The Broken Heart of a Child...

It was a Friday night and I was feeling fresh and eager to jump right into work in the emergency room. As I walked through those doors I was energized and ready  for whatever arrived, I learned later in the shift, I was not as ready as I thought.

Right away I noticed a sweet little elderly lady sitting in a wheelchair next to the bed in her room. She looked as though she had so many thoughts going through her head that it was spinning out of control. I watched her as she looked so deep in thought, then she noticed I was looking her way and she broke into a big smile. I asked could I help her get onto the bed and she said, “no, I am perfectly capable, but thanks.” Moments passed and I saw her slide onto the bed, scoot around until she found just the right position; then she displayed great pleasure in her accomplishment. To see her smiling and even clapping for herself, warmed my heart. 

We had a tremendous rush of cases coming in one right after another for several hours.

I looked up to see the most memorable case of the night was heading in the door. She had long black hair that hung down the side of the gurney and swayed back and forth as it moved, her thin fingers dangled and revealed neatly polished nails of pink and I noticed a Hello Kitty ring on her finger as she passed. It was a young girl, who was receiving chest compressions as they rolled her in. Her grandmother arrived at the same time as the ambulance. I listened to the grandmother as she waited outside the code room where the patient had been taken. I was unable to get her to sit or wait in the waiting room. She looked so frail, and her face showed so much pain and grief I could feel it in the air as she spoke.

The grandmother began to tell the story of her granddaughter. Della was 13 years old and had been full of life and mischief. She had always been headstrong and stubborn. Della’s mother had died when she was only a toddler and the grandmother said, “I done my best by this child but it just wasn’t good enough”. 

She told the story of Della coming home a few weeks ago and declaring that she was in love with a boy named Max. “Max is gorgeous, he is sweet and I love him!” is what Della repeated for days. The grandmother explained that she was far too young to be in love with anyone. Della insisted, “I am not too young, I know true love, I LOVE MAX!”

Today Della came in from school with such a sad look on her face. When asked, she told her grandmother that Max had kicked her to the curb. He was in love with another girl and no longer wanted to be her boyfriend. She repeatedly said, “I wish I was DEAD!”

Della screamed and ranted and cried for over an hour. At that point the grandmother told Della, “it will get better, you will see”. Della stubbornly insisted she did not want to live without Max and went to her room, slamming the door behind her.

The grandmother said that she decided to let her stay in there and calm down. She went on about her business, she checked on Della later when supper was ready. Della screamed, “I never want to eat again, go away”. Then she added, “I wish I was dead!”

The grandmother said, “I left her alone and went to bed”, "then I woke up at about midnight and I'm not really sure why". "I hopped up and decided to check on Della". "Oh, God!"
Her knees began to buckle as she spoke, but she regained her strength.

She told how she found Della on the floor. The empty bottle of blood pressure pills lay by her side. It was almost half a bottle of Toprol 100mg, and the child had taken about 10 of them. The grandmother said "I always left my blood pressure pills in the hall bathroom cabinet and never dreamed this could happen".

The paramedics had administered CPR all the way in and we had the best of the best in our ER  working to save this young, confused little girl who had her whole life ahead of her; but it was futile. This was the end of the road for Della. Our entire staff was suffering for the loss of this child. It is heart breaking not to be able to save someone who is so young. I felt her loss and everyone there was deeply moved by it; though we did not know her in life, we mourned her death. 

I also felt so much empathy for that grandmother who was in the depths of despair and no words could comfort her.

In the ER I watched the beginning of life, I watched the end of life and everything in between, but certain cases were more painful than others and this patient’s story tore at my heart for a long time. Over the years I had learned that when you work where tragedy and death are commonplace, it becomes necessary to let go of the painful things you see, in order to preserve your own joy.

No!....

I hate needles...

The shift had just begun in the emergency room and things were already running into a ditch. It seemed that everything that could go wrong, did go wrong.

A few hours into the night, everyone was settled in to a great rhythm and things were working like a well oiled machine. I was happy to see the worry and concern on the faces of my co-workers, begin to soften and leave.

The place was full when we had arrived and there was a waiting room full of sick people waiting to come back for treatment. Tensions heighten and tempers flare when people are suffering or their loved ones are suffering and treatment is not occurring as quickly as needed. We got the most critical people packaged and moved to ICU or to the Operating room or other rooms assigned in the hospital; this freed us up for more to come into the treatment area.

