When the young man staggered into my ER and up to my triage desk at 3am, my first thought was that he was very, very drunk.
Then he turned his head slightly, and I saw the massive bruising across the left side of his face, his eye swollen shut and oozing blood.
“What on earth happened?” I said, ushering him gently into a wheelchair.
“I fell,” he said, and turned his head away from me again.
In triage, I tried to push a little harder. “You’re safe here, tell me the truth. What happened to you tonight? Who hurt you?”
He gave a small shake of his head. “I fell.”
“Where did you fall?”
“The lake,” he said, still not meeting my eyes.
I raised an eyebrow. “What were you doing at the lake at 3am?”
He curled further into himself in the wheelchair, hunching his shoulders, crossing his arms around his thin torso, dropping his chin. “I was fishing,” he said, and tears began to stream down his cheeks.
He continued to insist that he fell, all through his entire ER visit. He wept silently the entire time, terror and shame written nakedly across his brutalized face.
We never did hear the true story.
~ ~ ~
ER nurses frequently don’t get the whole story. We don’t usually see the accident or the incident that sends someone to the ER. We get a report from the medics, but even that is sometimes a game of “Guess” crossed with “Telephone.” And we almost never hear what happens to our patients after they leave us — did they survive the surgery after their accident? Were they able to walk again after they broke that bone? Did they stay clean or relapse after we reversed their overdose?
We get a chapter from the middle of the novel, a page from the middle of the notebook. But we never get the whole story.
~ ~ ~
Sometimes, it doesn’t matter, because we know how it will end.
Winter, 2014-2015, Sierra Leone
On the first day I saw her, she was sitting along the edge of one of the buildings in the Suspect Ward, eating dinner. She was eighteen and very beautiful, with wide clever eyes. She looked so healthy, talking with other patients in our Ebola Treatment Unit, eating well, drinking fluids. I couldn’t imagine that she was infected, although I knew that the odds were stacked against her — she was the youngest of the five siblings infected by the body of their dead father at his funeral.
On the last day I saw her, she was lying on a cholera bed, limp, pale, her eyes open but dull, staring unseeing at the ceiling of the Confirmed Ward. We had truly believed that she would survive the infection — she seemed to be improving the week before — but a seizure had taken her in the night. She was now encephalopathic, unresponsive, essentially comatose. Flies landed unhindered on her open eyes. When we rolled her to place a clean lapa beneath her, maggots crawled out of the rotting flesh of her back.
We all saw the irony of labelling her a ‘survivor,’ but her body had technically cleared the virus, although at terrible cost. Her family wanted her back. There was no way we could provide adequate care for her at the ETU, not with us hindered in our head-to-toe protective gear and the daily temperatures rising as winter gave way to the heat of the West African spring. Half a dozen of us assembled one afternoon to bring her out of the ETU, wash her down at the gate to ensure no virus was left outside her body, and transfer her into a waiting ambulance.
When we carried her out of the ward on the stretcher and into view of her family, gathered on the other side of the chain link fence, her sisters fell to the ground, wailing and screaming and tearing at their clothes, pounding the dirt beneath them with their fists. Her brother, a survivor himself, watched in absolute silence. He shared the wide expressive eyes she once had, and they reflected a desolation so absolute that I could not bring myself look at him.
I did not need to finish reading that book to know the ending to her story. I knew that she would die in a matter of days, or maybe weeks. I knew that her family would fight to save her life, would fight to feed her and clean her and obtain any medicines they could possibly afford. And I knew it would all be in vain.
~ ~ ~
But, sometimes, once in a great while, we do get the whole story.
Jennifer and her husband Jeff were driving home, talking idly about dinner and their plans for the upcoming week. Out of the corner of her eye, Jennifer saw movement — and when she looked to her right, she saw the big SUV barreling towards her.
“Oh, Jeff, no,” she gasped, and instinctively raised her right arm to protect her face.
That was the last thing she remembered.
I was the recorder for the trauma activation. Our entire team stood ready when they wheeled Jennifer in — nurses, techs, xray, ultrasound, CT, pharmacy, the ER doc, the trauma doc, an ortho doc who happened to be finishing some notes after surgery when the trauma paged overhead.
EMS wheeled her headfirst into the room, c-collar in place, immobilized in a vacu-splint, blood on her face.
The medic started his report. “This is Jennifer. She was the passenger in an SUV that was hit on the passenger side by another vehicle. By the way, she’s deaf.”
I was so stunned by this revelation that I actually stopped writing for a moment. To be so badly injured, so shocked, so frightened — and she couldn’t hear anything we were trying to tell her. No reassurances, no updates, no warnings of upcoming procedures. Just silence.
I interrupted the medic’s report. “Guys, she’s deaf!” I shouted to the room.
The team responded instantly, and admirably. The bedside trauma nurse began speaking over Jennifer’s face, where Jennifer could try to read her lips. Another nurse returned with a laptop with a video sign language interpreting service, and held it over the bed as we tried to explain to her what was happening.
Her injuries were so severe that we knew almost immediately she would need to be flown south to the regional trauma center. As we made arrangements for transport, the x-ray team came to the bedside to obtain the dozens of films of her dozens of fractures. She cried out with pain as we placed the plate for each picture. I stood by the head of her bed and held her hand, squeezing it tight when she cried out. She was confused by the combination of pain and pain medications, and every time I met her eyes, I mouthed, “I’m sorry. It’s broken.”
“It’s broken?” she replied back, and I would nod.
And we would repeat the process all over again.
It was through a delightful accident of social media that I was able to connect with Jennifer again. We met in person for the second time in our lives – under much better circumstances – and we talked for well over an hour about what happened that night. She had received a new set of processors for her cochlear implants — her first set had been blasted off her head in the accident, and never recovered — and we chatted easily back and forth.
She told me the story of the moments leading up to the accident. I told her the sequence of events in the trauma bay. She shared with me the stories of her long hospitalization afterwards, and her ongoing rehabilitation.
She’s walking again — slowly, and with pain, but she’s walking. Not bad for a lady with two broken legs.
“We were so shocked when we learned you were deaf,” I said. “It was terrible for us — we had no way to tell you what was going on, or what we had to do next, or why we were hurting you by moving your legs.”
“What did you do?” she asked.
I shrugged, remembering.
With the med flight team on their way, the trauma began to wind down, and staff began to filter out of the bay and back to their normal duties. I signed out my charting to the primary trauma nurse, and then glanced back at Jennifer, still on the ER cot, still in her c-collar, still staring at the ceiling, the world bright and soundless around her.
One of our newer nurses had assisted in the trauma, and was busy tidying the bay. I grabbed her, and brought her to Jennifer’s side.
“Hold her hand,” I told her, as I stepped back into the noise of the ER, “and don’t let go.”
~ ~ ~
*Jennifer and Jeff have graciously given me permission to write about their accident, and to use their real names. Jennifer continues to push bravely through her lengthy recovery.
Their vehicle was totaled in the accident, and they will now require a handicap-accessible vehicle going forward. To learn more about their accident and their GoFundMe campaign, please visit: