Chapter 4
chapter
four
The witching hour in the ER isn't midnight; it's the dead space between two and four in the morning.
It's when the city's fever finally breaks, leaving behind a strange, quiet stillness punctuated by the rhythmic beeping of monitors and the occasional soft groan from a curtained-off bay.
It's when the exhaustion really settles into your bones.
"How are you holding up?" I asked Chloe, keeping my voice low. We were catching up on charting at the main nurses' station, the glow of the computer monitors painting our faces.
"I think the edge is wearing off," she whispered, her eyes wide. "Everything feels … weirdly quiet. It's creeping me out."
"That's just the night shift settling in," I said. "Don't worry, it never lasts."
As if on cue, the triage doors slid open and a young man, probably early twenties, shuffled in, holding a bloody rag to his upper arm. He was doing a poor job of acting casual, his eyes darting around the empty waiting room as if he expected a SWAT team to rappel from the ceiling.
"I'll take him," I said, nodding to Chloe to follow me.
I led him back to an empty bay, the scent of iron from the blood already sharp in the air. "What's going on tonight?" I asked, my voice calm and neutral as I pulled on a fresh pair of gloves.
"Uh, roofing injury," he mumbled, not quite meeting my eyes.
"Roofing injury?" I kept my tone conversational, reaching for gauze. "What kind of roofing injury?"
He shifted on the gurney, wincing slightly. "It was, uh... a roofing nailer."
I carefully pulled the rag away from his arm. It was a clean, circular wound. A through-and-through. "A roofing nailer," I said, my tone perfectly even. I glanced at the clock on the wall. It was 2:15 a.m. "At two in the morning?"
"Yeah," he said, a little too quickly. "Night job. Construction deadline."
"I see." I cleaned the wound, my movements efficient. "That's an interesting diameter for a roofing nail."
The kid just shrugged, his jaw tight.
I dressed the wound. It was superficial, clean, and wouldn't require much more than a good cleaning and some antibiotics.
But we both knew what it was. Chloe, standing behind me, knew what it was.
The kid knew we knew. But the word "gunshot" was never spoken.
Because if he said "gunshot," I'd have to call the cops.
The unspoken agreement hung in the air between us: I'll let you call it a roofing nail if you let us stitch you up and keep you from getting a nasty infection.
After he left, with a prescription for antibiotics and strict instructions for wound care, Chloe turned to me, her expression a mixture of confusion and frustration.
"That was a bullet wound," she said, her voice a hushed accusation. "We should have called the police."
I led her to a quiet corner of the nurses' station. "You're right, it was. Looked like a 9mm to me. And you saw how he was looking over his shoulder. He's scared. He's probably in trouble. But our job isn't to be detectives, Chloe. Our job is to treat the patient in front of us."
"But he lied to us!"
"Probably. Maybe he was roofing; heck, we don’t know.
But if he lied, it was because he was afraid," I countered gently.
"Gun violence in this city is endemic. Guns are everywhere.
But if we start pushing people, if we make them feel like this isn't a safe place, they won't come.
He'll go home, pour some whiskey on that wound, and show up here in a week with a raging infection, septic or worse.
We have to be a sanctuary. By our very nature, the ER has to make itself vulnerable to be a place people aren't afraid to come to in their most desperate moments. We treat the wound, not the story."
Chloe was quiet for a moment, processing this. I could see her wrestling with the ethical complexity of what we did here — the gray areas that nursing school never quite prepared you for.
"Come on," I said, gesturing toward the supply room. "Let's restock while it's quiet. Night shift rule number one: always be ready for the next wave."
We spent the next twenty minutes refilling the crash carts and checking expiration dates on medications. It was the kind of mundane task that gave your mind time to process what you'd just seen, to file it away in that mental compartment marked "things that happened but we don't talk about."
Around 3 a.m., we got a straightforward case — a middle-aged woman with a kidney stone, writhing in pain. I walked Chloe through starting the IV, drawing labs, and administering pain medication. Within thirty minutes, the woman was resting comfortably, tears of relief streaming down her face.
"Thank you," she whispered, grabbing my hand. "Thank you so much. That was worse than when I had my son."
"Just doing our job," I said, but Chloe caught my eye and I saw her understanding something — that sometimes our job was about more than medical care. Sometimes it was about witnessing someone's pain and making it stop.
We were back at the nurses' station, Chloe practicing her documentation while I reviewed lab results, when Carly appeared looking harried.
"I need a coffee," she announced. "This shift is testing me. Mrs. Patterson in Bay 6 has asked me four times if we can call her psychic to consult on her diagnosis."
"Did you?" I asked, deadpan.
"I was tempted. The psychic probably has better availability than cardiology." She rubbed her eyes. "How's the new kid doing?"
