Tuesday, July 31, 2012


Her face bore the bruises that could not be hidden any much longer. The abuse had escalated.

A few months ago, her discolored arms were concealed underneath the long-sleeved tops; her face a picture of contentment and happiness. With beautiful twin daughters and a hunky young son, a thriving career, and a successful, seemingly loving husband, she was the antithesis of a battered woman.

Now, she sat in her chair, her back rigid, and her eyes closed as she waited for the detective to finish his conversation with the social worker. As I waited by the door to come in to her room, I noticed the rivulet of tears running down her battered face.

I asked myself, “How could I have missed the signs?”.

My friend is also a nurse. As if that is some sacred reason why her husband would not use her as his punching bag. As if being a successful professional shielded her from the volatile behavior of an abusive husband.

Thankfully, the EMS brought her to another hospital. Away from the prying eyes of our own ED staff. Away from those who will make their own judgment. I could hear it already, those accusations that her businessman husband could not possibly have done this, and somehow she had made this all happen to her.

Elizabeth opened her eyes, and grimaced in pain with the effort of smiling through her tears.

“Surprise!”. She was still the ER clown, always with the jokes, always laughing. She had the most beautiful smile with a laugh that rang free and uninhibited in the nurses' lounge.

Who would have thought that the carefree nature hid a troubled soul?

But here she is now, in an emergency room on the other side of town with a sprained wrist, a bruised face, and a broken heart.

Her husband was in a local jail, nursing a broken nose courtesy of a bat she wielded after he paused during the night of terror. After he punched his own 17-year old son who lunged at his father in defense of his mother.

The sight of her son writhing in pain was the last straw for Elizabeth. Finally, after years of abuse, she fought back.

The stories of torment came rushing out. I could only sit by my friend's side, listening in horror at the unimaginable experience she had gone through, and at the same time, unable to process the image of Elizabeth with the usual patient we get in our ER.

Just yesterday, we had such a patient, an immigrant from an Asian country. She was unable to stand up to her husband, bound by her custom of obedience, crippled by her financial dependence on the man who controlled the purse strings, and who hid her passport.

Elizabeth stayed with the patient long after her shift was over. But there was nothing extraordinary about that. My friend was a nurse's nurse who gave her all for every patient under her care. Her compassion to her patients was legendary, but now I understand the connection she felt with the battered women who come in fear.

When Elizabeth's parents came, they looked stunned at the unraveling of the family that they've upheld as the model one in their family. And when they saw their daughter, I saw the determination in both their faces to never ever let this happen again. Elizabeth and her children will be returning to her parents' home in California.

Five years later, as I was walking back to my car at work, I heard the familiar and unmistakable laughter.

Elizabeth ran to me and hugged me tight. With her now grown children smiling behind her, she looked extremely happy with no cares in the world.She was just visiting her brother in New York.

She smiled at my unspoken question and squeezed my hands. "I'm not with him anymore. We're divorced, and he has no part in our lives. He's living in another country now."

She beamed, "I am happy. I am strong. Thank you."

Sunday, July 8, 2012

LEIGH'S SYNDROME: A Day in the Pediatric ED


It was an EMS notification of a 2 year old in cardiac arrest that stopped us in our tracks. The Pediatric ED was unusually quiet that morning when the EMS call came. Our hearts did a collective thump when we got the call.  

Some of the adult ED nurses rushed to the Peds ED to help. The rest of the ED staff called their families to check on their kids.  

The resuscitation room was crowded with personnel, four nurses, three doctors and a respiratory therapist. All trying to change destiny.

This poor boy should not die, too soon, too young, I thought. Did he choke on something; does he have a congenital disease? Kids are not supposed to come in cardiac arrest.  

From what I could see from my vantage point, he had thick hair and long-lashed eyes. His eyes were thankfully closed.A beautiful Indian baby face. The EMS had already intubated him at home, scooped him up from his crib, and brought him to our hospital.  

One of the nurses kept his rhythm as he maintained a one-hand compression on the child's sternum. The senior pediatric nurse's face was wet with unchecked tears. The pediatric attending's brow was creased in concentration as he managed the resuscitation efforts. Another nurse was checking the Braslow tape to guide with the medication doses.  

The cardiac monitor showed asystole. The orders came rushing: Epinephrine, continue CPR, Sodium bicarb, warmer, saline bolus, anything.  

"He has Leigh's syndrome.". The resident informed the team after he got this information from the mother. Everyone's shoulders sagged with the news.  

Leigh's syndrome is a rare neurological disorder that progresses rapidly in mental and psychomotor abilities, and eventually respiratory failure. It is a death sentence, just like some of the other congenital diseases that are brought to the PEDS ED every day.  

The triage nurse had escorted the mother to the next room while the doctors and nurses worked on her baby. There was nothing to do, but just sit with her as she closed her eyes in prayer. Her hands were on her mouth, as if she was trying not to break into hysterical tears; clinging to the hope that her son will survive.  

I relieved the triage nurse from her vigil with the mother. Her bleak eyes glistened as she looked hopefully for any information about her son. I could only say, "They're still taking care of your son."  

The mother's sari looked big on her; she must have just grabbed whatever she could. Her husband was just on his way in. The charge nurse gave instructions for the taxi driver-husband to just park at the ambulance ramp immediately.  

Her soft voice was tinged with worry. "He was just seen by the doctor two days ago, and he was doing well. He was sleeping two hours ago. Then when I looked at him, he was not breathing at all"... her voice trailed away as she stifled a sob.  

Even in the face of certain death, the PEDS staff would not give up., but all their efforts were unsuccessful. It seemed so much longer but it was just thirty minutes. At the end, the baby was pronounced dead.  

After the doctor broke the news to the parents, the mother rushed to her son's bed. From the room, we heard the plaintive keening of a grieving mother. The mother’s cries tore into our hearts, and even the paramedics were dabbing their eyes. The sound of sorrow stays with you for a long time.  

"This breaks my heart every time.", the seasoned pediatric nurse told me.

"I'm glad you're here so that I don't have to be here.", I said to her. I was being truthful. Pediatrics had always scared me.  

Emergency nurses are supposed to be the tough guys, but in my opinion, the nurses from Pediatrics, Oncology, and the Hospice are the toughest of them all.  

And in our ER, there was no time to dwell on that heart-wrenching scene. Just an hour later, a febrile baby came in and was worked up for sepsis. She lived.  

Just a few hours later, five kids were pulled out from their burning house. The fire started in the kitchen, but thankfully, all the kids (siblings and cousins) were fine, especially after an enterprising social worker brought in some lollipops. No smoke inhalation, no skin burns.  

The Pediatric ED staff does an incredible job every day, and as the nurse said, "It’s never easy to lose a child, even when it’s not our own.”  

Leigh's disease is a rare inherited neurometabolic disorder that affects the central nervous system. This progressive disorder begins in infants between the ages of three months and two years. Rarely, it occurs in teenagers and adults. Leigh's disease can be caused by mutations in mitochondrial DNA or by deficiencies of an enzyme called pyruvate dehydrogenase.  

Symptoms of Leigh's disease usually progress rapidly. The earliest signs may be poor sucking ability,and the loss of head control and motor skills.These symptoms may be accompanied by loss of appetite, vomiting, irritability, continuous crying, and seizures. As the disorder progresses, symptoms may also include generalized weakness, lack of muscle tone, and episodes of lactic acidosis, which can lead to impairment of respiratory and kidney function.