded and minor injuries are less frequently managed by doctors nowadays, instead being the realm of Emergency Nurse Practitioners. Eight years ago I wrote how I dreaded the day when political and financial pressures would result in all minor injuries being streamed away from ED consultants, recognising that it was these quick fixes and ‘Igglepiggle moments’ that helped me maintain a sense of balance in my world of resus, dying patients, targets, complaints and managers. Maybe the fact that a much greater proportion of my working week is currently spent in non patient facing work makes these moments even more special, even more important.

 The last few months have seen the working environment and daily routines of us all change in ways that we would never have imagined possible. Pandemic restrictions, PPE, red and green pathways, frustration at decisions made for us and about us over which we have little if any influence. We are realising that the first wave of the pandemic may well turn out to have been the easy ride compared to what we are about to embark on, and that realisation is a heavy weight to carry. Back in April the hospitals were quickly emptied, virtually all elective work put on hold and staff redeployed to shore up the ‘front line’ and share the load. With the country in lockdown and many frightened to leave their front doors, demand in ED plummeted meaning we were able to manage the not insignificant challenges of the many patients unwell with covid who needed our care. 

Things seem different now. There are clear expectations that business as usual in the NHS needs to be restored; much work has been undertaken and ambitious plans have been developed to achieve this. Our hospitals are full again, with the added complication of closed bays and wards due to appropriately stringent infection control procedures needed to keep us, and our patients safe. Staff are tired, and the dwindled footfall to the ED back in the early weeks of lockdown has risen back to the highs of pre-covid, and in some areas beyond. We now relish the days when a news flash reminding us all of the rising cases and latest local lockdown results in a downturn in emergency foot fall as the population busy themselves with toilet roll and pasta restocking activities!

The quick wins – noticing them and celebrating them. Little steps, the completed to do list, the smile from a patient or colleague, someone going above and beyond. An extra hour in bed, a beautiful sunrise, a wild stormy sea. All these little pleasures need to be noticed now. A reminder that in fact the world has kept turning and the day that seemed insurmountable was in fact manageable and passed without event. I was reminded this week that the seasons march forward. These strange times that started back in early Spring are still with us as we enter Autumn. The natural cycle of growth, greenness and harvest have continued unabated and now, if we only take the time to notice, the natural world around us is taking steps to prepare for a long winter ahead.

We need to do the same.

It may seem daunting. Terrifying in fact. How will we get through endless days of lockdown and the rule of six whilst the rain lashed our window panes? What will the restrictions become as the days grow shorter? Will ‘Our NHS’ become overwhelmed? Will schools stay open? Will the economy ever recover? I don’t know the answers to these and the hundreds of other questions that keep racing around my too active brain when it’s trying to rest. But what I do know is that the spring bulbs I planted in my garden last weekend will shoot through the winter frosts and flower on a bright February day. I know that the trees that are shedding their leaves now will be in full leaf again by the summer, and that next autumn will arrive in the same way it has this year, full of deep orange and golden foliage reflecting in still lakes ready for the perfect photo opportunity.

And I also know that my guilty pleasure of reducing a pulled elbow in a disgruntled toddler will always make me smile, and help me remember all the Igglepiggle moments that make me love the job I am privileged to do. Covid may have changed the way we live beyond all recognition, but it hasn’t changed everything.

The little things. The quick wins. Your guilty pleasures. Notice them.