I wish I could tell you exactly what it was like and tell you everything about her, but I can’t. I don’t know anything about her. I felt like I wasn’t even really there today.

When she first rolled in the trauma room, complete silence enveloped us, rather than chaos, which is the norm. Wisps of blond-hair floated around her soft, pearl colored face. The tiny pediatric bag valve mask brought this nightmare to life as I quietly took it from the paramedic and gave small puffs of air to the little girl. One one-thousand, two-one-thousand, squeeze. One-one-thousand, two-one-thousand, squeeze.

The trauma team slowly laid hands on her, while the attending called out the injuries as she found them. “Contusion to forehead,” she announced. The nursing report from the paramedic to the circulating nurse became a whisper. “Bruise to right anterior chest wall.” I fussed with her c-collar while an intern poked at her thready femoral arteries. How does a minor fall from yesterday result in a hypotensive coma? Why was dad doing CPR for an hour before he called anyone? Shouldn’t she have more evidence of CPR on her chest? What really happened at home?

We rolled her onto her side and examined her back. She had a large contusion to her mid thoracic spine. Is that a cigarette burn next to it? No, it blanches, said the attending, it’s just a birthmark. I asked for help with her cervical collar. Even though it was a child’s small, it was far to big for her. I stabilized the head while another resident removed the collar. She had petechial rash in a linear ring around her neck. We replaced the c-collar and taped it down to snug it up in order to fit her small frame. Her belly was growing in size right in front of us. Her blood pressure was 54 systolic. “Double the dopamine,” the intensivist offered. A nurse entered the new rate into the pump. Her hemoglobin was six. The bedside ultrasound showed a black stripe of fluid between her liver and her right kidney.

When we moved her from the bed onto the CT scanner, I felt the crepitus of bone on bone coming from her head. I wondered if I had just broken her neck, but then I remembered that she had a skull fracture diagnosed by the outside hospital. I was in too much disbelief to be sick.

She went immediately to the operating room. The trauma team dispersed. I remained silent for the next two hours, shuffling from chart to chart, trying to look like I was doing work. I tried to put together the injuries…a skull fracture in the back and a large contusion in the front of her head. Bleeding arteries inside her belly, a bruised spine. An adult’s fingers would create a mark in just the same place in her neck where her rash was. How long had she been enduring it? When did she stop crying? Some part of my conscious stopped me from seeing the horrible incidents that must have led to her being in the operating room upstairs.

How awful…how awful to see someone you love being hurt. To be powerless to stop it. To have the images seared into your memory. I couldn’t picture it. The images would not come into my brain. I considered myself lucky.