Two more snippets

FICKLE CATS::

When I am in bed, they snuggle up against me: likely due to the warmth from my electric blanket. I can pet them, and they do not beat feet, alarmed, at my approach. They purr, and roll into my petting. On the table in the cat room, similarly, I can pet them, and they purr like miniature motorcycles.

Elsewhere in the house, I approach them, and they elope as if I were the Cat Attacking Golem, or something. Of course, when they are on the counter, or the dining room table while we are eating, I do chastise them: “Are you on MY counter? Bad Cat!” accompanied with a sort of interpretive dance, which most closely resembles an effort to shoo away angry, invisible, hornets.

ANOTHE STORY FROM THE STREET

So, TINS, TIWFDASL….well, no. I was at home, long ago and far away, when The Plaintiff (aka TDW-Mark 1) and I were still in wedded bliss. In the very rural county in which we lived, EMS was provided by a sort of tiered response: in the event of an emergency, dispatch would alert the sheriff’s deputies on patrol, and tone out the nearest fire department to send their rescue. The ambulance would depart from the hospital in The County Seat, and the crew would make their way to the scene. There, the three agencies would address the problem, and then, response complete, resume whatever they had been previously been doing.

I volunteered for the local rescue, since, I figured, I would want SOMEONE to respond when/if we had our own emergency, therefore it seemed reasonable to carry a pager and respond when some neighbor had THEIR emergency.

Let me interject that I had a scanner at home, and so I (and TDW-Mark 1) could monitor the goings on in the Fire/Police/EMS world. Or, our corner thereof.

So, one evening I was home. The pager went off, and I responded to the fire hall. Another firefighter arrived, and we were off.

We arrived to find a sedan crumpled amongst the trees lining the side of County Road Whatever. The deputies had already triaged the scene, and pointed out one soul who was not making much sense. As I approached, my differential diagnosis expanded from head injury, to head injury, or intoxicated, or combinations of the above. This was elicited by the prominent odors of ethanol emanating from my subject.

Well, when you have a soul who was involved in a collision, as this guy had been, who is not able to navigate or articulate, as this fellow was not, one must wonder if the collision had cracked his coconut (not, strictly speaking, a medical term, you know…), and that was why he had his articulation and locomotion difficulties, or was he intoxicated into dystaxia/dyarthria, or (perhaps worst of all potential scenarios) was the intoxication obscuring his intracranial bleed, or something similarly dire?

I, paramedic and RN that I was at the time, was elected to ride in the back as Mr. Ethanol Odor was transported to hospital assessment and management. Of course, he was spine boarded. Of course, he disapproved. Of course, he protested, loudly and profanely, about our handling of him, as well as the fact that he desired to depart our company and be on about his business (not an exact quote).

I recall providing report by radio, his soliloquy in the background. He was describing my character flaws, and errors in my upbringing, at volume. As an exact quote, he suggested the my shortcomings included, “Assholes! M@74erf&25ers! Dickheads!” (I suppose he included my partners in this assessment, come to think about it.)

I unkeyed for a moment, prior to concluding my report, and, rekeying the radio, observed, as he renewed his Short Course On Character Disorders, “As you can tell, patient in no evident respiratory distress!”

I arrived home to find TDW-Mark 1, chuckling. “No distress, huh? Have you told your mother hello for him?”

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DUTY: A RETROSPECTIVE

It is the eve of Christmas Eve as I sit here. The roads were TFA (Too Freaking Awful) today for me to drive the lebenty some miles in to work, so I had called off.

TDW-Mark II had commented that today would be a good day to NOT be taking road calls, and I agreed.

I remembered a Christmas at home, 2 years ago.

So, TINS©, I was lolling around the house on Christmas Day. TDW-Mark II and I were casually surfing the web. I had my handheld amateur radio on, monitoring our county’s fire dispatch. Because, well, I can.

In our county, emergency personnel are generally volunteers. The EMS is paid/full time (such as THAT pay is!), Sheriff and local PD are paid/full time (but often respond from home, off duty, so to speak), but the firefighters and rescue are volunteers, dispatched by pager. The tones dropped for a cardiac arrest, CPR in progress, in the outskirts of the county. Now my county is rural, primarily (by surface area) farmland. The ambulance was called out, as well as the County Seat Volunteer Fire Department (Hereinafter, CSFD).

I heard EMS acknowledge, and the duty fire chief as well. He (the chief) directed that the firefighters respond without him, as he was a couple of miles from the scene and would respond directly.

