Our ER case manager and I recently walked out of the family room after having to tell an only-child that his 85 y.o. mother was critically ill. She was so ill, in fact, that she had required emergent intubation for her respiratory distress and was now being sedated and paralyzed. This allowed the ventilator to do all of her breathing, conserving this woman's body of some much needed energy. The patient's worsening circumstances had transpired over the past three hours at her nursing home prior to being transferred to us and, unfortunately, her son had been en route when his mother decompensated in our ER, circling the drain before our very eyes. Thus, he never got a chance to visit with her before her intubation.
As we left the family room to go back to the patient's room and continue medical management, the case manager and I walked in silence, affected by the situation at hand. I had tried to hold off this patient's intubation for a few minutes, hoping that her son might soon arrive to exchange a few words with his mother, but it didn't happen. Because the patient's living will had requested that she be a "full code" (my understanding was that she lived a fulfilling, independent life), all efforts would be employed in attempt to save her life and help her through this medical crisis. We had intubated her successfully and aggressively began her medical management.
Suddenly, the case manager stopped smack-dab in the middle of the hallway and spoke to me. "You are amazing in that room, do you know that?" I looked her in the eyes, trying to see if she had picked an inopportune moment to hassle me, to tease me the way that us ER co-workers sometimes do to lighten such heavy, burdensome moments.
She was being serious. "After introducing yourself and shaking this son's hand, you sat down on the couch beside him, touched his shoulder, introduced the rest of us, and asked him how he was doing before slowly, in words he could understand, explaining everything that had been done so far to save his mother's life."
"Yeah," I said, "so?"
She continued. "Did you not feel the tension in that room? And somehow, after you were done delivering the worst of the news, the room felt hopeful, at peace. You could see the son's face slowly accept the news you were giving him. You eased his worries by instilling that we were doing everything we can to help his mother, without falsely elevating his hopes."She paused here, taking in a deep breath. " You showed him that you cared."
"Doesn't everybody do this, though?" I said, knowing the answer before I finished asking.
The case manager laughed in a regretful, wistful kind of way. "Are you kidding? You would be appalled at some of the ways I've seen bad news delivered in that room. No introductions. No sitting down. Blurting out the bad news without any preparation to the family. Leaving without addressing any of the family's questions. Jim, you need to teach more doctors how to act and speak more appropriately in that room."
By now, we had started walking again and were standing outside of the patient's room. The son was going to be escorted back in just a few minutes.
Not one to gloat over getting a compliment, I walked back into the room and continued helping my senior resident with this patient's care. It was, once again, a thing of beauty to watch our team methodically go about each of their responsibilities and, as a result, we were soon rewarded with this patient's condition stabilizing. She was still very sick, but at least the son could now spend some time at her bedside. Which turned out to be a blessing as, in the end, this patient passed on that same evening.
Later on that night, at home, after tucking in my kids and a glass of wine in hand, I was giving much thought to our case manager's words. Just a few weeks prior, during a night shift, a nurse supervisor who had accompanied me in the family room spoke similar words to me when we were done. "The way you approach patients and their families is remarkable," she had said. I may have blushed, but her words were greatly appreciated and I viewed them as the ultimate compliment.
Why isn't everybody at their best, especially in that room? I thought to myself, though, becoming a little annoyed. When did medicine become so shifted to view patient's and their families as "its" and not as human beings, as "hes" and "shes"? When did we abandon learning patient's names and their life story? Of taking a little more time in their treatment room? When did compassion and kindness sneak out the window and rush, rush, rush sneak in. When did the the quantity of patients one treats replace the quality of care given to each individual patient, defining, in some peoples' eyes, a better physician?
Sadly, most of us in medicine know that answer. With the increasing struggles of our profession, from insurance cutbacks to legal threats, from hospital cuts of personnel to the shifting thought that patients' rights outstrip our own, medicine isn't the field it once was when I signed up for a career twenty years ago. Especially in the ER, it is now common for us to be 4-6 hours behind every day, patients now relying on us not only for emergent care but for treatment of their chronic illnesses as well as maintenance medications. Can you see the frustrations? This quantity has potential to impede on our quality, to cut into the time we spend with each patient and their family.
I recently gave an hour lecture to our residency physicians regarding kindness and compassion. I started it with a tragic video of 9/11, scenes playing out to Sarah McLachlan's "Arms Of An Angel." We then watched a synopsis of the Columbine tragedy before I started talking. There was nary a dry eye. "See this devastation, this grief, involved in such atrocious acts?" I asked the residents. "What makes this grief and loss any different from that which you will encounter in a patient's treatment room or our ER family room?" A dropping pin could be heard in the room. Grief is grief, I reiterated. Loss is loss. Death is death. Respect is necessary. Kindness and compassion are a must. Addressing such concerns, I assured the residents, is one of the most important jobs they will ever face. Put the time in and learn how to view this responsibility as a privilege and not a burden.
This lecture was never finished. Before my time was up, only half of the slides had been presented. Instead, we had spent a great deal of time talking about personal techniques on how to interact with patients and their families and how to deliver devastating news. My residents shared personal stories of their best and worst experiences. It was clearly evident that some of them were quite comfortable in their roles, while others struggled with this part of their jobs. This hour lecture on kindness and compassion had gone from the category of "light and fluffy" to receiving the respect it deserved. From the feedback of the residents, they were appreciative and definitely more cognizant of their roles in treating patients and their families.
As karma sometimes dictates, a few nights later, while reading Cutting For Stone, a brilliant fiction novel by a brilliant writer, Abraham Verghese (he who also happens to be a brilliant man of medicine), I happened upon a collection of words on page 519 that left me with goosebumps. In the novel, Dr. Thomas Stone, a leading liver transplant specialist, reads a letter from a mother of a trauma victim that he had treated. It follows:
Dr. Stone--
My son's terrible death is not something I will ever get over, but perhaps in time it will be less painful. But I cannot get over one image, a last image that could have been different. Before I was asked to leave the room in a very rough manner, I must tell you that I saw my son was terrified and there was no one who addressed his fear. The only person who tried was a nurse. She held my son's hand and said, "Don't worry, it will be all right." Everyone else ignored him. Sure, the doctors were busy with his body. It would have been merciful if he had been unconscious. They had important things to do. They cared only about his chest and belly. Not about the little boy who was in fear. Yes, he was a man, but at such a vulnerable moment, he was reduced to a little boy. I saw no sign of the slightest bit of human kindness. My son and I were irritants. Your team would have preferred for me to be gone and for him to be quiet. Eventually they got their wish. Dr. Stone, as head of surgery, perhaps as a parent yourself, do you not feel some obligation to have your staff comfort the patient? Would the patient not be better off with less anxiety, less fright? My son's last conscious memory will be of people ignoring him. My last memory of him will be of my little boy, watching in terror as his mother is escorted out of the room. It is the graven image I will carry to my own deathbed. The fact that people were attentive to his body does not compensate for their ignoring his being.
