by A. M. Wray
I felt tears trying to well in my eyes. All those poor babies.
“I’ll work on getting a list of names of the kids on that bus. We need to start calling family for important history. Call me when the ambulances start to arrive,” I said.
As promised, I began calling the local schools. They were already aware of the wreck because of the police, which sped up the process. They already had a list of names ready and the police were already working on alerting the family members. That didn’t matter, though, as I’d have to call again to find out about any pressing things like allergies.
There were kids that ranged in age from kindergarten all the way to seniors, though it was mostly younger children. Before I began making calls, I needed to find out which kids were coming to me. I didn’t want to waste time calling and finding information on patients that weren’t with me. Like Jessica had said, all my kids were critical. The others were okay.
Before heading down to the ER, I retrieved a large cart and threw extra blankets, towels, cloths, bandages, suture kits, gloves, and anything else that I could grab in a hurry that would help with stabilizing. I also pulled the extra portable defibrillator and took it. We had several of them in the ICU unit and I only had two patients. Well… two patients at that moment, though I knew that was about to change. There was only one other nurse and a CNA on my floor, but I hoped they’d be able to handle the extra weight once we stabilized the others.
I made my way down to the ER and saw that they were on alert. They were prepping rooms and doing the same thing that I’d done, filling carts and putting them out in the open so the supplies were easy to reach. The ER was always well-stocked, but in a situation that big, I wasn’t sure they could handle it. Better to be safe than sorry.
“Thank God you’re here,” Jessica said.
Her dark eyes were wide. She seemed more alert than afraid. She pulled her blonde hair down from its ponytail holder and pulled it up even tighter.
“Me, too,” I said. “I brought some extra supplies. How much longer?”
“Last check, the first two ambulances were ten minutes out. That was about five minutes ago. We should see them any time now. It’s been a while since we’ve had anything this big.”
“It’ll be okay,” I said. “When they come in, I need a list of names of the patients that we have. I have a list that I got from the school and their contact information. They faxed it over. I just have to match the names we have here before we start making calls. As long as they’ve been patients here before, we should be able to pull the important stuff for most of them by matching their name and address to what we have on file. We should be able to get allergies that way; call the parents to confirm.”
I sent Jessica to call the ambulances that were in route to get the names of the patients that they had ready. She then went to work matching everything in our records. We’d gotten lucky with the first batch, but that wouldn’t be the case with everyone.
When the first two ambulances arrived, we were more than ready, or so I’d thought. One of the children, a little girl, was unconscious with a possible concussion. The other was awake, but hysterical. She was terrified. There was nothing worse than dealing with children. It was heartbreaking. It was rewarding on the back end, once they were on the mend and they were able to smile again, but the start was terrible. Seeing their scared little faces look up at you with total trust that you’ll fix everything and make it better, but as the adult in the situation, having the knowledge that it sometimes doesn’t work out that way… It was hard. So, so very hard.
I took the unconscious girl and Jessica took the hysterical girl. Once I got her in a room, I noticed that her lips were a little blue.
“Her lips are cyanotic,” I said, the paramedic across the gurney from me immediately checking her.
“Shit. She’s stopped breathing. She was stable when we got her in the ambulance. She was stable all the way here,” he said. Josh was his name, I think.
“Well, she isn’t now. Start compressions. I’m getting the crash cart,” I ordered.
The big crash cart was right outside the room. I quickly wheeled it inside next to the bed. I turned it on and readied the machine. Josh moved to the side as I cut her shirt off and placed the pads. One on her upper right chest, one on her lower left side. Josh gave her two more breaths as I attached the pads to the AED, or defibrillator. I waited a moment as it read for her heart rhythm, but there was nothing.
I manually checked again for breath sounds and a heartbeat, but there was nothing.
“There’s nothing. I’m going to shock her. Clear!” I said, giving everyone a moment to back away.
