Watch Your Dam—Dang. Kids.

Sometimes I am really at a loss at this job.

A loss for everything except words.
I have words today.

I still remember the first time I witnessed a pediatric trauma. I really wish I had dissociated or entered some sort of transient, numb state to allow me to watch the trauma evaluation without tears filling my eyes. But no, every second of it was just as scary as you would think it to be. It was a three-year-old girl, red trauma alert, dog bite. "Bite" was an understatement, in my opinion. These dogs, plural, mind you, treated her like a squeaky toy they were trying to silence.

The worst part? The triage note said her dad had "no idea" how long she was alone with them.

American bulldogs, in case you're wondering. Go ahead, Google them. I’ll wait.

Look, I love dogs. I’m pro-dog. I’ll snuggle an English bulldog any day. I happen to love their slobbery, lazy, roll-y, lug-ness. I guess I can tolerate the Frenchies, even though they kind of freak me out. But American bulldogs? Absolutely not. I don’t care how “sweet” yours is. Keep it 300 feet away from my hypothetical children. Just in case anyone is offended, I had nothing against these dogs before that day, but you can't blame me until you see a 3-year-old covered in blood from being around them.

And this girl... her cry. It was the kind of cry that didn’t match her age. It was fresh, like a newborn. Maybe I haven't been around enough kids, but I was not expecting this child to sound like a baby. It broke my heart. Later, I found out she had lacerations on her liver. Liver. As in internal organ lacerations. The chew toy analogy was not an exaggeration.

Now fast forward to today.

Another RED pediatric trauma. Another three-year-old. Transfer from an outside hospital. Why? Because that hospital didn’t have Pediatric Neurosurgery. Why would a toddler need neurosurgery, you ask? Oh, that. Because he was shot in the head.

"Accidental discharge from the child playing with a loaded firearm."

It was written so casually. That's what sucks about writing notes sometimes, it's all matter of fact. No judgment allowed. That's what this blog is for, though, right? My own personal judgment forum. Enjoy. 

Let me run that back for you.
A three-year-old.
Playing with.
A loaded gun.

Through and through. Exit wound through the back of his head.

So maybe I don’t have all the words today. Because honestly, what do you even say about that?

I’m not a parent, and I’m not here to preach, but I am here to say: how does this happen? Truly? How do you leave a loaded gun anywhere near a toddler? Hell, how do you leave an unloaded gun near a toddler? Or leave them unsupervised in a place where a gun even exists?

~Side note: Maybe this is a product of my naivety. Maybe a seasoned physician or nurse wouldn't even bat an eye. I wasn't actually writing the note for this case, but I witnessed it. And it was enough for me to produce a million questions. It was enough for me to be angry. It was enough to inspire this post. Whatever my colleagues in the ER think, I hope you can be angry with me. ~

Now, I can forgive accidents. I had my fair share of my own, still have the forehead bump and lip scar to prove I was a hazard to myself as a child. And my parents were careful, I promise. But this? This didn't feel like an accident. It feels like negligence. Maybe worse. And I hate that my job forces me to even wonder that.

This is the part of emergency medicine that haunts me: the not knowing. 

The unknowns. The mysteries. The fragments.
The fact that trauma patients come in half-alive, and then they go, upstairs, to surgery, to the ICU, or sometimes... not at all. And I don’t always find out what happened. I don’t get the story. I don’t get the why or the what now. 

This is why I could never be an EM doctor.
I need stories. I need the full arc.
I want the history, the nuance, the messy details.
Call me nosy. I am.
I have an insatiable curiosity. So what? Maybe that's why I'm interested in psychiatry... But that's not the point of this whole thing.

Behind every trauma alert is a story I’ll never fully know. But I'll always wonder. 

Here's where I want to reflect a little deeper for a second, especially for any seasoned healthcare workers reading this and thinking, “This girl’s gotta grow a thicker skin.” I hear you. Maybe I do. But also… can you really blame me?

I’m still new. Not to medicine, not to hardship, but to this: this proximity to tragedy, this unfiltered front-row seat to pain. And some cases still crack me open. Some still sit with me long after I clock out.

Is that normal? I don’t know. Will it make me a better doctor, or just a more exhausted one? I don’t know that either.

But I do know this: when a 15-year-old boy came in with metastatic liver cancer, so frail he had to ask his mom if he was still getting chemo… when he locked eyes with me, not at me, but through me, I couldn’t stop the tears from flowing. I didn't mean to let it affect me that much, at least not in the room while we were still taking history, but there was no hope left in his eyes. He had already made peace with something the rest of us couldn't even begin to imagine. And when I saw the DNR/DNI in his chart, I almost stepped out. 

~ Another side note: Just to add to the already piling layers of the incredulity I already feel on a day-to-day basis, I have never seen a resident show even a hint of emotion to patients. The most I've heard is a half-assed "I'm sorry this is happening to you." What? HELLO?! Is THIS what they're teaching in medical school these days? How to respond to someone like a robot? Trust me, you'll be getting a whole post about the astounding lack of outward compassion I witness in most of these residents. I do not know if it is whipped out of them at some point in their training, because sometimes the most caring doctors are the interns, but jeez. Let's learn some appropriate social skills these days, shall we? ~

These moments, they don’t ask for permission.

They remind me of what I already know- that pediatrics is not where I’m headed. Just kidding... But they also remind me of something else each time. Every patient, every chart, every chief complaint… they’re layering something onto me. Not a thicker skin exactly, but maybe a sturdier soul. I like to think they’re lining me with a kind of quiet resilience. Padding me with experience. Preparing me.

So that the next time there’s a 3-year-old in the trauma bay, when they are at the liberty of my care, I can steady my hands, cry only in the chambers of my heart, and focus on what needs to be done. I hope one day I learn to balance this without coming off as distant, cold, or uninterested, like I see it sometimes.

That being said, I hope I never stop feeling it. I hope the emotion never drains out of me entirely. Maybe it’ll need to be tempered, softened, made professionally palatable, but not erased.

Because someday, when I’m a physician, I never want a scribe to look at me and wonder: Does she even care? How can she not care? It's coming across like she doesn't care.

I hope I always care.

And if that makes me soft, then let me be soft.

I’ll keep feeling it, until the day I don’t. And if that day ever comes, I hope I’m not the last to notice.