Physicians frequently get the choice roles in prime time television (if that's even a thing any more in the era of Netflix), so it's easy to forget that working in the Emergency Department is a team sport, where emergency nurses comprise the front line.
One of our docs put up a saying in the doctor's lounge long ago: ER doctors save lives. ER nurses save ER doctors. Experience continually reinforces this truth.
(Time has passed and details have been altered to obscure identities).
It's 1:30am on an incredibly busy shift as an obese female in her late teens is wheeled in by paramedics. She is screaming and writhing on the gurney. She won't answer more than one or two questions or even let me touch her abdomen due to pain, but at my insistence she reveals that her last menstrual cycle was 2 weeks ago, and she swears she's been regular like a Swiss clock.
The patient's mother arrives a couple of minutes later by car and relays the only additional history we are able to obtain: The patient complained of a stomach ache that morning that appeared to go away, ate lunch and dinner with her mother, and went to bed without incident.
She then awoke around 11pm vomiting with horrible diffuse abdominal pain. It was the worst of her life, and she'd had no prior similar episodes before that morning.
She is afebrile, with a systolic blood pressure in the 150s, and a heart rate in the 90s.
As a wise and trusted nurse coaxes an IV into her, I order labs and pain medication and the patient requests, not unreasonably, that once she's more comfortable she'll let me examine her abdomen.
I return to her bedside repeatedly over about an hour as I await lab results, but despite my ordering additional doses of pain medicine, she's still miserable. Each time I gently reach over to examine her abdomen, she grabs my hand using a white knuckle kung fu death grip.
Rebuffed, I move on to see other patients. Even from far away rooms, I can hear her screaming every few minutes. I run the mental list of problems in young, non-pregnant, otherwise healthy women that can cause severe episodic pain: Kidney stone? Ovarian torsion? Finally, as I am placing orders at the central work station, she screams something like, "I think I have to poop!"
My wise and trusted nurse looks over at me with a glint in her eye and says, "You know what this reminds me of?" She doesn't need to complete the sentence - I take off at a trot and wheel over the ultrasound machine - a surge of adrenaline at last allowing me at last to overpower her kung fu grip. The monitor reveals a term fetus.
After informing the stunned patient and mother, the daughter finally allows me to do a quick inspection of her pelvic region, which reveals yahtzee! She's crowning.
A quick heads up to the on-call obstetrician and our team is wheeling the gurney full speed to Labor and Delivery. Thirty minutes later a healthy baby is born.
Happy (belated) Emergency Nurses Week!
With highest regard, thank you for who you are and what you do.
