It is winter in a level-2 emergency room. It is busy and stressful, with novelty and surprises for both patients and staffers. The job of an emergency nurse is to help move the patient flow, to facilitate patient care, to troubleshoot when necessary, and basically to make it through the next twelve hours. Tonight the emergency nurse arrives to find four ambulances in the bay, with the emergency room and the waiting room packed with people. The nurse's station can be likened to the deck of a ship and that night it was choppy water right off the top. Some other area hospitals were already on bypass (when an emergency room which is fully occupied diverts ambulances to other hospitals). When other nearby hospitals are on bypass, it doesn't take too long for one's own emergency room to become overloaded. After two hours, this ER went on bypass as well. There was a waiting list for hospital beds and the main hospital wasn't discharging enough patients to alleviate the congestion in the ER. With the ER beds full, people waiting for treatment in the ER have to wait even longer.
Shortly after going on bypass a code green, an extreme emergency, was called in. No matter how full or occupied an emergency room is, even on bypass, room must always be made for extreme emergencies. Dealing with the adrenaline rush of emergencies is why ER personnel in Koi scrub pants decide to become ER personnel in the first place. An elderly man in cardiopulmonary arrest arrives. One doctor, three ER nurses and one ER tech jump to it. Half an hour into that code green another code green is called in. Another patient in cardiac arrest arrives, and another doctor, two more nurses, and another ER tech hop to it to receive this patient. The first patient is still struggling for his life.
Other patients and families watch the scene of real life saving efforts taking place, while the families of the two critical patients huddle in the waiting room. In the end, both patients die. Their families are told. This is an unpleasant and unavoidable part of work in the emergency room but it is all part of the job. A new patient comes into the ER in the wee hours to complain about a cough he has had for several weeks and the patient gets upset at having to wait for four hours to be examined. People can become abusive verbally, even have fits and throw things because they were not seen before dying patients. At times ER nurses in Koi uniforms working a code are berated by patients because their dose of Tylenol was delayed. That night eventually smoothed out and everyone made it through the twelve-hour shift. Emergency room nurses and personnel go home, sleep, and come back for more the next day. There is always more.