It's 8 a.m. on Sunday, March 10th, at the Mater Hospital, Dublin, Accident & Emergency Unit. The waiting room is unusually quiet - one woman is stretched out across three chairs, sleeping off a hangover, and a young couple are chatting and watching a TV positioned behind reinforced glass.
The smell is what hits you first. It's almost sickening - a stench of alcohol and unwashed clothing. There are cans of coke spilt on the floor, a bin is overflowing and the single ladies cubicle is strewn with litter, including blood-spattered tissues. A notice on the wall says it was last cleaned 24 hours ago.
It's the morning after the night before and the mop-up operation is about to begin following a night when almost all new cases arriving by ambulance at casualty were alcohol- or drugs-related. Two young men "out of it" on ecstasy had to be connected to heart monitors; three others - including a woman - were picked up off the streets almost unconscious from drink; and a group of young men arrive following an assault outside a pub on Parkgate Street, one of them with serious head injuries.
When they arrive there are already 10 people on trolleys in an area just off the public waiting room trying to settle down for the night - they have been admitted but there are no beds available. Among them is Mrs Ethel Jones (67) from the East Wall area who arrived in the hospital at 10 a.m. on Saturday. She is still waiting for a bed. But so also are two elderly men who arrived on Friday night and who are spending their second night on trolleys.
A night on a trolley is nothing new for Mrs Jones. She suffers from diabetes and asthma and had a bypass a few years ago. Now she has pneumonia. Just before breakfast yesterday, after yet another night on a trolley, she described the situation as desperate. "The trolleys are very uncomfortable. There is no way you can twist and turn and it's very hard to sleep with the noise."
Before the clinical nurse manager, Deirdre Rice, goes off duty at 8 a.m. Ethel asks again if there is any sign of a bed. Deirdre tells her that she's now second on the list. "God knows how long that will be," Ethel mutters.
It is because of the conditions patients like Ethel have to endure that A&E nurses are taking industrial action this week. Their action begins with a two-hour work stoppage on Wednesday afternoon followed by an indefinite work-to-rule during which they will not answer telephones, take blood, or do ECGs. They will provide basic nursing care only.
Nurse Rice says they have to take action because of the overcrowding in A&E and the poor facilities. "People always think industrial action is about more money. This is not about money. We are doing it for the patients. We are not able to care for patients on trolleys. We have no showers here and there is no dignity for patients. There is one toilet which is not wheelchair accessible. It's really appalling".
She says management has made efforts to improve conditions. "The public really take it out on the nurses because they are on the front line. We are constantly apologising for the situation. We always tell people to complain to their TDs, but when they get up to a ward they forget," she said.
"Violence is a huge problem here. We have two security men and we carry panic alarms. It can be very frightening at times." Gardaí from the local Mountjoy station now patrol the unit as part of their duties, but Nurse Rice believes there is a need for a full-time Garda presence.