The Unfortunate Incident - Part One

The subject matter of this post is unpleasant but I feel strongly that this episode in my life be shared.

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It was a sunny spring afternoon in Dallas, 1986 when the care-free, happy-go-lucky, "here-for-a-good-time, not-a-long-time", twenty-six-year-old, party-girl grew up.

I was at work when another nurse told me that I had a phone call... "It's the Dallas Police" she whispered with urgency as she covered the receiver with her hand.

I guess there was no way of candy-coating what he was about to say. The officer on the line identified himself and said "Are you Diane Smith's (not her real name) roommate?" I told him that I was. "Well Ma'am, I'm sorry to say, Diane's been raped and is at Parkland's ER" he said. When I asked if she was alright, he just said,  "she asked that I call you". I knew her ability to speak was a good sign.

Parkland Memorial Hospital was the only Trauma Center in Dallas County at the time and although they had not yet installed metal detectors, from the looks of things...they could have used a few. A consistently overcrowded county hospital, it was known for treating the hoards of indigent and President John F. Kennedy. When I finally found Diane, she was curled up on a stretcher in the hallway. Alive, alone and crumpled into a heaping mess of tears, blood and dirt.

Adult Lesson #1

Always listen to your inner voice.

Diane had been riding her bike around White Rock Lake. She told me that on her first loop of the lake, she saw a guy that "didn't look like he belonged there". "Everyone else was walking, running, skating, whatever, but they were doing something. He was just standing there". "I should have known". It was on her second loop of the lake that the same guy hid in a thicket of bushes, kicked her bike over and dragged her into a wooded area where he proceeded to rape and beat her.

With a hunting knife held to her throat, Diane's assailant threatened he would kill her if she made a sound. She said that she was stunned, shocked and could barely breathe with his weight on her. During the rape, she told me that her mind "went to another place. It was like I wasn't really there. I remember thinking of how my body would be found, what the newspaper headlines would say, how mom and dad would take it, when would you find out what happened to me" she said. "I guess I must have been moaning or something because he punched me hard in the face. That's when I 'woke up' and knew that I had to think of a way to get away." Eventually, Diane was able to talk her rapist into allowing her to sit up "just to get my breath" she said. It was then that she took the opportunity to "run like hell".

Bleeding, dirty and naked from the waist down, she ran out into an open area of the park. Screaming for help. She said, "Everybody ignored me. I guess you couldn't really blame them, because I looked crazy, but...a lady with a baby in a stroller literally turned in the opposite direction when I begged her to help me" she said.

Adult Lesson #2

"Be not forgetful to entertain strangers for by doing so, some have unwittingly entertained Angels." HEBREWS 13:2

"It was a Wino" who finally came to her rescue. He retrieved newspapers from a trash basket for Diane to cover herself with, then brought her to his "Winette" who stayed with her as he went to get help.
 

Parkland 9: Medicine ER

This may not be Parkland's Medicine ER - but it sure looks a whole lot like it

Imagine a place with no windows, whitish-gray walls and fluorescent lighting to match the pale environment. Now, add more sick people than you have space for – all stretcher spaces occupied so treatment is frequently administered ‘chairside’. Include the incessant cacophony of people wretching, cursing and howling in pain. Layer that with the shrill sounds of various monitor alarms, telephones ringing, call lights being activated and overhead pages. Include the constant staff discourse, debates and dialogues in this equation. You're in Parkland’s Medicine Pit

In the 80’s, “Medicine” was home to anything that didn’t fall into the other Parkland ER Specialties. The chief complaints were varied and frequently complex and you could bet that diabetes was involved. Cardiac patients within hand-holding distance of a drug overdoses, next to AIDS patients beside TB patients. The numbers of patients seemed endless and prioritization of care was paramount.

Medicine was staffed with three (or four if you were lucky) nurses, one PCA (Patient Care Assistant) and one Unit Clerk.

I learned early on that with as many very sick people that we had to treat, doctors who attempted to ‘bark’ orders to nurses were deemed unacceptable. It was not uncommon for a nurse to tell a doctor to “get it yourself” when the request was non-emergent. And they did. The more clever doctors were respectful towards the nurses and their role.

I also learned to appreciate the tone of three very different cries. The cry of pain, the cry of despair or grief and the cry for attention.

It doesn’t sound like a lot of fun but, for a young, enthusiastic ER nurse – Medicine was a challenging and interesting beast to tame.

