Sometimes you wonder why a mom brings her 6 year old daughter with cerebral palsy into the emergency department at 2:00 in the morning for a fever. What were they doing up at 2:00 AM anyway?
Sometimes you wonder whether parents even know how to take a temperature. The kid’s “fever” was 100.6 when she arrived in the emergency department.
Sometimes you wonder what you’re supposed to do when the mother tells the triage nurse that the child “isn’t acting herself.” How exactly are we supposed to test to see who the child is acting like that evening?
Sometimes you wonder why it always seems to take so long to get vital signs on children. How hard can it be?
Sometimes you wonder why the pulse oximeter doesn’t seem to work on kids. Her fingers are cold. We’ll get another reading when she warms up.
Sometimes you wonder if the techs even know how to use the pulse oximeter. What do you mean that the best oxygen saturation reading you can get is 78%?
Then you go into the room and notice that the child is only breathing 6 times per minute. And you notice that the child appears dusky. And you can’t feel a pulse.
Sometimes you wonder why things never seem where they should be on the pediatric code cart. Where is the damn Broselow tape?
Sometimes you wonder whether or not such a small Ambu bag can really deliver proper ventilations to an intubated child. Ventilate faster.
Sometimes you wonder how long it has been since someone checked the batteries on the intraosseous needle drill. Get rid of this thing and give me a Jamshidi needle. What do you mean “Where is it?”
As you do your best to keep the blips going on the cardiac monitor, and you see them come less and less often, sometimes you wonder what you’re going to tell the child’s family.
When you pronounce the child dead, sometimes you wonder whether your own children are safe and whether you told them you loved them before you left for work.
When the patient’s mother comes back into the room and you tell her that her child has died, sometimes you wonder how much sorrow a person can endure.
As you watch the mom sit in a chair holding her dead child and kissing her goodbye, sometimes you wonder what more you could have done.
When the coroner calls you the next day and says that the child died from overwhelming pneumonia in both lungs and that there was nothing anyone could have done to save her, sometimes you wonder whether he was just saying that to make you feel better.
Sometimes you even wonder why you ever wanted to be an emergency physician.
Then you remember all the people that you do save. And you try to remember all smiles that you have gotten from patients whose lives you have made better. And you try to remember that the power to heal that you’ve been given doesn’t work on every patient.
You try to remember that just because a child died at your hands, you’re still human and you did your best.
It still doesn’t keep you from wondering.
Very poingant. And I’m very sorry
I’m so sorry you had to face this situation with all its subsequent second-guessing. Please know that there are people who are sending you warm thoughts and wishes.
Very sad post, WC. It’s times like those we have to remember we aren’t in charge. All you can do, is do the best you can. You’re only human, and some things are out of our hands. It’s good to remember all those you’ve helped. Amongst all the losses, all the drug seekers, etc. are thousands of people that were grateful you were there when they needed you. It’s good not to lose sight of that.
Ditto, Chrysalis
Damn.
v___v
I’m with @DaveyNC: Damn. Sorry you had to go through that, WC.
Damn WC, you made me cry…
I would argue that being so close to loss, and the grieving, doubt, keeps you closer to humanity. You do your work, and put up with cr@p, knowing that someone has to be there to try to save the ill, just to face guilt and loss.
That is the best in humans…
May the “sometimes” fade fast and your heart heal, but dont ever let the “sometimes” go completely away. The “sometimes” are what make you a good doctor.
Oh WhiteCoat …I am so very sorry.
I know it hurts and causes second guessing. Mom probably doing a lot of it too ..the What ifs? ..can be torture. They’re good to the point that if it points out something needing to be changed and it’s acted on ..practically speaking, but not good when the burden clouds ones perspective on all the good things and people who’ve been helped. But you know of all the people you’ve helped and remember their smiles. You save lives all the time.
You take things to heart and that causes you to be the terrific and compassionate doctor that you are… giving care *so many* have *benefited* from.
I know how you feel, wondering if you told the kids you love them. I always try to say “I love you.” or something warm before leaving people I care about or before they leave… or on a happy note and definitely not on a negative note… and a hug to those I’m closest too.
Again ..I am so sorry. I know from reading the med blogs how hard it is for docs to have to deliver bad news and experience the loss with the patients and families. And I know from reading your posts for the last 2 1/2 years ..that your compassion would come through to her mother and that it would help to have someone like you to talk to, etc.
People handle grief in different ways and maybe don’t feel or process for a while ..all different.. But I clearly remember the compassion and patience shown to me that night in the ED when my mother was dying ..the nurse, doctor and hospitalist and respiratory therapist and even a random nurse as we were leaving. They couldn’t fix her ..reverse anything ..but I remember them ..their compassion, trying to help us and they did help.
Damn. Sorry brother…
Here’s hoping for easier days, sunny skies, and no codes…
WC
We don’t just say that to make you feel better. If you missed something important (like sending a febrile, obtunded 10 year old home with a white count of 75K and huge left shift) I will bloody TELL you. Politely, of course, but part of our jobs is quality control.
WtC
Thank you for sharing. I’m in med school now and don’t look forward to my own doubts in practice but it is good to know what I am getting myself into.
How sad, how honest, how tragic. I’m sorry you went through this, but don’t lose sight of the many positive outcomes you have seen in your ER as a result of your excellent care.
Another angel has her wings…
“I’m a doctor, not a miracle worker.”
Leonard “Bones” McKoy
Those days are rough
Holy crap. Those cases are crushing.
Keeps us humble, and remembering that there is Someone Else in charge. Offer it up, and do your best again for the next patient.
I often wonder about those “patient-isn’t-acting-herself/himself” situations. Like those who go into interviews, I wish people, whether presenting themselves or another family member, would think to have precise adjectives and phrases ready for the doctor before he comes in. The more accurate the descriptions can be, the easier it is for the doctor to decide how fast to move.
And yes… why *aren’t* cart supplies kept present and fresh?
Your story will help us all maintain more vigilance. Thanks for posting.
God kills again.
What a heartbreaker for all involved. Never doubt that your compassion makes a difference even when the outcome is horrible.
Speaking as a non-doctor, cannot an artificial lung help in such cases, see:
http://medgadget.com/archives/2007/02/novalung_ila_me.html
Made me cry, but, strangely enough has strengthened my decision that ER nursing is for me. Wish me luck, I graduate in May.
I am deeply sorry. It is especially difficult when a child seems to meet such an untimely end. Bless you for your compassionate heart.
You mention of telling your children you love them really sent shivers down my spine. Sometimes all you can do is your best, which is probably one of the hardest realizations of life. There are always so many what ifs, that if you spend too much time thinking about them, I think you are doing yourself a disservice.
Thank you for posting this. It reminded me to go check the I/O drills right away, and will add it to my daily equipment check.
Please never forget that there is a crucial difference between “died at your hands” and “died despite everything you could do to save her”.
Thanks for all the good wishes. I still become sad when I read what I wrote.
Patient death, especially the death of a child, has got to be one of the most difficult things that both families and health care providers face.
I think it makes us better doctors when we realize that they’re not just “patients”, they’re people with families and concerns who go home and sit around the dinner table just like we do. Hopefully it also does the patients some good to see that even when doctors are jerks, we’re still human, too.
Sometimes I wonder if doctors still have the courage to post such personal things like this. Thank you for sharing this story… I was touched and I am sure that the family appreciated all that you did for them.
eating lunch @ a chinese buffet, reading epmonthly, not expecting to be crying in my rice. I hope I never get ‘used to’ such cases, or I will no longer be a good doctor. Thanks for sharing & reminding me I’m not the only one out there who has emotion sometimes