I wanted to admit him to our ward for the test so he wouldn't breach but I was unable to. He had to be admitted to the main hospital. He would then be seen again by the medical doctors, who would then take the blood and sort him out. Six hours after admission to A&E, they had his blood results and knew that, medically, there was nothing for them to do. However, he ended up staying the night as the medical team was unable to get a psychiatrist to come and see him as quickly as we generally can in A&E.

It was a waste of a bed, a waste of time for the medical doctors as they had to 'clerk him' (take a history and examine the patient) and a huge waste of money. The patient got the right treatment but was confused as to why he was being shipped around the hospital.

For me, it made me feel that my job was pointless. I am not on a training scheme to become a consultant in triaging patients. I am a specialist in emergency care. I didn't need to refer this patient to the medical doctors for their expert advice it is my area of expertise. It really p.i.s.sed me off.

Am I becoming sick?

Is it right that I am hoping patients have various ailments to make my job easier or more interesting? Surely the humanitarian side of me should want everyone I see to be pain-and illness-free? I don't and I am worried I should, but at least I know my thoughts aren't right...

Today I saw a little old lady who had a fall. She was living at home, and her carer had found her on the floor. She was confused and it was very hard to understand what had happened. On examination, I could tell that she had a painful hip. I sent her for X-ray and thought, 'I hope it is broken, because if it is, then she will be an easy referral to the orthopaedic doctors. If it is not, then I will have to do some thinking and sorting out.'

How wrong is that thought? I wanted to condemn the poor woman to an operation, weeks of hospital stay and a 30 percentchance of dying in six months, just to make my job easier?

A couple of nights ago, I was getting quite tired and bored when I saw someone and sent them for a chest X-ray. I was concerned that they might have a pneumothorax (hole in the lungs). I was disappointed that they didn't. I wanted them to have that condition purely so I could get out of seeing another patient and put in a chest drain, which I enjoy doing. That surely isn't a right thought.

A few day before that, I was sure that I had seen a patient with a brain tumour. I was really proud of my clinical examination and history-taking skills. I sent her for an emergency CT scan and was disappointed to find out that she didn't have anything wrong with her brain at all. How wrong is that? (How can I be disappointed that someone hasn't got a cancer, just because it's lowered my confidence in my doctoring abilities?) Do all doctors think that? Am I unusual? Am I an uncaring b.a.s.t.a.r.d? My fears were relieved at the pub when an anaesthetic colleague told me about her day at work. The ICU was full and there was a cardiac arrest on one of the wards. She ran down and during the resuscitation attempt, she kept on thinking, 'I hope she doesn't make it, otherwise I'll be up all night taking her to ICU. I want to go back to bed.' She then said how relieved she was that the resuscitation attempt had failed (although it had been conducted properly). She was relieved that a 60-year-old lady about to embark on her well-earned retirement had died, just so that she could get back to bed?

To someone who doesn't work in the NHS, these thoughts may seem very sick. But as long as you treat your patients to the best of your ability, regardless of any feelings, do not let patients know what you are thinking and realise that the thoughts are wrong, then what you are thinking deep down shouldn't really matter...I hope.

Why do we all lie?

One of the things that I have noticed working in A&E is the lies patients tell us. Perhaps 'lies' is too strong a wordI mean the things they say when they mean something else. Here are some examples I've had in the last few nights: Patient says Patient says: 'I didn't mean to bother you.' Patient means Patient means: 'I did mean to bother you.' Patient says Patient says: 'I had a car accident two days ago and my neck hurts.' Patient means Patient means: 'My unemployed mate who watches lots of daytime TV told me about "no-win, no-fee", no self-respect lawyersforyou.com and I think I am in for a fortune.' Patient says Patient says: 'How do you spell your name?' Patient means Patient means: 'You are getting a thank you letter.' Patient says Patient says: 'How do you spell your surname?'Patient means: 'You are getting a complaint letter.' Patient says Patient says: 'I have got a personality disorder.' Patient means Patient means: 'I used to be known as an attention seeker. Now I am medicalised by a hippy psychiatrist and you have got to be nice to me and treat my time-wasting seriously.' Patient says Patient says: 'My drink has been spiked.' Patient means Patient means: 'I got so drunk I need an excuse for my behaviour.' Patient says Patient says: 'The GP told me to come/I tried for 2 hours to get a GP/The GP couldn't see me for two weeks.' Patient means Patient means: 'I didn't bother to try and see my GP as I knew you would see me anyway.' Patient says Patient says: 'I am an ex-smoker.' Patient means Patient means: 'I gave up an hour ago.' Patient says Patient says: 'You f**ker. You f**king f**ker. Why did you get me off my high you f**ker.' Patient means Patient means: 'Thank you so very much for saving my life by giving me naloxone and letting me breathe on my own and stopping me being in a coma all my life after I overdosed on heroine.' Patient says Patient says: 'I have been waiting over 2 hours.' Patient means Patient means: 'I have been waiting 20 minutes but am in a rush.' Patient says Patient says: 'I don't drink much.' Patient means Patient means: 'I drink less than my doctor.' Patient says Patient says: 'You won't break confidentiality with the police, will you?' Patient means Patient means: 'I have been very naughty.'

