August 25, 2005, 1:12 pm

And the Darkest Hours Are Just Before Dawn…


Oh, my….Google put ads for Vioxx lawyers on the site… not exactly a match with my editorial opinions!

I’m finally getting my cape.

And a cap!

With an itty-bitty uniform and teeny-tiny white open-toed pumps.

I happened to pass by eBay and there were a TON of Barbie nursing outfits (circa 1961) just waiting for a bid.

I didn’t bid, though. I’m smarter than that.

I went right for “Buy It Now!”.

The outfit comes with black-rimmed glasses, presumably because nurses can’t look too glamourous. But Barbie has her pedicure showing with the open toes shoes, and pumps no less.

I have wanted this outfit for approximately 40 years; it’s costing me the equivalent of four real uniforms.

What would we do without eBay?


There is a virtual bus stop in front of every emergency room and it disgorges its charges at regular intervals.

It runs 24 hours a day.

You can set your watch by its arrival and tell the time by the patients seeking care.

Here is what the night shift might receive….

1:00 am: The Earache Hour

What is it about the nighttime that brings out the worst in ear pain? Kids that were fine at home suddenly wake up screaming in pain. Very disconcerting to the parents, but fortunately easy to treat.

2:00 am: The Croup Hour

Sleepy parents and kids sounding like the seal enclosure at Marine World comprise this block of patients. Usually the child sounds better by the time he gets to the ER. That’s an ER rule, by the way. “All symptoms in children cease upon entering the ER .” Diarrhea since birth, four years ago? Not now. Total lethargy for three weeks? Now the kid needs medication for attention deficit disorder. Acute abdominal pain since breakfast? The kid picks the “smiley face” on the pain scale. The parents are aghast and then embarrasssed for “overreacting” but the staff believes every word. Those of us with kids have been there.

3:00 am: The Alcohol-Induced Head Injury Hour

Brisk bleeding head lacerations attached to intoxicated patients are the hallmark of this hour. They probably fell, they may have been whacked, but every head-injured drunk is a subdural hematoma until proven otherwise; the CT scanner is very busy. The ER rule for this hour is “Nice when drunk, mean when sober.” These patients will urinate half a liter for every ounce of alcohol consumed, while asleep (that’s before they recieve hydration in the department). The problem, as a nurse would put it IF nursing diagnoses were used in real life, “Alteration in level of consciousness secondary to alcohol consumption resulting in alteration in urine output leading to incontinence.” Translation: have a lot of clean linen handy.

4 – 5:30 am: The Wee Hours

Patients are usually few and far between during these hours so the ER nurses study their procedure manuals, work on their certifications and read every nursing journal they can. (That was for the benefit of my manager.) We actually read, crochet, knit, listen to the radio, have that fresh cup of coffee, surf the internet and I have been known to practice my “moonwalking” dance moves (don’t laugh – it’s taken me 22 years to get it right).

By the way, NEVER, EVER, EVER say the word “quiet” when in the emergency room. It’s like dropping the “F-bomb” in church. I just isn’t done. Utter the “Q” word and you will ensure an avalanche of patients the numbers of which have never been seen in this lifetime. The bus driver will have to apply for overtime. The nurses will recoil from you. The doctor will rue the day you were born. Save your breath… yourself!

5:30 am: The It’s-Hip-To-Be-Square Hour

Somewhere, someone over the age of 75 is getting up to go to the bathroom and tripping over an area rug. Their hip will take the brunt of the fall and they will join the legions of people with titanium hips. They are scared and in excruciating pain so the “hover mat” is placed on the gurney before they arrive. It’s like floating on a cushion of air and makes transfering from the gurney in xray virtually painless. That, generous medication and the reassurance that a broken hip can be repaired help immensely. Now it’s time to wake up the orthopedist on call. Heck, for that matter it’s time to wake up the ER doctor…..

6:00 am: The Code Hour

Before this hour is over, a patient will arrive Code 3 with severe respiratory distress. Their EKG will be abnormal, their lungs full of fluid, their pasty skin drenched with sweat and the proverbial “elephant” on their chest. The emergency staff will hit that patient with every weapon in their arsenal of life until the patient is stabilized; lungs cleared, breathing restored, blood pressure maintained. The patient goes to the ICU. The staff gets ready to go home, only it will take just a little longer to fall asleep; it takes a while for the adrenalin to subside.

7:00 am: Hey-la, Hey-la, The Day Shift’s Back!

And because I don’t work days, I don’t know their story. I’ll interview a few and see what their day is like and report back from the “frontlines”.

But the PM shift…….now THAT is a whole ‘nother story…..


  • kenju

    August 26, 2005 at 4:14 am

    Hey, Kim, where can I get one of those hover mats???

    Would you believe what you describe actually sounds like fun to me? Yeah, I know, after 1 week I’d change my mind about it.

    Thanks for reading me; the temporary mansion does not need to be decorated since it won’t be open to tours, and the gov’s. family go to their private home for the holidays anyway.

  • Kim

    August 26, 2005 at 8:09 am

    Those mats are great – they are made of vinyl, hooked up to a small machine that blows them up with air. One person can then pull the patient onto the other surface. For all my sarcasm in these posts, the job really is a lot of fun and I enjoy it most of the time. But I think your job would be MORE fun! LOL

  • D Bunny

    August 26, 2005 at 10:54 am

    Holy crap! You exactly nailed the ER timeline! 🙂

  • D Bunny

    August 29, 2005 at 9:49 am

    I don’t know if you’e going to keep it, but this layout is much easier to read than the dark blue one.

  • […] And as I am coming up on my first blog anniversary, I’ll pull out one of the posts from when my only reader was my mother. It’s about the night shift. I present: And the Darkest Hours Are Just Before Dawn. […]

  • d

    July 27, 2006 at 8:54 am

    [Almost] all your posts – but especially this one – make me wish I’d gone to nursing school. I’m missing out on so much with a 8-4:30, no call job!

  • lowest cost

    January 27, 2007 at 6:26 pm

    Sehr informative Seite. Vielen Dank für die Infos!

  • Smile! « monash medical student

    September 10, 2007 at 6:00 am

    […] Emergiblog […]

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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