It was Friday, and I was a little over halfway through my shift. The schools were out for a long weekend and the weather was nice so we were seeing a little bit of an uptick in pediatric injuries. A few stitches, two minor breaks, nothing that a cast or some ibuprofen wouldn’t cure. I was considering eating my lunch outside in about fifteen minutes, hoping for a brief reprieve in the sunshine. My anticipation of the upcoming break was abruptly interrupted by our CB radio crackling to life beeping an alert. The EMT on the line preparing us in a quick debriefing of what was headed our way, “Head trauma, six year old male, bicycle accident. Trauma team needed.” The nurses station that had been relatively quite a few seconds earlier started buzzing with activity. I shared a glance with our lead physician Dr. Morris. Over the fifteen years we shared in this department we had worked side by side to stabilize far too many pediatric head traumas. A silent communication passed between us, recounting the numerous conversations we had had both with each other, and with parents about the necessity of helmets when riding anything with wheels. I shook my head and turned to make my way to the nearby med room ready to grab our needed supplies. Dr. Morris headed to prep the trauma room, sighing and readying himself for what was to come. I wished these parents would just heed the warnings, so many of the cases we saw here could be prevented.
I carefully read off medication names to a younger nurse, double and triple checking I had the right vials and doses for a young patient. She grabbed IV’s and antiseptics. Hearing the commotion of a trauma response beginning outside the room I steeled myself for what was to come. I willed away everything in my mind but the determined focus that was going to be required of me. Quickly I ran through the treatment steps we had taken in previous cases as the younger nurse and I pushed through the door, our rushed steps leading us to Trauma room one. Two hands reached out to my shoulders as the room came into sight, preventing me from continuing my mission.
“Katie honey, you need to stay out here right now. Give the supplies to Molly okay?” My charge nurse Dana said gripping me gently on the front of my shoulders. I looked to her with a quizzical gaze. The young nurse, Molly, gently taking the items from my arms an evident concern showing on her face.
“What’s going on?” I asked Dana studying her. Had I made a mistake somewhere? Grabbed the wrong items? I looked toward the room trying to piece together my confusion. Standing near the wall in front of me, looking pale as a ghost, was my fifteen year old daughter Hannah. I left her at home today to watch her younger brother, their age difference making her a perfect babysitter for him. I took in her shocked look, the makeup and tears streaming down her face, and the blood staining her ivory shirt.
A sinking chill shoot down my spine. The hair on my arms stood up as I looked from Hannah into the little room where Dr. Morris was directing the urgent movements of his team. An EMT held an air pump forcing breath into the small figure stationed in the middle of the sterile white bed. I took in the sandy blonde hair that had been neatly trimmed last weekend but that now stuck up in a wreckless pattern, one side of the little head caked in blood. I took in the old Nike sneakers I had been meaning to replace for the last few weeks. I took in the blue and red striped shirt I had helped struggle the boy into this morning. My mind slipping from my calm and focused demeanor as a flash of a memory rushed into my thoughts. The toothy smile I had seen just this morning when I tickled the boys sides right before grabbing my keys and heading out the door to the hospital. I looked back to Hannah with distraught questions in my eyes. I realized it was my son lying limp in front of us, a team of my colleagues working to save his life.
“We did everything right!” Hannah sobbed, pleading with me to understand, “Mom I swear I made Tyler wear his helmet, it wasn’t loose I checked it! He even had his knee pads and elbow pads on. He fought me but I wouldn’t let him ride without them! He just…he went so fast. He went down the hill and I tried! I tried to catch him but I couldn’t! I wasn’t fast enough. I tried! He lost control and he fell. I don’t know how it happened, he had his helmet on! I watched it, he hit his head on the curb but I thought it was okay, the helmet was supposed to protect him! He wouldn’t move mom, he was bleeding so much, I don’t understand! We followed the rules! We did everything right!” She was in hysterics begging for forgiveness and trying to comprehend the situation.
My clinical calm had been replaced by a numbness that somewhere in the back of my mind I recognized as shock. I watched the team, my work family, hover over my son. My colleagues hooking him to machines I knew would display his vital signs, they would observe the monitors carefully, the numbers telling them the treatment path to follow. I watched a nurse take over pumping the bag of air into his lungs. Why couldn’t I remember what they needed to do next? In my shock my brain seemed to stop, rational thought escaping me. I couldn’t fully understand what was happening. We had always been warned that It’s different when it’s your child in distress. We were told that no matter how hard you try you can’t find the separation needed to objectively provide treatment. It was advice I had prayed I would never be able to explain from first hand experience.
“Vitals are dropping. Prepare the cart,” Dr. Morris ordered, his voice strong and calm. Collected but urgent, he remembered the steps. The only thing I remembered was the one reason we ever used “the cart.” It meant the patient was coding. Coding meant code blue, cardiac arrest. My son was dying and all I could do is stand by and watch.
“Katie you need to go sit down honey,” Dana told me trying to push me backwards. I couldn’t move, the only thing registering in my mind was the maternal urge to run to my child and help him.
