Peds call tonight; on my way into the hospital to admit S who is a doll of a three-year-old girl with sickle cell anemia and a hemoglobin one-third of normal I pass one of the nurses. "Multiple trauma coming in, I hear. Messy." Interesting. I head on into the ER for my admission.
They are buzzing in the trauma bays: moving patients out and readying for something of significance. It's a short walk from S's room to the happening part of the ER and I make it several times while I'm waiting for my attending to answer his cell phone. When I tell him the story of S, he's decisive and quick - and I find myself moseying back over to the bays as they're rolling in two patients. Hot drop, one nurse says. We go get 'em off the chopper and they go back to the scene. How many patients? It's morbid curiosity, as well as a bit of business sense - both bays are under 18, so they're my kids once they hit the floor. She flashes a hand, wiggles her fingers. Five kids.
Bay one is screaming as they move her - the driver, I am told, with a severe concussion and a lower leg that looks like pickup sticks, but able at least to talk. Bay two is silent - CPR in progress coming off the chopper, intubated, ventilated, and with a GCS of three. A rhythm is regained, and the pageantry begins. Like some sort of medical paparazzi, I circle in to join the crew. There will be chest tubes and lines and things, and if the right trauma surgeons are on I will be able to get my hands dirty.
(A digression about the GCS - for the uninitiated. GCS stands for Glasgow Coma Scale and it is a measure of relative level of consciousness. It has three components: motor, ranging from 1 point for no movement at all to 6 for "obeys commands"; verbal, ranging from 1 point for nothing to 5 for "oriented"; and eye opening - 1 for none, 4 for spontaneous. It is a common saying that a table has a GCS of three, and all things should be taken in context of that.)
The right surgeons are not on, but I stand by as a chest tube is slid neatly into place, and move into prime viewing position as neurosurgery ambles into the room. I ask questions - his reputation as a cranky old man is well-earned, so what do I have to lose? To my surprise, he answers them, and even explains what he's doing as he shaves the scalp, scrubs, uses a hand drill and a knife to put a hole into the child's skull. An intracranial pressure monitor - placed quite tidily in the ER trauma bay, no operating room needed. And to my further surprise he takes some time to talk to me about what he doesn't see - and what he doesn't see is a reason that our patient is comatose and unresponsive, why his pupils are the size of dimes, and why the GCS is three. He speculates. I listen. Best of all, this patient is going to the adult ICU, where we will wait and see if he ever recovers.
I memorize his face, between the C-collar and the ET tube and the newly-shaven scalp. His eyes are great empty black pools, ringed with a sliver of grey-green, staring blind and unblinking. They do not stay closed when I brush his lids shut with my fingertips. When the nurse washes the blood and broken glass away, a few tears are squeezed into a rivulet - meaningless, I know.
Somewhere in there, I hear the reason no more pediatric traumas have been wheeled in - one has gone to $next_city_over and (rumor has it) died, and the other two died at the scene. Five kids, barely old enough to be out alone, one car and a tree...
I can't stop thinking about Bay One and what she's going to carry with her forever now. I can't stop remembering what it was like when I was young and sixteen and immortal and we would drive around at night with reckless disregard for the potential consequences. It's one-thirty in the morning; I've been down there for three endless hours - and I want to go back and watch and wait for something good to happen.