Of Toddlers and Traumas
"Let's review" she told her students "If you have no epi, you can use Vasopressin. If you give Vasopressin, you have to wait 10 minutes before you can give any other vasoconstrictor. You cannot use Vasopressin again for that code. You can only use epi after you've used Vasopressin." She looked at all the bobbing heads. "So who can tell me what went wrong here?" The heads had stopped bobbing. "Which nurse was keeping time?" She was looking at a sea of vacuous stares. "Was there a nurse keeping time?" She felt rather Weaverish when she said it. It was an odd sensation to be sure.
"I was keeping time Dr. Chen" Nurse Han spoke up.
Looking directly at Nurse Han, Dr. Chen asked "What was the time on the Vasopressin push?"
She consulted her chart, "10:19 doctor"
"And the epi was pushed at what time?" Dr. Chen pressed
Looking again at her chart, she answered "10:27"
She turned to face her students. "Critical in any trauma, but especially one in asystole, is the chart nurse. She's there for a life and death reason. You need to know who she is and you need to consult her before you order the push. It's your responsibility as the doctor." She was stern and authoritative. She wanted to make sure each one of them thoroughly understood the consequences of not just their actions, but also the actions they failed to take.
"Dr. Chen" one of the students spoke up "was there any chance he would live?"
She exhaled forcefully, "slim to none, but that doesn't mean you don't try. That doesn't mean you don't give it 100% of your best effort. That wasn't just a patient on the table, that was a man, someone's husband, maybe a father." In her head, she could hear Dr. Greene at County give the same speech back when she was a med student. That was the second flashback to County in just a matter of moments, how odd, she thought.
She led the group over to the front desk and started to process the rack. "Okay, Yang: itchy red rash in 2, Zhou: take wound suture in 1, Feng: weak and dizzy in 4 and Xiong: belly pain in 6. Get a complete history, vitals, and order labs before reporting back to me."
She took a moment to reflect on the progress she'd been able to achieve in the three and a half years since she started the pilot program. They still weren't at the efficiency of the Chicago ER she came from, but they were certainly a lot closer than when she arrived. Survival rates on traumas were looking much better. Triage procedures were now in place and working well. There was still plenty of work to do, but overall, things were coming along.
All of a sudden a cold shudder came over her, like a ghost had passed through her. She tried to shake the feeling of dread off, but to no avail. She tried to get on with her day, to focus, but she couldn't get passed the feeling something awful was unfolding. Unnerved, she decided to get her daughters and go home.
She hurried across the street to the preschool. Mei Li was now 3 ½ years old and insisted she was too big to go to a day care center, so overnight and much to Mei Li's personal delight, the daycare became preschool. She went to Mei Li's class first. Her teacher was surprised to see Jing Mei this early, as she was faithfully there at 5:30 each day. Her daughter spotted her and came running over. "Mommy needs a hug" she told her, and Mei Li was ready with a big one.
Happy and satisfied Mei Li was fine, she went to Mei Xiu's room next. At 22 months, she wasn't quite big enough for the 2 year old class. Mei Xiu's teacher was also surprised to see her early and asked if anything was wrong. Jing Mei explained the irrational feeling of dread she was experiencing and the need to make sure her girls were okay. Mei Xiu came running when she saw her mom talking to the teacher. Jing Mei kneeled down and opened her arms to embrace her daughter in great big hug.
She packed each of her daughters' bags in the stroller. The girls hopped on board, and they headed home. Though she knew her girls were safe, she still couldn't shake the feeling something awful was happening. They typically stopped in the market on the way home but she was apprehensive to make the stop this time.
Jing Mei had brought up her girls to be creatures of habit, a necessity for any single mom, but this afternoon that would work against her. When she announced they wouldn't stop in the market today, both girls started to throw a tantrum. They were accustomed to getting a snack, a piece of fruit for the rest of the ride home.
Flustered and unable to control the tantrum in any other way, she gave in. Turning into the market, the girls calmed down. Per their normal routine, each girl selected a piece of fruit and Jing Mei picked up what she needed to make dinner that night. A tough task as she didn't have any kind of appetite in the middle of the afternoon.
Once home, the girls quickly separated themselves from the stroller and went off to their room in search of toys to scatter about. Jing Mei unpacked her groceries and the girls' bags. She put the stroller away. Though all appeared normal, she still suffered this feeling of dread.
She turned on the TV and flipped through the channels looking for the news network. She had just started monitoring world events when the girls came in wanting to watch cartoons. "How about we let mommy watch the news while we play a game together?" Jing Mei suggested.
"Cartoons, Mommy, please?" Mei Li asked with a hint of insistence. In no mood to deal with a second temper tantrum, Jing Mei struck another deal. She flipped through more channels, finally landing on something they could all agree on. They ended up watching a TV show about a widowed mother with two children, one of whom was called Yin Shi.
When the show over, Mei Li, who was seated on the floor, turned and asked "Mommy are you a widow?"
Jing Mei took a moment to consider her answer. She knew this day would come, but why this day? Wasn't it enough that she was dealing with this feeling of dread?
"Why do you ask Sweetie?"
"We don't have a Daddy, do we Mommy?"
Jing Mei rose from her seated position on the sofa and sat down next to her daughter on the floor. "Yes, you have a Daddy, everyone has a Daddy, even when you don't see him."
"Who is our Daddy? Mommy, why don't we get to see him?"
Jing Mei closed her eyes and said a quick prayer for the wisdom to know what to say and the strength to say it. She opened her arms and scooped both girls close to herself, keeping them in her embrace.
"You're Daddy is someone very special to Mommy. He's good and he's kind and he's sweet. He loved Mommy enough to want me to not ever be alone. He knew he had to go to a far away place, a very dangerous place. He had to go because the people there needed a doctor, but most doctors won't go to such a dangerous place. So before he left, he gave Mommy a very special gift. And that was a way for me to have the two of you." She smiled at her girls and stroked their hair.
Satisfied with the answer, Mei Li was up and running off to another activity, her little sister toddling behind her. Jing Mei was sure that wasn't the end of it. There'd be more questions down the road, but it left her to ponder. He was in a very dangerous place. Was this the dread she was feeling? Did something awful happen to John? She bit her lip. Her mind wandered back through the years, recalling how competitive they were as med students, the jokes they played on each other as residents, how they were there for each other through not just work challenges, but stabbings and addictions and adoptions and death. He was the father of her children, and he didn't even know.
She needed to find him. She just didn't know how. Maybe that was what this feeling was all about. She didn't have a working phone number, a forwarding address or an email address for him. She couldn't send to a letter simply addressed to John Carter, Congo, Africa. She took a deep breath and began flipping through channels, looking once again for the news.
Half way around the world, in an ER in Chicago, John Carter went down in the middle of a trauma. He now lay in a hospital bed awaiting a priority one kidney transplant. Holding on to life, but for what? His wife was noticeably absent during his entire bout with a disease that ravaged beyond repair the one kidney that had still worked. He was alone and lonely and facing a grievously serious health crisis...