Trauma in the slot
Notes in and out of the ER.

Oh hell.

I put down whatever I'm doing, sometimes spilling it/surprising the patient/abandoning my computer orders uncompleted, and quick lope across the hall to the Trauma Slot (it's a room with space for several trauma victims), where I put on a disposable gown. Then I am supposed to shear off the victim's clothes and stick an IV in their arm. He (they're generally hes) is lowing, often drunk or otherwise substance-addled, but definitely in pain. I don't move fast during this ritual, nor in general, so a few minutes into the slot I'm standing uselessly at the side of the room, waiting for some signal from a superior to go get more work done inside the ER.

Back in the ER desperation on all sides: patients ask when you're going to see them, families wonder what's going on, why hasn't the X-ray been read/glass of water brought/IV taken out of arm/broken bone been set. Nurses are busy doing something else. Senior residents drift from corner to corner of the ER, occasionally assuming a stance ten feet or so away from the patient board on your end, with a look of quizzical impatience: why aren't things moving faster? Why hasn't N, with the abdominal pain, been seen yet?

Rounds punctuate. Someone is admitted - off our hands. Someone is waiting for dispo - a test, for example, to decide whether they'll stay or go. Attendings talk about patients right in front of them, in the third person.

But nevertheless (despite all these initiation rituals that I thought I left behind with intern year, but now as a second year resident I am submerged in again, on this my ER rotation) I am seeing pathologies I never laid eyes on before: the dinner-plate eyes of cocaine, the writhing appendicitis, the horrible pain of a cancer patient that knows (or doesn't yet) that it will never go away completely.

Always the crush of patients to muddle through (primary care medicine in the Bush era), always the disappointed person who hoped that their months-long back pain would be cured by a 4 am visit to the ER. And always, in the middle of all this, the cursed interruption: Trauma in the slot!