Colorful Walls and Faces: A Night Spent in the Pediatric Emergency Department
In this observation article, Elizabeth Campbell highlights the human connections that form between doctors and patients in the Pediatric Emergency Department.
CHAPEL HILL, NC. UNC Pediatric Emergency Department.
I walk through the hallways of the hospital following a kind nurse willing to help me. After passing through the winding hallways, attempting not to lose my guide, I meet Doctor Smith, a tall middle-aged man who serves as the main pediatric doctor for the night. He wears a kind smile as he shakes my hand; I briefly give him the short list of fun-facts about myself. Elizabeth Campbell – first-year studying absolutely anything but medicine but still excited to be here tonight. He turns back to his computer, finishing the report file on one of his prior patients. A nurse named Sally in off-purple scrubs motions for me to sit down.
The night has been slow so far – a good thing for the doctors and their patients. Noises fill the space, the most overwhelming of which is the clicking of computer keyboards and the beeping of various machines. It all seems to blend together with Rupert Holmes’s voice as he sings about piña coladas. Songs pass by with the continuous clicking of letters and exchanges of medical lingo. “How did she die?” One residential student asks the other. The room tenses at the mention of death, so soon during the shift and brought up so casually. “Aretha Franklin?” She responds. “I think she was in her seventies. Probably just old age.” He nods and sings along; “Roxanne”. The room relaxes once again.
“Do you know Spanish?” Dr. Smith presents the first real question I have been asked all night. “I know some French.” He laughs, and without another word turns and opens the door. The patient is a two-year-old girl, struggling with some sort of rash that, I have been told, the doctors looked at two days before. She had been given ointment for treatment and the expectation that it would go away in a couple of days. When the medicine did not do as expected, the mother came back very concerned. “Nothing is wrong with her.” One residential student argues. “We have to make sure everything is fine,” Dr. Smith responds. “People come to the emergency room to make sure it’s not something more. We have to exhaust every possibility.” The child’s screams pierce my ears and my somewhat pleasant smile begins to fade. The mother continues to stare at me with a look of despair on her face, hoping something can be done for her shrieking child. We exit the room; the nursing team mumbles to themselves. Though it is barely audible, I manage to catch a few words: “Lovely family, interesting sort.”
“What is one of the most common reason kids come here with abdominal pain?” Dr. Smith poses the question. A chorus of “constipation” follows. He nods; they are discussing a thirteen-year-old male patient complaining about the sharp lower abdominal pain he is experiencing. “It will probably be more interesting for you if you follow the Residential students. I mostly just do paperwork.” Dr. Smith encourages me to follow one of the male students as he goes to do the upcoming formal investigation of a patient’s injury.
“This one is gnarly.” The residential student grins, excited. The patient, a twelve-year-old boy, is laying on the hospital bed while his mom stands tall beside him; she is not at all concerned. An interpreter lingers at the middle of the scene. The boy looks at me and I mouth a small hi at him; he musters the smallest smile he can through tear filled eyes. He ranks his pain at an eight; his arm is bent in the shape of an S, gnarly. “She says her oldest just had the same thing happen to him,” the interpreter explains as the mother pulls out her phone for photographic proof. “She says it happened to him when he was playing soccer too.” The boy smiles at a sports reference the student makes and proceeds to engage in conversation about Ronaldo. The patient in the room next door also suffers from a soccer injury; he appears to have hurt his collar bone. “I’d say he broke it,” a residential student jokes upon viewing the x-rays; the bone levitates in-between the structure, clearly broken on either side.
“I made pumpkin cookies if anyone wants one.” The only female residential student smiles. She is one of two women in the space at the moment and there seems to be a sense of solidarity between the two. The doctor takes one out of courtesy; three other cookies quickly disappear. Dr. Smith begins to give her feedback, something he does at the end of every shift for the students. He talks about the way she reports the cases to him and how she ought to sound more like Tom, one of the other residential students. Tom is confident in his opinions and is hoping to have a practice of his own one day. Smith says this student could benefit from a similar level of confidence. She smiles, thanks him, and puts the lid back on her delicious pumpkin cookies. She places them back on the counter. “Have a good last night,” she says to the gnarly residential student from earlier. There is a short exchange between the two: a small wink, a smirk, and an “I hope State loses.” He laughs and wishes her well on the last of her adventures.
