Monday, September 24, 2007
When You Least Expect It
Last week's hospital shift began fairly quietly. For the first two hours, the pace stayed calm: the same patients in the same beds, more or less, no apparent crises, mellow staff. Halfway through the shift, I'd visited every patient in the department, plus a few in Fast Track, so I decided to take a cafeteria break.
Volunteers get $4 meal coupons that can be redeemed after four hours of service, and I'd worked many more than four hours since redeeming my last one. I always feel a little funny taking a break during such a short shift, but on the other hand, I tell the charge nurse where I'll be if anyone needs me, and if I heard a code, I'd certainly respond. So I'm still available, even if I'm not in the ED proper.
I went to the cafeteria and waited in a line rendered ridiculously slow by a broken cash register. Several other ED staff were there too. When we all got our food, the medical folks went back to the department, and I sat down by a window to eat my fruit and chocolate-chip cookie, anticipating that the rest of the shift would be mellow, too.
Nope. When I got back to the department after half an hour away, all hell had broken loose. Ambulance gurneys lined the hallways, and three more were coming in the door. A hysterical family member was standing outside the ED doors with a patient, hunched over in a wheelchair and vomiting, who hadn't been able to keep anything down for twelve hours. "Why can't we get back there? What's going on? We shouldn't have to wait this long!"
As I walked back into the department, a nurse who'd seen me in the cafeteria gestured at the gurneys in the hallway and shook her finger at me. "See what happens when you take a break?"
"Yeah," I said, "this is all my fault." She laughed.
It turned out that another hospital had gone on ambulance divert, so we were getting hammered with patients who normally would have gone there. And hammered is the right word: calls from incoming ambulances were coming in every two minutes. I don't think I've ever seen it that busy.
In the middle of the chaos, yet another ambulance call came in. I was near the radio, and heard the paramedic describe a patient whose chief complaint was a headache. The patient was ambulatory. The paramedics hadn't started an IV.
The nurse at the radio shook her head, rolled her eyes, and said, "Bring the patient to triage, please. Do not come back here." (Moral: If you call an ambulance because you have a headache, you'll still go to the ED waiting room. You'll just have a very, very large transportation bill.)
Needless to say, I didn't take any more breaks during that shift. But driving home afterward, it struck me that the sudden change in the tempo of the department mirrored the experience of ED patients themselves. You're going along in your day, thinking you have everything more or less under control, and then, wham, everything turns upside down. You're hit by a car, a stroke, a seizure. Life as you know it dissolves into pain and chaos. You don't know what tomorrow will look like, and you may not know if you'll live to see tomorrow.
ED staff are far more used to chaos than ED patients are; working in emergency medicine for any length of time requires, I suspect, a capacity to find bedlam invigorating. But it's worth remembering, when a sudden onslaught knocks "normal" upside the head with a 2x4, that the patients aren't used to this, aren't trained for it, and desperately need any reassurance and order they can find. This is one reason chaplains are so valuable: one of our jobs is to stay calm and centered when everyone else is overwhelmed. (I'm not always good at this, but I try.)
Crazy shifts can, if we let them, give us more empathy for what our patients are going through all the time. This isn't, to be sure, a very profound observation. Still, it may help those of us on our feet connect more meaningfully with the people in the beds.