As reported by Hartford Magazine, August 2011.

Emergency! A Night in the Life of UConn Health Center’s Emergency Department

By Sarah Wesley Lemire

It’s mid-afternoon during an early summer heat wave, and the temperature soars to an oppressive 92 degrees. In Avon, 68-year-old Sheila Barnett is playing golf with her friends. On the 16th hole, she decides to skip her turn, citing the heat and the need to take a break. On the 17th hole, everything becomes very bright. She passes out for more than two minutes. “I woke up to police officers and an ambulance,” she recalls.

Barnett is taken by ambulance to the University of Connecticut Health Center’s John Dempsey Hospital Emergency Department (ED) in Farmington.

Still wearing her pink golf shorts and a johnny, she waits in one of the treatment rooms with a fellow golfer for the prognosis.

It’s an apparent case of dehydration. However some of the tests they’ve run indicate that Barnett’s kidney output is irregular and she will need to be admitted. The doctor, she says, is “keeping me overnight because he doesn’t like how much my kidneys are putting out.”

Barnett is just one in a never-ending stream of patients to come through the Emergency Department doors.

Any time of the day or night, 365 days a year, it’s a machine that never stops humming and it bears silent witness to some of life’s most exultant and tragic moments.

Within the walls of the ED, a child occasionally makes a dramatic entrance into the world as easily as another leaves it, a stark and constant reminder that death doesn’t discriminate between the young and the old.

Like an antiseptic casino, the ED is devoid of windows. And like slot machines, an array of monitors bleep in a litany of chimes paying out vital signs instead of coins. In place of the victorious cheers of winners, there is someone down a hallway copiously crying. Somewhere else, an elderly woman calls out for her husband, who has long since gone home for the night.

For anyone who has ever spent any time in the ED, it is a world unto itself – a place where time seemingly becomes irrelevant as injuries are treated, illnesses are diagnosed and dire medical needs are met.

To those who work in it, it is a job like no other, and often one that is indescribable to anyone outside the field. It is fraught with both highs and lows but most everyone in the UConn ED, from the doctors to the medical assistants, say they can’ t imagine doing anything else.

“It takes a certain kind of personality,” says physician assistant Barbara Pelletier. “You’re either good at it, you enjoy it and you thrive on that kind of change and emotion – or you don’t stay in the emergency room.”

For more than two years, she has worked in the UConn ED and says that it’s both the fast pace and the ability to help people that make her job rewarding. “Every day that I see someone here and I can help them at the moment they really need it, it’s very fulfilling.”

But while working in the ED may be gratifying, not everyone is equipped to handle it. Dr. Khalilah Hunter-Anderson, an emergency medicine physician, explained that the demands of the job mean that only the truly dedicated can be found working there.

“That’s the thing about emergency medicine – it’s shift work. [There are] a lot of overnight shifts, holidays and weekends. That’s why you have to love what you do.”

And she says she does, in fact, love her job. It’s partially the diversity that keeps her there. “It is truly a unique specialty, it really is, because everyone has their focus: dermatologists, surgeons, cardiologists. I’m theoretically all of those, from the emergency aspect of it.”

However, along with that diversity comes both challenge and responsibility, “You literally have people’s lives in your hands and need to have very quick critical decision-making.” Because of that, she said, everyone has to always be on his or her game, and there’s no margin for error. “That’s why we have to take everything seriously; there’s no petty component, even for what appears to be the simplest thing.”

Many cases are far from simple. For example, 81-year-old Beverly Chapman of Bristol has lost her ability to use her legs, without apparent cause. She’s been “trying to tell her legs what to do” but they won’t cooperate. Her daughter, Nancy, along with her 82-year-old husband, Robert, have brought Beverly to the ED to figure out why.

In the absence of an immediate answer, she’s been given a CAT scan to rule out a stroke and other obvious causes. Beverly’s daughter, who lives with and cares for her elderly parents, is not surprised to once again find herself in the ED with them. “I expect the unexpected because I’ve been to the emergency room nine times in one month with Dad; this is nothing new to me.”

She explained that because her mother has vascular dementia and her father suffers from Alzheimer’s disease, caring for them has become almost a fulltime job. Her mother’s complete loss of mobility is going to significantly complicate things and she’s not certain what she’ll do. After several tests and no conclusions, Beverly is admitted to the hospital and Nancy takes her father home for the night.

A large percentage of people coming to the department are elderly, according to assistant nurse manager Heidi Hedden. They often come, she says, for reasons beyond emergency care. “We see a lot of the same elderly population because they are failing at home. They [often] don’t need acute care, they just need someone to help them go grocery shopping and do laundry.”

Because of that, many of the staff find themselves serving as ad hoc social workers in meeting the needs of not only seniors but most everyone else who lands in the ED. “It’s a very different role for us [in the ED],” Hedden said, “because we have to take care of the entire person in a very short amount of time.”

In doing so, staff members often go above and beyond the confines of the department to help patients, including occasionally driving elderly patients home after treatment, knowing they have no one to care for them. They have even shoveled out cars and walkways to ensure a patient’s safety once he or she has arrived home.

And it’s not only the patients who require the staff’s time and skills, but their families as well. “All of a sudden, your patient isn’t really your patient; their whole family is your patient,” Hedden says.

