The Painful Realities of Four Hours Spent in the UNC-CH Emergency Department
Ariana Luterman writes about the daily routine of people working in UNC Chapel Hill’s emergency department, focusing on how they are able to find normalcy in inherently painful work.
CHAPEL HILL, N.C. – On a crisp evening in the UNC Medical Center Emergency Department, the lead physician makes casual conversation with two attending nurses. The fragrance of cleaner fills the air with the strong scent of lavender. Amongst the calm in the clinical space, nurses pass by as colorful wisps scurrying with purpose to assist recently admitted patients.
The waiting room is another world. Rows of chairs are filled with anxiety, uncertainty, need, and impatience. The walls appear darker and the air seems more pungent. A total of 93 soon-to-be-admitted patients ranging in age from 22 to 84 years old, along with their loved ones, await their turn to be seen.
Sam, one of the head nurses, organizes patients according to need. To him, this is just another day at the office. The soothing beeps of heart rate monitors are synchronized, and the subtle buzz of the air conditioning unit echoes off pristine, white walls. And so begins the drama of a four-hour stretch.
Dr. Lukas Hamill, the lead physician for the evening, approaches radiating confidence and knowledge. His statuesque profile is anchored by his only visible medical device – a shiny brushed nickel stethoscope displayed as a predominant superhero “S”.
The first patient of the night is a 32-year-old male who appears to be in excellent physical health despite complaining of back pain. As Dr. Hamill examines the patient’s vitals, he begins a targeted line of questions aimed at discerning the causality of the injury. The patient claims to have done yard work several days prior, but the source of the pain and precise location is unknown.
While wrestling in college, he broke several ribs, tore his ACL, and competed in nationals two weeks later with these ailments, yet he describes his current back pain as being worse. His day originated in an uneventful manner, yet around breakfast time, he began experiencing pain. He says, “What scared me the most was that my arms went numb.” Dr. Hamill orders an MRI.
Two nurses walk by. One asks the other if she prefers mayo on her sub sandwich. The other nurse responds with a subtle nod of her head.
A 23-year-old female is next in the doctor’s queue. Gina, one of the nurses on staff, briefs Dr. Hamill: “This female patient is being admitted for a seizure. Her previous medical records include multiple prior psychiatric events; she attempted suicide at the age of 16, has a history of alcoholism in her family, and has struggled with a personal history of Xanax abuse.” The doctor approaches the patient. “It’s my fault, obviously,” the patient says. Each time she has attempted to quit Xanax nearly four to five days will pass, and like clockwork, the onset of another seizure consumes her. This is the third time she has experienced this cycle, and this particular instance almost killed her.
As Dr. Hamill exits the room, he begins to fidget with his stethoscope and consults his nurse, Gina. He is at a crossroad. Should he admit the patient to the hospital or the psychiatric Emergency Room? “Money doesn’t grow on trees,” he says. “Why would I make her pay five grand to simply continue her addiction?”
He steps back into the room and in a fatherly tone says, “With a lot of structure and a lot of help, you can beat this addiction.” He suggests she apply for a spot at a local rehabilitation center. Gina begins outlining the details of an application in a soothing voice. As the doctor walks away from her room, his once stoic face is full of honest concern for the woman.
Gina and the nurses throw away their Subway sandwich bags as they prepare to head home for the evening. Meanwhile, Brenda, Emily, and Audrey, looking refreshed and full of energy to begin their duties, enter the building holding empty Starbucks’ coffee cups. The graveyard shift has arrived.
Room 24B. A woman, approximately 43 years old, received a tooth procedure one week ago. The entire right portion of her face is swollen. When asked to rate her pain on a scale of one to ten, she holds up the number eight. Dr. Hamill assures her that he will be back shortly with pain medication and antibiotics. Upon leaving her room, the doctor glances at the number of patients in the holding area awaiting treatment. Emily approaches, suggesting he promptly visit the next patient, who she deems a higher priority, rather than locating the medication for the woman. Acutely aware of all patient needs, he turns and says, “Do what you say you’re gonna do, always.” He searches for the correct medications and delivers them to the patient.
Allen Tommels was admitted to the Emergency Room after passing out on a bus. He had a dangerously low blood sugar level—around 45 mg/dL. Although he is hyperglycemic, Mr. Tommels admits that he often forgets to eat yet continues to pump insulin.
Dr. Hamill, reaching for his stethoscope, speaks in a hushed tone while he evaluates the patient’s vitals. Mr. Tommels is confused and has a fearful look on his face. He asks where he is and curls up in a ball as an apparent form of protection. The doctor assures him that he is safe and everything is alright. Nurse Emily brings the patient some orange juice in a clear cup, a banana, and a bag of animal cookies.
