Recently I had to have a few minutes in my office to regroup after I’d seen a patient. I didn’t quite know how to process my feelings. I was feeling ashamed and upset.

My patient had been in our waiting room for over 18 hours. He was a bilateral amputee and a wheelchair user.

His medical problem was not life threatening and easy to treat but was affecting his arm and so affected his ability to care for himself, hence the need for admission. He was usually normally independent, worked full time, headed up a local charity but now suddenly found himself incredibly vulnerable.

He’d not want to make a fuss and he was unable to get out of his wheelchair to get to a toilet. He had been incontinent and had no food or drink for fear of needing the toilet again.

As I took him into a room to assess him, he grabbed hold of my hand, sobbed and begged me not to abandon him in “that place”. I couldn’t look him in the eyes, I was so ashamed of how we’d treated him this far. I managed to get him into a bed space, and as we undressed him, myself and the nurses were horrified how he’d already got excoriations from sitting in urine in his wheelchair for 18 hours.

His story is one of many happening all over the country. We all know how hard it is to sit in a waiting room for hours when transport gets delayed etc, but this is people who are unwell, in pain and already suffering.

The ED waiting room is a difficult and busy place to be. The corridor where patients wait is a busy chaotic environment with very little dignity. Both these areas are exactly the opposite of where we’d want our patients to be and almost the perfectly designed area to promote delirium.

How do staff feel when they are faced with this? I talked about this recently at a The Society for Acute Medicine conference in Belfast and lots of people spoke to me privately afterwards. All had some story where they had experienced something that had left them with similar emotions, of anger but also shame, guilt, embarrassment and failure. One doctor told me that they hadn’t had a DNAR conversation with the patient as they felt that the corridor wasn’t an appropriate place. There were visibly upset as they described arriving at a resuscitation attempt on this frail patient who had clearly been dying.

One doctor told me that a patient had asked them to go to the toilet and they’d spoken to the nurse. When they later returned to take more blood tests the patient was sobbing in distress after being incontinent as the nurse hadn’t yet had time and they felt wracked with guilt.

Another told me that they’d taken time off unwell and had now agreed not to see patients outside of the ward anymore as it had just become intolerable.