CHAPTER TWENTY ONE
SOPHIA
My radio crackles to life: “Sophia, can you come to triage? It’s Nate.”
I frown. Nathan Crawford doesn’t call for backup unless it’s serious, and he’d normally specify if it was a medical emergency. Must be an irate patient or family member—probably someone demanding to know why their stubbed toe isn’t getting priority over the cardiac arrest.
“On my way,” I respond, setting down the chart I was reviewing and heading toward the triage area.
What I find isn’t an angry patient, but a petite woman in a tailored pantsuit standing beside Nate’s desk. She’s carrying a leather portfolio and wearing the kind of smile that screams “corporate.”
“Sophia,” Nate says, his expression professionally neutral but his eyes sending me a clear SOS. “This is Karen Scharenbroch from Workflow Management. She’d like to speak with me about some metrics.”
“In the middle of triage?” I don’t hide my incredulity.
“I understand you’re busy,” Karen says, not sounding like she understands at all, “but this will only take five minutes. It’s about the department’s patient flow inefficiencies.”
I glance at the waiting room—nine patients, none looking immediately critical, and as I recall, we only had one ambulance inbound. Not our worst day by a long shot.
“Five minutes,” I say firmly. I think for a moment, and then toggle my radio. “Tasha! I need you in triage.”
Tasha shows up in triage thirty seconds later, surprised. “Yes?”
“Could you cover Nate in triage so he can have a chat with our, ahem…‘ efficiency expert ’?”
Tasha doesn’t even attempt to hide her surprise. “Me? In triage?”
“Just for five minutes.” I give her a pointed look. “You’ve been saying you want more responsibility.”
She approaches warily. “Sure, but—”
“If anything looks critical, come grab me immediately,” Nate tells her quietly. “But don’t worry. You’ve got this.”
Tasha nods, taking Nate’s seat with a mix of determination and trepidation. It’s a vote of confidence she clearly wasn’t expecting, and despite her usual attitude, I can see she’s trying not to look pleased.
“Five minutes,” I remind Karen, who nods enthusiastically.
“That’s all I need!”
Fifteen minutes later, my radio crackles again: “Sophia? It’s Tasha. I’ve got five new walk-ins and you’ve sent two squads out here on top of that. Where the hell is Nate?”
I was in the middle of reviewing labs, but now my head snaps up. “What!? He’s not back yet?”
“Would I be asking if he was?” Tasha’s stress is evident even through the crackling connection.
I march to the charge desk. “Maria, where did they go? Conference Room B?”
Maria nods, not looking up from her computer. “Last I heard. Want me to page him?”
“I’ll handle it.”
I stride down the hallway, my irritation building with each step. Five minutes, she said. Five minutes during a relatively quiet period was manageable. But now we’re picking up, and I need my most experienced triage nurse back where he belongs.
As I approach Conference Room B, I can hear Nate’s voice—still professional but with an edge I rarely hear from him.
“—believe the data needs more context. You can’t just look at raw wait times without considering—”
“The numbers are quite clear, Mr. Crawford.”
I push the door open without knocking. Nate sits across from Karen, whose smile tightens when she sees me.
“What’s going on?” I demand. “It’s been fifteen minutes.”
“Miss Mitchell,” Karen says, maintaining her plastic smile. “We’re discussing some concerning patterns in Mr. Crawford’s triage metrics.”
“What’s she talking about?” I ask Nate directly.
“Apparently my wait times are too long,” he says evenly. “I’ve been trying to explain that I often get assigned the busiest shifts, and I tend to be more thorough with certain high-risk populations.”
“Nathan,” I say, using my charge nurse voice, “you’re needed back in triage. The department’s picking up.”
“Yes, ma’am.” He starts to stand immediately, but a hand shoots out from across the table to grab his wrist and stop him.
“Excuse me,” Karen interjects, “but we’re in the middle of a productivity consultation. I just need a few more—”
“ Don’t. Touch. My. Nurses .” The words slipped out of me in a low, venomous tone that made both Karen and Nate freeze instantly. Everyone in the room could feel the temperature drop ten degrees.
Karen’s eyes widen, her corporate smile faltering as she slowly withdrew her hand from Nate’s wrist.
“The hospital is paying me to run this emergency department,” I cut in. “If anything goes wrong, if anyone dies, that’s on me. That’s why they pay me that stunning extra dollar an hour to be a charge nurse.”
