A BESPECTACLED man hovers nervously outside the cubicle for critically ill patients. His wife is lying on a white sheet and murmurs to the doctor: 'I am scared', before fusing her eyes shut. 'Don't fall asleep,' came the reply. It is a scenario commonplace in accident and emergency rooms across Hong Kong every day. Agitated, confused and often in excruciating pain, patients seek escape in their sleep. But doctors know that drifting off into the world of darkness is sometimes final. It was 10.30am when Dr Yip Sai-hang heard his name being called on the public announcement system. Sprinting down the hallway he arrived at Cubicle One of Queen Elizabeth Hospital's Accident and Emergency Department in seconds. A confident smile flashed across his face as he swept aside the curtain. It takes somebody like Dr Yip to preside over the ER-like environment. His calm disposition radiates across the room. As nurses fussed around the patient, threading an intravenous drip into her vein and connecting her with a heart rate monitor and electro-cardiogram machine, the woman opened her eyes slightly. Dr Yip leaned over and listened carefully as the woman uttered something through an oxygen mask. She was suffering from flu and had stopped taking her heart medicine for three days. After examining the twitching graph on the heart rate monitor, Dr Yip said: 'Her heart is beating very fast now. Let's give her a shot of ATP.' The nurses sprang into action. One drew the medication from a bottle the size of a child's tiny finger; another shouted to the patient what to expect next: 'We are giving you an injection. You will feel dizzy and sick. But it will pass in a minute. Now don't sleep. Tell us how you feel.' At 10.40am Dr Yip declared the 40-year-old woman was out of danger. Her husband was welcomed into the small cubicle to greet his wife. 'This works very well on patients like her,' said Dr Yip, waving the empty bottle as if eager to explain it wasn't him but the medicine that had stabilised the woman. 'Ten seconds and she gets a normal heart rhythm.' Perhaps no area in a hospital is more nerve-wracking and stressful than an emergency room. Shocked and distressed families weep as they watch loved ones cry out in pain and fear, or lie silent and limp on a stretcher. Just minutes prior these men and women, fathers and sons, mothers and daughters might have been riding on a bus, walking in the street or resting in their homes. Now lying in a profusion of tubes and wires, they struggle for their lives as nurses perform blood tests and X-rays in a hurried analysis of the damage inflicted. It is a place where adrenalin pumps at top speed as doctors make split-second decisions, feverishly working to rescue victims from death's door. Michael Crichton, the mastermind behind the popular medical TV drama series ER, believes it is interesting that although medicine has changed a lot over the years, 'much has not changed, particularly in the sort of texture of emergency medicine and how people treat people in life and death situations that are very fast-moving'. Dr Yip, who is the department's chief of services, would agree. Emergency medicine is essentially the same as it was years ago. There are more modern tools and advanced drugs than before but conceptually nothing has changed. Speed is still the essence and doctors are required to stride in and out of dramas with a cool head. If anything, they are now working faster with better team co-ordination than before. Two years ago, a traffic accident victim would receive minimal acute care in Queen Elizabeth's emergency room. 'Now we will do the most that needs to be done here rather than in the general wards. It is just like ER,' said Dr Yip. A traffic accident victim may have head, chest and pelvic injuries and be suffering massive blood loss. As he is rushed into the emergency room his blood pressure may be dropping rapidly and pulse rate rising. There may be leakage of air and blood from the lungs, which needs to be drained urgently. Intravenous drips are needed quickly to replace his blood loss. Before, the patient would be wheeled out of the emergency room to the general ward and a surgeon called to assess him there; now he is rushed directly for a brain scan after emergency treatment. 'A neuro-surgeon will be called to read the film and the man will be wheeled into the operation theatre for brain surgery in no time,' said Dr Yip. 'We are doing things much faster and smoother now than two years ago,' he added proudly. The accident and emergency unit is a long, fluorescent-lit room divided into cubicles. The first room to the left, the R-room for resuscitation and major trauma cases, is where the battle for life is fought hardest. There are also cubicles for emergency and urgent cases. At the far end is the walk-in clinic for non-urgent cases, and an observation room. Patients will be screened, classified, and seen according to their urgency. Dr Yip said the exception is for babies aged one or under, who are always given priority. 'There was this one time when a one-year-old child died while waiting to be seen at another hospital's emergency room,' he said. 'He was suffering from gastroenteritis and diarrhoea-induced dehydration. 'The boy was not tended to immediately, probably because he was too young to complain. 'As his mother waited patiently to be seen, the boy went into shock, suffered cardiac arrest, and died. 'We are worried about the risk, so we make it a rule here that children of that age should be seen urgently.' The 600 or so patients who pass through the door of the emergency room every day may be too sick to notice it, but the unit does not have the sleek, high-tech look of a modern hospital. There are no spot lamps mounted on ceilings, no portable X-ray machines, and the furniture is old. Dr Yip is keen to emphasise the original accident and emergency unit is being renovated and will soon be reopened. 