Brilliant. Simply and utterly brilliant. Thank you, Dr. Verghese.
We need to bring back kindness and compassion. We need to fix the medical field as it now exists so we can begin, again, to pay attention to that which is most import--the patient and their families. With kindness and compassion at the forefront.
Enough said.
As always, big thanks for reading. If you have had any experiences, either as a patient or as a family member sitting in that family room, that may enlighten us readers and make us better at what we do, please share...
Showing posts with label nurses. Show all posts
Showing posts with label nurses. Show all posts
Tuesday, March 22, 2011
Friday, December 10, 2010
Keep Your Cranky
Although the majority of my emergency department time is spent in a local 36-bed trauma center, I continue to work a few shifts each month in the small rural hospital near my childhood hometown, several hours away. It is a great change of pace, treating the local folks, while affording me a chance to spend a few evenings with my father and siblings' families.
Last week, I had to drive through white-out blizzard conditions during my most recent two-hour trip, taking approximately four hours each way because of the weather. White knuckles, breath-holding, tense and contracted muscles, stress headaches, and bouts of complaining to myself in the car--these were all part of the package deal. I imagined the cozy, 12-bed emergency department awaiting my arrival, however, and kept plugging along the icy roads, refusing to abandon my place in the thirty-car line of traffic. Going 20 mph. And braking every five seconds. Yep, good times, as any of you ever caught traveling in a snow storm are familiar with.
Arriving at the small ER, then, I was pleasantly surprised to see the festive decorations that adorned the department. Gold, shimmery garland draped the nursing station. Felt stockings and striped candy canes hung in random fashion along the glass enclosure walls. A Christmas tree was standing tall, twinkling and proud, in a nook of inactive space in the corner. It felt Norman Rockwelly and old-fashioned, and I felt welcomed. 'Tis the season.
The first of my scheduled shifts was quite hectic. From my prime seating in front of the ambulance bay doors, I was able to appreciate the outdoor weather. Blustery gusts of snow and heavy thick blankets of engorged snowflakes descended and tormented, without pause, the small town through the day. Although I felt worry and concern for anyone out in this weather, a blazing fireplace, a good book, and a glass of wine were the only things that would have added to the enjoyment and appreciation I felt for this crazy weather.
Three hours into my shift, though, I remembered what the first snowstorm of the season means to an ER staff. Multiple MVCs (multiple vehicle collisions). First-time-of-the-season shovelers developing chest pain as they try to clear their sidewalks. Frequent falls resulting in contusions and broken bones and lacerations. Cough and cold symptoms magnified tenfold with every ten degree drop. Frostbite. And on...and on...and on...
By mid morning, we were swamped. And I loved it. All twelve beds were filled and the waiting room was starting to spill over. The multiple ambulance runs to pick up and drop off ill patients created a steady, rhythmic sense of humming chaos. Despite the craziness, the staff I was working with (many of them friends from my childhood) continued to smile while pushing onward. I was proud to be part of such a team, their hardwork quite evident. We were providing excellent care in a very efficient manner, discharging and admitting and transferring patients left and right.
So, was it really a surprise to me to find that, eventually, all good things come to an end and this run of busy but gratifying work would be interrupted by something unpleasant? I guess not, although I could still hope, right?
The unpleasantness came early afternoon, in the form of a man's booming, angry voice resonating from the hallway. I had been in Room 2 at the time, examining a new patient, an elderly female with dizziness.
"If you'll excuse me, maam," I said, "I need to go see what's going on in the hallway."
I left her room and shut the sliding glass door. Several nurses were in the hallway already, standing in front of a 60ish man, his mouth moving while he leaned forward into his walker. The obvious source of the angry yelling.
"Excuse me, sir," I said, walking between the nurses and right up to him, "what seems to be the problem?"
If any of you have seen the movies Grumpy Old Men and Grumpier Old Men, picture a shorter version of Walter Matthau with slightly more gray hair peeking out from his baseball cap. A pinched-up face. Angry, flaring eyes and a reddened, ruddy complexion. His flannel shirt was untucked from his blue denim pants. And his hands were balled into fists while maintaining his grip on his walker.
Those angry, flaring eyes didn't take long to focus on me. "Who the hell are you?" he asked, practically spitting on me with his disgust.
"I'm Dr. Jim, the emergency room doctor on shift for the day," I said, keeping my cool. "And you are...?" I deliberately left the question open.
"I'm the God-damned boyfriend of Room 6, if any of you lazy sons-of-bitches care," he screamed out, "and I need somebody from this God-damned first-aid station to tell me what the hell is going on with her."
I was surprised at this man's behavior, wondering to myself if he had tipped a few back during lunch. The level of rudeness and obnoxious behavior I encounter through my shifts continues to amaze me. Trying to placate this man would turn out to be an obvious failure.
Room 6, this patient's girlfriend, contained a woman in her 60s who had lingering burping and belching for six months. Today, this day of stormy weather, was the day she decided to pursue her symptoms, for no other reason than just "because I figured it was time to get checked out." She was right to come in, since her EKG revealed signs of heart ischemia that were confirmed by her elevated cardiac enzymes via blood work. I had seen and treated her immediately upon her arrival to our ER, as well as checked-in with her multiple times, making sure her symptoms had resolved and explaining the results of her tests. Currently, the cardiologist was on his way to the ER to make further recommendations.
At no time during this woman's hour stay did a boyfriend present himself. She had been in the room alone.
"Sir, keep your voice down," I told him, "we have a lot of sick patients in this ER today. And when did you get here," I continued, "since I've been in your girlfriend's room multiple times in the past hour."
"Me, too," piped in Marsha, the patient's nurse.
"I just got here," he said, shaking his head in disgust, "and nobody made it a point to explain things to me." He continued to rant and rave, insulting anyone associated with the small rural hospital.
"That's not true," Marsha disputed, "I explained everything I knew to you, just a few minutes ago, after you walked into your girlfriend's room. I even offered you a chair, coffee, a blanket."
"Regardless, sir," I said, proud of Marsha, "you could have asked in a much better way than walking into the hallway and screaming like this for everyone to hear." He eyed me up, surprised at my confronting him on his behavior. "Now," I said, "these are your two choices. Either leave the department and wait in the waiting room, or go back into your girlfriend's room and act like a gentleman. After she answers your questions, I'll be in to answer anything further. With her permission, of course."
There was a standoff. He eyed me. I eyed him. The nurses all held their breath. Finally, he spoke. Or yelled. "Screw you. I'm going to go, God-damn it, and feed her God-damn mutt of a dog. But I'll be back," he said.
Before leaving, he tried one last parting shot. "I envy your God-damn generation," he muttered, "none of you know what hard work is. Not a single one."