“I understand your concern, but—”
“I’m short-staffed, we’re getting busy, and you’ve just taken my most experienced triage nurse away for three times longer than you promised. If you want to pull my nurses for extended consultations, hire me more people.”
Karen’s smile doesn’t waver. “I understand hiring more staff is frequently the only solution that employee focus groups can articulate to improve workflow efficiency,” she says, her tone like she’s explaining to a five-year-old why they can’t have ice cream for dinner, “which isn’t surprising as they are often too involved in the problem to understand that’s an unreasonable expectation. ”
Nate’s eyes widen almost comically. He shoots me a look that clearly says, “ Can I please leave, now ?” and then prudently edges toward the door.
“You’re dismissed, Nate,” I say, not taking my eyes off Karen. “Head on back to triage, please.”
“Aye, aye, ma’am,” he says quickly, literally sprinting for the exit.
As the door closes behind Nate, I feel my blood pressure rising. Great plan, Sophia. Now you have to shut this jackass down properly. I check my watch; we have multiple patients waiting, but I’m not letting this go.
Three minutes. I’ll give myself three minutes to educate this woman.
I calmly take Nate’s vacated chair and deliberately drag it closer to Karen—just this side of professionally acceptable, but close enough that she has to resist the urge to lean back.
“Let me elucidate something for you, Miss Scharenbroch,” I say, not bothering to disguise the contempt in my voice, leaning slightly forward for emphasis.
“This isn’t Home Depot, where if you don’t have enough people working in plumbing, someone doesn’t get a faucet.
Okay?” I jab a finger in the direction of the ER.
“This isn’t Applebee’s, where the worst thing that happens is your food gets cold.
If we screw up here, people die . Do you get that?
Is there something inherently confusing about that? ”
“Miss Mitchell—” she starts, her corporate smile finally faltering as she shifts uncomfortably in her chair. I cut her off immediately with a dismissive wave.
“Do you want to know about our staffing problems?” I flatten my palms on the table, invading her space even more.
Karen inches her chair back slightly. “Corporate says we have to run understaffed for six months consecutively before they’ll even consider hiring more people.
Six months, understaffed, every. Single.
Day .” I punctuate each word with a tap on the table.
“But here’s the brilliant catch-22: If we have two nurses quit without notice, and I—as charge nurse—manage to cobble together coverage by begging people to work doubles, shuffling assignments, and pulling staff from other areas, then guess what?
According to your metrics, we weren’t technically ‘understaffed’ that day.
” I throw my hands up. “So our six-month clock starts over! Because I did my job and kept patients safe despite the shortage. It’s like congratulating a drunk driver for making it home without killing anyone! ”
Karen starts to reply, but I hold up a hand so close to her face she actually flinches.
“Wait, wait—it gets better!” I step forward, voice rising.
“Your precious metrics? They don’t even count the ‘hold’ patients.
So when the upstairs units are full or short-staffed—don’t worry, I know, silly me bringing up ‘staffing’ again”—I roll my eyes theatrically—“guess where those overflow patients go? They don’t go anywhere! They stay right here in the ER.”
I sweep my hand toward the department beyond the conference room.
“So now my team’s stuck boarding admitted patients for days.
Cardiac patients. ICU-level patients. Psych patients.
All of them. And we’re still expected to handle the new ER patients coming through the door—trauma alerts, strokes, overdoses—because technically our census only reflects ‘active’ emergency cases.
Not the ten or fifteen admitted patients we’re babysitting because there’s no room upstairs. ”
Karen’s clipboard twitches in her hands like she wants to disappear behind it. I’m just getting started.
“That means an ER nurse might be caring for a suicidal teen, a septic dialysis patient, and someone in acute heart failure—all at the same time. But does that show up on your precious dashboard? Nope. According to you, we’re not busy.
According to your spreadsheet, we’re not understaffed.
” I smile sweetly, venom in every syllable.
“So when patients wait hours in triage, the blame falls on us. Not the broken system. Not the bottlenecks. Just the frontline staff. But hey, no problem! Just like you said, it’s not a staffing issue, right? ”
“I don’t think—” Karen begins, finally frowning in earnest, her body language completely transformed from her initial confident pose; but before she can get anything else out, I swoop in, kneeling down to her eye level.
“Oh, I’m sure you don’t, honey,” I say, clapping my hands around hers congenially, my voice thick and sweet with sarcastic empathy.
