Resilience.

Abstract

Looking at my resuscitation team preparing for our next case, I feel good knowing I have over 20 years on the job, the residents are close to graduating from a stiff training experience, and the nurses and ancillary staff are experienced veterans. Collectively, there is over 100 years of patient care experience assembled in wait for the coming patient, a pediatric drowning. I'm confident we have seen nearly everything. The paramedics arrive. Quiet calm ensues as we take over. We hear this child was unattended in a bath and was found unresponsive by the guardian. 9-1-1 was called and CPR was started. EMS initiated great care and it is now our turn to guide this child on the next leg of the resuscitation journey. Although tragic, I know that we have run this type of resuscitation many times before both in training and for real. Airway check here, pediatric ALS there. Pupils fixed and dilated. I see sorrow in the eyes of my team as we realize this prognosis is grim. I'm impressed that despite the tragedy before us, we carry on. If there is a chance for a good outcome, we are going to provide it. Then it hits me. An alarm, deep in my brain, that something isn't right. Unsure of what it is, I try to distance myself from my myopic bedside view of the case and I suddenly realize that the child's hair is not wet. I struggle to process how a bathtub drowning occurs without hair getting wet. Before I can formulate that thought into words, another alarm hits me in the gut as the child's clothing is removed. Why is this bathtub drowning fully clothed? The pattern of bruises on the body becomes visible once the child is disrobed. Next, a thorough secondary exam and the genital trauma becomes apparent. Confusion about the etiology of this case becomes evident in the eyes of my team. The further the case progresses, the more alarmingly horrific the revelations become, bit by excruciating bit. Everyone struggles to connect the dots while still going through the motions of resuscitation. We try to remove the preset expectations of a pediatric drowning resuscitation from our minds and shift gears on the fly for the unexpected findings of this case. There is realization that monsters walk among us as I begin to see the first signs of emotional leakage from my veteran team. A frustrated, angry comment about the situation here, a solitary tear there. This is not what any of us could have predicted and certainly not what we would have chosen. Still, we are charged with maintaining professional composure to do what we can to salvage a terrible case. We had a short team debrief after the case was completed but little was said and we all found comfort in the distraction of moving on to the patients still waiting for care. In retrospect, although this case felt like it shattered the emotional backbone of my team, it really demonstrated their resilience. The reality is that we adjusted to a horror that was rooted in something much broader than what we thought was before us in the stabilization room. I am proud of the dedicated skill and commitment my teammates always exhibit despite the horrendous emotional tolls such as this that they have paid over the years. They motivate me daily and I am lucky to work with all of them. We did our best for this child and our resilience will get us up again tomorrow to do it all over again.