A triage nurse, staffing the desk in the waiting room, who sorts patients not according to severity or urgency, but according to their own whims and twisted love of power.
There is a tendency for many people (who don't understand the concept of triage
) to decide that the ER staff is indulging in this, even when they aren't. Add to that that the desk staff at an ER have to be firm about who they're calling, but can't explain to the other patients why they're being taken in that order, and you get an appearance of petty tyranny. While desk nurses are the most likely to get this portrayal, medical personnel, in general, are often seen as petty dictators who are unreasonable about things like visiting hours; admittance to the ICU; flowers, candy, and food being brought to the patients; and all the other annoyances about having a loved one in the hospital.
Of course, it should go without saying that, in Real Life, there are very good reasons for all these rules. Sometimes that is illustrated dramatically with a medical emergency that happens right in front of the complainer and the triage nurse has to go into action while the complainer realizes that there are higher medical priorities he must respect.
At the absolute worst-case scenario—a battlefield situation, an Urban Hellscape, or a complete sociopath of a nurse—they will use the concept of triage to justify letting people die.
Subtrope of Battleaxe Nurse, a very uncaring member of the "caring profession". A coworker of the Dr. Jerk, a talented physician who behaves like an ass. Related to Obstructive Bureaucrat, a bureaucrat who hinders others with paperwork, for better or worse.
Examples:
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Anime & Manga
- Black Jack: One of Black Jack's patients, a politician, accuses Black Jack of being this, and even sues him over it, when, in the aftermath of a violent accident that leaves three injured, Black Jack operates on an endangered wildcat first, a baby second, and the politician last. Black Jack defends himself by saying that he simply treated them in order of how serious their injuries were and that it's his policy to treat all life, both human and animal, as equal. (Though, privately, he admits that he considers saving a critically endangered wildcat more important than saving some Sleazy Politician.)
Films — Live-Action
- Bringing Out the Dead: The triage nurse gives lectures to the patients who come in. "Let me get this straight. You snorted cocaine and now you feel like your heart is going to explode. We didn't buy you the cocaine, we didn't shove it up your nose..."
- Doomsday: Discussed as a justification to commit a big Kick the Dog act regarding the people infected with the Reaper virus:
Michael Canaris: It's basic combat triage. Leave the dying to die.
- Gridlockd:
- Deconstructed. The two main characters, junkies on the run from some hoodlums and the law, are desperately trying to get into rehab. They repeatedly bounce off of gridlock and red tape while talking to a number of overworked and indifferent bureaucrats. While the junkies rage at the obvious dysfunction of the system, the bureaucrats get their own licks at the junkies, showing how there are many other people just like them jockeying for the same limited resources and that the world doesn't stop simply because they suddenly decide to ask for help.
- While the bespectacled bureaucrat at drug treatment enrollment is nothing but helpful and finally just snaps at two rude, frustrating junkies who get in his face for doing his job, the desk nurse in the hospital plays this trope straight. She has zero sympathy for the two main characters who carry their OD'd friend into the building. When one of them explodes at her for her indifference and prioritizing paperwork over treatment, she explodes right back and actually screams that she'll "let the bitch die!".
- The director was making a subtle point there, too. The sheer inefficiency and weight of the inner-city bureaucracy eventually corrodes well-meaning people into apathy and even scorn for the people they're meant to be helping. Definitely the case in Real Life, with underfunded and under-appreciated agencies.
- Little Miss Sunshine: She's not a nurse but a "bereavement liaison" and certainly qualifies.
- Pitch Black: Discussed between Riddick and Johns as they see that it's still a long road to go to get to the escape vehicle and the possibility of being torn apart by bio-raptors is just increasing. Johns' discussion is an attempt to try to convince Riddick to kill Jack and use her corpse to distract the bio-raptors. Riddick, who is a Friend to All Children even if he is an unrepentant criminal, decides Johns is better off dead right then and there.
Johns: Battlefield doctors decide who lives and dies. It's called "triage".
