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It's still just bad and worse most of the time up at Hood Hospital, but Monday being a Monday, it fell into the worse category.  Maybe even a worst.  Probably for this month, at least.  Hello, 8 hour waits.  It doesn't all completely suck.  ER BFF and I are team triage.  That means one of us is given up as a sacrifice to the anger of the waiting room at the desk, while the other hides in the booth and makes the life-threatening-or-not decisions.  Most of the time I make a run for the booth (mostly due to the fact that I am the least authoritative sounding at looking person here), but I couldn't do that to a good friend. Desk it is.
Days like this are a little frightening.  Triage is all caught up, but you're dealing with a waiting room full of people you haven't seen before, and you're responsible for all of them.  You're responsible for trying to decipher the computer notes of whoever the hell was triaging before you, which is extra fun if they don't include a lot of information and/or you don't trust their judgement. My nursing spidey-sense (which I rely on greatly in triage) really can't come into play here.  It's nerve wracking.
I'm getting my stuff together and scanning the waiting room to see if there's anyone I can place with the list of names on my computer screen and if there's anyone who just doesn't look right, even from across the room.  No red flags here, just a lot of dirty looks. In my scan of the crowd, an average chronically sick looking guy in no apparent distress meets my eyes and smiles.  I smile back, somewhat surprised and a little suspicious that anyone out here is directing any sort of good energy my way.  I go about my business, checking people in, explaining waits, fielding questions from the charge nurse about dozens of patients I know nothing about.
About an hour in, smiley man wheels himself up the the window to say he's been waiting a while and he thinks he's going to go ahead and check himself out and go somewhere else or see his doctor tomorrow.  I'm looking for his name on my list just as my charge nurse comes out to fill the handful of empty rooms and see that it's close to his time. "Hold on just a second for me.  I think they're coming to get you in a room right now. Can you wait for just a few minutes more?" He reluctantly nods, smiles and wheels himself back a few feet so another group of people can check in.  They come to collect him a few minutes later.  I think nothing of it and take some verbal abuse disguised as questions.
A couple of hours later I'm running back for my first bathroom break of the night when one of the friendlier doctors grabs me for some quick education. "Hey Hood Nurse, have you ever seen a dissecting triple A on a CT before? No? Come here for a second." He's showing me the space on the CT and talking about how this is one of the really bad kinds when my eyes wander up to the name at the top of the screen. It's familiar.  Did he come from the waiting room? Yeah.
I go back up to my post and look his chart up.  Oh. Shit.  It's the friendly little guy that was just about to leave. It makes me a little anxious that nothing about his appearance set off any alarms for me.  I look through his triage notes and vitals- nothing terribly notable there, either. I start to wonder if I would have suspected anything even if I had been the one to check him in.
This could have been pretty catastrophic for everyone involved. But he was fine.  It kind of makes you wonder how many close calls like this we see everyday without realizing it, or how many of the people that come in as CPRs might have been fine if they'd been seen a few hours earlier. Sometimes among all the toes pains and toothaches we forget the gravity of what we do.  It's actually some pretty scary stuff.