She’d been hit and dragged. The sheriff said sixty feet. Her injuries were indescribable.
Even trauma-hardened ER personnel were disturbed by the violence inflicted on her body.
Now I look at her still form and think of her husband sitting in the small waiting room reserved for grieving families. He’ll probably want to see her. We usually encourage a family to see their loved one before the body is permanently altered by the neat perfection of the embalmer. It helps bring home the reality; helps start the grieving process.
But this time I’m not sure. We can cover her body, but her face …
Bouncing under the car has ripped her scalp open. The tissue covering her forehead has been split apart, exposing her glistening skull.
We begin to clean up the room, to clear the evidence of the struggle for life.
I leave for a few minutes to attend to some other patients. When I return, I observe a miracle in progress.
The nurse in the room has carefully cleaned this woman’s head and is using clear tape to gently pull her face together. I am amazed at the difference. She has been changed from an unrecognizable form to an identifiably attractive woman. A simple towel turban to hide her wounds completes the transformation. Her elegantly manicured hand is placed casually on top of the sheet.
Now the grieving husband is able to face her. He probably will always carry the memories of this room, of this moment.
But at least in his memories he will recognize his wife.
WHAT MIGHT HAVE BEEN
It’s 7 A.M., a new shift. Not even time for coffee before the radio alarms. Auto accident. Two kids headed for home two hours away. Their truck flipped off a bridge into a wash. Now they’re on a detour to the ER.
He looks worse than she does, an obvious candidate for a few days in the ICU.
She doesn’t look too bad. She’s awake, knows what’s happening. She moves her arms and legs. She says her neck is sore.
She lies patiently, her body immobilized on a hard board, waiting for X rays.
I call her mom and dad.
How do you tell parents two hours away that their daughter’s been in an accident? You want to convey calm without lying about the seriousness of the situation. And you know nobody’s calm after a call from the ER.
I tell mom she looks pretty good initially, a few aches and pains but we’re just getting started, no X rays yet.
Parents are on their way.
Neck X rays are completed first. The radiology report’s negative, so off come the cervical restraints. I check her over again and find a couple of new aches. Back she goes to X-ray to find a fractured knee and shoulder.
Her neck is still hurting. I feel uneasy. The X rays have been checked by the doctor, she has no numbness, no tingling, no loss of movement, but I have this nagging voice mumbling deep inside.
She asks for a pillow. The nagging voice sputters. I compromise with a small folded towel behind her head. Five minutes later she tells me her hand is tingling. The voice inside me explodes with an accusation! Why didn’t you listen to me!
My calm exterior remains. I slide the towel out and grab the doctor. We reimmobilize her neck.
The films go back to the radiologist with the new symptoms. Another look shows a break in her second cervical vertebrae. Nerves to her entire body pass through this bone. Nerves that control breathing, movement, feeling. Nerves that control her present and future.
Inside I am screaming. Outside I am calm.
Without the towel, the tingling is gone. Relief! Sensation and movement are normal. Whew!
Mom and Dad arrive.
I have good news and bad news. Your daughter’s alive—but she has a broken neck. Your daughter’s not paralyzed—but she has to wear a brace screwed into her head for the next few months.
Inside, I am drained. I’ll remember this girl forever. Daily in this job I see the frailty of life. Today I am slapped in the face with it.
I wheel her to her hospital room. I stay with her while the neurosurgeon places the head screws.
She is great, very brave. She thanks me for my care. Sends me flowers. Promises to keep in touch.
That night I don’t sleep well, haunted by what might have been.
ID
He looks about fourteen or fifteen. It’s hard to tell with the animation missing from his face. One thing is sure—he’ll never be any older.
We know him only as John Doe. We need to find his real name. We look for a wallet, a card with a phone number—hopefully an address.
All we find are three pictures—yearbook photos of pretty girls. There’s writing on the back of two: “Luv ya always” and “To Spanky, Love, Maria.” It’s a start at least.
There’s some writing on his chest, a neat script below his right nipple. It says “Spanky.” Must be him. He doesn’t look like a Danielle (the name scratched on his right bicep).
The beeper on his belt is full of messages. It went off a couple of times during CPR. We didn’t have time to reply just then.
One phone number appears twice. A girl answers and we take a chance: “Hello, Maria?”
“Yeah.”
“Do you know a guy named Spanky who rides a motorcycle?”
“Uh-huh.”
“We need to get in touch with his parents right away.”
USO
It’s a crowded Saturday in the ER.
There’s a steady parade of people with the usual complaints—headaches, fevers, broken bones, lacerations—interrupted by the occasional ambulance with a more serious delivery.
I glance up to see a man walk by.
Double take!
I know that face. It’s the same one I see on record covers, on TV, in movies. The guitar and glitter are missing, a two-day beard is showing, but the face is unmistakable.
What’s he doing here?
I find out he’s with a kid. They’ve been out camping and the kid has hurt his arm.
We get the arm fixed up and they’re ready to leave. There’s a gentle ripple of excitement among the staff as they realize he’s here. We’re all smiling at each other, trying to be aware without infringing on his privacy.
