Just another Friday night

Mary Braid spends 12 chaotic hours in Casualty with the drunks, the drug addicts - and the doctors and nurses who can do little but pick up the pieces
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His eyes have been punched shut and a torrent of blood has splattered a hundred red flecks into the pattern of his oatmeal jumper. It is 9pm in the casualty department waiting room at the Royal London Hospital in London's East End - an hour into the 12-hour night shift - and the young man with the blueing, pulverised face is swaying dangerously.

The other patients in an already filling room are watching the news on a wall-mounted TV. But the blood-stained youth is only interested in where he can smoke a fag. In a corner, an elderly woman waiting for news of her husband, who has suffered an angina attack, rolls her eyes in disgust. "It's Friday night, innit," she whispers.

Young Shut-eyes is accompanied by two policemen who rescued him from a "good kickin" in Liverpool Street Station. "I'm trying to be straight with you mate," he slurs later at an officer as a nurse treats his wounds. "You'll see the security video, anyway. I didn't pick up anything until they hit me.

"Although I got a beating I'm not exactly... er... Snow White, know what I mean?" He asks if they have checked his record yet. That does not matter, they reassure him. This time, at least, he is the victim.

Surprisingly, the tough guy cries like a baby when he sees the Polaroid shots, taken as evidence, of his injuries. But menace still bubbles beneath the surface. One officer commiserates about his swollen nose. Trouble is, it is not swollen. "That's the fucking nose I was born with mate," he says with a thin smile. "Are those the ears you were born with?"

By 10pm, the profanities are already ricocheting around the waiting room, where Friday's pub- wounded have filed in to join other medical emergencies.

Tempers are already fraying about waiting times. "And the night is yet young," says a smiling member of the almost perversely cheerful staff. Some patients have already waited more than an hour, but all the cubicles are full. A hollow-faced, head-shaven, heroin addict has to make do with a trolley in the corridor. It hardly matters, for he has no idea where he is: no one could get any sense out of him about who should be contacted.

He has been injecting into a infected vein in his leg which, without treatment, will need amputating. "The funny thing about heroin addicts is that even when they are high they never look happy," says one staff member who, somehow, keeps the menagerie moving.

Just another violent, booze-sodden weekend in Casualty (or A&E), a weekly window into the casual violence which plagues British society. According to Mr Tinney, alcohol - and drugs - play a part in around 25 per cent of his weekday accident and emergency cases. On weekends and Thursdays (a big night for those on benefits) that rises to 40 per cent.

It is even higher in other London hospitals. One registrar says he can hardly tell the difference any more between weekends and weekdays. Friday night culture has colonised the entire week, making every night party night, at least for the punters.

In the trauma unit, Somali Mohammed Ibrahim, 34, is paying a belated party price. A junior doctor is preparing to drain his collapsed lung. Four weeks ago, Mr Ibrahim was beaten up by seven men after a difference of opinion, the details of which are now sketchy. He has been off work ever since. But until he started hyper-ventilating this morning, he had the pain, breathlessness and sleepless nights usually put down to heavy bruising.

From all corners of the trauma room - where the chests of stab- and road accident-victims can, as a last resort, be cut open and hearts massaged - hi-tech equipment beeps and purrs. But, in the end, the lung procedure is quite brutal. A local anaesthetic - general would be too dangerous - is injected into Mr Ibrahim's side. Then the skin is cut and a plastic tube shoved into his lung. It takes considerable force. As the young male doctor pushes, red liquid spurts from the tube and splashes onto the floor. Mr Ibrahim clenches his teeth.

For a man who came to A&E expected pain killers, he is amazingly philosophical about his attackers. He did not press charges. "It was partly to do with me and partly to do with them," he says, adding that alcohol was to blame. His attackers had been drinking. And he was too inebriated to defend himself. But it is a young man's game, the booze-induced brawl. "You think I would have learned some wisdom by now," he smiles.