Parkland 8: OB-Gyn ER

Parkland's OB-Gyn ER was the place to go should you be pregnant, in labor, sexually assaulted, having ‘female problems’, think you’re pregnant or somehow ‘lost’ something or other in your va-jay-jay. Next to Psych, I can safely say that OB-Gyn ER was my least favorite of the five designated ER specialties at Parkland.

OB residents were able to communicate with paramedics via a radio that was set up in the ER so we were lucky to have a heads up on what was going to hit the door via ambulance but all too often our OB Gyn patients would arrive by car, pick-up truck or bus.

Over 8500 babies were delivered at Parkland in 1980 – each and every mom was admitted through Parkland’s OB Gyn ER, staffed with a PCA, two ER RN’s and an OB Gyn Resident.

Sadly, many of our full term moms were under 16 years of age, had not received any prenatal care, had no idea how they got pregnant in the first place and refused physician examination. Any way you looked at it – their pregnancies were a result of rape. Who could blame these children for refusing an exam? As there was no way to determine their stage of labor, they would be instructed to ‘walk the halls’ of the ER until their water ‘broke’ or they felt they needed us. I saw more than one pregnant child checking into OB Gyn ER with a baby doll under their arm, and witnessed the look of terror on more than one thirteen-year old girl after giving birth.

Suffice it to say that (through my eyes) there was not a lot of ‘joy’ in Parkland’s OB Gyn ER.

Parkland was the designated hospital in Dallas County for rape exams and (unbelievably today) D&C's were routinely performed without sedation or anesthesia. Brutal.

Recalling Parkland's OB/Gyn ER brings back far too many sad memories of poor women who had to endure abuse, neglect and objectification all because of their gender.
I could go on forever.

The good news, is that things have changed. Hospitals throughout Dallas County are sharing the burden of rape exam through the SANE (Sexual Assault Nurse Examiner) program and D&C's without sedation or anesthesia? I would hope not.

On a lighter note –
The radio system was not great in OB Gyn and there was a lot of static when the call came in from Dallas paramedics… “Parkland – we’ve got a full term female, shot with two arrows.” The OB Resident (clearly on the brink of becoming unglued) responded by excitedly saying “Don’t bring her to OB …go to Trauma Hall!” The paramedics responded affirmatively. Trauma and OB Docs, nurses and techs were waiting for the arrival of a very bad situation. When they arrived – there was no evidence of penetrating trauma, arrows or anything else other than a woman in labor. The story goes that the pregnant woman was Native American and her last name was “Shot with Two Arrows”. Crisis averted.

Parkland 9: Medicine

Five GSW's

It was about 5 am and the drama had died down in Surgery ER. Most all of our patients were in the OR, the ICU, transferred to an in house bed or were *OTD.

We were pretty well ‘done in’ and several of us had been sitting on stretchers, when the overhead page came from triage… “Surgery... Five *GSW’s on the dock.”

Hopping off our stretchers and steering them towards the front loading dock, we found five, well dressed women wailing in pain and anxiety, who had been shot multiple times and literally dumped at our front door.

Each nurse scooped up a patient and snagged a *PCA, intern and/or medical student. We headed for an available trauma room and got busy.

My patient was agitated and howling so loudly that any attempts to calm her fell on deaf ears. Ours. Her loud and incessant wail was heard throughout Trauma Hall. Calming her was necessary in order to deliver good trauma care and to improve her outcome but it was more important to do what we were trained to do. Oxygen, IV’s, monitoring and diagnostic studies were initiated. Exposing every square inch of her body was necessary to determine any unknown wounds or injuries.

It was at about that time that I learned my hysterical patient was going to be alright. I also learned that ‘she’ was actually ‘he’ and I was surprised to notice how my approach to calming ‘him’ was markedly different than how I attempted to calm ‘her’. Food for thought.

Word travels fast down Trauma Hall and the same discovery was being made at about the same time in each of the five trauma rooms.

Luckily, all five GSW’s were not mortally wounded and would be OK. Unluckily, their wives were on their way to the ER and our patients were getting a little nervous.

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*OTD - Out the Door
*GSW - Gun Shot Wound
*PCA - Patient Care Assistant
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Parkland 7: Surgery ER Orientation

Parkland’s ‘Surgery Pit’ was divided into three separate hallways, each hall had an assigned RN and each hallway wound up connecting to one long corridor that we unimaginatively named "Front Hall". Front Hall was where it all happened. Two Unit Clerks (secretaries) ran the show along with the assistance of the Pit Boss, assigned RN's and everybody else.

