It is, in a phrase aptly supplied by a nurse, like five hundred hells. Apparently the whole town has converged upon the hospital, all migrating to the Emergency Rooms. We are overrun with crying children, anxious parents, impatient spouses, and hostile adults. Most of their complaints are minor: sore throats, sprained ankles, belly pain for three months. A few are critical, some urgent. The rest can be seen when the cows come home or after.
It is my job to be hands and feet to the rest of the staff. I am gopher, runner, and courier. I bring patients in from the waiting room, take their vital signs, try not to get annoyed when they complain about how long they have had to wait. Although I want very much to explain testily to them that we are a trauma center, not a venereal disease clinic, I try to look sympathetic and apologize for the inconvenience. They complain anyway, and I sigh. It’s going to be a long night.
Nurses dart about, giving medicines, drawing blood, starting IVs. Charts pile up at the desk, and the doctors are exhorted to move faster, see patients more quickly. Our attending physician puts an unofficial rule into effect: five minutes for each patient’s initial evaluation.
Tonight, as usual for a busy evening, I spend most of my time out of the Emergency Department. I must deliver specimens to the Stat Lab, blood gases to ICU, and always I must try to get the patients who are admitted up to their rooms as soon as possible in order to make way for the endless wave of emergencies. In addition, I am opening up procedure trays and handing out supplies. We run out of sterile towels and glass syringes; off I go to the supply room where I must chat with and cajole the clerk to obtain the necessary items. This socializing seems to take forever, but it works in the long run: I am able to wheedle the precious glass syringes from her by inquiring pleasantly about her church’s fund-raising project. She miraculously finds a few extra when I agree to contribute. This mission accomplished, I walk quickly back to the ER; I have learned to save running for the most crucial moments.
When I return to the unit, a flurry of activity is taking place over an empty bed. I learn that we are expecting a gunshot wound to the head. We are preparing IVs for rapid insertion, calling Respiratory Therapy to come and ventilate the patient, assembling blood tubes, drugs, and other equipment. Momentarily the ambulance service backs up to the front door and deposits our patient on the prepared stretcher. His heart has stopped beating, and CPR is in progress. He is a young man whose injury has caused extensive and immediately obvious head trauma. Blood is pouring from his scalp and there is a hole in his skull through which brain is oozing. I am surprised that we are attempting to resuscitate him in view of this massive brain damage without the immediate consultation of a neurosurgeon. The doctors, however, are asking for drugs to restore the acid-base balance of his circulation; they are chemically prodding the heart to resume beating on its own. I stare hard at one of the nurses — we are in unspoken agreement. She leaves to call the beeper of the neurosurgery resident, saying quietly into the phone: “I need your presence in the Emergency Room right now.” In short order he appears, three other neurosurgeons right behind him. He tells us later that they were making rounds when he received this urgent message on the beeper, so the whole group ran along. The on-call resident approaches the patient and begins to assess his injuries. I am watching him from the foot of the bed when the chief resident walks up to me and says, “What’s going on?”
“Gunshot wound to the head,” I reply.
He, observing the extent of the patient’s injuries, throws down his hand in a gesture of disgust and, turning away, impatiently exclaims, “Tell them to cut it out!”
Immediately the neurosurgeons depart. The patient’s brain damage is so extensive that he cannot live despite heroic measures.
We now turn our attention to preparing the dead man for the morgue. A cursory swipe with a wet washcloth makes his face more presentable; arms and legs are crossed and tied, diaper secured, sheet pulled over all. We lift him up onto the death cart, lower it, and place the cover on top. This device is part of a pointless ritual aimed at sparing the public from realizing that a body is being wheeled through the corridors.
Because we have been tied up for a while with the gunshot wound, we are now even further behind. We receive a call from a surgery resident, who tells us that he is expecting a patient from a neighboring state. She is a young girl who has been badly burned after touching a live electrical wire. She will be here in an hour or so.