There was a child who had a pearl in her ear. She had wild hair that stuck out in all directions as she cried continuously. I believed her tears were caused by the excitement and activity around her more than any real pain. She could barely talk but was eager to say, “I put it in my ear” when asked how it got in there. It was a delicate procedure but our physician was able to remove the pearl pretty quickly. This made the child and the mother happy, happy, happy. They were soon discharged.

There was an adorable little boy about 12 years old with red hair and lots of freckles who had been demonstrating some new tricks on his skateboard and took a spill down some concrete steps which left him with a broken left arm. He did not look particularly happy but he was doing as his father instructed. “Suck up the pain and be a man!” was an order yelled by his father repeatedly. His arm was set in the ER and after a few hours, he was released.

There were 3 heart attack patients and one who had COPD (a serious breathing impairment). All were stable at the moment.

One man had gotten drunk and accidentally shot the end of his finger off. He was using some foul language and had to be scolded many times by his wife and by our security.

I am sure he was in great pain, but we had children and people of all ages that did not need to hear those nasty words he was spewing out.

At about midnight we received an ambulance call saying they were 5 minutes away with an 82 year old woman who could not sleep. We all repeated, “Could not sleep!”

When she arrived, she was placed in one of our “fast track” rooms. These rooms are used to treat people who are not felt to be seriously injured and are expected to be treated and released pretty quickly.

This lady told her nurse that she insisted they bring her to the emergency room because she was afraid and could not sleep at home alone. Within 30 minutes of her arrival she was snoring so loud that we could hear her over the screams and cries of other patients and she slept for hours. My heart went out to this lonely little lady and I was actually glad that she was here, around others, peaceful, secure and resting.

I looked up moments later to see a tall scary looking young man being escorted to a room by his assigned nurse. He turned out to be the most memorable patient of this shift, for me. He was covered with tattoos. They were fully covering his arms, on his legs, neck, back, fingers and toes. He also had multiple piercings in his ears and nose. He looked like he had a significant infection on his right arm that needed attention. When Lisa entered his room with the supplies to start an IV and to draw blood for lab work, he said, “No!” She froze for a moment. Then he said, “I hate needles, please please don’t stick me”. He was not kidding, he really feared needles.

I looked at her and she looked at me, we both wanted to laugh but we thought better of it. Lisa asked him why he had so many piercings and tattoos, if he hated needles. It was obvious he had paid someone to stick needles in him many times. His reply was, “that’s different”.

The tattoo guy got an IV in each arm and he received IV antibiotics for a staph infection he had from his latest tattoo. 

This guy looked tough, scary and strong; yet he was afraid and teared up as his blood was drawn for routine testing. I will always remember his girlfriend holding his hand and patting him as she said, “It’s ok Edgar, you will be ok, calm down.” I couldn’t help but wonder if she did the same when he was getting tattooed or pierced.

People are interesting creatures. We saw pain, suffering, fear, loneliness and a huge array of emotions on every shift. 

I came to realize there are some people you can’t help but love, yet some you just can’t help.

It was hard to see her pain....

She was wise beyond her years....

We walked in for the evening shift at the emergency room; my friend and co-worker stepped in the door in unison with me that night. I said, “It’s Saturday night, bet things will be hopping all night!” Nancy said, “If it ain’t, something is wrong.”

I looked at the schedule to see which physicians were on duty. The physicians who are on the shift make all of the difference in a good night and a horrible night. I was very happy to see two of my favorite doctors were there. I smiled as I dropped my purse and lunch in my locker and headed into the emergency room to see what kind of cases we had and what cases were waiting to come back.

Nothing earth-shattering yet, but the night was young. The shift was going to be a good one for sure as I noticed Rod and Lisa (two of the best nurses ever), walk in the door. 

At the beginning of our shift, there was a 3 year old girl who had been bitten by a neighborhood dog as she reached out to pet him. She wore a pink and yellow tu-tu over her bright yellow tights. In her hair was a bow half as big as her head, in matching yellow. Her pink blouse, now stained with blood, lay across the foot of her gurney and a hospital gown was tied on in its place. The faded pattern on that gown was Sponge Bob Squarepants and that seemed to brighten her spirits  She required 14 stitches to close up the gap the dog had left in her right cheek. She quietly allowed the work to be done, unlike most children at that age. Her demeanor was calm and sweet as the stitches were set in place.. 

When the physician finished the last stitch and stepped back, she began to talk. I was amazed when she first said, “Thank you doctor, you did good!”; as she raised her hand for a high five! This tiny little girl had a presence about her that still sticks with me as I recall her that night. She interacted with us all on a level that was more mature than most of the staff. It was impressive.

Someone asked her parents what kind of dog had attacked her, it was then that her father said, “It is soon to be a DEAD dog!”

