24 hours in Wellington Hospital's emergency department

BY KERRY WILLIAMSON, KATHERINE NEWTON AND RUTH HILL
Last updated 05:00 12/09/2009
Wellington Hospital
NATALIE SLADE/The Dominion Post Zoom
The Westpac Trust rescue helicopter arrives with an injured motorcyclist.
Wellington Hospital
PHIL REID/The Dominion Post Zoom
A drunk patient lies asleep in his own urine.

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If you're here, you're probably in agony.

On any given day, the sick and injured converge on Wellington Hospital's emergency department.

Some are victims of bar brawls, too much booze, car crashes, sports injuries, moments of madness. Some are near death, and won't be going home. Others are patched up in minutes and sent on their way.

Patients slump in the waiting room, wondering when they will be seen, or lie on hospital beds surrounded by nurses and doctors. Friends and family hover anxiously.

The staff calmly treat those who need help, and every few hours they are called on to save lives. They say they are not heroes or angels - they are just doing jobs that they love.

Here's how last weekend went.

SATURDAY

Midday: An old woman, unconscious and covered in tubes, is wheeled into ED and lifted on to a bed in one of three rooms reserved for the sickest of patients. She has suffered a massive brain haemorrhage. Three nurses and two doctors do what they can to make the 91-year-old comfortable, as family members wait outside. "She'll die today," nurse co-ordinator Lincoln Earley says. "I could be wrong, but ..." Ninety minutes later he will be proved right.

Wellington Hospital Audio slideshow: Kerry Williamson and Katherine Newton reflect on their shifts behind-the-scenes in the emergency department at Wellington Hospital.

12.22pm: Three-year-old asthmatic Justina Yamoah is sitting on a bed while doctor Kirsten Brown listens to her chest. Her mother and father brought Justina in after she became short of breath. She's breathing more easily now, so Dr Brown tells her parents they can take her home.

12.34pm: Nikora Timutimu shivers in agony. A tall man, he has been "spewing" as the result of severe abdominal pain that doctors suspect is being caused by a kidney stone. It was meant to be his first day of work as a drainlayer and he's worried about what impression he might have made on his new boss. "The way I deal with it is clenching my teeth."

1.06pm: Dylan Bagci, 3, sleeps in the arms of his mother, Kerry McCallum, as they wait to be seen. Blood dries around his nostrils. "He rode his trike down about seven steps and took out a good chunk of skin from under his nose," Ms McCallum says. "It was bound to happen."

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1.25pm: With fewer than a dozen people in the waiting area, receptionist Pamela Bramley uses the downtime to file patient forms. Her job is "never boring" but can get stressful. "We're often dealing with patients who've been waiting a long time or come in drunk."

1.48pm: The 91-year-old woman who arrived earlier has just died. As nursing staff fill out the paperwork, a shaken relative stands in the corridor looking lost: "I'm not sure what to do now," she tells nurse Storm Baker.

2.50pm: Dylan Bagci's mother is resorting to bribery to get him to stay still as she and nurse Sheena Napier clean up his bloodied nose. "What would you like for dinner tonight?" "Butter chicken," he says as he jerks his head out of reach. Ms Napier goes searching for toys to keep the preschooler distracted.

3.07pm: Jakob Christie, 19, is lying on a gurney in a corridor, his neck in a brace. He says he was hit with a police baton when a party he was at the night before was shut down. He woke up that morning barely able to move and X-rays revealed one of the vertebrae in his neck has snapped. Now he's waiting for a CT scan to make sure his spinal cord hasn't been damaged. "It's pretty sore."

3.23pm: Doctor Abbey Lynch advises Ms McCallum that the surgical glue she's about to use to patch up young Dylan's nose will sting. "If we can have a deal that you hold him still, that would be great."

3.43pm: Mr Timutimu is back on his bed, a plastic container on his chest in case he needs to throw up again. He will have to pass the kidney stone himself - all department staff can do is help manage the pain. He's scared: "Somebody compared it to giving birth. I thought, 'Holy Moley'."

4.03pm: John Henderson is in a wheelchair waiting to be taken to the fracture clinic. In the last five minutes of his last rugby game of the season, his achilles tendon snapped and his ankle "turned to jelly". He's glad he won't miss any games, but he will need a cast for six weeks. "It's a bit of a hassle."

