Page 10 of Fighting For You
"Morning, Lori."
"What are you guys talking about?"
"Today's horoscope," I said, still scrolling through the list for the day.
Liz came through the doorway with Jen right behind her. They arrived together most shifts, coffee already in hand, already mid-conversation about something.
"You don't actually believe in that stuff, do you?" Liz said.
Liz had a way of walking into a room like she was resuming it. Jen was quieter about it, but she watched everything.
I put my phone away. "It's just for fun."
Gracelyn wasn't on today. I'd checked the schedule the night before, the way I always did. It shouldn't have mattered. The bays filled the same either way, and I'd done it plenty of times without her. But there was something about shifts without Gracelyn that made me feel like I had to be more careful.
"Morning."
Josie had the board already printed. She pinned it to the wall and turned around.
"Twenty-two in the department, three boarders waiting on beds upstairs, eight in the waiting room. We're starting behind." She looked at the board. "Liz, bays one through four. Nora, six through nine. Lori, ten through thirteen. Jen, fourteen through seventeen. Kip, fast track."
She ran through the high-acuity patients. A chest pain in bay eight waiting on a second troponin. A sepsis watch in bay two, antibiotics started on nights, lactate pending. A fall in bay ten, elderly, altered, CT ordered but not yet done.
"Dr. Sullivan is our attending today."
I wrote my assignments on my forearm. Cliff Sullivan was a good doctor, but he ran the floor like every minute you spent talking to him was a minute he didn't have. Under Harlan, the ER felt like everything was going to be alright. He answered questions like he wanted you to learn, and he trusted the nurses to do their jobs. With Sullivan, questions got short answers. Clarifications got a look. You learned fast to have everything ready before you approached him, and if you didn't, you only made that mistake once.
"One more thing." Josie set the marker down and turned to face the room. "I got an email from administration last night. They're tightening up on error tracking. They've seen a rise in incident reports department-wide, and they want numbers down."
She looked around the room. "This isn't new. This is the job. But I'm telling you now because I don't want anyone caught off guard. Do your checks. Read your orders back. If something doesn't look right, flag it before it becomes a problem. We don't cut corners in this department."
Nobody said anything. Kip tapped his coffee cup twice against his knee. Liz looked at Jen.
"Let's go."
Las Vegas doesn't sleep, and neither does its ER. CCMC is the only Level 1 trauma center in the state of Nevada. If it's bad enough, it comes to us. Stabbings, gunshot wounds, car accidents on the I-15 at two in the morning. But it's also chest pains and broken hips and a tourist who passed out on the Strip because she forgot to drink water. The city runs twenty-four hours a day, and so does the ER, and you never know which version of Las Vegas is going to walk through those doors next.
Sullivan came through on rounds midmorning. He stopped at bay eight and looked at the chart.
"Troponin back?"
The man in bay eight had come in overnight with chest pain. We'd drawn his blood twice to see if his heart was in trouble, and the second result still wasn't back.
"Pending. I called the lab ten minutes ago. They said twenty more."
"Follow up in fifteen. If it's elevated, I want cardiology on the phone before you page me."
"Got it."
He was already at bay ten, where Lori was adjusting an IV line on an elderly woman who'd come in after a fall. The CT had ruled out a brain bleed, but she was still confused and not fully oriented, which meant something else was going on.
"Did neuro see her?"
"I paged them," Lori said. "They haven't come down yet."
"Page them again. If they're not here in twenty minutes, call me and I'll do it myself."
Lori nodded and made a note. Sullivan moved on. That was how he worked. Question, answer, order, gone.
