A Transient Timetable of a Pediatric Emergency Room Night Shift
This article, written after Laura Piekarski shadowed the UNC Pediatric Emergency Room, shows how the pain of young patients can weigh on doctors and nurses.
CHAPEL HILL, N.C. — A lobby with a curved glass staircase welcomes visitors its glossy-white ceiling illuminated with pink and purple lights. A path to the right cuts through the Women’s Care section and ends with elevators in two parallel rows. The elevator arrives — one of six — and lowers to the ground floor. Arrows usher visitors in various directions in an attempt to prevent them from wandering, a mostly unsuccessful effort. Two rights, a left, and a final right reveal a sullen waiting room with uniform chairs similar to that of a dentist’s office.
Two visitors glance at their phones as a security guard dressed in black and yellow keeps watch. Beyond the guarded doors runs a hallway lined with rooms, dull paint coating the windowless walls. Nurses gowned in blue wheel computers along the tile floor. Dr. Linda Lowes backs out of Room Three and consults a screen, deciding who would need her attention next. The following documents her subsequent night shift.
An eight-year-old girl with leukemia — in maintenance of remission — waits in Room One. Esperanza Lopez and her family drove from Asheboro, North Carolina, to visit their second home. “We saw a golden sky!” the little girl tells Dr. Lowes, describing the hour-long drive. Her sister laughs shaking her head. She is not much older than Esperanza, yet she sits up straight and speaks with forced maturity.
Mrs. Lopez was concerned about Esperanza’s three-week-long fever. The mother knew she couldn’t try reducing her temperature; chemotherapy patients must exceed 100.5 degrees to warrant ibuprofen. Esperanza simply had to wait and get worse. A nurse enters, ready to administer medicine through Esperanza’s central line, mirroring the eight-year-old’s smile as she begins. She taps the needle and a few drops of clear liquid run down her hand. Used to being poked, Esperanza stays very still, though she can’t hold back laughter as the nurse sticks out her tongue in concentration. The little girl’s attitude is infectious.
In Room Nine, a 15-year-old girl, with a dead look in her eyes, lies down on a blue cot with the gurney’s side barriers pulled up to entrap her. She was brought in by her 18-year-old sister, who had found her lying unconscious on the bathroom floor. The teen had intentionally overdosed on 20 Motrin pills. A nurse lowers the barrier and helps the girl up attempting to corral her to the bathroom. The girl turns on her sole and walks back into the nurse instead. The Motrin has already taken effect settling into her bloodstream. Dr. Lowes whispers to another nurse, “Winter’s coming.” A little girl’s shrill laughter echoes through the hallway; it seems to be a world away.
A 12-year-old boy stares at his phone in Room Five, paying no attention to his bloody cheek and shoulder. A game flashing on the screen numbs the sting. His skin had been rubbed away when he skidded on the pavement in front of his house; he was hit by a car roughly an hour before, though he seems to be the last to realize it.
Dr. Lowes peeks back into Room Nine, then describes a similar patient to the older nurse sitting outside. A transgender teenager had been brought in after punching a classmate in the face. Dr. Lowes was informed that the teen was caught sitting on a bridge simply staring down and swinging his legs. “Four to six weeks into the school year and it all starts falling apart,” Dr. Lowes murmurs. The boy now resides in the psychiatric ward of the same hospital. The 15-year-old girl might join him soon.
A language barrier causes problems with the mother and sister of the 12-year-old boy hit by a car. While waiting for a Spanish-speaking translator, Dr. Lowes performs an ultrasound on the boy. “I’m going to put some jelly on your belly,” she says in a youthful voice making sure to keep him covered with the rough sheet as much as possible. His diffidence shows — body-consciousness peaks at this age — though not enough to stunt his fear. “I’m okay, right?” he asks, seeking reassurance exactly three times. Becoming more observant than scared, he watches the machine and takes deep breaths to reveal his kidney and later asks to see his heart. The ultrasound shows no fluids; nothing seems to be greatly damaged, besides a swollen lip. The mother who cannot understand this has tears welling up in her eyes frantically looking back and forth between the doctor and her son.
A four-year-old boy having difficulty breathing is rushed into the only free room and immediately surrounded by Dr. Lowes and six nurses. Clothes are taken off, a catheter is placed in his foot, and tubes of blood are filled. The boy has a long medical history: epilepsy, seizures, dystrophy, and cerebral palsy. A recent storm left his family’s home without power, and the boy’s oxygen machine couldn’t be charged. Now he gasps in pain with a warped expression on his face. His parents breathe at a comparatively slow rate. The mother holds the child still for the nurses while the father stands on the other side of the glass door arms crossed and cheeks dry. This has become routine.
