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1:00 a.m.

The Accident and Emergency department was not busy in the least. It was one of those slow nights with minimal activity. The time was 1:00 am, and there had been only three admissions since the shift began at 6:00 pm. Of the three, one required emergency surgery, and that was the most activity seen thus far. 

The time was 4:47 am, and the tedious shift was nearly over. The White-coats were strewn all over the department, free from any obvious tension, but present all the same. Nobody left, nobody sleeping – an impressive feat. There has been only one more admission so far – a case of diarrhoea due to food poisoning.

4:55 a.m.

Not 10 minutes after the last time someone broke out of lethargy to check the clock, the department was transformed into a flurry of activity. There was an accident involving a coaster bus and a trailer on the highway near the hospital, a code orange. There was such a flurry of whites, and the conscious patients must have seen angels on assignments.

To the very new nurse intern on her very first emergency shift, it was an intense situation. Everybody else seemed to know what to do and where everything was while she got tossed around, sent away from one bedside to another in favour of more experienced, steady nurses. Eventually, she was sent to the nurses’ station – no one expected any new patient anyway – to attend to anyone coming in.

5:56 a.m.

The doctors were all still occupied. The nurse intern was still dutifully seated at the nurses’ station, alone, however, as every other nurse was otherwise engaged. A young man walked in, looking tired but otherwise healthy. Enthusiastically, the nurse intern got to work. He was riding his motorcycle, he said, but fell off and hit his head hard on the ground. He felt dizzy and had a throbbing headache, so he thought it best to visit the hospital. There was no available doctor for this patient, nor were there available instruments to measure his vital signs. She could only do his physical examination, and because he seemed good enough to her, she triaged him as non-urgent. “Please wait; a doctor will soon be available to attend to you,” she felt like robotic saying that. He found an empty set of chairs and lay across them.

7:34 a.m.

Twenty-six minutes to the end of the shift. The Matron came around; now was the time for better-paced documentation. The nurse intern remembered her patient and told her about it. She spotted him lying where he had been all along, but now at a very unnatural angle. She raised an alarm just as a doctor was approaching the reception area. The doctor got to the patient, but he was unresponsive. Peripheral cyanosis and an unresponsive, dilated pupil stopped the doctor from proceeding with CPR—no heart function was detected.

Even through her haze, the nurse intern heard the doctor say dispassionately, “Time of death – 7:59 am.”

8:00 a.m.

The shift ended with a casualty, and it was not from the ghastly accident.

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