Those Shoes

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Birdstrike

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Some cases burn into your brain like a hot branding iron, for whatever reason, and never really leave. This was one of those cases.

One hectic morning before my shift, my wife and I rushed around the house trying to get our kids ready for school. On this day, my daughter was to go on a field trip where the teachers would walk the kids through the city to the local park to study the small oasis of nature in the “concrete jungle”. Before such field trips I would always wonder, how the teachers can corral all those little kids safely through such a crazy city, crossing such busy streets. “We are super careful,” the room Moms would ensure everyone. My wife had gone on a couple of these field trips and she remarked at how organized they were and how good the kids listened, holding hands and singing as they walked in a long hand-holding train through the city. “Okay,” I would say, “sounds like they’ve got it under control”.

Working in the ED, I knew better. At this point in my career, I had already seen most forms of human tragedy up close and personal. Sometimes I wonder half-joking, half serious, if there is something called “PTS-ED-D”, or “Post Traumatic Stress Emergency Department Disorder”? Of course, not, that’s nonsense.

As we rushed to get the kids ready for school, my 5-year-old daughter beamed her baby-blue eyes up at me, hair curly golden-blonde and said with a life loving smile, “Daddy! Can you put my shoes on, please?” She proudly raised her adorably tiny and favorite new hot-pink glitter shoes and handed them to me. I put them on her and she blew me a kiss. “Bye Daddy! I love you,” she said.

“I love you, too. Have a great day at school,” I said. At light speed, they rushed out the door and I rushed to work for the early shift.

Two hours into my chaotically routine shift the charge nurse gets off the phone and says, “Buckle up guys. We’ve got a pretty bad one coming in. EMS will be calling in any minute: Trauma, level I, no vital signs.”

“Alright, guys. Trauma room one. Let’s go,” I say. Before any radio call, the ambulance doors blasts open and all I see is a blue swarm of huge EMS men around a rolling ambulance stretcher, one up high doing chest compressions with sweat pouring off his red face like Niagara Falls, and all the others busily working this trauma looking notably more stressed than usual. As they roll down the hallway towards us, still I see nothing but a sea of big burly EMS men and haven’t seen even a glimpse of an actual patient yet. As they roll around the door and make their left turn towards me, a tiny but searing flash of hot-pink and glitter explodes into my eyes through the sea of blue uniforms. “Oh… My… God…” I think to myself.

T H O S E S H O E S

Hot-pink. Glitter. Tiny. Time stood still.

.

.

.

I felt my heart rate dropping. I was getting dizzy. Was my worst nightmare about to come true, right here in my own ED, on my own shift? I needed to see the face. NOW. I was afraid the see the face. As “clinical” as I could be to get through the most difficult parts of my job, this was too much. As the stretcher came towards me, the sea of uniforms parted and I saw her.

A girl 5 years old, with tiny hot-pink and glitter shoes.

The hair: brown and straight. The eyes: emerald-green. A beautiful child. Someone else’s child. She was frighteningly reminiscent of mine, with the exact same shoes, but with skin now fading to a ghostly white-gray and eyes as lifeless as a doll’s.

Time exploded back into the usual frenetic light-speed trauma-code pace. Airway Breathing Circulation Line 1 Line 2 Monitor Fluids Blood X-rays Needle-chest FAST-scan Chest-tube. ATLS protocol at light speed.

We ran the code for what seemed like forever. We did everything, and then some, and then some more. We did everything we possibly could for this child who was on a school field trip, run over by a drunk driver who jumped a curb in his truck on a Monday morning.

Pulse, none.

Pressure, none.

Pupils, fixed.

Pupils, dilated.

This beautiful child was dead. Someone else’s beautiful child was dead. My worst nightmare was not coming true. Someone else’s was.

I went back to the old dictation room to regroup. I could hear the sound of co-workers trying not to cry. I could hear the sound of one of my other patients saying, “G-d d—n it! What the hell is taking so damn long!?” I had to prepare myself to break the news to the parents. There is no way to sugar coat this type of news, no way to make it any easier. I felt like I was going to die.

I walked into the room and greeted two parents on their knees crying, praying, horrified but certain we could save their child with the same miracles they had seen on TV. They looked about the age of my wife and I. Their faces were hauntingly familiar. I was about to drop a nuclear bomb on their lives. The words cracked and fumbled as they came out of my mouth. “Hi, I’m doctor Bird. Are you the parents of…?”

