Three times a week around 7 a.m., 26-year-old Anisa Mertiri enters Montefiore Medical Center's Weiler Division in the Bronx, N.Y., to begin a 12-hour shift. She is a triage nurse, a critical and punishing job in an emergency department that handled some 220,000 patients in 2007, making it one of the five busiest in the country.
Triage nurses are like air traffic controllers, except that people are less predictable than planes. Mertiri may see 70 patients during her shift, sometimes in bursts, and may have to decide in a few seconds who can wait and who can't. But she has been tested. "When I just started, we had a man walk in who was stabbed seven times in the chest," she recalls. The 17-year-old "man" lived.
Entering through the front door into a waiting area about the size of a small classroom or on a gurney through the automatic doors of the ambulance entrance, all ER patients converge on triage. It is a cramped, windowless room with a small white desk, a few chairs, and several "vital signs machines"—an aggregation of gear atop a wheeled pole to measure blood pressure, temperature, pulse, and blood oxygen.
When the ER is busy, triage is jammed with patients, family members, nurses, aides, and paramedics, all in a hurry. On a Monday, the busiest day, Mertiri and the other triage nurses can see 220 patients in 24 hours. Patients are assessed for urgency from 1 (unconscious or unresponsive) to 5 (sore throat, bruises) based on vital signs, complaints, appearance, and history. Level 1 patients are seen immediately, level 2 within 15 minutes, and the others less quickly. The lowest-ranked patients are shunted to the "Blue Zone," where they can be given lab tests and medications and sent home within a few hours.
Mertiri loves the work. She left her native Albania at 17 to finish high school under the scorched palms of San Benito, Texas, then went north to nursing school in Corpus Christi. Mertiri was drawn to emergency care when she did her clinical rotation through the various hospital departments. "It's fast-paced, you see a lot of patients, and you see a wider group of people," she says.