A few nights ago I was working in Fast Track, where the walking wounded go. It was insanely busy. Volumes were high, many of the patients were unexpectedly complex, and since the rest of the department was stuffed with then more acute ill (as usual), admitted patients began to fill Fast Track beds. In Fast Track, this has two consequences. First, there is physically fewer places to see people, and second, one of the Fast Track nurses is essentially seconded to assume care of these patients. The effect is to significantly disrupt patient flow. Delays, as they say, were significant, though we were working furiously hard to get patients in and out of the department.
After about five hours of wading though patients, I was flushing an IV line just outside from the Fast Track waiting room when I heard part of a conversation within.
“. . .I have never seen such slow and stupid staff as here,” a woman was saying. Someone else said something inaudible, and there was general laughter.
Nurses in the ED are generally very conscious of the public overhearing conversations, especially if the subject is sensitive or confidential. The walls have ears. On the other hand, patients don’t generally realize there is no sound bubble that prevents their conversations from being overheard elsewhere in the department. And I get that patients are in pain, are frustrated, are angry. But to say this woman’s comment was bone-breakingly demoralizing would be an understatement.
I wanted to take this woman around the department, to show her the challenges of running an Emergency Department when it’s full of admitted patients.
I wanted to give her the private Blackberry number of the hospital CEO so she could complain to him, directly.
I wanted to explain to her that I had been nearly continuously on my feet for those five hours, without a break, and my only sustenance had been two stale chocolate-glazed Timbits from God-knows-when.
I wanted to toss in my stethoscope and leave.
I wanted to tell her to shut the fuck up.
I didn’t do any of these. Instead I went to start the IV: a chronic anaemia patient who needed a top-up of a couple of units of packed red cells. Not complicated, but time-consuming. She would be taking a geri-chair for four or five hours, and when the transfusion was running, she would need frequent nursing assessment and documentation. She was sweet, patient and even grateful and marvelled I had the time to find a warm blanket and a tuna sandwich for her. There wasn’t any Hallmark moment in this, if you’re wondering. There was no object lesson, no redemption, no new courage to carry on, et cetera. She brightened my sour mood, but only a little. Being human, the comment lingered like a bad odour — C. diff, maybe — for the rest of my shift.
I mentioned the comment to my colleague of the day. He thought about it for a minute. “Maybe,” he said, “we should fulfil public expectations.” We didn’t, of course. But the thought was enough to bring the merest smile to my lips.
