Another Night in A&E

I am in the emergency ward of the St Joseph hospital. My face is swollen to twice its size from an abscess in a back tooth. Because of my rapid heartbeat, because I've taken over 30 ibuprofen capsules in the last eight hours, I have been warned that if I leave the hospital the police will be called. To show how ridiculous the situation is, to show how physically well I am, I begin jogging on the spot. The stony faced nurse on reception who legally took me hostage, seconds after my disclosure that I am a heroin addict, asks me to stop. I carry on. I'm in tremendous pain but not unwell. As I jog on the spot I tell her the problem is my swollen face not my heart. She says that the face is a matter for the dentist or the plastic surgeon and that they don't deal with either emergency here. What concerns her, she says, is my tachycardia, a potentially fatal side-effect from an overdose of ibuprofen. She says I will be legally detained until a doctor is satisfied I pose no danger of collapsing and dying somewhere. I tell her I always pose that threat. She isn't amused, and I wasn't trying to raise a smile. She points to a waiting bed and tells me to take it.

 – How long must I wait? I ask, still lightly bouncing from one foot to the other.
 – Could be 10 minutes... Could be 3 hours, she replies.

It's not me she's protecting, its her - the hospital. She's thinking professional liability and malpractice, well, that cocktailed with a spiteful sense of revenge for me having destroyed my own teeth before staggering into the hospital, a lifetime too late, smacked up and begging for help. It's a donkey court and it always is.

In addition she also finishes her shift soon, I heard her say so:
 – I'm off in half an hour, make sure that one (her eyes sliding across to me) doesn't leave!

She finished with a weird amphibious glee pealing out from the corners of her lips, delighted at the prospect that some other poor soul will be obliged to stay under the the sallow fluorescent lights of A&E, amongst the ragtag of the public with bloody-DIY-bandages, burst bowels, vertigo and short tempers, while she does not. She likes that idea: someone else occupying her vacant hell for a while. That's who she is right there. No need to horrify you with any tasteless physical details, turn your stomachs with a nauseous description of her large, padded-arse preordained for flatulence, or describe the comfy, squeakless shift-shoes she melts down into, the flesh around her ankles spilling out and moulded obediently over the sides. They're just physical accessories to the real deal. Her real personage, her dire essence, the consequence of her twenty years fast trading in the 'care' industry was that which oozed out in her spitefulness, her scepticism and hatred of the sick and dying, the delight she took condemning another person to experience the torture of her daily existence... Someone she had judged undeserving of her or the hospital's services (which would be just about anyone still breathing) and who then merited a hefty spanner in their day's works.

Not long after and she's back, asking me how I feel: nauseous? Light-headed? I slide off the bed and onto my feet and begin jogging again.

 – I'm fine, look...

The nurse marks something down on a clipboard of information she's already started collecting on me and returns to where she came from, looking back with raised eyebrows to confirm she's never seen anything like this before. It's an insane thing I'm doing, but it's an insane place I'm in. An old woman leans across and whispers:

 – Young man, they'll section you if you don't stop. They'll say you need psychiatric help and you'll be up in the hills for 7 days. They can do that!

And I know they can. They did it to Mary's mother on the third time that week she was driven into hospital claiming to have suffered a heart attack. She didn't return home for over a month and when she did she was dressed like a whore, with a wig of red hair and a lurid smile painted across her face in cheap pink lipstick. Cured!

I think of my methadone at home, of the 3 grams of smack wrapped up in foil and left on my keyboard and I stop jogging. From the disgusted look that crosses the nurses face I know I'm the last patient in a stressful day and I'll wait every minute of the three hours she said it could take for the doctor to see me.

* * *

Being a coward, with an innate fear of hospitals, disease and doctors, I sit on the emergency bed comforted by one of two friends who'd accompanied me to casualty. I can't get my mind of the swelling in my face and the more I try not to think about it the more aware I am of its presence. I have thought of everything from deep vein thrombosis to a ruptured aneurysm as being the cause. Thoughts of blood poisoning and jaw and brain infections are whirring through my mind. I feel sick. My heart starts the mad beating again. I come over all cold. Then sweat. It must be the fever from the septicaemia. It starts of like that and then you fall into a coma. I'm in the emergency ward thinking of comas. If I lose consciousness and am dope sick on top I'd never survive and I know it. My heart pounds right through my head and I flush pale. I need the toilet. I don't want to be alone. The nurse arrives with what looks like bottle of gas attached to a coat stand.

