In order of increasing severity, I present the past four days at work.

[(number of cases): (presenting complaint)]

-80 kajillion: “Runny nose. Coughing.”

-40 kajillion: “Stomach hurts.”

-10 kajillion: “I twisted my foot/ankle/knee/wrist/finger playing volleyball/football/horseback riding/falling over my toddler while holding my infant.”

-2: Acute Renal Failure. Off to San Juan Regional for dialysis.

-1: Assaulted with baseball bat. (R) mandibular fracture. His teeth moved independently of one another when he spoke. It’s utterly unnerving to see.

-1: Early miscarriage, 6 weeks pregnant. She just sat on the bed with her feet tucked under her while we ran her labs and cultures and looked very distant, very introspective, as though she was trying desperately to hear the little voice inside of her speak again.

-1: Respiratory failure. He was working so, so hard to breathe — I mean, actually working. Sitting up in bed, leaning forward, using every muscle in his torso to suck air in. And when you work to breathe, you get tired — your muscles wear out. Imagine the moment when you simply are too tired to take in another breath, and you know that your own body has failed you, and you are about to feel yourself die….

That was the moment we shot him full of etomidate and succinylcholine, hyperoxygenated him, intubated him on the second try, and hooked him up to a ventilator. Flown out to Phoenix.

-1: Failure to Thrive (secondary to pneumonia): 6 months old. Fetal Alcohol Syndrome baby. Polydactyly. Chronic anemia. Stopped breathing at home, grandma (legal guardian) performed CPR, rushed to our ER, hooked up the crash cart, placed on oxygen via face mask. Baby was so sick and tired that he didn’t even cry. He looked teeny, sitting up on that huge bed, machines surrounding him. Flown out to Tucson.

-1: Sexual Assault. 17 years old. Blood Alcohol level well over 300. Found in the bushes behind the high school, shirt and bra above her breasts, pants and underwear around her ankles. It was freezing that night. Her core body temperature was 94 degrees. Mud and debris in her vaginal canal, in her rectum. Lacerations to her right hand. Scratches on her face. She was unresponsive to anything but painful stimuli for about five hours. I stood over her bed, watching her curled up in the fetal position under the bair hugger thermal blanket, watching her blood pressure hover around 80/50, and nearly cried imagining what she had endured….and then her body temperature finally came up, and she became belligerent. She was, essentially, still drunk.

After she truly woke up, she spoke to the NNPD Criminal Investigator. Refused the rape kit exam. Stated she didn’t remember anything. Then changed her story and stated that it was consensual..with whoever it was. I watched her in horror as she obviously, blatantly lied about the events of the preceeding evening — the ones that nearly killed her from hypothermia — and thought, who are you protecting? and WHY? I caught myself blaming her for what happened, and was disgusted with myself.

Her legal guardian did not override her refusal to be sent to Flagstaff for an exam. So she went home. On Plan B and four antibiotics to try to ward off any STDs.

-1: Pediatric Code, Death. He was a difficult pregnancy, his mother delivered him by emergency c-section about five weeks early, and he had severe brain stem damage. His prognosis was poor from the beginning — he was tube fed and had chronic cardiovascular problems. The pediatricans sent him home on an apnea monitor — the brain stem controls the most basic, vital functions of life — breathing, heart beat — and because his brain stem didn’t work right, he could basically stop living at any moment.

The monitor alarmed, and mom raced upstairs to find him unresponsive and blue. The paramedics performed CPR on him in the ambulance, but he had been unresponsive for 15 minutes by the time he ended up in our bed. It turns out that his brain stem was failing and necrosing without us knowing — and that his gut had been necrosing, as well. He was beginning to autoeviscerate on our table (please don’t ask me to describe it, it IS as horrible as it sounds). He had a non-shockable rhythm. He was pronounced dead.

And even though his mother had known from the moment that he was born that his time here with her would be very, very short, she sat by his body, stroked his hair, and whispered, “Come back, baby…..baby, baby….come back…….”

I have twice now this week stood by a bed and said, “I can’t do this….I can’t do this anymore.”

But every day at 6 p.m. I get on my scrubs, my Crocs, grab my nurse bag, and go back to work and do it all over again.