Night 1:
Walk into a four hour wait, as I'm walking by the nurses' station the night-time ER doc is throwing a fit, literally screaming for security, because a drunk guy tried to take a swing at him. Violence should never be accepted as part of the job, but nonetheless, the drunk guy is flailing around like a ferret on crack, and did I mention he weighs about as much as the doctor's left leg? Really, doc? Cut the drama. Next contestant just arrived in the waiting room and is demanding to see the charge nurse. "Yes sir, how can I help you?" "I just waited 4.5 hours at Hood Hospital up the road, and I left because they didn't do anything, and I come here and you have an even longer wait? This is ridiculous!!" Thinking to myself, well if your dumb-ass didn't leave Hood Hospital you would have probably been seen up there by now. But since you decided to give up your place in line, you go to the back of the line. Sorry, that's the rules. Unless you can make your heart stop on command, back of the line mister. Happily provide him with my manager's phone number while he's berating me in-front of the packed waiting room. Later on, chart review will reveal that he was actually removed from Hood Hospital by the police, screaming "If I was white you would have treated me already!" Ahh yes, the infamous race card. Well played, sir. Unfortunately we only take Mastercard and Visa here, not the RaceCard. Next up, the cranky and tired mother of a 7 week old who just got his first IV. Yes, please I insist, you should hold him in a way that allows him to bend his arm and now his IV is infiltrated. Don't be ignorant with me when I explain why the IV is coming out and why he's getting an IM dose of Rocephin. While hold the screaming demon-spawn, receive a phone call from the director:
"ER, how can I help you?"
"Hello, this is so and so, how are you?"
"I'm holding an infant for an IV stick right now." Thinking to myself, can't you hear the hyena-like howling in the background???
"Oh ok, I'll call you back."
Wipe demon-spawn slobber off my scrubs and retreat to the nurses' station to return director's phone call:
"So I've been watching your tracking board and I'm just calling to see how you're doing"
Momentary pause... I probably shouldn't say we're up shit's creek without a paddle. Probably.
"We're doing okay for now."
"Oh ok, well Hood Hospital is really bad off right now, but I see you're busy too so I won't put them on divert right now."
Oh really? Thank you for that astute observation!! I'm glad you realize that a packed ER, no dispositions occurring within the next hour, a waiting room that has run out of chairs for the people, and a five hour wait translates to "you're busy".
But instead I just say "Great, thank you, we expect to see some movement in all this within the hour. Thank you for checking in."
I look at the clock and it's not even eight o'clock yet. 11 more hours to go. Sweet Jesus help me.
Cue next scene, phone call from State Police:
"Yea hi, we've just received a 911 call about a 17 year old run over by a vehicle, they may be heading your way, they decided not to wait for the ambulance."
Fan-fucking-tastic. Trauma Alert with unknown ETA or injuries. While we mull around the idea of activating the Trauma team with an unknown ETA the State Trooper walks through the door and we chat for a bit. Kid's still nowhere to be found, should have arrived to the ED by now, so we stand down. Only to get the EMS radio patch a few minutes later: "Trooper 2 landing in the Walmart parking lot, I found him." My hair stands up on the back of my neck. A couple minutes later the EMS radio chirps: "2 minute ETA, awake & alert, no obvious injuries, Trooper 2 is on board." Page the Trauma Alert. Cut to 3am, waiting room is finally empty of patients but every single chair (20-25) is taken up by a family or a friend of the 17 year old, who only has a few superficial scratches. At least it's not Hispanic Hysteria.
The rest of the night is a faint blur, until 6:30am, when the next wave arrives. As we're leaving at 7:30, there is one open bed available. Not a good harbinger for those of us returning in less than 12 hours.
Intermission.
Night 2
Upside: awesome attending doc. Downside: short one nurse. Oh well. Another drunk guy is being belligerent in front of the nurses's station. At least the dayshift doctor believes in the healing powers of Ativan. Admission hold from last night is still here. Beds are very tight. An elderly, demented, pretzel of a man is curled up in front of my desk on a stretcher. Fx femur. Fabulous. He will wind up spending the rest of the night with me until he gets a bed. Play musical chairs for the next 5 hours, bringing people from the waiting room to hallway beds to start exams and then slinging them into the next open bed. My old friend gets a bed assigned shortly after 11 and off we go. Three floors and a winding hallway later we are met by a nasty floor nurse who says "We're not taking him, you can go back down stairs, I'm on the phone with my boss now." Practically flying through the hallways I parallel park him and get on the phone with the supervisor who is even more ticked that I am. Magically 15 minutes later the floor graciously accepts him. Make the trip back up-stairs, this time taking along my tech and saying to him "If I go off on a murderous rage I need you to be my witness that it was justified." He laughs, uncomfortably. Transfer the patient into the bed, nurse is nowhere to be found. Settle the patient into the bed and remove the extra linen, nurse still nowhere to be found. Discover her at the desk sitting on her lazy ass at the computer. Slam the chart down and tell her that I would have given her report at the bedside but she decided not to come in. Hateful bitch. Give report and listen to 15 minutes of groveling and back-pedaling about why they didn't accept the patient the first time.
