“Welcome to the Emergency Department. What brings you in tonight?”
“I’m having chest pain.”
(I now initiate eye contact and pay more attention)
“Okay. [typing noises] When did it start?”
“Five days ago.”
(less concerned now)
“Does it hurt more when you breathe or cough?”
“Yea. It hurts the worst when I cough.”
Bingo. You can wait.
I motion the patient to sit at a nearby chair and continue with the next person in line. The whole purpose of triaging is to decide who needs to go back to a room immediately and who can acquaint themselves with the waiting room. Survival of the fittest applies to many situations in life, but the ER is not one of them. If you’re the most fit you will wait longer.
The word “triage” came to us from France. It means “to separate out.” This is a wise idea to implement in the healthcare setting, right? Large volumes of patients requires a steadfast system to organize such chaos. As a triage nurse gains experiences, he/she learns to ask specific questions and listen for key words.
By working as a pediatric emergency nurse I have learned quite a bit about triaging children, and it’s actually remarkably different from triaging adults. For example, a fever of 103 F and a fast heart rate in a happy, pink-cheeked 9 month old isn’t really concerning to me. However, adults don’t have fevers as often and they’re generally less healthy than children, so my ears would perk up and ask for more details of an adult patient with the same symptoms.
There are multiple factors that contribute to a child’s triage, but there are three that I have learned are most important. First, how does the child appear? Is he acting normally for his developmental age? Is he sleeping? Screaming? When provoked, does the child react? Next, I look at the breathing pattern. Is this toddler breathing really quickly or irregularly? Do I see any ribs or abdominal muscle use? Nasal flaring? Lastly, I check the circulation to skin. Is the capillary refill on her fingernails < 2 seconds? Are her lips and skin pink? Dry? Flushed?
All of this happens with a glance, a lift of the shirt, and a tap to the nailbed. Within seconds a nurse can categorize a child as “sick” or “not sick.” (“not sick” indicates that they can wait, not necessarily that they’re totally healthy–although sometimes they are, and the parents are just nervous). In addition to “sick or “not sick” the nurse assigns an acuity (basically, a number 1 through 5) that communicates how delicate the patient’s condition is. I won’t bore you by explaining each number but the point is that a “priority 1” means someone is actively dying and needs intervention immediately, whereas a “priority 5” means that no resources will be used during this patient’s stay and he/she is completely stable–usually if they’re only being seen for a prescription refill or suture removal. (Yes, people come to the Emergency Department for these reasons.)
Unfortunately, my triage mindset has leaked out into my personal life, and I now do this with men.
Yup, it’s true: I triage my dates.
I didn’t try to, and I didn’t realize I was doing this until recently. The fact is that I just like to know my disposition towards a guy I’m dating. Basically, instead of sick/not sick I want to know like/dislike. There’s no in between. Obviously, I don’t use the same assessment criteria, although there have been times when I’ve wanted to lift up a shirt to “check breathing.” (Kidding…kind of? Can you blame me?)
So what assessment criteria do I use to triage my dates? I’m glad you asked. Again, three come to mind. First, I want to know about his faith. Does he have a personal relationship with Jesus? Is he actively pursuing his faith? Does he seek to be challenged? Second, I want to discover his sense of humor, and I really want to know if he thinks I’m funny. This is crucial. I think I’m hilarious…I want him to think so, too. Does he appreciate sarcasm? Puns? Can he be goofy? The last category is travel, and it’s just as important as humor. Does he care about the world? Does he think that all the adventure lies in a suburban house (boring) or in a hostel in Brazil? Does he respect people who are different and believe there’s something to be learned from them?
As you can see, my triage process for men is way more involved than it is for my patients. I know it’s not fair and I shouldn’t do it. Here’s the big difference: ER triage is based on appearance, while my personal triage is based on qualities and attributes–information you can’t gather sitting across from someone at a nice dinner, especially if it’s the first time you’ve met! Obviously, these things take time, but I put pressure on myself to assign an acuity to each man I date. I don’t want to waste time or end up feeling apathetic about someone while I wait for interest to accrue.
Do you see my challenge? Maybe I need to leave the ER so I’m not constantly triaging the people around me. Who knows, maybe that priority 5 will suddenly become a priority 1 in the midst of my assessment.