 – Roll your sleeve up, she demands, let's check your heart again.
It's jumping out my chest, and gets worse as an expression of grave concern comes across her face.

* * *

It's an hour and a half and I've not been seen. From one of the drawn off rooms an old man in groaning somewhere between panic, pain and fear. There will be no good news from that room. I think of my stepfather and an atmosphere of tragedy and loss seeps into the hospital. It's quiet, like a great storm is sat in the sky. My heart calms and goes again and a terrible feverish chill goes through to the bone.

***

 – So tell me, where did this fear of diseases come from? My friend asks.

 – I don't know, I say, without even having thought of it. It's always been there.

He pulls a face and we fall quiet. But now I am thinking. Of those young days, laying on my bed, with Parrots disease or breast cancer, my heart flipping out and desperately wanting some reassurance.

 – You know, I say, I think in a way it comes from wanting my mother to return home. In a way it was always and only that which I waited for... To be told everything was alright.

He doesn't understand.

 – Why, where was your mother?

The atmosphere in the hospital is dense, like it is when waiting for bad news to filter through, like it is after death has visited some place, and reality and life and nature suddenly become nostalgic and full of immense sadness, and human comfort and warmth becomes a real and needed commodity. I look at the floor.

 – She drank, I say, a lot. She'd leave for week's or months at a time with some man or other and only return when she was either half beaten to death or sober. But I waited for her... God, I waited like I'd wait for love all my life.

My friend had drifted on the emotion of my words. The French was bad but there was something in my throat, in the gloom and finality of the hospital which made my words work. I am pensive, maybe sad too, maybe pitying myself in this place and thinking of my cold empty room and not wanting to be there alone once this is over.

 – And when she returned, your mother, did she calm you? He asks.

 – Always, I say, nodding. Without ever really trying to. Then she'd go and I'd imagine I was dying again and be miserable until she returned.

 – And your father, couldn't he soothe you?

 – My step-father? No. He was an intelligent, knowledgeable man but I didn't trust him. Something about his knowledge seemed fraudulent. I'd never have believed him if he had tried to calm me. It's about my mother. My fear of hospitals too. Even sitting here, in this foreign place, the smell's the same. I can remember the overdoses and the hospital wards and not being allowed to see my mother because she was still unconscious but knowing she was laying half dead just in the room opposite. Those things burn images into the mind. Then on her waking, hearing her describe how the paramedics had bruised her breasts reviving her, speaking like each bruise was a token of honour. There was something about hospitals and doctors surgeries from those days on. Even though they saved her I associated them with death and they scared the hell outta me.

We fell quiet. The late spring evening was coming to a close outside and there was no doctor in sight.

***

I am looking at an old couple across from me. The man is thin but with a huge bloated chest – probably lung disease. He is laying out on a trolley bed, fully dressed but with his shoes off. He has cheap white socks, grubby on the soles, that make him look unkempt. His eyes are to the ceiling and his Adam's apple juts up sharp out his taut throat which in turn is covered with specks of dark grey and silver stubble. Resting down by his stomach is an oxygen mask. He looks like he's waiting for the white tunnel we've been told so often about. The woman is sitting tight alongside the bed holding his hand. She has tears in her eyes. Sometimes the man shrugs as if life was life and life is over now. The woman squeezes his hand and tears betray him. I know what it is, the tragic realisation that the years have really gone, that already you are here, and yet it seems you only crawled out from the cocoon of youth just yesterday. I watch his socks and then the two hands entwined. Wrinkles, veins, interlocking fingers, a gold wedding ring. The man closes his eyes gently and it reminds me of something I can't remember.

***

I'm starting to get dope sick. It puts the world in context, and if not context at least prioritizes what's important. Staying in the hospital is not important, and having the police call for me once I've stashed my crimes not so much either. If I leave I need to get a quick hit, pocket a bottle of methadone and then make good the apartment.

I roll a cigarette in the emergency ward. My friend tells me: they'll never let you out. I reply: they'll never keep me in!

As soon as I stand and pat my pockets down for my lighter the old grunt of a nurse is upon me, waving her clip board with some squiggles on it which is apparently my heartbeat. I tell her no living creature could possible make such a pattern. She doesn't understand, and it's not a language thing. She says there's no way I can leave to go for a smoke.
1) in case the doctor arrives; and 2) in the event that I lose consciousness out in the street.