I learned early on that Parkland's Unit Clerks could make you or break you and it was in your (and your patient's) best interest if you communicated clearly and respectfully with them. The amount of information that they processed simultaneously was awe-inspiring and they 'set the tone' for your shift. Unit clerks were responsible for tracking down doctors, nurses, interns, respiratory therapists, housekeeping and who-knows-else all while having to answer the telephones that rang incessantly, patient call lights, placing "stat" Dr's orders, dealing with irate, drunk or stoned patients and/or family members, calling radiology, lab, blood bank ...and the list goes on. Only the best Unit Clerks worked Surgery Pit.

Surgery ER Orientation:

• Trauma Hall: Had about nine fully equipped trauma rooms - one of which was outfitted for both pediatric and adult trauma. At the end of Trauma Hall, a door would lead to the Helipad. The patients who were triaged to Trauma Hall were in critical condition or had a very high likelihood of deteriorating rapidly. Many of our patients were in Trauma Hall as the result of Motor Vehicle Crashes, Penetrating Trauma (Stab, Gunshot wounds) and Burns. Trauma 1 was a room reserved for only the worst case scenarios. It was where John F. Kennedy was cared for.


• B Hall: About 10 rooms designated for high acuity surgical cases


• C Hall: About 10 rooms for low acuity surgical cases
  [my room numbers may be 'off'' ... as my memory can be 'fuzzy']


• Front Hall: Unofficial stretcher spaces along the front corridor of Surgery. Usually reserved for 'stable' people who had been stabbed in the chest (and the like) and were scheduled to have repeated chest xrays in six hours. If their condition had not worsened - they would be discharged. Parking these patients in the hall would "free up" exam rooms for others.

Front Hall was the place where docs, RNs, medical students, secretaries. PCA's and whomever else might be hanging their hat in Surgery Pit on that particular shift would congregate. A good PCA (Patient Care Assistant) was worth their weight in gold. They were an integral part of the team effort and I don't think I ever told them just how much they were valued. Just thought I'd mention that.

One night when we were running full tilt. I was the assigned “Trauma Hall" nurse. And then, "The Bus Let Out” (a familiar phrase used when we suddenly got an onslaught of patients). Our trauma rooms were filled simultaneously.

Fatigue-wearing. healthy-looking people showed up looking like they were ready to work in the trauma rooms, I took advantage of their presence...“splint this, apply pressure here, draw a ‘crit’for me, watch this guy, take vital signs, bag him…” They understood my language and seemed to know what to do. It wasn’t until around 4 am that I thought to ask one of them, “So, who are you guys anyway?” They were medics in training with The National Guard.

My last night shift in Surgery ER was like any other. Sick and injured people. A lot of them. Counting was just not done - no time - our mission was to keep our heads above water, stay alert for any clinical changes in our patients' condition and to be prepared for what might hit the door next.

He was a tall African American man in dark clothing and in obvious distress - pale, leaning forward, clutching his abdomen, his staggered gait forebode impending collapse - an acute abdomen, to be sure. Swinging out of C-Hall, I spotted this man who apparently knew exactly where he needed to be - as he had bypassed triage and security to present himself to our Surgery Pit.
"Sir! How long have you been in pain???" I hollered out as I rushed towards him in order to get him on the nearest stretcher. His response was somewhat terse... "Ever since I got shot!".

Ahhh. Parkland.



Parkland 8: OB-Gyn

Parkland 6: Pedi ER (Part Two)

Lesson in Humanity

It was as busy as every other night in Parkland's Pedi ER and we were (yet again) overworked, overstressed and coping when along came Rhonda and her 2 year old son. These two were “Frequent Flyers”.

“Frequent Flyers” were people who were well known to several ER staff. Despite having to wait for hours to be seen for a minor chief complaint, the frequent flyer would hang in there and be treated for “God-knows-what.” Generally, their complaint of the day was not even close to being an emergency but they perceived any minor ache, sprain or pain as life threatening. When the minor ache, sprain or pain was involving their child – it was frequently magnified beyond reason.