Well, I thought back to my 14 hour days working with my father's crews in the woods when I was a teenager. I thought about waking up in my childhood on Saturdays and Sundays to cut and stack firewood and cut grass. I thought about the numerous chores our parents expected of us. I thought about the endless sleepless nights I spent, first studying through college, then medical school, and finally through residency, before some semblance of normalcy finally arrived to my life.
"Sir, you don't know me or any of the nurses, do you?" I asked, sweeping my hand towards them. He nodded "no." "Then how," I continued, "can you say such a rude thing? I would never consider insulting you the way you've insulted our staff. It's not necessary and your bad attitude isn't helping anyone. It's time for you to go."
"Well," he stammered, "even if you aren't lazy, most of your God-damn generation is."
And with that, he continued on his way out of our "first-aid station," decorated to celebrate the joy of the wondrous holiday, shaking his head in disgust until he walked through the waiting room doors.
After he left, our staff regrouped in the nursing station. Amazingly, not one person was affected negatively by this gentleman. Everyone had the good sense to dispel his insults and demeaning behavior without a second thought. "I can only hope," I warned them all, "that I'm not that grouchy when I get older."
I visited Room 6, the girlfriend. She was still clear of all her symptoms, but looked teary-eyed. "I'm so sorry for his behavior," she said, obviously hearing the conversation that had just occurred in the hallway, "he's like that all the time. But Doctor, just so you know, your staff treated me wonderfully today." She assured me, upon my questioning, that she was safe and not being abused physically. She declined any counseling offers. "He's a dog with a big bark and no bite," was how she put it. I wanted to ask her "Why?" Why in the world would she stay with a man so unpleasant, so abrupt and obnoxious? But I didn't. We all have our reasons for living our lives the way we do, and she was no exception. Besides, the world was continuing to revolve and I was needed in several other rooms.
An hour later, Mr. Crank was back. Before even entering his girlfriend's room, he walked himself right through the nursing station, stopping on its edge. "Now what the hell is going on?" he yelled, lifting his walker from the floor before banging it back down, startling me from the chart I was working on.
And the conversation continued as before--him insulting our staff and hospital with vulgar language, me giving him the option of either going to his girlfriend's room or the waiting room. In my book, this was his last chance, and I conveyed it respectfully to him.
He walked to his girlfriend's room, entered it, and shut the glass door behind him. Surprisingly, he was only in there for a minute or two before opening the door, walking into the hallway and out the ER while muttering to himself. Whereas before he had conveyed, with his body language, some misplaced pride, this time while walking past our nursing station he looked like a man who had just been brow-beatened. No doubt, the girlfriend had the last say in this matter.
Throughout this holiday season, we will have many opportunities to spread good cheer and love. Compassion and kindness. And endless smiles. Or, we will have opportunities to spread poison and malignant anger. Hurtful words and deliberate insults. And pinched-up frowns.
The choice is yours. The choice is mine. Just remember to pause and look at the infinite garland, the Christmas trees, the stockings, and the candy canes--all of the beauty of the season that surrounds us. Notice and acknowledge the smiles on the faces you pass. Remember your inner child's spirit and reflect on the deeper meaning of this holiday.
I can only hope your choice fills your heart with warmth.
And I wish for nothing less for Mr. Crank.
As always, big thanks for reading. Despite our respectful attempts to break through Mr. Crank's grumpy exterior, we were unsuccessful. Darn it! I hope this finds you well and ready for the holiday season and all it brings your way...see you early next week.
Last week, I had to drive through white-out blizzard conditions during my most recent two-hour trip, taking approximately four hours each way because of the weather. White knuckles, breath-holding, tense and contracted muscles, stress headaches, and bouts of complaining to myself in the car--these were all part of the package deal. I imagined the cozy, 12-bed emergency department awaiting my arrival, however, and kept plugging along the icy roads, refusing to abandon my place in the thirty-car line of traffic. Going 20 mph. And braking every five seconds. Yep, good times, as any of you ever caught traveling in a snow storm are familiar with.
Arriving at the small ER, then, I was pleasantly surprised to see the festive decorations that adorned the department. Gold, shimmery garland draped the nursing station. Felt stockings and striped candy canes hung in random fashion along the glass enclosure walls. A Christmas tree was standing tall, twinkling and proud, in a nook of inactive space in the corner. It felt Norman Rockwelly and old-fashioned, and I felt welcomed. 'Tis the season.
The first of my scheduled shifts was quite hectic. From my prime seating in front of the ambulance bay doors, I was able to appreciate the outdoor weather. Blustery gusts of snow and heavy thick blankets of engorged snowflakes descended and tormented, without pause, the small town through the day. Although I felt worry and concern for anyone out in this weather, a blazing fireplace, a good book, and a glass of wine were the only things that would have added to the enjoyment and appreciation I felt for this crazy weather.
Three hours into my shift, though, I remembered what the first snowstorm of the season means to an ER staff. Multiple MVCs (multiple vehicle collisions). First-time-of-the-season shovelers developing chest pain as they try to clear their sidewalks. Frequent falls resulting in contusions and broken bones and lacerations. Cough and cold symptoms magnified tenfold with every ten degree drop. Frostbite. And on...and on...and on...
By mid morning, we were swamped. And I loved it. All twelve beds were filled and the waiting room was starting to spill over. The multiple ambulance runs to pick up and drop off ill patients created a steady, rhythmic sense of humming chaos. Despite the craziness, the staff I was working with (many of them friends from my childhood) continued to smile while pushing onward. I was proud to be part of such a team, their hardwork quite evident. We were providing excellent care in a very efficient manner, discharging and admitting and transferring patients left and right.
So, was it really a surprise to me to find that, eventually, all good things come to an end and this run of busy but gratifying work would be interrupted by something unpleasant? I guess not, although I could still hope, right?
The unpleasantness came early afternoon, in the form of a man's booming, angry voice resonating from the hallway. I had been in Room 2 at the time, examining a new patient, an elderly female with dizziness.
"If you'll excuse me, maam," I said, "I need to go see what's going on in the hallway."
I left her room and shut the sliding glass door. Several nurses were in the hallway already, standing in front of a 60ish man, his mouth moving while he leaned forward into his walker. The obvious source of the angry yelling.
"Excuse me, sir," I said, walking between the nurses and right up to him, "what seems to be the problem?"
If any of you have seen the movies Grumpy Old Men and Grumpier Old Men, picture a shorter version of Walter Matthau with slightly more gray hair peeking out from his baseball cap. A pinched-up face. Angry, flaring eyes and a reddened, ruddy complexion. His flannel shirt was untucked from his blue denim pants. And his hands were balled into fists while maintaining his grip on his walker.
Those angry, flaring eyes didn't take long to focus on me. "Who the hell are you?" he asked, practically spitting on me with his disgust.
"I'm Dr. Jim, the emergency room doctor on shift for the day," I said, keeping my cool. "And you are...?" I deliberately left the question open.
