And the Darkest Hours Are Just Before Dawn...

Oh, my....Google put ads for Vioxx lawyers on the site... not exactly a match with my editorial opinions!

I'm finally getting my cape. And a cap! With an itty-bitty uniform and teeny-tiny white open-toed pumps. I happened to pass by eBay and there were a TON of Barbie nursing outfits (circa 1961) just waiting for a bid. I didn't bid, though. I'm smarter than that. I went right for "Buy It Now!". The outfit comes with black-rimmed glasses, presumably because nurses can't look too glamourous. But Barbie has her pedicure showing with the open toes shoes, and pumps no less. I have wanted this outfit for approximately 40 years; it's costing me the equivalent of four real uniforms. What would we do without eBay?

There is a virtual bus stop in front of every emergency room and it disgorges its charges at regular intervals. It runs 24 hours a day. You can set your watch by its arrival and tell the time by the patients seeking care. Here is what the night shift might receive....


1:00 am: The Earache Hour
What is it about the nighttime that brings out the worst in ear pain? Kids that were fine at home suddenly wake up screaming in pain. Very disconcerting to the parents, but fortunately easy to treat.

2:00 am: The Croup Hour
Sleepy parents and kids sounding like the seal enclosure at Marine World comprise this block of patients. Usually the child sounds better by the time he gets to the ER. That's an ER rule, by the way. "All symptoms in children cease upon entering the ER ." Diarrhea since birth, four years ago? Not now. Total lethargy for three weeks? Now the kid needs medication for attention deficit disorder. Acute abdominal pain since breakfast? The kid picks the "smiley face" on the pain scale. The parents are aghast and then embarrasssed for "overreacting" but the staff believes every word. Those of us with kids have been there.

3:00 am: The Alcohol-Induced Head Injury Hour
Brisk bleeding head lacerations attached to intoxicated patients are the hallmark of this hour. They probably fell, they may have been whacked, but every head-injured drunk is a subdural hematoma until proven otherwise; the CT scanner is very busy. The ER rule for this hour is "Nice when drunk, mean when sober." These patients will urinate half a liter for every ounce of alcohol consumed, while asleep (that's before they recieve hydration in the department). The problem, as a nurse would put it IF nursing diagnoses were used in real life, "Alteration in level of consciousness secondary to alcohol consumption resulting in alteration in urine output leading to incontinence." Translation: have a lot of clean linen handy.

4 - 5:30 am: The Wee Hours
Patients are usually few and far between during these hours so the ER nurses study their procedure manuals, work on their certifications and read every nursing journal they can.
(That was for the benefit of my manager.) We actually read, crochet, knit, listen to the radio, have that fresh cup of coffee, surf the internet and I have been known to practice my "moonwalking" dance moves (don't laugh - it's taken me 22 years to get it right). By the way, NEVER, EVER, EVER say the word "quiet" when in the emergency room. It's like dropping the "F-bomb" in church. I just isn't done. Utter the "Q" word and you will ensure an avalanche of patients the numbers of which have never been seen in this lifetime. The bus driver will have to apply for overtime. The nurses will recoil from you. The doctor will rue the day you were born. Save your breath.....save yourself!

5:30 am: The It's-Hip-To-Be-Square Hour
Somewhere, someone over the age of 75 is getting up to go to the bathroom and tripping over an area rug. Their hip will take the brunt of the fall and they will join the legions of people with titanium hips. They are scared and in excruciating pain so the "hover mat" is placed on the gurney before they arrive. It's like floating on a cushion of air and makes transfering from the gurney in xray virtually painless. That, generous medication and the reassurance that a broken hip can be repaired help immensely. Now it's time to wake up the orthopedist on call.
Heck, for that matter it's time to wake up the ER doctor.....

6:00 am: The Code Hour
Before this hour is over, a patient will arrive Code 3 with severe respiratory distress. Their EKG will be abnormal, their lungs full of fluid, their pasty skin drenched with sweat and the proverbial "elephant" on their chest. The emergency staff will hit that patient with every weapon in their arsenal of life until the patient is stabilized; lungs cleared, breathing restored, blood pressure maintained. The patient goes to the ICU. The staff gets ready to go home, only it will take just a little longer to fall asleep; it takes a while for the adrenalin to subside.

7:00 am: Hey-la, Hey-la, The Day Shift's Back
And because I don't work days, I don't know their story. I'll interview a few and see what their day is like and report back from the "frontlines".

But the PM shift.......now THAT is a whole 'nother story.....