A night in A&E: Life on the frontline of hospital care

Caroline O’Doherty visits St James’s Hospital in Dublin to see staff cope with another night of the walking wounded

IT WAS a quiet night in the emergency department of St James’s Hospital with the main ailments being homelessness, drug addiction, depression, alcohol abuse, violence and a poorly functioning elder care system.

And then there were the accidents and emergencies.

Snoring wheezily on a trolley in the back corridor, one of several trolley-lined arteries feeding into the main treatment area, Peter (not his real name), a wiry man in his 50s or 60s, was deep in sleep despite the discomfort of a bloodied nose, a bruised forehead and a deep gash on the top of his crown.

He took a tumble, he said when woken to have his blood pressure checked. He wasn’t sure when. 10am? No, 8pm? He didn’t know. Did he lose consciousness? He didn’t think so. Had he been able to get up himself? He was getting tetchy now. Sure he wasn’t let get up. The passers-by who called the ambulance kept telling him to lie still.

He quickly apologised for his gruffness. The nurse assured him there was no need. The doctor would be with him soon. He shielded his face with his grubby bomber jacket against the glare of the lights and resumed snoring.

A young woman shuffled past him, swaying slightly, and sat down in the small, almost bare family room, followed at a discreet distance by an attendant tasked with sitting by the door to keep an eye on her and make sure she didn’t try to sleep.

The doctor who called in to her spoke in low tones but there was no way of keeping personal details private. Her chart showed she had been here several times before. What did she take this time? Sleeping tablets. How many? Not enough.

A night in A&E: Life on the frontline of hospital care

The doctor tried again, emphasising the importance of knowing how much of what exactly she had taken. The reply was monotone. All she knew was it wasn’t enough. Had she any family she could call? She didn’t.

At the other end of the corridor, another gashed head was being examined, this one owned by a chatty man who told how he’d been out drinking when suddenly the ground came up and whacked him on the skull. Christmas party? Not really, more like a one-man party.

From the main treatment area came a constant chorus of coughs and wheezes as senior citizens, brought in from nursing homes, were checked out for respiratory problems.

One man, grateful to see his daughter arrive, asked her to wheel him to the toilet. They returned to find his cubicle curtain closed and another man on his bed. They tried to be good humoured but it was a little unsettling to find squatters rights applied even in a hospital emergency department.

Eventually the squatter, a trim, fit-looking man in his 30s was moved, limping, to a trolley in the corridor where a doctor followed and brought him good news and bad news. The weight loss, the thirst, the black-out that he couldn’t fathom was, it turned out, a classic case of undiagnosed diabetes.

The good news was that his condition was very manageable. The bad news was it would take a bit of time to get it under control and he didn’t have time. He was supposed to flying abroad for his wedding in a few days.

Back at the far end of the corridor Peter was being quizzed gently by a doctor as she tried to convince him to focus his sight on her pen and follow it as she moved it.

Peter couldn’t be bothered. He was grand, he said. He didn’t want his eyes tested, his nose examined, his face X-rayed or his scalp stitched. He was fine the way he was.

In between the protests of being grand, the doctor extracted the information that Peter had already survived a stroke, was living in a hostel, drinking heavily and hadn’t taken his warfarin in months because it didn’t go well with alcohol.

The doctor explained if he didn’t take the warfarin, he was at a high risk of another stroke. That was fine with Peter. He was tired of living.

A night in A&E: Life on the frontline of hospital care

The doctor examined him more and the tetchiness returned. He didn’t want to be treated. He didn’t care if he died. He wanted to die.

The doctor asked him if he had ever spoken to anyone about how he felt, if indeed he had anyone to talk to. Sure I’m talking now, he replied. He didn’t mean to be cheeky, he said by way of apology. No need for one, she assured him again.

A new arrival with a bandaged hand and one eye swollen shut settled himself on another trolley with instructions not to doze off as a full head and eye exam was needed.

He had stepped in to break up a fight, he explained, and had no idea whether he’d taken punches or kicks but the next thing he knew he was in an ambulance.

Another trolley was wheeled by, carrying an unconscious girl who looked to be in her teens, her neat clutch bag carefully placed at her feet, the stains of vomit on her party clothes.

More coughs, more wheezes, more senior citizens with expressions that said they wished they could be treated at home, in their nursing home. Anywhere but here.

And this was a quiet night. Monday is rarely the worst an emergency department will see and the waiting time for non-urgent cases was recorded on the electronic notice board as four hours — nothing worth ringing Joe Duffy about. By 5am, it was down to one hour. Barely worth mentioning.

There were 11 patients on trolleys on the Monday morning and that was down to eight on Tuesday. One night earlier this month, it was 26.

A member of staff who kept tabs on the movement of patients appeared every now and again with a folder permanently printed with the words ‘back corridor’. This was no temporarily overspill. The back corridor is not just an artery serving the treatment area. It is a treatment area in itself.

A night in A&E: Life on the frontline of hospital care

With trolleys lining each side, there is just enough room to move a third one through to take a patient to X-ray or to a ward. There are no chairs for people accompanying patients as there is not enough space and besides, they can present a safety issue if trouble erupts.

After seven hours standing by a trolley, an attendant, without being asked and without speaking, appeared and slid a plastic stackable chair my way with a wink. I mustn’t look like the chair-throwing kind.

Much of the activity here isn’t even reflected in the daily trolley counts as people on the corridor who are discharged during the night are not included. Trolley counts only begin when a patient entering the emergency department is declared in need of admission to a ward.

The groom-to-be was allowed home with an appointment for outpatients the next day. The one-man party was declared fit to leave too. Various walking wounded were assured that they too could go once X-rays and/or blood tests came back clear or as soon as a drip bag delivered the last of some restorative fluids.

All the examinations, the tests, the explanations and the assurances were carried out and delivered with patience, empathy and the coolest of heads. These are qualities the staff will need in abundance as their campus is to be home to the new National Children’s Hospital.

It’s a much-needed, long-awaited facility but the chosen site is small, bordered on all sides by tightly packed old Dublin neighbourhoods, with two road access points that at peak times are backed up by the surrounding city centre traffic, with parking already a problem and with Viking settlements all round and probably beneath the ground that must be dug deeply for parking and foundations with all the potential archaeological headaches that may entail.

Whatever disruption lies ahead, there was no time to dwell on it on Monday night as ambulances pulled in, trolleys rolled out and corridors filled up.

However, there was time for the personal touch. As the doctor prepared Peter for X-ray, he stalled her for a moment. That thing he had said. He didn’t want to upset anyone. He really wasn’t going to do anything silly.

You don’t go to heaven if you commit suicide, he said, and he wanted to go to heaven.

“I want to see my mother again,” he said.

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