The Meaning of ER

sadmanFrantic nurses and doctors prepare for the incoming patient. A text page alert makes everyone take up their battle stations. The white-haired surgeon steps into the middle of the room, and the formation reforges around him like the scattering dance of iron particulates induced by a magnetic field. The surgeon extends his hands out in front of him and postures. The assistants encircle him to help put on his battle armor of double-layered blue plastic. A black teenager is wheeled in. A gunshot wound through the chest. Blood paints the room crimson. The room hushes. Only the surgeon speaks, giving commands. A siren of a pregnant woman’s scream resonates throughout the building as she is rushed down the hall through the chestnut double doors.

Next-door, a sixty year old man with ashen gray skin and a vacant glazed stare after years of advancing glaucoma lies still.

X-rays come back. The bullet has miraculously missed all vitals. Put a Band-Aid on it. He can go home. Within minutes, the sanguine battlefield transforms into a spotless, sterile laboratory.

I begin my night shift and enter the ER, stepping past a metal detector to the waiting room. Tonight it is at capacity. Tired families and sleeping children pack the spacious lobby. Some sit on the ground with blankets. A nurse tells me the old man with the crooked face over there has been waiting for over ten hours. I greet the security guard as I creep over patients and swipe my badge to gain entry through the gates of sanctuary.

I wander down the barren halls towards EM-3, where the emergency department admits non-critical patients. The hospital has a hierarchal structure. The attending physician, the most senior and experienced doctor, walks in front. The residents, interns, medical students then follow in that order forming a V-shape like geese in a flock. I scamper ten feet behind the entourage panting in order to catch up.

The ER triages every patient, a ranking system based on the severity and urgency of the condition. A ranking of 1 is cardiac arrest or a gunshot wound to the chest. A ranking of 5 is something like priapism: some dude decides that it is a medical emergency when he can’t get it down after taking his Viagra. The triage system is necessary because sometimes doctors can’t save everyone due to patient overload. But, how does one determine the value of another’s life? How can anyone decide that the boy turning purple from anaphylactic shock is worth saving before the elderly man suffering a stroke?

The emergency department is organized into four sections in a circle, EM-3, EM-2, EM-1, Trauma. EM-3 takes everyone, mostly patients in a non-critical condition. EM-2 houses pregnant women and newborns. EM-1 is called the “psychiatric ward,” where I am forbidden. Anyone that comes in an ambulance goes directly to Trauma. But, nothing is set in stone. Doctors constantly move, and patients are constantly being moved. The perpetual shuffling of patients from one CT scanner to the next makes my head spin.

I follow my resident’s steps like a careful shadow. We turn around the corner to EM-2 where he is working today. EM-2 looks unremarkable. The walls are steel gray, the air is biting cold, and the floors are strangely immaculate. The rooms are homogenized – one bed and comforter, one chair, a heartrate monitor and pulse oxidizer, several machines that I don’t know the names of, and two waste containers, the red one for biohazard.

A mother angrily picks up her child who is rolling on the laminated floor with his sister. I stare at the curious scene. The boy yanks his arm back from his mother and drops to the ground. He continues rolling, laughing and hugging his sister.

My resident heads to the physician corner to discuss the next patient with the attending. Although going to the emergency room is huge deal for patients, most hospital work is routine for the physicians. Life and death situations are rare, so there is no rush. Most of my resident’s cases he has seen hundreds of times. The elderly person with chest pain and shortness of breath. The diabetic war veteran with high glucose who is suffering from diabetic ketoacidosis. The seventeen-year-old adolescent named Jim complaining of neck pain after crashing his brother’s 1997 Ford. My resident rubs his face and sits down to drink some more coffee. He is near the end of his second sixteen hour shift this week.

We go to room 17 across the hall to see a Serbian woman with confusion and memory loss. My resident goes down the list of diagnostic questions according to protocol. He has done this so many times the words come out in a beaded string forming a monotone hum. What brought you to the emergency room today? When was the onset of your dizziness and confusion? Do you have chest pain or shortness of breath? Surprisingly, she doesn’t remember her name. She doesn’t know where she is, can’t remember the year, and thinks the president is Bush. The old Bush. Her balding American husband answers for her. My resident quickly rules out dementia due to the sudden onset and stroke after looking at her CT scans. He is baffled. I don’t find out the cause of the women’s amnesia because my shift ends.

I discretely take a shortcut through EM-1 to the exit adjacent to the waiting room. The white-haired surgeon and his entourage rush past me and head upstairs to the OR. I wonder how the emergency doctors are able to handle so much stress and pressure. Many are married and have children. How is my resident able to tuck his children in bed at night after hearing the despair of a mother who lost her only son after an accidental drowning in the neighbor’s pool that evening? How is the white-haired surgeon able to prepare meat for dinner after cutting open a man’s leg hours prior? A charred artery after cauterizing smells just like sweet honey BBQ.

I peer through the double-layered glass into the waiting room. I look for the old man with the crooked face and don’t see him. Patients seek the emergency room to be treated immediately, only to sit through an insufferable wait. To them, no matter how big or small, everything is an “emergency.” The physicians and residents work as robotic drones, fatigued and overworked. Yet, they come in every day, trudging along ceaselessly.

I exit the automatic sliding doors pointing to the parking lot into the night. The darkness is quiet, and the air is crisp. In the distance, I hear the faded wail of a siren, and I walk on.

 



About

Kevin Lou is a junior from Atlanta, GA. He can be reached at kevinlou@wustl.edu


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