The last hour assigned to triage is the longest and hardest 60 minutes of any position for an Emergency Room nurse. It’s often like a scene from Night of the Living Dead during which zombie-like creatures present complaining of symptoms they’ve had for months giving them 10/10 pain that “no one knows what’s wrong with me!” (I do! – you’re making others miserable, namely me, at this ungodly point in my shift!) It basically makes you want to fall on a sword just to define what 10/10 looks like!
Anyway, today is something special. I’ve just spent a shift where I triaged for 9 hours straight without a break – no bathroom, no food, no rest, no joke! The last hours of my shift were steady but not as bad – until now! Our patient registration associate slides open the window between the triage office and hers. She says, “A nurse from upstairs just dropped this patient off”. “What’s the deal?”, I ask. She shrugs her shoulders and says “The patient is not telling me. She won’t even give me a complaint”. I tell her to just send her over to me. Great! Just what I need with 15 minutes to go!
The patient walks in and I have to do a double take on her birthday. It says she’s 31 but she looks 50. She’s got long-since-healed torn earlobes, facial scars and a chronically deformed nose. Her eyes are cold enough to freeze lava. I attempt to mirror her coolness and ask, “Okay, what’s the story?” She tells me she left the floor where she was a patient and now the staff refused to let her back into her room. This irritates me because there’s more to the story and the person with that information high-tailed it back to her unit. I go a couple more rounds with the patient trying to get the whole story. I shoot myself in the foot by using an increasingly judgmental and condescending tone. I get what I’m asking for – a frustrated and angry patient.
Giving up on her, I call the charge nurse on the floor where she was admitted. The nurse knows the patient well and tells me the patient signed out against medical advice four hours ago, “probably to go get high.” “She left with her IV in so she I’m sure she used it”, she adds. She goes on to tell me that the patient’s plan included discharge today to an inpatient rehab for heroin addiction. Exasperated, I explain how helpful this information would have been if the person that dropped her off had provided it. The nurse actually laughed and said, “We’ve had five days of her. Now it’s your turn”. I flip back at her, “Oh yeah, so typical! Everybody’s problem algorithm ends with the ER solving it”. I hang up the phone, not giving the nurse a chance to reply.
Turning to the patient I ask, “Did you go out and get high this morning? Maybe one last time before rehab?” She tersely gives me a “no” with a look that could kill. I push harder and say, “Did you really think they were going to take you back upstairs?” She replies, “Listen you racist f___, I went home to see my kids. It’s not your business but they’re not going to let me see them when I’m in [rehab]. They’ll probably be gone when I get out!”
Her statement hits me like a slap to the face. I feel instantly ashamed. She is wrong about the racism but I’ve opened the door to that thinking. She’s nailed me on my feelings of superiority and misplaced anger. I realize the things I’ve already objectively assessed show me a life that’s seen greater tribulation than I’ll ever know. Her past history is made up of events that I could not survive. I’ve only attempted to make life harder for her and, in this moment, I hate the nurse I am.
I take a breath and say, “I’m sorry”, then finish the triage process. I turn around to see Margaret, my day shift relief, waiting to take the reins. Of course, it’s Margaret — the nurse who’s a “goofy” Christian (unlike the closeted one that I am). She bypasses me and says to the patient, “Let’s get you back and get this sorted out for you. How old are your kids?” I see the patient’s hardness soften as Margaret under hooks the patient’s arm with hers. Margaret treats her like a dear friend instead of the junkie, troll, failure approach I chose. Margaret is compassionate, empathetic and kind; she’s living what she says. She is being Jesus.
I expect her to strike me down when she comes back but she doesn’t. Instead she says, “You look like you need to get out of here and get some rest”. She gives my shoulder a warm squeeze. I expected a lecture, a judgement or something worse. Instead, she’s given me the room to do this for myself. I’m not leaving my shift feeling good about the nurse I was today but I won’t be that same nurse coming back tonight.