Authors: Robert D. Lesslie
Angels in the ER (2 page)
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T
wenty-five years in the ER have taught me a lot of things. I know without a doubt that life is fragile. I have come to understand that humility may be the greatest virtue. And I am convinced we need to take the time to say the things we deeply feel to the people we deeply care about.
I have also come to believe that there are angels in our midst. They may take the form of a friend, a nurse, or a complete stranger. And on occasion, they remain unseen, a subtle yet real presence that instructs, comforts, and protects us.
The ER is a difficult and challenging place to be, both for patients and for those of us who care for them. Yet the same pressures and stresses that make this place so challenging also provide an opportunity to experience some of life’s greatest wonders and mysteries. It is with a sincere appreciation of these mysteries and a profound sense of privilege that I offer some of my thoughts and experiences in these pages.
—R
OBERT
L
ESSLIE
, MD
M
ARCH 200
8
1 Even though I walk through the valley of the shadow
of death, I will fear no evil, for you are with me.
—P
SALM
23:4
E
veryone in the department turned to the ambulance entrance. We had all heard the screaming and shouting, especially the piercing wail of a young woman. Suddenly the automatic doors burst open, and a crowd of fifteen or twenty people, all teenagers or maybe a little older, spilled into the ER. In their midst they carried a young man. His arms and legs dangled wildly, and his head rolled from side to side. His T-shirt was soaked with blood.
“Somebody, help!” The cry came from someone near the front of the pack. “Jimmie’s been shot!”
We all moved in the direction of the door. Jeff Ryan, the charge nurse this night, was the first to reach the wounded man. “Follow me,” he instructed the people carrying Jimmie. “And don’t drop him.”
He led the group toward the trauma room, and called over his shoulder to the unit secretary, “Get Security!”
At the doorway, Jeff turned and took the bleeding boy into his arms and then carried him to the middle of the room. As he was carefully placing the young man on the stretcher, a few members of the crowd tentatively stepped into the trauma room.
“Nope.” One word from Jeff stopped them in their tracks. “You guys will need to wait outside.”
Few people questioned Jeff Ryan’s authority. He was in his early thirties, stood six feet tall, and weighed about two-twenty-five. He
had been in the ER when I first came to Rock Hill, and I soon came to appreciate the fact he was one of the finest nurses I would ever work with. He looked like a big teddy bear, but something in his eyes let you know that beneath that gentle exterior lurked a rugged strength and potentially explosive temper. I’ve seen it explode a few times…and woe to the person in its path. We referred to Jeff as our “enforcer.”
Within a few minutes, Jimmie was completely undressed, lying on his back. He had an IV line in each arm, each rapidly infusing normal saline. A catheter had been inserted into his bladder and oxygen was being administered through nasal prongs held in place by an elastic strap encircling his head.
I examined his abdomen for the second time. One bullet hole, just above his belly button. This was an obvious entrance wound, and there was no exit. He had been awake and talking since we placed him on the stretcher. His vital signs had been fair at the outset, with only a mildly depressed blood pressure. This had quickly improved with the IV fluids, and now things appeared to be stabilized. The lab techs had come down and they were now cross-matching blood for transfusion. We would give it as soon as it was available. The on-call surgeon, Sam Wright, had been notified. Fortunately he was still in the hospital—in the operating room finishing up a case.
A few minutes later he was on the phone.
“Sam, this is Robert,” I spoke into the receiver. “I’ve got a nineteen-year-old male here in the ER with a single gunshot wound to the abdomen. He’s alert and his vital signs are stable, but there’s no exit wound. The X-ray looks like the bullet’s lodged somewhere near his right kidney. And it looks like something small, maybe a .22.” I was making a guess about the caliber but in reality, it didn’t make much of a difference.
“Get him ready for the OR,” Sam replied through the speakerphone. “Looks like we’ll have to open him up and see what’s going on. I’m closing up the appendectomy you gave me earlier, so I’ll just meet him here in the operating room.”
“Okay, we’ll do that. He should have gotten about a unit of blood before you see him.”
“Fine.” Then he was gone.
Jeff was making some notes on our patient’s clipboard.
“Dr. Wright ready to see him in the OR?” he asked me.
“Yeah, as soon as everything’s in order,” I answered.
He picked up the board, stepped over to the side of the stretcher, and checked to be sure both IV lines were flowing. Then he headed for the door.
“I’ll get some help and we’ll get him going,” he told me as the door was closing.
I looked down at Jimmie and asked, “Are you sure there’s nobody we need to call? Family? Relatives?”
He had already been asked this several times and each time had told us that no one needed to be bothered. The “friends” who had brought him to the ER were of no help either. Once Jimmie had been deposited in our trauma room they had disappeared. Maybe they had heard Jeff request Security, or maybe they knew that a police squad would soon be on its way. Whatever the reason, they were gone.
We were alone in the room, and I was waiting for the transport team to come.
“Doc, I’m not gonna make it,” he stated matter-of-factly.
This blunt pronouncement surprised me. I glanced down at him, checking his color, and then over at the cardiac monitor to be sure I wasn’t missing something. He seemed stable enough.
“Jimmie, you’re going to be fine. I know this is no fun for you, but it’s a straightforward wound, and Dr. Wright will get you fixed up. You may have nicked some intestine or something like that, but he’ll patch things up, and you’ll be going home in a few days.” I didn’t have to try to sound confident, because I was. This would be a basic surgical procedure. Unfortunately, we saw too many cases just like this. He would be fine. He was young and healthy.
Now peaceful and calm, he continued to stare straight up at the ceiling. His arms rested at his sides, and a sheet was drawn up to his
waist. He had a lot of tubes connected to him, but he was stable and looked good.
“No, man,” he said, quietly resigned and still staring at the ceiling. “I’m not gonna make it out of that operating room.” His tone and words bothered me. He needed to be encouraged.
“Jimmie—”
Before I could finish, the door opened and the two men of the transport team came into the room. They made the necessary preparations and began pushing the stretcher toward the door. I stood out of the way.
Jimmie was halfway through the door when he twisted his head around and looked directly at me.
“Not gonna make it, Doc.”
“Everything’s going to be fine, Jimmie,” I told him once more, and then he was gone.
Of course I was right. And I would be able to tell him so in a few hours. I looked at the clock on the wall. 12:30 a.m.
At 1:00 a.m., a nineteen-year-old girl hobbled into the department and was led to room 2 by our triage nurse. She had stepped in a hole (which happened to be just outside one of our town’s drinking establishments) and sprained her right ankle. It was pretty swollen, and we would need an X-ray to make sure it wasn’t broken.
We had no sooner sent her down the hall in a wheelchair to X-ray than the ambulance doors swung open. EMS brought a twenty-five-year-old woman directly to the cardiac room. She had a long-standing history of kidney disease and extremely high blood pressure. Tonight she had apparently suffered a stroke. She was breathing, but was not responding to pain or verbal stimulation. We would need a CT scan of her head, and quickly.