The Hallway Seat

Our emergency department, including our express department, consists of thirty-six rooms, four nursing stations and three physician stations. Within the three physician stations, there are nine available computers strictly to be used by the ER team--the attendings, the residents, and the PA/NP extenders--during their shifts. We also have a consult area, a comfortable room with five more available computers, to be used by physicians visiting our ER to admit their patients.

You would think that with so many available computers, there would not be a lack of space to sit down and accomplish your work. But, unfortunately, this is simply not true. Because of the ever-evolving list of admitted patients, the consult room is typically filled with ancillary-service physicians. And between our emergency department coverage of multiple ER attendings and residents, it is rare to have an open, unused computer in our physician stations.

Sometimes, when I show up for a shift, it may take me fifteen minutes to sort out who is working at each computer station and which one might be available for my use. Although I don't enjoy it, I've even had to pull rank on some of the interns and medical students, kicking them off, just to have a place to sit. They understand my predicament, of course, and I try to do it in a respectful way. Still, though, that wasted time and energy can be a frustrating start to a shift.

One of the working solutions? As a result of the shortage of physician computers, we now have three additional laptop computers. They sit on a wheel-based pedestal and are easily plugged in and transported through our ER.

Enter one of my partners and her brilliant idea.

One day, out of her own frustration, my partner decided to set up her own work station. She grabbed one of the laptops, plugged it into an outlet in the main nursing station, and set up the computer just outside of the station, along a stand-up work counter. She got an extra phone and set it on the counter, facing her. She also found a two-foot by three-foot wood-paneled tray and cleaned it off, creating her own little desktop. A comfortable chair completed her newly-furnished work area. To really add a polished touch, she ran to the gift shop and bought herself a couple of carnations, trimming their stems and placing them in a make-shift dixie-cup vase alongside the phone. Compassionate and classy. What a combo.

Not only did she have her own work-space, but it was also an ideal setting for her to keep her finger on the pulse of the ER's activities.

It took a little getting used to, but slowly, the presence of her sitting in the hallway along the counter, just outside of the busiest nursing station, gained favor. From her viewpoint, she could see ambulances arriving and departing, talk directly to the nurses responsible for the most critical patients, and, most importantly, have direct access to the most important person in our department, the unit secretary, who sat just ten feet away. How perfect. And from the staff's point of view, it was nice to have an available physician right in the open.

One day, a few weeks later, after she had finished her shift and I had arrived for the start of mine, I couldn't find an available computer. I looked at Shirley's work station, immaculately clean and empty, and decided to give it a try.

"Shirley," I said, calling her cell phone from the counter phone, "it's Jim. Do you mind if I sit at your work station during my shift today?" I felt I owed her the phone call, out of respect for her diligence in making this new space. Shirley couldn't have been any more gracious. She was actually excited about someone wanting to experience her invented area. "Of course, Jim. And thanks for calling and asking. Anytime I'm not there, feel free to use it."

Slowly, I started using this work-space when Shirley wasn't. It quickly became apparent to me why Shirley enjoyed this spot so much. I didn't feel walled-off from the ER's flurry, sitting in the closet-sized physician stations. Instead, I sat quietly within the hectic pace of the ER, thriving off the frenzied energy that surrounded me. I accomplished my work with a new vigor and gained a new appreciation for our hard-working staff.

I knew I became a mainstay fixture, like Shirley, when I came in one day to find several folded, colored Kleenexes stapled into the shapes of flowers, sitting on the counter and welcoming me to a new shift. I looked at all of the laughing nurses, wondering which one learned such a useful talent in high school while serving on the prom committee. Probably Ken.

Still, there are some downsides to sitting out in the open. Sometimes, on the crazy days, the spillover patients from triage, at the end of the hall, will direct their angry gazes at me. Because I sit in the easiest-to-find place, nurses will often run to me to ask me to see a critical patient or show me a concerning EKG. Likewise, I might be the first one a patient or their family encounters to complain or ask a favor from. Sometimes, I return to my workspace to find a closed-container of urine or vials of blood sitting on my desk, waiting to be sent via our tube system to the laboratory. Just a few shifts back, while waiting for a room to open, the paramedics had taken my empty chair and given it to a drunk guy, who had just shit himself , to sit on. UGH!

Yesterday, though, was probably one of the hardest times I've had to date. While a family mourned the unexpected loss of their mother in the room directly across from me, a schizophrenic patient in the room next to them was yelling obscenities and acting out in the worst of ways. Despite closing his glass door and administering intramuscular medicines, he totally disrupted any peace we attempted to create for the saddened family. We had no other available rooms to move the schizophrenic patient to, unfortunately, and watching this family's misery deepen from his erratic behavior and yelling was upsetting to all of us.

I would not have witnessed this had I been in my corner of the physician's workstation.

Still, the good outweighs the bad, and I thoroughly enjoy my new seating arrangement. I wonder, though, if any of you have had similar problems in your work environment. Especially the ER setting. If so, how have they been solved?

Thanks, Shirley, for a great alternative. I owe you a bouquet of carnations!

For the next few days, if you need to visit your local ER and just happen to find a doctor sitting in the hallway doing his or her work, it's probably Shirley or myself. A buzzcut? That would be me. A pretty woman with highlighted, straightened hair? Shirley. Feel free to stop by and say "hi."

Just don't complain...

As always, big thanks for reading. Next post will be Friday, April 23rd. May the rest of your week by good...