Injury, Illness, Frayed Nerves All Part of the ER Drama : Medicine: On a busy night at Los Robles Regional Medical Center, the staff handles a variety of emergencies. Says one nurse: ‘We never sleep.’

It is just after 11 p.m. on Friday, and the emergency room at Los Robles Regional Medical Center in Thousand Oaks is packed.

A 12-year-old boy lies on cot No. 2, his face a patchwork of scrapes and bruises, the result of a hard fall off a racing bicycle earlier in the evening.

A blond woman in her late 30s squirms on cot No. 5 after having an allergic reaction to a wine she knew she wasn’t supposed to drink. She gasps and sobs dramatically while the attending nurse--attempting to give her a shot of Benadryl--dryly cautions her to calm down or she will begin hyperventilating.

There is a stumbling drunk, handcuffed and brought in by a sheriff’s deputy for a blood alcohol test, a man suffering from a possible heart attack who waits for his personal physician to show up, and two other patients whose painful kidney stones have left them silent and still.

The doctor and nurses have seen it all--and much worse--before.

Their way station in the middle of the room is like Grand Central at

rush hour, only cheerier. With the patients they try to be as calm and sympathetic as the short swatch of time allows.

But racing about the main desk, they are sarcastic and teasing as they bump shoulders and file patient records. Most have worked this emergency room for more than five years; by now, they don’t mince words.

Pete Harris, the nighttime pathologist, ambles in to administer a patient’s blood tests. Straight blond hair covers his crown like a yellow bowl. He speaks with the slow, deliberate air of someone whom life rarely ruffles.

“Hey, can you hurry up?” he asks of Lynn Tadlock, the head nurse, who is filling out paperwork for the blood tests. “I want to go to sleep.” He laughs.

“This is the night shift,” Tadlock answers with mock severity, “and we never sleep.”

11 P.M.

There are four nurses and one doctor running the emergency room when the night shift is at its peak staff-wise at 11 p.m.

The physician, Richard Midthun, is an emergency room specialist who has labored at his frenetic specialty for two decades. He confesses to having a short attention span that suits the chaotic pace of emergency medicine, rushing back and forth between patients with only a few minutes to spend at each bedside.

“I like that first-hour kind of approach to things,” he says. “There’s this sort of immediate gratification.” At 11 p.m Friday, Midthun is 16 hours into a 24-hour shift.

The nurses and technical staff call Midthun “Doctor” or “Dr. Midthun.” Everyone else goes by their first name.

Lynn Tadlock, the head nurse, came on at 7:30 p.m. and will work until 7:30 Saturday morning. The nurses work 12 hours to the doctor’s 24 because their shifts are more labor-intensive.

When Midthun is not with patients or dictating his diagnoses and prescribed treatments into a tape recorder for hospital records, he can relax or nap. But the nurses get few moments off their feet, even on the slowest nights. When they are not with a patient, there are medical forms to fill out and file. When the paperwork is finished, some area of the room always needs tidying up.

“Supposedly, we get a half-hour off like anyone else,” Tadlock says. “But after 3:30 a.m. there’s only two of us, and before 3:30, there’s too much to do, so we stay around.”

Like most other nurses on staff, Tadlock works three 12-hour shifts a week.

She has a great fluff of red hair that sweeps her shoulders and a smile that turns teasingly mischievous at the smallest provocation. Other people’s bedtime is Tadlock’s midday when she works in the emergency room, and so as midnight approaches, she is as energetic and upbeat as others are at lunchtime.

11:50 P.M.

“It was a good dinner!” laments Jacoba Burnaham, 41, the woman having the allergic reaction to wine. Burnaham has been joined in her curtained cubicle by friend David Stephen, who strokes her hand sympathetically.

Burnaham says she and Stephen went to a great Italian restaurant in Thousand Oaks. They ordered a bottle of wine, though Burnaham is allergic to a preservative in the drink. Sure enough, within 15 minutes, a red rash covered her body from neck to knees and her throat swelled so severely that she could barely breathe. Stephen took her to the emergency room.

Once there, Burnaham required a lot of attention. She gasped until she nearly hyperventilated from excitement, and she grew increasingly hysterical as nurse Tina Saffell tried to give her a dose of adrenaline to calm the allergic reaction.