However, there is not just patient to doctor lies; it's the other way round that I like best. Here are some things that I have heard some doctors say when I am sure that they might mean something else.

Dr says Dr says: 'This won't hurt.' Dr means Dr means: 'This will hurt.' Dr says Dr says: 'Don't worry, I have done this procedure loads of times.' Dr means Dr means: 'Don't worry, I read about this procedure earlier today.' Dr says Dr says: 'Emmm...I'll just be a minute.' Dr means Dr means: 'I haven't got a clue. I'll have a look on the Internet for some medical inspiration.' Dr says Dr says: 'So what accident or emergency do you have?'Dr means: 'Why are you wasting my time?' Dr says Dr says: 'I'll get a second opinion.' Dr means Dr means: 'I still haven't got a clue.'

However, the ones I love the most are when patients actually tell the truth. Some recent examples: 'I have a carrot stuck up my a.r.s.e. It helped me come and I like the feeling of it, but my wife is getting back from holiday tomorrow and Jason wants his carrot back.' 'My GP is s.h.i.t and not giving me the answer I want, so I came to you instead.' 'My GP is s.h.i.t and not giving me the answer I want, so I came to you instead.''I was lost so I called an ambulance as I live near the hospital. There is nothing wrong with me but I thought I'd come in for a check up as I am here already.'

The best honest comment I have ever heard was from one of our sisters who is slightly disillusioned by British culture...

Chaviest/ugliest girl ever: 'My drink has been spiked.' Senior sister Senior sister: 'I doubt it. People only spike your drink if they want to sleep with you.'

A typical day

So what is my average day like? Some people joke that it is same s.h.i.t, different daybut the wonder of A&E is that the same s.h.i.t comes in different colours and textures. I have chosen a random date to describe a typical daymy birthday.

I was doing a day shift, 86. Great, as it meant I that would see my wife and child in the evening, but s.h.i.t because of rush-hour traffic on the way to work. The alarm went off at 6 a.m. and then turned onto Snooze a couple too many times. Quick shower and into the carwith a breakfast bar en route.

7.40 a.m.arrive for the extraordinarily ridiculous hunt for the car park s.p.a.ce. Find a spot and celebrate only to see that it is reserved for the hospital Chaplain (who rides a bike anyway).

7.55 a.m.decide to park illegally by the back of A&E reserved for police and ambulance crews. Again, no s.p.a.ces there as all my colleagues have done the same thing. Eventually, I park at the local DIY shopI'll buy some screws on the way home from work, promise. Arrive 10 minutes late and stressed.

The first part of the registrar's morning job is to get a handover from the night doctor. After a quick a.s.sessment of the priorities in A&E, I delegate one of the junior doctors I have with me to see the two sicker patients. I then review the patients who were admitted to the A&E overnight warda combination of suicidal patients waiting to see the psychiatrist once they have sobered up, head injuries needing observations, little old ladies who have had a fall and need an occupational therapy a.s.sessment and the homeless alcoholic who was given a bed for the night.

Then it is off to see the minor patientsor patients that the triage nurse has deemed to be minor. You are expected to breeze through these patients and they usually require quick fixes such as a plaster cast or a few st.i.tches. Unfortunately, some are far from minor and can take ages to sort out.

9.30 a.m.the consultant emerges from his office, wondering why there are patients waiting: you either answer in a short-term view that you have been caught up with a complicated patientor you answer in a more socio-political way, i.e. there are increasing numbers of patients attending A&E without reciprocal resources, etc. Neither answer pleases the consultant and you are told to get on with it.

