Blood on the Lino: Twenty-Four Hours in Casualty
The following is an excerpt from our David Widgery essay collection titled Against Miserabilism:
David Widgery comments: During the 1970s, that political transition zone which delivered us to the mercies of Mrs Thatcher, I was working as a doctor in acute hospital medicine while attempting to write while on call or early in the morning. For over a year I was involved in a particularly gruelling Casualty rota at St Mary's Hospital, Paddington, which included one stretch of twenty-four hours without a break as the only Casualty officer in the hospital. This is an account of one such twenty-four-hour stint, written up at 9 a.m. the following morning in the tea bar on Paddington Station.
8 a.m.
The morning starts slowly enough: sprains, twists and tears; lumps, spots and abscesses. The daily influx of patients returning to have their stitches cut out, their wounds dabbed and redressed, their tetanus jabs, their certificates and their reassurance.
Not that the mornings don't bring real emergencies. It is almost impossible to imagine quite the things that can fall upon, hit, crush and cut the human body. The world of Casualty is like a gravity-less lunar capsule where limbs and surfaces are continually colliding and objects constantly tumble and drop. Heads are bombarded by falling saucepans, dropped cans, abandoned half-bricks and unexpected beams. Fingers are minced with an awful regularity on tin tops and chopping knives, scraped on potato knives and corkscrews – accidents of an awful banality and a great deal of blood and trouble.
Industrial work injuries are always on a bigger scale with flesh crashed instead of bruised, eyes bright red instead of pink and watery, fingers chopped clean off instead of sliced, hands burnt down to the wrist instead of scalded at their tips. A screwdriver falling from scaffolding unprotected by toeboards reaches a velocity lethal even to a helmeted building worker after one hundred feet. What is chilling is not the wounds but the victims' stoicism. Manual workers still take damage to their bodies at work as part of the deal and express an infuriating lack of anger over missing fingertips and sliced tendons.
"It is almost impossible to imagine quite the things that can fall upon, hit, crush and cut the human body."
And there are the morning regulars, those people mortgaged to illness and harnessed to pills, the dicky hearts continually dissolving tablets under their tongues to push away heart pain from hardening arteries, the diabetics for whom a single spot may grow to an infected boil and threaten life, the old with blocked and baffled circulation whose blood only just forces its way to toes and fingers continually threatened by gangrene. For them, Casualty is part of life and they will expound briskly on diagnosis and treatment, having overheard and memorised the seminars held for years over their faulty limbs. Regular, too, are certain medical emergencies, asthmatics who arrive panting on stretchers, blue and wrestling for breath, and epileptics raging with themselves.
It is a demanding kind of medicine and yet all the Casualty officer is required to do with the urgent cases is to admit them to the care of another doctor as swiftly as possible. The job is therefore exhausting, bewildering and, since it places paramount importance on diagnosis and little on treatment, curiously unsatisfactory. Shift work, low pay and lower prestige, generally poor facilities and lack of career structure has made Casualty a dead end.
1 p.m.
Lunchtime brings its small crop of violence. A warm morning in the pub which goes wrong by lunchtime and ends with somebody's boyfriend bottling somebody on the next table in a fog of drunkenness; the first of the traffic accidents; falls and black eyes with unconvincing stories attached. Heads are strong but bleed a good deal. Casualty starts to look like Casualty. Much of the lunchtime punching takes place inside the home, within the family. Frustration which ranges from a plate thrown accurately in anger to the systematic battering of a wife beyond unconsciousness. Those who uphold the sanctity of the family as a solution to all our problems might care to spend a few hours in a Casualty, to face the debris, when all the sugary ideals explode, when babies are bounced against the bedroom wall to make them stop crying and wives are loved and honoured and beaten up so thoroughly that they can't talk because their teeth are still chattering with terror. By afternoon there is already an hour-long queue to be seen and thirty pairs of eyes pierce any attempted emergency with the particular malice that the English reserve for queue-jumpers.
"Those who uphold the sanctity of the family as a solution to all our problems might care to spend a few hours in a Casualty, to face the debris, when all the sugary ideals explode..."
4 p.m.
Just as the queue is thinning down and you think there may be time for a cup of tea, pandemonium arrives. An ambulance team pound through the doors with a corpse they have kept alive by thumping his chest and puffing and sucking into his lungs. A cardiac bleep summons anaesthetists clumping in theatre boots and surgical greens, a worried medical registrar who has to interpret the electronic squiggles of the ECO into decisions about drugs which must be shot straight into heart muscle, and other floating doctors and nurses who connect up leads and position electrodes, draw up syringes and slice off clothes.[1] One anaesthetist threads a plastic airway through the bluish throat while another plunges the needle of a drip into a neck vein and pumps in replacement fluids. The cardiac man brandishes two electrodes the size of dinner plates and, dripping with salty grease, claps them on the chest and throws a two-hundred-volt current through the patient, jerking him momentarily clean off the table. They banter all the while in measured tones about golf, their last cardiac arrest, and hospital gossip. A nurse drops a bottle and everyone glares at her. Only the doctors are allowed to make mistakes. Someone is dispatched to find out, in the nicest possible way, the patient's age from his wife, sobbing outside. Then, to everyone's surprise, the patient starts to revive, achieves a row of perfect cardiac complexes so that his pupils shrink, and goes a seedy pink again. “Oh, God, I was hoping to go over to the boozer this evening,” says the registrar, glum at his success.
