Episode #36: Overcoming Trauma #36: In Charge

Feb,14 2026

<-#35: Overcoming Trauma #35 - Sunday Service Redux

Since I went to sleep earlier than usual, I woke up earlier than usual.

Pacing in the kitchen, I even had time to prepare myself a lunch, so I ended up leaving for the hospital. Better leave early than wake someone else.

I arrived at a tense hospital.

People sometimes arrive for the trauma room out of the blue, but most of them come via ambulance, and as such, we have an advance warning.

Anya, our usual charge nurse, will call out something like "Cardiac arrest incoming, 6 minutes"

When I came in, the trauma rooms were preparing for ambulances coming from a major pileup caused by a semi-trailer losing control and hitting about half a dozen cars.

Firemen were still on site to extract wounded commuters from their cars, and the first ambulance was 3 minutes in.

Right, I usually talk about being in the trauma room, and now, I mention trauma rooms, plural. We have two. We usually operate one, with the other on standby, unstaffed.

But today, I was assigned to room 1, but some of the ER nurses were already prepping room 2, with extra O negative blood on standby.

This was it. This was an emergency that pumped your blood, filled you with adrenaline, and made your month.

I was only scheduled to start 30 minutes later, but this is an all-hands-on-deck thing. I would get paid for this... Plus, this is my jam!

The night shift surgeon was there. He didn't know much about me, but Jane, one of the nurses I respect a lot, filled him in on the day shift specialties.

Hers were blood transfusions. The normal way is to plug a bag of blood and let gravity do its work. Jane is renowned for squeezing the bags to push blood faster, in a way that not only saves lives but also avoids any spills. I honestly don't know how she does it.

The first stretcher arrived, and it was a light case, with the paramedic having done a lot of work to help while in the ambulance.

The second was 30 seconds in when I was tapped on my shoulder.

It was Lucia, one of the ER nurses who sometimes rotates in the trauma room.

"Dr. Jones wants to see you; I am tapping you out", she says.

"Stretcher coming in; it will wait"

"No, it won't. He said, now"

I grunt and leave to find the emergency services medical director. He is the guy who is medically in charge of all medical decisions in the ER.

I want to tear him a new hole, but I have to stay polite. He can bench me.

"You needed me?"

"Elena, it's 5:32, you are now in charge and relieving Portia."

"What do you mean?"

Portia is right there. She tells me. "You are now the charge nurse; here is the incident clipboard. Hilary is our incident commander"

Portia is from the night shift, but Hilary is day shift. I see her on the phone, next to us.

An incident commander is the person in charge of coordinating the communication around the incident.

If the charge nurse needs more blood, the incident commander finds the person who will call for more blood.

"Wait, shouldn't Anya get this?",I said when I noticed that the clipboard was the charge nurse incident clipboard.

"Yeah, but until she comes in, you are the charge nurse now"

The stretcher gets in.

You know in movies how when the hero's world collapses, you can sort of see the camera zoom in?

Well, my vision zooms in on that stretcher, with a paramedic kneeling on top of the stretcher, doing compressions on a patient who is clearly drenched with blood.

My normal job would be to take over those compressions, but now it's to make sure that the stretcher gets to the right room and the right nurse is on the case.

What do you do when the proper nurse has her hands full with a clipboard?

"I've never been the charge nurse", I just tell Portia, because the medical director is already gone, and I'm looking toward trauma room 1.

"Then it's your fire baptism. I am out of minutes; I just about reached the legal limit to work, but lean on Hilary and just decide where each stretcher goes and when to call for supplies"

I look down and see that an emergency crate is coming up from storage. That might help.

I thank her and put my hand on Hilary's shoulder.

"Another ambulance in 2 minutes", she says.

I take the microphone for the loudspeaker and move it to her station.

"Change of plans; you will announce them directly"

"Normally the charge nurse reviews"

"I'll note them. I trust you"

I walk toward the trauma room, and I hear her say, "Amputated leg in 2 minutes, open wound in 3 minutes"

I look at Room 1. We have a pulse on the last stretcher. Good. I tell them, "Prepare for a fresh amputation", and I move just next door, to room 2, and ask them to prepare for an open wound.

I move forward. Jay is one of the younger ER doctors, and he was placed by Portia at the door to sort of triage the first arrivals.

"Jay, charge nurse, amputation room 1, open wound room 2."

I hear on the speaker: "Possible DOA 3 minutes"

Jay just said. "Shit"

"What's your plan?" I ask him.

"I have a crash cart; get me a nurse to try a last-minute Hail Mary on the DOA"

I approve and find Stella, who is finishing a bandage for a normal patient.

"Possible DOA in about 2 minutes; get by Jay when done"

"Almost done, I'll be there"

I return to the entry hall when the amputee comes in. A man in his 60s. Crushed leg, major blood loss, not conscious.

I let my colleagues handle him and soon find Dr. Jones, the medical director, coming forward to help with the DOA.

"Any idea when Anya will come over?"

"She might be stuck behind the pile-up. It's pure chaos apparently"

But that's when the open wound comes in, and we all freeze in terror.

Because under our eyes is Anya, our regular charge nurse.

"Well, don't stand there, do something," she says as she is being sent to room 2.

There goes my hope to help in the trauma room.

But when I turn around, I see that the medical director is already on the phone with the administration about Anya.

This is about to be a shitshow.

When the possible DOA arrived, however, we realized it was a major traumatic blood loss situation, so I got Jane to quickly fill him with blood after Jay wanted 4 units stat, and soon enough, resuscitation efforts began after Jane basically squeezed the blood into the poor man.

It took two doses of epinephrine, but they got a pulse after perhaps 5 minutes of work.

The patient might have aftereffects, and perhaps some brain damage, but their life didn't end on arrival.