“Hannah sweetheart come with us,” she gently called to Hannah who still stood frozen in the hallway, watching her brother fight for his life. Her hands covered the lower half of her face, her tears streaming without control, and her body in shock.
“Dr. Steinburg I need some assistance please,” Dana’s voice called out, a little more frantic than it had been in her previous requests. The young resident had been observing the activity from behind the nurses station, trying to learn from his mentor’s actions. He looked to us and quickly ran to help Dana gently pull me away, my eyes clinging in desperation to the scene in front of me. I was vaguely aware of Hannah being nudged away by a medical assistant who had been waiting in the hallway ready for any direction given. She stumbled over her feet also unable to tear her eyes away from the small lifeless figure of her little brother.
“She knows the patient?” Dr. Steinburg quietly inquired of Dana.
“Her son,” Dana answered her voice tight with emotion. Dana had known my kids for years. She had even watched them for me when Hannah was still young and Tyler was just an infant. She was always asking about their progress in school and chatting with them when they would come in to visit. She was one of their biggest fans and was genuinely excited when I shared recital pictures and news of good report cards. Her children now grown she relived her past years of parenting through my experiences. This was going to be hard on her too, but for right now she was succeeding in keeping her strength, knowing I needed her.
Dr. Steinburg’s demeanor faltered for a split second at her answer. He recovered quickly, his professional mask returning. He understood. This was the worst nightmare of any trauma professional. The fear of having your family wheeled in through those doors. This image at times keeping us all up at night.
We didn’t fight as they lead us into a small room off the front hallway. The innocuous sign on the door labeling it the “Family Room.” In reality it was reserved only for the families of our trauma victims. In hospital planning it was understood that no one ever needed to see their loved one in the process of emergency treatment. Nor did the trauma team need to be distracted by stunned horrified family in the already crowded treatment area. I hated this room. It was closed in by white sterile walls, generic floral prints were hung in a pathetic last ditch effort to make the space seem less daunting. Not that it would matter, no one waiting in this room was ever going to be calmed by any sort of decor. I let Dana lead me to the uncomfortable green couch across from the entrance and delicately sit me down. I stared into the empty space in front of me not really processing the events of the last ten minutes. I understood logically, but in my shock I couldn’t seem to get my brain to fully catch up. I could feel the sense of panic but it wouldn’t manifest itself the way Hannah’s was. I could only seem to shut down and disconnect. I felt as if for sure this was a horrible dream yet had enough wherewithal to understand it wasn’t.
“I’m so sorry! I’m so sorry!” I heard Hannah’s hysterics again, I glanced at her red swollen face, distraught with pain.
“I know baby,” I said, my voice sounding foreign and strange. The monotone not holding any of the comfort I had intended.
“It was an accident Hannah,” Dana tried to comfort her, crouching by the chair Hannah sat in and grabbing her hands. “Honey it was an accident. He has the best team in the city working on him right now. I know it’s hard but you’re going to have to stay strong for him.”
I listened to Dana try and comfort Hannah, realizing that those words, words we had repeated to families so many times in this room, weren’t a comfort at all. Repeating this mantra was more to remind ourselves that we really did have the best team around. If there was a fix they would find it. If there was a fix. My only thought, now experiencing trauma from the family’s side, being that the team was only human. I was painfully aware that sometimes humans make errors, even experts aren’t perfect.
I heard my husband arrive before he entered the room. Fathers had a tendency to let their fear turn into anger in these situations. Jimmy was no exception. We understood the emotion, their overwhelming instinct to fix. They were desperate to repair their child but realistically there was nothing they could do. They had no choice but to relinquish control to a group of strangers, being asked to trust that the people taking the control from them were better suited for the job. Many of these fathers tried to control inconsequential things, yelling and throwing items at registration clerks when asked to sign necessary consent for treatment forms. At times the anger was directed at us for not performing our jobs the way Grey’s Anatomy portrayed. They were terrified that we were incompetent. In the end this behavior only hindered the treatment process and we usually ended up having to assign support staff to reason with the distraught parent.
“WHAT DO YOU MEAN I CAN’T SEE HIM!!!! HE’S MY FUCKING CHILD!!!” Jimmy’s voice boomed through the door.
“Jimmy, right now he needs the attention of the staff we have working on him. We are going to let you see him as soon as possible, but for now it’s important that you allow them to do their jobs without interruption,” I heard the voice of Richard our hospital Chaplain explain to him.
“THIS IS BULLSHIT!” Jimmy yelled again as the door to our confining space opened and he was lead inside.
“Katie! Why the fuck won’t your damn hospital recognize a parent’s fucking rights?” He spit with venom. He was terrified.
“Jimmy, please stop,” I pleaded, “You need to let them try to fix him. How are you going to help?” I tried to reason with him, frustrated by his antics.
“I know I can’t fucking do anything! I just… I can’t just wait…” he trailed off allowing the fight to drain out of him.
“Right now we have to,” I croaked out wondering if there was even aid to be rendered at this point. I tried desperately to rid myself of the image stuck on repeat in my head, Tyler broken and bloodied unable to breath on his own, the crash cart being opened next to him.
