St Vincent’s Emergency Department
Illustration by Jeff Fisher.
Surrounded by coteries of friends, two young women in party clothes are slumped in the waiting room of St Vincent’s Hospital in inner Sydney, and groaning in tandem. Their eyes are heavy and their heads, when not rolling backwards, are slouched over plastic bags. You can hear them retching from the front door. It is 9.30 pm on Saturday. Their big night out has ended prematurely.
“I’m at a hospital which has no reception,” one of the women’s companions hollers as she cups her mate’s lolling head in one hand and somehow manages to answer her ringing mobile with the other. “I’m with a friend who has alcohol poisoning,” she continues with an upward inflection, and then: “Do you have any idea how heavy her head is?” Another mate takes leave of the business of caring for his drunken pal and stares at the dismal space where his night has halted: rows of plastic chairs, vending machines, and a prominent notice advising patients that the hospital does not tolerate violence in any form. “I would hate to be a nurse here,” he says.
On the other side of the wall separating this holding bay from the emergency department, a team of medical workers, overwhelmingly young and female, is busy sustaining life. Professor Gordian Fulde, the department’s extroverted director, surveys his domain of the past 30 years. There is a steady procession of heart attacks, migraines and abdominal pains on show tonight, but more noticeable are the endless alcohol-related arrivals, a stream that becomes a torrent as the evening progresses: car accident victims; assault victims; a man whose friend has hit him on the head with a bottle; a man with a blood-smeared face who begs for a phone to call his girlfriend; another who asks where he is; the two women vomiting in synchronisation. Almost everyone is young.
“We are one of the few endeavours in life where we are not looking for business. We have more than enough,” declares Fulde, 63, as he strides among the dozens of curtained cubicles that line the main room. Medical monitors beep incessantly and bright lights belie the late hour. Every weekend a resolute roster of staff is left to sort through the aftermath of partying.
“From midnight to dawn, where most hospitals wind down, we don’t,” says Fulde. “There are people out drinking all the time and they fall over, they get into a fight.” Alcohol presents itself in multiple guises at the emergency department’s bulletproof doors: in attempted suicide victims; in the mostly homeless who guzzle metho; and in the extraordinary number of young people.
For the medical staff cutting off the clothes of those too drunk to control their bladders, or battling to insert intravenous drips, this is no place for frustration. “If you started to be remotely judgemental, you don’t belong here,” says Fulde, whose estimate that one in four cases tonight are alcohol-related is probably accurate, although they are so much more noticeable because of the aggression that accompanies many. “Everybody thinks alcohol is disinhibiting, funny, a make-you-look-good type of thing, but it actually does all the opposite … It regularly turns normal people into monsters.”
Medical staff counsel the arrivals where possible. “If you say a very simple message, that’s nearly as effective as weeks of counselling,” says Fulde. “That’s been shown time after time, that it does bear fruit.”
In one cubicle, a young man is slumped in a chair, groggy and belligerent after downing a full bottle of vodka, among other things. His blood alcohol reading is 0.45. It’s left to a nurse of about the same age to explain to him, when he’s sobered up a little, that he could have ended up in an alcohol-induced coma.
By midnight the front section of casualty is filled with drunken young men. One, in fancy dress, is fast asleep in a chair; another keeps stumbling out of his bed; another pleads with a nurse to charge his phone; another is resting an ice pack on his cheek; another has his head between his knees; another staggers around without shoes, fresh blood staining his shirt and face.
The waiting room floor is littered with soiled tissues and bits of plastic. A couple seeking treatment for a pre-existing, non-alcohol related condition opt to wait outside in the rain. As Saturday turns into Sunday, Fulde clocks off. Half an hour later, a young man leaves his bed and prowls the emergency department. He seems agitated and disoriented as he moves past other cubicles towards the main doors. In an instant, he and two other men become entangled in a vicious fight, arms flailing, fear filling the emergency room. A nurse yells to sound the duress button and rushes towards the trio as a siren starts wailing. “Dude,” she says firmly, as she attempts to pull one of the men away. “You do not want to do this.”
In the seconds it takes for two security officers to arrive, the men have fought, been separated, and are preparing to fight again. Eventually one of them leaves. The other two return to their cubicles. Everyone else goes back to work.