Tuesday, December 21, 2010


One of the main responsibilities of my job, that we informally rotate between the three of us nurse practitioners, is carrying the on-call pager (aka the bomb- because you don't want it to go off while you're holding it;). We get various calls on that particular pager, including trauma pages. There are different categories of traumas, the two main ones being Trauma A and Trauma B. Trauma Bs are less critical and may or may not require neurosurgical consultation- we're not required to report to the ER unless we're specifically called (via separate page). Trauma As are more serious- report directly to the ER, do not pass go, do not collect $200. Once the patient arrives, we're sometimes dismissed by the doc running the trauma, but it's pretty unusual (and you NEVER leave without being dismissed). Most traumas major enough to be a trauma A involve some kind of CNS injury.

I was really unpleasantly surprised, when I went back to work after Grace was born, to find that I was really uneasy about, well, everything. I mean, I've questioned how much my job and I are a good fit for each other (who hasn't?), but it's never been due to a lack of confidence. I'm good at my job. I know what I'm doing. It took me a reeeeally long time to feel that way after I went back to work. So when I was carrying the pager one day and got a trauma A page, I asked Maureen to go with me. It ended up being a really wise decision, although not for the reasons I expected.

We got to the ER before the patient. We were able to piece together that a little boy (I can't remember his exact age anymore, somewhere around 4-6 yo) was found down (pulseless and not breathing), accidentally hanged on exercise equipment. We exchanged looks- the rate of survival for an out-of-hospital cardiac arrest, particularly in a child, is nearly zero. (The rate of meaningful survival is essentially zero, with rare, miraculous exceptions.)

When the little boy arrived, there were paramedics all over him, bagging him, pounding on his chest, yelling at each other, like a tv show. I never saw his face, but I saw his legs, and they were gray. He was wearing plain white tube socks and no shoes. That really, really bothered me, and I'm not sure I can clearly explain why. I guess because it just made him look so much like a little boy- I pictured him yanking his socks on and running down the hall after his brothers, yelling and throwing things. And I thought, in the middle of all of that, when he put those socks on, nobody ever imagined this would happen.

I had other weird thoughts. I remember thinking, abstractly, that it was strange to see everyone running and yelling and tossing things to each other, fighting so hard to save a boy who couldn't possibly be saved. (But what else do you do? I don't know. I just remember thinking it.) I remember one of the social workers commenting to Maureen and me that one of the paramedics working on him was one of the best, and he was lucky to have her working on him. I remember thinking that was the stupidest thing I'd ever heard in my life, because that boy wasn't lucky at all. (In the social worker's defense, stuff like this doesn't happen every day. It's hard for everyone, and we all say weird shit when we're rattled.) And I remember being totally horrified by the fact that I could not keep myself from crying. Crying at work, in front of other people, is Not Okay, and especially not in a situation where you need to be on your toes. They weren't hitching, heaving sobs, but the kind of tears that just plop out of your eyes and you can't do anything to stop them.

The whole time we were standing there, we knew we weren't needed. We couldn't possibly be needed, because the little boy was dead. But until they officially declared that they could not win the fight, we had to wait. We absolutely could not ask to be dismissed, as there were far more important things going on, but because there were far more important things going on, nobody even really noticed we were there. And, if by some miracle, the boy's heart started beating again, we would be needed. He would need c-spine evaluation, and he would inevitably have cerebral edema (brain swelling) as a result of his injuries and prolonged anoxia (lack of oxygen). So we stood in the hallway, watching them whale on him, until the tears started plopping on my cheeks, at which point Maureen walked over to someone in a position of quasi-authority, who wasn't otherwise occupied, said we would be leaving, and led me away. (And, to my eternal gratitude, never, ever said another word about it.)

So (and here's where I'm going to sound really flip, so bear with me), when I say I don't want to put Grace in a bed, it's not because she's a devilish little butthead who will never sleep again (although that is obviously a factor), it's because it means she will be free to find a way to roam around without my knowledge. And for now, all that means is tying up blind cords (or buying new, cordless blinds), mounting her dresser to the wall, only opening her windows from the top from now on, locking the bathroom every night, things like that. Knowing that I will go over her whole room with a fine-tooth comb, and the first night she's in a bed, even if she sleeps, I will not. But from that point, there's always another step. Letting her play in the backyard by herself, letting her play out front by herself, letting her cross the street, walk to school, ride a bike, drive a car (oh god, I just threw up a little bit).

The world is full of precipitous drops and hanging cords and cables and sharp edges and asshole drivers. We all need to learn to navigate that, as parents. We all need to learn to let go, and trust that things will be okay, or we run the risk of causing a different kind of damage to our kids than the physical injuries we fear. I fight every day to remember that. But at the same time, I'm also remembering gray legs and tube socks and horrible days that nobody ever thought would happen.


Laura said...

Big huge hugs. I get completely freaked out when I look at a preschool or kindergarten class and think about Abby being alone in an environment without me there to watch from the wings to make sure nobody hurts her feelings or gives her a mean look or pushes her on the playground. My heart races and I get this sick feeling in my stomach - and that's from imagining something positive like school.

If I let myself start thinking about the real dangers out there, I'd never ever put her down for a second.

Being a mom is hard like that. Good post. And you're a great mom.

SPOT said...

I get it...so get it...Lilli either had a fibral seizure or had an "incident of Asphyxia" in the back seat of my car on the way to the dr's. when she was 15 months old and really really really sick. I was singing to her, she got quiet and I thought she fell asleep. Then I looked in the rearview mirror, she had turned blue and her eyes were still open...flipping out would be a nice way of saying what happened next...Jim and a stranger (who might have heard my shreeks when I jumped out of the car) did CPR until the paramedics came. We went to Lutheran General, and she was totally fine. Us, not so much. Whenever she gets sick, to this day, I panic in my heart. I know that I cannot show that outwardly...but I worry ALL the time now that I have seen my child with blue non-breathing lips...and it sucks...