Now we work frantically, knowing that our resources soon will be severely taxed with the arrival of the burn. Consults are called for fractures, seizures, evaluation of abdominal and chest pain. Drunks who have wandered in with various imaginary complaints are forgotten in the waiting room. Lacerations are sutured, x-rays taken hours after being ordered. We are now so overrun that there is no hope of digging out on this shift. I want a cup of coffee and need to go to the bathroom, but there is simply no chance.
Soon the burn patient arrives. She is able to talk to us, which is a good sign, but her feet are white as snow: she looks as though she has already bled to death. She tells us that she is thirteen years old. A cousin dared her to climb an electrical tower; she accepted, touched a live wire after reaching the top, was burned, and then fell to the ground. Now we are more keenly worried; she is not only burned, but has also suffered a serious fall, injuring Lord knows what. We beep the surgery resident. He is operating and talks to us through the speaker in the operating room.
“How does she look?” he inquires.
“Bad,” we tell him. “Come over right now.”
He soon appears and can’t understand what our hurry was; after all, she’s talking and everything! He relaxes at the wrong moment; her blood pressure takes a dive, bright red liquid pours out of her catheter, and she is bleeding into her belly. As if we are not already in serious enough trouble, the radiologist emerges from his darkroom to announce an ominous finding on her x-ray. The surgeon dashes in to look at it. Momentarily he returns, yelling, “Her aorta’s torn!”
We move with lightning speed. I call the OR and tell them to get a room ready, he calls a cardiothoracic surgeon. For a frozen moment we are both on the phone, impatiently waiting for the interminable ringing on the other end to stop. Then our respective parties answer and we deliver staccato messages. Anesthesia and OR people materialize; we hook up oxygen to a portable tank, hang IVs on poles, gather papers, and take off, pulling the stretcher along while racing through the corridor to the OR. Immediate surgery is her only hope.
Her nurse and I go slowly back to the ER. The nurse’s face is red and wet; we are both sweating from the pace of this crisis. An incredible mess awaits us at the burn patient’s bed. Paper, dirty gloves, wrappings, syringes, and a dozen other objects lie on the floor. We scoop up everything and toss it into trashcans. We have to clean up this area quickly in order to move waiting patients in.
Now there are lots of chores to be done. While I have been helping out with the burn, the lab work has piled up, there are patients to transport, and higher and higher stacks of trays to wash. By midnight I am exhausted and wanting desperately to go home. As I am doing last-minute work at the desk, a young man approaches me. He has been sitting in the hall for a long time, waiting to be seen. His reason for coming to the ER is to have stitches removed. As a rule, we do not take out stitches; it is hardly an emergency procedure. This in mind, I turn my attention to his impatient question: “Can you tell me when I’m going to get waited on?”
Involuntarily I glance at the clock. I gaze at him for a moment and ask evenly, “Weren’t you supposed to call the health clinic for an appointment to have your sutures removed?”
He replies, defensively, “I did call them! I’ll just go home and come back tomorrow!”
I am exasperated and tell him, “There’s no need for you to come back tomorrow! What did they say when you called for the appointment?”
“Well, she said come on Wednesday, but I didn’t know which Wednesday she meant.”
Incredulously I ask him, “Why didn’t you ask her which Wednesday she meant?”
He exclaims with impatience, “It was too late then! I had already hung up.”
By now I have heard it all and so I let him have it: “I don’t know when you’ll be seen. We’ve got a lot of very sick and badly hurt people in here, and I have no idea when we’ll get around to you.”
I stalk off, unable to comprehend how it can be easier for someone to come to the Emergency Room and wait for hours than to redial a telephone number! Third shift relief is here; I gladly bequeath them tonight’s circus and go to my locker to collect my things.
In reviewing the night, I am struck by the disparity of experiences: the critically ill lie next to the desperately healthy and both compete for attention. When I find myself expending more energy on the latter, I wonder what we are really accomplishing. But it is a reality that each exists with the other, tragedy juxtaposed with comedy, forming an endless variety of patterns. It is, as they say, all in a day’s work.
This article previously appeared in Wake Forest, the alumni magazine of Wake Forest University in North Carolina, and is reprinted with permission.
— Ed.
