Stakes Are High: The night shift in shock trauma

Stakes Are High: The night shift in shock trauma
June Guadalupe, a nurse in the Trauma Resuscitation Unit at the R Adams Cowley Shock Trauma Center of Maryland Medical Center (J.M. Giordano/City Paper /)

It's 6:45 p.m. at the R Adams Cowley Shock Trauma Center at University of Maryland Medical Center when June Guadalupe, a nurse in the Trauma Resuscitation Unit (TRU), arrives. He will be there until 7:30 a.m. the next day.

He joins the other night shift nurses, all fully clad in their pastel pink scrubs, as they pile into a closet-sized break room. The charge nurse from the day shift gives a quick rundown of the unit's happenings by way of passing the baton to the night shift.


A self-described adrenaline junkie and night owl, Guadalupe prefers working the night shift. Tonight's roster of patients: an inmate from the jail, a sex worker, and a few elderly patients who have taken some pretty bad falls.There was a casualty earlier in the night—a victim of a brutal motorcycle collision.

After Guadalupe receives his assignment, he checks on his patient, an elderly man who took a spill at a car wash.

"Hi, I'm June. I'm going to be your nurse tonight," he says. "How are you feeling? What happened?"

Right now, Guadalupe is only caring for one patient, but that could change as the night progresses.

The Trauma Resuscitation Unit resembles NASA's mission-control center. There are 13 beds that form a semicircle around three long rows of computers and other medical machinery, like a password-protected set of drawers filled with medication and drive-thru-like chute that sends blood work to the lab. You can see pretty much everything from anywhere in here. Above the very first row of computers is a large flat-screen monitor that displays the name of each patient, which bed they're in, and who is taking care of them at the time. As nurses move among the patients, phrases—"How are you feeling?" or "Can I do anything for you?"—are the low-tech tools that echo the high-tech monitor beeps and purrs. Digital clocks with large red numbers tick time away.

Guadalupe wears a lanyard adorned with more than 15 gold pins, each signifying excellence in service and his five specialty certifications—emergency nursing, critical care, cardiac medicine, neuroscience, and trauma. He is in his 24th year of nursing and his 10th year as a trauma nurse here in Baltimore, with specialties that have served the Center well. "It makes you dynamic and competent in taking care of special cases," Guadalupe says.

As he starts each shift, he introduces himself to his patient and makes sure the patient is comfortable. Then he sits down with the day-shift nurse to get all the details. The day-shift nurse tells him everything she knows about the patient—his unique injuries, recent vitals, previous medical history, plan of care, and general disposition, among other things.

While Guadalupe uses a mobile computer to access his patient's electronic chart and provide medication for him, he stresses accurate charting. "Every second counts. Every number counts," he says. "Every second you waste, you're doing harm to your patient."

The stakes are high in the trauma center. "Getting a heartbeat back is only 10 percent of the goal," says Guadalupe. "Our goal is to get our patients back to what they were before the accident. It's a hefty goal. It's ambitious."

Guadalupe's current patient needs a CT scan. He gently pushes the patient's bed down the hallway toward radiology. Most of the patients here have been in car crashes, or sustained falls, or are victims of violence. It can be taxing, but he says his mind adapts to the situations to avoid getting emotionally attached. "If you're still emotionally bested from the last case, you won't be on your A game for the next," he says.

It is 9:08 p.m. and all is calm in the Trauma Center, but only for a fleeting moment. The phone rings. EMS says they're bringing in an unconscious assault victim. ETA is seven minutes. Check out the gallery here.

Disclosure: Casey Embert also works at the University of Maryland Medical Center as an administrative assistant in the office of Clinical practice and professional Development.