Trauma, Drugs, and Pain: Four Hours Shadowing at the UNC Emergency Department

Chapel Hill, N.C. — A well-renowned hospital sits in the southern part of a college campus, a few streets away from downtown. The University of North Carolina Emergency Department serves as a learning center for many recent graduates. Sauntering students, a complicated bus system, and plenty of parking surround the buildings. The Emergency Department rests on the east wing of the hospital. A short road paves the way for transportation of ill or injured patients to the entrance, located just below a sign displaying, “EMERGENCY.”

The radiant weather contrasts with the atmosphere awaiting behind the automatic doors. Security guards inside the entrance supervise over a metal detector, positioned adjacent to ready-to-use wheelchairs. Behind the metal detectors stands another set of doors, opening into a labyrinth of long hallways. Workers ensconce behind desks, guiding those who pass through the doors—visitors, patients, students—to their desired destination. Doctors, beds, bright lights, and complicated machinery crowd the hallways leading to the emergency department. Within the department, 75 rooms conceal bloody, groaning, confused, or sleeping patients, all sharing a simple desire to return home.

3:00 P.M.

The first hour commenced with a change in shifts. Exhausted doctors who worked from 7:00 A.M. to 3:00 P.M. stood around new physicians who anticipated the beginning of their shift, assembling a cluster of medical personnel. The compact huddle contained conversations regarding a number of patients in the partially-filled emergency department. The newly arriving doctors acquired information pertaining to symptoms, backgrounds, and possible diagnoses of patients.

Meanwhile, a constant, loud beeping emanating from an unknown source filled the room, but the conferring doctors appeared accustomed to the noise. They stood in an assortment of colorful scrubs. Younger doctors attired in blue and green suggested resolutions to various problems, and the more experienced doctor wearing black nodded his head in either agreement or disdain. The conversing doctors scribbled notes onto tiny notepads kept in their scrubs.

Computers on each doctor’s desk revealed the ailments, ages, and names of patients within the department, ranking each patient on priority. Urgent, life threatening issues appeared on top, while miniscule, smaller problems took the bottom of the rankings. Some doctors disappeared behind curtains, typically writing notes as they made their way out.

3:45 P.M.

After the conversation ceased, a doctor hurried through the department, weaving his way past machines and rooms. The first patient of his shift ranked very low on the computers. The older, large man complained of stomach pain and watched an episode of Cops on a flat-screen television while the doctor evaluated him. His wife messed around on her iPhone as she rested in a chair by her husband’s bedside. Pressing on different parts of the man’s stomach, the doctor asked him questions regarding his medical history, current medications, and potential alcohol or drug usage. Narrowing the pain down to a case of indigestion or acid reflux, the doctor suggested some medicine and moved on to other cases.

The doctor routinely explained to patients the purpose of an emergency department—to determine which patients require admittance to the hospital. Either a patient receives treatment for a mild injury or illness and returns home, or they require admittance to the hospital for more intense and long-term medical care.

Many patients in the department possessed similar complaints: stomach pain, abdominal pain, or back pain. The doctor’s assistant, who furiously typed notes on a rolling computer during each in-depth examination, explained that these moderate cases are often taken lightly when the patient is clearly not in extreme pain. The pain frequently serves as an excuse for people to obtain opioids. The opioid crisis—people obtaining pain medicine for recreational use—remains a serious issue.

One patient with particularly suspicious pain sat up on the side of his bed complaining of stomach pain while chugging an almost-empty Mountain Dew and staring at Netflix on his laptop. The man ensured the doctor be aware of how much blood he vomited into the blue trashcan next to his bed, pointing out the mixture of blood and mucous upon the doctor’s immediate entrance into the small room.

Other cases of reported pain contained much more severity. One man, who jokingly ensured this report contain no “fake news,” writhed in pain as the doctor ordered a lumbar puncture, or spinal tap, to discover the cause of his stomach pain, seizures, and weakness. The spinal tap consisted of a long needle inserted into the patient’s spine. The needle descended between two vertebrates, while the man uncomfortably whimpered in fetal position. Fluid slowly exited the spinal cord into the sample, while the doctor murmured words of comfort and reassurance. Along with a spinal tap, the doctor ordered the feeble man to receive immediate medication to treat meningitis, although tests had not yet confirmed the illness. The doctor commented that an untreated case of meningitis can end a life in just four short hours.

4:40 P.M.

Things remained calm in the emergency room, most likely due to the hour. People during this time make their journey home from work, school, or other daily activities. The bright lights of the department allowed a clear view of the many pieces of equipment scattered around. One drawer contained an assortment of wound-cleaning necessities: alcohol wipes, bandages, threads, hydrogen peroxide, and syringes. Other, larger pieces of equipment stood near the three trauma rooms: defibrillators, tubes, and other opaquely-named machines. The trauma rooms remained empty, perfectly clean and organized, in case of a sudden turn of events.

