A Nurse with a Gun

Tuesday, September 30, 2008

Saving a Life

She was six, maybe seven years old. Rumor in the suite was that she had been battered by her parents. There was nobody that cared for her enough to sign a consent. Not even an attorney. She had been stored somewhere in the hospital, on life support, as nurses and doctors valiantly tried to lower her intracranial pressure.

We gingerly transferred her to the cold back surgical table, and Patty removed the ambu-bag from her ET tube to transfer her to the array of anesthesia equipment that would keep her safe. Patty had her lavender hoodie on already, the chill in the room would soon be removed by the intense surgical lights. We transferred monitors and Patty pumped her pink pedi bag a couple of times, this time not having to instruct the unresponsive child to watch the balloon go up and down.

I gazed at the child's swollen little eyes, purple and black from assault, the corneas blood crimson, the pupils unresponsive underneath the swollen slits. I felt a lump in my throat, a growing anger that parents could treat an innocent in this way. Patty placed gauze and tape over the blackened eyes, intended to protect the organs, but also concealing the shame of their horrific appearance. After adjusting a few dials, Patty settled back into the latest pulp novel.

We removed the polymerized spica cast. We would have to prep and incise her abdomen. Underneath the pretty pink shell, she was again purple from the assault, her little pelvis broken. My scrubs were visibly shaken. "Why are we even doing this?" asked Kevin aloud.

"Shhhhhh!" I replied. If she could hear us, I did not want her to hear the doubt, the ambivalence, the fear, and the growing anger among us. She deserved love, and hope, not rage. I prepped her as the scrubs filed outside to scrub in.

"Doctor Fakhouri, this is Chasity _________ for a Cisterna magnum shunt," I announced as the masked surgeon bent forward to dry his dripping hands and arms with the towel offered by the scrub. He said nothing in response. He just donned his gown like so many times before, stuffing his hands into the sterile gloves offered him, and performing a pirouette to wrap the ties around himself. I did not particularly care for Fakhouri. I took pleasure in pronouncing his name "Fukyuri."

The tone did not register at first. "V-Tach" announced Patty, moving instantly to the pink balloon. Shit. I stripped off the drapes and threw them across the table. No pulse. The child's battered chest and abdomen were still wet with betadine as I began bare handed compressions. I overheard Fukyuri tell a scrub to get the anesthesiologist and he stripped off his sterile paper gown and tossed it in the kick bucket on the way out. Kevin tossed me adult defibrillator pads as he hooked them up to the Codemaster.

"No, Pedi," I snapped as I threw them to the floor. I grabbed a piece of torn drape to wipe the wet betadine from the child's chest while I continued compressions. Patty was pushing drugs furiously. Kevin quickly passed the pedi-pads and I slapped them into place. I looked at Patty.

Patty looked at me. "100 joules." Crrrrrrrrick. BeeeeeeeeeeeeeeeeeeeeeEEEEEEEEEEEE. "Clear?"

"Clear!" Bam! The child's body lept and shuddered with the force of the shock coursing though it. We looked at the screen, hopeful..........

Asystole. No, this is the new world. The politically correct world. Pulseless electrical activity. Dr. McIntosh charged into the suite, and was buffeted with a verbal barrage compressing the last two minutes of activity into a few seconds as I continued compressions. Crrrrrriiiiiiick BeeeeeeeEEEEEEEEEEEE. "Clear?" he asked.

"Clear!" Hands up, thighs away from the table. Bam! The child lept and settled again, lifeless. I found my place on her little chest. 1, 2, 3, 4, 5, BeeeeEEEEEEEEE.

"Clear?" Hands up, step back.

"Clear!" BAM! Shudder, settle. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, ..............

Later, we reverently washed the battered little girl, transferring her gently back to her gurney.

Tears were in Patty's eyes as we piloted the child past Recovery and to the morgue. "It's better this way, I suppose," Patty said.

"No. It's not." I replied firmly.

It's not.



Anonymous Anonymous said...


How do you deal with it?


9:04 PM  
Blogger Rorschach said...

Xav, If I had seen that and lived through that and then saw her "parents" in the hallway, you would have had to shoot me dead to keep me from killing them. And I would not have begrudged you that you did. Nor would I have begrudged you if you did the same. I'm not sure I would have lifted a finger to stop you if you did. Evil exists in this world and it is our duty to destroy it whenever and wherever we encounter it.