10.30 a.m.have seen more minor cases and I am frustrated for a number of reasons: 1. When the emergency nurse pract.i.tioner is away on a course, why isn't there cover built into the rota and why am I just expected to cover the workload? 1. When the emergency nurse pract.i.tioner is away on a course, why isn't there cover built into the rota and why am I just expected to cover the workload? 2. Why has the triage nurse let some of these patients through? A typical example is the toothache that has not been sent to the emergency dentist. So they wait for 2 hours for me to say, 'I am not a dentisthere is the number of the emergency dentist.' 2. Why has the triage nurse let some of these patients through? A typical example is the toothache that has not been sent to the emergency dentist. So they wait for 2 hours for me to say, 'I am not a dentisthere is the number of the emergency dentist.' 3. Why have some patients come? Typical examplelump on leg for four years; have you not heard of a GP? 3. Why have some patients come? Typical examplelump on leg for four years; have you not heard of a GP?

11.30 a.m.just about to get a coffee and the 'red phone' goes off. This is the phone which is meant to tell us when sick patients are coming in, so we can get prepared. This time it was used for a patient who had had chest pain but now had resolved and who had a normal ECG. I got ready by drinking my coffee and taking the time to flirt with the nurse I will be working with. The nurse flirts back and flicks her hair back and smiles at me The nurse flirts back and flicks her hair back and smiles at me.

1.00 p.m.lunch. s.h.i.t food. Not that cheap. Jamie Oliver, please come and look after us.

1.20 p.m.get asked out by the student nurse, aged 21, 34B, size 10.

24.50 p.m.see a few major and minor cases. Nothing that exciting happens, but what I do notice is the number of freaks that are coming in to see me. Too many freaks and not enough circuses I think. There are also lots of people who genuinely need my help and are appreciative. I like it when people say thank you.

4.50 p.m.have to remind another nurse that I am married and she shouldn't try and snog me in the linen cupboard.

5.00 p.m.see an overdose. Fortunately, not that serious and I don't get that emotionally involved.

5.25 p.m.turn down a come-on from one of the fit nurses.

5.30 p.m.department quite quiet, so I write a police a.s.sault form.

5.50 p.m.persuade a heroin user that he shouldn't self-discharge after my colleague has reversed the effects of their smack, in order to help them breathe. Get told to f**k off.

6.00 p.m.home time! Buy some screws in the DIY store and say I got lost in the timber section. Get the clamps removed from my wheels and go home as four ambulances rush by with major traumas that my colleague has to see.

So, while it can sometimes be a case of 'same s.h.i.t, different day', it is a fact that no s.h.i.t is like another and you never quite know what is going to happen next, which keeps my interest in my patients and my job. It is stressful, but time just flies past and at the end of the day I usually feel as if I've done something useful.

So all in all, a normal day with no major incidents, a few moans and a few pleasant patients.

P.S. Sadly, the bits in italics were all made up to boost my ego. The exciting, s.e.xy things that you see on TV A&E dramas don't actually happen in reality. Sorry to destroy the illusion.

JFWDI.

Contrary to what may come across in a lot of my rants at the pub/writings, I do not hanker after the good old days where the doctor knew best. They were bad old days. It led to arrogance in the medical profession and unaccountability. It is a very good thing that doctors have to justify their actions not only to themselves but also to the public and other professionals allied to health careradiographers, biomedical scientists, etc.

Having to justify our actions to other health-care professionals, especially when we are organising tests, makes us think more about exactly what we are looking for and why. When we write request forms or phone up for an urgent test, we, quite rightly, always have to justify it.

Most other professionals know that sometimes the information you have can be sketchy, owing to the nature of A&E work, and 99 percentof staff are very helpful and get test results done as quickly as possible. Sometimes, however, that 1 percent feels like 99 percent. You feel that they have no inkling of the stresses of working in the A&E department when they are stuck in their fume-filled laboratories. You feel they sometimes follow protocol just to get out of workand it can drive you mad. Here is a recent example of this.

I had a 43-year-old man come in to A&E. He looked dreadful, he had vomited blood and his heart rate was up but blood pressure hadn't fallen yet. My gut instinct was he needed bloodand quick. I fast bleeped the haematology technician, who slow responded. Five minutes later we got into a discussion on why I wanted blood when I hadn't got a result of his haemoglobin. (A pointless argument as, regardless of the result, he was going to need blood, or at the very least some standing by ready to be given just in case.) Apparently the scientist in his lab knew exactly what was going to happeneven though he hadn't seen the patient. An unsuccessful discussion ensued and I was only successful in my argument when I asked for his name so I could write it in the notes and move the clinical responsibility to him. My blood then arrived quicker than you can say a short sentence quite quickly.

