By Sally Henfield

THE gory depiction of Accident and Emergency departments in television dramas makes gripping entertainment, but few viewers are really able to follow the complex medical terms and tricky operations that the staff rattle out.

Dr Zul Mirza, an A&E consultant at West Middlesex Hospital, however, enjoys picking up the mistakes that the technical advisors let slip through. "I do sometimes think well that's not how I would do it' when I'm watching them," he says. He also admits to having his favourites: "Life in A&E is more like ER than Casualty, it reflects the true nature of going from one patient to another and is more exciting - although that has probably made it sound more glamorous than it actually is!"

Despite an early ambition for a different glamorous career - "like all boys I wanted to be a professional footballer" - Dr Mirza decided medicine was the path for him and he trained in several hospitals across London, including St Mary's, Chelsea and Westminster and Ealing.

He then worked as a registrar at West Mid, before moving to his consultancy position five years ago. "I felt that A&E was more dynamic and so made the change. No two days are ever the same. It's unpredictable. You don't know what's coming through the doors. You have to be on the ball as it can literally be a life or death situation," he explains.

At the tender age of 37, Dr Mirza is seen as youthful for his position and he jokes: "A lot of patients think I am rather young to be a consultant!" However, his professionalism shines through and it is clear that he is dedicated to his job. The hospital currently has two consultants working the A&E department and Dr Mirza and his colleague, Dr Mike Bennett, alternate being on call. A third consultant will be brought in for the new year to ease their work load.

As he can be called in at any moment to help deal with an emergency, he has to live within close proximity of the hospital and carries his pager with him everywhere: "I often stand in Tesco, hear the till bleep and reach for my pager. You never switch off; I am always a slave to my pager."

His work is not confined to the wards either, as a major accident can lead to him attending the scene with paramedic staff. One such incident in Isleworth, where a teenager went under the wheels of a lorry on his moped, revealed the pressures emergency doctors come under.

"It's a different kind of stress to on the wards," says Dr Mirza. "You have to fight your way through the traffic and then through the on-lookers. You have doctor' written on the back of your jacket and people treat you like Jesus walking on water - they are all expecting you to work miracles, or carry out heroic surgery at the roadside. But at all times you have to stay calm."

Back on the wards, some of the patients can have similarly life threatening injuries: "One night casualties from a road traffic accident came in, about three or four of them, and I was dealing with them. Within minutes of them arriving, a patient came in, in cardiac arrest. He was not breathing and his heart stopped. In a situation like that, you can be treating several very sick patients at one time."

Some injuries, however, can bring a smile, or a wince, to the face. Dr Mirza says: "Kids are always coming in with their fingers jammed in things, or toys stuck up their noses or in their ears. Some injuries can be quite grizzly - one man had nailed his thumb to a piece of wood and had to bring the piece of wood in with him as it was too painful to remove, another had fallen from a ladder and impaled himself through the groin on a large fence post."

At the far end of the scale some people attend hospital for something as simple as a cold: "Of course we have to treat them but we also try to re-educate them so that they are aware of the other routes available to them, particularly NHS Direct. Otherwise they keep coming to A&E and someone else will have to wait longer because of it."

The increase in revellers in Richmond's bars and pubs has meant that drunken causalities now take up more of the week's night shifts than ever before, as Dr Mirza explains: "It used to be that the weekend was classed as Friday and Saturday night but now it starts on Thursday and finishes on Monday. We are particularly active on Friday and Saturday, with drinkers coming in with cuts and bruises from falling over, vomiting, having been in fights or road accidents."

Even if patients are worse for wear, staff in A&E take a zero tolerance attitude to aggressive behaviour: "I have to praise the staff for their work in the face of adversity. They have people swearing and being unpleasant to them, but they always remain professional. I don't see why we should be abused for trying to help people."

Dealing with 280 patients a day can be a gruelling job, but the department is currently beating government targets for waiting times. This has been helped by the new hospital building and the improved computer system which allows doctors to track patients' progress.

"We have overcome the problems of the old department and overshot the targets," adds Dr Mirza. "We have more staff and more technology in the department. Nurses are playing extended roles, for example ordering x-rays and taking blood."

On top of his work in the hospital, Dr Mirza is involved in lecturing and is currently researching the best treatment for scaphoid fractures (this type of fracture may not show up on initial x-rays but can develop almost a week after the accident and can lead to restriction of movement if not treated properly).

And despite the long hours and often heart-wrenching cases, Dr Mirza has not regretted his decision to leave the football league tables for the operating tables, saying: "Medicine and the A&E department is an endlessly fascinating career."

2:30pmThursday11thNovember2004Printer friendly format