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Business for the chaplains... - Nobody wears a white coat any more...
...a tribute to becoming a doctor.
ayradyss
ayradyss
Business for the chaplains...
That's how the world becomes better, Rabbi says, nodding to a nurse. To look at a person and see a human being. Thank you for thinking of us.

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.

Tags: , ,
now feeling:: sad sad

12 whispers echo . o O ( ... ) O o . whisper a word
Comments
turnberryknkn From: turnberryknkn Date: June 11th, 2007 11:02 am (UTC) (etched in stone)
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.

(nods)

I remember once on Pediatric Neurosurgery they brought in a group of teenagers where the driver was drunk. Of the two boys that were transferred to U. Michigan, one of them is now wheelchair bound and severely crippled. The other died ten days after arrival, his GCS never going about 5. The driver ran from the scene.

One of the first firefighters on the scene was the father of one of the brutally injured boys. He had no idea who the victims were until he pulled his own son from the wreckage.

I remember all the times I too hoped that, when I came back in the morning or for next shift, or checked back on medical records, something good would have happened. I remember how often it didn't.

Good to hear from you again.

ayradyss From: ayradyss Date: June 11th, 2007 01:41 pm (UTC) (etched in stone)
It's been a while...between the baby and in the middle of 12 weeks of call blocks...
From: dafne99 Date: June 11th, 2007 06:19 pm (UTC) (etched in stone)
I just want to let you know how much I enjoy your posts. Few and far between, though they may be, they are all so intimate and expressive. Keep heart, it will make you a better doctor.
ayradyss From: ayradyss Date: June 12th, 2007 10:38 am (UTC) (etched in stone)
Aw, thanks.
omarius From: omarius Date: June 12th, 2007 12:53 pm (UTC) (etched in stone)
Hear, hear. In addition, I think reading this blog makes me a better person. There is not much exposure to compassion available in our culture, especially not the thoughtful kind. The occasional ayradyss post is deep nourishment compared to the complaints about mundane life events and TV shows that usually crowds my "friends" page.

From: dafne99 Date: June 12th, 2007 12:56 pm (UTC) (etched in stone)
It certainly is a nice break from our everyday distractions to hear stories about things that really, truly matter. We do love our ayradyss, don't we? :)
ayradyss From: ayradyss Date: June 12th, 2007 02:45 pm (UTC) (etched in stone)
Aww, you guys make me all mushy :)
Thanks - most sincerely.
From: broken_onewon1 Date: June 11th, 2007 11:07 pm (UTC) (etched in stone)
I hope you get your wish for something good to happen. Thanks for explianing the coma scale, it made the three revelant. The surgeon sounded like a neat old guy too.

I hope this finds you well
clipdude From: clipdude Date: June 12th, 2007 03:35 am (UTC) (etched in stone)
Wow. Stories like this make the everyday annoyances of life seem trivial.

Do you find yourself driving more carefully after seeing things like this?
ayradyss From: ayradyss Date: June 12th, 2007 10:38 am (UTC) (etched in stone)
Actually...yes.
blueeowyn From: blueeowyn Date: June 14th, 2007 05:24 pm (UTC) (etched in stone)
Touching post, quick question about the coma scale. Is a GCS of 3 an average score or is it the sum of the scores?

Thank you for taking the time to share your experiences with us.
ayradyss From: ayradyss Date: July 21st, 2007 05:39 am (UTC) (etched in stone)
GCS is a summary score. You and I have a 15 :)
12 whispers echo . o O ( ... ) O o . whisper a word