And so it begins.

It's 01:30 Christmas Day morning.  I haven't thought this through, a phrase which will feature on my epitaph I'm sure.

Do not take this the wrong way, but I think we need to build a foundation of trust before I reveal how I came to be here.

Where is here, exactly?  Well right now it is sat on my bed, in my pleasant little terraced house in a less than salubrious part of town.  I've been renting this place for about 4 months and, other than my son's infrequent stay overs, it is home to me and my cat.  (There were two cats, until a few days ago.  Unfortunately one had to go off to the litter box in the sky!).

Up until now, I have always owned my home.  The last being a rather nice detached new build in a very nice area.  The trappings of wealth soon disappear...

I have just got in from work.  Well to be quite clear, I have just got in from covering a 'Bank Shift' at another Hospital to the one I normally work in.

I do not hold an important clinical position, in fact I am a long long way down the ladder, but I enjoy the work and I always feel that I have achieved something at the end of a shift.  There is nothing quite like that feeling of contributing to making someone’s life a little better, especially after years of seeing people as walking disposable income holders.

Like most NHS workers I work long and often unsociable hours for very little financial return.  It will take me just over 4 years to earn the amount I used to earn in 1 year.  But that was a different life, before....

Tonight, Christmas Eve, saw an A&E department over spilling with patients.  Some drunk, some feeling off colour, some with Earache and too many with ?Tooth Abscesses.  Heck, there were even a few poorly people.

Tonight I met a guy, about my age, who has changed his name 4 times in the last 4 years.  His previous name had been the result of a change in religious beliefs 2 years ago.  He decided to change it again, a few months ago as “it is hard to be a white man with an Islamic name …. especially since 9/11”.

I did want to point out that we are located in the sleepy backwaters of the Midlands not NYC, but at that moment the unravelling of his aliases finally uncovered his given name.  Unfortunately this brought up a flashing warning on my screen:

"This patient is NOT to be seen alone!! Prone to violence against Healthcare Workers!! Will demand drugs!!"

Note the double exclamation marks, they must mean business.

The fact that this 5'6" guy with jam jar glasses and more than a striking resemblance to Sid Little, left me checking the name and details again.  Was it the same person?

Reading the bemusement on my face, he offered "It probably says something on there about me being violent.  Don't worry about it mate, I like you.  You listen to what I got to say, I won't hurt you".

He tells me that his mouth hurts and opens it too show me.  As I said, I do not hold a position requiring clinical decision making, however the wreckage of 30 years of oral abuse is obvious. I reassure him and bring through the nearest available Clinician.

Mr Multiple Names turned out to be a pussy cat, unlike Bert.

Bert is in his 70's.  He is blind and pushes his own wheelchair around, using it as a shopping trolley/battering ram/and seat when he tires.

Bert had visited the A&E mid-morning and had been admitted as an Inpatient on the Emergency Assessment Unit.  He had spent a few hours on the Unit, before packing is belongings and walking out.

A self-discharge is not uncommon and of course staff will point out the risks to the patients.  In Bert's case, he would not listen as he was not discharging himself.....he just wanted to pop around to his friends to cook her Christmas Dinner. He said he would come back in 2 days to have the Doctor's 'fancy tests'.

It was explained to Bert that he was admitted for a reason, not just to sit and wait for testing....most of which had already been done.  Also that Bert was homeless, so if he stayed a social care review could be completed....I think that was the straw that broke Bert's back!

He started hitting the nurse with his cane, telling her he was going to Mary's and that she should get the Doctor to visit him there for his tests.  For a blind man, his accuracy with the cane was uncanny.  Someone called Security who took one look at Bert, and phoned the Police! A blind 70 year old man obviously requires a police intervention.

It took about 10 minutes to calm Bert down, to sit him down and talk with him.  The police turned up and used their discretion well (they took the opportunity to get a coffee and watch some TV in the waiting room).

There was no Mary, there was nowhere for him to go.  He just hated the feeling that we may try and trap him in the hospital, to keep him here and institutionalise him.  I've noticed that anger & violence is usually built on a foundation of fear.

I could go on about the drunks that started arriving at 11pm, or the police bringing their detained brawlers, or indeed the endless tooth aches and runny noses that decided to call on our service.  But I'm tired, and I'm back at work later, on a 14:00 - 02:00.

My bacon buttie is digested, my cuppa is drunk.  Goodnight and Merry Christmas.