We fell into a suffocating limbo, the only sound Hannah sniffling in the corner. Dana was back next to me on the couch rubbing my arm in short movements, trying to provide any comfort she could. Jimmy’s pacing making the small room even more claustrophobic. I continued my study of the empty air in front of me trying not to focus on the images of patients I had treated in the past, who had succumbed to similar injuries. Time was passing slowly until Dr. Morris finally opened the door. Now it felt as though not enough time had passed, my heart began to hammer in my chest.
“Alright guys I’m going to go straight into this okay?” He started, “He fractured the lower part of his left zygomatic orbital bone, this part right here. Just below where the helmet would have been able to prevent,” he explained to Jimmy and Hannah pointing to his temple, “This is a particular dangerous area to fracture because of the important tissue surrounding it, obviously the eye being a major concern. However right now we do not think there was any major trauma to the eye, although there may be some bruising that will show in the eye itself,” he paused checking us for understanding before he continued, working up to what I knew would be the worst of the news he had to deliver. I expected what was coming next having experience with this type of injury. My body began to shake in preparation for news that even if my son survived he may never function the same again.
“A major concern with any head trauma is from the intracranial bleeding and swelling that can occur after the injury. In Tyler’s case the swelling was quite acute… meaning there was a fair amount. Edema, pressure inside the brain, can lead to respiratory distress, which unfortunately did occur in this case.” Hannah let out another sob and Jimmy made a noise that sounded as if he was choking.
“When talking about recovery from situations like these a concern is how much oxygen the brain was deprived of. Hannah, you did the right thing by calling 911 right away. Had he not had help breathing his oxygen saturation levels would have been much lower and his risk for long term effects much greater. He also would have likely entered cardiac arrest had it taken even ten more minutes before intervention was taken. We would be having a different conversation in that place.” He sighed and ran his hand over his face the first hint that this case had been wearing on him, his professional mask slipping.
“Right now he is being prepped in the OR. They do need to place a screw to repair the fracture and they will place a stent to relieve bleeding in the cranial cavity if necessary. I am hopeful that will not be needed. However we will need you to sign consent for all procedures just in case.”
“Is he going to be okay?” Jimmy interrupted frustrated with the drawn out explanation he likely didn’t even absorb half of.
“He’s not completely in the clear yet,” Dr. Morris warned, “That being said I feel fairly confident in his chances. We will know more when he comes out of surgery, but as your wife will tell you we have seen many of these cases over the years, and usually in cases like Tyler’s patients prove to recover from the trauma. It will not be a quick recovery, he will likely have lasting effects such as headaches, migraines, light sensitivity, fatigue to name a few. You will need to watch him closely for any sign of clotting especially in the beginning. He will need to monitored with a CT scan a few times as well. He’s lucky to have his very own and very qualified nurse to watch over him,” he said smiling over at me. The relief of having a good prognosis to report evident.
I finally allowed myself a deep breath, hoping to steele my chaotic emotions, images of our past patients filtering into my mind. The children we had treated for injuries like this with similar odds had all walked out of the hospital a few weeks after their surgeries. The human body could be amazingly resilient, especially under the correct care. I felt exhaustion infiltrate every part of my body. My fear and relief now pummeling in like a wrecking ball as the initial shock began to wear off. In that moment I had faith that Tyler was going to be okay. That soon I would be able to tickle his sides and hear his giggle again. That we would laugh over his silly faces and be able to kiss his little cheeks.
“Thank you David,” I stood, the tears I hadn’t yet let myself cry releasing freely.
“Katie I would have done anything for that kid, I am so glad he got to me when he did,” Dr. Morris, David, said his own eyes starting to tear as he wrapped his arms around me. “Take as much time as you need in here. You can wait in this room through the surgery or go to the OR waiting room. It will likely take a few hours.”
“Thank you,” I smiled weakly but with a gratitude that would forever hold a piece of my heart. He nodded his head before returning back to the patients still waiting for his compassion and expertise.
“I was so scared,” Jimmy said sinking to the seat on the couch I had just vacated, his head collapsing into his hands. Dana hugged him to her side briefly before standing and squeezing me firmly against her body.
“He’s going to make it honey, just breathe right now okay? I’ll come find you if I get any information,” she said.
“I know. Thank you,” I replied tearfully. She squeezed my hand and left, allowing us time as a family. I knew it was now vital for me to do the best I could to grasp onto my calm and focus, to provide strength to my family around me. I gently sat next to Jimmy and held him against me.
“I was so fucking scared,” he said again letting me squeeze my arms around his shoulders and kiss his head. I looked to Hannah who still had silent tears running down her face.
“Come here baby,” I requested stretching out one arm and making room for her on the stupid green couch. She threw herself into my open arm.
“I am so sorry!” she sobbed again.
“Baby it was an accident” I worked to sooth her guilt, “freak things happen, no one can prevent it all,”
I sat holding my husband and daughter to me for a long time just focusing on my breathing, in and out, in and out. I was incredibly grateful to whatever force was out there writing our destiny. Our family was one of the lucky ones in the book of life. Our little boy was going to stay with us, his story wasn’t over. With the strength and the support we would provide each other we would all survive.