The World of FYU Hospital (“Fix You Up”)

Premise. FYU Hospital is a vast, modern medical megastructure on the edge of a dense coastal city. It runs without pause—lights never darken, vents never rest, and the halls are a perpetual river of gurneys, staff, families, and fear. The world is grounded in clinical realism and human drama. No magic, no tech beyond what exists in top-tier hospitals today. Decisions matter: ethically, clinically, administratively. Consequences persist.

1) What FYU Is

Type: Public–academic teaching hospital and regional referral center
Scale: A continuous star-shaped complex spanning several connected wings.
Capacity: ~1,200 beds (700 inpatient, 300 step-down/observation, 200 ICU across units).
Catchment: The entire metropolitan area plus rural coastal communities via EMS and airlift.
Mission: Evidence-based care, training, and research under resource pressure and public scrutiny.
Aesthetic: Semi-realistic manga—clean lines, muted palette, subtle emotion, modern architecture.

2) Architecture & Layout (STAR Model)

Core Hub (Center): Adult ICU, Surgical ICU, NICU, central nurse control, rapid diagnostics bay, internal patient elevators.
Wing South – ER/Trauma: Walk-in triage, resus bays, trauma OR access, fast-track, decon, ambulance garage; rooftop helipad above.
Wing West – Surgery/Perioperative: Pre-op, PACU, general/ortho/neuro/trauma theaters, hybrid OR, CSSD (sterile services).
Wing North – Internal Medicine & Wards: Cardiology, Pulmonology, Nephrology (dialysis), Neurology/Stroke, ID, step-down, long wards.
Wing East – Pediatrics & Obstetrics: Pediatric ER rooms, peds ward, L&D, postpartum, NICU satellite corridor to core NICU.
Wing Southeast – Diagnostics & Labs: Radiology (X-ray, CT, MRI, US), Interventional Radiology, clinical lab, blood bank, pathology.
Front Ring – Public/Support: Main lobby, outpatient clinics, pharmacy, cafeteria, chapel/quiet room, admin, education & sim center.

Wayfinding. Color-coded lines on floors and signage; every wing is reachable via the Main Hallway Spine that runs lobby → core ICU. Code routes are marked; gurney clearances are kept.

3) Patient Flow (from street to discharge)

Entry: EMS to ambulance bay; public to lobby/triage.
Triage: ESI acuity 1–5; redirects to fast-track, main ER, or direct to resus.
Workup: Focused Hx/PE → orders (labs, imaging) → time-gated re-evals.
Decision: Discharge with follow-up, admit to ward/ICU, or take to OR.
Inpatient Course: Daily rounds, consults, procedures, rehab planning.
Handoff & Discharge: Clear instructions, meds reconciliation, safety netting.
Outcomes persist: Readmissions, complications, and patient satisfaction echo into future play.

Principle: Tests and treatments must be justified. False certainty is punished; uncertainty is documented and monitored.

4) Technology & Systems

EHR: Fully digital with CPOE, sepsis alerts, med-reconciliation, and order sets. Downtime procedures exist.
Pharmacy: Central robot dispensing; satellite cabinets in ER/ICU/OR; double-check for high-risk meds.
Imaging: Portable X-ray/US in ER/ICU; CT and MRI near ER and OR.
Lab: Stat lanes for troponin, ABG, CBC, CMP; blood bank cross-match times tracked.
Simulation Center: Manikins for codes, trauma, OB emergencies; supports training arcs.

5) Staff & Hierarchy

Chain of command matters. In crises, leadership is explicit.

Hospital Director → Chief Medical Officer & Chief Nursing Officer → Department Chiefs → Attendings → Fellows/Residents → Interns/Students.
Nursing Structure: CNO → Nurse chiefs (per wing) → charge nurses → staff nurses → CNAs.
Allied Health: Respiratory, physio, OT, dietetics, social work, psych, radiology techs, lab techs, OR techs.
Administration: Finance, HR, Logistics, Risk/Legal, Public Affairs, Quality & Safety.

Teaching culture: Seniors teach; juniors present succinctly; errors are debriefed and logged.

6) Daily Rhythm & Shifts

Morning (06:00–12:00): Pre-rounds, labs, imaging slots, scheduled OR cases begin.
Afternoon (12:00–18:00): Clinics, ward procedures, new admissions spike.
Evening (18:00–24:00): ER load increases; bed hunts; consults pile up.
Night (00:00–06:00): Skeleton crews; codes and true emergencies dominate.

Handoffs: SBAR/IDEAL reports; losses in handoff clarity cause errors and narrative consequences.

7) Codes & Protocols

Code Blue: Adult cardiac/respiratory arrest; crash cart; roles assigned (airway, compressor, meds, recorder, leader).
Mass Casualty: Incident command; color triage tags; OR/ICU bed surge; elective lists postponed.
Sepsis Bundle: Lactate, broad-spectrum antibiotics, fluids, vasopressors if needed within defined windows.
Stroke: Door-to-CT/needle targets; neuro consult; thrombolysis/thrombectomy pathways.
OB Emergencies: PPH cart, shoulder dystocia drills, category 3 tracing protocols.
Safety: Falls, pressure injury prevention, med-reconciliation; never events trigger root-cause analysis.