“I’m giving her a shot, and she’s like, ‘Oh, my, oh, me!’ ” Saffell says afterward. “It’s like, ‘C’mon, honey, get a grip.’ ”

Adrenaline is supposed to excite you, but it seems to have the opposite effect on Burnaham. Within a few moments, she is woozy from exhaustion, too tired to prop her eyelids open. She leaves just after midnight with admonitions from the staff to stay away from wine.

“It’s a shame,” Stephen remarks as they leave. “That was a great meal.”

MIDNIGHT

Saffell, Burnaham’s nurse, juggles her nursing job with raising four children, ages 9, 12, 14 and 15. Although her Friday shift runs from 3 p.m. to 3 a.m., Saffell’s day began at sunrise. “And I never got a nap!” she says with a pout. She’d planned for a short snooze in the early afternoon, but then the car-pool schedules got backed up, and the nap never happened.

So by midnight, she’s a little more beat than usual, this emergency room nurse who looks like a punk rocker in scrubs. Her short red hair stands up in gelled spikes on her head and she wears a short-sleeved, peach-colored top and pants. Since this is summer, Saffell is working full time at Los Robles. In the fall, she’ll switch back to once a week so she can teach nursing at Moorpark College.

Like the others on the emergency room’s night shift, Saffell usually says what she thinks.

“You’ve got to have a good sense of humor and a thick skin to work here,” she says.

12:30 A.M.

In those fleeting moments when Nick Czerneck, 12, was flying across his bike’s handlebars and onto the pavement below, he probably wished his skin was a lot thicker than it turned out to be.

Nick arrived at the hospital about 8:30 p.m., bleeding profusely but calm and quiet. He was dropped off at the emergency room door by a frantic father who screeched into the driveway and left his car planted in the middle of the parking lot until well after Nick was admitted.

That was four hours ago. Nick’s looking a lot better now, since the nurses scrubbed and disinfected his face. The right side--where he broke the fall with his face--is swollen and rubbed raw in spots.

But the left side looks like a pre-adolescent poster child, with his blond, all-purpose butch cut and unblemished skin. He suffered a slight concussion, the doctor said, but did not break any bones.

Nick’s mouth, however, is another story.

John Webb, an oral surgeon, sailed in from an evening at home to try and put Nick’s teeth back into some semblance of order. The fall separated the boy’s gum from his jaw. His front teeth were knocked backward and the other teeth on his right side were just generally knocked around. Before the night is over, Nick will get a bunch of stitches, some braces on his upper teeth, and many shots of Novocain.

He’s doing better than his parents, who have been sitting in front of the waiting room television most of the night.

“I don’t even know what’s on television at this point,” says Nick’s mother, Diana Richeson. “I’m just talking deliriously.”

*

All in all, Midthun’s having a mellow Friday night. The patient rush ended before midnight, he finished his dictation early. He runs a hand through his thinning salt-and-pepper hair and considers how emergency rooms have changed for the worse in the last few years.

“We used to get one or two shootings a year, and they were usually accidents, or suicide attempts,” he says. In the last 2 1/2 weeks, the emergency room has treated five gunshot victims and one stabbing case--all gang-related.

One night, Midthun found himself desperately trying to keep alive three failing patients at once.

Midthun acknowledges the weight of the life-threatening situations he often confronts during a bleary-eyed shift. Emergency room medicine, he says, is “where people get burned out and leave.”

But Midthun is easygoing and unfailingly pleasant. It takes a lot to shake him up. After all these years, he still savors the variety and excitement of his job, at which he works two 24-hour shifts a week. Plus, because of his compact work schedule, he spends a lot of time at home with his 9-year-old daughter.

“I’ve gotten to be involved with her life from Day 1,” he says.

The only really hard part about his job, he says, is when someone young is dying and he does everything in his power, but it isn’t enough.

“That’s one of the things that really haunts you,” he says quietly. 1:30 A.M.

Nick’s front teeth are covered with shiny metal braces. Webb asks him if he’d like one more shot of Novocain for the road, but Nick says he’d rather just go home.