When the discharge instructions were something along the lines of …”Go home, he has a virus, give him Tylenol for fever and have him drink plenty of fluids.” It was usually met with disdain as they were expecting a leukemia (or worse) diagnosis and they had “waited all this time for that?” You got me. I thought they would have been happy that Little Johnny wasn’t going to die but …

While I’m on this topic … It really miffed me when a parent would respond to my instructions to administer Tylenol for fever with... “I can’t afford it” yet they would be carrying cigarettes with them. They expected and would demand a prescription for Tylenol. Medicaid would pay for it. Over time, I just realized that I wasn't going to change them and I got over it.

You may think I sound disconnected, callous and arrogant. I was. Detaching myself from the human condition and its vulnerabilities was an effective way to cope with the incredible numbers of needy people. It worked. For a while.

On this particular night in Pedi ER, Rhonda and her son had been seen by the doc. I casually walked in to give her the same discharge instructions she had received time after time again. As I read the instructions to her, not making eye contact and caring less for her and her son than the kids who were “really sick”, I added, “follow up with the Pediatric Clinic at Children’s Hospital tomorrow morning”. Rhonda burst into tears.

In a lapse of arrogance, I looked into her tear filled, mascara smeared eyes and asked her why she was crying. "I work at night and sleep in the daytime" she said. It was apparent to me that she was little more than a child herself. I asked her how old she was…”17” she said and then the floodgates opened. Rhonda unfolded the story of her life. It sounded like a bad movie plot... pregnant at 14, kicked out of her parents house, met a guy who took care of her, turning tricks for a living, trying to be a good mother.

Listening to her, it came to me that her visits to the ER at night were a respite from her life. She didn’t have to “work” and she and her son were safe and relatively comfortable in our overcrowded Pedi ER.

Was the story for real? Who knows? I've been told a lot of stories. But on that night I made the conscious decision to look into my patient's eyes again.

What have I seen? A lot people choose the ER as a respite from their lives.

Parkland 7: Surgery Orientation

Parkland 5: Pedi ER (Part One)

Many moons ago, Children’s Medical Center in Dallas did not have an ER. They did have a clinic that was open during business hours, however. That meant that Parkland’s ER would always take Pediatric Trauma and it would manage all other Pediatric Emergencies daily from 4pm until 8am and 24 hours/day on weekends.


For a nurse with one year of ER experience, Pedi ER was scary but remains as one of the best clinical experiences I have ever had.

Opening daily at 3pm with two RN’s, a Patient Care Assistant (PCA) and a Pediatric Resident, we would prepare for the onslaught of sick children and anxious parents.

The gauntlet of waiting parents and kids sitting on the floor of the long hallway leading up to Peds was daunting. We didn’t have a lot of treatment rooms, so kids with asthma would be corralled into one room, sat side-by-side on two stretchers and hooked up to nebulizer treatments in hopes of an improvement in their condition.

Depending upon the chief complaint, children were seen as quickly as possible. We became expert in a 30 second pediatric assessment - check vital signs, listen to lungs and determine if the kid looked ‘good’ or ‘bad’. That was about it. Documentation was minimal. Starting IV’s and drawing blood even from the tiniest infant was common practice. Infusion pumps were rare back then, so we resorted to the use of controlled fluid administration via a device called a Buretrol that would allow only a specific amount of fluid to be administered – they ‘went dry’ a lot. Pulse Oximetry had not been invented yet (eeek) and our resident would obtain urine specimens by manually withdrawing urine from baby’s bladders via a needle and syringe.

Any Pediatric Trauma patient would be triaged to the Surgery Pit, not Pedi ER. Thank God.

Children that looked ‘bad’ (or worse) would be placed in one of two resuscitation rooms. One RN, a PCA and the doc would work the situation. The other RN would have to manage the rest of the Pedi ER. We would frequently have kids that “looked bad.”
Enough said.

Pedi ER was (at best) nightmarish from about 6pm until 2 am. Compounding an already stressed department with not only the numbers of sick children but also with the persistent crying, overcrowding and rising anxiety level of exhausted parents.


I loved it.

Parkland 6: Pedi ER - Part 2

Parkland 4: Psych

In the 80’s, Parkland’s “Psych Pit” included patients who were mentally ill, suffering from alcohol and/or drug dependency, the homeless, the hungry, and those involved in messy divorces.

Yes. Messy divorces. It was trendy back then that in order to “stick the knife in and twist it” you could have your estranged spouse served with a Mental Illness (MI) Warrant.

