This is Part 2 of a 2 part series where Dr. Tetwiler shares his story from Pediatric ED. Here is the link to part one of the story
The trauma surgeon’s voice was angry and disgusted. Outside the room I found the trauma surgeon, who had arrived in case the child could have been taken to the operating room, and my Attending speaking with the cop. The cop had taken off his bloody shirt, and a flat, empty expression and a quiet voice had replaced his desperate energy. They had received a call about gunshots being fired at a liquor store. On arrival they had found the child with the bullet wound lying in his mother’s arms. They hadn’t waited for the ambulance. They had made the decision to rush the child directly to the hospital. The cop’s eyes turned to my Attending, searching for something. My Attending shook his head, “With a mechanism like that, it wouldn’t have mattered. Thank you.” The cop sank down into a chair.
My Attending was a senior leader in the emergency department. He had previously been a military doctor, and had been the medical director during the first invasion of Fallujah. There was no one else I would have rather had watching over the team for a gunshot victim. The many stories he liked to tell were often punctuated with his wide grin and enthusiastic laugh. Now, his face was steady and expressionless, and he told us he was going to tell the family what had happened. Diana stayed, the work in the department continued. My Icelandic roommate and I followed our Attending towards the room where the family was waiting. I was drawn along by a sense of responsibility. I was the least experienced in many things, but I had already seen bad news given several times. I had seen families react with despair, anger, or disbelief. Despite the dread I felt as we marched towards the family, I felt the need to support my Attending as he told the news. Not that the former medical director of a military invasion needed the support of the intern. But even in those short moments, the boy had been my patient too, and the job wasn’t done.
As we entered the room, I saw a woman seated in a chair, whose face immediately turned towards us as we entered, and a man standing to her right. There were police in the room, which was unusual. My attending asked them to leave the room, and they said they would wait outside. The Icelandic roommate and I took seats to the side of the Attending as he looked at the couple, and in a soft voice stated, “I am the supervising doctor, and I am sorry to tell you, that your son is dead.”
He deliberately used the word, the definitive expression for the end of a life. Afterward, he paused. The woman crumpled into deep sobs, head in her hands, her back heaving as she took short gasping breaths. The man’s expression didn’t change. He looked at the door, then back down to the woman. Yet, his blank expression wasn’t dazed confusion, and I couldn’t understand his reaction. Then I berated myself, realizing I could have no idea what he must be experiencing. I reached out to put a hand on the shoulder of the woman as she cried. I heard my attending begin to speak, asking about what had happened, if they had been present for the gunshot, if they knew how many shots had been fired. I knew, academically, that he was asking in order to better understand the two wounds on the sides of the child’s face. That as emergency medicine physicians we should never label gunshot wounds as entry or exit points, because the assumption could be wrong. We could never truly be sure of the path the bullet took as it tore a maze of devastation through a body. My Attending was making asking if there had been more than one bullet.
“I already told the police everything”, the man retorted.
The room suddenly felt undeniable strange. Of all the reactions to bad news I had seen, this was different. The mother continued to cry. The face of my Icelandic roommate was unreadable, but his blue eyes were opened wide. My Attending frowned, expressed his condolences, and asked if they had any more questions.
“I’d like to go outside and have a smoke”, said the man. The woman looked up at us, then continued to cry.
My Attending nodded understandingly without directly addressing the question, and said that we would give them a moment together. As we stepped outside the police officers told the Attending that they needed to ask the man a few more questions. That was enough for me. I didn’t want to know what the questions were. I tapped my Icelandic roommate on the shoulder and pulled away. My shift had been over long ago. I gathered my things and waved to Diana as I left the emergency room. I left the notes for another time. I wanted to go home.
As I drove away from the hospital, I felt flat. I didn’t know what to think, or how I was supposed to feel. I couldn’t know. At that moment all my mind could register was how light the child had felt, and I could not remove from my memory the fixed gaze of the boy’s eyes as he hung in my arms. The next day I would read in the paper about a fight at a liquor store during which guns had been drawn, and how a child had died. Days later I would sit with my Icelandic roommate and his girlfriend in a diner and talk about the experience, about how we felt that something had changed but couldn’t explain the difference, didn’t know how to describe what we had lost. A week later a vigil would be held for the child in the middle of an urban community, and speakers would talk about the dangers of guns and violence in our society. Months later Diana would confess to me how hard the experience had been, that she could not separate in the moment the dead child and her own one year old son waiting at home. Over the next year she would lead a series of wellness lectures aimed at improving the psychological health of our emergency medicine residents. During the next few years I would put I.O.s into the hands of other interns for their first time, and I would run my own pediatric traumas. Still, as I drove home that night I couldn’t help think about the boy in my arms.
I would always know the weightlessness of the body of a small child.
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Michael Tetwiler, MD
Michael Tetwiler grew up in a small town in Kansas. After completing his undergraduate studies in English Literature, he pursued his medical degree at the University of Kansas. During medical school, he was awarded a Fulbright Research grant that analyzed clean water initiatives in the Peruvian Amazon. His work in his medical school's free clinic led him to pursue an MPH in Health Management at the Harvard T. H. Chan School of Public Health. These experiences led him to a residency in Emergency Medicine at Harbor UCLA where his work focuses on helping underserved spanish speaking communities and initiatives for resident wellness.