After packing up my room, and stripping the sheets ready for the next person, I store my bag in my locker. Before heading into the admin hub of the clinic, I divert into the kitchen where the ladies give me a rundown on what I missed. I walk out of there up to date and with a stack of cheese melts and blueberry muffins.
The admin hub is relatively quiet; I get the chance to eat while listening to the shift handover meeting. Like the kitchen ladies said, nothing strange or out of the ordinary happened while I was off.
The charge nurse stops talking, walks to the door, and looks down the hallway before coming back to speak to us again. “Why is it, you wish for quiet, but the moment it comes, you get worried?”
One of the nurses reaches over from where they’re sitting and checks the phone. “It’s working.”
“Which means a shitstorm is heading our way.” An orderly jumps in and says what we’re all thinking.
The reality is, until the storm hits, all you can do is wait. Our debrief finishes, and everyone goes to cope with the rising apprehension how they see fit. Some rush from one side of the clinic to the other, doing nothing but moving to burn the gathering energy. Others huddle in groups, staring at the set of double doors to the ambulance bay, waiting for them to burst open. Another lot of people sit around chatting and eating as much as they can before we don’t get the chance to eat again for hours.
I like to focus on paperwork. I sit at one of the spare desks and start reviewing patient files, trying not to waste any energy on what I can’t control.
Tension ripples around our little clinic; it’s like ants walking up your legs or over your hands. It leaves me jittery, and the more it builds, the less I can focus. When the PA system cackles to life with details of incoming patients, it’s a relief. All the noise quietens and my training kicks into gear, bringing a different version of peace.
The CN takes charge, assessing and prioritizing the cases as they come in. Some information gets passed along, but at thisstage, it’s based on the number of casualties, not patients being assigned. Everyone moves to their zones, to wait.
I’m scrubbing down when the CN finds me and starts listing off the patient details. “You’ve got the Cat 2. White male, aged mid-twenties early thirties, severe laceration to forearms, plus stabbing wound to abdomen. He’s been administered Tranexamic as pain relief but is refusing anything else. And of course, he’s not sharing anything personal. Nada.”
I roll my eyes, not at the CN, but the patient. People get so caught up trying to stay off the radar, they inadvertently put themselves at more risk in a crisis situation.
I turn to face the CN, one step ahead of what she was going to brief me on. “So, it’s a stitch up and clear the way for them to run if our patient doesn’t want our help. What else is happening?”
“Possible incoming from a bus wreck, depending on if the hospital is overrun too. I’ll keep you posted.” She stops reading off her list. “You’re one of the most senior staff working. Are you okay to take the lead? If not, I can ask Dr. Billings to.”
I read over the papers she hands out, reviewing the rough case notes and then double-checking who’s going to be working with me before answering. I’ve got a great team around me. “We’ll be fine. I’ll check in with you as soon as I’m done to see where you need me most.”
I’m talking to her back as she races on to the next bay to outline to that team what they’ve got coming in. I get a wave, letting me know she heard, and when I turn back to my team, they’re all waiting for my instructions.
“Okay, let’s do a quick rundown, then we can go back to getting stations prepared.” I talk my team through what we know, the possible injuries we’re facing, and other potential injuries and risks I want them to keep an eye out for before I turn the room over to them, so they each get a turn to explain whatthey’ll be doing and how they’d manage the situation. It’s how I learned on the job, so it’s how I teach.
Situational experience is vastly different from learning out of textbooks and lecture halls. And the same can be said about small clinics versus large hospitals. After a final once-over of the room and equipment, along with a private chat with everyone I’m supervising, I focus on getting myself ready. I wash my hands for a second time, slather on scent blocker, and suit up, hiding my hair under a cap and pulling up a surgical mask so all that remains visible are my eyes. I pull down the plastic visor to protect my eyes from splatter.
There’s a noticeable drop in the atmosphere, and my heart thuds, recognizing what's about to happen, but also that moment of excitement that comes from doing the very thing I enjoy doing—helping people as best I can. Being a doctor is like the ultimate comfort, bar the blood and guts, that is.
The stretcher appears first, and the paramedic pushing it in gets straight down to business. “I don’t know what’s going on, but it’s like Armageddon out there. Apparently, The Royal is even worse. A line of ambulances is already queuing.”
The Royal is the local hospital, which means our day might be even busier than first considered.
As soon as the brakes lock on the stretcher, my team moves with unspoken synchronicity as we transfer the patient onto a table. I feel the tension fade away to nothing. I love the rush I get as my movements become fluid-like, my thoughts clear and focused.
The paramedics stay out of our way. One stays near the cart, ready to move it out of the way, and the other starts relaying to our unit coordinator what they’ve done and seen since their first call out and subsequent patient care.
A part of working in ER is being able to assess and change in a split second. After seeing the patient, and hearingthe paramedics rundown, I know I—with a very small team—can handle the stabbing victim. Based on the wave of other casualties on their way or already in the clinic, I bark off orders like an Alpha and send the majority of my team out to help other teams.
Those who stay with me quickly settle into an easy and precise rhythm.
One of them cuts away the patient's very expensive-looking suit.
Generally, people don’t bitch about their clothes when the option is survival, but I’ve certainly had a few patients take issue. Thankfully, this patient isn’t one of them.
The anesthesiologist steps past where I’m working and starts trying to speak with him. The stab wound on his torso is more of a concern than his forearm. The bandages on his arms, wrapped by the paramedics, aren’t saturated with blood, which, for an initial assessment, is what I use to determine the likelihood of him bleeding out.
Before we start on the stab wound on his torso, I want to determine if he’s got internal bleeding. If I have any doubts, I’ll send him to X-ray, but at the same time, there’s a few tests you can do first. I’m pretty confident that, after a few stitches, he’ll be okay. Rattling off notes for the nurse, I twist to get what I need but am nearly knocked off my feet by a sudden, unexpected burst of aggression.
Stepping out from behind the anesthesiologist, I glance at our patient for the first time. He’s all Alpha, shockingly good-looking, and currently in a bitch of a mood trying to swat the needle away. His eyes are glazed, and even though he’s swatting my anesthesiologist away, it’s pretty easy to see he’s not fully with us.
“Hey!” I latch on to Dr. Peters’s scrubs and drag him out of danger.
