An Evening in the UNC Pediatric Emergency Department

CHAPEL HILL, North Carolina—Heavy rain plummets to the ground as winds from a heavy thunderstorm whip through the trees lining the dimly lit path surrounding Kenan Stadium eventually leading to UNC Hospital’s Emergency Department. When met with the door adorned with the bright red EMERGENCY sign, there is a sudden sense of eeriness. The waiting area is crowded with desperate families and patients full of hope that the doctors and nurses here can help them. The tired and irritable employees working the information desk point to a phone on the wall that will open the doors to the pediatric emergency department. Equal parts excitement and dread are felt while crossing the threshold to the battleground that awaits.

3:00 P.M.

Dr. Rita Getz walks into the nurse’s station drenched from the rain. Nurses and other staff members crowd around her, giving her all the information they can about the current patients before they are forced to clock out. Many do not want to leave their patients with others and are forced to drag themselves away knowing many of their patients’ situations are fragile.

Each patient is assigned a number 1-5 (1 being the most life-threatening, 5 being the least severe). Dr. Getz looks over the current patients and picks the most severe cases in need of her immediate attention. She stands up from her desk, walks to the wall, pumps hand sanitizer into her palm, and enters the psychiatric ward.

3:30 P.M.

Dr. Getz enters the room of a teenage patient who has had a history of suicidal thoughts and attempted to take her own life. After telling her mother she would kill herself if her boyfriend couldn’t come over, the patient found herself in a hospital bed being treated by Dr. Getz. During the quick examination, Dr. Getz finds a girl who has been desperately seeking help. Scars from previous cutting with a razor mar her legs. Old and new marks adorn her legs, indicating that the patient has been struggling with self-harm longer than previously thought. While reviewing the patient’s blood work, routinely taken from every patient upon arrival, Dr. Getz finds something.

The patient is pregnant. After several attempts by multiple nurses to get to her to be honest about her sexual history, she comes clean and admits that her boyfriend spent the night a few weeks ago. As a minor, physicians are required to disclose this information to a legal parent or guardian. The mother is beside herself but eventually makes the decision to focus on her daughter’s psychological health before deciding how to go about handling the pregnancy situation. Dr. Getz let them talk things over as she moves on to the next case.

4:30 P.M.

The next patient seen by Dr. Getz is a 6-month-old child that had been taken to the emergency department after his parents thought he swallowed an object of some sort. X-rays taken before Dr. Getz’s arrival present a clear picture of the foreign body—a nail. The concern amongst many at the nurse’s station is that the nail may be too big to pass safely through the intestines of the child and be dispelled naturally. Dr. Getz suggests than in an hour or so that they should retake the x-rays to see what path the nail will most likely take and if the surgical team will need to take action. Another concern voiced by Dr. Getz is how the patient got ahold of the nail in the first place. If the patient was not crawling at the time of the incident, there may be reason to believe that he was in an unsupervised environment during the time he swallowed the nail. Dr. Getz makes the difficult decision to speak the parents of the child after the new x-rays are taken and determine if Child Protective Services needs to get involved.

5:00 P.M.

Dr. Getz’s next stop is to the room of another teenager, this time suffering from an ingrown toenail. The toe in question looks extremely swollen and discolored and according to Dr. Getz, the best course of treatment may be cutting the toenail off altogether and then irrigating the infected area with a disinfectant. While the situation and its solution are relatively uncomplicated, all of this information is being communicated to the father of the patient through a translator as he does not speak English well. The translator offers comfort when speaking to the patient’s father and also voices concerns he has about his son’s toe to Dr. Getz. After they receive approval from the patient and his father, a resident comes into the room with a cart full of all the equipment needed for the procedure, assures the patient he will be going home soon, and starts the process of removing the ingrown toenail. Dr. Getz continues making the rounds.

5:30 P.M.

As Dr. Getz is updating and entering information into her computer, she receives a phone call. The call is quick and to the point. There is a teenager who identifies as transgender on route to the hospital and Dr. Getz is needed. They tell her the teenager was sitting on an overpass with their legs dangling off the edge, threatening to jump. After they were wrestled to safety, they were put on an ambulance and would arrive in 15 minutes. One of the nurses under Dr. Getz makes the call to the psychiatric department of the hospital to see if any empty beds are available for the student. After a quick confirmation, the incoming patient is redirected to the psychiatric department.