Why did I have to have a fight? I didn't ask for the blood just to p.i.s.s him off, my patient needed it. I didn't want a stressful battle but I had to have one. Yes, he can question why I need the blood but in an emergency repeating an argument 10 times is not helpful to the patient or to me.

A few days previously to that, I had a patient who had been in a fight (a case of nasty walls again!). I wanted both the hand he had used to punch with and the elbow he fell onto X-rayed. Both were tender on palpation. An hour later, the hand X-ray came backbrokenbut there was no elbow X-ray. I enquired as to why. Apparently, the radiographer didn't think it was broken and so didn't bother to X-ray it. However, I did think it might might be broken and didn't want to miss a fracture. I take clinical responsibility for the patient and not the radiographer. be broken and didn't want to miss a fracture. I take clinical responsibility for the patient and not the radiographer.

Again, I had to have a 10-minute argument about why I wanted to X-ray this man's arm. I didn't have the time for this. I tried to explain that the point of my being at work wasn't to upset diagnostic staff by getting them to do unnecessary tests, but to look after patients wanting (and occasionally needing) our help. Again, only by resorting to the 'What's your name so I can put it down in the notes, etc.' tactic, did I get my X-ray...which turned out to be entirely normal. I then got an episode of 'I told you so,' but at the end of the day it is my responsibility, so don't moan at me for being cautious and not wanting to end up in court for missing a fracture.

When the next pub opportunity arrived, I ranted about these episodes in a more and more manic way as the beer flowed (OK, I'll be honest, as the alcopops trickled). A friend of minealso a doctor but much older and with years of experience told me how he and his colleagues used to deal with these problems. They just wrote on the form JFWDIit stood for 'Just f**king well do it.' This was before people questioned doctors. Few knew what JFWDI meant and so n.o.body would dare question the doctor. It is an amusing thing to write, but totally inappropriate. As I said earlier, I am so glad that times have changed99 percentof the time.

At this point I want to say how totally reliant A&E doctors are on the other staff working in the labs/X-ray departments. They are usually highly skilled and, on the whole, highly efficient, helpful, frequently friendly and generally a pleasure to work with. It is just a small minority that drive me mad.

What these people lack is the respect and recognition for what they doespecially lab technicians and scientists. They have fallen behind the doctors' and nurses' pay scales and work hours that are often much worse than ours. However, unlike nurseswho are all apparently angels with a seat in heaven waiting for themthey don't get recognition and respect from the public, or politicians. An example I read in the paper was that a pop star wanted to say thank you for the care his mother had received in hospital. He was going to put on a free concert for NHS nurses. Great, but he didn't mention all the other NHS staff vital to making the place ticklab scientists, physios, OTs, radiographers, secretaries, etc. And before you ask, doctors don't really need free tickets for pop concerts. Whatever anyone says, we are quite well paid and can buy our own tickets. I know very few really poor doctors. Lots of p.i.s.sed off and stressed ones, but not many poor ones.

Male menstrual syndrome

I got really fed up at work this week. I tried to rationalise why and realise that my wife is probably right and I have got 'Male Menstrual Tension'a little known condition but with symptoms far worse than PMT. It is often exacerbated by a lack of sleep, beer, s.e.x and footballbut nearly always induced by stress. It was the stresses and annoyances at work which set it off. These include: 1. The 4-hour ruledon't get me started. 1. The 4-hour ruledon't get me started.2. The frequently rude patients that I have to treat.3. The chav night club where the chavs go to for their chavy fights and then come to see me. N.B. When I go to the club, I tell people it is retro chic and not chavy. 4. Toffs with excessive expectationsthere is only one little me. 4. Toffs with excessive expectationsthere is only one little me.5. People trying to kill themselves.6. People trying to kill themselves but not very effectivelyfive vitamin pills will not do it but it will get you a bed for the night while we wait until the psychiatrist can see you in the morning. 7. Medical doctors. They moan a lot, can be arrogant and condescending, copy our clerking, complain that unnecessary tests have not been done and then say, 'Well I wouldn't have referred it.' Well then, you can send them home, professor. 7. Medical doctors. They moan a lot, can be arrogant and condescending, copy our clerking, complain that unnecessary tests have not been done and then say, 'Well I wouldn't have referred it.' Well then, you can send them home, professor. Please note usually I don't think this of medical doctors and they are usually good colleaguesI am just having a bad week. Please note usually I don't think this of medical doctors and they are usually good colleaguesI am just having a bad week.8. Cardiologists who arrogantly say'So I suppose you want an unnecessary echo to make yourself feel better.'9. Ophthalmologists who answer 'chloramphenicol' to every question.10. Respiratory doctors who always ask if you have excluded TB. No! The test takes weeks. I only have 4 hours!11. Out-of-hours GPsdon't get me started.12. NHS Direct having no choice but to advise people to go to A&E to cover their own backs.13. People coming in saying, 'I just wanted to get a second opinion.'14. Drunk teenagerswhen I was young I went home to sober up, not to A&E.