4.40pm: Zacchaeus Clarke has been in the waiting room for about an hour, after friends carried him in when he sprained his ankle while "mucking around". He's a salsa and Latin dancer and is meant to be in a performance tonight at the Michael Fowler Centre. Despite his rapidly swelling ankle, he's confident he'll still make it there. "Nothing's going to stop me."

4.50pm: A 46-year-old man brought in earlier with chest pains has deteriorated rapidly and is no longer breathing by himself. Sedated and hooked up to a ventilator, he lies on a gurney in one of the resuscitation rooms as doctors work frantically to find out what's wrong with him. They know he has kidney disease and bone disease, but don't have a diagnosis for what's gone wrong with him today. A CT scan might provide some answers, but his condition is too unstable to conduct one. The room bristles with tension as doctors Scott Bomann, David Tripp and Abbey Lynch debate what to do, aware that time is running out.

5.18pm: Doctors working the night shift have arrived and gather with day-shift doctors in a nearby seminar room for a handover meeting. As they file back out, emergency specialist Andre Cromhout reminds them to make sure they eat something. It's easy to skip meals when things get busy.

5.40pm: The patient in the resuscitation room has been stabilised just enough to be sent for a CT scan. Dr Cromhout does not have high hopes for him. "He's got a very poor starting point of health already. The honest answer? He's probably just going to die."

6.13pm: Zacchaeus Clarke, the dancer, is still in the waiting room. He looks at the clock and decides it's time to leave so he can make it to his performance. "I'll come back after," he jokes. He doesn't return this night.

6.43pm: Jakob Christie has had a new neck brace fitted and is waiting to be discharged. "I've got to stay in this for two weeks and come back in a week to see how it's all going." He holds his X-ray up to a lightbox to point out where his neck was broken. "Now I've seen that, I'm glad I've come in."

7pm: A baby who hasn't been named yet is in one of the resuscitation rooms. He's crying - a welcome sound for his parents, who called an ambulance when he stopped breathing. He's OK now, but his mother and father are distressed - just half an hour ago they were giving their tiny son mouth-to-mouth.

8.25pm: Fourteen people are now sitting in the waiting room, including a girl who had one drink and fell over, and a woman who fell off a horse. There are 33 patients in the ED. Triage nurse Louise Corlett castigates someone who suggests it's quiet. "Don't say that word," - the "q" word is banned in the emergency room. It tempts fate.

8.30pm: A policeman asks triage if they've seen a skinny guy in his 20s with a bleeding lip. He might have been riding a bicycle, the cop says. "If he comes in, let us know."

8.35pm: A pale-looking patient approaches Louise Corlett and asks when he can see a doctor. "I've been waiting for almost an hour," he says. She tells him that it should not be long. Nurse co-ordinator Mel Taankink says most patients think they need immediate care. "They have really high expectations when they come to the emergency department. We just try and diffuse some of their agitation." Some patients should never have come in the first place: "We often get people who cut their finger on a baked bean tin, or something like that. They think it's an emergency, but it's not."

8.45pm: Inside the ED, a staff nurse who was pricked by a needle while taking blood from a patient must now have blood tests of his own. He's understandably worried. The baby with breathing problems who arrived earlier in the day is moved to the children's ward.

9:05pm: A 21-year-old man arrives by ambulance. He fell off a chair at a pub and says he had one drink. "They always say it was just one drink," Mel Taankink says wryly. "Then they end up in emergency and then they end up peeing themselves, waking up ... and leaving."

9.15pm: Three patients sit in the waiting room, two of them lying over chairs with vomit bowls in their hands. Someone has partly completed the crossword in a coffee-stained newspaper. Australian Idol is on the television.

9.25pm: The 21-year-old who fell off his chair at the pub is asked a list of questions by doctor Terrianne Cripps. He admits he had a beer at home, and a beer and half a glass of wine at the pub. "I was sitting in the chair and I felt it coming on. Then I woke up on the floor. I was cloudy in the head." He doesn't seem drunk and the doctor doubts it's anything serious.

9.30pm: A Kapiti Coast woman, 44, who fell off her horse when it head-butted her, is admitted. She was butted just below the cheekbone, her face is puffy and bruised and she has a black eye. She's been waiting for two hours. "The swelling just started going up and I started getting blurry vision." Her partner took her to a clinic in Paraparaumu, where a doctor told her to go to hospital. She is a little annoyed she's had to wait so long. "Everybody is busy, but some communication would help."