I find myself humming one of his songs and hear someone else doing the same.
As he’s leaving I see him talking with the secretary, writing things down. I hear her say my name, and look over his shoulder to see what he’s writing. He says he wants to send us tickets to his concert next month—the concert that will be a sellout in one day. He takes our names and signs a couple of autographs. He lets me shoot a Polaroid. We proudly display it on a mobile we’ve made with ER staff pictures.
Sunday we play his songs nonstop and sing along all day.
In the ER, we often feel like soldiers in a little war zone—a lot of tension with few bright spots. We usually have to make our own laughter. He was our USO show.
THANKSGIVING DINNER
The big family Thanksgiving dinner has been interrupted by two four-year-old cousins who got into Grandma’s purse and ate her heart pills.
Now, with the turkey getting cold at home and their moms standing nearby, the two little cousins are sitting side by side on the gurney.
Big towels are draped around their necks, big basins are in their laps.
They’re getting lots of attention.
Syrup of ipecac is mixing with the pills in their stomachs, getting them ready to throw up.
They’re smiling. They’re still happy. The ipecac tasted OK.
They’re not sure just what they are waiting for. Their smiles are about to fade, but before that happens, we shoot a couple of Polaroids for the moms. Pictures to save of cousins and their big basins, so when they’ve grown big and know it all, they can be reminded of this Thanksgiving.
TRAUMA
It’s a freak accident.
An elderly man has fallen from his roof.
We call the surgery team. His chest has been pierced by a stick protruding from the ground. The injury is near vital or
gans—heart, lungs, large arteries. We call for the blood bank to stand by.
When he arrives we are pleasantly surprised. His vital signs are OK.
There appears to be no real damage to his vital organs. No broken neck. He is lucky!
But look again. His legs don’t move. His arms are numb. What?
That stick. It has angled up through his chest, just missing heart, lungs, and vessels, and has severed his spinal cord.
My reaction is strange. I can’t really explain it. I don’t understand it. This type of injury is always tragic. It just seems worse somehow when the patient is an elderly person. To have survived all the minefields of life to come to this. Trauma happens to the young. Illness happens to the old. When the roles are reversed, everything is thrown out of balance.
DO EVERYTHING!
It’s almost time to go home.
An old lady is brought to the ER by ambulance from the nursing home.
She has a massive infection, pneumonia. Every breath is a gurgle. Her temperature is very high, oxygen level very low. She has no apparent awareness of anything. Her eyes are open, staring. Her skin is like tissue paper.
Most startling is her body.
It’s stiff, locked into an immobile position—a foam wedge is tucked under her upper body, because without it her head and upper back are raised from the bed with no support.
Her legs are twisted. She has severe deformities of her arms and shoulders, large bruises there—apparent fractures of fragile joints and bones.
She appears to be on her way to death.
Call her doctor; surely she must be a “no code” patient! Let her go quietly. One compression on her fragile chest will do her in for sure. Nobody deserves such suffering.
The doctor speaks to her son by phone, explains the situation.
The son says, “Do everything!”
I’m furious!
Where is he, this son who wants everything?
Make him come here and see just what “everything” means—the tubes, the suctioning, the chest compressions, the cracking ribs, the needles, the catheters, the noise, the pain, the indignity. Who is he to demand that we assault his mother in this way! Well, he got what he asked for.
I cried all the way home in my car.
FOUR HOURS IN TRIAGE
I’m working a twelve-hour shift. The first eight hours have been spent in the treatment area (“the back” we call it). Now it’s my turn to do triage—the Pit. Time to take on the job of sorting and categorizing—immediate, urgent, delayed, totally nonurgent. The patients are trickling in: Fever (we’re in the middle of flu season). Cough. Laceration. Headache. Fever—give Tylenol. Sprained ankle—give a cold pack. Cough. Prescription refill.
“My baby’s having trouble breathing!” Two weeks old, color dusky blue. His chest is caving in with labored respirations.
All his energy is spent on breathing. He has none left to cry or move.
“He’s been sick like this for three days.”
Three days! I’m thinking this baby’s going to die right here! What has this mom been doing for three days?
“Mom, you wait over there.”
I grab baby and dash back to a treatment room, calling for help as I run.
We have a sick one here! Call respiratory therapy. Get an IV ready. Temperature is only ninety-four degrees. Probably a massive infection. The pediatric resuscitation team takes over. Baby’s color is improving already.
I go back to talk to Mom, give her a progress report, get more information. “Was the baby OK at birth?”
“Well, there were amphetamines found in his body when he was born.”
Amphetamines found in his body! Well, Mom, who the hell put them there?
I try to hide my feelings of disdain. I tell Mom her baby is very sick and the doctor will talk to her as soon as they get the baby stabilized.
Back I go to triage, where the line is lengthening. Laceration. Crushed finger. Fever.
“Baby in van.”
The Hispanic-looking man interrupts and gestures for me to follow.
He speaks little English. I speak little Spanish.
I grab some clean towels and follow him out through the waiting-room crowd to a van parked outside the door.