As I said, I am having a bad week. Normally I love my job but at the moment I am fed up. Sorry to be moody.

Delivering oranges

The next patient's card I picked up was an elderly lady, in her mid-70s with 'abdominal pain'. I quite enjoy seeing elderly patients. They are usually really grateful and undemanding, and you can always try and charm them. My favourite tactic is pretending that they must have given the wrong details to the nurse as their date of birth must be at least 10 years out. It always gets a smile and then the patient gets more relaxed. This didn't quite work with this patient. She gave a faint 'Don't be a patronising t.w.a.t' smile and asked me if we could go into a private cubicle. I walked with her into the gynaecological room which has a door and some privacy. She started the conversation.

'I have an orange in my v.a.g.i.n.a, and I can't get it out.'

'OK. That's fine; I'll need to examine you to see if I can get it out. I'll go and get a nurse so that she can chaperone me. Don't worry, it's quite a common problem.'

What the h.e.l.l was I saying? No, it wasn't a common problem, and what the h.e.l.l was she doing with an orange in her f.a.n.n.y...and what was she doing not looking in the slightest bit embarra.s.sed? She would have had the same facial expression if she had said she had slipped and fallen and hurt her wrist. I wanted to know how it got there, but I just couldn't ask. I just stood there pretending I was unfazed and unembarra.s.sed. I always have to remember my medical ethics of being nonjudgmental. I found a nurse, who was free to chaperone me.

'Don't ask any questions. Just stay with me in the room. I need a chaperone and some psychological support.'

She looked at me strangely but came with me into the room. I examined her and there was this large orange. There was no way I could get it out. If it had been a Clementine, or even possibly a Satsuma, I could have 'delivered' it. I explained to her that I couldn't get it out, but that it needed to come out, otherwise she could get a nasty infection. I told her that I was going to refer her to the gynaecologists, who were going to have to retrieve it under a general anaesthetic. She just nodded and said 'Thank you, doctor'.

I have never before written in the notes 'Diagnosis: orange in v.a.g.i.n.a'. But then in A&E you get to see lots of strange things.

The problems of alcohol

I am writing this after a Thursday night shift. There was a common theme running through most of the patients I sawalcohol. Now I am not self-righteous or piousI love a good drink and I am grateful to that drug for helping me flirt vaguely successfully over the years. However, what most people don't seem to realise, both the general public and law-makers, is that alcohol is a drug, and an incredibly powerful drug at that. It is addictive and a depressant, and it can really b.u.g.g.e.r up your body if used excessively. The reason people like it is that its depressant effects depress the inhibitory areas of the frontal lobe. In other words, it makes you think that you have actually got a chance with that really fit blonde, but unfortunately also makes you think that you should beat up her boyfriend to win her affections.

It needs to be used with caution...and then it can be brilliant. Unfortunately, people forget about the caution bit and the consequences end up at A&E. The short-term consequences are the fights, accidents and deliberate self-harm, and the long-term consequences are liver failures, the dementias and the suicides.

My shift started at 10 p.m. The first person I saw was a man who had come in after being forced to by his wife. He was in his 40s and had combined a career in business with a social life in the pub. He was the nicest man you could ever wish to meet. He was like Homer Simpsonfunny, caring, devoted to his wife and children, and yellow. It was obvious that he was in acute liver failurecaused by the drink. Blood tests revealed his kidneys were not working either and that his liver was so damaged that as well as making him yellow, his blood couldn't clot properly.