"I'm the God-damned boyfriend of Room 6, if any of you lazy sons-of-bitches care," he screamed out, "and I need somebody from this God-damned first-aid station to tell me what the hell is going on with her."
I was surprised at this man's behavior, wondering to myself if he had tipped a few back during lunch. The level of rudeness and obnoxious behavior I encounter through my shifts continues to amaze me. Trying to placate this man would turn out to be an obvious failure.
Room 6, this patient's girlfriend, contained a woman in her 60s who had lingering burping and belching for six months. Today, this day of stormy weather, was the day she decided to pursue her symptoms, for no other reason than just "because I figured it was time to get checked out." She was right to come in, since her EKG revealed signs of heart ischemia that were confirmed by her elevated cardiac enzymes via blood work. I had seen and treated her immediately upon her arrival to our ER, as well as checked-in with her multiple times, making sure her symptoms had resolved and explaining the results of her tests. Currently, the cardiologist was on his way to the ER to make further recommendations.
At no time during this woman's hour stay did a boyfriend present himself. She had been in the room alone.
"Sir, keep your voice down," I told him, "we have a lot of sick patients in this ER today. And when did you get here," I continued, "since I've been in your girlfriend's room multiple times in the past hour."
"Me, too," piped in Marsha, the patient's nurse.
"I just got here," he said, shaking his head in disgust, "and nobody made it a point to explain things to me." He continued to rant and rave, insulting anyone associated with the small rural hospital.
"That's not true," Marsha disputed, "I explained everything I knew to you, just a few minutes ago, after you walked into your girlfriend's room. I even offered you a chair, coffee, a blanket."
"Regardless, sir," I said, proud of Marsha, "you could have asked in a much better way than walking into the hallway and screaming like this for everyone to hear." He eyed me up, surprised at my confronting him on his behavior. "Now," I said, "these are your two choices. Either leave the department and wait in the waiting room, or go back into your girlfriend's room and act like a gentleman. After she answers your questions, I'll be in to answer anything further. With her permission, of course."
There was a standoff. He eyed me. I eyed him. The nurses all held their breath. Finally, he spoke. Or yelled. "Screw you. I'm going to go, God-damn it, and feed her God-damn mutt of a dog. But I'll be back," he said.
Before leaving, he tried one last parting shot. "I envy your God-damn generation," he muttered, "none of you know what hard work is. Not a single one."
Well, I thought back to my 14 hour days working with my father's crews in the woods when I was a teenager. I thought about waking up in my childhood on Saturdays and Sundays to cut and stack firewood and cut grass. I thought about the numerous chores our parents expected of us. I thought about the endless sleepless nights I spent, first studying through college, then medical school, and finally through residency, before some semblance of normalcy finally arrived to my life.
"Sir, you don't know me or any of the nurses, do you?" I asked, sweeping my hand towards them. He nodded "no." "Then how," I continued, "can you say such a rude thing? I would never consider insulting you the way you've insulted our staff. It's not necessary and your bad attitude isn't helping anyone. It's time for you to go."
"Well," he stammered, "even if you aren't lazy, most of your God-damn generation is."
And with that, he continued on his way out of our "first-aid station," decorated to celebrate the joy of the wondrous holiday, shaking his head in disgust until he walked through the waiting room doors.
After he left, our staff regrouped in the nursing station. Amazingly, not one person was affected negatively by this gentleman. Everyone had the good sense to dispel his insults and demeaning behavior without a second thought. "I can only hope," I warned them all, "that I'm not that grouchy when I get older."
I visited Room 6, the girlfriend. She was still clear of all her symptoms, but looked teary-eyed. "I'm so sorry for his behavior," she said, obviously hearing the conversation that had just occurred in the hallway, "he's like that all the time. But Doctor, just so you know, your staff treated me wonderfully today." She assured me, upon my questioning, that she was safe and not being abused physically. She declined any counseling offers. "He's a dog with a big bark and no bite," was how she put it. I wanted to ask her "Why?" Why in the world would she stay with a man so unpleasant, so abrupt and obnoxious? But I didn't. We all have our reasons for living our lives the way we do, and she was no exception. Besides, the world was continuing to revolve and I was needed in several other rooms.
An hour later, Mr. Crank was back. Before even entering his girlfriend's room, he walked himself right through the nursing station, stopping on its edge. "Now what the hell is going on?" he yelled, lifting his walker from the floor before banging it back down, startling me from the chart I was working on.
And the conversation continued as before--him insulting our staff and hospital with vulgar language, me giving him the option of either going to his girlfriend's room or the waiting room. In my book, this was his last chance, and I conveyed it respectfully to him.
He walked to his girlfriend's room, entered it, and shut the glass door behind him. Surprisingly, he was only in there for a minute or two before opening the door, walking into the hallway and out the ER while muttering to himself. Whereas before he had conveyed, with his body language, some misplaced pride, this time while walking past our nursing station he looked like a man who had just been brow-beatened. No doubt, the girlfriend had the last say in this matter.
Throughout this holiday season, we will have many opportunities to spread good cheer and love. Compassion and kindness. And endless smiles. Or, we will have opportunities to spread poison and malignant anger. Hurtful words and deliberate insults. And pinched-up frowns.
The choice is yours. The choice is mine. Just remember to pause and look at the infinite garland, the Christmas trees, the stockings, and the candy canes--all of the beauty of the season that surrounds us. Notice and acknowledge the smiles on the faces you pass. Remember your inner child's spirit and reflect on the deeper meaning of this holiday.
I can only hope your choice fills your heart with warmth.
And I wish for nothing less for Mr. Crank.
As always, big thanks for reading. Despite our respectful attempts to break through Mr. Crank's grumpy exterior, we were unsuccessful. Darn it! I hope this finds you well and ready for the holiday season and all it brings your way...see you early next week.
Friday, May 7, 2010
A Mother's Cry
Every day is a gift...
Initially, this was posted February 17th, and your overwhelming response and compassion astounded me. Thank you. May it remind everyone of the tremendous treasures we have been entrusted with when we become parents.
It happened again last week. Among the hustle and bustle of a crazy shift. A pre-hospital radio call from an ambulance team that nobody ever wants to receive.
"We're bringing you a child in cardiac arrest."
Noooooooo. Word traveled quickly through our staff, and the mood immediately got very somber as everyone prepared the resuscitation room for this child. We could only pray that the child being brought to us would respond to our life-saving measures.
Nurses ran to get the intubation and IV trays, pharmacists ran to get the resuscitation cart with all the emergent medications, techs ran to get the EKG and ultrasound machines, and respiratory therapists ran to get a ventilator. Two of us physicians were working with a slew of residents, and we all reviewed our mental checklists and tried to enter our objective frames of mind. Organized frenzy.
