# 2202
In over 2200 blogs I've never spoken personally about the toll that dealing with illness and death - and particularly the deaths of children - takes on health care workers.
There are some things you simply don't get used to, some things you just don't take in stride.
Dead kids are one of them.
We expect that children will grow to adulthood. That they will get their full four score of years to screw up their lives and the lives of their loved ones, and that nothing will cut that short.
Of course, that doesn't always happen.
Back in `the day' - when I was a paramedic - we didn't have counselors or psychiatrists on hand to talk to or debrief us after a particularly grisly or emotionally devastating call. There was a stigma attached to seeing a shrink in the 1970's that doesn't exist today.
We were expected to `suck it up', and keep on going. In fact, asking to talk to a `professional' was viewed by most of the guys as a good way to get yourself fired.
Or at least farmed out to the non-emergency unit.
That probably accounted for our high burn out rate. The average medic lasted less than 5 years on the job.
I can only remember one occasion when one of our medics was sent home in mid-shift after a bad call. He'd heard the dispatcher give his parent's address to another unit over the radio. He raced to their home in his own ambulance, only to find his father had committed suicide with a shotgun.
Even when my best friend, and ambulance partner, Bob Boller was killed in a motorcycle accident on his day off, I was expected to work my next shift, and expected to take over his job as Shift Commander as well.
It was a lousy way to get a promotion.
All of us who worked in the field carry ghosts with us. Not from every call, of course. But a few stand out, even years later. Invariably either the funny ones, or the tragic ones.
I mostly remember the funny ones. But there were three or four . . . well, they don't exactly haunt me. But they do still hurt when I think about them.
Please allow me to tell you about one of them. Her name was Trina. And she was barely 16 years old.
Trina and a girlfriend decided to take a ride in her friends VW bug one rainy evening. It wasn't raining hard, but the roads were slick. Her friend, at the wheel, apparently was driving too fast.
She lost control and hit a light pole.
My partner Ed Straight and I were on the scene within minutes. The driver, a girl I honestly don't remember much about, had a scratch on her shoulder and not much else wrong with her. She was very lucky.
Trina, however, had not been wearing a seatbelt, and she'd hit her forehead on the windshield - hard - then crumpled face-first below the dashboard.
After I determined that Trina was still alive (but just barely), Ed and I got a c-collar on her, and got her onto a backboard. She was very small for her age, which made getting her out easier. It was dark, and we were working by flashlight, but the only obvious trauma was a nasty looking laceration on her forehead.
One pupil, however, was blown and non-reactive to light.
A very bad sign.
As we were loading her into the back of our rig - Unit 23 - she coded. Her heart stopped and she quit breathing. Ed and I managed to restart her heart after a minute of CPR and a quick shock with our defibrillator.
Ed bagged her while I started an IV and took her vital signs. I could see a thin trail of blood and cerebral spinal fluid dripping from her ears. It was bad, and I knew it.
I took over ventilating her and Ed jumped into the driver's seat.
Time to scoot.
I radioed ahead to the emergency room. Informed them of the patient's condition, and suggested they ring the on-call neurologist.
As we were backing into the ambulance bay, Trina's heart stopped again. I applied the paddles, and sent another charge of electricity through her thin chest wall to restart her heart. She was back.
We wheeled her into the ER. The doctors and nurses took over. Moments later, she coded again. The doctor went for his defibrillator, and discovered that it wasn't working. He called for another one.
I ran to my unit, grabbed our lifepak 5, and brought it in.
Unfamiliar with my EKG/Defibrillator, the doctor asked me to do the honors. I did, and Trina was back again. A portable x-ray machine was brought in, and a skull series taken.
Thirty minutes later, the neurologist appeared with the X-rays in hand. When he learned I'd brought her back 3 times, he read me the riot act.
In front of everyone.
I was an idiot, he said. Trina was brain dead. A vegetable. I should have known better. Congratulations, you've just created a living nightmare for her family. One that could go on for months . . . even years.
