Article Text

Download PDFPDF
  1. Adam Lalley
  1. Emergency Department, Maimonides Medical Center, Brooklyn, NY 11219, USA
  1. Correspondence to Dr Adam Lalley, Maimonides Medical Center, Brooklyn, NY 11219, USA; lalley{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

A newspaper on my neighbour’s stoop declares a Historic Drought in New England, but in my hospital’s basement, water leaks from the ceiling. A yellow sign warns of the “Wet Floor” with a cartoon man in free fall, seconds away from his own trip to the ED. In our triage area, a pool of patients stretches out on beds that extend down the hallway. Beyond them, in the collective treatment area, is a flood.

My attending likes to start shifts by asking about our daily goals. An intern says he wants to complete sepsis bundles; a second-year is shooting for more bedside ultrasounds. As the senior resident, I say I’m working on “volume”, but what I really mean is flow. I don’t admit it out loud, but I’m wondering if it’s possible to have a perfect shift, to glide smoothly from one patient to the next just once before I graduate. It would be beautiful, like a high dive without a splash.

As our huddle ends, I assign myself to three patients. On my way to the first, a man intercepts me and asks how much longer he will wait to be seen.

“I ask because, you know, the squeaky wheel gets the grease”, he winks.

To see him now would delay me …

View Full Text


  • Twitter @AdamLalley

  • Contributors AL is the sole author, is responsible for the overall content as guarantor, and accepts full responsibility for the finished work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.