THE sign seems to state the obvious. It’s 2 am in a busy casualty department at a secondary-level government hospital in Cape Town – who would want to be here at this time if it weren’t for a calamity that couldn’t wait?

The stretchers are filled with the “usual suspects”, as my consultant calls them: painfully thin people ravaged by the twin epidemics of HIV and TB, diabetics and smokers with gangrenous toes and diseased blood vessels, teenage girls who’ve overdosed on their mothers’ sleeping tablets and the drunks and misfits the cynical triage nurse likes to lump into the categories “mad, bad or sad”.

The usual assortment of asthmatics, brought in by the wet weather, sit clutching their nebulisers and wheezing in unison.

And in the waiting room the smells of alcohol and blood mingle as angry youths, their wounds sloppily bandaged, shuffle along the benches with the lonely and the homeless.

A young man is wheeled in by his friends, a bath towel soaked with blood pressed hard into his lap. He has been shot in the groin and his pale, breathless lips barely get the story out as a burly porter lifts him on to a trolley: a gang fight. His companions quickly disappear into the night, their loyalty discharged, anxious to avoid any confrontations with the law.

Flicking the ropey veins in his arms, more by feel than by sight, I slide a drip into his arm to start an infusion of fluid.

Beside me the surgical registrar is sleepily rubbing his eyes: he will need to take this man to theatre tonight to see which organs lay in the bullet’s destructive course to the exit wound on his back.

Rolling him over I discover another wound, this time in his chest. A quick listen with my stethoscope confi rms my suspicion: his lung has collapsed. Within minutes we have placed a drain between his ribs to evacuate the accumulated air and blood and the drainage bottle bubbles happily as his lung starts to re-expand.

Also in the resuscitation area the reassuring bleeping of a cardiac monitor keeps time as an infusion of clot-dissolving medication is administered to an elderly diabetic man who has had a heart attack. He retches into the blue kidney dish he is clutching, nauseous from the morphine he has been given for the crushing pain in his chest.

Next to him, a 45-year-old woman lies unconscious, the noise of her breathing rasping through the plastic tube in her windpipe.

The CT scan on the light box behind her reveals the culprit: the white blood from a burst aneurysm compressing her brain.

No amount of practice makes this part of the job any easier. Th e emergency department seems to draw a certain kind of doctor. Some are attracted by the emotional energy of the intense interface between life and death, which seems to reinforce their own vitality.

Others, like myself perhaps, confronted by the fragility of the human condition and the inevitability of death, are reminded of our own mortality – and of the potential of every one of us to have our lives irrevocably changed in a heart-stopping instant.

Looking around I’m forced to admit to myself there is nothing glamorous about this, the frontline in the war against death and despair: this is humanity at its most infected, intoxicated and incontinent.

My non-doctor friends, mesmerised by the profusion of medical docudramas on television, think saving lives must be a daily occurrence. In reality the goals of treatment are much more modest: the alleviation of suff ering, the relief of pain and only sometimes, tantalisingly, the opportunity to cure.

“Damage control,” my colleague calls it: plugging holes in the dyke of tragedy that threatens to break and overwhelm us as we try to sustain ourselves with the gains without being too diminished by the losses.

The discarded medication vials, bloody gloves, used syringes and accumulated plastic detritus of our frenetic resuscitation litter the fl oor – but the space previously occupied by my young patient is conspicuously empty. His fate is still uncertain but in the accounting that inevitably follows on the drive home later this morning perhaps I will be able to count him as one of my successes.

And that, for tonight, may be enough.

This story originally appeared in the first edition of Pulse magazine. Buy the latest copy, on newsstand now, for more fascinating stories in the world of health and wellness.