Day number 2 as an “upper level” resident was a little less hectic for me. I enjoy having newer people around asking me questions (as long as I can answer them), it makes me realize how far I’ve come this past year. Now that I’m out of the ICU, my daily stories will probalby be a little less grim, and possibly, downright boring. But today, I did have an interaction that was significantly more involved emotionally than most of my emergency department interactions.
I picked up a chart off the ledge of an 11 year old boy, whose chief complaint was “saw his brother get hit by a car, wants to talk.” My first reaction was that I wouldn’t have anything to offer to him and that he would probably need outpatient counsiling…after all, I didn’t have time to offer an 30 minute talk therapy session in the midst of all the traumas and other patients that had arrived last night. I procrastinated and dispositioned one or two patients first. I finally went to the ‘quiet room’, a room usually reserved for families of trauma patients, or psych patients if the ‘psych room’ is full. I had assumed it was for the latter reason. But when I walked into the room, I was immediately confrontied by about 12 pairs of eyes all focused on me. I suddenly realized that the car accident the little boy had witnessed was the the patient who had just been flown in to our trauma bay by the helicopter. An entire extended family was there, many with tearful eyes. There was a chaplain in the room with them, and a lot of sobbing as well. I felt like I had been sabataged as I tried to sort out which one of the twelve my patient was.
I finally sorted it out, and asked the father (of both the boy who had been hit by a car and the brother who had witnessed it) to come to a quiet room with me and his son. I spent about fifteen minutes talking to the boy, and giving him reassurance, without knowing what sort of injuries his brother had ended up with. He described to me exactly what he had witnessed, his brother running out, being hit by the car, then getting thrown forward and hitting the pavement. He watched while the paramedics responded to the scene, and intubated him. I still knew that all I could do was to provide reassurance that his feelings were expected and normal and that the doctors had taken care of people who had been hit by cars before. But I wanted to provide some kind of follow up for them.
I called our pediatric psychiatrist who was on call, who was extremely helpful. He seemed emotionally touched himself by the whole story and gave me several specific points of advice in terms of the comfort and reassurance I could provide for the family tonight…specifically to reassure them that although the scene may playback in their minds, not to be frightened of it, and the intensity of those thoughts will decrease with time. He also wanted me to ask about the families religous beliefs and encourage them to pray together according to whatever their own beliefs were.
I usually find psychiatrists to be very emotionally detached, but usually sympathetic to their patient’s circumstances. But tonight, I was very, very impressed with the advice that the psychiatrist had to offer to both me, as the doctor treating the little boy in the ED, as well as the advice he wanted me to pass on to the family. I was able to give them the phone number of the psychiatrist for urgent appointments, and also to set up an appointment for the following week.