Walking down the hallway of the hospital, headed to see a recent car crash patient, I heard the loud speaker come on. It relayed a message that would change my life forever, though I didn't know it at the time
"Dr. Carstairs, please report to ER 5. Dr. Carstairs to the ER. Code white gunshot victim. ETA 3 minutes."
In all my years as a combat medic, nothing else chills me to the bone like a code white. A pediatric emergency, the worse of the worst, and if their coming to me, it's not just a high fever. It's my job to save these kids, and when I can't, it's the worst kind of failure.
Rushing towards the ER, I saw the paramedics unloading a stretcher, with a small child laying on it. As the medics hustle in, I began asking them my routine questions. Noticing the intubator, I questioned the Medic. He responded with "punctured lung. Kid couldn't breathe, so we tubed him."
"Pulse?" I asked the EMT who was scrawling notes as quickly as possible, knowing they would affect how I treated the boy. "Yes, Doctor, but very thready. He's losing blood fast, I'd say at least a pint already." I nodded slowly, taking in everything he said. "I've already given him 5 cc's of oxycodone to alleviate the pain, and (blood thickener) to help clot up the blood before he loses anymore. He was responsive at first, asking for his mom, but then he passed out, my guess from blood loss. Sad too, mom was DOA. Take care of him Doc."
Nodding, I walked off to find the head nurse, Lisa. Turning to her, I explained what I needed. "I got a code White in my ER right now. I need you to get a blood vial from Steve and take it to the lab, have them tell you his blood type. Then call hematology. Have them bring me 5 pints of it, and 2 bags of o neg. I get the feeling we're going to need it." She rushed off to go find Steve, my head OR Nurse, and the one who always gets patients prepped in the room before I do an exam. He's my right hand, sometimes. Turning I went to go find Kassie, the head ER Assistant, and my best friend. "Kas, I need OR room 3 prepped and ready, stat. I need surgery team 9 prepped and ready to do a code white bullet removal, and anesthesiology waiting." "you got it, Nicki"
Returning to the room, I found Steve cutting the boys clothes off. "Hey Steve. What have we got?" looking up, he nodded, knowing this was a bad one. "Gun shot wound, bullet still inside. Looks like a big one too. And he's losing blood faster than I can plug the hole. We need to get him to the OR stat, before he crashes." Walking over to the boy, and knowing he was unconscious, I slipped my finger inside the bullet hole, gauging the size. I looked at Steve and almost cursed. "Steve, this is worse than we thought. This isn't a regular bullet hole, this was shot from a magnum. A big one. This kids probably got a hole inside of him a mile wide, that's why we can't plug the bleeding. It hit tissue, and then exploded everything inside upon impact. We need to get him to Radiology, get a MRI done, now." Wide eyed, he nodded, and ran to the phone to call Radiology.
10 minutes later, we were looking at the images, and damn near crying. The kid had a shattered spleen, a punctured lung, and a few busted ribs from the impact of the bullet. A lot of internal bleeding. This kid was shot bad. Racing back to the ER, the OR team rushed him to the operating room, and we began surgery, trying to save a life that should never have been wounded in such a way.
A few hours later, I sat in the staff room talking to the social worker who had appeared in the waiting room halfway through surgery. I'd sent Ryan, the hospitals newest intern, out to see if any next of kin had arrived. Instead, I got Alicia Geiger, the social worker assigned to the boys case. I found out his name is James Tyler McKlayne, and he was only 7 years old. His mother, Patricia, had been found dead on arrival by the responding deputy, Aaron Mathews, who was now off duty and nowhere to be found.
I'd have to call him later, and get the details on this little boys situation. He was a close friend, and if he claimed open investigation privacy, I'd simply call his father and have him make Aaron tell me. Working on kids usually doesn't affect md, but for some reason this little boys situation was calling to me to be uncovered. He seemed so innocent and small. It horrified me to think someone could shoot such a small child, but I'd just spent the last five hours patching up this boys wounds. It made me wonder how it had happened, and I asked Ms. Geiger If she knew. She claimed it wasn't her job to investigate, only find out how the boy was doing. I explained to her that he was stable, but that it could change at any time, and that he would be in the hospital for atleast a month in order to recover from his injuries. Taking notes, she continued to ask me questions, and then ask if she could see his wounds. I told her no, they were freshly stitched and needed to heal. I told her we could have a nurse take photos for her next time we change his bandages, and she agreed, but only if I took the photos myself. I conceded and allowed her to visit him for a few minutes, even though he was still under anesthesia and hadn't woken up yet. Then she left and I went on with my day. Calling my husband, I arranged for us to have dinner at my favorite restaurant. I needed a date night, but first, a good workout. He offered to meet at the gym, and I told him sure, but only if he'll spar with me. He didn't like that too much. 20 years together and he still hates play fighting with me. It's ridiculous, I mean I served in the Army for 18 years. Dedicated my life to fighting, and he's afraid of hurting me? Men are so irrational sometimes, I swear.