Dispatch then filled in the dispatch information, beyond the address. A 70-something male had collapsed. CPR was in progress. He was vomiting, and the family was clearing his mouth as best they could. A couple of minutes later (likely that seemed like days, to the folks on the scene, performing CPR on one of their family!), the fire chief called out on the scene “Chief on scene with one firefighter. Sheriff on scene. Dispatch, roll one engine for manpower.”

So, let’s “dolly back”, and consider this. With the possible exception of the deputy (who might also have responded, off duty, from home in his patrol car), all these folks were snug in their own homes, fat, dumb and happy, savoring the anniversary of The Birth of Our Saviour, as well as immersing themselves in the excitement of the children at All! The! Presents! they had received.

They carry pagers because, well, that’s what they do. More likely than not, they do not see themselves as heroic, or making sacrifices, because, after all, in most of America (hell, I suspect in most of the world), the men and women performing these jobs simply see themselves as doing what needs to be done, because they are able to do so.

And therefore, when the pager alerted them, they grabbed their coats, put on their boots, and left their warm and happy homes, heading to somebody else’s home, someplace where, as Chief Dennis Compton of Mesa, AZ Fire once described it, “We are responding to somebody’s worst day of their life”.

So, as I imagine it, the duty chief was enjoying a Christmas with his family, the tones dropped, and off he went. Before he could get out of the door, one of his sons, or maybe a son in law, (or daughter or daughter in law, here in the 21^st century) said something like, “Hey, Dad! Hold up a second! I’m taking that call with you!”

These folks voluntarily immersed themselves in another family’s tragedy. Strove to hold the line, to reverse the evident course. Went to work on Christmas.

When the firefighter came on the radio requesting the sheriff department’s (volunteer!) Victim Support Team, I could call that play. I do not know if I teared up at the family’s terror, at their loss, at the fact that forever more Christmas would not hold happy childhood memories, but, rather, would be “the day grandpa died”, or if I teared up thinking of the folks who, simply “doing their jobs”, had left their warm homes in response to some stranger’s plea for help.

But, I wept.

Please, give a thought to those who respond to those calls, today and every day of the year, all over the world.

And offer a prayer on behalf of those they go to rescue.

“Warn-A-Brutha”, in action.

So, TINS©, TIWFDASL©, and my MA, let us call her Maryann, exited the room that she had entered, shortly before, to assess and obtain vitals on a child.

“Reltney, this child here is working kind of hard to breathe, and he is coughing a lot: it seems to interfere with his taking a breath!”

I entered the room, and noted a child coughing approx every 10 seconds (and I mean a full throated cough, not some modest little “harrumph!” kind of thing), and, as I observed his breathing, noted a rate of around 60 breaths a minute.

Not so good.

We administered a breathing treatment, and he had kind of, sort of, maybe improved just a little bit.

I finished my assessment, and went to chart, intending to return and re assess him once my (generally 4-7 minute) charting was completed.

I did so, and noted that his breathing had dis-improved (is that really a word?). I invited the physician with whom I was working to lay eyes upon him, briefing her upon my observations and actions thus far.

Once she had assessed him, she was not favorably impressed. She, also, thought he was working kind of hard to breath. She, also, wondered if this was fixing to run him out beyond the end of his reserves, whereupon he would crash, likely biggly, and become a no shit emergency. She wondered if sending him to emergency, prior to that happening, might not be more wise than waiting until he did, indeed, crash.

I agreed.

I wrapped up my charting, once the child was safely on the way, and hunted up Maryann. I congratulated her. “You did good. Your prompt assessment that this child was not breathing right, set in motion events necessary to get him to the appropriate level of care, in a timely manner. Well done!”

WARN-A-BRUTHAH!

I was on vacation, early last year, and saw a t shirt, with the Warner Brother’s logo, and the script, above and below the shield, admonishing the reader, “If ya see da poleece, WARN-A-BRUTHA!”

https://www.topseasonshirtz.com/view/114/if-you-see-the-police-warn-a-brother–t-shirt

(this will be relevant soon. Be patient.)

The other day, I was watching our grease board, where the registrars enter each patient’s name, and a summary of their complaint. I was (unpleasantly) surprised to note one fresh entry, asserting that the named patient, an infant, had “difficulty breathing”.

I directed my MA to go see that patient, and assess this complaint.

He promptly entered one of the exam rooms with this child, obtaining vital signs, and telling me, “Reltney, I think you want to see this kid, next!”