With no seriously-ill patients to tend to, each doctor sat around, typing away at their computers, occasionally asking another worker about his or her week. Frequently, doctors retreated into a room half-full of medical supplies—syringes, peroxides, braces—and half-full of kitchen appliances—a coffee maker, microwave, and fridge. When a doctor received an inquiry regarding the source of the constant beeping, his reply was, “who knows?”

5:30 P.M.

Activities in the department quickly sped up. All of a sudden, one of the three trauma rooms filled with about eight doctors, now wearing lime green, full-body scrubs and protective masks. The room did not appear as spacious as before, since it was now crowded with workers. The mood became serious, as doctors discussed the older man on his way to the trauma room via ambulance. The man broke several ribs and suffered a fractured arm after a nasty fall. The numerous medical staffs that filled the room prepared equipment and opened notebooks. A man stood to the side with his rolling computer ready, waiting to record information about procedures.

Not even five minutes later, paramedics rushed the patient in on a gurney. Doctors began shouting medical terms and communicating while hovering over the patient. The main doctor stood at the head of the small bed, requesting various supplies from the other medics. After thoroughly analyzing the patient’s dire state, doctors deemed emergency surgery necessary, and six personnel wheeled him into a different, distant section of the hospital. Just like that, the department calmed again. Doctors continued earlier conversations and nonchalantly threw away the now-contaminated scissors, gloves, and wipes.

6:00 P.M.

The department, now much busier than at the beginning of the shift, filled up with more hospital personnel. Colorful scrubs blurred together as doctors rushed to their various patients. Each doctor wore different shoes—loafers, athletic shoes, boots—as they scurried through the space. Even the half-coffee, half-supply room filled up. Personnel entered the small room frequently as they rushed to retrieve tools they needed for procedures. One doctor snatched a syringe, gauze, scissors, and stitches before disappearing behind the curtains of an older man’s room. The man, seriously injured after a fall, maintained a bright spirit while the doctor slid the syringe into his face, just below the main laceration located between his swollen eyes. The man forced his blackened eyes shut as the doctor meticulously dragged a tiny string through the cut to seal the bloody wound. Sitting in a large chair by the corner, the man’s wife grimaced as her husband received countless dissolvable stitches in his face. Occasionally, the doctor used a glove-covered hand to wipe blood out of the man’s eyes. The focused doctor vowed to protect the man’s vintage yellow shirt from being bloodied, but ended up breaking his vows as the bleeding became heavier than expected. Finishing up and covering the newly-sealed laceration with gauze and bandages, the doctor removed his blood-stained gloves, throwing them in a nearby trashcan, along with bloody wipes. He gathered his tools and disappeared back out of the curtain to venture on to the next awaiting patient.

6:30 P.M.

Paramedics rushed three patients into the trauma rooms, all within ten minutes of each other. Crowdedness reached its peak, as every trauma room contained an extremely ill or injured person. One contained an older woman who flatlined several times. The screaming heart monitor panicked each time, blaring signals that indicated the woman needed saving. The defibrillator moved from its earlier spot in the corner and now rested next to the woman’s bed. A doctor furiously attempted CPR, then quickly decided to use the machine. The doctors raised their hands up and yelled, “clear,” followed by a click of the defibrillator. Instead of producing a loud shock of electricity as portrayed in movies, the defibrillator acted silently during the process of reviving the patient. The woman’s pulse restarted each time, and they closely monitored her vitals between uses. The outward appearance of doctors remained calm and focused, not wasting a second to display emotion. The man on the rolling computer intently observed the process, discussing the fact that, in his few months working at the department, he had not experienced this situation before.

Meanwhile, a seemingly unconscious girl laid nearby. Her limbs sprawled in disarray upon stiff hospital sheets, severely injured from a car accident. Her friends waited outside the thin curtains in wheelchairs, wearing neck braces. Since her vitals displayed stabilization, only one doctor stood in the room, tending to her. The man asked questions to the girl, attempting to provoke a response as blood dripped through the bandage covering her forehead. However, the girl laid limply in the harsh light, not moving a muscle

In the third trauma room, a middle-aged woman struggled while trying to survive an allergic reaction that restricted her airways. Doctors surrounded her, many of whom attempted to calm her while they inserted a breathing tube for assistance. Medical students observed the painful-looking routine. Paramedics briefly appeared in each room to explain the situation, before leaving the department to continue their job as emergency responders.

7:00 P.M.

The four-hour shift ended while the three trauma patients remained in critical care. The rapid beeping of the first woman’s monitor remained audible all the way out the front doors. The winding hallways eventually led to the calm, unknowing world outside. Near the exit, one woman sat in her bed, listening to headphones, happily moving to the beat of the music.