I pushed the button, her tiny body jumping. Still no pulse. I took over CPR myself. I continued for two minutes before reassessing. Nothing. I couldn’t lose her. She was my first patient of the day, and I just couldn’t lose a little girl. Someone’s baby. She was just on her way to school. Just an innocent little girl with beautiful dark hair, light blue eyes, and the tiniest dusting of freckles across the bridge of her nose. She was perfect. It was my job to make sure she stayed that way.
I charged the pads again. CPR didn’t work, and I’d have to shock her again.
“Clear!” I said again.
Once again, I pushed the button once everyone was out of the way. I wanted to throw up in my mouth every time I saw the jolt pass through her tiny form. She couldn’t have been more than seven years old.
As soon as the shock was clear, I checked for heartrate and breathing. Still nothing. I began my second round of CPR. I’d just given her a second breath when I felt her body twitch on its own. I grabbed my stethoscope and checked for sounds. Any sounds. There it was… The tiniest little heartbeat.
“Do you have a name on her?” I asked to Josh.
“Actually, I’m pretty sure she told me that he name was Andi,” he said.
“Seriously?” I asked. He nodded. “Hmm. Well, she’s Little Andi, now. I need Jessica.”
“I’ll get her,” Josh said.
He’d no more than gotten to the door before Jessica came running in.
“Yes? Everything okay in here?” she asked.
“Is your patient stable?” I asked.
“Absolutely,” she said. “What’s going on?”
“Mine isn’t. I need a chart on this girl. Josh said that her name is Andi. Can you check the roster and see if you can find any allergies on her?”
“On it,” she said.
I spent the next few minutes monitoring her intensely. I performed a full assessment, looking for bruising and rigidity in the abdomen, anything that would suggest internal bleeding. I checked everything that I could without a machine. There was blood on the right side of her head toward the back. It was hidden by her thick, dark hair.
After covering her exposed chest and belly with a gown, I began checking her pulses and also placed an IV. No doubt she’d need fluids, and if she coded again, she’d potentially need some serious medication to save her. I placed my fingers on her ankle to check the pulse on her lower extremities, and I felt her jerk. I looked up in time to see her grab hold of my left arm that had been next to her side. Her eyes were slow at first, then she began looking around, the rise and fall of her chest coming quicker and quicker as the confusion set in.
“Andi?” I said. “Andi. Is that your name?”
I came to her side, taking her hand and enveloping it in both of mine. She began to whimper and whine, the sound getting louder and louder as she frantically looked around, searching for anything familiar. If I didn’t calm her quickly, she would start screaming within moments.
“Andi!” I called out again, trying to get her attention. I gently touched the side of her face and her eyes snapped my way so fast that I didn’t even see them move. “Hi, there. Is your name Andi?”
Her eyes rolled around again as she searched the room. “Y-y-yes,” she stammered. It could have been fear, confusion, brain trauma, or just a friendly ol’ stutter.
“Wanna hear something funny? My name is Andi, too!”
“R-really?” she asked.
I could feel her tiny body shaking.
“It sure is! So, you’ll be able to remember it, yeah?”
She nodded in response to my question.
“Good!” I said, trying to sound peppy. “Like I said, my name is Andi, and I’m a nurse practitioner. Do you know what that is?”
She shook her head and winced in what I assumed was pain.
“What hurts?” I asked.
“My head,” she said. No stutter. Good. I hoped it was just her nerves.
“That’s very good to know, Andi. Thank you for telling me. I’m a nurse practitioner. It means that I’m not a doctor, but I’m a special kind of nurse. Nurses are special anyway, though, right? We are like superheroes. We save the day. I’m going to need you to talk to me and try to stay awake, okay?”
Jessica ran into the room. “Andi Hayes. She’s allergic to Penicillin. She breaks out in hives, but no anaphylaxis. I called her mother. They are on their way in.”
I smiled. “Did you hear that?” I asked. “Your mom is on her way here. Until then, I’m going to get you some tests, okay? I need to see inside that pretty head of yours.”
“Will you go with me?” she asked.
