The ones that get to you

Emergency med staff can appear to be callous, or cold hearted, or unemotional. We appear this way because we have learnt to protect ourselves against the constant barrage of disaster which appears before us every day: the heart breaking stories we hear and the evidence of human cruelty, day in, day out. Thats not to mention the HUGE amounts of stupidity we are faced with. We have to protect ourselves emotionally, because otherwise we wouldnt be able to do our jobs properly, and none of us would have family lives. So we learn to deal with patients... and then forget (emotionally at least) the things we have seen, so we can carry on.

But I believe every casaulty staff member has a pile of stories of patients that really 'got to them': the ones that you cant forget. These are mine:

The lady who tried to set kill herself by dousing the room, her blankets, and herself in paraffin and then setting the whole lot on fire. She came in alive.... barely. She had about 95% burn wounds (no exaggeration). She died later that night, on a morphine IV line, alone. I cant smell paraffin today without thinking of her.

The little kid who came in when I was an intern, with an hemoglobin of 3,4 and severe jaundice. According to his mother, he had been sick for one day (I doubt it..) He died before we could even start transfusing him, and I never did find out what it was.

The 1 year old who was brought in with 'scabies': sure enough, she had a scabies rash on the backs of her hands, but when I turned her hands over, her palms showed something much more ominous: cigarette burn wounds. Further examination revealed bruising in the shape of fingerprints all over her back, and more burn marks on her stomach. Although I did all the right things medically and legally, it stills upsets me: how can you burn a 1 year old's palm with a lit cigarette?

The 95 year old woman who came in with a pulse rate of 25, awake and talking. Together with her and the family, we decided on no invasive interventions (ie no emergency pacing). She was so polite and grateful for everything we did. She died later that night surrounded by family.

The first family I had to 'break bad news' to: I was an intern, shocked from my first 'real' resus and had to tell the chap's family that despite our best efforts, his MI had got the better of him. They all (of course) started wailing inconsolably, which left me floundering for words and trying not to cry myself.

I cant forget them, even if I wanted to.