Patient care the ‘nucleus’ of Wilcox emergency room

LIHU’E — To get an idea of what the emergency room (ER) at Wilcox Memorial Hospital is like, try to picture yourself inside an atom.

It is a place of almost exquisitely controlled chaos, electrons and neutrons flying around under the guise of medical personnel whose nucleus is patient care.

“Emotionally and physically, you always have to be ready. You never know what’s coming through the door,” says registered nurse Patricia Brooks. “It’s not for everyone. It’s almost like an art form. It’s orchestrated chaos,” said Brooks.

A recent weekend night in the emergency room brought a nearly-full moon. Nurse Judy Byfield, a 27-year veteran of the emergency room, is all too familiar with full moons. You never know on a full moon. You don’t mention the “Q” word — quiet — she said.

When Byfield started, the emergency room was basic: one doctor and one nurse. Now, the databases talk to each other. On this evening, there are at least a half-dozen nurses, and Dr. Erik Schumacher at the helm.

There are crash carts and monitors and patient-identification labels being printed. Somewhere, often, a phone is ringing.

For Byfield, some things have changed. “It’s much more intense now. The technology has grown by leaps and bounds.”

Some things haven’t. “The kids are the hard ones. You cry on the way home, and then you come back.”

Forget what you’ve seen on TV. An emergency room fills up like guests entering a home from different portals. Some arrive by ambulance, others walk in. They all go through a triage process. If you have a runny nose and didn’t get into the Kauai Medical Clinic before it closed at 5 p.m., you are going to wait awhile. ER personnel know some patients will arrive from hearing communications on the emergency-radio system from American Medical Response paramedics.

A woman who took a bad fall, reportedly chasing her child, is in one room. Brooks, who said what makes the emergency room exceptional is the professionals’ team-work and selflessness in putting care where it’s needed, is proven right.

Nurse Jeanette Austria is with the woman who sustained a concussion. Other personnel fly in and out. There is no duplication of effort. All hands are doing what they need to do.

The concussed woman requires multiple X-rays and a CT (computerized tomography, or CAT) scan. Schumacher is here, then he’s there. He’s telling a relative of the woman what to expect. Then he’s gone. It is not so much abruptness as it is efficiency. There is an elderly person with severe abdominal pain, and a man with a cardiac problem.

There’s a trauma victim here, and an elderly woman there.

The ER has 20 beds, and it is hard at any one time for those outside the atom to know who’s where.

There’s an ever-changing “tote” board behind the counter, indicating who’s where in which room

While Byfield and Austria are home grown, Brooks is from Philadelphia, and Felix Militante is from New Jersey. Both have been at Wilcox for less than a year. Brooks needed a change of pace. She worked at two innercity hospitals in the City of Brotherly Love and, as she puts it, “I got tired of helping people with gunshot and knife wounds get better so they could get shot again. It wasn’t why I got into nursing.”

The ER at Wilcox is, according to industry standards, among the top 100 among rural hospitals nationwide. It also garners high satisfaction ratings from patients who are surveyed after their ER visits. Brooks is a veteran of high trauma. Militante is a new-comer.

Right now, he sits quietly with an elderly women, trying to make her more comfortable.

He, like Brooks, Byfield and Austria, hail the teamwork, and enjoy the fast pace. He conceded the ER has life-and-death aspects, which he says comes with the job.

ER nurses work three, 12-hour shifts per week.

Militante says he sometimes goes home and dreams of what goes on in the ER. “It’s hard not to take it home with you,” he says.

Last week was Emergency Nurses Week. The nurses were recognized by hospital leaders, and given gift certificates.

Militante says he does not think members of the public know what it’s like to be an ER nurse.

“I don’t know if they know how truly hard it can be.”

Schumacher is joined later in his shift by Dr. Chris Elliott, who is so young-looking and smooth-skinned that it’s hard not to think of him as Doogie Howser. That is, until he starts seeing patients.

His approach is clear and incisive.

Elliott is a new arrival from Miami. Like Brooks, he is very glad to be in a place where mutual respect between patient and physician is the norm rather than the exception.

“It’s nice to be treated like a human being,” he says.

Meanwhile, a gurney rolls by, and someone exits. To where? It’s unclear.

According to the nurses, ER staff members are among the most versatile of practitioners. Some nights they give out Band-Aids. Other nights, like this one, they are operating cardiac-support equipment and treating trauma patients.

“We have to have very good assessment skills,” Brooks said. The shear detail of what happens in a ER is staggering. Dye cannot be entered into a patient’s blood stream until a kidney function test is done. Schumacher and Elliott have to keep track not only of patients and paperwork, but of mechanic dosages and nurses’ questions.

How much albuterol? This patient’s blood pressure keeps dropping. Why? It’s the morphine. “Trish, can you help with this? Felix, can you cover room four? Judy, are you busy?”

Schumacher keeps up to pace with everything by categorizing patients by their conditions.

They say no one can be two places at once, but RN Michael Barroga manages.

When Brooks says “everyone knows their jobs,” she’s not kidding.

Barroga does whatever is needed of him, from assisting with delivery of a patient to X-rays to administering the “Popsicle test.”

There is a little girl in a room under observation. Barroga gives her a Popsicle to determine if she can keep it down, and how it will interact with medication. The Popsicle and Barroga disappear.

Dr. Mark Magelssen is the medical director of the ER.

Two things about him.

Like Brooks and Elliot, he had done his time in heavy trauma. Magelssen used to work at The Queen’s Medical Center in Honolulu. He’s been on Kaua’i for about two years, and says, flat out, “The Wilcox ER is a very wonderful place to work. There’s a nice balance here,” he said. “We feel very lucky to have this job. The people at Queen’s envy us.”

The other thing to know about him is that he says ER doctors are a bit of a different breed. His screen saver is a surfing image. “ER docs have pictures of their families doing stuff. A lot of doctors just show their diplomas.”

ER personnel have state-of-the art software that allow them to review patient records on-line, including latest CT scans and X-ray history. Moreover, they can get immediate assistance from other doctors online if they need an X-ray read or an expert opinion.

As prepared as ER staff can be, things happen. Bad things.

Magelssen remembers a very night, prior to the new CT scan machine. The old CT scan went down for a while. There were critically-ill patients waiting to be air lifted out, but the air-transit plane crashed. The critically-ill patients were unable to get off-island for care. Two of them died. It’s the kind of thing an ER doctor does not forget.

But, as Byfield says, there is the funny stuff as well. One nurse says that, since Kaua’i is a honeymoon island, the ER often gets patients with urinary-tract infections from, well, overuse of passionate equipment.

Then there is the bantering and caffeine-drips, and the small payoffs.

The little girl, the one who passed her Popsicle test, gives everyone a big smile and thank you as she leaves with her family.

Her voice hangs in the air a moment, and is replaced by a gurney being moved into a room, two nurses and Schumacher not far behind.


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