Not having heard any other ambulance arrivals, I went to see Hilary.

"They are loading the last patient, but it's the least serious."

"Ok, so not that bad"

"No, all things considered", says Hilary.

I inform Dr. Jones, who is utterly relieved, so he goes to supervise the recuperation of the now non-DOA.

I went to see Anya, who was still being worked on and no longer conscious, but she was stabilized.

The last ambulance arrived when my shift was due to start, and it barely needed the trauma room. They just needed major stitches and replacement blood.

The emergency crate wasn't even opened. Better to have it and not need it... than to even need it at all.

I quickly realized something: I wasn't named charge nurse specifically for the emergency, but rather, until Anya would get back to work. Seeing how she was now recuperating unconscious in a bed in the ER, that means I would remain in charge until the end of the day.

Once the clipboard was stowed and the incident declared to be over, new ambulances began bringing new trauma patients I couldn't personally help, replacing those from the pile-up. We had diverted arrivals during the incident, but we are the only main trauma center in the surrounding area.

The one person, however, we didn't get to see was the one who caused the pile-up. The semi-trailer driver wasn't injured at all, from the safety of his tall cabin, behind his massive truck engine.

This solid block of metal worked as a ram on the foldable cars in front of his vehicle, sending victims to the hospital while protecting him from injury.

The injustice isn't just that he wasn't hurt, but also that I would probably never find out whether he would be arrested or not. Not unless it made the news or Anya was asked to testify.

I knew what my role was to be. It's not that complicated. The ER medical director is responsible for all the medical decisions. The ER manager makes all administrative decisions. I... am now in charge of all the nurses, which includes the triage of patients.

Why? Because outside an emergency, triage is the responsibility of nurses, and I am responsible for the nurses.

We often have 3 triage nurses, and they rarely talk to each other. Someone needs to tell them which room is available. The computer can do that... but someone needs to decide which rooms are reserved to offload a trauma patient or for a return visit.

And that person today is me.

I decide when people actually take their lunch. The admin decides the proper lunchtime, but I free a nurse from their responsibilities so they can eat.

But of course, that is all in theory, because in practice, neither Anya nor I try to micromanage anyone.

Hilary is back in triage, and she knows not to take a lunch break at the same time as another triage nurse. Stella knows to make sure no one else in the ER is away and no emergencies are in progress. Same for everyone else.

As such, they just inform me they are leaving, so I know where they are.

Anya tracks everything in her mind; I take notes. About everyone. Stella went off for lunch at 11:20. Hilary at 11:45. Stella is back at 11:56. Jane leaves at 11:58.

I don't know what is relevant and what isn't, so I note everything.

I am told that Anya is awake at 12:21, so I run to her room.

Hilary is already there.

"Holy shit, the girls went heavy with the morphine", she said

"Be glad; you were pretty banged up", said Hilary.

"Stupid semi. I tried to move to the curb; he hit the back of my car, and I ended up flat against the barrier"

Hilary replied. "I am shocked you aren't more hurt"

"Hey, I guess the airbag or something worked. How many did we lose?"

I replied. "None of those that came here, at least"

"Impressive. "

"One amputation, however, but most of the leg was gone by the time they got here", Hilary said.

"Yeah, I think I know which car. Poor guy. I could hear him wailing, but I was pinned in mine. I couldn't go help him", said Anya.

Hilary turns to me. "Looks like you will be charge nurse for a few more days"

But Anya speaks up. "How is she doing?"

"Better than you", says Hilary, laughing.

"Really?" says Anya, surprised.

"N'ah, but she's managing."

"Hey, don't worry, I can't wait to return to Trauma. When you want your job back, I won't fight you for it", I say.

"Not that I would mind. I miss helping patients all day. Hey, you can see patients sporadically if you delegate for a few minutes"

"You don't", I say.

"No, I don't. But I could", said Anya.

It was sadly time for me to return to my post, well, her post, and I ended up eating rin a rush with Hilary taking my place while I was absent.

But I didn't go into the cafeteria; I just went to the employee room. That way, she knew where to find me.

I was relieved by Ingrid, of the evening shift, a few minutes before my own shift ended, giving me 7 minutes of glorious trauma room work... during which no new patient arrived.

Still, it helped me keep my sanity...

I finally got home and wondered where the pileup had been.

My kids made it home, and soon enough, the homework and supper routine began.

John soon came back, and the family ate a delicious meal, as I knew Anya would have a bland one.

It made me sad, and no, I didn't see this as an opportunity. I knew my place, and that brought me comfort.

And that night was the second evening of me reading A Wizard's Guide to Defensive Baking to Sarah.

So far, we both love it. The main character is 14, the tone is light, it's cozy, and it's the perfect bedtime story.

Mona, the main character, is just adorable. There is magic in the kitchen, and that's charming and wholesome. I can understand why another 11-year-old girl might think it's the best book ever written.

And don't think I don't like how the tension in the city is mentioned in the background; there is something for me to wonder about.

The strange part is that it technically starts with a dead body, but it doesn't feel like a scary book. The girl is just there, in the bakery, and Mona is more confused than terrified. It's treated almost like a problem to be solved, not a nightmare to run from. I found myself appreciating that, the way it lets the reader stay in a child's point of view, even when something serious happens.

It makes me think of the story being read in the other room, Percy Jackson, and I love the symmetry.

Sarah didn't even flinch at the dead girl. She was more interested in the living bread, the sourdough starter with a personality, and in how Mona kept thinking about ovens and recipes even while the adults started panicking. That felt very real to me. Kids notice the small, familiar things first.

So, we both look forward to the rest of the story...

<-#35: Overcoming Trauma #35 - Sunday Service Redux