We’d been working together for about a month, and I had mostly resigned myself to seeing Mrs. Murphy pop up in unexpected places. I had assumed noone else saw her because someone definitely would’ve said something about her being on so many scenes. As it was, I did my best to ignore her-although I couldn’t help but wonder how much of an influence her husband really had on what happened, and how much was just the deep rooted desire to pin blame on something or someone when bad things happen.
My husband had deployed, so I was picking up extra shifts to keep myself occupied. I had filled this opening last minute in a daytime slot, and it was miserably overcast making it even more difficult for me to stay awake. It had been a slow morning, which was great since I was feeling like my limbs were filled with lead. My partner stretched his legs out the window, reading. I put my own book down, eyes too heavy to focus, and contemplated the relief of having a partner who enjoyed reading. No attempts at initiating conversation while my book was open, no getting irritated at my absorption in the book over the current gossip, no comments about bwing antisocial….the skies opened up and it began pouring rain. Not even five minutes later we got a call for a serious accident in our zone.
“Here we go baby!” My partner yanked the ambulance in drive, flipped on the lights and sirens, and blasted the airhorn in quick succession as we tore out of the fire station. I stuffed all emotion into a tiny ball and strove to control the adreniline rush. It was a rush-but I was never sure if it was a good rush or a bad one. Mostly I felt shaky and a bit nauseous. I finished typing the dispatch information in to the chart, snapped on my gloves and handed my partner a pair.
“Cumberland, This is Engine 8, who is coming to G-street for the 29 Delta?”
“Medic 12 is enroute to your location.”
“Medic 12, this is engine 8”
My partner grabbed the mike, “Go ahead Engine 8”
“We’ve got three patients. Two are peds. One is not conscious, not breathing, we’ve initiated CPR. The other is a male about 7, not conscious, looks like a bad scalp laceration, and we’re attempting to extricate the driver now.”
“Where do you need us?”
“If you could come from the south end of G street, turn left on to P—- and park to the left of our truck. And we’re going to need another unit.”
“Cumberland, do you copy?”
“10-4 Engine 8, we’ll get another unit sent your way.”
The rain slowed to a drizzle as we slowly pulled on scene. A four door sedan had hydroplaned into a dump truck that had been sandwiched in the middle lane by a minivan on the other side. The truck had gone up and over the entire right side of the car at an angle down the front hood. The woman in the front seat was screaming non stop, her lower half completely squished by the dashboard and crumpled up metal. Bits of glass and metal littered the road, the dump truck had pulled to the side of the road and a crowd was gathering as traffic came to a complete standstill. Police lights were flashing, firefighters swarmed over the car, and the rain continued to drizzle down, adding a shiny sparkle to everything.
In the middle of the chaos, two firefighters performed CPR on the inert body of a toddler. She had been strapped forward facing in a booster seat and the momentum of her head on impact had snapped her neck.
“Triage.” My partner said softly. “We leave her for the next unit, she’s dead. We take the boy.”
I nodded, emotions were still tightly tucked away, I didn’t have time to feel anything more than logical acceptance of my position in this drama. Our patient soon had my complete attention. It was a cluster trying to get him out of the car, tensions were high and there was some debate as to the best way to stabilize c-spine, but eventually we had him boarded and in the back of the truck. “Hey, buddy can you hear me? Can you open your eyes for me? We’re going to take you to the hospital, ok?” I talked loudly, trying to get a response. Something had sliced his head straight across right below the hairline and peeled his skin back several inches-effectively half scalping him. His skull was a sticky pinkish red, the thick rubber of his scalp puckered up on his crown. I ripped through his tshirt and jeans with my trauma shears while my partner put the pediatric defibrillator pads on. “Oh damn.” My partner reached over the patient to get a sterile gauze pad out to cover the evisceration I had uncovered as I stripped the patient. “How fast was she going?” I asked half to myself. The slice lined up with a seatbelt injury along his left side, the intestine glistening wetly from between the edges of flesh, but not protruding.
“We need to go.” I said, finishing taking a manual blood pressure and wrapping the automated cuff around his arm. “Make it a code.” My partner nodded in agreement, “You’ve got this. I’ll call in the first set of vitals. Try to call in an update after the IV.” And he jumped out. I was thankful for his vote of confidence because I truthfully felt the farthest from competence you could get. The ambulance eased off the scene and gathered speed as we cleared the traffic back up. I started two IVs, I knew that much. He was already on oxygen and his lungs had been clear when I listened. I kept talking outloud, trying to get a response. He didn’t even twitch when I stuck him, which was a bad sign. I hung a bag of fluids. His blood pressure and heart rate were within normal limits, but the golden rule of pediatric trauma was to be prepared for the worst-children compensated amazingly well for an amazing amount of time…and then they crashed hard and fast. I fervently prayed we got to the hospital before that happened.
