Chapter 19 - Tasha
nineteen
tasha
"You think you're ready for triage? The real deal this time, not just covering for five minutes?"
Sophia's question caught me off guard. I looked up from my charting, remembering that brief stint covering for Nate when he'd had to step away. That had been manageable; a few routine patients, nothing too complex.
"Flying solo. Well, not completely solo. Nate’ll be right there with you.
But you'd be primary for a full shift." She studied my face.
"Triage isn't for the faint of heart, Tasha.
You don't have to deal as much with some of the more complex stuff, like the nursing home patient covered in God knows what, the gunshot wound that needs immediate stabilization. But triage is different."
I set down my pen, giving her my full attention.
"The triage nurse is arguably more responsible for patient flow than I am," Sophia continued.
"You have to make snapshot judgments about patients.
You have to theoretically wrangle every patient in the waiting room, and if you have ten, twenty, thirty people waiting, that adds up fast. People pile up at your desk, so you need focused assessments that get all the information you need without taking too long.
But that's balanced against the fact that if you miss something, if you screw up something subtle.
.." She paused. "That's on your conscience. "
I felt a flutter of nervousness mixed with something else—excitement? Pride? Those five minutes covering for Nate had gone smoothly, but a full shift was entirely different.
"Not just any nurse can do triage, especially not here at Metro General," Sophia said. "It's recognition of your clinical skills. Also, fair warning—triage nurses always get their asses beat because it's not easy. But you're ready for it, if you want it."
Two weeks ago, I would have jumped at the chance without hesitation. Now, after the Mia case, after falling apart in Nate's living room, I found myself hesitating. What if I missed something? What if I wasn't as ready as Sophia thought?
"You'll be shadowing Nate for the first few hours," Sophia added, reading my expression. "He's one of the best triage nurses we have. Learn from him, then take the lead when you're comfortable."
I took a deep breath. "Okay."
Sophia smiled. "Good. Go find Nate. He's expecting you."
I found Nate at the triage desk, reviewing charts with the same methodical precision he brought to everything. He looked up when I approached, and I saw something soften in his expression—the same gentle concern he'd shown me that night on his couch.
"Ready to see how the other half lives?" he asked, gesturing to the chaos of the waiting room beyond the glass partition.
"Define ready." I hesitated, then added quietly, "What if I'm not as prepared as Sophia thinks?"
Nate's expression grew serious. "You've got the best instincts in the department, Tasha. Trust them."
The simple confidence in his voice steadied me. "Let's do this."
The first patient was Mrs. Rodriguez, a regular who came in monthly for medication refills she could get at any urgent care clinic.
Nate handled her with patient professionalism, explaining once again that the ER wasn't the right place for routine prescriptions, while I watched his technique—how he kept his voice calm, his questions focused, his documentation precise.
"The key," he murmured to me as Mrs. Rodriguez left, "is not to get frustrated with the frequent flyers. They're usually here because they don't have anywhere else to go."
The second patient was a middle-aged man who approached the desk with a slight grimace.
"I've been having back pain," he announced.
Nate's fingers moved to the keyboard. "Okay, sir. Did you injure yourself recently? Lift something wrong? How long has this been going on?"
"Five years."
Nate's hands stilled. He looked up with a perfectly neutral expression. "Well, sir, you got here just in the nick of time. Did something change in the character or nature of your pain that made you come in today?"
"No."
I bit my lip to keep from smiling as Nate calmly directed the man to the waiting room.
The third patient was a college kid with obvious food poisoning, retching into a basin. Straightforward triage—IV fluids, anti-nausea meds, probable discharge in a few hours. I watched Nate's hands as he started the IV, steady and sure.
Then came Mr. Swanson.
"What allergies do you have, sir?" Nate asked, fingers poised over the keyboard.
"Advil," Mr. Swanson replied confidently.
I watched Nate start typing "ibuprofen" into the allergy field.
"No, no," Mr. Swanson said, leaning forward to see the screen. "Advil."
Nate paused, looking up. "Yes, sir. Ibuprofen."
"No, I can take ibuprofen. I just can't take Advil."
I felt my left eye twitch involuntarily. Nate's expression remained perfectly neutral, but I caught the slight tightening around his own eyes.
