The blood and the guts don’t actually matter in this story. There were four moments that mattered that night.

1: We were in radiology with the patient in the CT scan machine. Massive head trauma. Adolescent. I was in the CT room as the heart rate was unstable. I already pushed epinephrine once. We were waiting to pounce on the patient to start CPR. The Mom stood just outside in the hallway with the patient’s teenage siblings. Dad hadn’t made it yet. He would. I knew the neurosurgeon was on the phone with the emergency department fellow. I was watching her. Everyone who knew what was going on was watching her. It was one of those moments. Those Grey’s Anatomy moments where there should have been a camera. She was standing up tall on the wall phone. Perfect posture and fit. She turned to face the wall. Away from the nurse’s and the respiratory therapists’ knowing eyes. We couldn’t hear a thing. But we saw her lean her forehead against the wall, lift up her left arm bunch it in a fist and pound the wall.

We collectively exhaled and some of us had tears welling in our eyes. None of us needed to be told. She came into the CT room from the reading area and had quickly regained her composure. “Let’s get him to the PICU.”

2: We dropped him in the PICU thankful he was still alive. Thankful we didn’t have to be the ones to call it. But the nurse who was there for the end. She was one of ours. Some one who floated between units. She came down to see us all later. She told us that as she was trying to mop up the fluids coming out of his nose and both and ears so that the Mom and Dad could see him as their child and not a trauma…she felt a hand on her shoulder. The mom’s voice cut through the room, “You don’t have to do that,” she said quietly, “I’ll never forget how beautiful my baby was.” 

3: Two siblings who worked in the emergency department sobbing in the medication room. It was the only space where you could sort of have maybe some privacy. They had watched our patient’s sibling watch our patient dying. It was heavy. Makes shit real when the family gets there. Every time. Until the family gets there it’s just an anonymous person. The family gives them a name, an identity, a history, and what should have been a future.

4: The friends. There were about five friends who showed up just after he died. They didn’t know yet. They were so young, so hopeful. After several checks with the PICU staff and family we walked them up to the room where the family was. I still remember the looks on each of their faces as they realized they were going into a conference room and not a patient room. I had to leave because I just couldn’t take in any more pain that night.

This was a particularly horrible trauma. For a lot of reasons. The family was so composed and so gracious and they made me want to do better for their child. But I couldn’t. None of us could. The injury was too massive.

Yesterday we lost power due to an ice storm. I had a fire going in the fireplace and the boys napped on the floor in front of it in their sleeping bags while I dozed on the couch above them. They both fell asleep and with the crackling fire and the even sounds of their breathing I felt content. I felt like this was a moment I wish I could freeze.

Working in a pediatric ED changes people. Because we don’t live in a bubble. We live having faced a harsh and stark reality. It can either make us go a little crazy or it can make us focused on the present with an uncanny ability to filter out what the future may bring. Or perhaps both.

It changed me for sure. It made me realize I could never work there after having my own children. It made me appreciate every moment I have with my sons. It made my eyes well up with the sheer joy of hearing their breaths in and out in front of a crackling fire while the world ground to a halt outside in the ice and snow.