October 21, 2006, 6:56 am

ER: Here to Save Your Derriere, Not Feed It

yeast flakes

So this is the secret!

You, too can be normal and charming!

Lord knows I need a truckload of this stuff.

Perhaps we can dispense it in the emergency department!

Here you go, Mr. Smith. This will make you normal and charming.

Side effects?

Well, your BMs will be regular and your skin will be flawless.

I wonder if yeast flakes help you “rise” to the occasion?

Has to be a lot cheaper than Viagra!


“I haven’t eaten all day”, he said. Approximately 8 packages of saltines lay open on the Mayo stand. “Get me something to eat.”

He’d been in the ER for all of 90 minutes; brought in by ambulance for “not feeling good”. Oh yeah, and the ubiquitous “nausea and vomiting”.

Hence the saltines.

He repeated the demand three different ways three different times in the sixty seconds it took to unhook him from his BP cuff and IV so he could go to the bathroom.

“I want a meal. I want a piece of toast and a cup of coffee.”

“Well, I can certainly try to get you some coffe….”

“Make it decaf.”


Now, I had worked my way through my first year of nursing school as a waitress, so I was no stranger to having someone place an order for food. Raising three teenagers just reinforced my ability to juggle multiple meal requests.

Only I’m not a waitress anymore. I’m a Registered Nurse.

He was a patient in an impacted ER on ambulance diversion.

He was neither destitute, nor homeless. He was neither debilitated nor emaciated.

He was alert, oriented and appropriately reponsive. He was older, not elderly.

He advised me that he couldn’t “hold his urine” and had peed through all the linen so his trip to the bathroom was preceeded by orders to change his linen after I obtained a pair of pajama pants for him.

Followed by another order. For a plate of pasta.


I’m pretty easy to get along with. If there is time and the patient requests it, I’ll jump on one foot three times around the gurney with party hat on, if it makes them happy.

I’m all about patient satisfaction. I will do everything in my power to make that trip to the ER as quick, as stress-free and as comfortable as I possible can.

But this was time for a bit of limit-setting.

Something in the tone. Something in the attitude. Something in this patient’s behavior hit my “now wait just a doggone minute” button.


“You and I need to come to an understanding here,” I said quietly but firmly as he returned from the bathroom.

“This an emergency department, not the local Denny’s. While I am happy to try and get you a cup of coffee, and decaf if I can, I am not a waitress, I am your nurse.”

That was all I said. In an even tone of voice. No sarcasm, no anger, no frustration

The patient didn’t make another request in the twenty minutes he had to wait before his transport to his in-patient room.

I’d have sent him up with a cup of decaf, except we were out.


My ER keeps a type of “box lunch” available for patients. These meals are primarily for those patients coming in with hypoglycemia. They must eat!

Patients who are homeless are offered meals. Patients who have to wait in the ER for their inpatients rooms are offered meals.

Usually it’s the family who comes out requesting a meal because “Auntie hasn’t eaten since breakfast.”

And it’s only 11:30 am.


While I understand the importance of nutrition in the healing process, let me make one very provocative, controversial statement:


Unless you are a diabetic, missing one meal is not going to hurt you.

There, I said it.


As far as I am concerned, food has a very limited place in the milieu of the emergency department. And so, I’d like to make the following observations.

  • Most ERs are equipped with saltines, milk and juice. If lucky, there are sandwiches available for those patients who require them.
  • If you come into the ER with abominal pain, nausea, vomiting or any potential surgical problem, you will NOT receive a meal.
  • We are sympathetic to the fact that you have not kept anything down in two days.
  • This does not automatically stop because you are in an ER.
  • What we WILL do is get your vomiting and nausea under control and offer you clear liquids.
  • Yes, we know you are hungry.
  • It IS possible to be nauseated and hungry at the same time. I’ve been there.
  • The hunger you are feeling will not kill you. The Double Whopper with Cheese complete with the “I’ll take fries with that” will hurt you.


The ER.

Its dedicated mission: to explore strange new symtoms.

To seek out diseases and life-threatening situations.

To boldly fight Death where Death has never been fought before.

Its prime directive is not, to quote the eminent philosopher Winnie-the-Pooh, to cure the rumblies in your tummblies.

So while your nurse may be happy to get what you request:

  • Make sure it is within reason.
  • Realize that in addition to your request for food, your nurse
  • is also working with 2-3 other patients
  • is giving medications with some potentially serious side effects
  • may be dealing with either imminent death or new-onset disability in the room next door.

Unfortunately, it isn’t all about your stomach.

And if you are like me, prolonging that meal by a couple of hours or missing a meal altogether, will NOT make you an emaciated version of Kate Moss.

After your discharge, you can always hit the local Taco Bell.

I’ll take a bean buritto with green sauce, extra cheese and onions.

Just in case you ever need to know.


  • Susan

    October 21, 2006 at 8:11 am

    Heh! Good post, Kim!

    An addition to your list of who gets food: in the ED where I volunteer, we once gave a meal tray to an older patient who’d collapsed in a casino after not eating for 24 hours, because he was so entranced by the slot machines.

    He and his wife were really sheepish. But the food sure made him feel better!

  • Airway Control

    October 21, 2006 at 8:23 am

    Jeez, you are so right, i agree completely. Personally, I don’t give anyone coffee, because before too long I know I’ll have a scald burn on my hnds to go along with the “multiple complaints.”

    I frequently tell my patients “this is not a restaurant,” “you are in an emergency department, not burger king,” and on a few occasions I’ve even told them “It’s not your stomach that concerns me,” as I walk out of the room.

  • Prisca

    October 21, 2006 at 8:36 am

    Good advice for those of us just starting out and trying to bend over backwards to please our patients. I swear right now I would go to Denny’s and get my patient take-out if it meant I would pass clinicals. I love your real-world nursing sensibilities. I am keeping your little “talk” in mind…

  • Azygos

    October 21, 2006 at 1:48 pm

    Several ER’s I have worked in had meal tickets we could give out to the family. We would send them to eat and give a ticket to pick up food for the patient on their return. This worked well as the family knows what the patient likes and does not like. It was a great PR system also.

  • Kim

    October 21, 2006 at 2:15 pm

    We have those meal tickets, too. They are very nice – we give them to families who have a long haul in the ER, and if the patient CAN eat, then it works well for them, too.

    My problems is that, working the late PM/night shift, the cafeteria is closed so we don’t have that option.

    It really is a great PR tool, also. Not everyone remembers to bring money when then have to rush to the ER with their family!

  • Kim

    October 21, 2006 at 2:19 pm


    it takes awhile to know the balance between really going the extra mile for your patients and understanding when the patient is out of line with their request.

    I usually give the patient the benefit of the doubt, this case was so blatant I had to set a line in the sand.

  • Chemo Lady

    October 21, 2006 at 2:55 pm

    I ended up in the hospital a few months ago with post-surgical complications, admitted via the ER (I arrived at 3:30 a.m.). For the first nine hours the only thing I got to drink was contrast on the rocks. After I went from emergency surgery possible to non-emergency surgery likely, I did get clear fluids for the next 48 hours on the med-surg floor. I got a little cranky when the BE exam was postponed because they were “so busy down in radiology,” but I held up. I left my bed for the BE at 10:00 a.m. on the third day of fasting, and got back to my room at 3:00 in the afternoon. Only one thing was keeping me going: they had promised me dinner when this last one was over. I should mention, I guess, that I was in medical trouble in the first place because chemo was doing a number on my nutritional status, and the day I was admitted I weighed 112 pounds on my 5’9″ skeleton. And I’m familiar with the delights of hospital food, but at that moment it didn’t matter. So when the tray finally came in and I found jello and a popsicle on it, I cried. Really, I did. Wept. Like. A. Baby. Somebody had either not updated the order or the kitchen didn’t pay attention or something. I’m telling you this because I want you to know what those nurses did for me. All of them–the day nurse, the night nurse, the charge nurse, the techs, the students, everybody got in on the act. They called the kitchen, they faxed orders, they tracked down the resident, they called the kitchen again, they raised hell for three hours. By the time someone finally brought up a tray I could barely eat it, because nurses had been slipping me tidbits from their own stashes and stuff from the snack shop in the lobby and every damned saltine on the floor. I love you nurses. The thought of some self-involved ass making your lives miserable makes me want to march my skinny little ass in there and sort him out for you. A day does not go by in my life that I don’t remember what nurses have done for me. Godspeed you all always.

  • Susan

    October 21, 2006 at 6:36 pm

    I can’t believe patients are actually that stupid and rude!

    I don’t expect anything but crackers in the ER. I spent last Sunday in the “cancer ER” with my son and he got hungry and I went out to ask for crackers. Instead they called the kitchen for a snack tray and I got to pick out an apple and some cookies off of it for him. I was thrilled!


    October 22, 2006 at 10:29 am

    Love your BLOG – as a fellow ER nurse your got it!

  • Jo

    October 22, 2006 at 11:51 am

    Wow, On the floor I’ve had several asrgements with patients especially the ones who are NPO for GI concerns about why they cannot eat.
    Yet, some people really do believe if they miss one or two meals they are gonna waste away.
    Or perhaps they are just bored.
    Great Post!

  • Mel

    October 22, 2006 at 1:50 pm

    I think I asked for a Diet Pepsi in the ER when I took my dear hubby there with e. coli. I’d been there for several hours and was wilting. The nurses gave me one out of their own stash. 🙂

  • MandyHamm

    October 22, 2006 at 1:58 pm

    Love, love, love your blog! I’ve been an ED/trauma nurse for 8 yrs, worked in varied hospitals; so it’s the same shit, different place. Glad to know it’d the same all over…keep the posts coming! I thoroughly enjoy them…

  • TuxBaby

    October 22, 2006 at 3:52 pm

    I found your blog through Nurse Ratched’s Place- and I’m thoroughly enjoying both! I hope you don’t mind that I’ve linked you- just so I can find my way back here easily. I used to be an ER nurse, and I soooo understand where you’re coming from. It’s a zoo of a place, that’s for sure!


  • Chemo Lady

    October 23, 2006 at 6:20 am

    Another bit of advice for the ER or the GI problems: turn the TV off. Look, I’ve had weeks where a “square meal” was a Compazine and a multivitamin washed down with 2cc of water. I’ve had weeks where it’s the 4th day post-surgery, a mouth like the Sahara, and the poor resident lifts up the stethoscope from my tummy and says, “I’m so sorry. No sounds yet.” So take it from me: exposure to food commercials is not a good idea. You must find some other way to entertain yourself. This goes double for all the family and friends you bring with you who hang around outside my door discussing food. It’s bad enough that they want to use patient bathrooms and people like me get C-diff. Do they have to torture me by letting the TV blare Taco Bell commercials? I control my own visitors; why can’t other patients do so? If there were a legal defense fund for frustrated nurses who locked a bunch of family members into a blanket warmer for six hours, I’d donate to it.

  • At Your Cervix

    October 24, 2006 at 4:14 pm

    “Unless you are a diabetic, missing one meal is not going to hurt you.”

    I have GOT to remember this line. You would not believe how often pregnant women in L&D ask for food as soon as they arrive, or shortly after they arrive. “I haven’t eaten since XXXX o’clock.” If it’s dinner-time, and you haven’t eaten since breakfast, why oh WHY didn’t you eat lunch?? You are not only feeding you, but also your baby. You wouldn’t not feed your baby all day long after he/she is born, so why did you not eat?

    L&D is NOT a restaurant. When you come here, it’s for a pregnancy related concern (I hope!). You will NOT be fed any food. You are lucky if you will get some clear liquids. And that’s not until we determine your problem and treatment. If there is any chance at all that you will need a c-section – you will be NPO.

  • hypnoid

    October 25, 2006 at 11:49 am

    And even if you are a diabetic missing a meal is STILL not going to really harm you 90% of the time. Most of my diabetes patients have type 2 diabetes and are treated with diet, with metformin, with a thiazolidinedione, or some combination of the above. Hypoglycemia can happen, but really isn’t likely.

  • Regina

    November 7, 2006 at 7:48 am

    LOVE this! I just found your blog today and I am already addicted!

    I’m not sure why patients and families believe that lack of planning on their part (e.g. “I have not eaten today” and it’s 8p.m.) constitutes an EMERGENCY on our part!

    Sometimes I feel like I work 2 jobs, one full-time job as a highly educated RN, plus a part-time job as a waitress (or an indentured servant)! A waitress almost ALWAYS gets a tip, a nurse, serving as your waitress RARELY receives a simply “thank you”!

  • Kelly

    December 3, 2006 at 4:45 am

    I stumbled across your blog and absolutely loved it! I am an ICU nurse and we run across the same types of things. The families of the patients who are no longer ICU patients just can’t understand why we can’t get their family member a cup of coffee when the patient in the next room is coding!?!?!? I think people lose all common sense when they come into the hospital. I have friends who work ER and they all have stories similar to yours. Keep up the good work.

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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