In the controlled chaos of Queen of the Valley’s emergency room, the staff’s sensible, earth-toned shoes and sprightly athletic sneakers cross the cool, white floors. From the mobile mix of leather and nylon, a pair of lively orange clogs break up the steady parade of nondescript footwear.

“People can’t seem to remember my name, but they know me by my shoes,” said Stefan Nissen, a registered nurse who joined the Queen’s ER staff in 2004.

Nissen is one of a small army of about 80 who staff the Queen’s 15-bed ER every hour of the day, 365 days a year. ER work is the antithesis of the staid, sleepy medical office, and attracts a rare breed of doctors and nurses. They are a relatively young crowd. The average age hovers somewhere in the 30s, said Jennifer Selby, a registered nurse at the Queen’s ER. They are also energetic, equipped with cool heads and thrive on treating life-or-death emergencies — often with little notice and without access to patient medical histories. They are adrenaline junkies.

“We deal with life and death every single day. It does take a certain type of doctor or nurse to deal with those decisions,” said Shannon Watkins, a nurse who is director of emergency services at the Queen.

In fact, the unpredictable nature of ER work is one of few things staff can count on.

“Nothing around here is the same day to day. ... And when it goes bad, it can get bad really quickly,” Nissen said during a recent shift, as a faint antiseptic smell wafted from a nearby patient room.

Just as inconstant as the conditions of hospital-bound patients is the volume of people who visit the ER each day. By 4 p.m. on Thursday, Jan. 14, not one free bed remained in the Queen’s ER, as doctors and nurses tended to patients suffering from an array of conditions: heart failure, chest pain, shortness of breath and complications of diabetes, said Michelle Monroe, a lead ER nurse who has been with the Queen for 22 years.

Although these ailments are among the most common reasons people find themselves in the hospital, you might be surprised by what registered ER nurses like Jennifer Selby see on the job.

During a recent daytime shift, Selby recalled a summer day in 2001 when a woman in her 20s arrived at the ER complaining of abdominal pain. If you’re thinking appendicitis or influenza, think again. The woman — who didn’t know she was pregnant — was in an advanced stage of labor.

“The baby required some initial resuscitation but ended up doing well. ... I later found out she gave the child up for adoption,” Selby said.

More of the unusual?

“Foreign objects in people’s bodies,” Selby said matter-of-factly.

The red phone

The intake and discharge of patients never ends, but the background noise of the ER is constant. It is a cacophony of the soft beep of heart monitors, businesslike chatter at the nurses’ station, the occasional pain-induced yelp and ringing telephones.

A few yards from the nurses’ station — where employees frequently stop to wash their hands and where SpongeBob SquarePants stickers are stowed away for the ER’s youngest visitors — the lifeline of the whole operation sits atop the lead nurse’s desk. Urgent calls from paramedics and Napa Fire Department rescue workers reach the ER through a surprisingly old-school instrument, given the defibrillators, heart monitors and IV drips nearby — a red touch-tone phone.

It is used by ER staff to record information about those who are soon to arrive by ambulance, including name, age and general physical condition. During an early January afternoon, the phone began ringing after a man was discovered unconscious outside a Napa home. He had fallen some 20 feet from atop a ladder. The patient — who arrived by ambulance with a large laceration to the back of his head and scrapes and bruises on his left leg — received a CT scan and X-rays. Internal injuries were ruled out.

A few minutes later, an ER tech scrambled to answer the phone after an 84-year-old woman ran into trouble at home. Following her arrival at the ER by ambulance, she explained her frightening ordeal. “I was separating income tax receipts and had a horrible, sliding feeling like I was passing out,” she said. “I had had pain in my back for several weeks and thought it was a pinched nerve.”

Nissen said the arrival of the woman, later found to have a small leak in a major blood vessel, represented one of the two to 15 times each day an ambulance rolls up to the back entrance of the Queen’s ER.

Although the rhythm of the ER ebbs and flows, one of the ground rules among its colleagues is firm — “quiet” is a bad word. Although their work requires an unshakable belief in medical science, it turns out that doctors and nurses don’t like to tempt fate.

“It’s one of those nursing superstitions ... If you say that we’re quiet, then in an hour or two we’ll be so busy we won’t be able to turn around,” said Watkins.

ER employees see their share of hectic days. Watkins said the ER serves more than 30,000 patients each year, about 82 a day.

The nurses’ mantra

Astute visitors will likely discover evidence of a few of the Queen ER staff’s coping mechanisms — fierce camaraderie and a healthy sense of humor. A calendar page from a day long past is affixed to a wall next to the lead nurse’s desk. It reads: “Nurses’ mantra: ‘I can survive anything for 12 hours.’”

As the hours slip into days and then months, changing seasons — and even the phases of the moon — provoke shifts in the rhythms of the ER, according to staff.

Monroe said October through March brings an onslaught of respiratory illnesses such as influenza and pneumonia, while summer weekends provoke the lion’s share of boat-related accidents and other traumas — many of which happen on Lake Berryessa while children are out of school, she said.

In contrast, Watkins said the autumn crush season prompts a rise in car crashes on highways 29 and 121, as wide-eyed tourists and slow-moving farm vehicles navigate Napa County’s windy roads at the same time.

Watkins added that the full moon — credited with causing everything from craziness to crime and increased births — brings more patients to the ER, but did not offer any theories why. “Everyone says it’s a myth,” he said. “Everyone in the ER says it’s not.”