four hundred twenty three

 Emergency Room Triage

Triage is the clinical process of sorting patients based on their medical urgency to maximize survival rates and use limited resources efficiently.

Sorting through the spectrum of illnesses and injuries is a tough job. Day after day, night after night there can be extremely sick children, seriously injured athletes, critical auto accidents, heart attacks, strokes, bleeding wounds, life threatening allergic reactions and so on. On the other hand there are people using the ER as their family doctor, hypochondriacs, drug seekers, the homeless mentally ill and so on. 

The stress level is high and patience is low. People in pain, uncertainty, fear but mostly boredom. Our average trip to the ER has been five hours. This is a small hospital that is the only trauma hospital in central Oregon. Helicopter Life Flights fly directly over our house day and night and usually get front of the line treatment priority, but if you seem stable you can be waiting a very long time.

The usual first come first serve rules do not apply in an ER. This seems to be beyond some peoples' sense of reason. A sprained wrist vs a heart attack, seasonal flu vs a severed hand is different than a place in line at the bank or grocery store check out. Some people understand and just grin and bear it but some get angry and loud and a few lash out. 

The chaos becomes second nature to the staff and at times, their patience wears thin but being bored one minute and overwhelmed the next never seeing a normal shift takes a toll over time. An impatient question or rude response rarely happens but when it does it is well earned in my opinion.

I've spent many hours in the Bend ER over the years and find it is an excellent people watching spot. The drug seekers are the most fun to watch because as soon as a nurse or doctor passes by they flop faster then a professional soccer player. The cringed look on their face and posture of chronic pain is entertaining. 

Entitled Kens and Karens march to the desk each time they take a patient that arrived after them sighting unfairness and giving their best suffering face, if you have children you know that face.

The couple that is still drunk and fighting as they wait for stitches. I've actually seen couples like this pass a brown bagged bottle. The worried mother holding her new born or her very healthy all boy with a broken tooth waiting for an x-ray and a few stitches. 

Every face tells a story and you grow an opinion of every nurse, doctor and cleaning staff as the walk by and ignore or smile. 

I believe an ER is in an alternate universe or dimension. All sense of time is distorted one side never having enough time while the other is experiencing a complete time stand still. 

I've been on both ends of the spectrum, the dehydrated stubborn athlete who never drinks enough water to the guy a severed artery with the risk of bleeding out. Both times I got the "why are they taking you before me?" look.

Mostly I'm the guy who just sits and watches people. I'm already sick or injured I'll get in when I get in. I make the staff laugh and thank even the cleaning crew, my visit doesn't go faster or slower. 

I want to thank the ER staff in Bend or anywhere they work. I understand they can grow numb to the things they witness but I do think they all have a great sense of dark humor. 

I pity that poor soul who uses that story "I accidentally fell on a cucumber in the garden" or whatever they can't retrieve from their rectum. I hope the staff gets a private laugh but I think he will be sitting on that hard plastic chair for a very long time.