SWEET DREAMS, ANGEL

Sherry Jones, RN, AEMT

The telephone's ringing was an unwelcome intrusion into the night,
breaking our silence into a thousand shards reflecting bits of dreams
and pieces of reality mixing into an unreachable moment.

"Station nine, Cheryl," I mumbled, feigning coherence.

"Priority one," said Ronda, the EMS dispatcher. "I need you on the air
right away."

I shook off the last bits of sleep and called out to my partner in the
bunk beside me. "Bob, priority one. Ronda sounds a little edgy \-- we'd
better move it."

Sometimes the dispatchers have to use creative management skills when
the crews on twenty-four hour shifts rebel at being allowed only a few
minutes of sporadic and often interrupted sleep. Working a double, this
had been one of those shifts; we were trying to grab a quick nap and
hadn't had time for lunch or dinner. Company policy dictated that we had
three minutes to get into the ambulance and report on the air. Instead
of using our time to freshen up, we each popped a piece of chewing gum
into our mouths and immediately headed out the door. We assumed that
Ronda was in a \'mood,\' and didn't want to incur any further wrath \--
we still had ten of the forty-eight hours left to work.

"Alpha 255 is on the air."

"255, priority one for Dearborn Park. Make northbound Southfield ramp to
I-94 westbound. Child hit by a van. Your D-card number is 3472, time of
call 2209h."

"255 copies."

We now understood the edginess in Ronda's otherwise calm voice. The 'big
three' in dreaded EMS calls are those involving family members, friends
and children. Normally, I drove and Bob navigated, but this was a race
against time. Bob jumped in the driver's seat and I hopped in the back
to set up the advanced life support equipment. We knew before we pulled
the ambulance out of the bay that when a pedestrian takes on a motor
vehicle, the vehicle usually wins.

"Spike two lines, normal saline and lactated ringers," yelled Bob over
his shoulder, straining to be heard above the screaming sirens. I knew
what to do, but Bob's calling out orders and my responding as I
completed each step began the process of communication that was vital to
our success as a team. "Pull out the drug box and set up the (cardiac)
monitor. Don't prepare the paddles or leads until we see how big this
kid is."

I hung the bags, though it seemed to take an interminable amount of
time; my hands felt big and especially clumsy as I tried to pull the
packaging open and bleed the IV lines. The overhead strobe lights cast
eerie red intermittent bursts inside the patient compartment, ticking
off the seconds in our patient's 'golden hour.' It triggered an almost
comical mental image: a wino, sitting in a cheap hotel room, was chain
smoking cigarettes with eyes transfixed on a small black and white TV
screen. In this image, a red 'hotel' sign flashed just outside his
window, giving momentary peeks, in the red, smoky glow, of his reality.
At that particular moment, my own reality was just as undesirable.

"Both bags are hung, the tape is ripped and hanging on the overhead bar.
Catheters are in a box on the bench seat with the pulse oximeter, and
the oxygen is on. Do you want the intubation kit left in the jump kit or
opened and set up back here?"

"Leave it in the jump kit," said Bob. "We might have to tube him on the
ground."

It was hard for me to monitor the radio communications from the back, so
I asked Bob if the fire department was on scene: "affirmative." We knew
that if fire-rescue workers were already there, they would stabilize our
patient and perform whatever basic life support measures necessary. The
fire trucks were a welcome sight as we rounded the curve toward the
accident.

It isn't our job to judge patients or their circumstances, but that
level of professionalism is extremely difficult to maintain when you see
something like severe trauma to a child. You can't help wondering what
prompted him to be in such a dangerous place, especially at night \...
and where on earth were his parents?

Taking a look at our patient, it didn't seem as though anyone would ever
have the opportunity to question his judgment, or take away some
privilege as punishment for his playing in traffic. He was paying a
pretty big price for what was probably an impulsive act. Instead of
worrying about the things that normally

concern kids \-- like cool clothes and catching something awesome on the
tube \-- this kid was struggling to breathe.