After the tense situation, Dr. Getz states that the pediatric emergency department is entering their “psych season” during which they see a definite increase in the number of pediatric patients admitted with psychological issues. While no one knows for sure what causes the spike, everyone working agrees that the psychiatric department is getting busier and busier with every passing year. One of the nurses says that the average wait time for a room in the psychiatric unit is now over 72 hours—meaning that someone needing to bring their child into the hospital could wait more than three days to see an actual doctor or even longer to receive a solution to their problem.

5:45 P.M.

Fifteen minutes later and the emergency department is in a flurry when a teenager is brought in with several cuts and bruises after being hit by a car. After being wheeled into a large room, blindingly bright from the fluorescent lights, the examination begins. The conscious patient is scared and flustered but communicates with all of the medical personnel and informs them that a car going about 10 miles per hour struck him in the parking lot. His severely scraped face and his apparent shivering are the only signs of damage upon the initial onceover performed by staff. As the extent of his injuries are not yet known, all hands are on deck as the tests continue.

The patient’s mother and sister rush into the room a few minutes after he has been admitted. Both of their eyes are wide with shock and are visibly trembling as they do not fully understand what is going on and do not speak English well. The translator on duty is present, speaking in Spanish to the mother and sister, informing them of what has happened and what tests will need to be performed in order to figure out what treatment the patient will need to receive. The mother nods and then rushes to comfort her son while his sister stands stoically in the corner, unsure of what to do.

6:00 P.M.

Two girls enter the emergency department. One barley holding herself up as her friend tries to support her. The girl holding the other tells the nurses that her friend took a handful of unknown pills in an attempt to kill herself. The patient is asked to change into a hospital gown and is then taken to an unoccupied examination room. Before going to take her vitals, the nurse asks the friend of the patient what events sparked this action. The friend tells her the patient has been bullied at school for the past several weeks and has been attempting to cope by cutting and, when that did not suffice, she decided to try and end her life.

Upon entering the examination room, the nurse begins the interrogation. “What is your name?” “Why do you think you are in the hospital right now?” “What caused you to feel the need to take all those pills?” All of these inquiries are met with very abnormal answers. The incoherent and unstable patient tries her best to answer the questions, but continuously loses her train of thought and switches topics completely. After listening to her rambling for a while, the nurse proceeds to take the patient’s vitals and collects blood samples that will be sent to the lab in order to discover what types of pills the patient ingested. While the nurse collects the patient’s blood, she discovers the fresh, angry looking cuts on the patient’s arm that had been discussed earlier with the friend that brought her in. The nurse maneuvers around the wounds as effectively as possible and then leaves to make room to allow other medical personnel inside that also need to run tests. She sends the samples off to the hospital’s lab and works on the patient’s paperwork until the blood test results come back.

6:50 P.M.

Nearing the end of the evening, there is a rush to enter patient information and updates into the computer system in an effort to organize things before the chaos of the night shift. A tiredness hangs in the air as those ending their shift begin to pack up their things. Yet, is also a newfound energy that spreads as the staff for the next shift arrive. The night staff are debriefed on the current status of patients and Dr. Getz is welcoming those arriving as she makes calls to other areas of the hospital. There is a lull in the steady pace that patients have been arriving, as if the universe knows to wait for the change in staff. The switch between new and tired members is like that of a well-oiled machine, both quick and professional. A chorus of goodbyes fills the air as those being relieved of their duties head to the exit. As the doors close, a new 12-hour-long adventure begins for those who have just arrived.

7:00 P.M.

Exiting the hospital, the wind is still howling and whipping angrily through the trees while the rain pelts the ground. The pitch-black sky makes the world feel eerie and lonely. It is strange to see the abundance of artificial light given off by the street lamps as the passage of time goes unnoticed in a place with no windows and activity that never sleeps even when we do. A heaviness dwells in the air that is felt all the way down to the bones. The trek back to south campus is a slow one as there is now ample time to process all that has been seen and heard in the last four hours. From an ingrown toenail, to a swallowed nail, to an attempted suicide—these scenarios do not often come to mind when thinking of a pediatric emergency department and yet, these are the realities.