On Terror

"EMS to ED."

My charge nurse hit the button on the transponder.

"This is ED, go ahead EMS."

"ED, this is EMS en route to your facility, emergency status - "

All the staff within hearing distance stopped what we were doing to listen further.
I work in a rural, medium size emergency department, so while we see a lot of sick people, on the whole it's fairly unusual for a rig to declare that they are coming in under emergency status.  The vast majority of patients that come to the emergency department via ambulance are declared non-emergency status; that doesn't mean they're not sick, but it does mean they're not in the process of dying right now.  The distinction matters, because emergency status patients require doctors, nurses, and multiple other staff members (respiratory, radiology, laboratory, etc.) to be present and ready to receive the patient in the room before they even arrive.  It's often an all hands on deck situation and the rest of the department is put on hold while we all deal with this critically ill or injured person.  It probably only happens a few times a week.  The department had a rare quiet moment as we all waited for more information.

"We have a three year old post drowning.  She was underwater about 10 minutes.  She does currently have a pulse back after CPR, remains unresponsive and we are bagging her..."  The EMT started rattling off vital signs as a mixture of groans and sighs sounded around the nurses' desk. 

The charge nurse jotted down the vitals and when the EMT was finished, said, "Understood.  Room 1 on arrival, see you when you get here.  ED out."

Wait, I thought.  Wait, wait, wait.

Room 1?! Room 1 is my trauma bay today! I pressed my hands together in my lap and tried to keep my expression neutral as fear sank its claws into my belly.

Lord, please help me. 

You already know this, but...

I have never resuscitated a three year old before.

There's a particular feeling that I get these days when I feel like I'm in way over my head.  I get the urge to look around like there's someone who can step in and dig me out of whatever crisis I'm managing, and then I have to remind myself, Zoe, you're not a resident anymore.  There's no one to help you out of this.  You can do it.  Figure it out. 

I cannot overstate how scary it is to go through this time and time again.  And it doesn't even matter that I (generally) know what I need to do, or at least what I need to do next.  It doesn't matter that I've done it all before under supervision.  It's still terrifying to be out on my own every time I do something solo for the first time.  The first time I set a broken bone without supervision.  The first time I couldn't stop a seizure.  The first time my patient lost their blood pressure, the first time I oversaw chest compressions, my first stroke patient, first major heart attack patient.  The first time I walked into a room to see an artery bleeding everywhere and had to stop the bleeding all by myself.  The first time I had to decide to intubate a patient - and then intubate them.  For the first six months of this job I would lay awake the night before every shift because I was so nervous about what 'firsts' I might greet the next day.  I sleep better now, but I still get an uncomfortable adrenaline dump when something new comes in the door.

That little girl came in seizing and I had to intubate her - the youngest patient I have had to intubate to date.  I am proud to say that my team was able to stabilize her and get her on to the nearest children's hospital with minimal delay, and I heard through the grapevine that they were able to wake her up a little while later and she's doing fine. 

My partner, a much more experienced ER doc, congratulated me on the smooth resuscitation afterward.  I mentioned how scared I was in the room, and I asked him when that gets better.  I thought he would say that after a couple of years the fear fades, once you've cut your new attending teeth on most of the types of high-stakes decisions you will face in this line of work.

Instead, he laughed.  "Wait, is it supposed to get better?"  He leaned back in his chair and yelled out of the fishbowl at the other doc working with us that day, another very experienced emergency medicine guy who has worked in a lot of different environments. "Hey, Zoe wants to know does this job get less scary with time?"

I heard more laughter, then,  "What, is it supposed to?"

"Ha!  That's what I said!"

"Man, if it's meant to get less scary, I'm doing something wrong!"  They both laughed again, and the first guy turned back to me.

"I don't know that it gets less scary, Zoe.  You just have a better idea of how to do some of these things as you do it more.  But it will always be pretty tough work.  People are complicated, you know."

I sighed.  "Yeah, I know."