My partner requested to be the lead physician during the resuscitation. Being young and recently-trained, he wants to save the world. We all want to save the world, I guess, but for now we'd focus our energy on saving this child. I assured him that I would stay in the room and help with the resuscitation efforts.
The ambulance arrived. With a sad nod of his head, a trusted paramedic gave answer to our searching faces. No response. Yet. We all caught our breath as our hearts plummeted.
We transferred this child to our hospital cot. We emergently intubated this child, checked for any pulses, and continued CPR when we found none. IVs were hard to establish, so I started an intraosseous line by sticking a needle into this child's left tibia. Aggressive fluids were given. Medications were administered. Ventilations were forced into uncooperative lungs.
Efforts continued. My partner followed the life-saving protocols but didn't get any response from this child. Prayers were whispered. Seconds were watched as they ticked on the clock. Slowly, as slow as any time had ever passed, a heartbreaking realization permeated the room. We might not succeed.
My partner ran to the family room to discuss options with this child's parents, while I continued to follow all the resuscitation protocols. We had nearly maximized all of our medications. And still...nothing. CPR was continued, ventilations were continued, more medications and hydration were given.
My partner returned to the treatment room. He looked at me expectantly, and I shook my head "no." My partner shared his conversation with me. Dad was still at work, and Mom was in the family room with our social workers, waiting for family to arrive. She had been invited back to watch the resuscitation efforts, but declined. Her child had been through this once before, because of chronic, ongoing medical problems, and had survived. Surely, she thought, her child could survive again.
After almost an hour of failed heroics, with absolutely no response to any of our interventions, we confirmed what we were most afraid of. There were no palpable pulses. There was no cardiac activity, confirmed on monitor and with our bedside ultrasound. There were no spontaneous respirations. There were no signs of life from this child.
There would be no miracle.
My partner asked if anyone in the room objected to his pronouncing this child's death. Nobody objected, since we had all been involved in trying to save this child's life. We knew the efforts that had been put forth were monumental. No attempt had been spared by our team to bring this child back. Unfortunately, and for unexplained reasons, the fates held different plans. My partner announced the time of death.
I requested a nurse to clip some of this patient's hair for the family. I crossed myself after my silent prayer. I fought my tears. Hell, we all fought our tears. I consoled my partner, who, like me, has three young kids of his own. Slowly, a wave of profound sadness and nothingness swept across us. What good are any of us if we can't save a child's life? My partner went out to the family room to deliver the awful news.
Then, time stood still. From two hallways away, I heard the haunting sound. A sound that I knew was coming. A sound that is played over and over in my mind for days after an event like this. A sound of profound anguish. A sound of utter disbelief. A sound of infinite pain.
A mother's cry.
Slowly, as we all knew would happen, the mournful wails of crying crescendoed, and our emergency department came to a stand-still as Mom was escorted through our halls into her little child's room.
Despite our best attempts at maintaining our objectivity, and despite the fact that there were many more patients waiting to be treated, our ER staff cried collectively and gave consoling hugs to one another. We are mothers. We are fathers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And, we were broken.
Dad arrived just minutes after Mom was escorted to the room, and the cries of desperation were repeated. This time, husky and deep. Slowly, though, his cries softened and dissipated, until there was but one lone cry that began again. Higher-pitched. Guttural. Primitive. Emanating from the womb. A cry that conveyed the raw anguish and helplessness that only such a profound loss as losing your child could bring.
God Bless this mother. God Bless this father. God Bless this child. And may God Bless and watch over this family. And all of us.
My most heartfelt wishes for every mother, and mother-figure, for a blessed Mother's Day weekend. May your presence in the lives of those you love be cherished. And may unbridled love be returned to you in deserving, infinite amounts. New posts next week...
Initially, this was posted February 17th, and your overwhelming response and compassion astounded me. Thank you. May it remind everyone of the tremendous treasures we have been entrusted with when we become parents.
It happened again last week. Among the hustle and bustle of a crazy shift. A pre-hospital radio call from an ambulance team that nobody ever wants to receive.
"We're bringing you a child in cardiac arrest."
Noooooooo. Word traveled quickly through our staff, and the mood immediately got very somber as everyone prepared the resuscitation room for this child. We could only pray that the child being brought to us would respond to our life-saving measures.
Nurses ran to get the intubation and IV trays, pharmacists ran to get the resuscitation cart with all the emergent medications, techs ran to get the EKG and ultrasound machines, and respiratory therapists ran to get a ventilator. Two of us physicians were working with a slew of residents, and we all reviewed our mental checklists and tried to enter our objective frames of mind. Organized frenzy.
My partner requested to be the lead physician during the resuscitation. Being young and recently-trained, he wants to save the world. We all want to save the world, I guess, but for now we'd focus our energy on saving this child. I assured him that I would stay in the room and help with the resuscitation efforts.
The ambulance arrived. With a sad nod of his head, a trusted paramedic gave answer to our searching faces. No response. Yet. We all caught our breath as our hearts plummeted.
We transferred this child to our hospital cot. We emergently intubated this child, checked for any pulses, and continued CPR when we found none. IVs were hard to establish, so I started an intraosseous line by sticking a needle into this child's left tibia. Aggressive fluids were given. Medications were administered. Ventilations were forced into uncooperative lungs.
Efforts continued. My partner followed the life-saving protocols but didn't get any response from this child. Prayers were whispered. Seconds were watched as they ticked on the clock. Slowly, as slow as any time had ever passed, a heartbreaking realization permeated the room. We might not succeed.
My partner ran to the family room to discuss options with this child's parents, while I continued to follow all the resuscitation protocols. We had nearly maximized all of our medications. And still...nothing. CPR was continued, ventilations were continued, more medications and hydration were given.
My partner returned to the treatment room. He looked at me expectantly, and I shook my head "no." My partner shared his conversation with me. Dad was still at work, and Mom was in the family room with our social workers, waiting for family to arrive. She had been invited back to watch the resuscitation efforts, but declined. Her child had been through this once before, because of chronic, ongoing medical problems, and had survived. Surely, she thought, her child could survive again.
After almost an hour of failed heroics, with absolutely no response to any of our interventions, we confirmed what we were most afraid of. There were no palpable pulses. There was no cardiac activity, confirmed on monitor and with our bedside ultrasound. There were no spontaneous respirations. There were no signs of life from this child.
There would be no miracle.
My partner asked if anyone in the room objected to his pronouncing this child's death. Nobody objected, since we had all been involved in trying to save this child's life. We knew the efforts that had been put forth were monumental. No attempt had been spared by our team to bring this child back. Unfortunately, and for unexplained reasons, the fates held different plans. My partner announced the time of death.
I requested a nurse to clip some of this patient's hair for the family. I crossed myself after my silent prayer. I fought my tears. Hell, we all fought our tears. I consoled my partner, who, like me, has three young kids of his own. Slowly, a wave of profound sadness and nothingness swept across us. What good are any of us if we can't save a child's life? My partner went out to the family room to deliver the awful news.