“I’m sure you don’t. Listen, I’d love to sit here and talk to you about all of it, but I’m probably boring you to tears!
Clearly, you already know all this, and I have to get out to triage and make sure our numbers don’t keep making us look bad. Mmmkay? Mmmkay.”
I straighten up, smoothing my scrubs, and head for the door without a backward glance. My heart is pounding, adrenaline coursing through my veins. I haven’t laid into someone like that in far too long.
When I return to the charge desk, Maria gives me a knowing look. “Feel better?”
“Much.” I grab the nearest chart, needing to focus on actual medicine now. That’s when I spot it—a cup of coffee and a small paper bag from my favorite bakery sitting at my station. A sticky note in familiar handwriting: “For after your shift. Hope your day gets better. -J”
My stomach sinks. Jack must have stopped by while I was educating Ms. Workflow Management. He left this sweet gesture and I wasn’t even here to see him.
“When did this get here?” I ask Maria, trying to keep my voice casual.
“About ten minutes ago. Your Kiwi dropped it off. Said he tried texting but figured you were busy.” She raises an eyebrow. “I told him you were educating corporate on the realities of healthcare.”
“And?”
“He laughed and said he’ll call you later.” She lowers her voice. “Left those flowers too.”
I hadn’t even noticed the small bouquet of daisies next to the coffee. Simple, cheerful, and thoughtful—just like him.
For a moment, I’m irrationally angry that Karen Scharenbroch’s corporate bullshit made me miss seeing Jack. Then I’m just sad that I missed a bright spot in an otherwise frustrating day.
I sigh and begin typing an email to my manager, certain I’m going to have to explain this more in detail later, when Nate appears at my elbow. His expression is a mixture of gratitude and awe.
“Thank you,” he says quietly. “For rescuing me back there.”
“Just doing my job.” I pause my typing and look up. “How bad was it before I arrived?”
“She had spreadsheets comparing my triage times with everyone else’s.” He shakes his head. “No consideration for acuity or patient complexity. Just raw numbers.”
“Corporate,” I mutter.
“I’ve never seen anyone shut someone down that thoroughly.” There’s a hint of admiration in his voice. “Everyone in the department’s talking about it.”
I narrow my eyes. “You were back in triage. How would you know?”
He winces, caught. “Okay, so…apparently a few folks were, uh, charting nearby and kind of…stayed to listen.”
“Stayed to eavesdrop , you mean. And then bolted like roaches when I wrapped it up.”
He shrugs noncommittally. “Who can really say?”
I sigh. Great. Just what I need: to be on administration’s radar and the talk of the ER. “That’s fine. Let them talk. I meant every word.”
“I know you did.” Nate hesitates. “By the way, I checked on Tasha. She’s actually doing really well in triage.”
That surprises me. “Really?”
He nods. “She’s got good instincts when she bothers to use them. Caught an elderly sepsis presentation that was masquerading as ‘just feeling weak.’ Tagged it ESI 2 when most would have probably scored it a 3.”
I glance over at Tasha, who’s efficiently working through assessments with more focus than I’ve ever seen from her. “Huh.”
“Maybe we should let her flex there more often,” Nate suggests. “Under supervision, of course. But she could learn.”
For a moment, I see something in his expression—a flicker of…not just professional interest. Interesting.
“We’ll see,” I say noncommittally. “One medical save doesn’t erase a year of attitude.”
“No,” he agrees. “But everyone deserves a chance to grow.” His eyes drift toward Tasha again, lingering a moment too long to be purely professional.
“Nathan Crawford,” I say, keeping my voice light. “If I didn’t know better, I’d say that almost sounded like optimism.”
He looks startled, then a small smile forms. “Don’t tell anyone. I have a reputation to maintain.”
“Your secret’s safe with me.” I gather my charts. “Back to the trenches.”
Nate nods, already moving toward his next patient. His reliability is comforting—a constant in the chaos of the ER. I make a mental note to remember this moment: Nate, defending Tasha. Seeing potential where others see only problems.
Maybe Karen was inadvertently useful after all. Not that I’d ever admit it.
I take another sip of Jack’s coffee, drawing strength from the caffeine and the thoughtfulness behind it. Seven days until New Zealand. Seven days until we’re far away from efficiency experts and metrics.
Seven days suddenly feels like forever.