"She's got good instincts," I said, glancing at Chloe, who was pretending not to listen while clearly hanging on every word.
"Good. We need more nurses who can handle the weird stuff without losing their minds." Carly started to walk away, then paused. "Oh, heads up — Bay 3 just got interesting. Might need you in a few minutes."
"Interesting how?" I asked, but she was already heading toward the medication room.
I turned to Chloe. "In ER speak, 'interesting' is never good."
Sure enough, ten minutes later, the charge phone rang. Carly's voice was strained. "Jimmy, can you and your new shadow come give me a hand in Bay 3?"
We walked in to find a man in his late forties on the gurney, his face a mask of pain and profound embarrassment. He was curled on his side, clutching a pillow to his abdomen.
"Mr. Smith here had an accident," Carly said, her face a perfect, professional blank. "He tells me he … fell in the shower."
"On a bottle of shampoo," the man added, his voice a pained squeak.
I looked at the X-ray pulled up on the monitor screen. A full-sized bottle of shampoo was lodged, impossibly, in his rectum.
"I see," I said, my voice betraying nothing. "Well, let's see what we can do to help you get fixed up, Mr. Smith."
Chloe stood frozen by the door, her mouth slightly agape. I gave her a look that said, Not. A. Word.
Later, after we had successfully assisted the doctor with the, ahh … extraction, and Mr. Smith was resting comfortably, Chloe finally spoke.
"There is no way," she whispered, shaking her head in disbelief. "There is no way he just fell on that."
"The physics alone are staggering," I agreed quietly. "The aim required would get him into the Guinness Book of World Records. But you know what we do here, Chloe?"
She looked at me, the lesson from the "roofing nail" incident starting to sink in.
"We don't judge," I said. "We don't laugh.
We don't share the story in the breakroom.
Because we want Mr. Smith, and every other Mr. Smith out there, to feel safe enough to come to us when they've made a mistake, or done something they're ashamed of, or just found themselves in a situation they can't get out of alone.
Our job is to fix the problem, no questions asked. "
I could see the understanding dawning in her eyes. This was the real work of the night shift. It wasn't just about medicine. It was about creating a small, brightly-lit island of non-judgment in the middle of a dark and complicated world.
"Does this happen a lot?" Chloe asked as we headed back to the nurses' station.
"More than you'd think. People are creative, and sometimes creativity meets poor judgment. Our job isn't to figure out how they got into these situations. It's to get them out safely."
The rest of the shift settled into a more predictable rhythm. A woman with chest pain that turned out to be anxiety. She was convinced she was dying, tears streaming down her face as she clutched at her hospital gown.
"My heart won't stop racing," she gasped. "Something's wrong. Something's really wrong."
I pulled up a chair beside her bed — not standing over her, not hovering by the door, but sitting at her eye level. "What's your name?"
"Patty."
"Patty, I want you to breathe with me. In through your nose, hold it, out through your mouth." I demonstrated, exaggerating the slowness. "Your body thinks you're in danger, but you're safe. We're going to remind it together."
For twenty minutes, we sat there breathing together. I told her about the physiology of panic — how her body was doing exactly what it was supposed to do, just at the wrong time. By the end, her heart rate had dropped from 140 to 85, and she was managing a shaky smile.
"Thank you for not making me feel crazy," she said.
"You're not crazy," I told her. "You're human. There's a difference."
A teenager with what his mother was convinced was appendicitis but was actually gas. The relief on both their faces when the CT came back clear was worth the radiation exposure.
At 5:03 a.m., right on schedule, the charge desk phone rang. I happened to be passing by, so I answered it.
"Metro General ER, this is Jimmy."
"Hi, this is Sandra from Sunset Gardens. We're calling EMS, but I just wanted to give you report. We've got an 82-year-old female, ground-level fall, found down by her bed about twenty minutes ago. She's alert and oriented but complaining of hip pain..."
I took the report, hung up, and then turned to Chloe. "And there it is. 5 a.m. Right on time."
"What?"
"Someone just went to check on grandma and found her down on the floor. Gravity. It's not just a good idea, it's the law."
Chloe looked confused. "Is that... normal?"
"Like clockwork. The 5 a.m. nursing home calls are as predictable as the sunrise. Poor lady probably got up to use the bathroom, got a little dizzy, down she went. We'll get her sorted out."
As the ambulance pulled up outside, I felt the familiar satisfaction of another night shift drawing to a close.
We'd handled gunshot wounds disguised as construction accidents, embarrassing injuries that required delicate care, and now we'd help an elderly woman who'd had an unlucky encounter with gravity.
This was the job: meeting people in their worst moments and somehow making them better, one patient at a time. No judgment, no questions they didn't want to answer, just care.
And in a few hours, day shift would take over, and we'd do it all again tomorrow night.