Into the Night with a UNC-CH Emergency Department

CHAPEL HILL, N.C.—A rainy, brown, hazy, Thursday night. The sidewalks climb the hillside and lead to the entrance of the UNC-CH Emergency Department (ED). Double doors open revealing a security guard and a service desk employee. A set of doors and a short hallway transport visitor to the Emergency Department. Staff comprised of nurses, emergency medical technicians, interns, and management scour the area preparing for the night shift workers to take over. They quickly begin signing off on their computers and gathering their belongings, while the new rotation of people come in and prep for the night ahead. A wide, U-shaped desk, with a gap in the middle, divides the staff from the patients. This area serves as an office space for the majority of the staff, surrounded by rooms for patients. The design allows the staff to monitor patients from their desks and get to them efficiently. The area is divided into two main sections: one operated by team A and the other by Team B, each made up of about eight people.

7:00 PM

Chairs lined, shoulder to shoulder, huddled together in the corners of the work space creating a close quarter environment. Pink cardiographs pile on desks. Hospital beds line the walls.

Dr. Terry Robbins, the attending physician of Team B, walks in and heads to his area, greeting coworkers on the way. Dr. Robbins is responsible for supervising and guiding the team as well as overseeing his own patients. Working under the supervision of Dr. Robbins is Dr. Lawrence, an intern for UNC-Chapel Hill.

Dr. Robbins pulls out his dinner, Chinese takeout, and sits at his desk. He talks with Dr. Lawrence and some staff members as he eats. The atmosphere is light and happy as the night shift settles in.

7:13 PM

A woman rolls through the doors of the clinic on a hospital bed. Staff guide her into a room divided into three sections, promptly positioning her in the corner of the room and connecting her to the proper medical equipment. The woman appears to be cold. The nurse places a blanket over her. She tells Dr. Robbins that she is having heart issues and consistently feels freezing. As Dr. Robbins arranges for her to have more blankets, the woman quietly lays there, tucked into her hospital bed after just having survived a car crash.

As they talk, the nurses monitor her vital signs and prepare her for an IV to stabilize her. After Dr. Robbins ensures that she is settled in, he along with another staff member leave the room and designate Dr. Lawrence to oversee care of the patient.

Dr. Lawrence monitors her EKG (electrocardiogram) and checks what he calls the “ABCs” which stand for airway, breathing, and circulation. He notices an irregularity in her heart rhythm that prompts him to use an ultrasound scanning machine to look for anything alarming. He applies a special gel and then utilizes the ultrasound’s wand-like device to check for fluid in the lungs and bladder. He explains to the patient that her heart beats irregularly, due to the stress and shock of the crash and arranges for her to have extra blankets to make her feel more comfortable. He exits the room and heads back to his desk where he reviews patient incident history.

7:45 PM

Dr. Lawrence sees another patient, sitting upright in her room. She needs to be cleared so she can leave the clinic. After spending several hours in the hospital, the lady just wanted to go home. She expresses frustration and answers his questions with irritable and short responses, but Dr. Lawrence understands and knew how to handle the situation. He uses some humor when talking with her and gives her a compliment to make the process more enjoyable. He asks her questions about her back pain and the medications she has been using. After checking her back one final time, Dr. Lawrence clears her to go home.

7:56 PM

Another case pulls Dr. Lawrence into another room similar to the last. The television show Friends plays in the background.

The patient lays in critical condition. Bandages are wrapped around the lower part of her midsection while an eye patch covers her right eye. She has a trach on her neck that helps her to breathe. With every movement, she winces in pain as Dr. Lawrence attempts to ask her a series of questions about her medications to properly understand her situation, however the patient displayed the inability to speak. After a short moment, Dr. Lawrence pulls out a piece of paper and a pen and has her write down her responses. In addition to questions about the medication she takes, he also asks about her pain level. He pulls out a stethoscope and moves it to different locations on her chest and her back, listening for abnormalities in her breathing. He then uses an ultrasound device to evaluate the condition of her lungs and finds that one of her lungs lacks proper (pleura) membrane movement. This usually indicates that a patient has fluid in their lungs or a collapsed lung. Dr. Lawrence promptly sends the patient down a long hallway to the UNC hospital where she can receive further evaluation.

This is only the beginning of the night for Dr. Lawrence. He receives a call and is off again.

8:23 PM

The woman who was experiencing heart trauma begins losing blood count. Dr. Lawrence rushes in and adjusts the IV, stabilizing her. At the desk, Dr. Robbin’s frustration becomes apparent. Members of a different department did not review his patient’s medical history clearly and instead ran the standard procedure. This one error caused the patient to have an allergic reaction with the IV. Dr. Robbins had to start the procedure over to ensure the patient was receiving the proper treatment.

Meanwhile, Dr. Lawrence enters a room of solemn, worried faces focused on the man lying in the hospital bed lying on the hospital bed, their father. The atmosphere tensed as the intern arrives. He begins to inquire about the father’s health. Quickly, Dr. Lawrence realizes that his patient only speaks Spanish. This poses an issue for Dr. Lawrence who has difficulty communicating with this patient. Conveniently, one of the patient’s family members is bilingual and helps by acting as translators.

The patient experiences sharp pains in his head, pain in the back of his neck, chest pain, swollen legs, diabodies, liquid behind the eyes, and a loss of vision. Dr. Robbins comes in to check in on Dr. Lawrence’s progress and assists with the ultrasound scanning. Fortunately, Dr. Robbins is proficient in Spanish, improving the doctor’s efficiency.

9:21 PM

The patient with the bandage rolls back into the emergency medicine clinic. Dr. Lawrence performs a second ultrasound, this time looking at her heart and lungs. Dr. Lawrence heads back to his work space and goes through old files and reports. Shortly after he sits down, around 9:40 pm, a patient is rolled in from the ambulance. Then another about forty minutes later.

10:52 PM

A person with severe burns is pulled out of an ambulance. One second a tense excitement spreads amongst the hospital staff and then everyone springs into action. The patient moans under his oxygen mask. Excruciating pain written all over his body. His flesh shines pink on parts of his legs, feet, face, and torso. Burnt, shriveling skin hangs from his feet. Dr. Lawrence and several staff members urgently leave their desks to follow after him.

The staff surround the man and watch as a nurse tests his nerves. She taps on his foot and asks if he can feel her touching his foot. He moans. She asks again and he moans louder, unable to give a coherent response.

While work for most has long ended, the work in the ED is just beginning.