The ambulance entrance to the ER has sliding doors like those of a grocery store. I walked in with my dad at my side. My dad waved and smiled at the familiar faces he knows so well from working there. We walked over to the doctors’ station and that’s when I was introduced to Dr. James. He was the doctor that I would be shadowing for the next two days. My dad gave me a hug, kiss, and left. I was a little bit nervous about the fact that I wouldn’t be able to handle the things that I might see. I was also very excited about the fact that I was in a real ER with a real doctor I was allowed to follow him around. I was wearing khaki pants, a white buttoned-down shirt, and my comfy pair of green Puma tennis shoes. I was ready to go to work.

The Emergency Entrance

First, we went to look at one of the many computers scattered throughout the ER. Dr. James logged in to check the people who needed to be seen.

When I first met Dr. James he was wearing khaki pants with a blue scrub shirt. He had brown wire rim glasses and a shiny gold wedding band on his finger. He was very calm and collected and clean-cut. Around his neck was a St. Christopher medal.

The computer displays a chart with the patients’ names as well as their ailments. Patients who walk into the ER sign in with the triage nurse. A triage nurse is someone who sorts people into groups based on their form or likely benefit from immediate medical treatment. Triage is used on the battlefield, at disaster sites, and in hospital emergency rooms when limited medical resources must be allocated. The rooms are then sorted by the charge nurse or head nurse of the ER.

The very first patient we saw was a man of about 70 years who had extremely swollen legs and possibly congestive heart failure. I walked in the room and my heart skipped a beat. This man looked exactly like my grandfather who had passed away two years ago and whom I was very close to. I thought to myself, “Great, I’m going to lose it and it’s only the first patient.” The man had stunningly crystal blue eyes and a round belly. He spoke very little English. He was from Argentina and he spoke three different languages. Among them was Spanish. I can speak some Spanish so I decided to put my four years of studying to good use. Dr. James left the room while I stayed and talked to the man in Spanish.

“Donde esta?,” I said.
“Argentina,” he said.
I asked him, “Como esta usted?”
He answered, “ Muy cansado.”
“Tiene ojos muy bonitos,” I told him.
“Y tu,” he replied.

I became carried away and realized that Dr. James was gone. I left the room and was worried that Dr. James would be upset that I hadn’t stayed with him. About an hour or so later we went to look at the X-ray of his heart. His heart was huge. It looked like a large worn-in baseball glove that was falling apart. He also had excess fluid in his lungs.

The next patient we saw was a woman who had a possible miscarriage. About twenty minutes later we went back to do an ultra-sound on her. The amniotic fluid in the uterus is black, while the baby was very small and white. It was very difficult to find a heartbeat. Then, we sent her down to radiology and a pelvic exam. Then, one hour later we went to tell the woman and her husband that she was going to have a miscarriage. She seemed to take it very well.

The next patient we saw was an 80 year old woman with a pulse rate of 161. She was having a myocardial infarction or more commonly known as a heart attack. I remember that she had glasses on and her eyes were closed. She was wearing purple sweats and a gray shirt. Dr. James gave orders to the nurse to give the woman something to bring her heart rate down.

Around 12:30 p.m. I sat down to eat my lunch that was ordered about an hour ago from Chili’s. Then a cardiac arrest came in. Dr. James was excited in that I would be able to see what happens during a cardiac arrest, but to my disappointment the yellow curtain that blocks curious eyes was whisked across my face. I suppose it was for the better because the room was very small and about ten adults were already in there. I would just add to the chaos and discomfort of the room.

At 2:16 p.m. we got called to a trauma.

The case that will always stay in my mind forever was the 2 week old girl who had been run over by a car. Dr. James and a team of other trauma personnel waited patiently and quietly in the pediatric trauma room while I made my way back to sit behind a glass window which allowed for a clear view of what was about to happen. She was rushed to the hospital, but with no pulse. The doctors and nurses had the look of rush on their faces like they were running in order to catch a plane. I watched as they frantically worked on the baby girl for 45 minutes. There were tubes running from all over her body like highways on a road map. Everyone was so gentle seeming like she was a porcelain doll and were careful not to break her. After 45 minutes the little girl did not survive. Slowly the doctors and nurses began to file out of the trauma room in a zombie-like state as I carefully walked into the room to the view precious girl. I found myself walking so carefully it was almost like I was trying not to wake the child for fear she would cry. If only that were true. Her head was mush and she was sheet white. Blood soaked the table, her head, and her once snow-white clothes. My feelings were sadness and anger. Sad because she was just a baby and helpless. Angry for the same reason. Her eyes were still open, but you couldn't tell what color they were because of the blood that covered her face. I then went with Dr. James to the quiet room to tell the mother of the child the grave news. A police officer, 3 women, a doctor, a liaison, and a 15-year-old girl were all packed in a very small room with low lighting. I sat in a corner while Dr. James sat next to me. The officer stood with his arms crossed. The liaison sat on the arm of a chair. One woman, of what relation to the child I don't know, stood next to the heavy door teary-eyed with her hand to her mouth. The mother of the baby girl was sitting on her mother's lap shaking and whimpering. A multicolored fleece jacket covered her while her mom stroked her hair.

"She didn't make it."
The mom stared.
"Oh God!" she cried

I didn't move. It felt like I was watching an episode of ER only I wasn't. This was real. Dr. James and I left the quiet room to allow the mother to cry in peace.

The X-ray came back of the baby girl. This is what I saw: her skull was shattered into thousands of pieces. Her skull looked splintered like that of an old and dry piece of wood. She died of severe head trauma.

The story goes her mother was holding her, but her other child slipped their car out of gear. It then started to roll. The mom, wanting to stop the car, dropped the baby, but it was too late. The car had already rolled over the infant's head.

This was an amazing experience. I had experienced the death of another person. I actually witnessed a death in a hospital not of a family member, but of a complete stranger. I knew then that I wanted to be an ER doctor. I felt like I had found something amazing and that I wanted to do it for the rest of my life.

The people in the ER were great. They were very nice and interested in what I was doing. Dr. James told me something that I will always remember. “Be kind to your nurses. They will either make you or break you.” He was referring to the many ER nurses who attend to every patient that is in the ER. These nurses are in contact with patient more than the doctor is and it is important for a doctor to listen to his nurse. Dr. James points out that the nurses might pick something up about the patient that is vital.

© Copyright 2006 by the author(s)/photographer(s) and www.castlebar.ie

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