Wednesday, October 13, 2010
Pediatric Trauma: Pedro and his Mets Baseball Cap ("When the Boy's Heart Stopped")
In honor of Emergency Nurses Day (Oct. 17), here's a reminder of the many rewards that keep us sane, as well as make us grateful for the chance to make a difference.
Author's note: This is an updated version of the article I renamed "When the Boy's Heart Stopped" with an 8th place finish at a US writing competition. 11/5/11
"This is EMS. You're getting a 9-year old boy in traumatic arrest after a direct blow to the chest with a baseball. He's intubated; we'll be there in 2 minutes. " My hands shook when I replaced the EMS notification phone.
After years of dealing with gunshot wounds and stab wounds in our Level 1 Trauma Center , I was not easily fazed, but taking care of pediatric patients scared me. I worked at the Adult Emergency Room but hospital policy dictated that pediatric traumas come to the Adult side for the initial rescue interventions. Many of the ED staff have young children at home, and cases involving kids always evoked strong responses among the parents in our group. I could almost imagine some of the parents in my staff calling on the phone for their family.
The baseball stunned our patient's heart, and it was being squeezed to life by the frantic efforts of the paramedics who initiated cardiopulmonary resuscitation at the field. Commotio cordis describes a sudden cardiac arrest from a blow to the chest. The baseball had caused a disruption on the heart rhythm at a critical point during the cycle of a heartbeat resulting in ventricular fibrillation. The quivering heart did not produce a heartbeat. There's a 65% mortality rate. A nightmare coming to our doorsteps.
The ER staff's collective groan when I told them about the notification reflected all our anxieties. The sight of the trauma surgeons and the pediatric doctors and nurses rushing to our side was met with some relief. We expected them to lead the rescue efforts.
The ambulance doors whooshed open, and the Trauma Team who was called in advance stood in attention. I was standing at the Trauma entrance and saw a paramedic perched on top of the guerney doing CPR on the patient, while another paramedic was giving breaths to the patient via an ambubag. Several pairs of hands reached up to hold on to the EMS guerney. I could smell the sweat of fear around me. Everybody took a deep breath.
The Trauma team swung into action. At that moment, everyone was focused on the small kid; he was ours and we would exhaust all efforts to bring him to life. Without question, this kid demanded our full attention.
"Check the pulse!". The ED attending physician barked. CPR was held as one doctor felt for the carotid pulse. The cardiac monitor confirmed the negative reply. External defibrillation failed. We knew that prognosis was bleak.
The decision was made to open the chest for the internal cardiac massage. Within minutes, the chest lay open and the surgeon started to massage the young boy's heart. Anxious eyes watched for any sign of response. A short burst of applause broke out when the heart started to beat on its own.
"We are not done here yet so hold the applause" was the curt reply from the Trauma Chief. The patient needed to go to the OR stat.
A commotion at the door caught my attention. The mother had arrived. I grabbed one of the residents to talk to the mother. She let out a piercing wail before she collapsed to the floor.
In a plaintive voice, she sobbed, "Please help my son, please." I heard sniffling behind me and saw the other nurses wiping tears. The mother was trembling, her cries of agony filled the Emergency Room. We assured her that the Trauma Team was doing their best. Empty words. Vague promises.
"His name is Pedro. He loves the Mets." The mother said softly, as she showed me the picture of her boy. He was in full Mets uniform , complete with the baseball cap. Pedro's face beamed in delight as he struck a pose for the camera.
Not knowing what to say, I replied, "Me too." It was a stupid remark, I thought, but it brought a tentative smile to the mother's face. Perhaps she thought that a little humor meant that her son was not that sick.
The mother wanted to see her son, but the Trauma Team had gathered around the patient's bed. The surgeon was issuing orders to his residents while the nurses were busy preparing the patient to the mad dash to the OR.
Being a mother myself, I shared the fear that gripped Pedro's mother. Knowing that her son was extremely critical, I wanted to give the mother a chance to see her son. In my mind, I wanted her to say goodbye.
I cleared the pathway so that the mother can finally kiss her son's blood-caked face. The surgeon did not want to wait and impatiently glared at me. I raised my eyebrows at him in defiance and said, "Just one moment."
For some of the team members, I could sense their annoyance at the interruption but I pulled the mother to the head of the bed and motioned for her to kiss her son. At that point, a sterile drape covered the hole on Pedro's chest, but the mother reacted to the intubation tube on her son's mouth with an anguished cry before she finally leaned over to kiss her son on the cheek. She closed her eyes and muttered a short prayer.
I gently pulled the mother away as the trauma team rushed the patient to the operating room. The Trauma Coordinator offered to accompany the mother to the OR Waiting Room. I ran after them to give the mother the Mets cap that Pedro had left behind.
The case had shaken the ED staff. As we cleaned up the trauma room in preparation for the next patient, we spoke in hushed tones about little Pedro. I worried about the boy's family as they struggle to keep their hopes alive. Pedro's distraught father had arrived a few minutes after. He was being held up by his friends as they all rushed to the OR waiting area.
We got word that the boy survived the operation but was placed on sedation. There was the unspoken fear that the boy will emerge brain-damaged when he is weaned from the medications.
The emotions that had churned in me that day left me feeling drained. As I walked towards the hospital parking lot, I met the boy's mother in the lobby. She kept her face composed but I could feel that she would be unleashing her emotions pretty soon. As soon as she saw me, she asked where the hospital chapel was. Alarmed, I asked about her son's condition. She informed me that her son was still being sedated.
I accompanied the young mother to the chapel. She appeared to be Catholic but I am not so I turned around to leave. My steps were halted when the mother burst into heart-wrenching sobs, so I stayed behind and patted her back in consolation. After sometime, she stopped crying and knelt down on the pew. I remained seated as I uttered my own prayers to God. Our different religions did not matter, but we both prayed to our Supreme Being for the little boy in the Mets cap.
When I went home that night , I enveloped my seven-year old son in a tight embrace. I thanked God for my precious son, then added an extra prayer for the boy named Pedro. The next day, I learned that all my fellow nurses did the same thing with their own children.
Several days later, the Trauma Coordinator informed us that Pedro was transferred to a children's specialty hospital in Long Island.
Three weeks later, the Trauma Coordinator surprised the ER with a most welcome sight.
A mother was guiding a young boy with a shy, tentative smile towards the group of ED personnel in the Nursing Station. Pedro stood in front of us, in full Mets uniform, his blood-stained Mets baseball cap clutched in his tiny hands. His mother explained that Pedro refused to part with his baseball cap. Pedro pulled his shirt up to proudly show the scar on the left side of his chest.
All the patients around us looked bewildered at the sight of nurses with tears in our eyes as we grinned and high-fived with Pedro. I said a silent prayer of thanks.