It’s Monday night in the Emergency Department. The day shift has gone home, I’m here until morning with a skeleton crew, and there’s no help coming for 12 more hours.
The weather is terrible but it isn’t keeping the patients away. With a full hospital, sick patients who are admitted have nowhere to go but into hallways to make room for the crowd outside.
We have over 100 patients already inside our treatment areas with 40 in the waiting room. The wait time stretches to an average of around four hours to be seen, with only life-threatening complaints able to skip to the front of the line.
This is going to be a night when I don’t stop, sit, eat, drink or pee.
I know from the moment I pull up to the hospital what kind of night it’s going to be. The parking lot is full, there are six ambulances in the trauma bay, and when the automatic doors to the triage area whoosh open, the ambient noise hits me. The people I walk past run the gamut from frustrated to suffering, and there are no friendly faces.
My stomach tightens as I feel a wave of nausea, but it quickly passes as I go into battle mode. This is going to be a night when I don’t stop, sit, eat, drink or pee. I guzzle a hot coffee before I begin, knowing that I’m unlikely to even find my cup after an hour of navigating the chaos.
A few hours in, I scan the ER board for the sick folks hidden in the mob. My next patient has waited a few hours and is listed as “neck injury and fall” with good vital signs.
As I walk in, it takes only a few seconds to see that the calm woman standing in the room probably doesn't have a significant airway issue. She will likely need a cursory screening exam before she settles in at "Labour and Delivery" so her very swollen belly can be attached to “the belt”, monitoring her obviously late pregnancy.
I’ve already mentally moved on, going through the motions but prepared to be surprised at signs of serious injury. I introduce myself and ask her to tell me what happened as my hands are on auto-pilot, simultaneously examining her neck and spine. I interrupt occasionally for answers to key pregnancy questions, but she does most of the talking.
She tells me how she and her 17-year-old son have been arguing over his new girlfriend. How he’s grown more angry and rebellious. That he’s been moody and aggressive, and has demanded money for the both of them.
She meets my gaze and crumples, her hands covering her face.
Tonight, yelling escalated into shoving, and then he had his hands around her throat, choking her. Did she pass out? No. Any other injuries, any stomach or back pains? No. I’m calm, unaffected by her tale, already thinking of the new patient getting moved into spot 10.
Then she tells me how he splashed her with petrol and went looking for a match. I stop cold and look her in the eyes for the first time.
She meets my gaze and crumples, her hands covering her face. I feel my eyes fill with tears and I’m acutely aware of the other staff in the room,
Why am I suddenly moved out of action mode by this? As if being choked by one’s son wasn’t terrible enough.
Perhaps it’s that her skin colour is so close to mine, or that her son’s photo similar enough to what my son might grow to be. Perhaps I’ve heard too many stories of women burned or splashed with acid. I put my hand on her shoulder and we cry.
After what seems an eternity but is surely a mere minute, wheelchair transport arrives and whisks her away.
I leave the room and the moment is over. I’m refocusing on new priorities, people who need my help, demand my attention, or even simply need my reassurance.
The wait time is down to two hours but a new wave of patients hits, swelling our waiting room back to 40. I don’t have the luxury to feel right now. Perhaps there will be time later for reflection.
Dr. Mukherji is the Residency Program Director of the Long Island Jewish Medical Center’s Emergency Medicine Program. Follow him on Twitter here.
24 Hours in Emergency series 8 starts Monday, 29 August at 7:30pm (AEST) on SBS. After they air, episodes will be available on SBS On Demand.
Missed the last episode from series 7? Watch it right here: