November 7, 2006, 10:50 am

The Rhythm of the ER


Buy. This. CD.

See. This. Man. In. Person.

If you do only one thing, go to the website. Songs from Under the Skin will begin streaming.

Click until you find “Cast Away Dreams” (PS: it works in Safari, not Firefox for some reason. Not sure about IE; I disavow any knowledge of Microsoft anything.)

Sometimes you need to be able to let a dream go before you can move onto the next level of your life.

If you have ever faced the need to do that, the song will resonate.

I just returned from the Lindsey Buckingham concert at the Palace of Fine Arts in San Francisco; the best two hours I’ve spent in a long, long time.

An artist thinks outside the box.

Lindsey Buckingham doesn’t even acknowledge a box.



I have unfettered access to the most beautiful city in the world.

I had forgotten how much I loved San Francisco until I was flying “halfway to the stars” over the hills to the concert. When I left the concert I had no clue on how to find my way to the freeway and home.

“Who cares!!!” I yelled to the Marina. “We built this city on rock and roll and tonight you’re all mine!”

Okay. Occasionally I talk to myself.

It was a cool, clear, fogless night and I was alone in the City…ahhhh. I could have driven all night taking in the sights and sounds.

What an unexpected gift! Rock and roll cranked as high as my not-yet hearing impaired self could handle, windows down, I think I actually had “lift off” on some of those hills. I probably should have gotten a ticket, but I’m sure SFPD had bigger fish to fry than myself.

San Francisco. Loony, liberal, off-the-wall. It’s everything I’m not.

(Okay, I’ll admit to off-the-wall…)

So why am I so comfortable there?

Trust me people. You have not lived until you have crossed the Bay Bridge or turned the corner on US 101 and seen the skyline of San Francisco at night.

Tony Bennett isn’t the only one who left his heart in the City.

I think part of my right ventricle found a home on Van Ness.


There is a rhythm to be found in the emergency department.

You feel it when you walk in the door.

Initially, it resembles an orchestra anticpating of the arrival of the Concertmaster; the cacophony of tuning replaced by one tone that turns individual musicians into a symphonic cohesiveness.

In this case the symphony is the ED staff, under the direction of the emergency physician. The charge nurse is the Concertmaster.

Some shifts can rival a Beethoven concerto in their rhythm and harmony.

Others resemble a night with the Grateful Dead; the structure is there, but buried somewhere under extended sets with unremitting improvisation.

Occasionally your department channels the late John Cage. Instead of four minutes and thirty-three seconds of ambient sound, it’s eight hours, the “music” being whatever is tossed into the potential vaccum of your shift. Atonal. Unorganized. Disturbing.

There is a beauty at both ends of the spectrum.


Unlike a symphony, the emergency department embraces many guest musicians during each performance.

The patients.

Some will be delicate flute-like children accompanied by strident trumpet-blaring parents. Others are like haunting oboes, bringing with them a forboding of doom.

Then the violins will enter. Some of them melodic and soothing, others with a screeching dissonance in their presentation.

Some will bring with them the coolness of a jazz piano. Others will resemble french horns; monotonic, but consistent – unable to be suppressed or ignored.

Many will present as high-pitched obstructed harmonicas, working with all their might to make a sound. Any sound. Some will not breathe at all, providing an inadvertent and unwanted “rest” to the score, signalling the entire orchestra to mobilize.

While the world plays in 4/4 time, the emergency symphony will accomodate those whose hearts beat in 32/4 time. Or provide choral support for those who can barely manage 1/4 time.

And stand in awe of those whose movement in the symphony of life has simply ended.


Underneath it all: the steadying presence of the percussion section.

The unrelenting base drum of the unit coordinator, keeping the ED in rhythm. Rarely seen by the visiting musicians; earning the eternal gratitude of the “regular” performers and working tirelessly with the Conductor to ensure a seamless progression from one refrain to another.

The flowing sound of the bass guitar in registration. Changing chords as they encounter each new musician and working in tandem with the drumming of the unit coordinator, they provide a solid riff for the rest of the “regular” musicians to work off of.

Transient percussionists will make their way through the ED in any given performance.

The clash of the Cymbals of Administration, causing a brief ripple in the motif.

The stand-by tambourines of security; acoustically invisible but available on a moment’s notice.

The triangle and maracas of dietary, radiology, lab and volunteers who add their small but invaluable beat to the ongoing movement of the night.


No performance of the emergency department is ever the same.

Oh, the regular musicians are always there.

It’s the visiting musicians who steer the tone of the piece to it’s final destination and provide the highlights (or lowlights) of the evening.

They keep the regular musicians on their toes as they work to assimilate each new addition into the rhythmic flow of the selection.

In reality, each shift in an emergency department is a work in progress.

Until the last musician has left the stage, you really don’t know what you’ve heard until it’s over.


  • Candy

    November 7, 2006 at 12:38 pm

    Oh. My. I feel as thought I’ve just listened to a perfect concert, the words flowing over me like water, cool and refreshing. The memory of it will come to my mind later on and I’ll remember a phrase or a sentence, or a thought, an idea, and I’ll smile again.

    Oh. My.

  • #1 Dinosaur

    November 7, 2006 at 1:47 pm

    Beautifully written, Kim.

  • medic5

    November 7, 2006 at 2:24 pm

    What a fascinating view of the ER. I’ve never thought of it that way, but you are so right. Don’t forget the trumpets of EMS, slowly crescendoing as they reach the door… Thanks for having such a wonderful perspective!

  • ChiaLing81

    November 7, 2006 at 6:04 pm

    Ahhh… I think I left my heart in San Francisco. Thanks for the photo. I spent six wonderful years up there (go bears!), and I still miss it so.

    Loved your writing of the orchestra as metaphor. Just beautiful.

  • Mother Jones RN

    November 7, 2006 at 7:50 pm

    I remember Lindsey Buckingham from Fleetwood Mac. Thanks for the post about his CD. Has soon as I can hobble out of the house, I’ll pick it up.

    Great post about working in the ER.


  • Steve

    November 7, 2006 at 8:45 pm

    I think San Francisco is the greatest city.

  • TuxBaby

    November 8, 2006 at 5:44 am

    That is just absolutely beautiful, Kim! I love the ER. I’ve always told people that “it’s its own world” when people ask what it was like to work there. But your description fits it perfectly. Some days things just flow, other days, you feel like nothing goes right. But yet they still flow even when they don’t flow. People either love working in the ER or they hate it… and I love it, I miss it. Thanks for taking me back with this blog entry!

    Oh- and the S.F. photo is gorgeous as well. I love looking at city skylines, day or night. But there is always such a peace about the night shots.


  • Dana

    November 8, 2006 at 7:33 pm

    Awesome post about the ER.

    Lindsey Buckingham went to high school with my dad.

  • Erica

    November 9, 2006 at 3:39 am

    Wonderful musical metaphors, Kim! I’ll share this post with my co-workers. Wow.

  • Enrico

    November 9, 2006 at 7:45 pm

    Site works fine in Firefox (Mac, of course) 2.0. You probably just need to update your Flash plugin since that’s what the music depends on.

    Otherwise, I don’t know anything about Lindsey Buckingham, but it sounds good!

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...

Continue reading »

Find Me On...
Twitter     Technorati

Subscribe to Emergiblog

Office of the National Nurse

Zippy Was Here

Healthcare Blogger Code of Ethics

  • Perspective
  • Confidentiality
  • Disclosure
  • Reliability
  • Courtesy