Saturday Night: Blood, a little sweat and a few tears

THE Accident and Emergency unit at the London Hospital in Whitechapel can get busy on Saturday. But tonight will be quiet; a relatively casual casualty department, in fact. There was a rush earlier on but that has been cleared, says Tony Kelly, the senior house officer. Then a woman is led in, screaming, by two green-garbed ambulance men. A psychiatric patient, she was discharged only two days ago. She is placed in a secure room with a nurse and monitored via video cameras while a psychiatrist is called. The time is 22.40.

'Did you see Casualty last night?' Tony asks Pete, the orthopaedic registrar, describing an unlikely scene involving an RTA (road traffic accident). Pete says no, but that the show's medical adviser called him recently asking for an example of traumatic emergency. 'I suggested an external fixator. It's when somebody's smashed their pelvis and you have to pin it back into place to stop them losing blood.'

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22.54: The first RTA of the evening. A pizza delivery boy, knocked off his motorbike by a Mini, is trolleyed in wearing a neck brace and a splinted leg. X-rays show no fractures; he is extremely lucky. The thing to remember about motorcycles, I tell Tony, is that you are the bodywork. 'Yeah, it's horrible,' he says. 'I heard recently that an old friend from school was riding a bike and got sucked under a lorry by the downdraft. Lost a leg. But we see everything here, including a lot of time- wasters. Actually, if you want a quote, use this one: we cannot cure 'flu, so don't come in here with it. See your GP.'

Jan Forber is the junior sister, in charge of the A & E unit. She explains how patients are assessed by the triage nurse (tonight, Linsey), and prioritised into major and minor. The London's 'resus' or resuscitation room is probably the best equipped in the capital, perhaps the country. This means that when there is a major accident - train crash, multiple pile-up, bomb blast - the London goes on red alert. However, it also means people come here from 'out-of-area', expecting better and quicker attention than elsewhere. Is Saturday the big night for alcohol-related injuries? 'No, most of the PFOs come in on Thursday, that's Giro day.' PFO stands for Pissed, Fell Over.

Whitechapel is notorious for its drunks and derelicts, but the A & E staff are tolerant of the boozy wrecks who wander in off the streets looking for warmth, repair and solace. 'I like my dossers,' says Tony. Last winter, he says, some bloke came in asking for his feet to be put in plaster casts, because his shoes had worn out. But Jan is listening to Mike Walsh, duty surgical registrar. 'Nice ruptured liver or spleen, that would suit me fine,' he says. 'What? Now?' she asks. 'No, about 6.30, after I've had a good night's sleep.' He walks off, checking his bleeper.

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00.20: Jason has cut an artery in his hand and is squirting blood all over reception to amuse his mates, who are all drunk, like him. He is hurried into a 'minor' cubicle, where he swears a lot. Jan barks at him to cut it out. He does. 'He won't get any local anaesthetic when they stitch that,' says Tony. 'It'll teach him a lesson.'

00.32: There is a middle-aged couple, whose car was rammed by another on a roundabout. She has a shoulder injury. They are remarkably polite and patient. 'That's it, I'm not coming out on Saturday night again,' says hubby. X-rays show a slightly fractured clavicle.

00.40: A 30-year-old woman arrives for her fertility-drug injection. 'She's on an IVF (in-vitro fertilisation) programme, and the injections have to be timed very precisely, within half an hour. She's been told to come in for a one o'clock injection,' explains Stewart, a medical student who is glad to earn pounds 90 working all night on reception. That is more than a senior house officer earns, he says. After qualifying as a house officer, Stewart will get pounds 3 an hour. We both know people who get that much for cleaning flats.

00.59: A large Middle-Eastern man wants his haemorrhoids seen to. Denise, a nurse, draws the short straw.

01.00: A man, 21, wants innoculations for typhoid, hepatitis and tetanus before he flies to India tomorrow. He is told to wait.

01.05: Leroy, 30, has been knocked out in a fight. He cannot remember the incident and will be kept in.

01.13: A policeman brings in Darren, 19, whose hand is swollen and bloody with a purple sheen. After getting drunk, he has attacked his uncle, his girlfriend and his brother. There are tears in his eyes. His hand is certainly broken.

01.18: Alice, 91, known to have cancer of the breast and uterus, is admitted with vaginal bleeding.

01.52: A 20-year-old Asian man is admitted, bleeding from a head wound. His friend is hurt, too. After getting drunk at a party, they argued with another group of Asian guys, who ambushed them with chains.

02.24: Leanne comes in with a friend's ring stuck on her finger, which is now white. The ring must be cut off. She laughs.

02.50: I make my farewells. All apologise for such a quiet night. I tell Denise that if I am hospitalised, I hope it is here. 'Well, you try to smile at people, try to reassure them,' she says. I realise that in five hours no one has raised their voice except to tell a drunken buffoon to act his age. That is the difference between Casualty and the real thing: here, no one screams or shouts. There is no fuss, no bravado; the job is done quietly, swiftly, with humour when appropriate, and sensitivity. I go home, and everybody else keeps working, as usual.