Back downstairs. The seizure that was coming in when I left to go up is still seizing. The short doc is power-walking past me "Oh hi, you're back, we're intubating." Oh good, I came back just in time. Just barely get him intubated when EMS radio goes off with a 5 minute ETA for 70-something year old conscious V-Tach, cardioverted to A-Fib. Clear out the other trauma room, the previous patient looks a little bewildered as we usher him onto the transport stretcher for his ride to Georgetown University Hospital, the ER stretcher is instantly stripped, cleaned, & made just in time for the cardioversion to roll through the doors. House supervisor sends an ICU nurse to help. ICU nurse is pissed "because I have patients upstairs too you know". Cardioversion is in a steady, rate-controlled A-Fib. Ask ICU nurse politely for EKG machine & Amiodarone drip. ICU nurse is completely flustered by this request, adjusts her glasses and in a shrill panicked voice asks what I need. I turn around and slowly and calmly repeat myself. She disappears, only to reappear saying that the patient's name isn't in the Accu-Dose. Okay, no big deal, it sometimes takes registration a little bit of time. Again, I calmly and slowly ask if she knows how to do an Emergency Admit on the Accu-Dose. This is where it really gets good. Ready? She starts doing calming breaths, with the hand motions and everything!
Total meltdown imminent. And here it comes. Still standing there, she flips out on me "No I don't know how to do that! Just give me a plan and tell me what to do!! If there's nothing else here I have to go back upstairs!" At this point I can't keep a straight face any more and I bust out laughing, shaking my head and telling her she can go if she needs to. I don't have time do deal with this shit. She's more worked up than the elderly patient who just got zapped! I instantly reconsider my decision of ever working in the ICU here as a nurse.
Back to Saturday night at the zoo. Primary nurse is done with the Georgetown transfer and he steps into the room, just in time for me to catch an EMS crew rolling in with a young man with an obviously dislocated shoulder. He goes to my last open bed, to the same nurse who had just gotten an ambulance with a 74 year old who drank rubbing alcohol. After that patient is seen I grab the doc, asking for pain meds. Dislocated Shoulder Man is very nice, stoic, and trying his hardest to be as polite as possible through the excruciating pain. I quickly pick up on the Russian accent and make a point to tell him hello once his arm is back in the anatomically correct position. Unfortunately the doc is still tied up trying to manage the seizure, and Dislocated Shoulder Man has to wait a bit. I get orders for a second dose of pain meds and turn him over to his primary nurse. Stepping out to go check on the Seizure Man and Cardioversion Lady, Seizure Man's nurse pulls me into the med room with an exhausted and trembling voice. There's a large puddle of Propofol all over the floor and shards of the 100mL glass vial. Now I'm laughing uncontrollably, pretty much deliriously. Not so much at the poor primary nurse who had to fight with a poorly designed AccuDose and almost got clocked in the head by the bottle but at the entire picture of the night. We are absolutely up shit's creek without a paddle, and we just lost the entire canoe. I mop up the spill with paper towels, contemplating if I can lick it up off the floor or if I should use a straw. After my shift it will dawn on me that I should have used a straw with a filter needle on the end.
I have been back downstairs for barely an hour and the place is absolutely exploding. Hello Shit Magnet status. Obviously the moon and stars are not aligned tonight. Seizure Man has been seizing for almost two hours now, refractory to all medications. Cardioversion Lady is doing as well as expected, awaiting her ICU bed with the ultra-frazzled ICU nurses. Dislocated Shoulder Man is still dislocated, we're paging the Orthopod for a last-ditch favor. He calmly tells the ER doc to stop the seizure and reduce the shoulder later. Wow. Thank you for your expert medical opinion doctor asshat. Hood Hospital with Neuro ICU is refusing to accept Seizure Man because they won't be able to do a STAT EEG, Neurologist is refusing to come see the patient unless he is at Hood Hospital; recommend transfer to Trauma Magic North. After trying to coordinate this nonsense for four hours (oh and by the way, he's still seizing) we have a 20 minute ETA on flight. In the midst of which the attending politely but firmly tells the fiancee over the phone that there is no way in hell that the patient can be transferred to rinky dink hospital down south at her desire. Flight arrives and packages up the patient, they are friendly, efficient, and thankfully know what the hell they're doing. At the same time Cardioversion Lady gets the ICU bed assigned, and Dislocated Shoulder Man is reduced by the PA with 15lbs of sandbags. It's after 5am and we all finally take a breath.
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