The procedure was a simple one…

1. Complete the appropriate paperwork and attest that your spouse is a danger to themselves or others.
2. Have the document signed, before a notary and sealed.
3. Courier the affidavit to the Dallas County judge who would review your claims and then endorse the “MI Warrant” with his/her signature.

Dallas County Sheriff’s Deputies would then be dispatched to your estranged spouse’s home or place of business, handcuff them and take them to Parkland’s Psych Pit. At that time, Texas Law gave the state the right to hold the above-mentioned spouse for 72 hours in order to determine their competency.

Needless to say, we had some very pissed off estranged spouses.

Staffed with one Registered Nurse and one Psychiatric Intake worker – I had been warned by my peers that Psych was "each man for himself". The Psych Intake worker usually hid out in a small booth in the back of the Psych office - the ER Nurse managed the "Psych Pit" and was responsible for ...

• Meeting and Greeting patients, police, sheriff’s, paramedics.
• Crowd control
• Searching pockets, removal of belts, boots, matches, guns, knives and/or anything that could be used for inflicting injury or used as a weapon.
• Initial Psychiatric Nursing Assessment and Documentation
• Medication Administration
• Self Preservation

During my orientation, the topic of “self-preservation” was addressed by the more seasoned ER nurses at lunch…

1. Buy a pack of cigarettes before starting your shift – it will make it easier on you (it was the eighties and smoking was allowed in hospitals).
2. Make friends with your psych patients. They’ll help you out if somebody goes ‘nuts’ on you.

Oh God.

I soon learned that the cigarettes were not for me, but to be used as a way to entice the psychiatric patient into being my friend.

Manipulative? Yes.
What can I say? We did the best we could. We survived.

Parkland: Pedi ER - Part 1

Parkland 3: Triage

There were many nights that as the sole triage nurse and with a gaggle of people lined up in front of me, I would hop off my chair, grab my clipboard and walk the line of sick and injured so that I could pull out those who looked ‘bad’ and triage them first.

“The Public” didn’t get it.

Derogatory remarks pointed in my direction were frequently heard from fit-looking '30-somethings' and exhausted moms. I learned early on that it was best not to respond to 'triage catcalls'. Explaining just how an abdominal stab wound 'trumps' a broken wrist would most likely fall on deaf ears and was a waste of time. You didn’t want to get into it.

Triage is an art. The effective Triage nurse is perceptive, knowledgable, communicative and decisive. An added 'skill' learned at Parkland was the trained ability to "never let them see you sweat".

On my first night alone at Triage, I was approached by a disheveled, diminutive man in a long trench coat. When I asked him how I could help him, he burst out into tears and sobbed – loudly. Heads turned. I paused and again asked him how I could help. He threw his head onto my desk, burying it in his arms. Wailing. There were several people waiting to be triaged and I’m afraid that I was a little less than therapeutic when I said in my most firm ‘Nurse Ratchit’ voice…“Sir. Tell me why you are here today.” With that, he lifted his head, looked me straight in the eye and with a disgusting amount of snot coming from his nose, said… “I have a gun in my pocket and I’m going to blow my head off”. Well then. Triage decision-making time.

- Do I become more sympathetic to the little fella? Yes.
- Do I ask for the gun? No. Could be problematic.
- Do I call for Police backup? Wanted to – Couldn’t do that without causing him alarm.
- Do I make him my friend? Definitely yes.
- Do I offer a tissue? Without a doubt.

So, asking his first name, I introduced myself and reassured him we were here to help him. Then I asked him if he wouldn’t mind if I took the gun from his pocket. Abruptly, and to my surprise and relief, he stood up and assumed the ‘frisking’ position against the wall. I took his lead and began searching him all the while looking back, all big-eyed and mouthing the words, “Help Me” repeatedly. I was trying to get anybody's attention. Nobody bit. Two Dallas Police Officers were having a conversation only about 20 feet away and were oblivious to my dilemma, the clerks at triage were busy entering data into their terminals and the patients in line were waiting their turn, people coming and going glanced in my direction but would just continue on. Not one person so much as raised an eyebrow. It was then that I gathered 'frisking' to be an added Triage nursing expectation.

Welcome to Parkland.

I never did find the weapon.

Parkland 4:Psych

Parkland 2: The Times

Dallas Morning News September 1985

The 80's to me, were a lot like the 60's to others.

