I've been in the ER nearly a year (next month it will be) and until now, I've been lucky enough to not have this experience, but last night I witnessed the second of two pediatric arrests in two weeks. Two innocent beautiful babies died (9 months and 17 months). Fortunately neither were my patient, but it was something I 'needed' to see for the time that comes when it will be my patient.
I saw two different parts of the process. The first arrest, I saw them roll the baby through the doors and into the room (at the very start of a shift, not really a good way to begin). Then I saw bits and pieces of the attempts to save this childs life. TWENTY ONE people in the room from nurses to docs to techs to respiratory therapists - everyone trying to do something to help. There were even a few of us just watching for the simple fact we hadn't seen a pediatric resuccitaion in progress before. I knew it wasnt that different than an adult, but I needed to see it. I dont want to be a disaster when I have to be the pts direct nurse. It was amazing to see that many people in the room because for an adult arrest there are probably no more than ten people. And not because adults dont matter so to speak, I just think in a pediatric situation everyone needs to feel like they are doing something to help. The first parents were less dramatic than I would expect out of someone who lost a kid, but I know everyone reacts differently. I only saw that baby while they were performing compressions and bagging the kid and pushing meds. While it was still being worked on. I wouldnt be surprised if something turns up in the investigation on this one, the family dynamics were very odd and their hygiene sucked (in fact they smelt like cat piss).
In the second arrest, I knew the ambo had called and consulted. I knew they were coming and I actually wanted to be in there start to finish, but because I had my own patient load I couldnt. I missed all of this one didnt see them come in, didnt see them work on the kid. What I did see, or really hear was the parents hysterically sobbing. The mom had to be wheeled down the hall she couldnt even walk. The Dad left the room and was walking down the hall just bawling his eyes out. That was horrible. I was literally seconds from losing it myself. Just imagining the weight on your heart after an ordeal like that. Honestly how the hell do u even get out of bed? I certainly don't think I could. For pediatric patients we have a color coded bag that is stocked with the proper equipment and meds for patients based on their weights. You have easier, faster access to the items that will fit the child based on weight versus having to search or try several different ones. Adults are built differently and there isnt so much variance. This bag, once used has to be restocked acccording to a list we have detailing the sizes that belong to each color. Tonight the nurse responsible for the baby asked if I had ever seen it restocked, I said no and she said ok when I stock it you can learn. We went into the room, and I knew the baby was still there. (There has to be an autopsy and police investigation into any pediatric arrest) So the baby was waiting to be taken to downtown Baltimore for the autopsy. In any case, I walked in and the baby was so sweet looking just like a porcelin doll. Still had the tube down his throat, covered mostly with a blanket. So peaceful. Yes, his face was very lifeless with a blue/purple tint to it, but all I wanted to do was stroke his little face. It just seemed so unfair - whether he was 'in a better place' or not - he was so sweet, so innocent, just a baby. I felt the tears welling up. I didn't touch him but I wanted to, I just couldnt stand the thought of him being alone although I knew he was gone. It was just sad, and I can assure you when it is my direct patient, I will be a disaster. I just hope and pray that no one I personally know will ever have to deal with this. And I pray for those that do.
Wednesday, January 10, 2007
Sunday, January 07, 2007
Suicidal at 13
So this is one Ive been meaning to post since I had the experience.
Either just before or just after Christmas I had a THIRTEEN year old girl who I had to treat. Why was she in the ER? Because she, for the last 24 hours or so, had been taking Tylenol in an attempt to kill herself. Now, her immaturity shows in the simple kind of drug she decided to take. Her immaturity was also apparent in the fact that she was barely pubescent. And I literally mean barely.
She arrived lethargic, barely able to climb into and out of the wheelchair. While one of her parents was getting her registered, she was brought back to my zone. Actually she was put into the room we reserve for codes, and we only use when busy if something is super important. I see this very lethargic, very petite little girl get up onto the bed. I go into the room, we help her get undressed. I introduced my self to her and as we are doing all this I begin questioning her as to why she is at the hospital. (I will refer to her as A in this post)
She said "I've been taking Tylenol since yesterday".
I said "A, do you know how many you took?"
A said " I think about 32"
I said "Honey why did you take all those Tylenol?"
A said "Because I was trying to kill myself"
Now at this point I paused for a moment, partially in shock, partially because I just could not understand what could possess a 13 year old to want to kill them selves. And quite frankly I don't know that I even knew what suicide was at 13, or even how to attempt it.
I then said "A, have you tried to hurt yourself before?"
A said "Yes"
I said "When"
A said "Last year, I tried to cut my wrists"
I said " Did you end up in the hospital when you tried to cut your wrists?"
A said "No, I didn't do a good enough job"
At this point, I'm about to bawl, I mean all I wanted to do was tell this little girl that she had a long life ahead of her and that she was going to be alright, but I kept my cool and kept talking to her.
I said "A why are you trying to hurt yourself?"
A said "Because my mom and dad are getting a divorce"
Then she started bawling.
