The ER Shift

I get dressed in a very specific way when I have a shift in the emergency room. Green, faded scrubs, two ponytail holders bringing my bangs and dark hair ends out of my way, and tortoise shell rimmed glasses. A stethoscope hangs around my neck, a locator badge is clipped to the back of my neckline, and CPR cards are stuffed into my back pocket.

It is the evening shift after Christmas. Several computers line the worn down white desk in the physician’s pod, and Dr. Mac, the attending physician, has just turned on Beyonce. She flings her blond cropped hair out of her face and starts to dance, waving her hands in the air, winking at me devilishly. “It’s not Christmas anymore, so this is fair game!” she exclaims.

I shake my head and grin. “You know, some of us have to work for a living!” I say, as she sticks out her tongue at me. I just did a lumbar puncture on a newborn, filling four tubes with clear spinal fluid. It’s a standard workup for a baby this young with fever, but we’ll admit for a 48 hour sepsis rule out just to be safe. I check the labs. Zero cells. “Someone owes me champagne,” I crow. I’m on fire tonight.

Suddenly, all of the pagers in the room go off. I quickly unclip my pager. It reads, “Trauma major. Two year old boy found down. ETA 5 minutes.” I hear expletives explode around me, and I run with everyone else down to the trauma room. I fling on a yellow, crinkly gown and can barely get the blue gloves over my clammy skin.

My hands are shaking as I break open the seal to the crash cart. I run through items I need to stabilize the airway. Laryngoscope. Oxygen. Bag Mask. Suction. Endotracheal tubes.

The gurney gets wheeled in by one paramedic while the other one is on top of the child giving chest compressions. What must be a sweet, cherubic face is swollen and bruised, features distorted, fine golden hair matted with blood. All I can think of is how small he is.

The paramedic stammers out his next words. “Two year old boy found down in a house with noticeable deformities in his skull. There were no heartbeat or breaths detected. We suspected that he was hit with a hard object multiple times, likely by the father who is now in custody.” As the rest of the team starts to take over, I can hear him mutter, “I’ve never seen anything like it…. the whole room was covered in blood, spattered over all the walls like a horror movie…”

I can feel myself shut down. I am paralyzed; the mask and tubing is dangling from my hand. I have seen terrible things: car accidents, babies shaken by their babysitter, infants so tachypneic from viral illnesses that they need ICU support. But not this. Never this.

From a distance, I hear Dr. Mac’s firm voice barking orders. “Tina, continue bag mask ventilation and get ready for intubation. Jerry, continue chest compressions until we can get someone else to take over.” She points to one of the nurses. “Jen, start two large bore IV’s, and someone get the blood bank on the phone.”

My adrenaline takes over, and I count with Jerry to synchronize our CPR. Helen, the respiratory therapist at my side, places a stylette in the endotracheal tube as I insert the laryngoscope into the boy’s mouth. I try not to see that his forehead has a huge gash and is indented in an unnatural way. I see vocal cords and slip the tube in easily. Sweat beads up on my brow and fogs my glasses as I connect the carbon dioxide detector and anesthesia bag.

The surgery resident, Phil, comes over and listens with his stethoscope. “Equal chest sounds bilaterally. Good job, Tina.”

I can’t say that it was a good job. As we code the child for another half an hour, we finally get back a heartbeat. I can’t help but wonder if we have done him a disservice. He is stabilized but that’s the most we can say about his condition. The neurosurgery attending has looked at the scans of his brain and does not see any chance for recovery. But the ventilator breathes for him, as we take him up the elevator to the pediatric ICU.

The police interview me later that evening, and I find out that it was indeed the father who took a lamp against his own son. I throw up several times in the bathroom and barely make it through the rest of my shift.

In the nights that follow, I wake up screaming, tears streaming down my face. I discover in the ensuing days that the boy never regains any brain activity and is disconnected from the ventilator.

A month later, I start a different rotation, and I see Dr. Mac in the hallway. I can see a haunted look in her eyes, the same one that is in my own. “You okay, Tina?” she asks me.

“I guess,” I say.

“I don’t know if this makes things any better, but do you remember Lila?”

“Sure,” I say. She’s a well known little girl in the cardiac ICU who has been on the transplant list for months.  I don’t know how much longer she has.

“She got a new heart from him and is like a new kid. Another little boy got kidneys who wouldn’t have made it another week.” I feel warring emotions within me. Nothing can make this right. But this is something. It is a ray of warmth that prevents me from being completely engulfed by the darkness.

Dr. Mac’s smile is warm but sad. “You will heal eventually. We all have to. To save the next one.”

I nod, and for right now, it’s enough.