That can be difficult, considering how often the doctors must deliver bad news to family members and then deal with the fallout. It’s something that emergency medicine physician Dr. Richard Kamin knows all too well. He’s had families become physically confrontational upon receiving the news that a loved one has died.

However those challenging moments are often assuaged by the gratifying ones. “[There have been] terminally ill people who happen to pass away in the Emergency Department. I was able to make them comfortable with their family at their bedside, knowing full well that it’s an intervention that they wouldn’t have gotten unless I had taken care of them,” he says.

The patients, families and cases he sees run the gamut from traumas to illnesses to simple constipation, and Dr. Kamin quotes his father, also a physician, about the honor of being a doctor. “People will come to you at their most vulnerable, their most embarrassing and their most needy times, and they will look to you to be able to confide in, to help them and to provide them with guidance.”

Yet that honor can come at a steep cost, and Dr. Kamin admits that some of the things he’s seen keep him awake at night, long after he’s left the ED. “There are plenty of times I go to bed thinking about people, and there are plenty of times I wake up thinking about people.”

For most everyone in the department, some of the more difficult things they see can take a toll. Assistant nurse manager Gloria Valentino acknowledges that over time, staff members learn to be strong and compartmentalize those images. But it doesn’t always work. “There’s always one or two that hit close to home; maybe they act like your child or look like your mother. I can still see those patients in my head today, years later.”

For Valentino, one of those patients is a young boy who died. “I remember thinking to myself, ‘His eyebrows look just like my son’s and his face looks just like my son’s. If this ever happened to my child, I don’t know what I’d be able to do.” And then she looks away and quietly admits, “I still remember that particular boy, and those days are hard.”

Perhaps that is why many of the nurses only work three 12-hour shifts a week, to ensure that they don’t burn out from the stress and intensity. “I think because of the job we do, you can’t be here five days a week. Everybody who comes in is coming in to complain about something – something emotional, mental or physical. It is very hard because you’re emotionally putting yourself at different levels every time, and as a nurse, you’re really the first responder.”

To temper that, most of the ED staff find personal outlets to provide relief, and all say that maintaining a sense of humor is necessary. Also helpful is the fact that their patients are often humorous and good-natured, despite the reason they’ve come to the emergency room.

Among those is 69-year-old Mary Ann McLaughlin. She’s in fairly good spirits, considering that there is an angry-looking puncture wound surrounded by a baseball-sized lump on the top of her foot. Though it looks like it hurts, McLaughlin smiles and she quips that it’s not too bad and that she’s a “tough broad.” Then she points to her foot and says, “That’s what Batman did to me. He’s supposed to help people and save people, isn’t he?”

The Batman in question is a 30-pound, 8-inch brass replica of the Caped Crusader belonging to McLaughlin’s nephew. Perched on the edge of a stereo subwoofer, he came down full-force on her bare foot after she accidentally knocked him down.

She’s waiting for an X-ray and has been told she’ll need a tetanus shot. Superhero or not, Batman can apparently still carry germs. McLaughlin is optimistic that her foot isn’t broken (perhaps overly so judging by the looks of it) and insists that no matter what the outcome, she’ll still have to be at work at 5 the next morning.

Also seemingly immune to what appears to be a pretty gruesome injury is 18-year-old Giovanni Rand, who sat down on a school bench that had a piece of metal sticking out, and nearly sliced off his finger. He’s just been stitched up and shows off the offending digit, complete with a neat row of five Frankenstein-looking sutures.

He appears nonchalant about it all. His mother, Lauren, who sits beside him, says that because he had finals, he refused to seek treatment until after his school day ended. And continuing to be studious, he did his homework while waiting for the stitches.

Giovanni shrugs off any suggestion that the wound is a painful one and says it was such a clean cut that he didn’t even feel it until he saw the blood. Though he bled most of the day, according to his mother, he simply “toughed it out.”
Injuries like Giovanni’s are commonplace and more often than not comprise the bulk of the cases that come to the ED. “It’s not life or death every day,” says emergency medicine physician Dr. Heather Sibley. “Sometimes it’s just primary care.”

When it isn’t, then it becomes a matter of rising to the occasion and doing the job to the best of her ability. “You have to have a mechanism by which you say, ‘I’m here to practice good medicine, to be the best doctor and human being that I can be, and to serve other people. That’s what I have control of.”

And for those things over which she doesn’t have control, she must find acceptance.

“We work in the Emergency Department and people die here sometimes. That’s just part of what we do. You have to be able to accept that you’re not in control of every single thing. Death and bad things are a part of life and I have to be able to do my job and get up the next day and function.”

Though Dr. Sibley can’t change what happens while she’s at work, she said that her work has changed her.

“It makes me savor every moment. In a moment, things can change; people’s lives can change. You have someone come in who’s short of breath and then you’re giving them a cancer diagnosis and changing their lives forever. It makes you go home and say, ‘You know what? I’m just happy to be here.’”

It is late evening and the heat is finally starting to recede as 49-year-old Miguel Velasquez comes to the UConn Emergency Department. It has only been a matter of weeks since he had three stents put into his heart and he is suffering from chest pain and shortness of breath. In a treatment room, he lies on a bed with oxygen flowing into his nose. Beside him sit his wife and 1-year-old daughter in a stroller.

Dr. Kamin comes in and asks how long Velasquez has been feeling this way and how much exertion it takes for him to lose his breath. Though the day is nearly over, in the ED, it has only just begun.