No matter how many times it happens, I can never get used to extreme cases that roll through our ER doors; yet, as a doctor, I have to expect that.

We had a terrible one come in yesterday.  A little boy, roughly two years of age, was brought in by ambulance; we knew once we heard the call it was bad.  Very bad.  Apparently, the child was playing near the railing of his porch, and the railing gave way when he leaned too far to reach a flower that was on the tree above him.  He plummeted 2 stories down to the pavement; he was gravely injured, and now he is in the Pediatric Intensive Care, fighting for his very life.

When he was rolled into the ER, we discovered that he was unconscious and unresponsive, according to the paramedic team that brought him in.  We soon had him hooked up to lines and monitors; his vital signs, at best, were terrible.  Very unstable blood pressure, in deep shock, gasping, labored breathing, poor skin color, unconscious, bones protruding from his lower limbs, arms bent unnaturally.  Serious fractures throughout his tiny body; it was apparent that he needed immediate surgery, or he could very well die.

Once we got him (somewhat) stablilized and patched up, the head doctor of the ER department (Dr. Arjuwahl) suggested that he immediately go to surgery.  He was immediately wheeled to the OR; he would probably remain in surgery for the next four hours (possibly more), the way things were looking now.

After the kid left, I cried in spite of myself.  I couldn't help it.  To see a child in that kind of shape was devastating; there was no sense behind the accident except, perhaps, negligence on the parents' part.  They would probably end up getting investigated by the state.  It was a terrible situation that left a lingering black cloud in our ER department; the gloominess and despair could still be felt this morning when the day shift came in.

Any case that is bad is horrible enough, but to see a helpless baby or child involved just does something to you.  They didn't ask to get injured or sick; sometimes things just happeen for no reason, and then we have to deal with it.  We deal with sick, injured, or dying people on a daily basis; we cannot escape it, no matter how hard we may try.  Yet when it is a baby or child who is dying or mortally injured, it goes against the laws of nature; it doesn't make any sense whatsoever.

We don't know if this little boy is going to make it:  only time will tell.  It will be a miracle if he comes through this without any lasting marks, but we know that he could end up being permanently disabled or brain damaged.

~Written by Winnie Brady, M.D., Nashville, Tennessee.