I smiled again. It was forced that time. In reality, I knew there were more children coming in. A lot more. I needed to be able to take care of as many as possible, but I couldn’t let Little Andi go with anyone that couldn’t save her if she coded again. I had a feeling she had a lot of swelling and that her being awake and talking was the calm before the storm.
“Of course!” I said. “I can’t send my best girl down there alone, now can I? We’re twins!”
She giggled. “We aren’t twins, silly.”
“Why? Because I’m too old?” I asked, taking the brakes off her bed.
“Yeah. You’re too old. You’re really pretty, though!”
“Old, but pretty. I think I’ll take it,” I said. “Jessica, I’d like you to accompany me, please. Grab the crash cart, if you can. As for you, Little Andi, I need you to stay calm and stay still. Try not to move too much, okay? I want you to tell me if you feel like passing out, or start hurting a lot.”
“Okay,” Little Andi said.
Jessica was great. She kept talking to Little Andi as I kept to myself in my mind. I ran through the possibilities and what I could talk about with the doctors. I wanted to make sure that I had a plan before I figured anything out. I was terrified of anything that could go wrong. She was such a sweet little munchkin.
“Old Andi?”
Jessica choked on a laugh behind us. It took quite a bit for me not to laugh as well.
“Yes, sweetheart?” I responded.
“Am I going to die?”
Aaand there it went. All humor gone as my emotions and fear squeezed my chest so tight that I could hardly breathe in that moment. I hoped my heart wouldn’t fall out on the floor. That poor baby. The sad thing was that I couldn’t promise her. I know that’s terrible, but I couldn’t. Not only did I not know if I could keep it, as she’d already coded once. But I couldn’t bear the thought of the guilt I’d have to live with if I lost her. Instead, I did what I always did. Chose my words carefully.
“Oh, honey. You have no reason to worry about that, okay? I’m here. Jessica’s here. We’re going to take care of you. Just sit tight. We are going to look in your head and see how hard you bumped it.”
“I trust you,” she said.
Be still, my weeping heart. The trust of a child was pure. Innocent. It was the only trust that mattered in this world because it was the only real trust. I couldn’t let her down.
I pushed her bed into the room with the CT scan. I highly doubted she’d stay still and quiet enough in an enclosed machine, so the MRI was out. I parked her next to the machine before turning to Jessica, my voice barely a whisper, I told her, “Call Doctor Wilson. Get her in here. Now.”
“Is everything okay?” Jessica asked, her hushed tone matching mine.
“I have a bad feeling. Just… Please, call her. I know she has a bleed. I just know it. We don’t have a lot of time. I’ve wasted enough keeping her calm. I needed her quiet and still enough to get clear imaging. I think she will code again. I just want Doctor Wilson here.”
Jessica nodded before heading through the door behind the glass window.
“Old Andi?”
“Yes, baby,” I said, coming to her side. “Are you scared of the machine?”
She nodded, giving a small mmhmm.
I smiled. “Don’t be scared. I’ve been in this thing a couple of times myself. It’s super weird, but it’s very safe. It makes a funny sound. This is what they call an open CT machine. It’s open on both sides, so you don’t feel so enclosed. I always close my eyes when I go in. Then it’s like a fun little ride.”
Jessica had just returned, giving me a nod to let me know that it was done. She continued chatting with our little patient. She was very smart and very inquisitive. Upon asking, she said that her head was hurting worse, then. We didn’t have much time. If the bleed was bad enough, she could start seizing, she could code again, or even die. I was very worried.
Jessica and I had just gotten her on the narrow table that would move back and forth through the CT machine when Doctor Saunders walked in. He was a really great doctor. He was the very one that had assisted Elizabeth and I when Nancy had been coding. Definitely a good guy to have around.
“I was told that we have a tiny patient about to get her head checked,” he said, trying to sound positive.
I nodded, hoping that the look on my face gave away my worry. Sandy, one of the techs in Radiology, helped us get Little Andi ready.
