Medical Matters:A clear full moon hung brightly in the winter night sky and a light frost covered the fields in a crystal-white sheen. I remarked on the beauty of the moon to my driver. "The lunatics will all be out tonight," he said knowingly - and he was right.
Welcome to the twilight world of the red-eye shift, the emergency service in the wee hours provided by GPs in many parts of the country.
Many of the calls are not objectively urgent; parents worried about a sick child or those concerned about a feeble older person, will often be reassured by the visit of a doctor, and no doctor will hesitate to treat any genuine medical problem.
Less welcome, especially at weekends, is the emergence of social pathology which, by default, falls into the lap of GPs and gardaí, at the expense of more worthy cases. This night was no exception.
Our first call was to the Garda station, where a young man arrested for being drunk and disorderly demanded medical attention with veiled threats of self-harm if he was not seen. When I arrived, he decided he no longer wished medical advice, and told me to f**k off.
I was struck by the number of gardaí on duty this night, whizzing in and out of the station, bringing prisoners into the cells, eating takeaways, and snatching cups of tea and coffee. The scene reminded me of the opening sequence in the classic 1980s cops drama, Hill Street Blues, where the sergeant on duty would address the officers before each shift, advising them there was a jungle out there and to "do it to them before they do it to us". Such advice seemed quite relevant as the night wore on.
As we were leaving, I was asked to see another prisoner, a man from one of the EU accession countries, detained for suspected drink-driving. This needed the services of an interpreter, who took some time to arrive. We were just leaving the Garda station when another "urgent" call came to visit a man who was sitting on an upstairs window with a rope tied around his neck and the other end tied to a bedpost. A resourceful garda managed to cut the rope just as the man fell from the window on to the bonnet of his car, which sustained more damage than he did.
Having reassured myself that no serious spinal damage had occurred - he was able to wiggle his toes - I took a history from a grandmother, her daughter and her child, all talking loudly in an Eastern European tongue. The mother informed me that the man, her ex-boyfriend, had been barred from seeing his child, and after some heavy drinking had decided to do away with himself. It was not the first time this had happened.
No sooner had the ambulance gone than a call came to see a woman who had fallen down the stairs. She was quite drunk but fortunately had broken no bones. Her story was another familiar one along the lines of the "I-love-my-man-but-he-keeps-beating-
me-when-he-drinks-too-much" variety.
It was 3am before I saw my first genuine patient, an older woman with painful cystitis who had had to wait for three hours while I was trying to deal with the social flotsam and jetsam of the locality. She was polite, appreciative and apologetic for calling out the doctor although in truth it was I who should have been offering apologies to her for the delay.
Things quietened down after that; we saw a couple of sick kids and a woman with biliary colic, and at shift's end drove off into a beautiful blue cloudless dawn, trying to put the nightmarish past few hours behind us.
My experience is far from unique. All over the State, doctors and gardaí on night shifts will have similar stories to tell, especially at weekends and during festivals. There is a common thread of disaffected young men with too much money to spend on too much drink, acting impulsively, sometimes with tragic consequences for themselves, their intimates and unrelated innocent persons who happen to be in the wrong place at the wrong time. It is a paradox that in a time when we have never been so prosperous, and when international surveys regularly place us among the "happiest" people in Europe, such behaviour is an increasing problem.
Perhaps expectations of happiness are too unrealistic, perhaps there is a lack of coping ability, a lack of spirituality, or a decrease in the importance and value of family ties; I do not know. What I fear is that before we get a handle on it, it will get worse, and those of us in the front line can do no more than stick our fingers in the hole in the dyke.
Dr Charles Daly is a GP in Dungarvan, Co Waterford and president of the Irish College of General Practitioners.