I argue the toss, but as the door is securitized and needs to be released by a member of staff I cannot leave by it no matter how determined I am. The only way out would be to rush into the staff area and leap out over the reception desk. I think of it, imagine the shocked expressions such an act would encourage, but sit tight. Then I spot my chance, a member of staff entering with a swipe card. He hesitates while swapping a few pleasantries with the girls at the reception desk. As he holds the door open I dart out. There's a confused noise, a feminine screech of annoyance and then the same voice calling "Monsieur?.. Monsieur???" I hold my cigarette up above my head and make for the exit, purposely lighting up a few steps while still inside the hospital.

I am smoking calmly, though caught in thought, when my favourite nurse arrives and stands staring at me. She hasn't got her hands pressed into her sides and she doesn't tower over me in the shape of a capital 'A', it just appears like that.

 – Put the cigarette out and get back inside! She says.

I tell her I will smoke and I have the right to smoke and I will come in once I've finished.

She warns me that if I disappear she WILL phone the commissariat and I WILL be taken against my will and I WILL be returned to the hospital. I tell her my bag is inside and I have no intention of doing a runner but I WILL smoke my cigarette... maybe two or three. She pierces me with a chilling stare of hatred, leaves, and then does a Colombo, spinning around and coming back at me.

 – Oh, and if you collapse out here and we don't get to you in time it WILL NOT be the hospital's fault!

 – I understand, I assure her, and if I collapse I'll make sure to do it inside.

She leaves again but incredibly she cannot. The Colombo is an overwhelming force within her; she needs the last definitive word. So she's back, this time warning me that if the doctor calls me and I'm not there then the wait will begin anew. I'm sure this is now what will happen. I could annoy her further but decide to allow her the victory of last retort. I continue smoking, light a new one with the remains of my last, and watch as she re-enters the hospital all bosoms, ass and calves, and a face that speaks of another victory and serves as a warning that no one else should try fucking about on her shift.

My God, I think, who needs the love of a woman like that.

* * *

The mild spring evening has fallen, the stodgy-arsed receptionist has gone home, an air of tiredness and reflective calm is manifest in the corridors of casualty awaiting the night-shift and all the blood and street life that that will soon start dragging in. Now and again from one of the various screened-off wards someone is wheeled or stretchered out and past me, up into the main hospital where they've earned their place for the night and maybe much longer. In this securitized heartland of A&E I am the only person not in a bed, on a drip, or being treated by multiple doctors. My face is horrendously swollen and so may give a false sense of urgency concerning my presence here, and even though I've been told I will not be treated I have still been needlessly leapfrogged over the poor souls in free-town, that side of casualty which is drop in or drop out whether you can bear the wait or not. In fact the wait seems more like a surreptitious filtering system designed to clear-out the patients who aren't strictly emergencies, and acting as nothing more than a sobering room for others. Now and again the police lead someone in and sign them over, cast a look over the wounded for any known criminal faces, and then leave.

Taking me by total surprise a young nurse approaches me and asks if I'd like to see a female Welsh doctor who works there.

 – Only if she's younger than 35! I reply. The young nurse looks at me strangely, bemused. Not even I know what I meant.

 – Whoever's the quickest, I say. Apart from my tooth and the pain I'm not in need of any urgent treatment and just want to be home.

The young nurse understands I'm really not an emergency, and that if I am irritable it's due to having been kept here when if anything I should be at an emergency dentist having my tooth and swelling treated. She asks if she may take my blood pressure and heart rate one last time. I look at her long delicate fingers, her slender flat figure beneath her light uniform and nod my approval.

 – The thing is though, as soon as you pump up that pressure band my heart is gonna rocket... It's always like that. It's why I did so miserably earlier. It's why my doctor always takes my pressure twice.

 – And why's that? she asks softly. There's really nothing to fear. Even a high reading isn't the end of the world and in most cases not serious at all. But it's nothing to be scared of, really.

By the time she's said that, and asked me: – How long have you been in France? she has inflated and is now releasing the pressure band. She is tricking me and I let her trick me, and I need to be tricked.

 – 7 years, I reply, and the language is still a nightmare.

 – But you speak French well. I understand everything... except the 35 year thing??? Maybe an English joke?

 – Maybe? I say and smile, Or maybe it's just a Me joke... Which hasn't any meaning and isn't funny.