Riddick: They kept calling it "murder" when I did it.
Literature
- Juggernaut: Desmond Bagley makes this mistake. After a bombing raid during a civil war in Africa, some doctors are asked if they used to triage and indignantly reply that they tried to save everyone. From Bagley's description, he appears to be confusing it with "reverse triage" (treating the least injured first so they can be returned to battle).
- Star Trek: Vanguard: In the first novel of the series, Bombay, the CMO complains bitterly about "battlefield triage" - she and her staff can't treat crewmen who may need their help the most if they aren't critical to keeping the ship from being destroyed while under attack. To her, it feels like a perversion of the Hippocratic Oath.
Live-Action TV
- The Big Bang Theory: Justified in an episode. Howard is faking an allergic reaction to keep Leonard's birthday party a secret, and the nurse refuses to play along. She looks like a tyrant when she tells Leonard that Howard is not a legitimate patient — until Howard appears to have actually eaten nuts and given himself a severe reaction.
- Dr. Quinn, Medicine Woman: In "The Prisoner", Custer demands that Dr. Mike treat his soldiers first, regardless of medical priorities.
- Emergency!: In "Musical Mania", two yokels take their son with a bad case of lead poisoning and the emitting nurse brusquely tells them to wait while she fills out a report. However, Head Nurse McCall immediately tells her to process them, noting that people in need take priority over bureaucracy any day.
- Friends: "The One with George Stephanopoulos", aka the one who ends up with a face full of hockey puck.
- The Incredible Hulk: David's friend-of-the-episode, a badass biker, gets a broken arm. David takes him to a doctor's office, where they end up sitting for hours. David finally calls the doctor on this; the doctor says that he can tell by looking that the biker is only there to get some prescription drugs and he refuses to participate in such activities.
Doctor: I've found that, contrary to the saying you can judge a book by its cover.
David: That's amazing doctor. You can stand all the way over here, on the other side of the room, and just from a glance, you can tell that that man doesn't have a broken arm. - MADtv (1995): Nicole Sullivan, as the "Vancome lady", as a nurse at Sisters of Mercy Hospital. She turns away an unmarried woman going into premature labor, a hemophiliac because "we don't condone that lifestyle choice," and sends a man with a flesh-eating disease to the doctor who fired her.
- M*A*S*H: Given that the camp typically receives dozens of wounded at a time at least, triage is a matter of life and death every time, which has led to disputes.
- In one episode, Frank Burns (who's usually guilty of this trope) deliberately sends in American troops over Koreans even when there are Koreans in much greater need than soldiers. Regulations say "Americans first, allies second, enemies last." Nothing about severity or urgency.
- In another episode, Hawkeye is on the bus doing triage and gets into a fight with a soldier over being a Commie lover by prioritising seriously wounded North Koreans over wounded American soldiers.
- One Tree Hill:
"I didn't like cheerleaders when I was in school"
"But she's pregnant and in pain!"
"Guess who's waiting a little longer?" - Star Trek: Voyager:
- In "Critical Care", the holographic Doctor gets stolen and sold to an alien hospital, where patients are assessed not according to urgency, but according to how "valuable" their skills are to society. As a result, the working classes suffer in crowded, undersupplied halls while the rich recover in luxury. In the Doctor's efforts to help, both the Prime Directive and the Hippocratic Oath get severely bent.
- In "Latent Image", the Doctor is faced with two patients (Harry Kim and a Red Shirt) who have an exactly equal chance of survival. He can only treat one of them in time, and the other will die. Because his program cannot find a logical way to decide, he chooses to save Harry because he's a friend. This causes a severe malfunction in his program that forces the crew to erase his memory of the event or risk losing their only medical officer.
- In the two-part episode "The Killing Game", the ship is taken over by Hirogen who places the crew into brutal holographic simulations and forces the doctor to treat them. When a crewmember with life-threatening injuries and a Hirogen with minor burns are both brought in, the Hirogen medical officer orders the doctor to treat the Hirogen patient first. He protests that this goes against the rules of triage stating that critical injuries take priority. The Hirogen replies "your rules, not mine" and deactivates him when he refuses to comply.