I entered to see an infant, with audible rhonchi (coarse breath sounds). The heartrate wasn’t awful, the respiratory rate was sort of elevated, and the oxygen was 94 %. Not perfect, but OK. This child was retracting wherein the skin beneath the lower margin of the ribs was being drawn in, a little, with each inspiration. We administered a breathing treatment, in hopes of resolution of the rhonchi, and less effort of breathing.

After the treatment, the rhonchi had improved, just a little, and the retractions might have maybe, sort of, kinda improved. I asked the parents to hold on a while, to see how the child progressed.

I rechecked in another ten minutes, and the retractions had definitely gotten worse. Vitals were still not awful, but one of the principles of treating children is that they generally tend to do OK when ill, until, abruptly, they do not. I was concerned that this child was running out of steam, and approaching a crash. So, I called ED, gave report, and sent the child over.

Subsequently, I was talking to the registrar supervisor, and told the story with which I started this story. I amended it to read, “If you or the mother think that the child is sick, warn a brotha!”

And, in this scenario, my pale ass is the “Brutha” in question.

Another post, from another website

Bad Dancer (commenting at Gun Free Zone blog) says:

October 21, 2022 at 9:50 am

Thank you for the article and links Reltney McFee I’ve read it several times and will go through it again to make notes soon. I appreciate you sharing your experience and advice.

I’m building a few kits as Christmas presents this year. Are there any supplies you recommend added for a family that has a 1-2 year old?

Thank you for reading. Outstanding question! With regard to families that have toddlers (or infants), my first pass suggestions would sound very much like, “What did you want on your last camping trip, that you did not have?” along with, “what sort of comfort item does your child love?”

If I were to add to that, I would look to my own “Grand Kids Are Here: What Might I Need RFN?” (GKAHWMINRFN) supplies. Now, remember, I’ve been a paramedic, paramedic instructor, ED Registered Nurse, and mid level provider since Jimmeh Cahteh was the HMFIC (OK: President).

On the top of my “GKAHWMINRFN” bag is a pediatric BVM (Bag-Valve-Mask: commonly referred to as if they were all branded as Ambu Bags). You might be happy with a pediatric sized rescue breathing mask of some sort, or, easier to pack, mastery of mouth-to-mouth resuscitation.

Near the top would be comfort items, so as to both distract the child, as well as help the child “buy in” to the procedures to be performed. Blankets, pacifiers, stuffed animals: whatever floats the child’s boat.

Remember that children, particularly infants and toddlers, are NOT simply pint sized adults. Due to differences in body surface area, kidney function, maturity of their livers and other factors, they may metabolize medications quite differently from adults. So, just slapping some QuikClot on Little Johnnie’s wound may be a problem. OTOH, here is what I did find in a reference that I use, myself, clinically every day:

“Compared with standard sponges, the use of the kaolin-impregnated sponges in 31 infants undergoing the Norwood procedure had a significantly lower intraoperative use of blood products and lower incidence of perioperative bleeding requiring return to operating room for hemostasis (0 versus 41 percent) [44].” (source: https://www.uptodate.com/contents/overview-of-topical-hemostatic-agents-and-tissue-adhesives?search=quick%20clot&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2249912903

That means, better bleeding control. THAT suggests that a kaolin-impregnated sponge (QuikClot), at least, is not inappropriate for use on bleeding in children that is not otherwise controllable by dressing, direct pressure, and (in extremis) tourniquet-ting. So, small (2×2, 3×3) dressings impregnated with QuikClot appear to be reasonable.

Splinting materials for fingers, limbs, or whatever, are going to be a challenge, both because children do not, as a rule, comprehend the entire “lay still while I splint you” thing, nor the bit about “do not wiggle about, you will work you way out of this splint, and your injured (whatever) will hurt, and be injured further.” So, however much tape or gauze you THINK that you will need, you are wrong, and will require considerably more than you guessed. Unless, of course, you have made it a habit to secure IV armboards to infants and toddlers, several times a day, for the past several years. If you have done so, and done so successfully, please tell me when/where your classes will be, and save me a seat.

Another tangent from adult IFAK/Jump Bag/Holy Fertilizer kits, and child directed emergency care, is that children will both dehydrate, as well as become hypothermic way, way more rapidly than adults, and, once they have burned through their reserves, will crash and burn, often irretrievably. The axiom is that children generally do OK with their injuries, until they don’t. And, when they don’t, they crash biggly. Adults generally slowly decline, until they die. Therefore, measures to protect a child from heat loss are important. That means blankets and knit caps in appropriate sizes. The foil “emergency blankets” are a mixed bag: they are not going to get saturated in whatever bodily fluid is present (good thing), but they are not going to trap heat in a maze of air pockets formed by a Mark 1, Mod Ø fuzzy/fleece/wool blanket. (and you will notice the difference). Select thoughtfully.

