PICU Shadowing
(slow motion)
I arrived outside the PICU at around 8 PM. A quick exchange with a nurse over the speaker, and the double doors opened slowly into the dimly lit unit. Room after room it felt whimsical, one sleeping baby after another being rocked on automatic cradles. The last room, number 14 was the only one that had lights on. I quickly passed it trying not to get in the way of three family members looking through its transparent doors.
(regular speed)
Dr. (attending) greeted me with a calm voice and smile in the backroom (must be awesome to have a bed in your office, or not (hey—half full or half empty?)). A brief introduction and we walked back into the unit, but more lights were on—like I had suddenly waked up. Dr. introduced me to the family and the family to me. They shared that she had been through six other cardiac procedures, and had ended up here from a post-surgery complication. Everyone spoke calmly. Through the glass, the fellow was occupied with her leg, trying to find a clot source—or any explanation for her unstable stats. Standing outside, the echo doctor and her gigantic machine joined our conversation. We looked over her chest x-rays and echoes and saw that the leads were still exactly where they were supposed to be.
The next room down was a sleeping little boy. I mimicked Dr. pumping hand sanitizer and walked into the personalized dim room. Dr. explained his condition, and the next steps for him as he had been in and out of the PICU for several years. Walking out, she signaled me to pump sanitizer.
(2x)
One moment I was talking to nurses, and the next I am back again in front of Room 14. The parents are asking Dr. questions who is halfway inside now, the Dr. is asking the echo doctor questions, the fellow is asking Dr. questions, Dr. is asking nurses questions, nurses are asking other nurses questions. I am just trying not to get in anyone’s way. With her huge machine the echo doctor went inside, and Dr. signaled me to suit up and follow (This was the week of the ultrasound module—never had been so thankful for ideas before). Nothing looked abnormal, but she still was not stable.
(4x)
I ask “What’s a GSW?” Dr. explains that a gunshot wound is being transported over and we should expect him in an hour. Simultaneously, the situation started to get worrisome two rooms down. She is only ten months old, but her heart is very weak. Dr. worries that they may need to intubate her and her heart may not be strong enough for the procedure. So we walk out the PICU to find the ECMO technician as a precautionary measure.
(8x)
We find the ECMO technician in the ICU and return to the PICU. In the elevator, Dr. explains that it is not usually this busy. In the PICU, the scans for the incoming GSW have arrived. We look at them, and I can see where the bullet went in and where it went out through the skull.
(16x)
The fellow is now trying to communicate with the Spanish speaking parents of the ten month old through a set of blue phones that has a translator on the other end. Standing nearby, I can hear the static and background noise from the other end. At the end of the hall are Dr., the echo doctor, and nurses still trying to stabilize Room 14.
(32x)
Somehow the blue phone worked and we are preparing to intubate the ten month old. With the ECMO machine standing by and an on call surgeon notified, the two nurses, the fellow, Dr. and I are suited up sterile inside the room. The fellow looks at the intubating device and then at me, and says “Can you believe these only come in two sizes for peds?” One too big and one too small. Almost done with the procedure and Room 14 calls Dr. and fellow. She gave me her job of monitoring the baby’s heartbeat with the tip of my fingers on her upper thighs as the nurses took over the rest. Everything went smoothly and the ECMO was put away.
(64x)
The first empty room gets prepared for the GSW’s arrival. A nurse asks me which blanket I think he would like. At the end of the hall in front of Room 14, another attending has been called in. All the doctors are standing in a circle running through scenarios. The ECMO technician is called to prepare one for Room 14. The parents are still nearby.
12 AM
We are informed the GSW arrived at the UVA hospital. Room 14 is still not stable. Her long-term doctor is called and informed of the situation. She is prepped to be put on ECMO.
The most heart wrenching part of the night was at this point when her parents could no longer contain their emotion. With the doctors they enter the back room, the door closes, I hear tears.
The GSW does not make it past the ER. The first room’s lights are turned off.
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