canât believe Iâm getting paid for this. But Iâll tell you, I donât think itâll be long before I start thinking Iâd damned well better be getting paid for this. I think that happens when you start to respect your skills. Iâm not there yet; but Iâm getting there, I think.
But I do get really pissed off about working in the West Bronx emergency room [West Bronx, also referred to as WBH, is a municipal hospital adjacent to Mount Scopus] . I was drawing blood today from a four-year-old and I had to stick him three times because he kept pulling his arm away and pulling out the needle. The reason he kept pulling his arm away was because the nurse wasnât holding him tightly enough. When I told her, she said, âI donât care, I donât give a damn!â Oh, really! She just didnât give a shit about the kid! Hereâs a woman who must really love her job.
I forgot to talk about something I canât believe I havenât mentioned yet. Something really significant happened tonight, something horrible, and I guess I blocked it out of my mind for a while. As the triage box was filling higher and higher with charts and we were getting farther and farther behind, we were called by a frantic clerk to come over to the critical care room. He said there was a pediatric cardiac arrest going on.
So we tore over there to see what was happening. I got there first. I found the place jammed with doctors and nurses working on what looked like a pretty big adolescent. They were pumping on his chest, they had him hooked up to the cardiac monitor, they were sticking him for blood and starting big IVs in his groin. I had no idea what to do. The resident showed up a few seconds after I got there and we stood around for a couple of minutes until they just told us that we could leave unless we wanted to run the code. âNo,â we said (laugh), âit looks like you guys are doing just fine.â But no one had taken a history yet, or even talked to the mother, so the resident told me to go out there and get the story. I found the woman; she was perched outside the critical care room looking scared to death. I took her over to the social work office and started talking to her.
Briefly she told me the kid was a fifteen-year-old asthmatic whoâd been in the middle of a bad asthma attack when it sounded like he had become obstructed [the main breathing tube, the trachea or one of the mainstem bronchi, the tubes leading from the trachea to the lung, became blocked] . He stopped breathing and they loaded him into a car and sped off to the hospital. They were headed for Jonas Bronck but on the way the kid was snatched up by a passing EMS team and brought to West Bronx. He had been pulseless, breathless, and unresponsive for God knows how long. When he got in the ambulance, he had vomited and aspirated [leaked stomach contents into his lungs] and gone into arrest.
So he was kind of dead when they brought him in, but I donât think I really believed it. His first pH was 6.9 [indicating severe buildup of acid in the blood, a condition resulting from lack of oxygen delivery to the tissue and not consistent with life for longer than a few minutes] , which isnât great. His heart was beating only about eight times a minute, but he was a kid, and kids just donât die like this. Not the ones Iâd known anyway.
When I was getting the history, the mother asked me, âHow is he, Doctor?â and I was about to say . . . I donât know exactly what I was about to say, but then the clerk opened the door and took the mother away because he had to register the kid or something administrative like that, and I left, after telling her Iâd come back to talk to her again when she was done.
Next thing I knew, that clerk came back to me, not as excited this time, and he said, âThe kid died; heâs dead.â I couldnât believe it. I knew he hadnât been