The medical treatment isn't that complicatedonce you have a diagnosis and a cause, you try and stabilise him, stop him drinking and send him to the ICU where they do expensive and clever stuff. Once patients go to ICU, it really is touch and go whether they survive, but the prognosis is usually very bad, especially if their kidneys are not working. I don't actually know what happened to this patientone of the worst things about A&E is you don't get to follow up your patients. However, from experience, I wouldn't give him much of a chance. What a waste of life: a man in his 40s who should be spending time with his kids won't be because he spent too much time drinking.

The next patient I saw was a typical Friday night injury (I think Thursday is becoming the new Friday). He came in with a punch to his face and an injured little finger (known as a Boxer's fracture). I am not sure exactly what happened, but he mumbled something like: he went to the pub, got p.i.s.sed, knocked into someone and spilt their pint. A 'What you looking at?' type of conversation started up. His mother was insulted and he questioned the other person's parentage. The final straw was that his sister's celibacy wasn't accepted as gospel by the person he b.u.mped into. He had to defend the family's traditions and honour. He punched the bloke, who then punched him back, and, being a lot less p.i.s.sed, the other bloke won the fight and left. My patient got the silver prize of an ambulance ride to A&E.

I examined him, and X-rayed his hand. His finger was broken, but the facial bones were normal. Now I don't really know why, but he didn't like this fact. I think he must have wanted them broken so he could press charges or something, and so when I tried for the fifth time to explain that he hadn't fractured his face, he called into question my masturbatory practices and implied that I f**k in a quite incestuous way (for the record I have quite an average masturbatory practice and have a very conventional s.e.x life).

I had seen this bloke in the past and remembered that he was usually pleasant but this time because of booze, he had got himself beaten up and then become obnoxious. The time was only 10.45 p.m., so he had also ruined a potentially good night out. That was the second example of cautionless use of alcohol.

After grabbing a coffee, I saw my next patient. Some university students had been on a drinking binge all day, gone to a party and one of the girls had become so p.i.s.sed she couldn't talk.

'She has had her drink spiked, she must have,' her friends informed me.

'So what has she drunk then?' I asked.

'Five double JDs and c.o.ke, five VOs and seven bottles of WKD.'

After deciphering the letters into drinks and then into units, I soon realised that I would be p.i.s.sed on half of what she had drunk.

'She can normally handle her drink and so she must have had it spiked. Can't you do a test to prove it?'

I explained that this amount of booze will make you completely unconscious and that it is not usual to test for 'spiked drinks'. Her drink was already spiked with JD (Jack Daniels), VO (vodka and orange) and whatever alcohol they put into bottles of 'Wicked' (WKD).

The girl's night was ruinedshe was so paralytic she wasn't bothered about the puke in her hair and didn't seem to care that she had wet herself. Our nurses' time was taken up by cleaning her up and my time was taken up by putting up a drip and giving her some fluids to help wake her up. Until she was safe and we were confident that she wouldn't choke on her own vomit, we had to keep her on a precious bed on the A&E ward with constant supervision. Because she so overindulged, our taxes paid for her to be cared for and she got a s.h.i.t night. When she left in the morning, we didn't even get a thank you.

It makes you think that if booze wasn't so relatively cheap (especially alcopops and especially at university bars/drinks promotions nights), then she might not have the money to spend on this much booze, especially with tuition fees and the cost of shoes, etc. Maybe the government should think about increasing the price of booze, especially alcopops, as a deterrent to this sort of behaviour. I'll leave that to them and continue my recollections of last night.

While I was writing my patient notes, the 'red phone' went off. Ambulance control informed us that there had been a serious incident. A cyclist had been hit by a car doing 50 m.p.h. The cyclist was seriously injured.

I called the trauma team and the cavalry arrivedalbeit a slightly bleary-eyed cavalry, moaning that they had been woken up and saying, 'I bet it is a load of b.o.l.l.o.c.ksI want to go back to bed.' I arranged the team and got ready to lead them. The patient arrived a minute or two later.