“He will be OK as long as he doesn’t bite into any apples or anything, which he’s not going to,” Webb tells Nick’s parents. “I want to see him back in my office on Tuesday.”

Across the ward, in her own private room, Christy Michaels, 22, is in pain.

For the last three days, Michaels stumbled about with sharp, stabbing pains and cramps in her lower abdomen. Finally, on Friday, unable to finish her night shift at a laboratory, she asked her mother to take her to the emergency room.

Now Michaels lies on a hospital bed, her face pale and drawn. The brightly patterned leggings and cropped sweater she came in are gone--a hospital gown and white blankets wrap her thin body from ankle to throat.

She worries that it may be an ovarian cyst. Nurse Susan Murphy gives her Demerol to stop the pain; soon, also, she will have an ultrasound to determine precisely what has gone wrong.

“It’s all kind of scary,” Michaels says, smiling weakly.

3 A.M.

A little more than an hour later, Michaels is beginning to feel the effects of the Demerol. Or, rather, she is feeling very little, except a pleasant, distant sensation as the ultrasound technician pokes and prods at her abdomen with a plastic sensor, speculating as to what might be on the ultrasound screen in front of him.

Perhaps she’s got endometriosis, technician Scott Jones says, referring to a gynecological disorder that sometimes results in removal of the uterus. Her calm face now clouds with worry.

Or then again, he notes, pushing again on Michaels’ pelvic area, she could have appendicitis. Awful thing, appendicitis, Jones says, and really painful, too. But, well, probably not with this patient, he concludes.

It is a long and uncomfortable procedure, marked only by Jones’ occasional speculative diagnoses and the gray light coming from the ultrasound screen, which is filled with hazy outlines of Michaels’ internal organs, veins and arteries.

4:30 A.M.

The emergency room has been dead quiet for almost an hour. Then Tadlock gets up from the control board with a yawn and announces that an ambulance is bringing in an elderly man having trouble breathing.

Bill (Smoky) Seiler, 71, pale and overweight, is brought in on a gurney five minutes later, gasping for air with the wild-eyed look of a man who thinks each breath may be his last. Ten minutes later, the nurses have him hooked up to an oxygen tank and have taken his blood, performed two electrocardiograms, and administered drugs to clear out some of the fluid blocking capillaries in his lungs.

“So, where are you from, sir?” Tadlock asks, pulling off his shirt and putting a hospital gown on him as the respiratory nurse tries for another EKG. Seiler was shaking too badly for the first one to get an accurate reading.

“I’m visiting from New Jersey,” Seiler coughs out haltingly from behind his oxygen mask.

“Oh, New Jersey! I’m sorry!” she jokes.

The nurses chide him for his sunburn and tease him about the chest hair they must shave off to apply the EKG sensors. Seiler, irrepressibly chatty, tries to join the conversation but is shushed up in an effort to get him to breathe rather than talk.

Slowly, with the help of the drugs, his chest stops heaving. Midthun, awakened from a nap in a side room, pronounces the condition congestive heart failure and calls for a cardiologist after detecting an irregular heartbeat.

Seiler had a heart attack 22 years ago and insists that this is something different. The doctors haven’t completely made up their minds yet on that question.

“Tonight, there was no pain,” Seiler tells cardiologist Thomas Casey an hour later. “Just dyin’ for a breath of air, you know?”

4:45 A.M.

Michaels goes home with her mother at 4:45 a.m. Midthun explains his diagnosis. An ovarian cyst burst, he tells her, and the pain she felt was the liquid inside the cyst irritating her abdominal wall. It’s not dangerous; it only hurts. Michaels will take painkillers for the next few days until she feels better.

Casey escorts Seiler and his family upstairs to the cardiac unit at 6:30 a.m. Seiler will have to be admitted for a few days until doctors determine why his heartbeat remains irregular and his lungs refuse to drain completely.

The emergency room is empty of patients. In an hour or so, the morning-shift nurses will begin to straggle in the back door. But for now, the place still belongs to the night shift. Restless as ever, Murphy cleans trays and straightens cots.

Outside, the morning fog rolls in across the parking lot.

Soon, it will be time to go to bed.