A night on the emergency ward at Tawam Hospital

In one night at the Al Ain trauma centre, a man whose symptoms seem mundane is airlifted for life-saving emergency surgery and a grandmother comes in, but doesn't leave.

21/04/10 - Abu Dhabi, UAE -  Emergency Room of Tawam Hospital in Al Ain on Thursday July 1, 2010.  **Will resend with names in captions**  (Andrew Henderson/The National)

AL AIN // When the doctors and nurses who staff Tawam Hospital's emergency room clock in for the night shift, they never know what the 12 hours will bring. Working at the region's primary trauma centre, one that attracts patients from across the UAE as well as Oman, they face cases that range from routine to horrifying. One minute they are tending to a sprained ankle, the next they are trying to save lives.

"I remember we had patients from a single-vehicle RTA [road traffic accident]," said Dr Bibars Yakoub, 41, a Syrian emergency room specialist. "The car carrying eight members of the same family had overturned. Inside were a mother and father, five children and another family member. The mother, her eight-year-old daughter and an infant were killed. The surviving members of the family were brought to the resuscitation room inconsolable. It was a tragic scene."

But emergency room doctors and staff try not to let the sadness get to them. "Otherwise we cannot do our job," explained Dr Khaled Naim, 46, a Tawam Hospital emergency room specialist from Egypt. "I can't let the things I see affect me. If I let them affect me then I can't work. After my shift is over and I am driving home I think about the good that has happened. When someone thanks me or says 'God bless you', that's what affects me. In this career you do all you can for the patient but you can't win all the battles. That's the nature of this line of work, and that's life."

On a recent night, when The National was allowed to observe the hospital's emergency centre in action, the most serious case was that of a 47-year-old American who complained of back pain and difficulty breathing. Within minutes, doctors determined that he had suffered an aortic rupture, which can happen from a trauma or a previous condition. The patient was in danger of bleeding to death from his body's largest artery. He needed emergency vascular surgery, a complex procedure for which the hospital had no team in place that evening.

Gordon Allan, the 31-year-old Australian nurse manager on duty, got on the phone for a helicopter to transfer the man to Mafraq Hospital on the outskirts of Abu Dhabi. The clock was ticking, and nothing was moving quickly enough. The transfer was unusual, said Des Walsh, the South African charge nurse, 43. She had seen only two others in her 13 years at the hospital. "It took 20 minutes for the police helicopter to get here and for me to convince Mafraq that this man was about to die, and that he must be admitted," Mr Allan said. "The surgery he needed had to be done at Mafraq because at that moment they had a vascular surgery team on hand."

During the 40-minute flight to Mafraq Hospital, Mr Allan and Russ Craven, 39, an Australian ambulance nurse educator, worked feverishly on their patient. "We cut into his chest to drain some of the blood because it was putting pressure on his heart, and stabilised him until we got to Mafraq," Mr Allan said. "Looks like he is going to survive." The man spent three weeks recovering at Mafraq Hospital from his emergency surgery. He later turned up at the Tawam ER with a fruit basket, thanking the staff for saving his life.

There are four areas in Tawam's emergency services department: one of relatively low priority for relatively minor cases, such as a cold or small injury. Priority three cases are not life-threatening but can be serious. They are sent to the main treatment area. Priority two and one cases are those considered life-threatening, including diabetic emergencies, heart attacks and strokes (the American was a priority one case). Children are sent to a separate paediatric emergency room.

Staff have to make quick judgement calls on cases, and adjust treatment as the condition of their patients fluctuates. Later in the night, an 81-year-old woman turned up, having a hard time breathing. From the moment she arrived, the woman wanted desperately to leave. Her family pleaded with her to let the doctors and nurses do their jobs. "Teta, Teta," said one of her grandsons. "Let them draw some blood and we can take you home."

The woman quickly began to deteriorate. She made it through the night, as Dr Yakoub hoped, but she died the next day. In another room, Hamad Saeed al Hassani, a 13-year-old Emirati, was being stitched up after he fell running through the house, shattering the glass he was carrying in his hand. Hamad Saeed stifled tears as the tip of his forefinger was sewn together with five stitches. As he left the emergency room admiring his bandaged hand, he tugged at his mother's veil.

"See Mother," he said, "I didn't cry." @Email:ealghalib@thenational.ae