Somehow he is still smiling when the consultant spots what the junior doctor missed. Mr Ibrahim's other lung is also collapsed, a surprise to staff who are already amazed he had functioned with one for so long. A tube must be inserted into the other lung, and this time Mr Ibrahim knows what to expect.

He is stoical to the point of saintliness when the next blow is dealt. The first tube has been inserted badly and will have to be redone. Doctors, like other professionals, tend to learn on the job.

All over town the bars are filling up. And so is Casualty. The Whitechapel hospital caters for the City as well as the poverty-ridden East End and smart suits trickle in, blooded, with the down-at-heel. "Get him stitched up and we can go," calls one young suit to a passing nurse. His tipsy friend, with a gash in his head and blood on his tie, sniggers. Beside him, a girl in gold shiny trousers and matching platform shoes, is crying hysterically after being hit with a glass at a local pub.

Amidst the boozy injuries, the worthy cases keep flowing in. There's a woman, 16 weeks pregnant with worrying bleeding, a sunken-cheeked old man whose fight for breath heralds the onset of the respiratory season, and an old woman with diabetes who arrived with a Selfridge's bag rattling with at least 15 different types of pills.

"All right love," says Mr Tinney to the diabetes sufferer's elderly friend. She asks if he is a doctor. "Doctors are ugly, nurses are beautiful," he tells her. She cups his face in her ancient, sinewy hands.

Do the staff ever get fed up on a busy night with the drunks and druggies? "I treat all patients the same," says Mr Tinney, and seems to mean it. "I smoke. I can hardly moralise." The waiting patients are feeling less generous. "We've been waiting an hour," complains a young woman being led to a cubicle. "Have you love?" says the male nurse breezily. "That's very good here."

"An hour is a long time to them, but it's nothing to us when we're busy." All night she has been patching up assorted drunks and sending those with head injuries on for scans. A victim of a handbag snatch has passed through to have her arm put in a sling and her face bruises treated. But at 11pm, the nurse reveals she is just warming up, for the late nightclubs are just about to get into swing.

In a small room around the corner a young Muslim is being interviewed by police after being held up at a cash machine at gun-point. He was lucky not to be shot, but his attacker hit him over the head with the gun, leaving a deep gash. He cannot believe he was mugged just off the main street in a Muslim area. "They were probably addicts," he says.

In the waiting room he has already rubbed shoulders with those who steal to feed a habit. A fragile, little man - 28 but looking 14 - came in two hours ago with a "sore arm". He did not have to roll up his sleeve. Heroin screamed from every needle-hole in his pitted hands. An abscess as large as an egg straddled one of his tired veins. In minor injuries, the nurse in charge catches him trying to lance the sore with a matchstick. "I'm just trying to get the woozy out," he says, innocently.

The nurse laughs. Again, there is no moralising, though they are cleaning him up so he can shoot up again. "You can't force a long-term user to come off," sighs the nurse. He has been using for four years and began injecting a year ago. "I started to economise," he claims. "When I inject I do it twice a day. When I smoke, I take it more often."

Shooting up still costs pounds 20 a day. Where does he find the cash? "I shoplift," he says. "If I smoked I would have to shoplift more."

In the early hours of the morning the stream of wounded actually slows down. A skinny teenage skinhead, accompanied by two clones, is among the few late pub casualties. He is peculiarly proud of the long, ragged Stanley knife cut in his back. "Friday night is when you get paid," shrugs his friend, as if in explanation. "It is when you want to get out."

By 3am the staff are smiling after a night they, rather surprisingly, describe as "quiet". They reel off far worse nights when junkies stole needles and locked themselves in the toilets to inject, or rival Asian gangs, or white and Asian youths, battled in the waiting room.

On the TV in the waiting room the cross-dressers and transvestites have hit the US chat shows. Only four people remain; swapping addiction stories. The only woman addict pauses to make a final complaint about queues. "That bitch receptionist is going to let me die if I wait much longer."