It wasn't a load of b.o.l.l.o.c.ks at all. The ambulance men had done a brilliant job in getting the patient here so quickly as well as starting vital fluid resuscitation. But he was in a bad way. His heart rate was high and blood pressure low and his abdomen was rigid. (Coincidentally, my heart rate was off the scale, BP sky high and rectal continence indeterminate). He needed an emergency operationno time for a CT scan. He needed his abdomen opening and the source of bleeding found and stopped. While explaining all this to him, all I could do was notice the stench of alcohol from his breath. This man was as p.i.s.sed as a fart. No wonder he hadn't needed much a.n.a.lgesia. He was rushed to theatre and a bleeding spleen was found that had to be removed. He will now need lifelong antibiotics, a week or two in ICU and weeks of intensive rehabilitation...oh, and a new bike.

The drinkdrive message is starting to get through to people, but we seem to forget that it is also dangerous to drink and cycle. The majority of pedestrians injured in the evening have also been drinking and this may have contributed to their injury. Please remember this when you are running across the road after six pintsthe green cross code still applies even if the kebab shop is about to close.

During the time it takes to run a trauma call, a lot of senior doctors and nurses are tied up and the other patients in the department end up having to wait a long time. The next patient had been waiting over 5 hours to be seen (3 hours 59 minutes in management timing). He was 16 and had gone over to his mate's house as he had a 'free house'. (Not a pub, but his parents had gone out for the evening.) He came in with his friend's parents after they found him vomiting (in their sock drawer for some bizarre reason) and because he couldn't walk straight or speak in a coherent manner.

They had initially tried to go to the pub, but first couldn't get served and second couldn't afford a pint anywhere except at the local Wetherspoon's and his granddad was there so he didn't particularly want to go in. They decided to go to the local supermarket with the friend's 19-year-old brother. Now I can hardly complain that he tried his best to obtain alcohol underage. I used to try every trick in the bookeven resorting to brewing our own alcoholic drink in the local woods (you don't need to be 18 to buy yeast). But when I drank underage, I couldn't afford as much as this young lad could with his paper-round money. At the supermarket they managed to buy two packs of 20 bottles of Stella for something ridiculous like 14.99rea.s.suringly dirt cheap, unlike the adverts would have us believe. These supermarkets are deliberately using amazing offers, potentially as loss leaders, to encourage people into their shops. This is ridiculous and just encourages excessive alcohol consumption.

The drinks industry doesn't approve either, because it is encouraging a form of drinking much worse than in a pubisolated and without social interaction...or high profit margins. In the process the price war is causing local pubs to close. Can the government not stop this practice? I want more sensible red tape to protect the public. Why can't these supermarkets go back to their original loss leaders and sell baked beans for a penny, instead of shed loads of booze for not much?

Anyway, the young lad was examined and left to sleep it off till he was safe to go home. His parents then came in and I started to feel a little sorry for himhe got such a b.o.l.l.o.c.king it was unbelievable, but also quite amusing.

So far it was five out of five patients who had been to A&E because of booze. The next patient I saw was an overdose. Yippee! Not an alcohol-related patient...except I had jumped to the wrong conclusion. He had taken a bottle of vitamin pills after drinking a bottle of JD (a very popular drink, I am finding out). The pills won't cause him any harm, but he needed a psychiatrist because he really did want to die and he thought the tablets would kill him. However, because he was p.i.s.sed, no psychiatrist would see him until he had sobered up. He was someone else who was parked on a valuable observation bed for the night.

Six out of six became eight out of eight. Accompanied by the local constabulary two fine young members of the public had been brought in with various cuts and bruises. They had been to a local pub and got into a fight; police were called and then they were brought to us to get them checked out and st.i.tched. Just so that the police wouldn't have to hang around for hours, I saw them promptlyno major injuriesjust bruises. It was a waste of my time and it meant other more needy patients were not seen so speedily.

The pub in question is notoriousa new one built where I used to pay in cheques. They have also got a late licenceallowed by the government which is trying to encourage a continental cafe-style drinking culture and not a 'drink up, roll your sleeves up and fight' culture. However, at this new pub, they still have lots of heavy drinking and no one goes for a 'quiet coffee'. Why not? Well, the pub chains care about profit and not social responsibility and so to maximise profits they built a 'vertical drinking bar' as opposed to a French-style cafe. What this means is that you cannot sit down to have your drink slowly, the music is loud so you can't chat and there are no tables to rest your drink. So all you can do is drink till you get paralytic. If the councils just thought a little harder and granted late licences only to pubs that actually encouraged a cafe-style drinking culture (i.e. by having seats) then it might help with our booze problem. It is not a genius idea, just common sense.