Health: Don't you dare mention the pain

So you've been admitted to Casualty. Big deal. You can't possibly be suffering more than the nurses. Ruth Padel waits her turn reports on an icy encounter with the `caring' profession

Just before Christmas I revisited that traditionally British hierarchy of unspoken pain that hangs round Casualty. Putting up tinsel I trod on an overhanging sofa cushion, fell, and came down on my ankle. Bolts of pain like I'd never known. We rubbed arnica cream on in and bandaged it and a neighbour took me to the hospital for an X-ray.

I limp into Casualty at 7.40pm, in shock. A pretty West Indian girl - braided hair, long silver nails with black hieroglyphs on their tips - at a computer gives me a form and tells me to "sit on the blue chairs". Everyone else waiting is on green chairs. I write my name and address on my form; for "injury" I put "suspected broken ankle". The white-board says: "When the Triage Nurse sees you, your injury will be graded. Immediate and Very Urgent, 15 minutes. Urgent, 2-3 hours. Non-urgent, 4 hours. Standard, 4-5 hours."

Channel 5 is on, beside two sold-out soft drinks machines. The door's open: knife-like wind blows in. My foot is excruciating. I put it up on a seat. I have a million things to do; I've got to drive four hours to Somerset on Boxing Day. Everyone here has things like that. After 15 minutes, the Triage Nurse calls me to an alcove. I limp in. She looks at my form in disgust and crosses everything out. Without either of us saying a word, she creates an atmosphere of utilitarian dislike. She asks what's wrong. I explain; she writes on the form. I start unwrapping the bandage. "A doctor will see you in four to five hours," she says. "Depending how many accidents come in."

I've already become "patient": from the passive voice Latin verb patior "I suffer". "Are you going to look at it?" I ask. "When you've taken the bandage off," she says coldly, watching my hands unwrap it. She looks, writes on the form. "Standard," I expect. She prods. It's swelled up everywhere. I flinch. "Shall I put it back?" I ask. "Doesn't make any difference," she says. "Only pressure from knee to toes makes a difference." "It makes a difference to how it feels," I say. "Psychological," she says. "Take the form to the desk."

If we're talking psychology, this feels like the iciest ever encounter between two women, one in a caring profession, the other in a lot of pain. But the guide-lines are set up, almost menacingly, to make pain not the issue. I'm suspected of being about to mention it.

I don't. I limp over to the desk. The girl with silver nails exclaims at the messy form and asks my name and address. I return to the blue chairs and put my foot up. It's throbbing like mad. A nurse comes along. "Do you want to take a seat on that side of the room?" She means the green chairs, nearly all of which are occupied. I wouldn't be able to put my foot up. The blue ones are empty, except for a sleeping tramp. "Do I have to?" I ask. "The blue ones are Triage," she says. I move.

This ballet of unspokenness rests on the fact that we all know people who work here are under terrible pressure. These nurses see human beings cut up and dying - and this is the iciest night on record. Accidents come in round the back. A broken ankle, a five-hour wait, changing Christmas plans, is nothing. The message is, "Don't even think of complaining."

Besides, a dog in a trap bites the person who helps it. These people are in the front line of not just the most hurt but some of the angriest people in society. This hospital has had its share of madmen slipping in and savaging patients. A poster on the wall says: "We want to help you but abuse, threats and violence will not be tolerated."

The tramp stirs. A manure scent strays across to the green chairs. He opens his eyes and says, "Bollocks". The receptionist sprays behind her desk, smiling when she catches my eye. He opens his eyes. "Excuse me, sister," he says. Nothing happens. She's used to it. Nothing urgent or wrong there - just everything. His life. He shuts his eyes. He has the blue seats to himself.

By 9pm there are 30 of us. A 13-year-old in a track-suit breaks down and howls, "Two hours!" Children get faster treatment. The elderly lady behind me was going to West Side Story tonight with her grandchildren, but had latent thrombosis. Her doctor said to go to hospital now. She came in half an hour before me. Her friend sits with her on the achingly hard seats. I hobble outside to phone my daughter on the mobile.

By 11.30pm I'm beside a Cypriot boy doing GCSE revision with his grandmother. My foot's on fire. "I could have gone to West Side Story," says the thrombosis woman. I halt to the desk. "Can you tell me how much longer?" I ask. Checking the screen, the new, male receptionist says someone who came at 7pm has just gone in. "But we've had a big accident. Ask the Triage Nurse." I go to the Ladies instead. Earlier there was no paper; someone's replaced it. I go and ask a nurse. "I've just called you," says a doctor. "Come in."

My foot has swelled enormously. He prods. "Torn ligament," he says. "Commonest injury we see. Not broken." Thank God. "I bet it's agony," he says. First time anyone's mentioned that. "It's a myth that broken bones are painful and soft tissue isn't. I'll get you some painkillers. Take them three times a day for the next few days. You've got to get the swelling down." "Arnica?" I ask. He smiles. "Ice," he says. "Put frozen peas on it." My thrombosis friend is still there. I hobble home under the moon, bandaged knee to toe.

We know funds are low and you have to wait. But is this system of training nurses to handle people in pain as if daring them to mention the fact, this withholding of ordinary sympathy, the best society can do?

We know these injuries are minor. But they're upsetting. Why should people in pain be treated with such suspicion? Why couldn't we be told, "There's a coffee machine on the first floor, if you can get there. Sorry the drinks machines don't work. Don't write on your form. Sorry you're in pain and sorry you've got to wait: we'll do our best." It would make all the difference. Is it so difficult to arrange?

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