10:10pm: Three ambulances arrive at once. A 78-year-old woman is taken into room C2 with pelvis/hip trauma. A 56-year-old man who has suffered a stroke is taken into one of three resuscitation rooms. And a man with a heavy American drawl and chest pains sits on a chair in the corridor, filling out a form.

10.31pm: The woman head-butted by her horse is discharged after X-rays show she hasn't broken anything. She was at the hospital for three hours, spending two in the waiting room. "It's a long road back up the coast," she says.

11:03pm: Dr Cromhout makes a beeline for the door, his shift ending. His beloved Springboks are taking on the Wallabies and he might catch the second half if he hurries home. "It's not common that I get out of here on time, so I'm going to make a break for it," he says.

11.15pm: Ron "Cowboy" McClung - the American with a thick Texan drawl - lies on a stretcher. The 57-year-old will stay the night. He was at home in Waikanae when he started feeling pain in his abdomen. When it moved up his chest, he told his wife, Suzanne, to call 111. The couple waited half an hour before an ambulance arrived, during which time Mrs McClung become so concerned she phoned 111 again to tell them to hurry up. "Had Ron had a heart attack, he could have been dead before they even got there. That's alarming to me."

11.33pm: Triage nurse Jinty Graham takes a call from an ambulance in Kapiti. It is transporting someone with breathing problems who is deteriorating fast. She is also told that the Westpac rescue helicopter is at the scene of a motorcycle crash and will be returning with a badly injured patient. Two resuscitation rooms are prepared.

11.47pm: The rescue helicopter arrives from the north and touches down. Crew member Logan Taylor and Wellington Free Ambulance paramedic Glen Worthington emerge, pushing a stretcher bearing the badly hurt motorcyclist. His right foot is twisted at a right angle and his face contorted with pain. Mr Taylor says the 22-year-old and his brother were both injured when their motorbike veered off Coast Rd near Wainuiomata. Both broke their left femurs. They waited for three hours before a passing farmer heard their cries. "His feet are like ice," Ms Graham says. The brother was taken by ambulance to Hutt Hospital.

11.50pm: The ambulance from up the coast arrives and the woman with breathing difficulties is wheeled into the room right beside the injured motorcyclist. Both rooms are hives of activity. The motorcyclist screams in pain as he is lifted off his stretcher and on to a bed.

SUNDAY

Midnight: "Cowboy" McClung can hear the motorcyclist's screams from his room. He's waiting for his blood-test results and wife Suzanne is waiting with him. "The service here, starting with the paramedics, has been great. Everybody is, in typical Kiwi fashion, warm and friendly," he says. "It's never fun being in hospital or emergency, but sometimes it's better to be safe than sorry."

12.49am: The night's first drunk arrives - a young man with a moustache and beard drawn on his face. He's been celebrating his 18th birthday - and is now unconscious. His worried father is with him and his friends are out in the waiting room, talking about their night.

1am: The injured motorcyclist's pregnant wife arrives, pushing a baby in a pram. The couple were supposed to spend tonight celebrating their anniversary - now they're together in ED. Ten minutes later they are joined by a policeman, with a request to take a sample of the man's blood. Hospital staff say he reeks of booze.

1.34am: A call comes in from a family looking for a missing relative. An elderly man went for a run at 6pm and never came home. Police are looking for him. "Has anybody seen an unidentified man?" a receptionist asks. Another drunk young man arrives on a stretcher, unconscious in the foetal position. Five minutes later, he vomits all over the floor.

1.48am: Wellington Free Ambulance paramedic Andrew Truesdale is back with another drunk. The 16-year-old was found by police lying beside Kent Tce. Staff nurse Ange Campbell attends to him. "Bless his little heart," she says. "He doesn't want us to call his mum because he says she'll give him a hiding." Four drunk young men now take up beds in the emergency department, pumped full of fluids. "It's one thing to have a few drinks, but to get so drunk that you end up in hospital, there's something quite wrong," Ms Campbell says.

2.12am: The mother of the 16-year-old drunkard arrives. She was at a party herself, had too much to drink, and got the boy's grandmother to drive her to hospital. She doesn't give her son a hiding, just stands next to his bed and shakes her head.

2.15am: "Cowboy" McClung's first blood tests show no sign of cardiac problems. The results of more tests are due back in two hours, and then he might be allowed to go home. Wife Suzanne is still by his side and looks shattered. "Hopefully we can get out of here," she says. They do leave, but not for several more hours.

