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Emergency Department staff care for a patient during a recent night shift.
BWH Bulletin spent a recent Sunday night shadowing the many staff who care for patients and keep the hospital running during the nocturnal hours. This article on Emergency Medicine is the third of a short series shining a light on nights.
There is no typical night (or day, for that matter) in Emergency Medicine.
“We see people from all walks of life at all times of the day and night, weekends and holidays,” said Christian Arbelaez, MD, MPH, who began a shift one recent Sunday at 11 p.m. by rounding with a second and third year resident.
As he looked around, patients filled the bays, requiring treatment for everything ranging from broken facial bones to fast heart rates to injuries suffered from a possible domestic violence case.
“You get to meet people and gain their trust literally within five minutes,” he said. “Their lives are in your hands.”
The most urgent case—a woman recently diagnosed with cancer who presented with severe abdominal pain—was seen immediately by a multidisciplinary team including Arbelaez, residents and nurses.
They obtained a CT scan to diagnose her abdominal pain, and within minutes a radiologist from the Division of Emergency Radiology personally reported the findings directly to Arbelaez. On this particular night, Emergency Radiology's Maria Alejandra Duran-Mendicuti, MD, Scott White, MD, and Gamaliel Rodriguez-Herrera, MD, were working the night shift. “I don’t know of any other hospital that has attending radiologists right in the ED around the clock,” Arbelaez said. “It’s a remarkable resource and directly affects our patient care—they immediately tell us what they are seeing and together we determine what it means for the patient. ”
Even before the patient had the scan, the OR and SICU already were preparing for her possible arrival for surgery and intensive care afterward. Lisa Pugh, MS, APRN-BC, the nurse administer on-call that evening, coordinated with all three units to inform them of the patient’s condition and needs.
“You understand why people come to this hospital when you see a case like this that is so well-coordinated,” she said, as she watched Arbelaez and the radiologist reviewing the scan together. “It’s amazing what the staff of this hospital do on a daily and nightly basis—their heroic efforts save lives and preserve quality of life for our patients.”
As a general surgeon consulted on the patient in preparation for emergent surgery, Arbelaez informed the team that the patient’s family must be called before surgery, as she had come in alone.
Part of his role is to teach residents about treating patients with compassion and providing high quality care and emotional support—even in a specialty as fast-paced as Emergency Medicine. “You can have 20 patients at a time but each patient is an individual and must feel cared for in a compassionate way,” Arbelaez said.
Teamwork is crucial throughout the ED. “When a very sick patient arrives, it is all hands on deck – we all help each other,” said Sue Botsch, RN, nurse in-charge, who has worked in the Emergency Department for 20 years. “We have a great team and we know we are ready for anything that might come through that door.”
Brian Johnson, BSN, RN, who began in the Emergency Department in 2005, agreed. “Our team of caregivers is great,” he said, as he rapidly evaluated a series of arriving patients. “And we pride ourselves on being able to provide the very best care to every patient, even in the darkest hours of the night.”