Sign up for newsletter >>
Tales from the ER #9

Tales from the ER #9

ER Rhythms: Why and when things get busy

TV shows like ER and Chicago Med lead viewers to mistakenly believe that Friday and Saturday nights are the busiest nights in the ER.

That is not true.

However, the craziness inside ERs does follow a weekly rhythm, which may be of interest to readers seeking the truth behind media portrayals of ERs as “overwhelmed.” The truth is that COVID-19 did not alter ERs time-tested weekly pattern of crazy, but rather amplified the absolute number of patients as well as the insanity coming from administrators.


Starts out quiet. Despite working on a weekend, staff are in good spirits. It is relatively calm and there are no administrators. Many bring coffee and food to share with their colleagues. Around noon a few pious folks who were really feeling the spirit at church are brought in after fainting.

Sunday afternoon more patients start to check in, especially after the conclusion of football/basketball/baseball games. Still, the hospital has available beds for those who need to be admitted, and those who can be discharged are eager to leave lest they miss Sunday Night Football or Sunday Night Baseball.


Starts steady with rush hour car crashes. The administrators trickle in, well rested, and obliviously ask staff who worked through the weekend how their weekend was. When you reply with, "Not too bad we weren't that busy…" they interrupt with, "Did you see that game? Boy the Giants are bad this year!"

Around noon Mondays get busy. Patients come in with a variety of ailments, but for all the symptoms started 2 or 3 days ago. It turns out that no one wants to ruin their weekend by coming to the ER. I imagine the patients I see on Mondays have spent the weekend drinking beer and watching football while wheezing or eating wings while ignoring abdominal pain from burgeoning appendicitis.

People are sicker on Monday (because they've let their symptoms fester), and therefore more have to be admitted. The hospital begins to fill up. Yet administrators are still sparse and oblivious to the growing patient volume because they are "catching up on emails" and discussing "new initiatives" by the water cooler (or now, via Zoom).


Tuesday is a blood bath. It is the worst day of the week in the ER.

The hospital filled up Monday night, leaving admitted patients “boarding” in the ER, and thus nearly all ER beds are filled by Tuesday morning. ER nurses become inpatient nurses to the "boarder" patients while also tending to the wave of new ER patients.

On Tuesday the honest, hard-working people who went to work on Monday despite the pain of their ailments finally come to the ER. Patients who had blood work done during the previous week have their lab results magically unveiled in the electronic health record on Tuesday. Outpatient physicians see abnormal lab values and frantically urge their patients to go to the ER. Meanwhile, those patients have been living with “dangerous lab values" for 4 or 5 days now.

Compounding matters is the administrators have done all the real work they were going to do on Monday. Left with nothing else to do for the remainder of the business week, administrators pay attention to the ER on Tuesday. Suits swoop in with unhelpful and unsolicited advice like, "Hey, if you downgraded Bed 4 from ICU status then Bed 10 could go to ICU instead, and Bed 4 could go to short stay." When you reply that Bed 4 is intubated and on dialysis, the administrators give you a blank stare.

Tuesdays are all about not getting "overwhelmed” and just seeing patients one by one until they all have got what they need - or at least, have gotten what you in the ER can provide.


Wednesday and Thursday are recovery days. Slowly, one by one, the boarding patients from Monday and Tuesday begin to disappear upstairs to their proper inpatient beds. The administrators still lurk around, "checking in" to see if the aftermath of Tuesday has any repercussions for their career prospects. If you ask them what they're doing in the ER, administrators will make some awkward joke about "hump day" on Wednesday or "almost to Friday" on Thursday. I'm often tempted to ask if they think the hospital closes Friday at 5pm.


Very quiet. Although you can never say the word “quiet” in the ER, because that is a curse of epic proportions that will result in you being shunned by your colleagues and forever becoming a "black cloud." (A black cloud is someone who always has busy shifts).

Friday night there may be a gunshot or two, or a stabbing if the weather is warm enough because it is hot weather that makes people passionately angry and stabbing is a very intimate form of violence. There will be plenty of drug overdoses and psychiatric cases. The psych patients will have to wait until Monday for a bed at an inpatient psychiatric facility. In the meantime, they will decorate the ER with their colorful atmosphere, especially if they are schizophrenic and in their delusions think they are a historical figure. Because of this I can say I personally have treated George Washington and Martin Luther King Jr., at the same time!


Also quiet, unless there is some local sports game or event that brings revelry, intoxication, and subsequent car crashes. Saturday night is similar to Friday night, with intermittent spicy encounters with the underworld and the psychotic. Overall Saturday is very manageable.


Anytime it rains or snows = Car wrecks

Three-day holiday weekends = Tuesday becomes the new Monday, Wednesday the new Tuesday, etc.

Full moons = Multiple sequential apocalyptic events are likely to occur. At the very least a singular, life-altering patient case will happen that may give you a glimpse at the devil himself. Smart ER doctors look at the lunar calendar when making time off requests.