2.30am: Jinty Graham manages to sit down for a few precious minutes. She has worked in emergency rooms for close to 16 years and has no home clothes that are blue - she spends so much time in scrubs that she hates the colour. She loves the job though. "It's the variety. No two days are the same," she says. "You're always exhausted after a shift. And you never know what's going to happen next ... When you don't see their name in the death notices, it's a good outcome."

3am: The badly injured motorcyclist is moved to an orthopaedic ward on the sixth floor to await surgery. The 18-year-old who was out celebrating his birthday is asleep on his hospital bed; his father is asleep in the family room.

3.15am: The drunk 16-year-old is up. He can barely stand but is allowed to go home. As he walks out the door, he stops to give nurse Ange Campbell a hug. "Thanks, Miss," he slurs as he leaves.

3.18am: An ambulance drops off a 20-year-old man. Drunk, he got into a fight in Courtenay Place and was kicked in the stomach. He can't remember the fight or police showing up and he isn't sure where he is. "Oh, he's gorgeous ... he's unconscious," says Ms Campbell, after cleaning up more vomit.

3.50am: Another young man wobbles in, his face covered in blood. He says his name is Corey and he remonstrates with ambulance staff who tell him that they brought him to hospital; he insists his mates brought him in and doesn't believe he was in an ambulance. "I'm honestly sweet, I honestly can't believe I'm here," he tells them.

4.04am: An alert sounds and staff sprint to the ambulance bay. A young man bleeding from a chest wound is wheeled in by paramedics. He was arguing with his flatmate and slammed the ranch slider, shattering the glass and embedding a 6cm shard in his chest. Ambulance officer Graeme Quinn says the man had already pulled out the shard by the time paramedics arrived - "a complete no-no" - because sometimes the object is the only thing stopping someone bleeding to death. Jinty Graham notes he's "very lucky" that the shard penetrated the right side. "Further to the left and it would have gone through his heart."

4.15am: Corey wants to discharge himself, despite his injuries and drunkenness. A burly security guard is called to help a nurse, who persuades him to stay - for now.

4.34am: Liam Hickey, 12, from Island Bay, who has been waiting five hours, gets a temporary cast applied to his broken leg. Dad Chris Hickey says Liam was bouncing between mattresses when he caught his foot and fell awkwardly. As the father of three sons, he's familiar with ED. "My wife spent four hours at the accident and medical centre last night after his big brother injured his toe."

4.40am: Police arrive to chat with Corey, who still wants to leave. Doctor David McQuade tells police he is worried Corey may have a head injury and does not want him to leave without someone to watch over him. Corey wheedles: "Honest, mate, I'm sweet ... I just want to go home." The police officer tells him to have a seat and keep trying his mates.

5am: Paramedics wheel in an old woman with chest pains followed by a middle-aged bloke in an oxygen mask who has had an asthma attack. The kid who drank himself into a coma on his 18th birthday is allowed to go home with his dad. "What kind of a party was that?" his old man asks him, shaking his head in disbelief.

5.15am: A bed in a ward is found for the older woman in resuscitation room 1, about six hours after she arrived with severe breathing difficulties. She has been stabilised and perches on the side of the gurney with her legs dangling. As she is wheeled away, the patient looks about her with rheumy eyes.

5.16am: A young woman arrives in a wheelchair pushed by her friend. One of her feet is twice the size of the other. She was in a car accident two weeks ago and something embedded itself in her toe. At a visit to ED last week, she was given intravenous antibiotics and told to come back the next day, but did not. "She hates hospitals," her mate says.

5.35am: A scan of the guy with the chest wound shows the shard has punctured his lung, allowing air to enter the chest cavity. An ED registrar put in a drain but it has not worked so a cardiothoracic consultant is called in. Angela, 78, from Paraparaumu, who has been here since 10.10pm, is parked on a hospital bed outside, watching with interest. She fell last night getting into a taxi outside the RSA and has been diagnosed with a fractured spleen. She needs to spend four or five days in hospital but there's no bed for her yet. "I can't sleep a wink but I know some people can because I can hear them snoring."

5.55am: One of the young drunks is described as "code yellow" - he's wet himself. Ange Campbell rouses him - "you've had a little accident" - and shuffles him off to the toilet to clean himself up. "He'll get out of here and go straight back to town, pick up his car and drive home still over the limit," she says. Corey makes another break for freedom but is thwarted by the security guard. "Why the hell is this guy trying to make me stay? It's weird." He sounds genuinely aggrieved. "I want to get out of here and go home."

