It’s Friday night in A&E, ‘Enjoy the show’

“SIT back and enjoy the show,” the patient was told, as he settled into a night in Accident and Emergency in the Mid Western Regional Hospital Limerick to watch the horror show unfold.
It was 1am Saturday and although he was just admitted to the hospital by an A&E doctor, who was too concerned for his health to let him home for the night, the nurse in charge was giving him no false hopes.
He was 27th in line on trolleys in the overcrowded A&E Department waiting for a bed and the night was still young.
His bed for the night would be that trolley, and he would be lying as close to strangers as he had to his wife the night before in a loud, bright and very busy accident and emergency department.
The man in question had arrived from Clare at 7pm on Friday evening, having been referred on by his own GP.
After an hour’s wait in the waiting room he was called and assessed by a triage nurse.
Afterwards he was given a trolley situated right in the middle of a corridor.
A few hours later he would see a doctor, hours later again have an x-ray and hours later again the results.
Behind his head about 20 feet away was the entrance for the patients brought to the hospital by ambulance from Clare, Limerick and North Tipperary.
All hoped no one would be coming in that entrance in a hurry because there were patients on chairs and on trolleys causing more than just a small obstacle.
To the Clareman’s right was a row of chairs with patients holding arms and sides, some with blood cannula, where they had given blood samples earlier, still in their arms.
Beside them were three beds with patients on trolleys lined up perpendicular to the wall. Then a curtain and more of the same until the corridor turned left, or you went straight on to the ambulance entrance.
At his left arm just metres away was a door used by staff; beside that a chair with a patient holding his left arm; next a man on a drip trying to sleep on a trolley with “Ambulance triage point” on a sign overhead; next a collection point for blood samples with yet another two trolleys in front of that, before a door to what appeared to be a treatment room for seriously ill patients.
Yes, no one was going anywhere fast that night – nurses, patients, tea ladies or paramedics.
I wasn’t going anywhere either, as I observed over stretched, stressed staff and tired, ill and irritated patients making their way through the night.
Each area of the A&E was filled with trolleys, people on chairs and the walking wounded.
A teenage girl with a gash on her head was semi-conscious and vomiting into a paper tray held by her father.
A man in a full back brace was wheeled around at will to make way for other patients as they came and went.
Young mothers arrived with crying babies, more experienced mothers with sons who had left the hurling field early holding arms and legs, and other people with their elderly mothers who were all lined up side-by-side hoping for a quieter spot for the night.
In the mix of the physically ill and the injured were the drunks, prisoners and patients with mental illnesses who just had nowhere else to go.
For a lot of the later patients, a visit to A and E was a regular occurrence as the other services had let them down.
Staff were doing their best many using trench humour to survive the battle of the night. The few that could laugh were the lucky ones; most were beyond seeing the funny side.
“Morale is at an all time low,” I was told. It wasn’t hard to see why that was the case.
One staff member told me how she had broken down in tears earlier in the night out of pure frustration.
“How can we help anyone like this? It is the patients that will suffer,” she said.
Another employee told me they were not allowed to talk about the horrors of the service, but said to her mind it was all a health and safety issue.
In the midst of the madness was a nurse you knew had seen it all before.
She walked through the chaos adjusting drips, reassuring patients, all the time bringing in the next person for the long wait.
Here was a woman who could be of use to James Reilly and the Government, but had anyone ever asked the frontline staff what needs to be done, not the unions or the person who shouts loudest but the quite ones that gets on with the difficult job.
“We were told there would be two patients coming from Nenagh after it closed. There were 16 the other night,” said another staff member at the end of his tether. “It is getting worse, much worse.”
Among the Clare people I met was one man who walked out after a five-hour wait with a cannula still in his hands.
Some people took umbrage that they were resigned to a chair, but it was a case of “those in greatest need”.
Another couple had driven from West Clare after the woman had a serious fall.
It was 11pm, so she bypassed Ennis General Hospital and travelled all the way to Limerick to be told it was just bad bruising.
As the night went on, a rowdy drunk in danger of hurting staff or other patients was taken away by security guards to another room and, if the sounds were anything to go by, was soon sedated.
And all the while very sick people were expected to rest as they awaited their fate, many eventually making it to wards where there would be less staff on for the weekend.
The staff in the meantime moved patients around like a game of draughts, refereed drunks, and tried to appease patients who were becoming impatient, all the while trying to do their own jobs.
And this was just Friday night; Saturday would as always bring the worst of the weekend excesses. Thank God we weren’t there to see that.


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