Then, time stood still. From two hallways away, I heard the haunting sound. A sound that I knew was coming. A sound that is played over and over in my mind for days after an event like this. A sound of profound anguish. A sound of utter disbelief. A sound of infinite pain.
A mother's cry.
Slowly, as we all knew would happen, the mournful wails of crying crescendoed, and our emergency department came to a stand-still as Mom was escorted through our halls into her little child's room.
Despite our best attempts at maintaining our objectivity, and despite the fact that there were many more patients waiting to be treated, our ER staff cried collectively and gave consoling hugs to one another. We are mothers. We are fathers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And, we were broken.
Dad arrived just minutes after Mom was escorted to the room, and the cries of desperation were repeated. This time, husky and deep. Slowly, though, his cries softened and dissipated, until there was but one lone cry that began again. Higher-pitched. Guttural. Primitive. Emanating from the womb. A cry that conveyed the raw anguish and helplessness that only such a profound loss as losing your child could bring.
God Bless this mother. God Bless this father. God Bless this child. And may God Bless and watch over this family. And all of us.
My most heartfelt wishes for every mother, and mother-figure, for a blessed Mother's Day weekend. May your presence in the lives of those you love be cherished. And may unbridled love be returned to you in deserving, infinite amounts. New posts next week...
Friday, February 26, 2010
It Wasn't Me!
Forgive my warped ER humor today...and big thanks to Dr. A for the awesome adventure/interview last night. He rocks. Find it here... Doctor Anonymous.
To the nurse who "expelled gas" in the nurses' station a few weeks ago and didn't fess up to it, I have just one thing to say. Shame on you! What would your mother say?! I hope you felt bad that night when you got home and thought back to how you just sat there, quietly, while I absorbed the blame and derision meant for you.
I was raised in a conservative, Catholic family. Seven of us kids with a loving mother and a providing father who, with gusto, cherished their traditional roles. Besides the obvious rules that accompany a Catholic background, we also had an 11th Commandment: "Thou shalt not expel gas in public." In my family, the "f" word stood for "farting." To this day, I still have more trouble with that word than the real "f" word. I'm not f...... kidding, either. If we did have to "release," we were taught to leave the room and find a private spot where you could wallow in your stink all by yourself. It's a rule I still try to uphold to this day, despite my wife making the best f...... chili I have ever had.
So, a few weeks back, I sat down in the nurses' station to catch up on a chart. It was an easy-going, friendly crew, consisting of three female nurses, a female secretary, and moi. Yes, I was the only guy in the vicinity. And, of course, I wouldn't have sat down if I knew what was coming.
We were all immersed in our work when, suddenly, I smelled something rancid. No, it wasn't a pine-scented plug-in. Or the industrial-strength apple-scented spray. I would have welcomed those scents. Instead, imagine a rotten egg mixed with a touch of skunk. Seriously, it was bad. I would rather have been sitting in a neglected Johnny-on-the-Spot than in that nurses' station.
I looked up, crinkling my nose and grimacing my face, hoping that it was a patient in a surrounding treatment room, one stricken with a lower GI bleed, rather than one of my coworkers. One of my female coworkers. No such luck. My coworkers were looking around as well, noses crinkled with as much disdain as my own.
We were all silent. And suddenly, the next thing I knew, I was being glared at by all four women, supposed friends, their eyes hurling their accusing daggers in my direction. It suddenly dawned on me what they were thinking.
"Oh, no," I said, shaking my head vigorously, "it wasn't me. I didn't do it. Don't assume that just because I am the only guy around, it was me."
I was met with silence and continued stares. I felt the overwhelming urge to explain my way out of this. "Seriously," I said, giving them my puppy-dog look, "I didn't do it. Maybe it was a patient or someone walking by in the hallway. Heck," I even chanced, "maybe it was one of you."
I was met with more silence. Frustrating silence. And more continued stares. Sneers, actually. If this was half as bad as a police interrogation, just declare me guilty and throw away my key.
Finally, I heard the secretary say in a low voice "Whoever smelt it, dealt it." Hey, come on people, be fair here! I "smelt it," alright, and I had the singed nasal hairs to prove it. But I didn't "dealt it." I promise. If we did an underwear check, I would have been cleared in an instant.
"Yeah," one of the older nurses added, smirking, "to think that one of us could do that!" She quickly darted her eyes away from me as I focused on her. Okay, at least now I knew which nurse did it. I stared at her just a brief moment longer, silently hoping (in that kind, gentle Catholic way) that she would choke on her Chex cereal the following morning.
Well, of course, there was no underwear check. No confessions, either. And I refused to leave. I was not going to let some wayward, XX stink-bomb embarrass me out of my seat. Go ahead and look at me, you four co-conspirators, and think whatever you want. I don't care. Okay, maybe just a little...
Of course, before the fumes could clear, the nurses' station became Grand Central Station. The neurology team, the cardiology team, the phlebotomists--they all passed through. Yep, they all crinkled their noses. Nope, none of them had the gall to address the stink with us. I refused to leave my seat. I'm not a stupid man--I knew the moment I left they would all be pointing their fingers at me. Finally, though, after what seemed like an eternity, I was able to appreciate the returning smells of moth balls and sanitizer and floor wax and vomit and illness--the glorious smells of our ER. Welcome back!
This episode, unfortunately, was not isolated. It's happened to me in an elevator, in my writing group, in a car, at the gym, getting a haircut, and so on. Surrounded by women, the guy will always be looked at with disdain. Am I right, guys? And every time it's happened, I've gotten this primal urge to jump up and down and declare my innocence. Which, of course, just makes me look all the guiltier.
I've even had one brilliant senior resident teach me the finer points of dealing with this issue when I was under his supervision as a medical student. "What you do," he said, "is find a room with a really old patient in it. Preferably a sleeping patient. Man or woman, it doesn't matter. Then you go in and, while you pretend to check their cardiac monitor, you let it rip." He was being completely serious. "The best part, though," he finished, extremely proud of himself, totally ignoring the disbelief on my face, "is when you come out, make sure you tell the nurse that you think their patient just shit them self."
Call me crazy, but I don't think that's really the answer. After giving it some thought, though, I think I've come up with the solution. Well, besides the obvious--hiring more male nurses (simply to reduce my odds of getting undue blame) and posting the 11th Commandment on every free inch of ER wall space.
The solution? A pin. A nice, big visible lapel pin. Round. I'm thinking fluorescent colors. A bold, clear Times font, set at 60. Ready to be pulled out and worn in an instant. And, of course, what it will read goes without saying.
"It Wasn't Me!"
As always, thanks for reading...next post will be Monday, March 1. See you then...one last shout-out to the famous and talented Doctor Anonymous. Thank you...