I’ll never.

Ever.

Forget.



T H O S E S H O E S



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This author does not divulge protected patient information or information from real life court cases. Any post that appears to resemble a real patient or trial can only be by coincidence. This author does not post, has not posted and will not post factual identifying information about real patients. To the extent that any post is based on the real life experiences of the author, names, dates, ages, sexes, locations, diagnoses, and all other factual information are routinely changed to the extent that it should be considered fictional. Any opinions expressed here are of the author alone and not those of epmontly or WhiteCoat.

Also posted here:

http://www.kevinmd.com/blog/2012/10/worst-nightmare-coming-true-elses.html

http://drwhitecoat.com/2012/09/those-shoes/

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Dude,,, crazy... cant even begin to imagine...

I work at a LOT center.. had to tell this mom her 19 year old was dead... ive done the little kid thing too.. nothing gets at me, my staff and the whole dept quite like the peds code..

your story is undoubtedly any ED docs nightmare.. your kid.. dead.. Amazingly well written.. wow...
 
Yep, reading that in the hour between when my wife took my son out and the beginning of my shift made me quite nauseous. Fortunately I didn't see any kids come in shoe-first tonight.
 
Well written. I always enjoy reading your posts.
 
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As a 4th year medical student I rotated through a peds ED. I noticed a plaque on the wall saying the peds ED was named in memory of XXX. The last name of the person on the plaque was the same as one of the ED attendings, so I asked another attending why the peds ED was dedicated to this person. It turned out the other attending was working one night when his son was brought in as a full arrest (and there were no other docs working at that time). After an hour he had to declare his own son dead. Thus the plaque and dedication.

I decided that I never wanted to work in a single coverage ED because the last thing I would want to do is have to work on a family member in this kind of situation.
 
Very moving

I could hear the sound of one of my other patients saying, “G-d d—n it! What the hell is taking so damn long!?”

This kind of **** would make me start kicking teeth in... you guys need some tough skin in the ED
 
Do you walk it off like you did in pee-wee football, forget about it and see the next patient? Talk/vent about it with a friend/significant other? Not talk about it? Or, nothing gets to you, the ideal doctor should be robotic and detached at all times, and if anything does bother you, there is something wrong with you?

This is an excellent question; I think responses would vary from person to person.

For me, I have to remember I still have a room full of other patients that need my help; after a bad code, I have to walk it off for the rest of the shift... afterwards, well, that depends on the circumstances. Typically - venting, commiseration, and scotch.

-d


Sent from my DROID BIONIC using Tapatalk
 
I think that promoting emotional resiliency by acknowledging instead of suppressing your personal response is something that residencies are starting to talk about more specifically.

With one particularly horrific pedi abuse case, my program actually had an open therapy session, a sort of moderated group venting for all involved, the next day. I hadn't been on so I don't know how it went down in the moment. Last month I saw a co-resident hit pretty hard by a code, he was given some time to collect himself, a hug from one of the Chiefs, and a brief space to vent. Of course, that meant the Attending was covering for that part of the family care, and it couldn't have gone that way if it had been a busier time of day.

The cases that make you feel horrible tend to get nominated for M&M, so we get another chance to come to peace about it.
 
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Another good one Birdstrike. Such a scary circumstance. I live now knowing I won't have my family roll through my doors (I live too far away), but often fear a phone call. If I ever have a family of my own, I am not sure what I would do if one of them came in. Very humbling.
 
Grave Of The Fireflies

I had a similar episode recently. I was working the trauma pod and got report of a toddler w/ GSW to head. Was about same age as my son. I knew it wasn't my son, but the thought kept replaying. I'm going to talk to folks just like me with kids just like mine and tell them some terrible things.
 
As a 4th year medical student I rotated through a peds ED. I noticed a plaque on the wall saying the peds ED was named in memory of XXX. The last name of the person on the plaque was the same as one of the ED attendings, so I asked another attending why the peds ED was dedicated to this person. It turned out the other attending was working one night when his son was brought in as a full arrest (and there were no other docs working at that time). After an hour he had to declare his own son dead. Thus the plaque and dedication.

I decided that I never wanted to work in a single coverage ED because the last thing I would want to do is have to work on a family member in this kind of situation.

Holy ****...worst nightmare
 
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