"Ah," Nate said carefully. "Well, name-brand Advil has orange dye in it. Are you allergic to that?"
"No, no. Just the Advil part."
I bit the inside of my cheek to keep from laughing. Nate slowly deleted "ibuprofen" from the allergy field and typed in "Advil, not ibuprofen."
"Let someone else wrestle with that one," he murmured to me after Mr. Swanson left.
We moved through a few more cases when the man with back pain approached the desk, looking slightly annoyed.
"Hey, I didn't know I'd have to wait this long," he said. "I'm just gonna go and make an appointment with my family doc."
Nate looked up with the same deadpan expression. "That's probably a good idea, sir."
By the next patient, something had shifted.
I found myself anticipating Nate's questions, reaching for supplies before he asked.
When an elderly woman came in complaining of chest pain, I was already pulling up the EKG machine while he took her history.
We moved around each other like dancers who'd been practicing the same routine for years.
From the corner of my eye, I caught Sophia watching us from the charge desk, a small smile on her face.
Then came the moment that surprised us both. A young mother arrived with her toddler, both of them in tears. The child had been crying inconsolably for hours, and the mother was convinced something was terribly wrong.
"He won't eat, he won't sleep, he just screams," she sobbed. "I know something's wrong. I know it."
Nate started his assessment, but the toddler only screamed louder at his approach. I stepped forward without thinking.
"Hey there, little guy," I said softly, crouching down to the child's eye level. Something about my voice seemed to catch his attention. "That's some impressive lung capacity you've got there."
The crying reduced to hiccups. I pulled out my stethoscope and made it into a pretend telephone.
"Hello? Yes, this is Dr. Tasha calling about a very important patient," I said into the stethoscope. "Really? He's the strongest crier you've ever heard? Wow."
The toddler giggled, reaching for the stethoscope. In the sudden quiet, I could hear it—the telltale wheeze of a reactive airway.
"Mild asthma exacerbation," I said quietly to Nate. "Probably triggered by crying, which made him cry more."
Nate nodded, already reaching for the nebulizer. Twenty minutes later, the little boy was breathing easily and playing with toys in his mother's lap.
"That was sharp, picking up on the wheeze with all that screaming. Good instincts," Nate said as they left.
Before I could respond, chaos erupted in the waiting room.
"Excuse me! EXCUSE ME!" A man's voice, loud and increasingly frantic. "I need to be seen RIGHT NOW!"
Through the glass, I saw a middle-aged man in a business suit pushing past other patients, his face flushed with panic. He practically ran to our desk, leaning over it with wild eyes.
"I'm bleeding to death," he gasped. "I'm going to die. You have to help me now!"
Nate remained calm, but I could see him shift into high-alert mode. "Sir, I need you to take a deep breath and tell me what's happening."
"I'm bleeding internally! There's blood everywhere! I've been bleeding for hours!" The man—Mr. Hendricks, apparently—was practically hyperventilating.
"Okay, sir. Can you tell me about any changes to your diet recently? What have you had to eat or drink today?"
Mr. Hendricks waved his hand dismissively. "You're not taking me seriously! I'm BLEEDING TO DEATH! I don't have time for twenty questions!"
Nate's jaw tightened almost imperceptibly. "Sir, I understand you're scared. We're going to take good care of you. But I need you to work with me here."
"I need a doctor! Now! Not a nurse asking me about my lunch!"
I felt my own temper flare at the dismissive tone, but Nate just nodded calmly. "Let's get you back to a room and figure out what's going on."
Because of his dramatic presentation, Mr. Hendricks got bumped ahead of several other patients who had been waiting longer. As one of our ER techs wheeled him to the main treatment area, Nate leaned over and whispered in my ear.
"He's loud, which is usually a good sign.
It's the quiet ones who tell you they're dying, matter-of-fact, that you really worry about.
That 'sense of impending doom' is no joke.
We take this guy seriously because of what he's saying, but the way he's saying it.
.. usually means we have a little more time to figure it out. Still, never get complacent."
In Room 6, Mr. Hendricks was still agitated, pacing back and forth despite our attempts to get him on the gurney. His vital signs were completely normal—blood pressure, heart rate, oxygen saturation all within normal limits.
"I need a stool sample," Nate said. "If you're having GI bleeding, we need to confirm it."
