Night Shift: Chaos


The ambulance blasted its grinding foghorn siren repeatedly as it rolled around the corner of the hospital to see a private vehicle blocking its path to the ambulance bay.

“Get out of the damned way,” the EMT actually screamed at the old man who was unloading his hunched over wife into a wheel chair.


“I’ll take your wife into the registration, sir,” I said to him as I was walking past to go to my shift.  “You really have to move your vehicle right now.”  The EMT let out another loud blast just to emphasize my point.

“Oh, oh, oh, ok”, the man muttered shaking his head in confusion.  I dropped the patient off at the line waiting for the registration desk and got my first look at the packed waiting room.  Everyone looked angry.  There weren’t even enough seats for everyone to sit down.  The home football team on the television was even taking a shellacking.

“Shit,” I mumbled under my breath.  This was not going to be a good night.  When I got to the nurses’ station, the doc I was relieving already had his coat on and was standing by the computer.


“I don’t have any patients to hand over.  Sorry for the mess.  But my wife made dinner arrangements and I can’t be late.”

As soon as I looked at the tracking board I mumbled another expletive.  It didn’t look like he had taken a new patient in the last hour and a half.

Then the coup de grace came around the corner — my early night PA.  The absolute nicest person in the world.  She was so thorough.  She ordered every possible diagnostic test.  And wanted to discuss every patient with me to make sure she wasn’t missing anything.  Working with her was like swimming in molasses.  Sweet, but deadly.

“Oh, hi, Dr. Plaster,” she said cheerily.  “I was looking forward to working with you.”


All I could muster was a strained grimace.  I was going to drown tonight.  I was just praying I didn’t take anyone down with me.

I had barely signed into the computer and started to scan the patients when the nurses started to line up with questions.  ‘Work the problem,’ I said under my breath.  ‘Eat the elephant one bite at a time.’

“Why are you talking about eating elephants?” the first nurse asked indignantly.  Lois had been a nurse for over 40 years and looked as if she had eaten a few elephants in her time. But now she was looking at me like a rhino about to charge.

“It’s just an expression about patience in chaos,” I said with an apologetic grin.

“Well, ok then,” she said breaking the tension with a big grin herself.  “Because if you were talking about taking a bite out of this elephant, I was going to kick your ass.”  I just smiled and gave her a thumbs up.  “The guy in room 12 wants to know what his bill is going to be.  He says that the price of gas has doubled and knows we probably raised our prices too.”

“I don’t know,” I moaned.  “I don’t know how much any of this stuff costs.  Tell him I feel his pain.  But if he really has to know he’ll have to call administration.  That’s their problem.”  She stepped out of line with a cynical shrug.

‘If the rest of the problems are like that one,’ I thought, ‘we might make it through this night after all.’

“The 50-year-old lady in room 5 was just diagnosed with COVID,” Jack, our most aggressive nurse said.  “Mild symptoms for two days.  Pulse ox is fine.  The PA wants to get a chest CT.  With our back up that means she will be here another four hours at least just taking up a bed.  I want to send her home.  But she wants you to write her a prescription for Ivermectin.  I told her it was worm…”

“I’ll do it,” I cut him off.  “Next?”

“You’re going to prescribe a ‘horse dewormer’ for COVID?  The studies don’t show…”

“I’m familiar with the studies,” I said.

“Administration will come down on you.  You might even get a complaint to the state licensing board.”

“I can handle that,” I said holding up my hands in a signal to stop his protesting.

“I’m proud of you standing up for patients’ rights,” Brandy said, who was standing behind Jack as he walked away shaking his head.

“I’m not standing up for anyone, but me,” I said.  “I still have to live with my wife.”  Brandy gave a ‘he knows what’s good for him’ look.

The story of my little controversy with my wife last month had gotten around the department.  “Behind everyone good man stands a woman,” she said.  “With a gun.”

“You better get crackin’, Dr. Plaster,” the charge nurse said as she passed the dwindling line.  “We are losing about half of our beds after midnight.”

“Wait,” I begged.  “You can’t do that.  Have you seen the waiting room and the ambulance line up?”

“Can’t help it,” she said with a shrug.  “The administration put almost 20% of the nursing staff on unpaid leave when they refused to get the vaccine.  Most of them got sick with COVID early on and feel they are immune now.  The rest are worried about how it might affect their fertility.”

“I get it,” I said softly.

“And they just don’t want anyone telling them what they have to put in their bodies.  And some of the staff who have had the vaccine are siding with them and calling off just to show solidarity.”

“I get it,” I said loudly with a resigned look of frustration.  “But here we are with the patients caught in the middle.  I just hope that no one gets hurt by this, patients or staff.  Whoever in administration thought up this policy had never tried to force a strong woman to do something against her will.  It never works.”

I tried lightening the mood by saying, “I understand that there is a new therapy from Pfizer, that could soon be available, that we can use to treat patients in the early phases of COVID,” It sounds like the perfect drug.  In the study I read it completely prevented death from COVID, prevented 90% of COVID hospitalizations, wasn’t promoted by any politician, and was expensive as hell.”

“What could be better?” Brandy said cynically.  “And the birth defects caused by the drug are catastrophic, leading to massive awards for rich lawyers.”

“I hate to interrupt this wonderful exchange of ideas, Dr. Plaster,” said the charge as she passed yet again.  “But we really need you in room three.  It looks like another drug overdose.”

“We’ve really been hammered by drug overdoses in the last several months,” Brandy puzzled.   “With a real spike in OD deaths.  Those that do survive to the ED are taking more Narcan to wake up.”

“I had a patient like that not long ago.  He was a big guy and even after we counteracted his fentanyl he was still hyperventilating while claiming that he couldn’t breathe.  It turned out to be fentanyl induced pulmonary edema,” I said with a mounting fear.  “I don’t really need this tonight.  He’ll probably need some sedation, a lot of diuretics, and a vent.  And don’t let security get involved with trying to hold him down.  We don’t need another round of riots.”

“Are you ready for this?” I said.  “Let’s go Brandy.  Let’s, see if we can make some order out of this chaos.”



FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 years in emergency departments across the country. During that period, he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.


  1. I can certainly relate to walking into chaos and restoring order. I would draw the line however at prescribing placebos such as Ivermectin. I have been quoted in the past as saying to my patients I’m here to help you if I can. Im not here to make you feel good.
    Kelly Robinson MD FAAEM (and night doc exclusively for the past 5 years)

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