The Intern Blues(4)

But I do get really pissed off about working in the West Bronx emergency room [West Bronx, also referred to as WBH, is a municipal hospital adjacent to Mount Scopus]. I was drawing blood today from a four-year-old and I had to stick him three times because he kept pulling his arm away and pulling out the needle. The reason he kept pulling his arm away was because the nurse wasn’t holding him tightly enough. When I told her, she said, “I don’t care, I don’t give a damn!” Oh, really! She just didn’t give a shit about the kid! Here’s a woman who must really love her job.

I forgot to talk about something I can’t believe I haven’t mentioned yet. Something really significant happened tonight, something horrible, and I guess I blocked it out of my mind for a while. As the triage box was filling higher and higher with charts and we were getting farther and farther behind, we were called by a frantic clerk to come over to the critical care room. He said there was a pediatric cardiac arrest going on.

So we tore over there to see what was happening. I got there first. I found the place jammed with doctors and nurses working on what looked like a pretty big adolescent. They were pumping on his chest, they had him hooked up to the cardiac monitor, they were sticking him for blood and starting big IVs in his groin. I had no idea what to do. The resident showed up a few seconds after I got there and we stood around for a couple of minutes until they just told us that we could leave unless we wanted to run the code. “No,” we said (laugh), “it looks like you guys are doing just fine.” But no one had taken a history yet, or even talked to the mother, so the resident told me to go out there and get the story. I found the woman; she was perched outside the critical care room looking scared to death. I took her over to the social work office and started talking to her.

Briefly she told me the kid was a fifteen-year-old asthmatic who’d been in the middle of a bad asthma attack when it sounded like he had become obstructed [the main breathing tube, the trachea or one of the mainstem bronchi, the tubes leading from the trachea to the lung, became blocked]. He stopped breathing and they loaded him into a car and sped off to the hospital. They were headed for Jonas Bronck but on the way the kid was snatched up by a passing EMS team and brought to West Bronx. He had been pulseless, breathless, and unresponsive for God knows how long. When he got in the ambulance, he had vomited and aspirated [leaked stomach contents into his lungs] and gone into arrest.

So he was kind of dead when they brought him in, but I don’t think I really believed it. His first pH was 6.9 [indicating severe buildup of acid in the blood, a condition resulting from lack of oxygen delivery to the tissue and not consistent with life for longer than a few minutes], which isn’t great. His heart was beating only about eight times a minute, but he was a kid, and kids just don’t die like this. Not the ones I’d known anyway.

When I was getting the history, the mother asked me, “How is he, Doctor?” and I was about to say . . . I don’t know exactly what I was about to say, but then the clerk opened the door and took the mother away because he had to register the kid or something administrative like that, and I left, after telling her I’d come back to talk to her again when she was done.

Next thing I knew, that clerk came back to me, not as excited this time, and he said, “The kid died; he’s dead.” I couldn’t believe it. I knew he hadn’t been doing well and that they were doing everything they could for him, but dead? I just couldn’t believe it. I had to walk in and see him myself.

In the critical care room, the crowd was gone; there were just a couple of nurses, removing all the lines and stuff, cleaning him up, getting ready to bag him, and there he was with his glazed corneas—yeah, he looked dead, all right. The medical resident came in and we talked about it for a minute. No one had said anything to the family yet. I told him I’d gotten the history from the mother. “Well, I guess you’re the only one who’s established rapport . . .” he said. Rapport? I spoke with the woman for five lousy minutes; that’s not exactly what I’d call establishing rapport.

But I was elected. Other than me, nobody had even laid eyes on the woman. The medical resident said he’d come along with me. On the way back to the social work office, I stopped myself and thought, What the hell am I going to say to this woman? I knew she was totally unprepared for this. When I had talked with her earlier, I got the impression she thought everything was going to be okay. I knew things weren’t okay. I had seen him getting his chest pumped, being a full code. I should have said, “Your son is in critical condition. There’s a chance he won’t make it.” I wish I had said it when I’d had the chance, but then that damned clerk had come in and had taken her out to register her. I should have booted him out, told him I was talking and that it was important, but I didn’t think to do that, so I didn’t get to prepare her in any way. Ah, maybe she didn’t want to know, maybe she would have been worse off had I tipped her off beforehand. Who knows?