Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER (40 page)

“You're not in,” the respiratory therapist says.

“No, no,” I tell her. By now I have my hands down on the patient's chest and feel for the first time the right chest wall. It gives way a little as I press, collapsing inward. Rib fractures. Several. I can feel them and I can feel as well fine crepitance, bubbles of air in the chest wall that collapse under my touch.

“That's all we need tonight,” Donna says. “A fucking dead kid.”

“No!” I say.

I know now what is going on. I press on the chest wall, which gives again, just like before. “Tension pneumo,” I say. “We've got to needle the chest.”

“Heart rate thirty-five,” Mary Ellen says.

Tension pneumothorax. The kid's rib fracture has torn a hole in the lining of the lung and as the lung collapses, a pocket of air forms next to it. With each breath the air pocket has gotten larger and larger, and now the lung has completely collapsed up against the heart, squeezing it so that the heart can no longer pump. Deadly, deadly, unless you fix it, and it is actually easy enough to fix. Just put a hole in the chest wall and let the air escape. The lung collapses back into place and the heart can start pumping again. You can save a life that way—once in a while.

I glance at the clock. The boy has been here for a little over three minutes, three precious minutes.

“Give me a fourteen.”

A 14-gauge angiocath, a whopper-sized needle to any doctor or nurse or paramedic who tries to fit it in a thread-sized vein, but still, so slender, really, no bigger than a very small piece of straw.

I take the package from Mary Ellen, strip off the paper cover and fold the plastic back. The needle, the plastic catheter sheath, the flange, the hub. I don't even look; I know what's there. I gently nudge Bill to move him out of the way. Now for the easy part. Go to the middle of the collarbone and then drop down about an inch or two until you are just above the third rib. Steady your wrist against the chest wall and then don't think, just act. Push the needle through the chest wall and keep going. Especially don't think about the fact that if you are wrong, you are making things much worse, tearing a hole in the lining of the lung—
causing
a pneumothorax, if one wasn't there before.

Push
now.
Now listen.

What you are listening for is a rush of air, the sound of a deflating balloon only just barely audible.

“I swear I hear something,” I say. “Check for a pulse.”

“Nada,” Donna says. She has her hand on the child's carotid.

Mary Ellen is looking up at the monitor. “Heart rate is coming up, though.”

We all look up. There it is: 52…54…55.

“Whoopee,” Bill says without enthusiasm.

“More epi?” Donna asks and then, “Wait a minute. I swear I feel something.”

My heart is everywhere at once. I put my hand on the child's right groin, searching for a femoral pulse. “I think…I think…Recycle the blood pressure cuff. Get the Doppler…Have we got that second IV? We need a blood gas for Christ's sake.” I keep barking orders, but as I do so I remain just standing there, not thinking, not moving, just feeling with my fingertips. Yes, no, yes, no.

“Seventy-five,” the respiratory therapist says. I look up at the monitor. Heart rate: 75…76…77.

“There is a pulse here,” Donna says. “Now I really can feel it.”

The blood pressure reading comes up: 45/30. Terrible. But there. The kid has a blood pressure.

“Would you look at that,” one of the paramedics says. I didn't realize they were all still in the room but they've stayed on. But then, this is why they are paramedics—because of patients like this.

“I don't believe it,” Mary Ellen is saying, a voice filled with wonder.

“Well, let's keep going, guys,” I prod. “We need a blood gas, chest x-ray. And where
is
Surgery by the way?”

But I don't want to go on. I've done this for so long that I know how deceptive things can be—maybe this is a tension pneumo, a save maybe, but saves tend to go sour again. Fix one thing and then discover something else just as lethal that you can do nothing about What I really want to do is just stay here in this moment. But I know what I need to do, go back to check out the lungs again, the heart, those pulses. Cut off the rest of the clothes, do a limited neurological exam…

Even here, in my mind's eye, I balk. It is one thing to save the rest of the body but what about the brain? How long had the kid been out without a blood pressure or a pulse?

“Repeat blood pressure seventy-four over fifty-two.”

“Miracle,” I breathe, despite myself.

Donna must have been thinking along the same lines as I because she sighs. “Let's hope it's not one of those
bad
miracles.”

“His hand is twitching,” Bill says.

We all look down. His right hand is motionless.

“No way,” Donna says.

Then it does twitch; we can see it. It jerks and the fingers start wiggling.

“The kid needs a chest tube,” I say. I finally unstick myself and go to the head of the bed, back in ER mode now, back to myself again, brusque, emotionless, and thinking, What next? what must I do next? because that's all that matters. Look after the kid's heart, stop thinking about my own.

The kid's other hand is moving now, fingers wiggling as well. I look down at the child's face. A small bruise runs along his right cheek. I think of his parents…his grandmother walking him to the house…all those parents…grandmothers.…I think of Nigeria…the little boy whose life we saved with that tiny IV cannula. I think of the tools in front of me, the laryngoscope, the blade, an ET tube, a monitor, a defibrillator, the chest tube, my hands…

“Leave this world,” I think suddenly, and despite myself, despite where I am and what's going on, I laugh. As if anyone, anyone here, could ever truly leave.

I can see now as I strip open the chest tube tray that there are no certain answers for me, no absolute solutions, no wise moves that will ensure my happiness. There is only the late night and Donna and Mary Ellen, Bill and me, the paramedics, Mary and the rest, all of us bent over this tiny figure, naked, hopelessly fragile, yet resiliently young and, I hadn't noticed before, now suddenly radiant—radiant with a kind of roseate flesh that seems lit up from within. I stop for a moment to look up at the monitor. Oxygen saturation: 100 percent; blood pressure: 129/68. Well, perhaps there is no clear future for me, but for this little one, I believe with all my heart, the future is an open book.

The paramedics start drifting out, satisfied, while we bustle around like mad, mumbling orders, repeating them, bumping into each other, swearing. It looks like chaos and it is chaos, but if you have specially trained eyes, you can see what all of us are thinking, and you can hear, as we stumble through our paces, what all of us are mumbling.

It is that this little one is going to wake up and live.

F
OLLOW
U
P

B
AFTI, HIS BROTHER
I
RFAN, AND
D
INI
are currently studying in the United States.

Doctors without Borders won the Nobel Peace Prize despite my contribution to their overall efforts.

Dr. Daiquiri voluntarily surrendered his medical license after pleading guilty to thirty-one felony counts of trafficking in drugs. He was sentenced to five years in prison.

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