It's Saturday morning, 6:55 a.m.: Eight nurses sit around a conference table bemoaning the selection of rotten assignments on the Trauma Intensive Care Unit.  Not a posh assignment among them. Everyone paired; two rooms are empty for admissions. The charge RN gives us a quick rundown that goes like this:

Beds 1 and 2: Spanish-speaking bowel resection gone wrong, possible sepsis, breathing on his own. Lots of pain. Bed 2 is a 400-lb. woman with massive soft tissue infection in her abdomen that's oozing blood constantly.  She'll get a surgical washout of the abdominal wound here in the ICU today. Oh, and she's on MRSA isolation.

Beds 3 and 4: Bed 3 is a 40-something homeless Mexican immigrant whose addiction to alcohol is leading him to believe the nurses will help him escape from this joint if he only asks one more time and tries to crawl over the siderails to escape one more time. Treating him with benzodiazepines and beer. He's paired with a 17-year-old paralyzed white kid with really, really bad luck. C 4 and 5 fractures. Nice family. Ventilator, lots of drugs, anxious.

Beds 5 and 6:  In room 5 there's a 31-year-old man with a gunshot wound incurred in a dispute with neighbor over a scratch on his car that he believed to be the neighbor's doing. Neighbor violently disagreed. Result: gaping abdominal wound that's wide open to allow for the massive swelling that accompanies these things. Room 6 is a 60-year-old long-termer with respiratory issues. A suction-his-airway, clean-out-his-mouth, get-up-in-the-chair, keep-the-tube-feeding-going kind of guy.  No big deal. Transfer when his airway clearance improves. Frequent suctioning.

Beds 7 and 8:  Bed 7 is empty, awaiting the next unfortunate, foolish,  possibly addicted victim. Bed 8 cradles "Mr. Joe", well-known to the trauma staff. No family (at least none that will visit him), no home, and no ability to breathe, eat, or even move unassisted, he will stay in trauma ICU until the trauma floor has a room near the nurses's station where he can be watched constantly. He's got a bad habit of sudden cardiac arrest, so check his electrolytes frequently and make sure he's breathing properly. First admission goes to room 7.

Beds 9 and 10:  Bed 9 is the trauma resuscitation bay, kept stocked with IV fluids, emergency airways, fluid warmer, cooling blanket,ventilator, and assorted other supplies. If we're lucky we won't need it today. The RN who takes room 9 also gets room 10, a 22-year-old male admitted last night, high blood alcohol, severe head injury from a high-speed car crash. He's on a ventilator, has a tube coming out of his skull to measure pressure in his brain, and is getting several intravenous drugs to stabilize his blood pressure.

Beds 11 and 12:  A 19-year-old whose mother describes as "wild" is receiving elephantine doses of ICU drugs to keep him sedated.  He gets the drug that killed Michael Jackson, propofol, for sedation as well as fentanyl, a morphine-like analgesic, for pain. Broken bones, contused lungs and a bump to the brain can make anyone a bit agitated, but this young man has broken all the records. He's paired with an easy patient, a 72-year-old woman being observed after losing consciousness and vomiting when her car was hit. She is stable and will leave the ICU today, if the floors have beds. 

Beds 13 and 14: All the nurses thank our colleague Ted for volunteering to take this pair again today.  He jokes about bonding with them on yesterday's shift. Bed 13 is in isolation for vancomycin-resistant enterococcus (VRE), necessitating face mask, gown and gloves when entering his room. VRE is a nasty bug, and hospitals must be very careful to contain it. Bed 14, a 55-year-old with an IV drug abuse history, has acquired the habit of spitting at nurses when provoked. He is provoked by turning, giving medications, emptying drains, physical exams, and so on. His abdominal drain is leaking bile and we'll have to figure out some method of containment. Ted, thanks again. We owe you.

Beds 15 and 16:  Overflow from the surgical ICU landed this frail 85-year-old in bed 15. He had bled extensively during a vascular bypass and was in shock. Prolonged low blood pressure is bad for the young, but much worse for the elderly. The Surgical ICU transferred him to our unit because we KNOW bleeding. Bed 16 is the last patient from the multi-car crash on Thursday. He's got a bad liver laceration, diaphragm  injury, low blood count and episodes of low blood pressure. Still needing 100% oxygen.  His parents went to the floor yesterday.

"So that's the menu. Have a good day!" 

I don't get to choose my assignment first. Those who worked yesterday do. After they've taken their pick, I take rooms 3 and 4 to avoid being stuck with 1 and 2 - I HATE working isolation rooms.  At 7: 10: I get moving; only 20 minutes to get the rest of report on my pair.

And so the day begins. Only 12 hours, 20 minutes to go.