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Friday, January 21, 2005

There were ten nurses in class today, talking about the most horrible of subjects in the most mundane ways. We were taking a course called Pediatric Advanced Life Support or PALS. We sat casually around the table, drinking coffee, eating bagels and contemplating the beginning steps in assessing a child in peril. Not that any of it was new information; we needed to take a refresher course every two years. It was the familiarity that allowed us to slouch and scribble and laugh.

Not that this is an easy part of the job. There are too many ways to be humbled on a daily basis, too many ways that things can take a sharp left turn. The rule is that sick kids look sick. If a child is smiling, laughing, making good eye contact - that's not going to be a truly sick child. On the other hand, the child who lies quietly, who is using all her energy to breathe, who looks "floppy", that's the child that can go sour in a minute.

We can all remember an "Oh shit!" moment - when we get the radio call that a child not breathing is coming in; or when we see a parent coming through the door holding a child that is profoundly ill and there's nothing between nurse and baby but the parents' fears and our rapidly rising adrenalin levels. Invariably, the first thought is "oh shit! " For a split second we wonder if there's a graceful way to back out the door before we turn the mental pages to the section that deals with "What Do We Do Next?" After that, things just happen. But every one of us can remember "oh shit" moments.

I was standing at the triage desk one quiet morning, talking to a nursing student who was spending a week in the ED. I looked up to see a mother come running in the door (running is never a good sign), carrying her six-year old, yelling "They shot my baby!" She handed the child to me and I looked down at the little girl who had been shot in the neck, It was definitely an "oh shit" moment. But I'll never forget what I didn't see. I didn't see an unconscious child. I didn't see blood spurting. I didn't see the signs of death that ought to have accompanied such trauma. I did see a missing section of skin and muscle and a neatly excised, but miraculously intact jugular vein. There was really nothing for me to do but run toward the trauma room while calling for some help. The girl lived and, I hope, is now in college. It was an example of the kind of thing that can happen when you're just standing around.

So we sit around the table like college students listening to their professor, taking notes, asking questions and comparing experiences. We take the course again in the hope that what we practice will go unused. It won't, but it doesn't hurt to wish.

6:34:32 AM

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