What logic we can get

The other night, we had three trauma cases come into the pediatric emergency department, almost at the same time. The first to arrive was a boy who'd collapsed and stopped breathing after being hit in the head with a ball during his prep school's baseball practice. Then, in quick succession, came two 14-year old boys who had been shot while visiting a great-aunt. One had been hit in the arm, and one in the neck.

I was in charge of the airway of the kid who'd been shot in the arm. Trembling in his neck collar, blood oozing slowly out of the bullet wound, he eyed the IV catheter a nurse was preparing to insert into his arm. He was terrified of needles, he said, and asked if it would hurt. "Not as much as that bullet did," I answered.

He was the lucky one that day. Both of the other kids were brain dead within an hour of arriving at the hospital.

After the traumas were managed, we wandered back to the pediatric ED, where we sat quietly, picking at our fingernails. A passing nurse from the adult side swung through, and I eavesdropped on her conversation as I shredded my cuticle. She'd heard about that baseball player, she said. "What happened to the other kid?" "Organ donor," said another nurse.

"Good," she replied.


"Otherwise, he'd have just ended up a quadriplegic with a tracheostomy and would be in here all the time with bedsores and pneumonias, costing the system even more than he did before. At least now, it's over for everyone."

"Yeah," she continued, with something resembling indignation: "That baseball player did nothing wrong. A good kid with shitty luck, and in a second, he's dead. That other kid dying somehow makes things right."

I won't say I agreed with her, but I can't say I don't understand her at all.

Most normal people, I imagine, are asked to understand that good people make mistakes maybe once a day. In the emergency department, providers are asked to understand this about 10 times an hour. It gets old fast. And while it might seem hard to pin a mistake on kids visiting a great-aunt, their story rings false to the seasoned emergency room provider, in whose mind it is highly likely that the average gunshot victim is a member of a gang or is somehow involved in the drug trade.*

It often doesn't make sense when people who make mistakes get killed. But it makes more sense than when people who don't make mistakes get killed. And amid the chaos of the emergency department, I guess many of us take what logic we can get.

What shook me more than the perverse algorithm itself was its application to kids. A fourteen-year old kid doesn't have the judgment that an adult should have. Even if--perhaps especially if--his youth doesn't earn him any mercy from his surroundings, it should at least earn him some in our post-mortem calculations.

* There's a joke in our ED that an inordinate number of kids in this city get shot while reading the Bible on their front porches.

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Holy s#*%, hon. 2 peds deaths in one ED shift? Are you okay?

OMG Signout, I'm the most jaded person you know in medicine...or at least the most jaded person at my level of training, and I found that harsh. I don't have much of a filter on what comes out of my mouth at work but the "Those other kids dying somehow makes things right." comment is just about the worst thing I've heard of someone in medicine saying. I'm sure they were not at their aunt's house and I'm sure you are probably right about what they're doing and we all say "they're better off" or even "they deserved it" at times, but this is just callous. I agree with EGM...two deaths in a peds ED in one night is pretty horrendous but that's the last reaction that would come to my mind to cope.

I actually get none of it. Why is even a drug dealer's death making anything right?

The shooting could've very well been drug related, but it might have been the aunt who was involved and the kids got caught in the crossfire. Without any evidence it seems callous for her to speculate. There has to be a better way than blaming the patient to protect oneself from the pain of the death doctors see everyday.

it may be harsh, but people find whatever way they can to cope to keep doing their jobs. kids dying from traumas is shocking and horrible and so very wrong in the grand scheme of the universe. if that's what you see every day in an urban ED, your sense of what is normal and what is a socially acceptable way to cope gets a little muddled, i'm sure.

in the past, before we had these wonderful medical blogs, these comments were heard only by colleagues, people who had seen the same thing and had been traumatized by seeing a child, or in this case children, die. i think it's great that we talk about this stuff openly now, but we have lost that veil of privacy when it comes to our more honest outbursts.

actually, the thing i find most compelling in this post is the asterix...it speaks to a much deeper, more pervasive cynicism than that expressed explicitly by the nurse.

girlMD, thanks. That makes some sense now.

So many people are affected forever by one (and one's) single mistake..One should feel lucky to break a leg or an arm and stay alive to learn a lesson.