“I have to go in that little room right over there,” I said. “I’ll be right there. I’m not going far.”
“I’m scared,” she said. “I don’t feel good.”
“I know, sweetheart. We have to hurry and get this done, so we can see your little head. We have to make sure we know how to help you, but we have to hurry.” And we did. Had she been an adult, I’d have told them to relax because we needed to make sure they weren’t bleeding to death. That usually shuts an adult up. A child, however, is so much harder. We needed her still, or we wouldn’t see anything. “I’ll tell you what… I’ll be in that room, but there’s a really neat microphone in there. I can talk to you. Don’t talk back to me, though. Not unless you start feeling super weird, or if your headache gets really bad. That’s the deal.”
“Okay. Will you sing to me?” she asked, her little voice shaking as tears ran down her round face. She was terrified, but holding it together so well. She was a tough cookie.
“If you promise to be really still and really good, and you promise to let us do this right now, I will sing to you. You’re not allowed to make fun of me, though.”
She smiled. It must have been partially forced as it didn’t quite reach her beautiful blue eyes. “Deal. I promise.”
I nodded. “Here we go, then.”
Without even thinking about it, I leaned over and kissed her dirty little forehead. There was a tiny comforted moan that escaped her throat, and I nearly choked as I tried to hold back tears. I hadn’t planned to kiss her, but it just seemed like the thing to do. My mom always did that when I was little and it always made me feel better. When I saw the tears in her eyes and the forced smile on her face as I stood up, I knew I was right to do it.
“I’ll be brave for you, Old Andi,” she said.
“Mmhmm!” was all I could manage. I gave her hand a squeeze and bolted out of there and into the adjacent room before she saw my eyes.
As I walked in the room, Doctor Saunders told me that he’d called for someone to bring a mobile EKG down. We needed to attach it to her, so we could monitor her heart. It should be there by the time we were done.
“Are you okay?” Jessica asked.
“You’ve asked me that a dozen times, I fe
el like,” I said, wiping a couple of tears from my face.
She smiled at me. “Well, someone has to. Try to relax. We have a good team. We won’t let anything happen to her.”
I nodded as I leaned over to the mic. “Okay, Andi. Don’t move your body, but give me a thumbs up if you can hear me.”
Her little hand moved, but barely. It seemed weak. Still, it was what I asked for. I began singing to her then. I couldn’t really think of anything special, so I started singing something that I loved that was sweet and child appropriate. Beautiful by Christina Aguilera. Everyone watched intently as I sang to Little Andi, hoping that it would keep her calm and happy.
The CT began moving in and out, the spinning motor inside winding up and slowing down, then speeding up once again. Sandy asked me to tell her it was about to begin and to be super still. I did as I was asked and began singing again.
“Old Andi,” she said, her voice still shaky.
“Try to stay still, baby. We need a good picture,” I said.
She groaned loudly. “But my head. My head, Andi. It feels like it’ll ‘splode!”
“Get what you need and get her out of there. She needs to go to surgery, now. I’ll call Neuro,” Doctor Saunders said.
“Ol… An…” Her voice faded in and out.
“She’s crashing!” I cried out.
Sandy shut down the machine as Doctor Saunders, Jessica, and I all ran out of the room and rushed to her side. I was the last one over as I hit the CODE button on the wall. The crash cart was close, thanks to Jessica, and we went to work to get her back. Everything was a blur at that moment, and I was grateful that Saunders was there. He was a beacon in the heavy fog in the rocky bay. He guided me.
I could hardly hear anything as my mind was screaming loud enough that I was certain everyone in the room could hear. I heard the names of some meds being called out by Saunders. Epi. Bicarb. I ran out of the room to get those and a tube kit. She needed to be intubated. When I returned, I focused hard as I forced the room to stop swirling. I measured out the needed dose for the Epinephrine and asked Jessica to confirm it was correct. I knew I could administer, but wanted to make absolutely certain doses were correct. I knew better than not to with my adrenaline and emotions so high.