Nearly ten minutes later, Mr. Tommels is wide awake and is discussing his favorite foods. “Boy do I love me some green beans!” he exclaims. The doctor discusses several on-the-go options for Mr. Tommels what to pack in a lunch box and steps he should take to ensure this does not happen again. Additionally, a timer is set on Mr. Tommels’ phone as a reminder for when to eat throughout the day.
I ask the doctor, “How are physicians working in Emergency Rooms able to compartmentalize their experiences at work?” Dr. Hamill says, “You get used to it and appreciate your own life more. You always try to do the best job you can so you can sleep at night.”
A homeless man, age 68, with multiple facial lacerations near his left eye appears inebriated. Shaking, he is unable to remember his name or age. Dr. Hamill speaks with a warm tone and slow annunciation while reaching for his stethoscope. The man struggles to answer any of the doctor’s questions: “Everything is fuzzy. I just can’t remember. I just can’t.” He rocks back and forth, slowly at first, but the pace intensifies with his frustration. He is now shaking with blood from the gashes dripping down his face. He aggressively grunts as the intense movement pulls the flesh apart near his eye. The blood begins to smear across his nose and along his cheek masking the source of the wound. He curls up in a ball with his eyes closed praying in a soft, slurred manner that the pain will end soon.
“Trauma patient! Estimated Time of Arrival is approximately six minutes. You all know what to do,” exclaims Dr. Hamill. The doors of the ER blast open as two paramedics wheel an injured man into the Emergency Room. Working as a unit, Emily and Audrey assist in transferring the patient onto a hospital bed. Simultaneously, the third paramedic addresses the team: “A 28-year-old man was on a motorcycle traveling approximately 70 miles per hour when a car aggressively cut him off…”
Dr. Hamill checks his airway, breathing, and circulation using his handy stethoscope. Clear. No loss of consciousness. The patient appears to be alert. Dr. Hamill says, “He has a three-centimeter abrasion to the right of the forehead, his trachea is midline, and a paralyzed upper lower extremity. Let’s roll.” The team jumps into action.
The ambulance’s lights outside of the facility fade into the background as the EMS professionals drive towards their next emergency.
Drama ensues the moment the next patient arrives in the ER. He kicks violently and screams vulgarities at anyone who will listen. Once on the hospital bed, all four of his limbs begin flailing uncontrollably as he is forcibly tied down. Emily explains that the man had been heavily intoxicated at a party and threatened to hurt himself. With a small sigh of relief, the man is rolled out of eye sight.
Ten minutes later, the man’s hospital bed rolls by, except the man lying on the bed appears to be in a drowsy state. One of the nurse’s reports that the use of a taser by security was necessary to subdue the patient.
19 patients remain in the doctor’s queue. As Dr. Hamill walks towards his next patient grasping his stethoscope with confidence, he describes the Emergency Room as “controlled chaos.”
A woman, approximately 84 years old, consumed nearly double her prescribed dose of Ambien. Her daughter and husband rushed her to the Emergency Room after she exhibited symptoms of slurred speech and the inability to sit upright. She currently only has 47% lung function. Her typical two-liter oxygen intake has been increased by her daughter to six liters.
The doctor instructs Emily to give the patient an X-ray, observe her for the next few hours until the Ambien has worn off, and release her later in the evening.
The daughter insists they stay overnight to ensure her safety, but the woman has a hair appointment at 9 A.M. the next morning that she refuses to miss. Dr. Hamill chuckles to himself.
“I can only imagine what the fridge must look like!” Emily jokes. After fighting with his girlfriend, who allegedly mocked his stuttering and southern accent, the next patient reportedly punched his refrigerator. “She knows I’m self-conscious about my speech impediments,” the man says. His wrist suffered a small fracture with massive swelling. Dr. Hamill assures him that a nurse will come over shortly to splint his hand.
The same 68-year-old homeless man with multiple facial lacerations who was seen at 11:15 P.M. is now ready to be stitched up. Fast asleep with dried blood coating the left side of his face, two lesions protrude both above and below his left eye. His hands are caked with blood while his clothes and bed covering are crumpled in a heap. Without waking the patient, Dr. Hamill gently cleans his face. He then injects the man with lidocaine (numbing medication), and proceeds to slightly pinch the skin with his two fingers. The pinching wakes the patient. As the wounds begin bleeding, he becomes more alert and starts tearing up. His jaw clenches. Dr. Hamill prepares the sutures and carefully threads them through the wounds with precision. The stench of flesh and blood fills the air. The man begins gagging and shaking. Emily helps to restrain him while Dr. Hamill completes the last loop and tie off. “You’re all done,” the doctor says to the patient. With a thankful shrug, the man rolls on his side and slowly closes his eyes.
Audrey checks her Match.com profile. She tells Emily that she just received a virtual wink from a “cutie.” The Emergency Room is not the only place brimming with activity this Saturday evening.