To the nurse who "expelled gas" in the nurses' station a few weeks ago and didn't fess up to it, I have just one thing to say. Shame on you! What would your mother say?! I hope you felt bad that night when you got home and thought back to how you just sat there, quietly, while I absorbed the blame and derision meant for you.
I was raised in a conservative, Catholic family. Seven of us kids with a loving mother and a providing father who, with gusto, cherished their traditional roles. Besides the obvious rules that accompany a Catholic background, we also had an 11th Commandment: "Thou shalt not expel gas in public." In my family, the "f" word stood for "farting." To this day, I still have more trouble with that word than the real "f" word. I'm not f...... kidding, either. If we did have to "release," we were taught to leave the room and find a private spot where you could wallow in your stink all by yourself. It's a rule I still try to uphold to this day, despite my wife making the best f...... chili I have ever had.
So, a few weeks back, I sat down in the nurses' station to catch up on a chart. It was an easy-going, friendly crew, consisting of three female nurses, a female secretary, and moi. Yes, I was the only guy in the vicinity. And, of course, I wouldn't have sat down if I knew what was coming.
We were all immersed in our work when, suddenly, I smelled something rancid. No, it wasn't a pine-scented plug-in. Or the industrial-strength apple-scented spray. I would have welcomed those scents. Instead, imagine a rotten egg mixed with a touch of skunk. Seriously, it was bad. I would rather have been sitting in a neglected Johnny-on-the-Spot than in that nurses' station.
I looked up, crinkling my nose and grimacing my face, hoping that it was a patient in a surrounding treatment room, one stricken with a lower GI bleed, rather than one of my coworkers. One of my female coworkers. No such luck. My coworkers were looking around as well, noses crinkled with as much disdain as my own.
We were all silent. And suddenly, the next thing I knew, I was being glared at by all four women, supposed friends, their eyes hurling their accusing daggers in my direction. It suddenly dawned on me what they were thinking.
"Oh, no," I said, shaking my head vigorously, "it wasn't me. I didn't do it. Don't assume that just because I am the only guy around, it was me."
I was met with silence and continued stares. I felt the overwhelming urge to explain my way out of this. "Seriously," I said, giving them my puppy-dog look, "I didn't do it. Maybe it was a patient or someone walking by in the hallway. Heck," I even chanced, "maybe it was one of you."
I was met with more silence. Frustrating silence. And more continued stares. Sneers, actually. If this was half as bad as a police interrogation, just declare me guilty and throw away my key.
Finally, I heard the secretary say in a low voice "Whoever smelt it, dealt it." Hey, come on people, be fair here! I "smelt it," alright, and I had the singed nasal hairs to prove it. But I didn't "dealt it." I promise. If we did an underwear check, I would have been cleared in an instant.
"Yeah," one of the older nurses added, smirking, "to think that one of us could do that!" She quickly darted her eyes away from me as I focused on her. Okay, at least now I knew which nurse did it. I stared at her just a brief moment longer, silently hoping (in that kind, gentle Catholic way) that she would choke on her Chex cereal the following morning.
Well, of course, there was no underwear check. No confessions, either. And I refused to leave. I was not going to let some wayward, XX stink-bomb embarrass me out of my seat. Go ahead and look at me, you four co-conspirators, and think whatever you want. I don't care. Okay, maybe just a little...
Of course, before the fumes could clear, the nurses' station became Grand Central Station. The neurology team, the cardiology team, the phlebotomists--they all passed through. Yep, they all crinkled their noses. Nope, none of them had the gall to address the stink with us. I refused to leave my seat. I'm not a stupid man--I knew the moment I left they would all be pointing their fingers at me. Finally, though, after what seemed like an eternity, I was able to appreciate the returning smells of moth balls and sanitizer and floor wax and vomit and illness--the glorious smells of our ER. Welcome back!
This episode, unfortunately, was not isolated. It's happened to me in an elevator, in my writing group, in a car, at the gym, getting a haircut, and so on. Surrounded by women, the guy will always be looked at with disdain. Am I right, guys? And every time it's happened, I've gotten this primal urge to jump up and down and declare my innocence. Which, of course, just makes me look all the guiltier.
I've even had one brilliant senior resident teach me the finer points of dealing with this issue when I was under his supervision as a medical student. "What you do," he said, "is find a room with a really old patient in it. Preferably a sleeping patient. Man or woman, it doesn't matter. Then you go in and, while you pretend to check their cardiac monitor, you let it rip." He was being completely serious. "The best part, though," he finished, extremely proud of himself, totally ignoring the disbelief on my face, "is when you come out, make sure you tell the nurse that you think their patient just shit them self."
Call me crazy, but I don't think that's really the answer. After giving it some thought, though, I think I've come up with the solution. Well, besides the obvious--hiring more male nurses (simply to reduce my odds of getting undue blame) and posting the 11th Commandment on every free inch of ER wall space.
The solution? A pin. A nice, big visible lapel pin. Round. I'm thinking fluorescent colors. A bold, clear Times font, set at 60. Ready to be pulled out and worn in an instant. And, of course, what it will read goes without saying.
"It Wasn't Me!"
As always, thanks for reading...next post will be Monday, March 1. See you then...one last shout-out to the famous and talented Doctor Anonymous. Thank you...
Wednesday, February 17, 2010
A Mother's Cry
It happened again last week. Among the hustle and bustle of a crazy shift. A pre-hospital radio call from an ambulance team that nobody ever wants to receive.
"We're bringing you a child in cardiac arrest."
Noooooooo. Word traveled quickly through our staff, and the mood immediately got very somber as everyone prepared the resuscitation room for this child. We could only pray that the child being brought to us would respond to our life-saving measures.
Nurses ran to get the intubation and IV trays, pharmacists ran to get the resuscitation cart with all the emergent medications, techs ran to get the EKG and ultrasound machines, and respiratory therapists ran to get a ventilator. Two of us physicians were working with a slew of residents, and we all reviewed our mental checklists and tried to enter our objective frames of mind. Organized frenzy.
My partner requested to be the lead physician during the resuscitation. Being young and recently-trained, he wants to save the world. We all want to save the world, I guess, but for now we'd focus our energy on saving this child. I assured him that I would stay in the room and help with the resuscitation efforts.
The ambulance arrived. With a sad nod of his head, a trusted paramedic gave answer to our searching faces. No response. Yet. We all caught our breath as our hearts plummeted.
We transferred this child to our hospital cot. We emergently intubated this child, checked for any pulses, and continued CPR when we found none. IVs were hard to establish, so I started an intraosseous line by sticking a needle into this child's left tibia. Aggressive fluids were given. Medications were administered. Ventilations were forced into uncooperative lungs.
Efforts continued. My partner followed the life-saving protocols but didn't get any response from this child. Prayers were whispered. Seconds were watched as they ticked on the clock. Slowly, as slow as any time had ever passed, a heartbreaking realization permeated the room. We might not succeed.