"I KNOW I'm bleeding! Look!" Mr. Hendricks gestured wildly toward the bathroom.
I glanced in, and sure enough: there was bright red color in the toilet bowl. My stomach dropped a little. Maybe this wasn't as routine as I'd thought.
We got an IV started—Mr. Hendricks barely flinched, too focused on his panic—and drew blood for a complete workup. His hemoglobin, hematocrit, and coagulation studies all came back normal. No signs of blood loss.
Twenty minutes later, the stool sample results came back. I read them twice to make sure.
"Heme negative," I said quietly to Nate. No blood detected.
"Interesting." Nate pulled up a chair next to Mr. Hendricks, who had finally calmed down enough to sit on the gurney. "Sir, I need to ask you again about what you've had to eat or drink today. And I need you to really think about it, because it's important."
Mr. Hendricks looked sheepish now, some of his panic having subsided with the normal test results. "I... well, I had my usual coffee this morning. And then around ten, I tried that new Berry Blast Juggernaut from the smoothie place downtown. The seasonal one."
I felt understanding dawn. "The bright red one? With the special holiday coloring?"
"Yeah, that's the one. But I don't see how—" He stopped mid-sentence, his eyes widening. "Oh. Oh, God."
"That Berry Blast Juggernaut has an awful lot of food dye in it," I said gently. "It can... well, it can make things look pretty dramatic on the way out."
Mr. Hendricks' face went through several shades of red that had nothing to do with food coloring. "You mean I... the blood wasn't..."
"Not blood, sir. Just dye."
The silence in the room was profound. Mr. Hendricks buried his face in his hands.
"I am so, so sorry," he said, his voice muffled. "I was so scared, and I... I was rude to you both. I thought I was dying."
"It's okay," Nate said, and I could hear the genuine compassion in his voice. "When you think you're in danger, it's natural to panic. We see it all the time."
We discharged Mr. Hendricks with instructions to avoid red-dyed beverages if he didn't want a repeat performance. He apologized three more times on his way out, shaking both our hands.
The moment the door closed behind him, I felt it start- a giggle that bubbled up from somewhere deep in my soul. I tried to hold it back, but when I looked at Nate and saw his lips twitching, I lost it completely.
"Berry Blast Juggernaut emergency," I gasped between laughs.
"The seasonal one," Nate added, and that set me off again.
We were both laughing so hard we had to lean against the wall for support. Every time we started to calm down, one of us would say "bright red" or "bleeding to death" and we'd start up again.
"I thought we were gonna have to hang a couple units of uncrossmatched blood to gravity," Nate said, wiping tears from his eyes.
That image—universal donor blood running wide open through an IV, as fast as physics would allow—made me laugh even harder. "The look on his face when he realized..."
"I thought he was going to melt into the floor," Nate said.
It felt so good to laugh. Really laugh, the kind that makes your stomach hurt and your cheeks ache. After the heaviness of the past few weeks, the breakdown and all the emotional intensity, this moment of pure absurdity was exactly what I needed.
"You know what the best part is?" I said as we finally started to recover. "He's going to tell this story at parties for the rest of his life. 'Remember that time I went to the ER because I thought I was dying from a smoothie?'"
"His friends are never going to let him live it down," Nate agreed. "Especially if he tells them about pushing past other patients in the waiting room.”
I grinned at him. "This job is insane."
"The best kind of insane," he replied, and something in his expression made my heart do a little flip.
We stood there for a moment, still smiling, and I realized something had shifted between us. Not just back to normal—forward to something new. Working together like this, sharing the ridiculous and the profound, felt natural in a way I hadn't expected.
From across the department, I caught Sophia's eye. She was still watching us, but now her expression held something that looked like approval. Like she was seeing exactly what she'd hoped to see.
"So," I said, "what's next? Someone allergic to the alphabet? A patient convinced they're turning into a werewolf?"
"Don't jinx us," Nate warned, but he was still smiling. "In this place, anything's possible."
As we headed back to triage, I felt something settle into place inside me. This was more than just doing the job—this was finding my place in it. Finding my rhythm, my confidence, my partnership with someone who brought out the best in my clinical skills.
It was about realizing that I was exactly where I was supposed to be.