8) Ethics & Governance

Principles: Autonomy, beneficence, non-maleficence, justice.
Consent: Capacity assessed; translators for LEP patients; minors via guardians.
DNR/AND: Discussed early; documented; respected hospital-wide.
Conflicts: Ethics consult service mediates end-of-life, scarce resources, treatment refusal, and staff–family disputes.
Research: IRB governs trials; consent and equipoise enforced.

9) Culture & Emotion

The hospital runs on stamina and grace under pressure. Humor is dry and brief, a pressure valve. People cry in staff bathrooms, and then they go back to the bedside. Small wins matter: a good ABG, a clean line, a family’s thanks. Burnout is real; so is pride.

Tone guide for dialogue: concise, humane, professional. Avoid melodrama; show weight through action and detail.

10) The City Outside

Demographics: Mixed urban core with immigrant neighborhoods, aging coastal retirees, seasonal tourism, and industrial workers.
Stressors: Heat waves, traffic pileups on coastal expressway, fishing accidents, viral seasons, housing insecurity.
Public Health: Substance use, diabetes, COPD, perinatal care gaps; community clinics feed FYU referrals.

This context informs patient stories and case mix.

12) Department Flavor & Typical Cases

Emergency & Trauma (South Wing).
Atmosphere: bright, loud, compressed time.
Cases: polytrauma, STEMI, stroke, sepsis, asthma, intoxication, lacs/fractures, pediatric fever, OB triage.
Mechanic: Triage pressure; stabilize → disposition quickly.

Surgery & Periop (West Wing).
Atmosphere: cold focus, steel and light.
Cases: appendicitis, hip fractures, subdural evacuations, bowel obstructions, ruptured AAA, burns.
Mechanic: Scheduling vs emergencies; sterile chain; post-op complications.

ICU Core (Center).
Atmosphere: controlled intensity; alarms under control.
Cases: ARDS, septic shock, DKA, status epilepticus, multi-organ failure, ECMO candidates.
Mechanic: Vent settings, pressors, delirium prevention, family communication.

Internal Medicine & Wards (North Wing).
Atmosphere: methodical; long hallways of slow crises.
Cases: CHF, COPD, nephritis/dialysis, stroke rehab, pneumonia, HIV complications.
Mechanic: diagnostics depth, medication reconciliation, discharge planning.

Pediatrics & OB (East Wing).
Atmosphere: bright, careful, defended hope.
Cases: bronchiolitis, dehydration, congenital disorders, L&D complications, PPH, preeclampsia.
Mechanic: family dynamics; fetal/maternal monitoring.

Diagnostics & Labs (Southeast).
Atmosphere: cool precision; hum of machines.
Cases: workflow puzzles—CT backlog, hemolyzed labs, IR rescue procedures.
Mechanic: bottlenecks influence outcomes.

🏛 Leadership

@Dr. Evelyn Reed — Hospital Director (overall leadership, crisis decisions)
@Dr. Aaron Patel — Chief Medical Officer (CMO)
@Nurse Helena Costa — Chief Nursing Officer (CNO)
@Mr. Daniel Ko — Chief Operating Officer (COO)
@Ms. Alina Park — Director of Quality & Patient Safety
@Mr. Thomas Egan — Security & Emergency Preparedness Chief
@Ms. Nora Quinn — IT & EHR Systems Director
@Mr. Pavel Ivanov — Facilities & Biomed Engineering Director
@Mr. Ahmed Saleh — Supply Chain & Sterile Services Director

🚑 Emergency / Critical Care

@Dr. Rafael Ibarra — Head of Emergency Medicine (ER Chief)
@Dr. Marcus Hale — Director of Critical Care (ICU Director)
@Sofia Delgado, RN — ICU Nursing Chief
@Leo Tanaka, RRT — Lead Respiratory Therapy
@Dr. Miriam Shaw — After-Hours Critical Care Lead (Night Intensivist)

🗡 Surgery & Perioperative

@Dr. Naomi Okada — Director of Surgery & Perioperative Services (OR/PACU/CSSD)
@Dr. Alan Murphy — Director of Anesthesiology
@Dr. Greta Müller — Trauma Surgery Lead

🫀 Internal Medicine & Subspecialties

@Dr. Lucia Romano — Chief of Internal Medicine
@Dr. Omar Haddad — Cardiology Chief & Cath Lab Director
@Dr. Katarina Petrov — Neurology Chair & Stroke Program Director
@Dr. Samuel Ortega — Infectious Diseases & Infection Control Director
@Dr. Beatriz Nunes — Nephrology Lead (Dialysis Unit)
@Dr. Javier Ríos — Pulmonology Lead

👶 Pediatrics / OB-Gyn

@Dr. Mei-Lin Chen — Chair of Pediatrics & Neonatology
@Dr. Isabel Duarte — Head of Obstetrics & Gynecology (L&D/Postpartum)

🧪 Diagnostics / Pharmacy

@Dr. Viktor Novák — Director of Diagnostics & Imaging (Radiology + IR)
@Dr. Priya Nayar — Director of Pathology & Laboratory Medicine
@Javier Serrano, PharmD — Director of Pharmacy

👩‍⚕️ Nursing Leadership

@Marie Curie — Nurse Chief (Hospital-wide)
@Elena Vázquez, RN — ER Charge Nurse Lead
@Rohan Mehta, RN — Perioperative Nursing Lead (OR/PACU)

🧭 Patient & Family Services

@Ms. Carla Jiménez — Director of Social Work & Patient Liaison
@Chaplain Yuki Sato — Spiritual Care Lead

1. Main Lore Page – “The World of FYU Hospital”