Another feature of kid injuries, particularly infants and toddlers, is that they are top heavy. Their heads are a greater proportion of their body weight than adults, and that means that their initial point of impact may be more likely to be their heads, than their hands/wrists/forearms. Therefore, when you are in the hot seat, you need to be suspicious of the possibility of a head injury, when children fall. You have learned to spine board/cervical collar/secure for transport, head (and that is often spelled N-E-C-K) injured patients, right?

Right?

Another needful skill, that you pray is never needed.

That is it for my off the cuff, just got home from work and warmed up my laptop, answer to your question.

Thank you for the stimulating inquiry. Gonna be food for more rumination!

Reltney McFee

Lessons Learned From Other’s Experiences

Another blogger posted a recounting of his experience, recently, at a public range (I believe he is in Canada). He cited Elisjsha Dicken, the armed civilian who stopped the Greenwood Indiana mall shooter, hereafter referred to as Some Asshole In Greenwood, within 2 minutes of the crime beginning, and, according to Dicken’s attorney, from a distance of 40 yards.

Speaking only for myself, and throwing no shade one way or the other, I attempted to recreate Mr. Dicken’s accomplishment, with my EDC sidearm, and no time/life threat pressure. I failed, miserably. My personal take home, is “Moar! Range! Time!” If you get advice to practice, practice, and practice some more, that is sound advice, and we all should do so.

Other reports that I recall seeing, assert that Dicken’s girlfriend, a student nurse, responded to care for casualties, once the shooting had stopped.

THAT reminds me of everyday carry. As is often asserted on the blog, Gun Free Zone, if you carry a sidearm in order to put holes in bad people, should the need to stop such arise, then you ought to anticipate that these selfsame bad people may put holes in you, yours, or other innocents. Therefore you (and I) ought to be ready to address that problem.

There are many ways to address that need. I carry a CAT tourniquet in an ankle holster, as well as a SWAT-T elastic tourniquet in my pocket, all the time. There are two exceptions: when I carry TWO CAT tourniquets, or when I am swimming.

While it is worthwhile to carry a medic bag, suitable to your own training, getting that training is JOB NUMBER ONE! I betcha that I can finagle trauma dressings from at hand materials, faster than I can learn, in the first place, what sort of thing is immediately needful to care for a trauma patient.

Of course, I have something approaching 50 years (not a typo) of experience in this business, so, there is that going for me, I suppose.

If you wonder what you ought to pack for bad times, look over my blog post, here. Or, you could see what Aesop has to say. He is controversial, but, regarding medical matters that I have the experience to have an opinion about, he is spot on. No crap, straight up. He recently posted a set of links to his “greatest hits”. I direct you to peruse same: there’s GOLD in them thar hills!

So, I will attempt to let my preachin’ end, here, for a while. Thank you for riding along.

REDUNDANCY.

The other day, I was reading about everyday carry, and one writer was talking about how “two is one, and one is none”.

I recalled one night, nursing midnights in ICU. Now, every single hospital that I have ever worked at, has an emergency generator. These are equipped (or, at least, SUPPOSED to be equipped) with an automatic apparatus, that is intended to identify an interruption in the supply of power from the local power company, and start up the on site emergency generator, and then, once said generator is up to speed and functioning, disconnect the hospital from the shore power, and energize all “emergency” circuits from the generator.

As it developed, on this night, the power went out, and everything went black. We eagerly awaited the onset of generator power, but, alas, such was not to be.

Now, y’all may not know this, but in an ICU, there is an abundance of very, very sick folks. Indeed, several of them are dependent on ventilators to, well, ventilate them, since their illness renders them incapable of breathing adequately on their own.

With that thought in mind, it may not be a surprise that these life saving ventilators require an uninterrupted supply of several things, not the least of which is electricity, in order to function. When the power fails, and the emergency generators do NOT promptly start up, well, things get interesting.

While the ventilators, themselves, do NOT have battery backup, the alarms signaling malfunction, do. In order to respond to these alarms, the nurses, such as myself, need to alight from our chairs, walk around the nurse’s station, enter the room, and identify and remedy the fault eliciting the alarm.

