It's 11 o'clock on a Saturday night — on a July Fourth holiday weekend, no less — and Dr. Angela Siler Fisher is at the center of a bank of computers in the holding area of the Ben Taub General Hospital emergency room, calmly managing the controlled chaos around her like a traffic controller at the airport on a busy night.

Nearly 50 patients with a host of maladies, ranging from a broken ankle to severe abdominal pains, lay side-by-side on rollaway beds, awaiting a final diagnosis so they can go home or be admitted to the hospital.

Another 40 patients are in the waiting room; their illnesses aren't severe enough to warrant immediate treatment but they are next on the list.

In the ER, renamed in honor of philanthropists Ginni and Richard Mithoff in 2006, five cubicles, called "shock rooms," remain open for life-threatening cases that have to be addressed immediately at the Level One trauma center — one of only two such facilities in the entire city. (When it comes to trauma centers, Houston is woefully understaffed. The recognized rule of thumb is there should be one Level One center for every million in population, so in a city this size, there should be at least four.)

Surprisingly, this night is relatively quiet for acute trauma cases at the Harris County Hospital District facility — by 7 a.m., when the shift changes, doctors will have seen only a couple of minor car accidents, a fight where the victim's front teeth were knocked out, an apparent sexual assault and a stabbing. But on the few times on this night when ambulance workers rush a patient into a shock room, the critical care team methodically springs into action, quickly stabilizing the patient.

"Ben Taub is the place you want to go when you're hurt really bad," Fisher says.

Detective work

The bland, windowless holding room inside the trauma center is peppered with a kalediscope of colors: Registered nurses dressed in black, aides in blue or purple, residents from Baylor College of Medicine in green scrubs, doctors in white lab coats. Over the next eight hours, a visitor is struck by their dedication as they work to get patients out of the room and on with their lives.

To reduce wait times, the ER recently instituted a screening procedure which divides patients into low, medium and high priority in order to funnel them to the proper attendants for diagnosis as quickly as possible. They aim to initiate a case within a hour; obtain a diagnosis by four hours. Everything is documented on a computer and officials say response times have markedly improved. But on a night like this, the wait often drags on.

Once a patient is seen by a doctor, Fisher and her team become detectives: They often huddle at computers, looking at the latest lab results and X-rays — everything is online — to zero in on what's wrong. It's methodical work. Fisher constantly quizzes the residents, who resemble a less sexed-up version of the cast of Grey's Anatomy, to get them to think analytically about each case and come up with the best solution.

"Is he sick or not sick?"

"Are you worried or not worried?"

"What if it's a heart attack? We have to come out with a good reason why it's happening or get him admitted."

"Give me a good plan," she says.

"What else have you got?"

Few complaints

In the holding area, there's precious little privacy. Patients are wedged in, side-by-side, with only a flimsy curtain separating them. However, most curtains are not even drawn; everyone seems to garner some comfort in the group atmosphere. Conversations begin; illnesses are compared. A couple of patients are so relaxed, the sounds of their snoring permeate the room.

Surprisingly, given the cramped quarters, there are few complaints, perhaps because patients see the staff working nonstop in the open room, so they sense that everything possible is being done considering the circumstances.

Most are resigned to the long wait of an ER stay. But one woman with cancer begs Fisher to let her spend the night in the holding area. She needs to have a prescription filled and the pharmacy is closed for the night, but she doesn't want to drive all the way home and come back the next morning. Fisher softly explains there's just no room.

As the night turns into morning, a mother lovingly strokes the face of her severely disabled young son, whose body is contorted, his eyes staring at the ceiling. A young man with a jaw swollen the size of an orange — the result of a possible abcessed tooth — looks miserable. A woman who was in a car wreck but doesn't appear injured begs Fisher without success for a prescription refill and a letter stating she is too disabled to work. A scary-looking man covered with tattoos like Robert De Niro in Cape Fear lies in a neck brace and handcuffs as a police officer hovers nearby. An elderly woman is curled in pain, apparently with a bad case of shingles.

"Show me where it hurts, love," Fisher whispers.

A young woman in a black cocktail dress who planned a night on the town but who drank too much curls up in the bed, while her concerned brother watches over her. "A little alcohol drama never hurt anybody," Fischer says to the woman, who looks embarrassed and dazed as she leaves. "Just be careful, sister."

Fisher stops by a wizzened old man with gangrened feet.

"Whose taking care of these wounds for you?" she asks.

"Nobody," he responds.

She calls in a surgeon who wants to amputate part of each foot. The patient balks.

"The bones are infected," she explains. "That's why we called the bone doctor. If you won't have surgery, there's nothing we can do to make it better."

He shakes his head no.

The surgeon leaves and Fisher goes back to the computer to update several files.

"Hey, doc," the man, who is within shouting distance of the computer bank, says to Fisher.

"Yes, love, I'm listening. So you want it?"

He nods his head.

"I'm going to call the surgeon," she says.

He falls asleep as the shift change approaches and a new round of residents and their supervising doctor come in to make rounds with Fisher, before she heads home to her family in The Woodlands.

In the background, the overhead speaker blares, "Code One," signifying that a new patient has been transported to a shock room. The critical care team races to evaluate her condition.

Another day has begun.