I crawl inside, where his wife is lying with a small naked daughter, wet and bloody, between her legs.
Baby looks bright eyed, alert. Color is pink and healthy. Mom looks OK too. There’s a normal amount of bleeding.
There is another woman in the van with her, maintaining Mom’s modesty, replacing the blankets I’ve moved to look.
Apparently she’s the acting midwife.
I run back for help. Call for a gurney. Grab warm blankets. Grab the OB delivery kit.
Crawl back inside the van. Wrap up the baby. Clamp and cut the cord.
Mom is moved onto the gurney for an anticlimactic trip to the delivery room to deliver the placenta.
Baby and I head up toward the nursery. Oops, go back to get Dad. I need him to go with me. I don’t even have a name on this little one and want no chances of any mix-up! He can stay with the baby until an absolute ID is made.
What a little cutie she is, peeking out from the blanket with the bright eyes of an alert newborn! I smile going up in the elevator with the baby and Dad.
Then, hurry back to triage.
Where were we? Oh, I remember: fever, laceration, cough, vomiting, miscarriage, fever, earache, cough, leg pain …
“My baby’s having trouble breathing,” Oh, no, not again! Chest caving in, wheezing.
This baby is alert and more active than the previous one. Color is better this time. But still he is puffing away—working too hard at breathing. Back we go, to a treatment room. (I think the nurses working in the back must hate to see me coming, the bearer of another disaster.) Call respiratory therapy!
Then back to my post. The dinner-hour crowd is gathering, lining up at the door of the triage room: fever, vomiting, congestion, bladder infection. Get a urine sample.
“My son has had four seizures today. I think it’s because of some medication he took. He’s never had seizures before today.” His temperature is 101 degrees. High enough to cause a seizure? Not usually.
The toddler is sitting on Dad’s lap. He appears sick but alert, a little fussy.
Suddenly it starts, seizure number five. Eyes roll out to side; hands, then arms grow stiff, start to twitch. The whole body gradually joins in.
Check the child and question: “Dad, are you OK? Can you hold him? Let’s just carefully carry him back to the doctor.” Stay calm. Don’t alarm the crowd. A seizing kid always looks bad.
We lay him down on a bed. Nurses join in. Color is turning blue. Get the oxygen. Dad is anxious. Is he breathing? Call respiratory therapy. Breathing is OK. Heartbeat’s OK.
The team takes over, start IVs. Give medicine to stop the convulsions.
I take Dad back to the family waiting room to find Mom and explain what’s happening.
Then back to triage: splinter, lip laceration, anxiety reaction, suture removal, fever, chest pain, headache …
7:00 P.M. Done! Fresh troops have arrived. Time to go home! A-h-h-h-h. What a day!
WHAT AM I DOING HERE?
There aren’t many jobs like mine.
There aren’t many jobs where your workday ends the way mine did today:
By washing the face of a 16-year-old boy.
Cleaning red crusts from his sparse chin whiskers,
Straightening him up, helping him get presentable.
And then bringing his father and sister to see him,
So they can see it’s really true.
So they can see he’s really dead.
INTIMATE STRANGER
I’m just breaking for lunch when the radio call comes. Single-car rollover, nineteen-year-old male.
Condition serious—unconscious—head and facial trauma—over a liter of blood lost already—paramedics trying to control his airway.
He’s a long way out. They’ve dispatched a helicopter.
This will not be an easy one. Forget lunch. Call the troops. Prep the room. Blood is hanging. We’re ready.
When he arrives, it’s worse than the paramedics reported. We scoop him on the gurney and run from the helicopter. We almost never run from the helicopter, but blood is pouring from his face. There is so much it is hard to recognize his features.
The docs surround him to make an airway and stop the bleeding. We pump the blood in as fast as we can while it pours out. If we win with his blood pressure, we loose with the bleeding. The score is close. It’s hard to tell who’s ahead and our guts say it’s not us.
His head is a spongy mass, but the rest of his body looks perfect—only a couple of scratches.
We restart his heart a couple times.
As usual, we laugh some and make little jokes as we work. We don’t know him. We don’t want to know him right now. We don’t think about him as a person. A housekeeper comes in to clear away some of the rubble. She glances at him and comments what a shame it is—he’s so young. I nod in agreement but look at him and think how strange it is—the lack of human connection I feel. Right now he is trauma number RT7698 and he is dumping—testing our skills to the max.
Finally he is stable enough to survive a CT scan of his brain, or what is left of it. The CT confirms our worst suspicions. To diagnose brain death is probably only a formality.
After three exhausting hours, we get him to the ICU. It is a relief to let someone else worry about his dipping blood pressure and swollen brain.
Little details of his recent life are gradually discovered. His name is Richard and he is a freshman in college. We learn he lives out of state. I talk to his friend who will call his parents across the country.
I’m glad I don’t have to tell them.
An ICU nurse pulls a card from his wallet and shows it to me. The picture shows a handsome, smiling young guy with brown hair. I stare and feel my throat tighten.
Emergency! Page 9