'Two governors have visited our emergency unit, first David Wilson, then Chris Patten,' he said. 'I told both of them it was my dream to have a new unit. Now it is happening.' Minutes after Dr Yip dealt with his first major casualty of the day he was ushered into the next cubicle. A junior doctor wanted to admit a 104-year-old woman complaining of abdominal pain. As in hospitals all over the world, the 'donkey duty' - filling in forms, taking the history of patients, listening to their chests, taking their blood pressure - is assigned to junior medics while senior ones like Dr Yip are there to answer their queries. In this case, as more tests were needed to decide whether the woman was suffering from a recurrent gall stone disease or peritonitis, admission was approved. There is another job that Dr Yip would like others to tend to. 'I think the nurse can do a better job when it comes to telling the family a patient has died,' he said. 'What I usually do is to briefly tell the family we have failed to revive him or her and leave the rest to the nurse.' It was difficult telling a stranger sitting opposite that a loved one's life had been lost. 'It is the most frustrating moment, especially when the person is a child or young,' said Dr Yip. 'I graduated in 1982 and I see these things all the time but I often have to hold back tears. I have to control my emotions.' One time he broke down in tears following the death of an eight-year-old girl who collapsed during a ball game at school. 'When she arrived her heart was not beating and she was not breathing. The ECG indicated her heart was dying. 'Six doctors, including three paediatricians, and five nurses tried to resuscitate her. One-and-a-half hours later we knew we had lost her. I went to tell the mother. She held the child's body, crying and saying repeatedly what a good girl she had been. She wouldn't let go of her for half an hour.' Dr Yip said a common phenomenon in Hong Kong was people either seeking or receiving help too late. 'In Hong Kong, the average time from the onset of chest pain to the person being rushed to an emergency room is eight hours while in the United States and the United Kingdom, it is four hours,' he said. 'Old people may be home alone when chest pain hits them. They may want to wait for their sons or daughters to come home so they can be consulted. So there is delay. 'And it may be in the Chinese culture; people don't like to interfere. They mind their own business. But when a person collapses, not breathing and is without a pulse, mouth-to-mouth resuscitation and cardio-pulmonary resuscitation (CPR, or heart massage) should be administered immediately. 'This chain of survival is essential. Only two months ago, a Thai tourist collapsed at the Immigration Department. Luckily for him a nurse was there to administer CPR . . . by the time he arrived at the hospital, his heart was already beating normally and he survived. CPR is an important technique for all to learn.' As it turned out the 104-year-old woman was only the first of the many senior citizens Dr Yip was to attend to that day. A 64-year-old woman complaining of chest pains was rushed in by her pregnant daughter and it quickly emerged she had just had an acute myocardial infarction, which occurs when blood circulation to a region of the heart is obstructed, causing the tissues to die. A man in his 60s found lying unconscious in Temple Street the previous night and smelling of alcohol had woken from his deep sleep in the observation ward. Nurses had given him bread and milk for breakfast and now medical staff were called in to investigate his numb thigh. Then there was a 77-year-old woman who had just disembarked from a ferry from China. A Hong Kong citizen who moved to the mainland to live because of the lower cost of living, she was suffering from a swollen knee, probably arthritis , and had decided to return to the territory for treatment even though this meant enduring a three-hour boat trip and a lot of walking. As she screamed in pain she also let it be known to Dr Yip that her son and daughter-in-law had left her and there would be nobody to call. There was also a 76-year-old man complaining of breathing difficulties. Dr Yip did not need to strain his eyes to understand the tell-tale signs on the X-ray film of the man's lungs. They were cloudy and scarred. 'You know your lungs are severely damaged?' he shouted to the man lying on a stretcher outside his office. The man and his son, who had probably heard it all before, did not seem offended by the brusque way the news was delivered. 'Have you stopped smoking?' The man, who had a bout of tuberculosis when he was young, said he stopped smoking a few months ago. Dr Yip was equally blunt when the mother of a two-year-old boy with breathing difficulties asked if his condition could have been brought on by the fact her husband smoked at home. 'He smokes and you still married him? You should kick him out,' he said, albeit jokingly. Thirty-two per cent of Dr Yip's patients are aged 65 or over. There are about 300 or so trauma cases yearly, mostly traffic accident victims, or people who have fallen. Patients suffering gunshot, stab and chop wounds amount to less than 10 per cent of all trauma cases. 'Hong Kong is not yet a violent city,' said Dr Yip. 'In San Francisco 40 per cent of the trauma cases are what we call penetration injuries,' Dr Yip added. Perhaps the only risks medical staff encounter is infection through the handling of patients' bodily fluids. The clock on the scrubbed wall of the accident and emergency room is showing 4pm and Dr Yip is about to finish for the day. But there is no end to the stream of ill and broken bodies. 'Sometimes we can sit down and take a rest,' he said. 'But this is a 24-hour service.'