- In "Author, Author", the Doctor has written a holo-novel in which the user plays the part of an EMH in a triage situation. A bridge officer is brought in with a minor concussion, but there is already a patient dying from a ruptured aorta. Captain Jenkins (Captain Janeway's Evil Counterpart) ends the debate by shooting the poor Red Shirt.
Magazines
- MAD: A law to outlaw Triage Tyranny is proposed in the popular article "New Laws Congress Should Pass Right Now!"
Video Games
- Warhammer 40,000: Space Marine: One set of logs is a recording of various conversations between a Medicae with no combat wound experience and a nurse who had plenty. As the logs go on, the amount of treatment given to the wounded is reduced to the bare minimum needed to keep them alive, then locking the doors to the clinic because they no longer have room for any more patients. Ultimately, they have to Mercy Kill all of their patients before the Orks arrive.
Western Animation
- Codename: Kids Next Door: In the episode "Operation: H.O.S.P.I.T.A.L.", Sector V has to get into a hospital to rescue an injured operative who later turns out to be Bradley because operatives who are treated there are being assaulted. Numbuh One has no luck with the triage nurse; even though she seems friendly and harmless, she doesn't take his authoritarian demands seriously. Numbuh Five, who is more polite and often the Only Sane Woman of the team, is luckier and gets some information, but is still unable to get them admitted formally. Despite this, seeing as Adults Are Useless in this cartoon (the ones who aren't evil, anyway), sneaking in is surprisingly easy, and no one tries to stop them. Lucky thing too, because Bradley is targeted by the assailant, who happens to be Numbuh Five's evil sister Cree.
Real Life
- In most hospitals in North America, emergency department presentations are assessed according to a 5-point scale called the Emergency Severity Index, which assigns a "priority level" based on the patient's chief complaint, vital signs, and a few other factors. Priority 1 patients, such as CPR in progress, major trauma, STEMI (heart attack), and stroke, skip the triage queue entirely and go straight back to the Trauma/Resuscitation area ("Resus" in department slang). Non-emergent events, such as suture removal or medication refills, are classed as Priority 5. Patients are seen in order of ESI priority, not in order of arrival time and not necessarily in order of graphic or exaggerated symptoms (i.e. nausea and vomiting aren't usually an emergencynote , respiratory distress is). Explaining the concept of triage to lay people without sounding like a petty tyrant is one of the hardest tasks of the triage nurse.
- By law in most countries, emergency department staff cannot turn any patient away until he/she has been provided a medical screening exam and, if necessary, adequate care to stabilize his/her condition. In the United States, this law is called EMTALA. If the patient isn't really that sick or injured, then they'll get the basic assessment and will be put in the triage queue to wait until the higher-priority cases are handled. Patients who are known to abuse EMTALA for drugs, attention, or other non-health-related reasons are much looked down upon by emergency department staff, as these cases are perceived as wasting time, staff, and bed space that could have been better used on a legitimately sick patient.
- One of the cruel realities of any mass casualty incident, such as a large multi-vehicle wreck in the middle of nowhere or something on the scale of Katrina or September 11th, is that not everyone can be saved, even with the miracles of modern medicine. Mass casualty triage rests upon providing the most benefit to the greatest number of people; if you expend all your resources saving one catastrophically injured patient, you may have just doomed ten more to die for lack of care. Enter the principle of Simple Triage and Rapid Treatment. If you can walk: Priority 3, help carry the person next to you over to the casualty collection point. If you can't walk, but follow commands, Priority 2: We'll get to you as soon as we can. On the other hand, if the only thing you do is breathe or babble incoherently, you get out of there pretty fast: Priority 1. Unsurvivable injuries, such as massive burns or amputations, no pulse, or no spontaneous breathing? Expectant/Morgue. See Triage for a breakdown of how this works.
