Why is the waiting time for A&E the same as a flight to Gothenburg?

The adventures of a broken toe.

When your luck runs out, it runs out all at once. I muse on this as I enter the third hour of my wait in A & E. The day before, I had banged my little toe against the door frame so hard that it is still too sensitive to touch a day later and the configuration of the pain strongly suggests that a bone might have been broken.

I suppose there’s nothing much they can do with a broken little toe, except tell you not to use it, which I think I could work out all by myself, so what I was really after in St Mary’s was information and validation of my own suffering. Which, after the rather painful journey to the hospital – it’s a 15-minute stroll from the Hovel but a rather longer hobble – was fairly acute.

Still, what the hell is this, my waiting here with a possibly broken toe (I did it while rushing to get the clothes out of the machine, which makes me one of the few people in the modern age to have hurt themselves while doing the laundry) when there are people around me visibly suffering? As I write, my friend Leyla Sanai is contemplating the amputation of her leg because of her scleroderma, and is bearing her sufferings with a fortitude that is beyond comprehension. There is a young Spanish man sitting next to me who appears to have something terrible going on with his arm. “Joan,” calls a nurse from a consulting room. He looks up and there is a silence. Of all the people in this room, none is prepared to answer to the name Joan.

“Joan Estevez,” says the nurse. The young Spaniard lifts his head. “Juan,” he says.

“It says ‘Joan’ here,” replies the nurse, in tones which suggest that the name “Juan”, which this young man seems to be claiming as his own, is an imposture and an affectation. Eventually, though, as no one else seems to be claiming the surname “Estevez”, she lets him go into the room.

The quarter hours go by. A nurse had offered me a couple of co-codamol on turning up and I had accepted more out of politeness than need; in rest, the toe was quite docile, but the nurse had charmed me by calling me “sweet pea” and I had a hunch that a couple of these on an empty stomach would have a rather soothing effect. They do but I recognise another pain bubbling up: that of the end of a brief interlude of domestic happiness.

The Beloved, you see, has been offered a job in Gothenburg for something approaching twice the salary she is bringing in here. The offer was made some time ago and she has been putting off making a decision for as long as she can. I have been to Gothenburg and wouldn’t go back there if you paid me, but she is for some reason enamoured of the country and the language; so it’s rather as if someone had offered me a job in Verona.

Is that right? In my campaign to dissuade her from going, I have been doing a spot of research, both on the internet and the internot (ie, books) and have come up with some killer facts about this country, for which I am beginning to nurture a dislike – as you would a rival in love.

“There are 12 people in Sweden,” I tell her, only slightly massaging the facts to suit my purpose. “In the summer, three of them are eaten alive by giant mutant mosquitoes. In the autumn, feral moose, pissed out of their minds on decaying windfalls, account for about four more. Those that remain blow their brains out in winter, which lasts for nine months.

You can only buy alcohol from a small corrugated-iron shed in Malmö, and when you do your name is put on a criminal register, right next to the paedophiles and heroin traffickers. A bottle of beer costs 6,000 kronor and tastes of moose piss, for the very good reason that that is what it is made from.”

I reinforce my point by demonstrating that when you type the words “bad things about Sweden” into Google you get 36,200,000 results (try it). But it’s a jump up in terms of her career and if I was the one to hold her back by having a crying fit, I’d feel guilty for the rest of my life. So, I know that all I can do is try to ignore my own very strong feelings for once and think of what is best for her.

Hence, perhaps, my concentration on my toe. Which, as it turns out, is not broken (but a week later is still painful and impossible to touch). It took four hours to learn that; as long as a return flight to Gothenburg, I reflect.

Turn up with a broken toe at A&E, and be prepared for a wait. Image: Getty

Nicholas Lezard is a literary critic for the Guardian and also writes for the Independent. He writes the Down and Out in London column for the New Statesman.

This article first appeared in the 06 November 2013 issue of the New Statesman, Are cities getting too big?

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Wrists, knees, terrible rages – I felt overwhelmed when Barry came to see me

I teach my registrars to be aware how a consultation is making them feel: that can give valuable clues to the patient’s own emotional state.

To begin with, it seemed that Barry’s wrists were the problem. He told me about the pain he was experiencing, the pins and needles that came and went in his hands. I started to examine him. His palms were calloused, his fingers thick and stubby, veterans of the heavy work he’d undertaken throughout his 57 years. Even as I assessed this first problem, he mentioned his knees. I moved on to look at those. Then it was his back. I couldn’t get to grips with one thing before he veered to the next.

I teach my registrars to be aware how a consultation is making them feel: that can give valuable clues to the patient’s own emotional state. Barry was making me feel overwhelmed, the more so as I learned that he’d been experiencing all these problems for years.

“Why are you coming to see me about them now,” I asked, “rather than six months ago – or in six months’ time?”

“I need some time off, doc.”

There was something about the way he wouldn’t meet my gaze. And again, that feeling of being overwhelmed.

“What’s going on at work?” I asked him.

His tone hardened as he told me how he’d lost his temper a couple of days earlier. How one of the others had been winding him up, and something inside him had snapped, and he’d taken a swing at his workmate and landed a punch.

Barry had walked out and hadn’t been back. I tried to find out if he’d heard from his boss about the incident, if he knew what was likely to happen next.

He told me he didn’t care.

We talked some more. I learned that he’d been uncharacteristically short-tempered for months; his partner was fed up with being shouted at. Sleep had gone to pot, and Barry had taken to drinking heavily to knock himself out at night. He was smoking twice his usual amount. Men like Barry often don’t experience depression as classic low mood and tearfulness; they become filled with rage and turn in on themselves, repelling those closest to them in the process.

Depression is a complex condition, with roots that can frequently be traced right back to childhood experiences, but bouts are often precipitated by problems with relationships, work, money, or health. In Barry’s case, the main factor turned out to be his job. He’d been an HGV driver but at the start of the year his company had lost its operator’s licence. To keep the business afloat, his boss had diversified. Barry hated what he now had to do. He was now a “catcher”.

I didn’t know what that meant. Getting up at the crack of dawn, he told me, driving to some factory farm somewhere, entering huge sheds and spending hours catching chickens, thousands upon thousands of them, shoving them into crates, stashing the crates on a lorry, working under relentless pressure to get the sheds cleared and the birds off to the next stage of the food production chain.

“It’s a young man’s game,” he told me. “It’s crippling me, all that bending and catching.”

It wasn’t really his joints, though. Men like Barry can find it hard to talk about difficult emotion, but it was there in his eyes. I had a sudden understanding: Barry, capturing bird after panicking bird, stuffing them into the transport containers, the air full of alarmed clucking and dislodged feathers. Hour after hour of it. It was traumatising him, but he couldn’t admit anything so poncey.

“I just want to get back to driving.”

That would mean landing a new job, and he doubted he would be able to do so, not at his age. He couldn’t take just any old work, either: he had to earn a decent wage to keep up with a still sizeable mortgage.

We talked about how antidepressants might improve his symptoms, and made a plan to tackle the alcohol. I signed him off to give him some respite and a chance to look for new work – the one thing that was going to resolve his depression. But in the meantime, he felt as trapped as the chickens that he cornered, day after soul-destroying day.

Phil Whitaker’s novel “Sister Sebastian’s Library” will be published by Salt in September

This article first appeared in the 21 July 2016 issue of the New Statesman, The English Revolt