The fire department rescue crew had already applied MAST pants (to
stabilize lower extremity fractures), and secured our patient to a long
backboard. He appeared to be about eleven years old, blonde hair, about
five feet tall, maybe 95 pounds. There were multiple abrasions on his
head and face, matting that blonde hair into bloody clumps, with
bruising around both eyes. Blood oozed out of the boy\'s nose and mouth,
staining the cervical collar around his neck. He was in labored, agonal
respirations as we approached.

Bob checked for pulses, and found a faint radial pulse at a rate of
about thirty. The boy's pupils were fixed and dilated, his skin cool and
pale, and his lungs were already filling with fluid. We popped an oral
airway in his mouth and began bagging with 100% oxygen. Lifting him onto
our stretcher, we welcomed him into our world: a guaranteed, miracle
making, emergency room on wheels. Prayers administered copiously at no
extra charge.

After loading, we again checked pulses. Finding absent pulses, and
confirming that the boy was not breathing, Bob muttered an expletive and
called for CPR to begin. A rescue worker jumped in the front seat to
drive. While the firefighters on board continued compressions and
bag-valve-mask ventilations, we got the intubation equipment ready. A
"quick look" on the cardiac monitor showed an AMF rhythm (Adios, Mother
F'r), also known as asystole \-- flatline. Firefighters continued CPR
with hyperventilations while Bob intubated and I looked for an IV site.

The firefighters had already cut the boy\'s rather thick coat sleeve. I
assumed they had prepared an opening for me to start the line and
grabbed the boy's arm with both hands to look for a good vein. The upper
arm bent quickly in half like a rag doll's, mid-shaft. Apparently, his
humerus had sustained a complete fracture, and the arm bent grotesquely
and flopped off to the side. I took a deep breath, grabbed my medic
shears, and exposed the other arm. Finding an acceptable vein, I
muttered an audible and brief prayer \-- something to the effect of,
"dear God, please let me get this first try," \-- and popped a needle
into his right antecubital vein. I taped the line down as Bob secured
his tube, and started preparing the drugs while Bob established a second
line in the left external jugular vein.

Things moved smoothly and efficiently, like a well-rehearsed movie
scene. It felt like an aberration of time, as sound and movements
achieved a slowing distortion. Our on-scene and enroute times would
later prove to be exceptionally brief, but it felt as though we were
there for eons. In spite of our perceptual conflicts, we did manage to
get weak pulses back after pushing the epinephrine and atropine. The
monitor showed an ever-hopeful sinus tach at a rate of 120, but it
didn't last.

We pushed all the appropriate drugs and performed our protocols
flawlessly, but the boy, whose name we later learned was Scott, died
shortly after arriving at the hospital. His skull exhibited profound
crepitation, and his abdomen was rigid and distended with spilled blood.
My partner wrote the report as I cleaned our rig with 'big orange' to
replace the smell of blood with a more socially acceptable citrus scent.
When we had both finished, I went back into the room and held onto
Scott's cold foot for a moment, trying one last time to will life back
into him. Our training concentrates on producing positive results and
saving lives. Nobody ever told us what to do when our advanced skills
and expensive toys don't work.

Bob and I didn't talk about Scott, or the call, except to critique
procedures performed. There was nothing we could have done additionally
or differently, but the boy died. I reminded myself that God performs
miracles in His time, and on whom He decides to confer them. Scott just
wasn't to be a recipient. My partner and I finished our shift and went
home.

I spent the next several hours cuddled up with my daughter. I phoned my
son and told him I loved and missed him. The ambulance call, every
detail perfectly preserved \-- a video without end \-- played itself
continuously in my head. It was like a song that keeps repeating itself
in your consciousness, getting louder and louder, and you can't escape
from it regardless of how hard you try. My heart raced and I couldn't
take

one of those deep, cleansing breaths that reduce stress and offer some
measure of relief. There was no relief. There was no return to normalcy.

