On February 5th this year, a Dublin city accident and emergency consultant dialled a restricted number, identified himself and ordered that the hospital's Major Emergency Plan be activated. Air disaster? M50 pile-up? A bombing? No. Dr Pat Plunkett had simply reached the end of the line on a Thursday night in St James's Hospital, writes Kathy Sheridan
A department designed for 12 seriously injured patients was overwhelmed with 41, all so ill as to require emergency admission. The oxygen had run out, very ill patients had a choice of plastic seats or the floor, staff scrabbled to clear a spare bit of the same floor for the next stretcher-borne patient.
All in a department with one wheelchair-accessible toilet, no hot food other than tea or instant soup, and no semblance of privacy for people in crisis or dying.
So the very next day, the hospital authorities door-stepped the Minister and demanded delivery of the 3,000 acute beds the Minister's own experts had decreed, several years before, were necessary to solve the national problem. Right?
Wrong. A hospital spokesperson told The Irish Times that reports about the activation of the major emergency plan were "untrue".
But then the entire population, stung beyond endurance by the incompetence and cowardice, and the outrages being perpetrated on their elderly and infirm, hit the streets and declared war on those responsible. Right?
Wrong. They let it be known that they wouldn't pay another penny in taxes to sort it out.
After seeing her elderly mother endure Armageddon-like conditions in the Mater, Janette Byrne broke the mould. She marched out and formed Patients Together. "The support was unbelievable," she says, "we had so many emails and calls, the media was full of stories about vomit- and blood-spattered floors, and cancer patients on chairs for three days"
They got a meeting with Ms Mary Harney and gave of their time and money to print leaflets and plan marches.
"From all the feedback we were getting, we thought people would come out in their thousands," says Byrne. And indeed, the marchers, many of them walking wounded, travelled from as far away as the north-west.
But they numbered nowhere near the thousands.
On a march from the Garden of Remembrance to Dáil Éireann, they managed to get just 375 signatures for their petition.
"Bewley's got 2,000 signatures the day it closed down," says Byrne. "I was so disheartened. It seems that people are prepared to write the letters but not prepared to give their time. They want someone else to do it for them."
So we have the health service we deserve? "Yes, you could say that."
Her view is echoed by a senior journalist still dismayed at how the health issue was quietly buried in the run-up to the general election last year: "I was all geared up for health to be the be-all and end-all of that election. It never happened."
All but two of a raft of patient advocacy groups refused to go on the record for fear of offending a Government that looked likely to be re-elected. "As a society, I think we actually don't care. We're a bit sloppy about the way we treat our own lives and health, and maybe that's reflected in our attitude to the health service."
How long can this go on? As 2004 draws to a close, we are at a critical juncture, not only for the health service but for the lifestyles we lead and how our behaviour feeds back into the fiasco.
Our alcohol problem is well documented. A young Irish professional just back from New York marvels at how a group of friends could go out to dinner there without a drop of alcohol in sight. Here, the reverse applies.
There is anecdotal evidence of Irish parents taking the decision to raise young families away from alcohol-soaked Ireland and of school-leavers choosing foreign colleges to avoid the drink culture.
"If McDonalds is colonising the world with the golden arches, we're colonising it with Irish pubs," says Dr Patrick Wall, acting health advisor to the new Health Service Executive; adjunct professor at UCD Centre for Food Safety, and former chief executive of the Food Safety Authority of Ireland.
Meanwhile, between a quarter and a third of children in the Republic are either overweight or obese.
Adult obesity (a major risk for nine different cancers) is climbing steadily. New patients presenting with Type 2 diabetes at St James's - "a time bomb clearly a fruit of the obesity tree", in the words of Prof John Nolan - have quadrupled since 1996.
Our death rate from lung disease is the highest in Europe. In fact, Irish mortality rates are now worse than the EU average for almost all diseases, including cancer, heart disease and suicide, according to Dr Elizabeth Cullen of the Irish Doctors' Environmental Association.
"The most amazing thing to me," says Prof Wall, "is when people have lost their health and their first question is - 'will I have a heart by-pass or a stent? Chemo or radiotherapy?' Then they'll tell you afterwards: 'I'm walking five miles a day since the by-pass' - and I'm thinking 'pity you didn't walk even one bloody mile before it'.
"I think the problem is that people think the health service is better than it is. The attitude is 'sure I can wreck the liver or the heart and I can just get a transplant or by-pass', and it's as if by some kind of magic that you have a group of professionals working heroically to put you back together"
A recent NUIG study for the Health Research Board confirmed by-pass surgery does not prompt patients to quit smoking or change their diet. Why? Because they feel their operation and drugs have taken care of the problem. Hey presto!
The view that money can cure all ills is borne out in any number of ways. Prof Wall notes the uptake of foods called neutraceuticals - certain types of yoghurt, high-fibre breads with wheatgerm, and cholesterol-lowering margarine. Thus we have the mother who fills the lunch-box with crisps and a tub of Actimel for insurance, or the man who likes a feed of pints most days but is a stickler for low-fat spread on his bread.
One of the striking findings of the 2002 National Health and Lifestyle Surveys was how many respondents (36.3 per cent of men and 45.4 per cent of women) viewed financial problems as the single greatest barrier to improving their health.
Clearly, that cannot be true. Giving up smoking, drinking less, having porridge instead of a fry costs less, not more. Going for a walk costs nothing.
In Ireland, the notion of looking after yourself is still a challenging one.
Dr Tom O'Dowd, professor of general practice at Trinity College and a practising GP, attributes much of this to the fact that half the population is under 25 and the young are not known for thinking very far into the future.
"In general, we're very brittle as a nation I don't see us as a united society. We have had nothing to rally around, like the world wars for example. The Church has departed So this is very much living on the edge, needing more stimulation to get the buzz, then the let-down brings more problems We have become more risk-taking and it's the risks that are causing the problems."
But while much of the problem lies with our apathetic, reckless selves, no one is letting the Government off the hook.
Prof Wall talks about the urgent need for an "enabling society", one prepared to fork out for gyms, playgrounds and decent cycle paths for example, and in which parents feel sufficiently secure to allow their children to walk to school.
Richard Douthwaite, an Irish-based economist, and editor of a report, Growth - The Celtic Cancer, blames our stressed-out "sick society" on this Government's economic policies.
But there can be no avoiding the fact that social class and education are among the great unmentionables in this debate.
Survey after survey shows that these factors have an enormous impact on healthy or unhealthy behaviour.
Stephen McMahon of the Irish Patients' Association notes it's the lower income groups - "the early school drop-outs, the dignified poor in the midst of so much" - who are not only the sickest but the least aware.
Among other things, their basic reading problems mean that "adherence to medications is lost, information about medicines is lost, the written word on lifestyle warnings is lost"
Prof O'Dowd, whose GP practice in Jobstown, west Tallaght, recalls undertaking a survey of middle-aged men in the area. Among the questions asked was what would they do if they experienced sudden chest pain. Only half said they would seek medical help. The implications for A&E departments are blindingly clear.
He believes that the big debate now should be about access. "My practice is in an area with a population of 8,000 and I'm the only GP there. In DúLaoghaire, you would have eight or nine GPs."
There are no simple answers.
The only certainty is that what he calls "the scandalous public squalor" of A&E departments is only the tip of the iceberg. And that, as a nation, we are still adolescent.