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
A man wearing a smart shirt and tie is wide awake and pacing the corridors. He doesn’t look sick but one of his shirt sleeves has been cut clean off at the shoulder. He is a security guard and hours earlier was bitten by an IV drug user. The bite is barely noticeable now but he is at risk of HIV or Hepatitis. All he can do now is wait for the results of blood tests. “He has a long few months ahead of him before he gets the all-clear,” says Majella Kilmartin, the triage nurse on duty tonight
She has been here since 1999 – “so long that the drama doesn’t impact on me any more”, she says. She is still affected by the sadness though. “A lot of patients’ self worth is nothing, absolutely nothing. I see a lot of second- and third-generation drug problems coming in and too much long-term alcohol abuse problems. As a triage nurse I would sometimes like to delve a bit deeper and go past the superficial problems but I just don’t have the time.”
It is 10pm and the man with suicidal tendencies has just been seen by an on-call psychiatrist and moved from the “quiet room” to the loud corridor. He is staring straight ahead, barely blinking. He looks utterly lost and terribly sad. It is a heartbreaking sight.
Helen Schuster, the senior nurse on duty, walks past him and notices the man who fell out of the wheelchair has pulled a blanket over his head to block out the fluorescent lights. “Don’t pull the blanket over yourself,” she says to him. “You’ll end up in the mortuary.” She laughs. He doesn’t. He is still dead to the world.
“Security to the waiting room. Security to the waiting room.”
The hospital PA comes to life. At the front desk, a very drunk and barely coherent woman in her 50s is shouting the place down. Kilmartin immediately takes her into triage. “I’m not drunk, I’m just tormented,” she says. The nurse is calm and firm and tries to establish if she should be concerned about anything more than the reek of booze from her new patient. “When am I going to lie down? When am I going to lie down? I’m a very bad case I am, ” the new admission slurs. She is given a trolley and she passes out in seconds. I marvel at the nurse’s calmness in the face of such belligerence. “When you are dealing with someone who is really hostile you can’t confront them,” she explains. “Once you do, the problem can get a lot worse very quickly.”
It is just before midnight and the number of people in the waiting room has fallen to 14. Critical Care One is empty but the beds in the other units are full and there are 11 people on trolleys in the corridors. An earthy fog of booze and body odour hangs over the place.
A man in his 40s comes in wearing only jeans and a leather jacket. He has his mother-in-law with him. His head is covered in blood and her arm is in a sling. A family event has just turned nasty “after a few drinks” and he was hit on the head with a bottle. She was pushed to the ground in the commotion. Triage nurse Kilmartin bandages his wound and tells him he will need stitches. The mother-on-law needs an x-ray. He wants to go home. “I am a very fast healer,” he assures her. She’s not buying it. He stays.
The first one through the doors first thing on Sunday morning is an ashen-faced man who can walk and talk unaided. He looks inconsolable but physically fine. “The ambulance men told me to come in,” he says in a quiet voice. He gives Hartigan his personal details at reception and when Kilmartin takes over, he admits to having overdosed on heroin. “I’ve smoked it a few times and it was grand but this was the first time I injected it and I collapsed,” he says. “I feel like such a scumbag.” He wants to go home but Kilmartin explains that the ambulance staff have given him drugs to counter the effect of the heroin but warns that they will soon wear off. “It’s a short-acting drug and once it wears off you will need to be here,” she says. He is assigned a gurney. “You’re on a very dangerous path,” she tells him in a very non-judgemental way.
Just minutes pass before the next drug victim comes in. An man in his 20s is unconscious as he is wheeled through the doors by Dublin Fire Brigade. They picked him up after he fell down at a house party. “We were told he had two ecstasy, a naggin of vodka and some Budweiser,” one of the ambulance men tells Schuster, the nurse who meets them. “There was a load of them at the party and they were all out of it,” the ambulance man tells me. “We asked them what he had taken and they all say ‘nothing’ and there they are with their eyes like portholes. We don’t know how much he took. They eventually said two but it could have been eight.”
Kilmartin takes a roll-call of the waiting room. There are now eight people waiting to be seen. Hugh Laurie’s House is on the muted TV. Nobody is watching the medical drama unfold – they have their own dramas to be concerned about.
After 1am a very well-spoken man walks up to the reception desk. “Nurse, I think I am banjaxed. I think I am finished,” he says before adding that he just had “a few drinks”. Apparently he fell and hurt his back. “But I wasn’t under the influence,” he insists. “I’m not a messer, I’m not a troublemaker. You’re a magnificent lady and I am sorry to be like this.” He seems more lonely than any thing else. He is given a trolley and he falls asleep.