Anybody who works in the ER knows not to mention or even notice if things are quiet. When the torrent of patients that flow through the doors ebbs disaster can't be far behind. Saturday morning. Beautiful late fall weather outside, more staff than patients inside the sliding glass doors. Ten empty stretchers waited in the triage area, more lined the hallway of trauma alley. I had just dropped off an intoxicated patient and sat behind the triage desk for a while with Joanne, a lovely RN from England. We reminisced about last Christmas Eve, a bloody mess we recalled, more heartache and suffering than joy visited upon the ER. I asked her how her plan to give goats to needy African families as Christmas gifts in lieu of presents was working. Before she could answer my portable cracked to life. "Rescue 1, respond to the Rhode Island Hospital helipad for an incoming Medflight." "Rescue 1, message received." "Duty calls," I said and walked out the doors and into the brilliant sunshine. The medflight ended up being cancelled, the victims of a head-on collision being transported by rescue. We went back in service and drove toward the station, hoping things remained the same, not that we noticed things were quiet of course.
Two hours later, we returned to a different ER. Most of the stretchers were full, everybody was busy. The head-on collision had taken the life of two elderly ladies, the driver of the other vehicle remained in critical condition. It is amazing how quickly things change. Joanne, busy now managed to take a minute to talk. "Terrible thing," she said. "Two nice ladies, all dressed up. Their hair was done, make-up perfect. They must have been shopping." She shook her head and walked away. I walked my drunken patient through the madness toward the CDU (clinical decision unit) where he would be monitored until he sobered up, then released. He remained oblivious to the suffering surrounding us. Perhaps he knows something we don't.


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