Another try at tea but you can't get away from the noise reverberating over the institutional surfaces: the groans of inpatients, the noisy sobbing, the overloud conversations, the abandoned lung-bursting scream of kids in pain which echoes on long after it has actually stopped. But as night rises, a swath of drunkenness seems to sweep across the outside world, as single bemused and fallen creatures, couples propping each other up right, and the wounded dragged away from street-corner arguments and pub affrays by friends, lurch in.
With the booze comes violence. Between drinks and after closing time sober patrols of muggers round up the staggerers and relieve them of their valuables. The violence is bewildering, inexplicable, random.
1 a.m.
Fortunately, alcohol solves the problem of anaesthesia. Little lignocaine is used after closing time. The police breeze in and out, squawking like upright birds. Their vital weapon is now their radio, not their truncheon. But it can order them away in the middle of trying to piece together a case against the person they end up arresting. Police vans shuttle drunks between the cells and the Casualty ward. The smell of stale alcohol and the tongue-tiedness of the drunk fill the rooms, and the once prim and orderly department is reduced to a wash of plaster of Paris footprints and bloody bandages. With the drunks come the suicides, midnight's other staple.
"As night rises, a swath of drunkenness seems to sweep across the outside world, as single bemused and fallen creatures, couples propping each other up right, and the wounded dragged away from street-corner arguments and pub affrays by friends, lurch in."
2 a.m.
The mentally ill who do come into Casualty are often curiously sane, just unacceptably honest about the lack of love in the heart of the city. A lab technician is lugged in screaming with terror, his whole appearance scatty, as if something inside has slipped sideways. He is terrified that he is dying from chest pain. In a quarter of an hour he has quietened down and desperately wants to talk, to show the family photos he sleeps with under his pillow. A young wife collapses, convinced she is unable to breathe, panting and screaming and shaking. When she pulls herself together she's worried that her husband will beat her up for breaking down. It's mental, all right: an acute anxiety state. But it's only just the other side of the Radio One phone-in and the Lonely Hearts ads and the sex shop.
4 a.m.
A tramp with magnificent eyebrows and a mane of silver hair describes the biblical proportions of his diarrhoea in language he has learnt to use to shut officials up. He says he is a shepherd by profession. Under the trolley his paper bag contains a large furry gorilla. “Well, I am also a street entertainer,” he says with dignity. When he realises he is not going to get a bed for the night, he becomes wrathful. “You're a Londoner, I suppose. Once London was a city. Now it is a mess.”
"A tramp with magnificent eyebrows and a mane of silver hair describes the biblical proportions of his diarrhoea in language he has learnt to use to shut officials up."
6 a.m.
It's almost morning. Still, unbelievably, people wander in with toothache and constipation exhausted by a night spent wrestling with pain. The night staff, alert but exhausted, having paced their weariness through the small hours with phone calls, fags and cups of coffee, are now anxious to stumble home to a morning bedtime. In comes a Belfast man shattered with drink but somehow totally in control. We sit in the corner of the waiting room while a Portuguese ancillary cleans the blood off the floor with an electric scrubber. “I'm on these pills, you see, Doc, Valium. I started taking them in Belfast and now have them sent over to me. Without them I just couldn't get myself across the front door. I take about thirty a day. You know I can only talk to you like this because I'm drunk.” He wants to go into a hospital where he can get off his tranquillisers. He wants a doctor to talk to about the terror in his head. The floor is almost finished now. “Well, I can get you an urgent appointment with our psychiatric clinic?” I offer. He smiles without warmth. “Well, I'm sorry to have wasted your time, Doc. I just thought maybe you could help me.”
Time Out, 1976
About the Author: David Widgery was born in London in 1947 and died in 1992. He lived and worked as a socialist doctor in the East End of London for twenty-two years. He was the author of six books: The Left in Britain 1956 – 68 (1976), Health in Danger (1979), Beating Time (1986), The National Health (1988), Preserving Disorder (1989), and Some Lives!: A GP's East End (1991). He was a regular contributor to the New Statesman and Society, Socialist Worker and The British Medical Journal as well as writing occasional articles for numerous underground and socialist magazines and journals. He also wrote articles for the Guardian and Observer newspapers.
On Against Miserabilism: “Socialists are people too. Their lives are not all about ‘politics’. Indeed the strength of Widgery’s writings is to show how it is only the lived experience of people’s lives that makes their politics real. There are only a handful of revolutionary socialists who have ever been able to write convincingly about popular music, about suffering and dying – and indeed self-critically about the successes and failures of the socialist movement itself. It is astonishing to read pieces written 30/40 years ago that are so prescient. This collection is a living memorial to and by one of the finest writers and critics ever produced by the revolutionary left.” – Stuart Weir, former editor of the New Statesman (1987-91); founder of the democratic movement Charter 88
[1] ECO, short for echocardiogram.