My partner ran to the family room to discuss options with this child's parents, while I continued to follow all the resuscitation protocols. We had nearly maximized all of our medications. And still...nothing. CPR was continued, ventilations were continued, more medications and hydration were given.
My partner returned to the treatment room. He looked at me expectantly, and I shook my head "no." My partner shared his conversation with me. Dad was still at work, and Mom was in the family room with our social workers, waiting for family to arrive. She had been invited back to watch the resuscitation efforts, but declined. Her child had been through this once before, because of chronic, ongoing medical problems, and had survived. Surely, she thought, her child could survive again.
After almost an hour of failed heroics, with absolutely no response to any of our interventions, we confirmed what we were most afraid of. There were no palpable pulses. There was no cardiac activity, confirmed on monitor and with our bedside ultrasound. There were no spontaneous respirations. There were no signs of life from this child.
There would be no miracle.
My partner asked if anyone in the room objected to his prounouncing this child's death. Nobody objected, since we had all been involved in trying to save this child's life. We knew the efforts that had been put forth were monumental. No attempt had been spared by our team to bring this child back. Unfortunately, and for unexplained reasons, the fates held different plans. My partner announced the time of death.
I requested a nurse to clip some of this patient's hair for the family. I crossed myself after my silent prayer. I fought my tears. Hell, we all fought our tears. I consoled my partner, who, like me, has three young kids of his own. Slowly, a wave of profound sadness and nothingness swept across us. What good are any of us if we can't save a child's life? My partner went out to the family room to deliver the awful news.
Then, time stood still. From two hallways away, I heard the haunting sound. A sound that I knew was coming. A sound that is played over and over in my mind for days after an event like this. A sound of profound anguish. A sound of utter disbelief. A sound of infinite pain.
A mother's cry.
Slowly, as we all knew would happen, the mournful wails of crying crescendoed, and our emergency department came to a stand-still as Mom was escorted through our halls into her little child's room.
Despite our best attempts at maintaining our objectivity, and despite the fact that there were many more patients waiting to be treated, our ER staff cried collectively and gave consoling hugs to one another. We are mothers. We are fathers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And, we were broken.
Dad arrived just minutes after Mom was escorted to the room, and the cries of desperation were repeated. This time, husky and deep. Slowly, though, his cries softened and dissipated, until there was but one lone cry that began again. Higher-pitched. Guttural. Primitive. Emanating from the womb. A cry that conveyed the raw anguish and helplessness that only such a profound loss as losing your child could bring.
God Bless this mother. God Bless this father. God Bless this child. And may God Bless and watch over this family. And all of us.
If only life were filled with just happy moments...As always, thanks for reading. Next post will be either Friday, February 19, or Monday, February 22. See you then...
"We're bringing you a child in cardiac arrest."
Noooooooo. Word traveled quickly through our staff, and the mood immediately got very somber as everyone prepared the resuscitation room for this child. We could only pray that the child being brought to us would respond to our life-saving measures.
Nurses ran to get the intubation and IV trays, pharmacists ran to get the resuscitation cart with all the emergent medications, techs ran to get the EKG and ultrasound machines, and respiratory therapists ran to get a ventilator. Two of us physicians were working with a slew of residents, and we all reviewed our mental checklists and tried to enter our objective frames of mind. Organized frenzy.
My partner requested to be the lead physician during the resuscitation. Being young and recently-trained, he wants to save the world. We all want to save the world, I guess, but for now we'd focus our energy on saving this child. I assured him that I would stay in the room and help with the resuscitation efforts.
The ambulance arrived. With a sad nod of his head, a trusted paramedic gave answer to our searching faces. No response. Yet. We all caught our breath as our hearts plummeted.
We transferred this child to our hospital cot. We emergently intubated this child, checked for any pulses, and continued CPR when we found none. IVs were hard to establish, so I started an intraosseous line by sticking a needle into this child's left tibia. Aggressive fluids were given. Medications were administered. Ventilations were forced into uncooperative lungs.
Efforts continued. My partner followed the life-saving protocols but didn't get any response from this child. Prayers were whispered. Seconds were watched as they ticked on the clock. Slowly, as slow as any time had ever passed, a heartbreaking realization permeated the room. We might not succeed.
My partner ran to the family room to discuss options with this child's parents, while I continued to follow all the resuscitation protocols. We had nearly maximized all of our medications. And still...nothing. CPR was continued, ventilations were continued, more medications and hydration were given.
My partner returned to the treatment room. He looked at me expectantly, and I shook my head "no." My partner shared his conversation with me. Dad was still at work, and Mom was in the family room with our social workers, waiting for family to arrive. She had been invited back to watch the resuscitation efforts, but declined. Her child had been through this once before, because of chronic, ongoing medical problems, and had survived. Surely, she thought, her child could survive again.
After almost an hour of failed heroics, with absolutely no response to any of our interventions, we confirmed what we were most afraid of. There were no palpable pulses. There was no cardiac activity, confirmed on monitor and with our bedside ultrasound. There were no spontaneous respirations. There were no signs of life from this child.
There would be no miracle.
My partner asked if anyone in the room objected to his prounouncing this child's death. Nobody objected, since we had all been involved in trying to save this child's life. We knew the efforts that had been put forth were monumental. No attempt had been spared by our team to bring this child back. Unfortunately, and for unexplained reasons, the fates held different plans. My partner announced the time of death.
I requested a nurse to clip some of this patient's hair for the family. I crossed myself after my silent prayer. I fought my tears. Hell, we all fought our tears. I consoled my partner, who, like me, has three young kids of his own. Slowly, a wave of profound sadness and nothingness swept across us. What good are any of us if we can't save a child's life? My partner went out to the family room to deliver the awful news.
Then, time stood still. From two hallways away, I heard the haunting sound. A sound that I knew was coming. A sound that is played over and over in my mind for days after an event like this. A sound of profound anguish. A sound of utter disbelief. A sound of infinite pain.
A mother's cry.
Slowly, as we all knew would happen, the mournful wails of crying crescendoed, and our emergency department came to a stand-still as Mom was escorted through our halls into her little child's room.
Despite our best attempts at maintaining our objectivity, and despite the fact that there were many more patients waiting to be treated, our ER staff cried collectively and gave consoling hugs to one another. We are mothers. We are fathers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And, we were broken.
Dad arrived just minutes after Mom was escorted to the room, and the cries of desperation were repeated. This time, husky and deep. Slowly, though, his cries softened and dissipated, until there was but one lone cry that began again. Higher-pitched. Guttural. Primitive. Emanating from the womb. A cry that conveyed the raw anguish and helplessness that only such a profound loss as losing your child could bring.
God Bless this mother. God Bless this father. God Bless this child. And may God Bless and watch over this family. And all of us.
If only life were filled with just happy moments...As always, thanks for reading. Next post will be either Friday, February 19, or Monday, February 22. See you then...
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