Fail, fail, fail, fail, succeed

2 Strokes, A Respiratory Failure & A Suicidal Ideation

You’re the charge nurse in a busy NYC ER and it’s the middle of a business-as-usual busy day. In your main ED you’ve got 2 docs and a PA, 5 nurses, 2 ERTs and 46 patients. It’s 6:30 PM and there’s a shift change at 7.

You get a “notification” from EMS that a stroke in progress will arrive in 5 minutes. Just as you hang up the phone your walk-in triage nurse approaches you and says “I have an active stroke that just walked in.” Your mind is already figuring out where you’re going to put these critical patients and which doc and nurse will get them when your unit clerk calls out “EMS notification on the top line.” You think “WTF – is she talking about the stroke note?” Nope – there’s a respiratory distress coming in 5 minutes! Now your mind shifts gear and you realize the PA will have to take the respiratory distress and you’re quickly figuring out which patient to pull out of a room since you now have no beds. You also realize you have no one to triage since your internal triage has one stroke and you have your boss triaging the second stroke, so in the middle of this shit storm you’ll have to triage the respiratory distress…

Just as this is happening, your walk in triage approaches you with a “suicidal ideation” that is hearing voices and wants to kill himself. She calls security for a 1:1 and you think “Ok, that’s covered, I’ll deal with it once I make sure everything is under control with these other critical patients.” Since you have run out of nurses you assign it to yourself.

Fifteen minutes later both strokes are at CT and have had a neurology consult, the respiratory distress is on BiPap, and security is calmly cataloging the SI’s belongings.

Not one person has complained, raised their voice, or even gotten excited. Everyone is taken care of quickly and I prepare to give report to the night charge nurse. I mentally take a moment to acknowledge this in my mind, and I think of how fucking cool my colleagues are and what a privilege it is to work with them.

I love my job.