First extreme: Scene call on chopper for girl on bicycle vs. tractor trailer. Bad. My first field intubation that I directed. It’s different trying to manage not only the medical aspects of the patient’s care, but coordinating six EMTs/Medics that you’ve never met and don’t know anything about their skills. I was at the head of the bed, with a pair of legs at my right shoulder, a beer belly by my right ear, two arms infront of my face holding inline stabilization while I intubated, and a distracted, enthusiastic, adrenaline charged BVMer (bag valve masker) to my left. Screaming, blood, twisted extremities, vomit. Family right outside the ambulance. My 2 flight crew are in the back of the ambulance with at least one other participant who I never really saw. And the patient. You do the math…that many people can’t possible make good things happen inside of an ambulance.

Finally get her on the helicopter, give medical report requesting a pediatric trauma alert. No arguments from the staff doc. Fly her in, spend another hour in the trauma bay assisting with resuscitation, blood products, access, splinting…

I’m wiped out by the time I exit the room. Hands sweating, hair mussed, soaked in sweat underneath my lead apron, trauma gown and flight suit. But I can’t decompress because her family is gathered in the hallway with the chaplain trying to usher them into a family waiting room. I slink around the opposite side of the ED, not wanting to make contact with them.

Second extreme: Pick up the next chart to be faced with fairly obvious “narcoting seeking behavior.” Her pain pattern and history don’t make sense. Says she hasn’t seen a doc in forever, but there are numerous visits to a PCP over the past month, all requesting narcotic cough medicine. I offer her a double whammy of indocin and flexoril for her wierd pain. FInally her boyfriend says it…”what about percocet?” She asks for a work note. I give her tomorrow off. She wants 2 days off. I basically say take it or leave it, put the prescription on her chart and walk away, pissed that my time has been consumed by this manipulative couple while a 9 year old girl lays dying in the next room.