A calm comes after the storm, and the nurses wait for the next surge. Maintenance becomes the priority as time moves forward. A janitor checks each room for leftover food containers and discarded latex gloves. Painted on one wall of the hallway a dog and child sit in a sandbox with a ball and bubble-blower in use respectively. A “Kids Only!” treehouse stands flat on the wall across the way. The paint — primarily muted oranges and blues — chips at the edges, and a closer look at the floor tiles reveals a complicated pattern. A hub of sorts sits precisely halfway between either end of the hall, and multiple computer screens display admitted patients. They list the children by illness and age assigning them temporary identities. By any other name, they would still be in pain.
In Room Two, a mother — a nurse herself — and a father desperately try to keep their eight-year-old son from bouncing off the walls. Embarrassment manifests on the parents’ faces as Dr. Lowes walks in. A cartoon plays at a low volume on the television hanging in the corner distracting the young boy. The next minute, he demands ice cream, though he struggles to decide between chocolate, vanilla, and strawberry. His father sheepishly tells Dr. Lowes that the boy’s favorite flavor recently changed to Neopolitan. Dr. Lowes tames him for a brief moment to check his vitals, handing him her rainbow stethoscope as a distraction. She ends the examination heading towards the refrigerator. The decision is made for him, chocolate.
The four-year-old boy remains in his mother’s arms the warped look still on his face. His chest rises and falls, assisted by a large, grey machine beside him — the elephant in the room.
Esperanza’s favorite nurse visits Room One. A sticker hangs between her fingers meant for the girl to put in a “special place.” At least the girl’s heart stays under 100.5.
The shift plateaus as time drags on, and the cases become more juvenile. Everything and everyone stabilizes. A soft, persistent ding echoes from a speaker in the center hub, and a blinking red light pleads for attention. Nobody seems to care all that much. Both stop shortly after — a problem meant for someone else.
A little girl no older than three brought in with impetigo, a skin infection identified by red sores on the face, sits on her mother’s lap in Room Eight. She wears bright red leggings and her hair tied up in three pigtails. Dr. Lowes notices similarities from her brother’s case; he came in just last week. A nurse peers around the doorframe to talk to the mother, which is enough to scare the girl into a fit of tears. The crying softens when the nurse closes the wooden door. Peace and quiet follow.
A stillness settles cooling the atmosphere. A hospital psychiatrist slips into Room Nine nearly unnoticed. The patient’s sister exits and invades the hub asking for a cup of water. The door closes before she can return providing complete privacy for the tricky conversation to come. The girl’s mother finally arrives, carrying a pizza box stained at the corners. She warns Dr. Lowes that she has to go to work and seems agitated rather than concerned. She ends up leaving ten minutes later.
Voices talk over each other as they weave through the grapevine. A nurse with a pink flower tattoo on her lower arm wipes away tears after checking on the four-year-old. Still, it doesn’t keep her from laughing at a joke. She cannot get attached. Above the flower is one word – believe. The nurse can be heard saying, “I don’t know what I’m believing in.”
Coming in late, an eight-year-old girl with a pink bow in her hair cries in Room Seven. The mother combs through her disheveled hair and blinks away sleep. The father — who has grey hair tied back in a low ponytail — looks to his wife and, without words, asks her to take the lead. Their daughter had hurt her leg jumping over a puddle a few hours ago; she slipped and fell into a split. Dr. Lowes holds the girl’s right hand while her mother holds the left supporting her as she walks heel-to-toe along the tile’s thin lines. She suddenly jumps into her father’s lap leaping off of her hurt leg. Dr. Lowes smiles. An x-ray had already been taken showing no signs of a fracture. How much longer can the girl stay up past her bedtime?
Final walkthroughs and discharges flow through the hallway. The eight-year-old’s father wheels his daughter towards the exit with her mother trailing behind to thank everyone she passes. The disappointed look on the girl’s face bespeaks her former intentions.
Another shift passes with no casualties — patients, stuffed animals or otherwise. The translucent backing that once held a sticker sits rejected on the floor. A blanket hangs from a chair in the hub — teal, Esperanza’s favorite color. The last of her vanilla ice cream melts in the waste bin. She would get more tomorrow.
The remaining night shift nurses slump down the hallway lifting their bags from the recently-mopped floor. They trade places with the overnight nurses, who are much more awake than their counterparts. Dr. Lowes remains in her chair swiveling back and forth slightly as she looks at the patient charts. After a quick glance back into Room Nine — the teen was still awake staring at the ceiling — and saying ‘goodnight’ to the overnight shift, she walks with heavy steps toward the door. Still weighed down with a constant flow of thoughts, she brings the baggage of another shift home with her.