The little girl quickly spoke up and said, “Daddy, please don’t hurt the dog, he didn’t mean it!”

How wise this small child was as she begged her father to give this dog another chance and as she told in detail how the events unfolded and how she was the one who had provoked the dog and he was only reacting to her.

Later that evening when things slowed down in the ER, my mind drifted to that dog-bitten child and her calm, intelligent presence. I decided if she was an example of future members of our community, we were going to be ok.

Hours later we had a lady come in who was in cardiac arrest. She was so thin and frail. As I watched Rod doing chest compressions I worried that her frail chest might snap from the pressure. She was not able to recover, there just was no bringing her back. When the family was advised of her death, they wept. They wept softly and with great pain. One daughter spoke of her kindness, her spirit and her joy. She told of the long fought battle her mother endured to be with them as long as possible. Then it was like a ton of bricks had landed on her suddenly, as she began to speak of the rest of her life without her mother.

Each shift in the ER is filled with sadness, loss, deep sorrow; yet there is laughter, and funny things that happen too...so to me it is like the journey of life in fast motion with all emotions coming and going with an ebb and flow unlike anything you could imagine.

I found it to be invigorating and exhausting at the same time.

Another shift was over, I grabbed my things from the locker in the break room and scooted out the door, happy to be alive.

You know its going to be a busy night when...

The Rodeo is in town

I came in to work that day in the emergency room eager to see what would greet me. This is one job that always got me excited. There were lots of sad things that came through our doors and lots of wacky things that showed up too. We never knew what a shift might hold, that is what excited me.

I poured a cup of coffee to boost me for what might be in store that night. Charlie, one of my favorite nurses, said, “Juanita, you know its going to be HELL tonight don’t ya?” I said “No, why?” He said, “The Rodeo is in town!”; he added, “This place will be hopping with broken up cowboys all night.”

Charlie was right. Soon after the rodeo began we got a call from an ambulance headed in with an injured bull rider. These rodeo guys are the best people on earth, maybe not the brightest when it comes to career choices, but they are awesome to have around. This young man had a broken jaw and left arm. That bull was rough on him. He said the bull’s name was “Loco” and he loved riding him. But tonight, Loco had been wilder than normal and unpredictable. He spoke through his broken jaw pain and a swollen tongue, “Loco is my buddy but he just don’t know it!” Besides the blood and spit from this guy, I will always remember the smell of his feet when they took his boots off. Nice guy, but smelly feet.

Rodeo people are never upset about being in pain and they act like it is just in a day’s work to break bones and get bruised and skinned up. They don’t complain and seem happy to have someone eager to help them.

About an hour after our bull rider came, we received two patients at once from the rodeo. One had been slammed into the arena fencing and had a broken ankle and lots of bruises. The other had a collapsed lung after being thrown from his horse. Both were in great spirits and wanted to tell the story of exactly how the injury occurred. 

Our final patient that evening from the rodeo was a clown. I learned just how dangerous that job is. There isn’t really much “clowning” going on in their job. It consists mostly of throwing themselves between an angry bull and a cowboy or jumping into the mix to try and free a hung up cowboy from a rope tied to a bull or a horse.  He said "I have heard people say they risk life and limb to get the job done; well I say life and limb ain't nothin!' "I risk my rear-end every time I'm in the arena!". "One day I jumped in to help a fella and got gored in the butt by a huge bull!" "I couldn't sit down for months!" He went on to say, "If that bull's horn had been an inch to the left, I would have become a girl!" He was so animated and hilarious as he told of the day he got "horned in the butt by a bull!"

I could have listened to this rodeo clown for hours as he told tales of extreme danger he had faced. His day at work was always considered a great day if he survived. I decided I would never again say that I had a tough day, because now I knew what a tough day really was. I admired their courage and also secretly thought they had to be a little bit nuts.

By the end of that shift we had seen 6 men who were injured at the rodeo. A job that definitely should carry hazardous duty pay. Yet, all 6 were happy and excited to be alive. They seemed to wear the injuries like a badge of courage. You couldn’t help but love them all.

Soon after the rodeo ended, all of the people who worked there showed up at the hospital to check on their buddies. 

I saw more boots, cowboy hats and big belt buckles that night than I have ever seen in my life. I believe that rodeo people are the best people you could ever meet.

These special people may have been suffering from head injuries or post traumatic stress disorder, or they may have been a little crazy their whole lives but they were enjoying themselves  and they were happy just to be breathing.

When this shift was over, you could hear my co-workers yelling, “Yee Haw” on their way out  the door.