DR RAJ Thakkar has spent a year working at Wycombe Hospital and has another year to go as part of his training to become a family doctor in a GP practice.

The 26-year old Londoner spent his first six months working in the psychiatry department but for the past six months he has been a senior house doctor in the Accident and Emergency Department known as the hospital's front door.

Here, he never knows what the day or night will bring. It could be someone injured in a road accident or merely stitching a cut finger. Delays for many patients are a fact of life and medical staff may be the subject of abuse, as Dr Thakkar explains.

Another day in the Accident and Emergency (A&E) department.

It's the weekend and as a senior house doctor, I have to work ten hours, two more hours than a weekday shift. Night shifts are even longer at 12 hours. Nine more days before I get a day off.

As I walk through the waiting room all hope of a quiet shift quickly disappears. Twenty pairs of eyes all stare in anticipation and three more are closed sleeping off Friday night.

The receptionist is threatened with a fist because the waiting time has just gone up to four hours and a wave of moans echoes around the department.

The triage nurse prioritises the patients in order of urgency. As I wander past the triage room I catch a whisper of the conversation with a patient: "But what medical problem do you have?", the nurse asks. "None", the patient replies. "I just want a cup of tea and a sandwich."

Having developed a degree of immunity to the dreaded 'waiting room walk', I see my first patient with some enthusiasm. Back pain, for three months!

An Accident perhaps but certainly not an Emergency.

The patient intended to go to her general practitioner (GP) but decided to drop into A&E as she was driving by.

While I am seeing her the waiting time for the real accidents grows longer and longer, the receptionist gets more complaints and tempers begin to fray.

The next patient arrives, demanding a repeat prescription. Their GP had issued one, five days ago, but he didn't get round to the pharmacy in time.

While I'm talking to him a patient's relative shouts from the next cubicle: "Oi! My dad has been waiting in a cubicle for four hours. When's he going to get a bed?"

The bed crisis is an everyday issue and out of my hands but nevertheless A&E staff usually get the brunt of the abuse.

"Ring ring!" The red phone trills throughout the whole department.

The ambulance crew is on its way with a patient involved in a road traffic accident. They request the trauma team on standby.

I have to stop what I'm doing and prepare for the casualty arrival. Fuses shorten as the waiting time is put back an hour.

Those in the waiting room don't see the work going on behind the scenes. More information is phoned through from ambulance control.

The casualty is male and in his 20s. He was involved in a car crash on a country lane. Tragically his female passenger was ejected through the windscreen and died.

Flashbacks of last Tuesday's trauma begins to haunt us a lorry driver tailgating on the motorway.

The casualty arrives through the emergency door, out of sight from the anxious patients in waiting room.

Within seconds he is transferred onto a resuscitation trolley, blood is sucked from his mouth, his chest is examined for life threatening conditions and he is given fluids into his veins to replace the blood he has lost from his broken legs.

The oxygen levels in his blood begin to fall. There is fluid around his right lung, probably blood. We ask for a chest drain kit when the red phone screams once more.

"Cardiac arrest! 70-year-old female. Expected time of arrival, five minutes!"

The trauma team continue with their patient while we organise staff on standby for the cardiac arrest.

Eventually the sick patients are stabilised. The number of patients waiting has grown. I call the next patient. Apologising for the wait I show her to the consulting room. A torrent of abuse erupts about how she has been waiting five hours for her splinter to be taken out.

I explain there have been some emergencies and apologise again. She continues to protest. She says: "My finger may become infected and fall off!"

Other patients appear more understanding while some accuse the staff of being lazy, having no idea what has happened in the resuscitation room.

The day finally starts to settle and some patients have left, their injuries being less important than watching Wimbledon.

The shift is finally drawing to a close. I haven't managed to grab my dinner but at least it's over. I leave, not daring to go through the waiting room but rather the back door as another ambulance arrives.

A&E is for accidents and emergencies conditions that require the care of medical staff in a hospital or that cannot wait until an appointment with a GP.

The demand for quick service and first class care is ever growing. With limited resources we must prioritise our efforts to treat illness in order of severity.

While we strive to keep waiting times down it is inevitable patients with non life-threatening ailments will have to wait until sick people are treated.

The waiting times are made longer by some who misuse the department for non-emergencies. Of course if these patients became sick for another reason in the future, they would be grateful for, and rightly expect, prompt attention from staff in A&E.