Joy, EMT/RN, writes:
The opportunity to provide medical care brings with it risks unimaginable before the actual practice of care is begun. The timber and nails of the academic and the practicum seem, at first glance, to create a sturdy dwelling, a safe place from which to work. But when the winds of crisis blow, when the unexpected occurs, the house, if it has no sure foundation, if its framework is not both supple and strong, will fall.
The following story illustrates what happens when a nurse builds beyond the books and the gadgets and into true nursing.
Sunday, 1500, my pager tones. ‘Medic 1, Rescue 2, Engine 3, Engine 4. Respond MVA with injuries.’ I shovel the last bite of food into my mouth and put on my jacket. My partner meets me in the ambulance bay. We do not speak. It’s Christmas and there is a crash. There is nothing to say. We leave two minutes ahead of the other units.
Enroute we learn the location and nature of the crash. We do not look at each other. I request two more ambulances and additional rescue assistance. I move to the back of the rig to hang fluids. I put three constricting bands into one pocket and stuff a pair of heavy gloves into another. A couple of trauma dressings go into other pockets.
We arrive to an obvious high-speed, off-set head-on collision. A small pickup and a small, 2-door car are separated by 25 yards, one headed east in the west-bound lane, the other crosswise in the east-bound.
I run to the closest, the pickup. The passenger door is bent out of frame and is immovably 5 inches ajar. In the broken seat a middle-aged woman, sparkling with glass dust, sits with eyes closed, arms limp. When asked, she says she is at the mall. She is pale, breathing OK, has a rapid, thready pulse, no significant external bleeding. Move.
I go to the driver. He is enmeshed, the front of the vehicle folded around him like frosting on a cake. Awake, he looks at me with huge eyes. He does not speak. He is breathing OK, has a strong radial pulse of less than 100, no visible bleeding. Move.
I race to the other vehicle. Oh, Dear God. The two young adults in the front seat look like my oldest children. They are dead. Move.
I look at the back seat. The approximately 18-months old baby in the car seat in the middle of the bench appears boneless. He is slumped forward; his struggle to breathe is weak and uneven. His lips are white. Both eyes are purpled shut. Time stops. He looks like my Matthew. The doors are crumpled. I can’t reach him through either shattered window. Move.. Almost two minutes have passed. Move.
I straighten up and key my mike. As the first units arrive, I call for life-flight, activate the trauma system at the closest hospital, and request increased scene and traffic control.
I then order the scene. You guys, use ‘jaws’ on this door. You, the kid is yours, life-flight ETA 15 minutes. You and you, help him with the kid. You guys, use the other ‘jaws’ on the driver’s side of the pickup over there. You, that man is your patient. You, you, and you, get the woman out of the pickup. I’ll be right there.
I use the mike again to contact the second-arriving units. Rescue 6 and Engine 7, set up a landing zone. Medic 8, help them with Matth’ with the baby. Get the baby out of the car. Medic 2, find me at the pickup. You will take control of the scene.
I sprint back to the pickup. My partners yank off the door as I hand over the scene. Move. We are losing her. Never mind the c-collar. Move. We slide her onto a spine-board, place the board on a gurney, and leave.. Eleven minutes from time of arrival we are screaming down the highway. Move.
Her eyes are closed. Her breathing is peaceful. She has a fluttery carotid pulse that comes and goes. She moves her feet when asked. I give high flow oxygen and place two large bore IVs with blood tubing, NS wide open. Time now for a secondary exam. I cut off her clothes. Her anterior chest is crushed. The skinny woman has a round abdomen. I prepare to intubate.
She speaks. She is still at the mall buying pretty things. I listen to the woman. I put the laryngoscope away. I update the ED. The woman is taken into the OR within 10 minutes of our arrival. She dies there.
I ask an ED nurse to keep me company as I race-walk the parking lot and tell my story.
Two days later a critical incident stress debriefing is held. A cop says he has had about all of this he is going to take. His partner nods. A dispatcher says, ‘It was awful listening to what was happening. It was Christmas, this shouldn’t happen on Christmas.’ She can’t sleep. A cop jokes that she sleeps on the job all the time. She smiles and threatens, ‘I’ll send you out on the next barking dog complaint!’
The paramedic to whom I had assigned the baby says to me, ‘I knew the kid was bad when you walked away. I knew you’d never leave him if he had a chance. As soon as the helo took off, I went behind the ambulance and vomited.’
Someone says everything happened too fast, another too slow. A firefighter talks about the incredible noise of the scene. Another says he did not hear a thing, all he remembers is the stillness of the baby as he held his head for intubation. Another whispers in horror as she recalls the man in the pickup saying, ‘I did not hurt anyone.’
It’s my turn to talk. I thank them for being on scene. I thank them for coming to the debriefing. I thank them for talking. I say that I feel as if I had killed the baby.
A paramedic immediately and emphatically states, ‘You were first on scene. You had to triage. You did the right thing by walking away. You gave that lady the best and only chance she had. You did good.’ A few nod. A few look into the distance. A cop says, ‘That’s right.’ Someone puts a hand on my shoulder.
We tell our stories again. We listen. We joke. Some of us cry, others curse. Some do both. The next day, we go back to work. And I think about buying pretty things.