Sometimes, in a hidden corner of the mind, there exists a place removed
from reality. Darkness and the images that saturate the senses reaffirm
an individual's powerlessness; these images are beyond the point of
chosen exposure or experience. I spent the next 48 hours unable to eat
or sleep, reliving the violation with its unrelenting intrusive thoughts
in the aftermath of the trauma. As the second night filled with a
darkness

devoid of mercy, and the line between rational and irrational thought
turned into a chasm leading to an emotional abyss, I reached out for
help.

Mark is a good friend who holds a degree in psychology. When I called
him, a friend of his answered the phone, telling me that Mark had just
stepped out. "This is Cheryl. It's nothing important, really, not a
matter of life and death. Well, I guess it is about life and death, but
it's no big deal. Just tell Mark I said hi."

He called back within minutes.

"What's going on?"

"I had a bad call. We picked up a kid who had been FUBAR'd (F'd Up
Beyond All Recognition) by a van. I don't know what the deal is because
I've been doing this for five years, and nothing has ever really
bothered me before, but I can't eat or sleep or turn it off, and it just
keeps rolling around in my head \..."

"All right. First of all, I have a lot of respect for what you do. I
could never do it. What you do and what you see out there are not the
normal things that people see, or should see. Tell me what happened."

Relating the call in elaborate detail \-- with the images so firmly
imprinted I could effortlessly rattle them off \-- I told Mark what
happened. I still couldn't catch my breath, and the room seemed to swim
as I visited the place again. My senses relived their experience; the
smell of exhaust and blood, the bits of glass crunching under my boots,
the controlled panic in the eyes of the emergency workers as they fought
so desperately against our common enemy \-- death. Feelings of
inadequacy mounted, accompanied by the urgent desire to quit my job. I
wanted to never have to go back, never face another parent who hands you
their dead baby, or have to wonder, as you race against time to a scene,
what you will find. There was a wave of understanding beginning to flow
over me. The medics I worked with had told, in their most private

moments, of a desire to have the power of God, just once, to reinflate a
soul with life in the middle of senseless tragedy.

Mark listened patiently. After I had answered all of his questions, he
asked the one that opened the door of my prison. "What was different
about this call?" It took a few minutes to understand what he was
asking. I had seen a lot of people in pieces, handled drowning victims,
offered comfort and understanding to those who faced a loss of dignity
and sanity. I'd been the recipient of projectile vomitus, and perceived
as a hero and then scorned, all in the same day. What was different
about this particular call was not the call itself.

I was in the middle of some demanding personal problems. That same day,
my ex-husband had stormed out of the house, refusing to watch our ten
year old daughter, leaving her to fend for herself. At work, and far
from home, I was powerless to care for her, and hoped that the neighbor
she was visiting would see to her safety. I assumed she was safe, as she
rode her bike with her friends down our quiet streets, but I couldn\'t
justify that assumption. There is no safe place.

The anger at my situation and the realization of the parallel between
the family of the dead child and my own became clear. Scott's mother
left him with friends, trusting that he would be all right. I was with
this other mother's child as he took his last breaths and died before my
eyes. Where was *my* child during this time? I remembered suppressing a
horrible fear as I fought for Scott's life: another medic may have been
cutting *my* daughter's coat sleeve, looking for a good vein, and trying
to will life into her lifeless form. Would they have mourned her loss? I
could feel Mark's hand leading me gently out of the darkness. I cried
for Scott and his family, prayed for their strength through each coming
day, and felt a release as I let him go.

My daughter was upstairs in her bed, asleep. After hanging up the phone,
I stood over her and just watched for a while; her breathing was deep
and even, her face as sweet and innocent as a newborn's. Thanking God
for her, and for Mark's kindness, I climbed into her bed and wrapped my
arms around her. Tucking her warm feet between mine and whispering,
"*sweet dreams, angel*" into her ear, I drifted off to sleep.

![](media/image1.jpeg){width="2.1in"
height="1.1902777777777778in"}"Angel" (Michele) and Mom (Sherry)