(Note to readers: This story contains graphic content.)
She launched herself out of the crowd, a wailing projectile aimed directly at me. Her kick to my chest knocked me out of my crouch, and I crab-walked backwards to escape but was trapped by the wall of people in the room. Heart pounding, I curled into a ball and let my arms absorb the blows aimed at my face until a security guard forced his way to me and dragged me out of the melee.
Earlier that evening, someone tossed a Molotov cocktail into a house where a drug dealer lived with a woman and their three children. As the place lit up, the man jumped out a window, sprained his ankle, and was now in an exam room with a police escort, waiting to be seen. He would be there a long time.
The woman and her children, asleep upstairs, did not escape the house. The flames ignited chemicals stored there—a basic meth lab—and all four were not gently suffocated by smoke, but burned by the flash of the explosion. Firemen managed to carry them out of the blaze into ambulances waiting to deliver them to the emergency department. The mother and oldest child were dead, gray skin cracked and peeling, features melted by the heat, and (thankfully, we believed) no signs of life. But the two younger children, maybe three and five years old, still had weak pulses, and so we tried to save them.
We struggled frantically, recklessly, intensely, to help those children, an emergency department doctor and a pediatrician for each victim. We peeled off fragments of burnt clothing fused with skin, assessing injury, looking for a place to begin. The smell enveloped us as we worked to secure an intravenous line through swollen and charred muscle. The smell of burnt flesh is like no other odor: acrid, metallic, meaty, and primal in the reaction it elicits. It is much worse than the sight of burned bodies. You want, no, need, to run away, but there is no way out.
Fire seared the child’s lips, mouth, and tongue.
The tiny windpipe was swollen shut; we couldn’t pass even a newborn sized endotracheal tube. We had to open the trachea with a scalpel and it was full of black soot, mucosa destroyed by super heated air. Our hands were filthy with blood and human particulates. There was nothing more to do. The tiny bodies looked alien, no hair, collapsed eyes, skin disintegrating onto the floor. Babies born from the sun.
There was no time to reflect; paperwork waited, as did a department full of patients, most upset at the delay, a few somber and apologetic for bothering us now. I washed my face and arms and threw my dirty coat under the desk, but that smell followed me everywhere. I chewed the inside of my cheek and swallowed words made from ash as I examined, treated, and discharged the window jumper to the police. He didn’t ask about his family.
Violent tragedy brings large, loosely related groups of people to the hospital. They congregate outside in the ambulance bays—sisters, brothers, friends, neighbors—and violence occasionally begets violence. Doctors prefer to talk to immediate family in a small grief room, but hospital administrators, in an attempt to appear “inclusive,”insist that these groups be accommodated somewhere in the hospital. That night, some forty agitated people, not searched for weapons, not limited to close relatives, were herded into the empty endoscopy suite. Someone needed to talk to them, and because the pediatricians were finishing paperwork and the other ED doc closing out his shift, I was elected. Although police swarmed the department (I had no idea what they were all doing there), I was sent into the room with a lone security guard.
The family matron, a bird-like lady with tight gray curls, sat in a chair in the center of the group. I introduced myself and knelt next to her, taking her hands in mine, and told her how sorry I was that her daughter and grandchildren were lost. I didn’t see the other daughter rush forward until it was too late.
I took a half-hour break to be examined by another physician and make a police report. At the time of the assault, I was taking the anti-coagulant warfarin so my bruising was pronounced, and there was a risk of internal bleeding, and I wanted this documented in a medical record. There were patients to be seen, and I was the only physician left after 3 a.m. Returning to work was not negotiable. The coffee was burned and I was too tired to make another pot. I may have eaten some candy, the sugar replacing my exhausted stress hormones, as I went on seeing patients.
When I got home, not even my lavender and vanilla soap could dilute the smell. I washed my hair twice, in my ears, even up my nose. I admired the shoe print bruise on my chest and the stripes on my right forearm. I had to sleep because I was working again that night, but I needed several glasses of wine to grab even a few hours. Exhausted, I burrowed into the covers, only to be awakened by that smell and nightmares of dead children.
My medical director, who was out of town, phoned that afternoon and asked me if I was going to press charges against my assailant; it never occurred to me not to do so. He told me the hospital’s CEO thought it “would be bad for community relations”and that it was just a “cultural difference”that led to the assault. I told him that I knew of no racial or ethnic group within which attacking a physician was acceptable, and that whoever believed that was the worst sort of racist. Neither he nor the CEO asked after my well-being or commented on the earlier tragedy. Those children, that family, my experience—forgotten already.
I had to forget, too. The assistant director called to ask me if I would be working my shift that night. He could find someone to replace me, if I was “still upset,”but it would be an imposition on other docs. He didn’t mention the deaths. He didn’t offer me time to see my doctor or recheck my warfarin level. I went back to work.
I began shaking as soon as I pulled into the parking lot and continued to do so all through my shift, seeing as few patients as possible, asking that all visitors be removed from the rooms, standing next to the door, being hyper-vigilant. My heart raced and I took a step back from every person of color. Everything had changed; I was afraid of the patients, afraid of being in the ED. I didn’t realize then that this was the onset of PTSD and that it would get worse. And then I went home to the smell of my dreams.
There were many shifts like this as an ED doctor. No time to be ill or in pain. No time to eat, to sleep, to pee. No time to grieve over murdered children. No time to deal with the mental and physical effects of a workplace assault. No acknowledgement of the normal human responses to the awful things we saw and did and had done to us every single shift. No time to cry, to heal even a little, before the next crisis arrived. No time at all.
IMAGE CREDIT: Flickr Creative Commons/Frank Hebbert