An inner-city county E.R. Nurse who smoked like a freight train and rarely (if ever) wore a seat belt, I drove a 1979 Pinto, drank way too much alcohol and reserved glove use for sterile procedures and only for the most obvious body fluids. It was the 80's. It was also the time when a poorly understood, spooky new disease was killing young gay men left and right.

If someone had said I was on a path of self-destruction - I would have thought they were nuts.

Parkland Hospital was the only Level 1 Trauma Center in the Dallas area and as a young ER Nurse, I had a need to be there. I was warned that Parkland was 'no frills', the patients were poor and uneducated and that the nurses were 'tough' but I was looking forward to 'a walk on the wild side' and would not be deterred.

I worked the night shift, 11pm - 7am and soon learned that most of what they said was true. Many of my co-workers were in fact 'tough' but they were also compassionate and real.

Generally, my patients were very poor and uneducated but they also taught me more about humanity than they will ever know.

Although we worked hard, we played hard as well. Breakfast tacos and margaritas were commonplace at a Mexican Restaurant nearby named 'Rositas' or a "Grand Slam" breakfast and cocktail could be had at Denny's after work.

But when we wanted to dance on a Friday morning ...it was a dark little place on Northwest Highway where you would never attempt to frequent at night but who opened their doors at 6:30 am. With the lure of mixed drinks, flashing colored lights, strobes and a lit-up dance floor pulsating to the rhythm of the disco beat... cops, firefighters and various health care workers would fill the place. Closing time was 2pm and I can tell you that it was certainly a slap in the face to come outside and into the bright sunlight.

We were, young, single and indestructible. Sleep was for sissies.
Parkland 3: Triage
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Not surprisingly, as of 2008, the numbers are up. The most recent data that I can find is from cityrating.com... Be careful out there.

• Murder = 226
• Aggravated Assault = 8075
• Rape= 601

Parkland 1: The Introduction

"WHEN YOU THINK YOU'VE SEEN IT ALL, WE CAN MAKE YOU THINK AGAIN..."

This was the ad campaign for Parkland Memorial Hospital, Dallas Texas circa 1984-1985. The slogan was on T-shirts and ball caps and included the following text “…we think you can do more, learn more in one shift at Parkland, than you can in a month at a lot of other hospitals. The experience is that intense, that demanding. Nursing at Parkland isn’t for everybody. It’s hard work and there are no guarantees. The Parkland nurse knows that. Instinctively. It’s nursing that tests every skill you have. And some you haven’t.”

I was hooked.

With a year of ER Nursing experience embedded in my stethoscope and despite the fact that I was advised to have my head examined, I was willing to ‘suck it up’ and be a Parkland ER nurse. OO-RAH!

My formal orientation to Parkland’s ER included six weeks of combined didactic and hands-on instruction. My ‘preceptor’ a seasoned ER nurse named Cathy C. was tougher than nails. Once, I thought saw her smile, but soon learned it was just a little gas bubble. Ahem. We were joined at the hip for three long months.

In 1984, Parkland’s ER was divided into five separate ‘pits’ or specialties, all under one roof. Each 'Pit' had a doctor in charge - he or she was referred to as "The Pit Boss" and was a senior resident of that specialty.
Upon reporting for duty, I would be assigned to any of the following specialties on any given shift. Each specialty was unique and had their own set of challenges, but that was why I signed up to be a Parkland nurse in the first place.

Triage: 1 RN + 3 clerks Determine level of acuity of every person and ambulance that hit the door, based on chief complaint, vital signs, gut instinct and/or simply vision. The triage process was simple back then: Chief complaint, name, birthdate (which was optional) and level of acuity – emergent, urgent, non-urgent.

Surgery: 3-4 RN's + 2 clerks + 1 Patient Care Assistant (PCA)
All surgical (or potentially surgical) cases including trauma and burns – considered ‘clean’

Pediatrics: 2 RN's + 1 PCA
All children excluding pediatric trauma (they were triaged to surgery)

OB-Gyn: 2 RN's +1 clerk
All women of child-bearing age with complaint of low abdominal pain, gynecologic issues, pregnant women, and female sexual assaults.

Psychiatry: 1 RN + 1 MHMR (psychiatric intake) worker
Enough said.

Medicine: 3-4 RN's + 1 PCA + 1 clerk
Anything that didn’t fit into any of the other specialties – considered ‘dirty’

And so begins my Parkland Experience…and the nurse with the "gas bubble"? I could only aspire to be as good an ER Nurse as she was.

Parkland 2: The Times