There are ER nurses, and there are nurses who work in the ER. 

Becoming an ER nurse usually happens over weeks and months of hard work and focused learning of skills that mean the difference between life and death. Sometimes, it happens in an instant. This is a story from 1994, my first year in the ER.

I worked for six years on an ambulance as an EMT, and for a year as a nurse in the ICU, before getting a job in the ER that felt like coming home. I was in my element, but still needed to become an ER nurse—pay my dues—have a night when the 90% boredom and 10% sheer terror didn’t make me want to throw up, or quit.

Our ER was small, rural, and 30 miles from any other hospital, so we got it all and sorted out who to transfer somewhere else after the bleeding stopped or the heart started. Night shift was my choice, for the people, both staff and patients, and most of the time it was a good bet. 

At 1:00 am, we got a "head's up" notice from the medics that they were responding to a multi-vehicle accident about twenty minutes north of us. Then another medic called, said they were headed to the same accident. Then another, and another, called to warn us. The entire county's complement of field personnel were responding to an accident and we would get the most and the worst of it.

At 1:00 am, there were three of us on duty; myself, the Charge RN who happened to be my medic partner from my days of working ambulance, and the ER doc. The likelihood of the patients quickly outnumbering us was high, so we called the Nursing Supervisor for her help and asked if she could spare any one else.

At 1:00 am, we got out trays to open chests and re-inflate lungs.

At 1:00 am, we got dressed in our yellow gowns that were an ineffective barrier for the pain and suffering, but kept the blood from our clothes for the most part.

At 1:00 am, we were ready. My stomach fluttered with the excitement/terror of big trauma. In a twisted way, it was fun to take a situation that most people on the planet would run from and make sense of it, put the pieces back where they belonged, or be present and brave when you couldn’t.

The radio opened up to the sounds of voices with the pitch and the edge of panic, trying to convey data and situation to us while reassuring the patient or themselves that time would move quickly and help would make things better. My spine stiffened at the words and the picture that formed in my head. Medics never sound panicked.

The first two patients coming in were in the same car, both with massive lower extremity trauma. When the medic says the right foot was pointing backwards and he realigned it, but it’s still blue—you don’t need medical training to know that’s a bad thing. Charge RN said he’d take the first two and both he and Doc met them in the bay to do a quick look before assigning them a bed. Our three trauma rooms would need to be reserved for the worst of them. 

When a trauma patient comes in, there is so much to do that time can seem to slow down and you certainly lose any realization of other things going on around you. At the big hospitals, there is usually a whole team of four to eight people for the first hour but here in our tiny ER, we just had to do it or it didn’t get done. Some things didn’t get done. 

Charge RN and Doc started the process with the first two patients who were assigned to Trauma 5 and 6. Surely, they must be the most seriously injured. I asked the medic after the handoff if these were indeed the worst and he said bluntly, “Nope.”

I must have gotten a weird look on my face and he explained that there were three trapped in another car and these two were easy to extricate from theirs, so they left with them. Ah, something my field-brain understood exactly.

“How many are there total?” I asked.

“Thirteen.”

I had a punishing rush of fear in my gut and my chest. I was doing everything I could not to run out the door and keep going. When I worked in the field, a lead foot was the solution to being in a nightmare situation—take the patient to someone else. I was the someone else now.

I stared down at my shoes, took a breath, and looked up to see the medic walking away, unconcerned with my feelings about being in the worst night of my life.

Great, I thought. Look up sympathy in the dictionary. You’ll find it between shit and syphilis.

I peeked in the Trauma Rooms and found that they had help from a MedSurge nurse and our Supervisor too, so all was well, so far.

Then my disaster showed up. I had a critical patient, by myself, in Trauma 7. Lucky for me, the Surgeon on call, who I loved and trusted because she’d operated on me (my appendix) and because she was awesome, strode into the room as the medics were transferring the patient to the ER gurney. The patient was broken. Everywhere. She was intubated in the field by the medic and lucky for her, she was unconscious as well. The medics stayed and offered any help they could.

The Surgeon did a peritoneal lavage and it was grossly positive, meaning she had internal bleeding which was her most immediately dangerous injury. The bones were ugly, but they were not bleeding as much as her belly. The OR crew had been notified when we knew we were getting patients, but they had not yet arrived. The Surgeon called out to the Supervisor in the other room and said she was going to the OR, with me. I thought I would die I was so scared. But I talked to the patient, cooed really, telling her what we were doing. That much was ingrained so far.

Before we could move, her blood pressure crashed and we gave more fluid and ordered more blood. The Surgeon said she was going to open her belly. Here. In the ER. We don’t do surgery in the ER. No anesthesia, no crew.

She made a smaller incision than she would have in the OR, just to be able to explore her belly briefly—to find a major bleeder or organ rupture. I remember distinctly holding the retractors so she could see into the space. I’d never held a retractor in my life. I did not like this.

I felt panic well up and subside like a boat on high seas. Nurse specialties are specialties for a reason—I knew nothing about surgery. Panic was keeping me close to the crest of the wave more often than leaving me in the trough. And then, like in media res, the OR crew showed up and saved me.

Other patients were incoming and I was thrilled that I wasn’t going to be dragged kicking and screaming to the OR. I blessed my fellow nurses and gave them the quickest report in history. I really hadn’t done much—she had an airway and IV’s courtesy of the medics, we’d given her fluids and two units of blood. You could look at her and determine her extremity injuries. She’d been in my care for 32 minutes. She sailed off to OR and I turned my attention to the now full ER.

The medics had stayed with the patients they delivered since there was no one free to accept them. Some of them waited for 30 minutes or more, without complaining. Bless them too.

The rest of the patients, 10 more, were what we called “walking wounded” because they could walk and talk and had minor injuries. There were broken arms and lacerations. Most of them were shell shocked by the event. Gradually, a normal level of busy hum returned. I thanked God that no one came into the waiting room with chest pain.

The two trauma patients who came in first eventually went to the OR as well and then on to ICU for all three of them. I have no idea what their outcome was. I’m sure I knew then, before the advent of HIPAA in 1996. I just don’t remember now.

I became an ER Nurse that night. Nothing could ever overwhelm me again. I often found myself using that night as a touch stone—I’ve done that, I can do this.

And surprisingly (to me), I needed to remind myself of that often over the next 20 years.

Just when the terror rose in my throat, I could coax it back down by reminding myself this was nothing compared to that night.

Then, there were others shifts that replaced that night, and now all of them are stacked like dinner plates on the shelf in my mind that I reserve for keeping memories safely removed from my every day.

ER Nurses take care of the sick, the injured, the dying, and the insolent unharmed. We are blessed to be with others when they are in pain and when they die. We get to live a hundred lifetimes by being there for moments large and small that need a confident voice and a steady hand.

I’m lucky. I can use those memories for writing. I can pull them down off the shelf and inspect them when I want and put them away when I’m done. Not just for the particular event or story, but to mine the feeling of dread, fear, or terror that I was able to experience that most people don’t routinely feel, unless they watch a movie or have very bad luck. And, of course, I’ve been witness to grace and abject depravity. I use those too. I get to process all that living (and dying) by writing. Thank you for sharing it with me by reading.

Peace,

Jo