I was mortified and devastated, all at the same time. I'd done my job, exactly as I was supposed to, but that didn't help.
I didn't have the latitude to decide in the field not to try to revive her. Not a 16-year-old kid. And the last time she coded, I'd acted under the ER doctors express orders.
That didn't help either.
The neurologist's stinging appraisal of my actions hung with me the rest of my shift, and for days to come.
The next morning, I went to the hospital to see how Trina was doing. The news wasn't good. She was on life support, and even though the doctors didn't express any hope for her, her mother refused to pull the plug.
I visited Trina in Intensive care every day. I sat with her for hours, watched her - with her pixie haircut and freckled cheeks - as she lay in limbo, hooked up a ventilator, IV's, and a catheter.
All the while I silently asked her to forgive me.
Five days later, mercifully, Trina died.
Sleep well, my little angel. Sleep well.
In two and a half years of blogging, I think this is the first `war story' I've told.
I hope you'll forgive me, but I do have a reason behind it.
Every day health care workers deal with tragedy and loss. Most of the time they can compartmentalize their feelings, and shield themselves from serious damage. We often use gallows humor as an adjustment mechanism.
Those who have never dealt with these types of situations may not understand, but finding irony, or humor, in a tragic situation may be the best defense you can mount.
Sometimes though, events can overpower even the most stable, rock solid, hardened professional. I've seen firefighters in tears, along with LEO's (Law Enforcement Officers), Medics, and of course doctors and nurses after a particularly tragic event.
And sometimes it isn't one single traumatic event that gets to you, it can be the result of a death-of-a-thousand-cuts. The daily grind of seeing nothing but tragedy and pain. That takes it's toll, too.
No one comes out of emergency services unscathed. No one.
Of course, it gets worse during a mass casualty event, such as a pandemic. As dedicated, experienced, and tempered that our health care workers may be, dealing with a pandemic will be something well beyond their experience.
They will have to not only deal with losing patients, who often will be young adults or children, they will have to accept the limitations of what they can do for them.
It is one thing to do your best, and lose a patient. You can tell yourself the damage was too great, that nothing could have saved them. It is a minor form of solace, but solace nonetheless.
It is quite another to not have the right medications, or a ventilator available, or even a bed to offer. The frustration of only being able to offer minimal, perhaps only palliative care, will be enormous.
With at least 40% of the health care system absent during a pandemic, those that are working will be working extended hours. A 40 hour week will likely become a dim memory. This too will have an adverse affect. The working conditions are likely to be brutal.
And of course there will be fear as well. Justified fear.
Health care workers will be at a high risk of contracting the disease. And those that are healthy and still working will be watching as their friends and colleagues are stricken.
And some of them they know may die.
Despite their dispassionate demeanor, their professionalism, and their dedication, these people are not robots. They are every bit as human, and fragile, as the rest of us.
If you prick them, they will bleed. If you abuse them long enough, mentally or physically, they will break down.
As traumatic as a pandemic would be for the entire world, it will be a private little slice of hell for most health care workers. They will deal with a mindnumbing onslaught of new pressures, fears, and traumas each and every day- for weeks, perhaps months on end.
If the CDC's estimate of 1.9 million deaths in the U.S. during a severe pandemic holds up, then we risk losing more than 500,000 kids in a matter of just a few months. The pain of dealing with this will be enormous.
And without support, many will break.
Hospitals need to make serious provisions for counseling and support for their workers if they expect them to survive a pandemic wave intact. They need to be thinking in terms of how they can relieve some of the inevitable stress a pandemic will bring.
And these interventions should come before, during, and after a pandemic. They need to be proactive, as well as reactive.
My guess is that few facilities are addressing the psychological needs of their staff in their pandemic plans. That most think `we'll deal with it' if it happens.
That compared to other preparedness issues, this is a low priority.
And that would be a tragic mistake of monumental proportions.
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