The Queen’s ER staffers are routine witnesses to the fragility of human life, but sometimes it is just too much. In 2007, 51 patients — some of them just children — died in the emergency department, according to Shannon Watkins, the Queen’s director of emergency services. Some patients cannot be saved, or arrive fatally maimed from bloody car crashes.

ER workers brace themselves, especially when the seriously injured are friends, family members or even coworkers of the staff. Roughly seven times a year, supervisors offer support services to workers who respond to the ER’s most difficult scenarios. But most of the time, staff members draw on their inner strength, medical training and activities outside of work to provide what their jobs demand, turning from one emergency to the next.

At the start of his shift at the Queen’s ER, Dr. Ed Carlson, a kind-faced, fit man whose white hair belies his youthful energy, gets into work mode. “It’s like going on stage in a way,” said Carlson. “If you just lost a patient and talked to their grieving family and next have a kid with a sprain, you can’t bring that in with you.”

With nearly two decades under his belt as an ER physician at the Queen, Carlson knows his shift will have him thinking and working on his feet.

From doing triage and treating patients to unraveling comprehensive, puzzling health problems, the Queen’s ER physicians and nurses spend most of their seven- to 12-hour workdays multi-tasking. And at the start of each shift, it is impossible to know whether car crashes or traumatic injuries will turn a quiet day into a series of crises.

All this creates considerable pressure on the ER staff, who understand the value of keeping stress levels manageable.

Throughout his experience as an ER physician at the Queen, Carlson, 65, has managed to strike a healthy balance.

“One reason I think I’ve lasted as long as I have is attitude. Certainly we get tired. We’re human and make mistakes. (But) we try to minimize the mistakes and move on,” Carlson said.

While intimately familiar with the stresses of the job, Carlson credits a positive outlook — coupled with a regular exercise routine — with keeping his stress level in check.

Like Carlson, Dr. Paul Kivela, a fiercely energetic ER physician who nearly buzzes with animation, has discovered his own tactics for managing stress.

“Most emergency physicians are pretty active,” he said. “I run, ski, and my unique sport is speed golf. ... I don’t have time to do a 4-1/2-hour round and this way, I get my running and my golf in and get to be in a gorgeous outdoor setting.”

Kivela said he visits Fairfield’s Green Valley Country Club at sunup before most others arrive, carrying just four clubs while powering through 18 holes in less than an hour.

The dizzying effort is conducive to stress relief and fitness. But Kivela said some adjustments to his usual golf game — like sporting running shoes and holding his breath while hitting to keep his swing steady — are a must.

Kivela, one of several athletic emergency physicians who work at the Queen’s ER, said many of his co-workers find intense pastimes that serve as pressure valves: They are triathletes, surfers and cyclists.

Finding ways to cope

Stefan Nissen — a registered ER nurse at the Queen whose wife gave birth to their first child on Jan. 26 — said putting a spin on conventional humor is one of his most valued tactics for getting through the day. “I have a pretty irreverent attitude that tends to help a lot with stress relief. Admittedly, a lot of my humor would be considered ‘gallows humor,’ but I find that it helps me to blow off steam before it builds up.”

Nissen also said he uses his 40-minute commute to and from work to decompress. The long drive supplies a physical and emotional  distance that helps him keep his home and work lives separate, he said.

Watkins said although ER staff members “thrive on being able to help in the most serious situations,” tragic events such as the death of a pediatric patient or an accident that lands a fellow staff member in the ER require intervention. The hospital offers the Critical Incident Stress Management Program to employees following difficult events.

“When it’s one of our own, it hits even closer to home. ... And usually, the young, unexpected ones do affect staff the most,” said Watkins.

Typically led by social workers and chaplains who work at the Queen, Watkins said, the sessions start with a debriefing after the incident. Employees can also seek one-on-one assistance if necessary.

“We really try to take care of our staff. ... (The sessions provide) a safe environment and nobody is there to judge or discuss anything other than how this is affecting them,” said Watkins, adding that emotionally-charged incidents can take even the ER staff’s veteran employees by surprise.

“Just because you have to be strong to work here doesn’t mean it doesn’t affect you,” said Michelle Monroe, a lead ER nurse who joined the Queen’s ER staff 22 years ago. “We all have things that hit us, but kids are always very hard.”

What to expect

In the emergency room, priority goes to trauma patients and others with the most serious conditions. Patients at the Queen’r ER wait an average of 40 minutes before seeing a doctor. The average patient stay is 130 minutes.

“Unlike fast food, you might have to wait. We have no control over the flow,” said Dr. Richard Bernini, who has worked in the Queen’s ER for 30 years.

Prepare yourself

• Keep in mind that the ER can be a noisy place, and that waits vary depending

  on caseload and the seriousness of the case.

• Bring a list of your medications to the ER. If you are unable to, ask a friend or family member to do so.

• Ask your ER physician to make a copy of any test results or care instructions that should be provided to your primary care doctor.

• Return to the ER if your symptoms return and you are unable to follow up with your primary care doctor.