6.11am: A four-year-old comes in with earache, and 20 minutes later a man with a seeping surgical wound is readmitted. The ED is filling up again.

6.38am: Corey is finally allowed to leave - against medical advice. Dr McQuade says there is a small chance that Corey may have a bleed in his brain and he would have preferred him to have a CT scan. "He was able to repeat back to me the implications of his decision to leave, so we have to accept that."

6.50am: The morning shift is arriving and getting the handover from the night crew. Forty minutes later, Jinty Graham finally finishes her shift. The young drunk in the wet jeans ambles out without a word of thanks, muttering: "How do I get out of here?"

8.03am: The ED doctors have their handover meeting and read through case notes. Scott Bomann from Connecticut is the consultant today. He has a bandanna printed with the American flag wrapped around his stethoscope to let patients know he has an accent. He's two months into a three-month locum stint and already plans to return permanently next year with the whole family: "I went into medicine to care for sick people, and emergency is where you find the really sick people," he says. Having spent nine years working in an emergency room in the South Bronx, he says New Zealand traumas are "a little less acute" ... with fewer gunshot wounds, for instance. "But it's always interesting. I worked in Timaru and there were lots of strange 'sheep-related injuries', for which the explanations didn't stack up quite right."

8.15am: The health assistant delivers breakfast to each patient - a choice of cornflakes, rice bubbles or porridge with pineapple and toast. The waiting room is filling up - there's a young Asian woman in a facemask holding a baby on her knee, three teenage girls with slept-in hair and an older Brethren gentleman with a dodgy eye.

9.24am: With the flow of young drunks stemmed, it's now the turn of the elderly. The next hour sees the admissions of a 71-year-old woman with diarrhoea, a 60-year-old man with asthma, a 72-year-old man with a head injury and a 60-year-old woman complaining of back pain.

9.30am: Claire Graeme from Mt Victoria is waiting for her sick baby Freddie to be assessed. He's only four weeks old and had already been admitted to hospital last week with a chest infection. This morning, his breathing seemed especially laboured. "I rang Plunketline and they said, 'Don't muck around, get to ED. So thank God for Plunketline."

10.38am: A middle-aged woman in shorts and trainers is wheeled in on a stretcher, clutching her arm. Michelle Scown from the New Plymouth Youth Ladies roller hockey team was in full-swing at Kilbirnie Rec Centre when she went down backwards. She put out her hand to break her fall and now her wrist has a distinct bump. "I could have done this sitting at home knitting," she says. "Very dangerous hobby, knitting."

10.49am: A boy, 13, with abdominal pain is admitted, followed by a one-year-old boy with an injured face and mouth, a man, 28, with abdominal pain, a 67-year-old with chest pain, a 23-year-old with something in his eye, a 76-year-old woman who is vomiting and a 59-year-old man who fell over and hurt his hip.

11.30am: The girl with the badly swollen foot is off to surgery - something she could have avoided if she had simply followed doctors' orders.

11.31am: An 82-year-old woman arrives after collapsing at home. Baby Freddie and his mother are allowed to go home.

Midday: There are 12 people in the waiting room and another 15 still in the emergency department. Last night's drunks are probably back home sleeping off pounding hangovers, and the elderly are receiving visits from concerned relatives. Another ambulance is on its way and another room is readied. There is no let-up.

FREDDIE'S RIGHT TO GO HOME

He is only a month old, but little Freddie Conn is back in hospital for the third time.

He has been having trouble breathing, so worried mother Claire Graeme has taken him to the emergency department from their Mt Victoria home. A week earlier, Freddie had spent time in the paediatric ward after bronchiolitis - a chest infection - was diagnosed.

So when his breathing became particularly laboured on Sunday, Ms Graeme rang Plunketline - "they said, 'don't muck around, get to ED'."

The pair spend close to three hours in the emergency department before Freddie is discharged.

Doctors do some tests, which show few problems. The baby has a cold, but nothing serious.

"The staff were lovely, they were really nice. They make you feel really supported and looked after and they don't make you feel like a mad hysterical parent, which is really good," Ms Graeme says. "It's a pretty intense sort of environment. It was a bit too soon for him to go back to hospital - he's only a month old."

Freddie is fine, now. "He's just got his brother's snotty nose. He's doing really well."

- The Dominion Post

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