It was not unusual in one busy ER to have 15 bays with true emergencies, all of which I was handling with orders given out to supporting staff simultaneously. I had a team of nurses, x-ray technicians, lab techs and specialists on whom I could call, of course. Yet in a small community hospital with only one or two patients over a 12 hour shift, it took a great deal more effort to concentrate, make decisions and act quickly. My mind likely had been dulled by hours of inaction. Often, too, these were night shifts and I had been awakened from a sound sleep.