(a) That is considerably easier to accomplish when you can see where the frack you are going, and identify trip-and-fall hazards, prior to, uh, tripping over said hazard, and falling upon your face.

(b) Should you have TWO ventilated patients, you are tasked with reaching each patient, disconnecting that soul from the (nonfunctioning) ventilator, and manually ventilating them employing the manual bag-valve resuscitator kept at bedside for just this sort of problem.

Except, you are one, non elasto-nurse, person.

As it developed, our ward clerk was in nursing school, was intelligent, and had paid attention. She ventilated my second patient, and the on-unit respiratory therapist ventilated Mary Sue’s second ventilated patient.

It only took a couple of minutes (…that seemed like hours!) before we regained power. But, I thereafter took to carrying a flashlight on my person.

Problem solved, right?

Not so right. A couple of weeks later, the power failed, again. The generator failed to generate, again, and I thought, “Voila! I’ll whip out my handy-dandy flashlight, and illuminate the area!”

Problem with that, is that the flashlight had somehow turned itself on, while on my belt, and was deader than disco. So, same cluster…er, hug (yeah! HUG!), same musical ventilation, and same subjective eternity until power came back on.

New! Improved! Plan, was a couple of flashlights, with a regularly (every other month) assessment of function and battery charged-ness. As well as additional flashlights squirreled about my person. So, presently, I have two flashlights on my belt, two in my shirt pocket (one Streamlight Stylus Pro, another that has been customized with a near UV emitter, so that I can use it as a Wood’s Lamp), one on my badge (one of the coin cell lights thrown in with my order from the folks selling me my CR 123 batteries), and one on my keyring (a Streamlight Nanolight). (none of these are any sort of freebie: I bought the Nanolight, and the Stylus, and then bought several more, at retail, because they perform for me what I need doing. Like, illuminate my way when nocturnal dogwalking, allowing me to avoid a dirt faceplant.)

Fighting Disease, And Saving Lives

Gather ’round, boys and girls, and let Uncle Stretcher Ape regale you with another tale of FDASL.

So, the other week, I meandered into work, safely early (or so I thought). I was just about to drop my lunch, backpack, and coat, when the overhead page alerted: “Code Alert to walk in!”

Well, that was odd. I grabbed my stethoscope, and walked out of the office, simply to be certain that I was, indeed, in the walk in. Yep, I certainly was.

One of the MAs, looking excited, directed me to the room adjacent to where I was standing.

I entered to find a flaccid child, eyes literally rolled up into her head, as the MA at the bedside was busily obtaining vital signs. She gave me hurried report: child had arrived looking unsteady, reception had twigged, promptly to my FAVORITE “vital sign”: (“Dude Don’t Look Right”), summoned the MA staff, and, well, then things got exciting.

The child, as soon as she had been laid down, had gone unresponsive, per the report I got. I auscultated, verifying presence of air movement and heart beat. Finding a radial pulse, I went to the registrar, and asked, “Where is my bus?”

She smiled, knowing how I think, and replied, “I’ve called the ambulance already”

“Outstanding!” was my reply, and I returned to the room.

As I turned around, I noticed my physician supervisor, as well as my pediatric supervisor. I gave them a brief synopsis of what I knew, and what my plan was (“get her off to ED, as soon as humanly possible”, if I recall correctly).

Soon, EMS arrived. I gave them report, as best I could, and they packed her up and skedaddled (No, that is not strictly speaking a medical term. But, it worked for me!)

I subsequently spoke with the registrar who had first contacted mom and child. She had determined, indeed, that this child very much did not look right, and had promptly summoned assistance.

The first MA to respond, had promptly identified that this was way, Way, WAY beyond our level of care, and had initiated calling EMS, RFN (Right Freaking Now), as well as the “Code Alert”.

Good call.

So, a couple of days later, my physician supervisor, along with the administrator, passed through for a weekly review of our quality indicators. Winding up their pitch, they asked if we had anything to call to their attention. Yep, I did.

I praised the registrar who correctly, and promptly made the triage call. I praised the MA who had responded, and initiated the “Code Alert”, as well as the EMS call, properly, promptly, and effectively. I wound up by stating that they deserved praise for responding appropriately and calmly in a crisis.

This is to illustrate, again, quiet people who, taking pride in what they do, strive to improve, attend to duty, and take care of business. As Heinlein said, “Take a look around you. There never were enough bosses to check up on all that work. From Independence Hall to the Grand Coulee Dam, these things were built level and square by craftsmen who were honest in their bones.” (https://thisibelieve.org/essay/16630/)

I work with these folks. I rely on their intelligence, their judgment, their engagement with what they do. As Eaton Rapids Joe noted, “You get more of what you recognize”.