Her trick has worked. Her hands are warm and her fingers delicate and caring as she loosens the pressure band from my bicep.

 – That's fine, she says. A tiny bit higher than average but still within norms.

 – And the heart, I ask, feeling it rise in tension and begin pumping what feels like thick blood up into my head.

 – Normal, she says, nothing worrying there either.

 – So I can go?

 – No. You must still wait the doctor but he won't be long now.

Not 5 minutes later a bespectacled, middle-aged, fair-haired, balding doctor arrives and calls out my name. As I jump up he looks at me with an air of horror and surprise.

 – But you, are YOU an emergency?

 – No, I say, I feel fine. It's my face... A tooth, but the receptionist said...

He shakes his head and cuts me off, beckoning me to follow “This way” into a small curtained off surgery.

 – OK, so you're not ill but you're here as a potential fatality sat in one of our our few emergency beds alongside your own emergency buzzer? Please do explain?

I tell him about my face and the toothache and the nurse, then about my heroin addiction, methadone treatment and the ibuprofen I've taken. Of course the only detail he hears is that about addiction to heroin and methadone maintenance, and not even allowing for me to finish he is laying it down very firmly that the hospital, not this hospital or any other hospital in France, gives out methadone to addicts.

 – That's impossible, he says getting angry.

I tell him I'm not there for methadone, that I have plenty and better at home. I tell him I am there because some receptionist-cum-nurse threatened to have me arrested if I left, even after telling her I didn't want any treatment for the suspected ibuprofen overdose it was obvious I wasn't suffering from.
 &nbsp- So if I'm here taking up valuable time it's not by choice and it's not to try and swindle a meagre dose of shitty methadone either!

Even after my words the doctor isn't having any of it. The way he speaks, the harsh fashion he tells me to strip to the waist and take the couch, the way he washes his hands and violently slings the water of his fingers into the metal sink, rubs a heap of tissues between his palms and let them fall free into the waste bin, and then the look of absolute vexation on his face when he turns to find me still standing there fully dressed.

– Listen, I say, I just want to be outta this place. I don't want any more blood pressure checks, no more heart monitors, no more looking down my throat or peering in my eyes and you're certainly not doing a fucking liver damage test or whatever it is you want to do. That's my right and I don't want to be touched or prodded any more. I just want to be left to go home. I came here 3 hours ago for my face and tooth, I'm in tremendous pain, you tell me you can't help me but keep me here for a treatment I don't want or need but will have to pay for! Well I don't need treating and I refuse treatment... I just want to get the hell outta here.

The doctor looks at me and with all his intelligence, all his ten years of study and fifteen years of practice, he says: So you are here just to try and get methadone?

I feel sad and I don't reply. I have no words and I do not want words in the face of such disastrous care. Words and language are useless when you come up against someone so stupid as that. I let my head drop. The swelling in my jaw and cheek is pulled by gravity. My face feels like it is falling off from one side. The pressure and throbbing rise and pumps around my head. I close my eyes and let the pain take hold.

* * *

It is almost 8pm when I finally step out of A&E, hurting more than when I entered, too late to find an emergency dentist and holding a prescription for antibiotics I don't need and which is to be exchanged at a chemists which closed almost two hours ago. On top of that I am now snivelling and yawning hard from dope withdrawal and am the best part of sixty euros out of pocket for my treatment. The money doesn't matter. If I'd have been treated for my actual ailment I'd have paid sixty and a whole lot more besides. I'll get them back at death, I thought... I'll rack up such enormous medical costs then fail out on life and all due payments!

The sun was then almost gone from the sky. It lay half below the horizon, an orb of light through shutters of evening cloud. The city was a silhouette of buildings in front of it, under a mauve sky darkening off in one direction. It was that time, on such an evening, where a beauty descends far out over the city and the shapes of a few migrant birds swoon off alone. In that descending light, with the crisp sounds of evening ringing out, a faint chill having us tighten our coats, I walked from the hospital with my two friends and we made light fun about my visit and the nurse and that ultimately I was fine and that at least my swelling wasn't the onset of a painful death. It was affectionate humour, a means to balance my very real panic about health and death and being alone. And one friend said he was going one way, and the second said she was going another, and I said I was going straight on, into yonder, into pain, into the ever decreasing, darkening light home.

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Thanks as ever for reading and a new text will follow soon... Shane. X


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