I suspect you went home and hugged your little (and not so little) ones til it hurt.

9:32 PM  
Anonymous Anonymous said...

Xavier....thanks, thanks for writing this. It takes me back. I have felt that same frustration in the ER and on the street. I also picked up my pen, sometimes all we can do is write and remember. The ones saved don't warrrant any less, but the lost ones sometimes need this closure, for them and for us...one last signal to know that they were not alone...that someone still cared...I can tell you do care and always will.

9:34 PM  
Anonymous Anonymous said...

Your right sir. It's not better, perhaps that's why I stay in Law Enforcement. Someone has to speak for the little ones who can't defend themselves

9:36 PM  
Anonymous Anonymous said...

God Bless you for the work you do, and for the compassion you have.

It's things like this that kept me away from being in Law Enforcement. I probably would take the "enforcement" part too far when I found cases like this.

9:42 PM  
Blogger JAFO said...

Bless you, sir, for what you do, and those of you in Law enforcement as well.

I couldn't do the medical side as I'd be a basket case after going through that. I couldn't do the law enforcement side because it would be all too easy to go the way of Vic Mackey with "parents" like this little one's.

Rest easy, unknown child, and I pray that the Beyond is full of icecream on a summer day, puppy dog tails, and loving parents.

10:11 PM  
Blogger Thernlund said...

Hmmm... I normally skip the non-gun posts. For whatever reason I read this one.

Wow. Bad day. More some than others, eh?



10:32 PM  
Anonymous Anonymous said...

As always, this was a well written piece demonstrating some of the "routine" things we in healthcare have to deal with on a regular basis. I hope your words encourage others to do what they can to prevent such tragedies, which sometimes include removing the child from the parent(s) as opposed to the PC practice of "keeping the family together."
Another nurse with a gun...

PS. I don't mean to be overly critical, and please do not feel it necessary to publish this portion of my message, but you incorrectly use asystole as the unPC term for PEA. I am sure you realize that asystole is no electrical activity, whereas PEA is electrical activity without cardiac output.

10:44 PM  
Blogger Xavier said...

Asystole is one of the conditions necessary to certify death. In some areas, PEA is the term used by nurses until the MD arrives, just in case what is being viewed is very fine V-Fib. Asystole is close to a diagnosis, while PEA is more of an assessment.

12:01 AM  
Anonymous Anonymous said...

May God bless and comfort you. Thank you for your effort.

12:07 AM  
Blogger Bob said...

Jesus wept.

I have no words to express the admiration I have for the work you do, Xavier.

1:18 AM  
Anonymous Anonymous said...

My condolences--May you find the strength daily to keep working to heal others.

As for those who did this, they'll beg for a millstone and a deep ocean
on Judgement day than to endure the real punishment they deserve.

6:10 AM  
Blogger Ric in RIchmond said...

You are a better man than I.....

7:28 AM  
Blogger Ric in RIchmond said...

You are a better man than I.....

I couldn't do it...no way. No how.

Thank you.

7:28 AM  
Blogger Daniel said...

Thank you Xavier for being there for her.

You're a good man.

8:03 AM  
Blogger jdog said...

Godspeed Chasity and may you rest forever in the arms of a loving Father for eternity.

8:19 AM  
Blogger Brandon said...

Dammit. I'm sorry you have to deal with this kind of thing, and I'm very sorry for little kids who have to live and die with this kind of crap. There's a special place in hell for those animals who would do such a thing to a child.

9:13 AM  
Blogger George said...

Thank you for posting this heart-wrenchingly short tale of a wee life. While I admire your gun posts, it's the others that are a true measure of your story telling abilities. In some small way, we all share your grief, and your anger, over a senseless loss.

10:16 AM  
Anonymous Anonymous said...

"It's better this way."

Yes, it often is, if the alternative would have been a "lifetime" of vegetative or near-vegetative existence.

I appreciate and sympathize with your frustration as a nurse in dealing with such cases, but given the damage already inflicted on the child, and speaking as a doc who deals with such issues frequently, I believe that the other side of the coin deserves recognition.
That a child should be so abused in the first place is the issue, not the failure of resuscitative efforts.

11:01 AM  
Anonymous Anonymous said...