I couldn’t think of anything else to do. He was bandaged, wired up, IV’d and oxygenated, the monitor ticked his heart rate away steadily-I printed off a strip for the chart-bag of fluids was flowing nicely….basically all the leaks were plugged and the patient was momentarily stable. I hated this part of bad calls. The moment when you’ve done all you can think of to do and you aren’t at the hospital yet. I switched the radio over to the Emergency Department channel and called in an update, balancing on the captains chair as the ambulance wove through traffic.
I continued to talk to the boy, rubbing his arms, checking and rechecking his lung sounds and pupils just to keep in contact. He moaned as we pulled into the hospital bay, eyes fluttering. I felt a surge of relief that almost undid the knot in my stomach. His eyes opened all the way as the stretcher was pulled out and I ducked my head to hop out after him, still talking. “Hey buddy, I’m Sarah. What’s your name?” He stared at me for a second and then his eyes rolled back and fluttered shut. “Hey I know you want to sleep, but you gotta stay awake for a little, ok?” I chafed his arm a little as we wheeled into the room where we managed codes-medical and trauma.
Codes were basically bad calls. Calls that warrented immediate medical attention or they’d get a lot worse. Someone, I’m guessing my partner, had prepped the ED about the nature of the MVC because there were double the amount of staff present with nurses pulling out tubes for blood and a doctor already present at our bed with another one getting gloved up for the next patient.
I started talking the moment I locked eyes on the doctor and nurse in charge of charting. “Approximately 7 year old male involved in an MVC. Laceration to head and evisceration on left lower abdomen. Blood pressure of….”
“One, two, three lift”
We worked as I talked, shifting the patient still on the backboard to the hospital bed. Answering the doctor’s questions as we unhooked our monitor and hooked up theirs. I had started bilateral IV’s, just in case, and one of the nurses started drawing off tubes of blood. The little boy opened his eyes again, eerily calm despite his injuries. “I’m Doctor R what’s your name?” He blinked once and whispered.
Just then the second set of medics came tearing around the cornor into the room, the dead baby visible in a tangle of tubes and wires, a medic riding the stretcher pumping the little girl’s chest. They slid the patient to the bed and CPR was taken over by a waiting nurse, the medic spouting off her report rapidly and answering the doctor’s terse questions. The radiology tech stood waiting with the portable xray, having just finished with our patient. The toddler’s face was oddly swollen, like a pale bloated moon, it seemed three times the size it should be. I opened the lap top and waited patiently for a nurse to sign over transfer of care. I knew it was best to give everyone a few minutes to settle in the routine of patient care before pushing for a signature. Thankfully, the nurse in charge of our code was one of the good ones, one who wasn’t prone to snapping at medics just because we had to follow protocol and transfer care.
Signatures accomplished, I forced myself to leave the room. It’s human nature to want to see what’s going on in a crisis, and even worse when you have a more vested interest in the outcome. The boy was MY patient, transfer of care or not, and I wanted to know he’d be ok. It took my partner another 20 minutes to clean up the ambulance and restock what we had used while I worked on the chart. I automatically filled in the boxes, my mind fixated on the image of the firefighter doing CPR in the rain. We later found out that the mom had hastily put her kids in the car after a fight with their father, and drove away. She wasn’t under any influence or speeding, it was just a fluke that the downpour had flooded the road just then, and she hydroplaned into the dump truck. The dump truck was hemmed in on the other side by a mini van so he couldn’t swerve very much out of his lane (he did actually scrape the van in his attempts to avoid crushing the sedan). A fluke. A legitimate accident.
Mrs. Murhpy’s face swam into my mind and I clenched my fist. No. I refused. I REFUSED to believe this was a result of Murphy. Sadistic bastard. He would not get credit for that little girl’s life. If she had been rear facing in a car seat odds are she wouldn’t’ve had a scratch on her. But accidents happen. And they’re just accidents. They aren’t divinely inspired by any minor deity. I stressed minor in my mind with the perverse hope that Murphy could hear me. Besides, that was way too many flukes for any one person to arrange, that would’ve had to been intentional on Murphy’s part to arrange things just so and it didn’t sound like he worked like that. Maybe he had influenced it to rain, but that was it. So really his part was just a fluke, too, and he’d try to claim credit for something he didn’t do to inflate his sense of importance. Well, I wouldn’t let him. It was a legitimate accident, an unfortunate combination of a multitude of events, end of story.
“Sarah…..Sarah…” My partner had his head in the charting room trying to get my attention. “Hmm? What?” I stared blankly at the chart and deleted the last line in my narrative. “Calls are pending, we need to go.” “Right. I’m coming.” I shut the laptop firmly and left the room. At least I was now fully awake.