Do you have any idea how weird it is to ask someone, let alone a 13 year old, why they tried to kill themselves? Its not easy, but it is part of my job, and I sadly enough do it on the regular. And actually I thought I was used to it, but apparently this had a slightly different twist to it. The twist was that this little girl had barely been on earth 13 years, she'd only really been talking for 11. There was so much more for her to see and learn and love. But the truth is, I bet she doesn't get to. Her acetaminophen levels were high enough when we tested her blood, that its a good possibility that she died several days after the event. See Tylenol metabolizes through 2 pathways in the body. In the first it breaks down into something non-toxic to the body. In the second pathway, which only gets used when the first one is overloaded (in the case of an overdose), it is broken down into something toxic. This is what kills someone who OD's on Tylenol. Indeed, you have to ingest nearly 7 times the maximum dosage in order to overload the first pathway, but once that's done, you are stepping into bad territory.
Unfortunately she went there. I asked the Dr. who had her if he knew what happened to her and he said, no I don't know what happened. What he did say was "I wouldn't be surprised, based on the levels in her blood if that little girls liver stopped working a few days later". Keep in mind, you treat them with something called Acetadote which blocks the Tylenol from being broken down in the toxic pathway, thereby removing more of it via the safe pathway - but its not a guarantee of any sort.
This is another one of those that I won't forget. For the simple fact that she was so young and, so immature making such adult decisions (to take her own life). It's also something that makes me wonder what in the hell our kids will have to face, if this is happening to 13 year old's now, what about in 15 or so years when I have one? What will he/she be facing? How in the world will I be able to protect my child from things like this? Or at least raise them somehow to allow them not to feel the weight of the worlds problems? What if I get a divorce (not planning on it, but who knows), how is that going to weigh on my kids? The whole thought scares the hell outta me. Just wanted to share.
Either just before or just after Christmas I had a THIRTEEN year old girl who I had to treat. Why was she in the ER? Because she, for the last 24 hours or so, had been taking Tylenol in an attempt to kill herself. Now, her immaturity shows in the simple kind of drug she decided to take. Her immaturity was also apparent in the fact that she was barely pubescent. And I literally mean barely.
She arrived lethargic, barely able to climb into and out of the wheelchair. While one of her parents was getting her registered, she was brought back to my zone. Actually she was put into the room we reserve for codes, and we only use when busy if something is super important. I see this very lethargic, very petite little girl get up onto the bed. I go into the room, we help her get undressed. I introduced my self to her and as we are doing all this I begin questioning her as to why she is at the hospital. (I will refer to her as A in this post)
She said "I've been taking Tylenol since yesterday".
I said "A, do you know how many you took?"
A said " I think about 32"
I said "Honey why did you take all those Tylenol?"
A said "Because I was trying to kill myself"
Now at this point I paused for a moment, partially in shock, partially because I just could not understand what could possess a 13 year old to want to kill them selves. And quite frankly I don't know that I even knew what suicide was at 13, or even how to attempt it.
I then said "A, have you tried to hurt yourself before?"
A said "Yes"
I said "When"
A said "Last year, I tried to cut my wrists"
I said " Did you end up in the hospital when you tried to cut your wrists?"
A said "No, I didn't do a good enough job"
At this point, I'm about to bawl, I mean all I wanted to do was tell this little girl that she had a long life ahead of her and that she was going to be alright, but I kept my cool and kept talking to her.
I said "A why are you trying to hurt yourself?"
A said "Because my mom and dad are getting a divorce"
Then she started bawling.
Do you have any idea how weird it is to ask someone, let alone a 13 year old, why they tried to kill themselves? Its not easy, but it is part of my job, and I sadly enough do it on the regular. And actually I thought I was used to it, but apparently this had a slightly different twist to it. The twist was that this little girl had barely been on earth 13 years, she'd only really been talking for 11. There was so much more for her to see and learn and love. But the truth is, I bet she doesn't get to. Her acetaminophen levels were high enough when we tested her blood, that its a good possibility that she died several days after the event. See Tylenol metabolizes through 2 pathways in the body. In the first it breaks down into something non-toxic to the body. In the second pathway, which only gets used when the first one is overloaded (in the case of an overdose), it is broken down into something toxic. This is what kills someone who OD's on Tylenol. Indeed, you have to ingest nearly 7 times the maximum dosage in order to overload the first pathway, but once that's done, you are stepping into bad territory.
Unfortunately she went there. I asked the Dr. who had her if he knew what happened to her and he said, no I don't know what happened. What he did say was "I wouldn't be surprised, based on the levels in her blood if that little girls liver stopped working a few days later". Keep in mind, you treat them with something called Acetadote which blocks the Tylenol from being broken down in the toxic pathway, thereby removing more of it via the safe pathway - but its not a guarantee of any sort.
This is another one of those that I won't forget. For the simple fact that she was so young and, so immature making such adult decisions (to take her own life). It's also something that makes me wonder what in the hell our kids will have to face, if this is happening to 13 year old's now, what about in 15 or so years when I have one? What will he/she be facing? How in the world will I be able to protect my child from things like this? Or at least raise them somehow to allow them not to feel the weight of the worlds problems? What if I get a divorce (not planning on it, but who knows), how is that going to weigh on my kids? The whole thought scares the hell outta me. Just wanted to share.
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