I ask the two remaining students where they attended college for undergrad. Tom went to UVA, gnarly went to State, but we all choose to forget our differences and agree that Duke is the absolute worst. “At least we can all agree on that.” Tom jokes.
“I just like to look in the rooms.” Dr. Smith peaks his head through the open curtain. “see, that kid does not look sick.” Not many could make a snap judgement in the way Dr. Smith can, but he knows what to look for. He states it in a matter-of-fact sort of way. “So, is it mostly worried parents that bring their children in?” He stops dead in his tracks and maintains eye contact, as if a secret of the Emergency Room has been uncovered – “YES.”
The theme of worried parents continues as yet another baby is brought in with similar symptoms to the first. He had experienced an allergic reaction to some egg that he had eaten. It was the first time his parents had ever fed it to him and they had never seen him react as he had. The parents tell the student that they gave him expired Benadryl hoping it would work and rushed to the emergency room. “We didn’t know what else to do, and we weren’t entirely sure if Benadryl still worked past expiration.” No signs of an allergic reaction could be found on the baby, so the decision remains: should he be sent to the allergy clinic? “Worried parents.” The room shares a laugh as the small boy attempts to eat the cold stethoscope lying against his chest. All the paperwork and beeping monitors seem worth it to hear him giggle even a little bit.
The never-ending computer typing continues; it is everyone’s least favorite part of the job. Doctors do not go to medical school to learn how to fill out forms, but to one day save someone’s life. They copy and paste the same basic email format from screen to screen and edit the names, symptoms, and diagnoses of each patient. The typing becomes background noise to the sound of heart monitors and classic rock, a mixture everyone has become quite well acquainted with at this point in the night. The heart monitors dance, and every so often the lines vary, jumping up off their platform.
At the moment, every patient in the department is ranked a 3 or higher, meaning none of the patients’ lives are currently at risk. A ranking of 1 is life threatening, a ranking of 5 means it is of lowest concern.
Seven or so computers fill the tiny working space; Dr. Smith’s personal laptop is set on his lock screen. The same fifteen family photos swivel across the screen. Their trip to Paris looks the most appealing. His oldest looks much older in the later photos than she does in the start of the slideshow. What are those kids up to, and do they miss their father so late every night? These thoughts are lost in the commotion of crying babies and Spanish television.
Eyes grow numb from being glued to the heart rate monitor and the background noise is all but tuned out. Things have been slow, and the team feels thankful for that. “Does she speak any English?” Gnarly asks a nurse regarding a new patient. “No, call an interpreter before you go in,” she responds. So, we stand outside the doorway, waiting. There are only so many interpreters in the hospital, and they bounce around where they are needed. It is about a ten-minute wait before one of them is available and the various medical staff members are able to go in. A small girl whose tan skin makes her pink shirt even more vibrant is staring at a T.V. as her stomach pumps up and down in an attempt to breathe. The T.V. is playing an unrecognizable show in English, but the young girl remains in a state of entrancement nonetheless; she refuses to look at the doctor or even the translator.
“Can you have her point to where it hurts?” The residential student makes direct eye contact with a confused mother. “Apunta a donde duele.” The translation is delivered. The small girl touches her stomach, no clear indication of the location of the pain. We file out of the room, the student discussing the symptoms with the Doctor. Eyes wander to the heart rate monitor out of habit; the small girl’s heart beats at 145 times per minute.
“Thank you so much for letting me shadow.” The doctor turns and shakes my hand, wishes me well, and sends me off. I file down the hallway, glancing in each of the rooms. I will never know of their fates, their various diagnoses, the medications, the treatments, none of it. I will never know what became of the sweet little girl struggling to breathe in a hospital bed. I left the department before any of them with nothing but a damaged heart. The walk through the hospital is somewhat hopeful; the sun has set by now, but the fluorescent lighting of the building makes me feel safe.
I wander around the hospital to let the experience sink in. I can somehow still see the faces of the patients smiling through tremendous pain or screaming from the horror of the unknown. The doctors I shadowed do this every day – care for children they will never see again and somehow cope with the ever-present ghosts of a smile. It takes copious amounts of bravery, and I am indebted to them.