SURPRISE!

So, there I was, fighting disease and saving lives, and my MA came to me, regarding somebody who had arrived for a subsequent Covid inoculation. This soul had informed my MA, AFTER THE INJECTION HAD BEEN ADMINISTERED, that she, the patient, had had a reaction to her first inoculation. She described this reaction as swelling, itching, and feeling ill. This had developed in a couple of hours after the injection.

It turned out that, today, this patient had, indeed, developed swelling, runny nose, cough, and whole body itching within FREAKING MINUTES after her injection. (those of my studio audience who have some sick people experience might recognize these indications as harbingers of anaphylaxis)

Weellll, we administered some IM Benadryl, some IM steroids, a breathing treatment, and close attention from my MA. Several repetitions of vital signs and reassessments later, this lady had seen her breathing improve, her itching subside, her swelling tapered, and the cough and runny nose reduced.

So, pro tip: If you swell up after the first dose of whatever the frack you are being injected with, tell a motherfucker, ya know, like, BEFORE you get the next injection. Personally, my geezerly ass will very, very much appreciate it.

HALLOWEEN

A long, long time ago, in a county very far away, I was an ER nurse working nights. Indeed, this was so very long ago, that The Plaintiff had not, yet, become The Plaintiff.

It so happened that one Halloween I found myself working. At that time, in that county, we had a dispatch radio in the nurses’ station. After all, in a small hospital, in a very rural county, if you have advance notice of ill tidings, well, sometimes you can gather your selves, and more effectively address the particular ill tidings that are brought to your door.

My shift started at 1900 hours, and day shift had hardly departed when the tones went off dispatching the firefighters, rescue, and sheriff’s department from a couple of townships over. The nature of the call chilled my blood: child pedestrian, pedestrian vs auto on one of the local two lane state highways.

In rural The Un Named Flyover State, traffic on our state highways commonly travels at around 60 mph. Now, KE=1/2 MV². That means that a, oh, say, 3000 pound vehicle at 60 mph runs around 361,040 foot pounds of energy. (By comparison, a 30-06 bullet runs around 3,133 foot pounds, and will kill any large game animal on the North American continent). When this strikes a, say, 80 pound child who abruptly darts out from between parked cars, well, it is catastrophic.

And, it was, indeed, catastrophic. Responding to the call, mothers, fathers, uncles, aunts, sons, daughters: the entirety of the emergency response apparatus in that corner of our county: hell, from couple of surrounding counties, as well: responded, praying, hoping, that somehow they could mitigate this disaster.

It seemed as though the medics spent seconds on the scene. It likely seemed like hours to the horrified family. One second, this child was running along, gleeful and excited at Halloween, eagerly anticipating All! The Candy! that would soon be spread out on the living room floor, and a second later, he was unconscious, broken, in the road.

The county and State Police ran interference, shutting down the expressway to speed the ambulance along it’s way. Our local city cops closed the cross streets, and the medics screamed into our parking lot, where we waited, alerted by the phone call from dispatch.

There were an amazing number of personnel in and about our ER that night. Every floor in the hospital detailed someone to either help, or stand by to see how they could help. The lab was there, cardiopulmonary, and that is not to mention the firefighters from our town, and our cops, in the parking lot, waiting to see if they, too, could help.

The ER doc was not about to half step, and employed every tool at his disposal. But, sometimes Death wins, and we can do nothing to forestall His victory.

We nurses cleaned the child up as best we could, tucking him in with clean linens, and a clean fresh gown. We tried our best to make him appear simply asleep.

The family came into the resuscitation room, and wailed their grief. In that setting, there is really nothing that you can do, nothing of any substance. We stood by, silent witnesses to their heartbreak.

Eventually, they had wept themselves dry. Neighbors assisted the parents from the room, to drive them back home. Later, they would have to plan his funeral, put away his toys, clothing, and things, and come to terms with the forever loss of their little boy.

Halloween would never ever be the same for that family.

A couple of hours later, TDW-Mark I (subsequently The Plaintiff) stopped by. She had taken our two kids then aged 6 and 3, Trick-or-Treating, and they were so darned cute, it finished me. I swept them up into a hug, and likely puzzled them by weeping. Truth be told, I suspect that TDW was surprised, herself. Until one of my partners told her the story of earlier in the night.