A hard day’s night - 12 hours in a Dublin A&E
Smelling of alcohol and body odour, with the constant threat of violenceand staff pushed to the brink, St James’s Hospital A&E in Dublin is a grim place – especially on a busy Saturday night, as Conor Pope, discovered on a 12-hour shift there. Photographs by Alan Betson
It is just before 7pm on Saturday night and there are 19 people sitting on the hard blue chairs in the emergency department of St James’s Hospital in Dublin in various states of distress. Everyone’s anxious but only some are in pain. A man in a blue tracksuit is slumped in the back row snoring loudly. His phone rings but not loud enough to rouse him.
Heads turn as two young men burst through the double doors and scan the room urgently. They don’t look sick – or concerned for anyone who might be – they look angry. As they walk between the chairs one takes a phone from his pocket and answers it. “He’s where? Is he running? Right.” He hangs up. “They seen him, he’s in Rialto.” They leave, with menace in their eyes, like pasty-faced extras from Love/Hate.
This mysterious mini-drama over, the room goes back to waiting. I am the lucky one. I don’t have to wait long and minutes later Patrick Plunkett, head of emergency medicine, picks me up and takes me on a tour of his department. He grew up in nearby Ballyfermot and is more deeply embedded in the community, one of the most social disadvantaged in the State, than his consultant peers.
He’s not one for sugar coatings and he talks openly of the intolerable delays patients under his care tonight will face and the violence that will constantly simmer in the hostile waiting room. He tells me my night in A&E will not be easy. But I know he’s wrong. Of all the people here, my night will be the easiest.
At the doctors’ station Plunkett points to a computer screen that has given all the patients seen so far a number based on the severity of their condition. The Ones are very seriously ill and will be treated by doctors within minutes. Right now, an elderly woman with a swollen leg has been waiting longest to be seen. She has been here for nearly 10 hours and keeps getting bumped down the list because she’s only a Three. There are lots of Twos. The drunks tend to be Twos.
Triage is separated from the waiting room by three blue doors and behind it is the clinical care section of the department. This is where the handover from day to night staff starts at 8pm. Medics crowd round a white board and discuss patients already admitted. The registrar on duty tonight is Úna Nic Iomháin. Plunkett is on call but is heading home soon. Before he leaves he highlights the complexity of the bed management system. “If someone is to be moved from here to ICU then someone has to be moved out of ICU to high dependency and then someone has to be moved to a ward. It is like one of those little plastic puzzles which have a piece missing and until you get it just right the clear picture doesn’t emerge.” Often moves can’t be made – particularly overnight – so patients are left on trolleys or on the hard blue chairs outside.
An emaciated man in his 20s is sitting alone in one of the “quiet rooms” reserved for patients with psychiatric conditions. He has been admitted as a potential suicide risk. The last few weeks have been tough for him. He has been moving from hostel to hostel and has been denied access to his children. He also has HIV. “Where’s he going to sleep tonight?” asks Plunkett. “I’ll take care of it,” Nic Iomháin says.
She is specialising in emergency medicine largely because of Plunkett. “I worked here as an intern and he became a role model. He kind of inspired me,” she says as soon as he has left the building. “The beauty and the hell of this job is you never know what is going to come through those doors. You might be working for 12 hours straight and struggle to get something to eat or drink and you are constantly putting out fires and worrying that you are not seeing enough patients or spending enough time with them. ”
It is 8.30pm and Gabrielle Dunne, the advanced nurse practitioner’s shift has ended. “I have been here a long time but I still get shocked by the stories,” she tells. “A mother might come in having lost two kids to drugs and then there is the domestic violence. We get a lot of domestic violence. But the single biggest problem is alcohol. If we could just reduce the amount of alcohol consumed.”
She walks me to reception and points to the two women taking patient details. Colette Hartigan and Anne Ryan are “often forgotten about but they take a lot of grief”, she says. They shrug off the praise. “People are waiting so long,” says Ryan. “And often they are with an elderly relative who is in pain. That is very hard for them, particularly when they see some drink-related cases of coming in and apparently being given a higher priority.”
The security guards sit behind a thick glass window watching the waiting room. They would rather not be named. “It is always likely to kick off out there,” one says. “Saturday nights are bad but the worst things are the shootings. You never know what is going to happen when there is a shooting,” he says. “Especially if they’re not dead.”
Aoife Pedreschi has been a nurse here for four years. “The waiting times are horrendous,” she says. “Last night was particularly bad. I went out at one point and was surrounded by desperate people wanting to find out what was going on. I just wanted to tell them that I was on their side.” Her attention is diverted by the arrival of an ambulance. A very drunk man is wheeled in. He fell out of his wheelchair and then passed out, the ambulance man says. He is hoisted on to a trolley where he starts snoring loudly.