Ohh Xavier
The tears are streaming down my face. How oh how could this be done. And where will the just punishment be?

1:10 PM  
Anonymous Anonymous said...

When I clerked in the DA's office, I came across a photo of a 2 year old that had been knocked out a window. He still had the bootprint on his back. Fortunately, he lived. My desire to work in the criminal justice system did not, because said system has no justice in it.

2:50 PM  
Blogger Xavier said...

That a child should be so abused in the first place is the issue, not the failure of resuscitative efforts.

My point, exactly.

3:32 PM  
Blogger Don said...

No words...thanks for sharing Xavier.

3:38 PM  
Blogger nature223 said...

aint a low enough place in hell for someone who does that to a kid..Xav,you did all humanly possible...and she knew you did too. you save the ones you can and mourn for those you cant,harsh reality for a surgical/field corpsman/nurse..who needs that compassion to excel at their craft

4:13 PM  
Blogger Kyle The Opinionated said...

As a fairly new father, I cannot imagine the depravity, cruelty or abject evil that would allow a parent, or anybody else for that matter, to harm an innocent, loving child.

This is all the proof that we need that evil exists in this world, and that we need to do everything we can to fight it.

This brought tears to my eyes.

4:35 PM  
Blogger SpeakerTweaker said...

There is nothing that I can say here or elsewhere to bring any kind of good to this, so I won't bother trying.

I do hope that you get some comfort from sharing with us, and from having us feel your pain.

I am glad you tried to save her.


7:15 PM  
Anonymous Anonymous said...

I haven't the words....

I couldn't do it more then once.

9:33 PM  
Blogger Don said...


6:32 AM  
Blogger Tam said...

I don't know how you do it.

But I'm so glad you do.

8:31 AM  
Anonymous Anonymous said...

Without access to local news, tell me that at least, the child's parents are sitting in county lockup with no chance of bail, getting that "special attention" doled out by other inmates to Child Killers. I know it won't bring her back, but I guess I'm just not man enough to think something like this should just be let go.

9:25 AM  
Blogger DouginSalcha said...


I could not think coherently in order to post a comment when I first came across this article.

I still can't think of much much more to say. I could feel the pain in your writing and hope that it is eased by sharing it with others. Thank you for trying to help her.

12:02 PM  
Blogger TheBronze said...

Xavier, thanks for trying.

I couldn't do what you do.

2:02 PM  
Blogger Assrot said...

Xavier, I really feel for you and for this child. I was a foster parent for almost 25 years. I cared for so many children that had gone through what this child went through and lived.

You are correct. "No it's not." Some foster and adoptive parents are as bad or worse than the abusive parents the child was taken from. However, most of the foster parents I knew, including myself would do anything to show a child like this what good the world has to offer.

She would have been loved and cared for as if she were my own had she lived and come to my home.

It breaks my heart just to think of this because I have seen it so many times. It's something you never get used to and it's something that makes me angry and heartbroken at the same time.

Too bad we can't treat the abusive parents like they treated their child. But, if we did, I guess that would make us monsters just like them.

I think I would love to slowly and agonizingly torture the parents to death but if it came down to it, I'm not sure I could do that to another person. On the other hand, after seeing a child like this, maybe I could make an exception.

My prayers are with you and with that little kid's soul. She's at peace now. God has her.

I think someone else will get the parents when they pass from this life.


4:14 PM  
Anonymous Anonymous said...

Tam speaks for me.

11:54 PM  
Anonymous Anonymous said...

As someone with 32 years working in child welfare in Louisiana my only reminder to those so vengeful is the quote, "Those who hunt monsters should take care not to become one." Years ago I realized there was not enough room in my heart for the hatred abusive parents deserve. Particularly if your job calls for working with them every day. There are typically 40-60 confirmed child fatalities from abuse or neglect in Louisiana each year. I do get visits in dreams still from some of the kids I've worked with. Thanks for what you do, XB. Heartbreaking.

1:54 PM  
Anonymous Anonymous said...

Thanks for writing this.

It's not.

7:03 AM  
Blogger Ashley said...

I know what I really want to say but I will say this-I hope those sorry excuses for human life will burn in hell and may this little girl rest in God's loving hands.An eye for an eye..These people will pay if not in this life,surely the next.
-Chris in Georgia

8:27 PM  

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