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
The man admitted on ecstasy is nolonger unconscious. He is roaring. He has wet himself and is wandering the ward unsteadily, looking for his mates. He has no idea where he is. Nurses get him back to bed and remove his soiled clothes. He passes out again.
An old lady is brought in after collapsing at home. She is the first person admitted with a non-drink related condition in more than five hours. She is sober and sorry. “I am an awful nuisance,” she says in a quiet voice. “I don’t want to be bothering anyone.” She is seen quickly and given another trolley.
Half an hour passes and ecstasy man wakes up again and goes for another walk. A naked one. He approaches the elderly woman’s bed. She looks terrified. Within seconds medical staff surround him. Despite the intense provocation and his aggressive stance, they remain calm and take him back to his bed. Security men hover nearby but aren’t needed.
At 2am a burns victim is rushed into the high dependency section. His face, hands and knees are black with soot. Eight medical staff, including the senior doctor and senior nurse, attend to him. He is shaken but coherent. “I lit a candle for my mother. Her anniversary is tomorrow,” he says. The candle set some plastic bags on fire and he tried to extinguish the blaze with a damp tea towel which caught fire too, as did his flat. He got out alive. Jokingly staff tell him he looks like Al Jolsen and he starts singing. “How I love ya, how I love ya Mammy!” Everyone laughs. Then he is given a chest x-ray because, while the staff make light of his condition, they are concerned soot inhalation may have done serious damage to his lungs and airways.
Minutes later an elderly man with a long white beard is wheeled in. His nephew says “he had a few drinks” but collapsed and the left side of his face started drooping.
“We’re just not winning on the list tonight,” says registrar Nic Iomháin. “Sometimes you get the drunks trumping the others in the waiting room. It is sad but there is not a whole lot that we can do about it. We can’t ignore someone because they may have been drinking.”
Ecstasy Man is back on the ward still naked. He is returned to his bed and a stoney-faced hospital orderly stationed by his bedside. “We can’t send him home,” says Pedreschi. “His heart rate is elevated and he is still very confused and there is no-one to take care of him. This can be a bit of a baby-sitting service sometimes.” A very, very expensive one.
Next through the doors is a man in his 30s who seems confused. Another drunk? No. He was struggling to focus or keep his balance when he got up for work an hour earlier. He is the second sober person to come through the doors. There is concern about his condition and he is scheduled for a CT scan just in case he is suffering from a brain bleed or worse.
The bearded man admitted with the suspected stroke has made a miraculous recovery and is getting dressed despite not having seen a doctor. Pedreschi advises him to stay where he is but he gets agitated. “This place is too noisy. It is like being in f**king Afghanistan with all the beeping and banging. I came in here for treatment not torment,” he shouts. “Now, what I need is a smoke to clear my head.” She tells him to go for a smoke and promises to move his bed to a quieter spot.
There is high drama at 6.30am when a catatonic man is rushed through the doors by ambulance men. Three guards are not far behind. He had wandered into a station drunk a couple of hours earlier, keen to discuss a murder dating back to 1994. The garda on duty refused to take his statement while he was so unhinged by alcohol so he got aggressive and was arrested. Then he had a seizure. Nic Iomháin revives him by running a thumb hard along the base of his foot. He sits up, looks in the direction of the arresting guard and shouts “ya baldy c**t. I’m going to get you, you bald pr**k.” He tries to get past the medical team but they are having none of it.
While they attend to him, the burns victim takes a turn for the worst. His airways have swollen and he needs intubation quickly or he’ll stop breathing. An anaesthetist is called and the procedure done in minutes.
It is done to the strains of Raglan Road which waft in from the corridor nearby. The suspected stroke man has agreed to stay and is singing. He has a good voice which carries through the unit.
Not far away a woman in her 70s struggles to keep her eyes open. The song reaches her and she smile the smallest of smiles. She is clutching tightly the hand of her husband, admitted more than 12 hours earlier. He is sleeping fitfully but she is bolt upright. She won’t go home until he has a bed. It will be hours yet. A few feet away, on the other side of locked doors and a thick glass window is a room where patients already seen and those still to be seen are waiting. Their number has dwindled to just five. Then an ambulance pulls up and the cycle of sadness and suffering starts up again.
To see more of Alan Betson’s photographs, go to irishtimes.com