I was playing a game with my kids. How many ambulances are going to be waiting outside the emergency room today? I used to play there with my kids as I had an elevator for a first shift.

“Three, dad. “

“No, I think it’s gonna be two.”

“Well, I think there will be five today.”

And we clapped when one of us was right – another point for the seven-year-old. But now it’s too hard to guess. Blue and white are parked wherever they can fit, in varying states of readiness.

Some, having disgorged their load of patients, sneak a few meters away, waiting to be cleaned and disinfected. The paramedics who managed to unload their patients stretch out, change their mask and get some fresh air.

They talk about stoic gentlemen who didn’t want to disturb and therefore waited until they could no longer take care of themselves before calling for help. They speak of lonely Greek nuns who have fallen and have not been found for 24 hours – their families have not been able to visit them at home. They speak of young women, isolated and scared and unable to see their advisers and who simply could no longer live in confinement. And they’re talking about young men, who thought it was okay to hang out with their friends, even though they knew they had the virus, thinking they were invincible.

As I walk past the yellow carts and patients waiting to be seen, I look through the plexiglass in the waiting room. It’s already full, and it’s not even eight in the morning. Some people are wrapped in hospital blankets, obviously having had to wait far too long. I know what I’m going to tell them when I call them.

“I’m so sorry you had to wait so long… Yes, that’s unacceptable… I’m sorry.”

I say this every day now because patients are waiting longer and longer to be seen. We have nominal goals to achieve. The sickest patients should be seen on arrival, but the challenge now is to find a place to see them.

The department is already full. The emergency department reminds me of a casino – all the bright lights and noisy machines. Somewhere this time does not register. Where weekends and evenings cease to exist.

Previously, you could guess the time of day by the ebb and flow of patients. Now the only way to find out is when the operator’s soft tones remind visitors it’s time to go home – registration is no longer necessary as hardly anyone is visiting.

Every bed in every cabin is occupied and the night staff seem exhausted. They ran into 20 patients waiting to be seen on the shift before struggling with the access blockage. Hospitals tend to operate at near full capacity under normal circumstances (whatever they are) and therefore a patient can only leave the ward when a bed becomes available in the ward. Before, we had targets to hit. Each patient had to be seen and sorted within four hours. They either had to be demobilized or moved. Now they are barely seen in four hours, let alone processed. You cannot see the patients in the waiting room or in the hallway, so you have to wait.

As the emergency medicine consultant responsible for the morning, I know that I will be playing the role of Human Tetris for most of my shift. We’ll move patients from one booth to another, hoping we can insert one more, getting dangerously close to that row at the top of the screen. But there can be no game over for us. Not when it means loss of life.

I spend my shift on the phone getting impatient in-patient teams to see their patients again. They have already been in our service for 20 hours, on hard gray carts. Coats and jackets double up for pillows that have already followed the same path that most people’s goodwill has. How can you expect someone to get the rest they need under these conditions?

The radio is screaming and we have to find somewhere, anywhere to get the next seriously ill patient. Someone is taken out of the resuscitation room to make room. We’re going to park them in the hallway, just a little while, we say to each other. After all, the access managers assigned them a bed. But we know the bed is not ready, not empty yet. There’s still someone inside, waiting for transport to get home.

The first hour of my eight hour shift is over. Seven more to go.

I am tired. We are all. When we started preparing for the coronavirus 18 months ago, we were ready for an onslaught of patients. We had seen friends from overseas go through the mill and out on the other side. And so we prepared. And, nothing happened. Not really.

Some of us have felt this anticipatory anxiety, like a surfer paddling a big wave. But the wave never came. As horrible as it sounds, it might have been better if the wave hit us at this point. It’s up to us to struggle and spit, before coming up to the surface to breathe the fresh air again. The human body can only maintain tension for a while before it breaks.

We, the people who care for you, have been holding it for you for so long now. And we break.