Before they let you loose on the wards with actual patients, the medical school I went to required a CPR course. I'd taken one before but this one felt different. Instead of training for an improbable situation, we were preparing for what we’d actually signed up for. Saving lives.
Paul was my partner and he was ready to hear the mock situation. He leaned over the dummy, staring at it like he expected it to take a breath...or stop breathing. The paramedic described the scenario and then related the vital signs. It was up to Paul to intervene based on the information given to him. Reacting incorrectly might cause the heart rate to drop dangerously low...or stop altogether. Paul was practically hyperventilating with stress and I couldn’t blame him...I clenched my fist with each of his answers. Telepathically offered my support as he ran through the drill and demonstrated different life-saving techniques. When the paramedic announced the last set of vital signs, Paul looked up at me in confusion...and then in triumph. The vital signs were normal, completely normal. He’d saved the patient. He flung his fists up into the air, threw back his head and in a deep voice announced...
“I am a GOD!”
The paramedic chuckled. Waited for Paul to meet her eyes somewhat bashfully after his outburst. Informed him, “It feels exactly like that...”
Not for me.
The first time wasn’t quite like that.
There are two entrances to the ER. The main one handles toddlers with fevers, football players with broken clavicles, asthmatics with coughs. The back door is for the the paramedics unloading ambulances.
It was to that door that I ran to when the overhead paged the arrival of a patient. The paramedic burst through the door holding a limp toddler. He transferred her into my arms and as he did I could see the flash of relief in his eyes. He’d done his job, gotten her to the hospital alive. Barely.
I looked down at her face. Dark lashes feathered over too pale cheeks. Scary long pauses in between breaths. She sagged in my arms as if she were in a deep sleep. Oddly, my first instinct was maternal, I hugged her to my chest and thought of running away from what was about to happen to her. Instead, I pivoted and headed to the trauma room. Oh so gently, I laid this wispy haired little girl on the gurney.
Staff flew in behind me. Nurses, techs, a pharmacist who opened what looked like a toolbox loaded with emergency medicines. I stood at the head of the bed, brushed her hair out of her eyes, and called out the first set of orders. And then I put the mask over her face and starting squeezing the bag that would give her the oxygen she needed.
There is a system to remember what to do in emergencies like this. It starts with ABC-Airway, Breathing, Circulation.
Since she was still not responding, I put a slender tube into her throat and down her airway. It went smoothly but the nurse to my side wasn't as fortunate. Despite several attempts she couldn't get the IV started.
Having secured the airway, I hooked up the ventilator and ordered settings that would help take over for breathing. As I attached the tubing, the nurse on my other side announced that she 'got the IV' only to have it 'blow' shortly afterward. By this point, this child's arms were dotted with bleeding holes from failed attempts to get life saving fluids into her body.
My mouth was dry and my heart was slamming in my chest. There is no partial credit for correctly performing the first couple of steps in CPR, for knowing what blood work to order or what drugs may be needed. Without access to the circulation, a simple IV, she would die.
She was not responding to any of it. The repositioning of her body, the cacophony of voices, the repetition of needles jabbing and digging into her skin. I was losing her and I was absolutely out of my mind terrified. From that day forward, whenever I hear a child screaming when my nurse goes in to draw blood, I think the same thing...”you fight little one...you fight!”
Exactly one second before my head exploded from the angst of the situation, the tech on the left announced that he thought he had something. In her ankle. Every person in the room watched as he hooked up the iv bag and opened the tubing to let the fluid flow. We held our breath to see if this would hold or if it too would 'blow', the term used when the vein ruptures and the fluids leaks into the surrounding tissue instead of entering the circulation. It worked.
Almost immediately, the color improved in her cheeks. We finished stabilizing her and she was whisked upstairs into the ICU. I was left standing amongst the debris- blood soaked gauze and empty IV packages with all kinds of thoughts running through my head.
Thank GOD they got her in time.
Thank GOD he got the IV.
Thank GOD she's going to be alright.
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