"Don't look at my FEET"

*specific info/events have been changed to protect the patient and those involved in the care of this patient

A few weeks ago I was working my usual night shift schedule 7p - 7am. It was moving right along with nothing seemingly abnormal about it. The waiting room was exploding at its normal exponential growth multiplied by that unknown K-FACTOR (Karma) that increases the numbers at an extra fast quadruple rate. It happens every time I work. The typical myriad of patients were arriving all through the night and with all kinds of complaints.

You know.....I often wonder if the patients wait until I start my shift to come into the ED. I really think they sit around and say, "Hey, Dr. Warren should be in about right now, let me head on down there. In fact, let me call all my peeps so we all can go down together."

It's like the ED has a huge flashing Las Vegas sign that screams....

"DR WARREN is ON...DR WARREN is ON !!!"

Naw', I'm just kidding, but deep down I do wonder sometimes.... :-)

Anyway, as the clock approaches 2am, I get a medic control call (a call between the ED doc & ambulance/EMS via phone) that I'm getting a patient with a GSW (gunshot wound) to the back and they would be arriving in 5 minutes. The patient was awake, alert and vital signs were stable.

OK, so at this point, myself and the trauma team are setting up. We're preparing for anything that could possibly come through the door. We never know if the story given by medic control is correct or if some vital info has been left out. Nevertheless...we're READY.

Within 3 minutes, EMS comes in rolling a stretcher with a young girl screamin' and hollering. She was lying supine (on her back) and moving all four extremities (arms/legs). She could be no more than 15 years old. We can see the blood on the stretcher, but have not visually seen any wounds yet. As we try to stabilize the patient, we're becoming more concerned because we have no idea where there bullet is or where it has traveled, yet the young patient is jumping and squirming all around on the stretcher...

THOUGHTS....

1. ? Bullet moves into the spinal canal = paralysis
2. ? Bullet has transversed the body = internal damage ie. lung, kidney, intestines, etc
3. ? Bullet has hit a bone = fractured bones

We're worried. And as usual, I begin my calming approach to get the patient to relax. I know that even the slightest movements could move a bullet or worsen an injury or fracture. I wanted her to relax.
It was at that point that I realized that she wasn't screaming and hollering because of pain OR because she was just shot in the back at 2am on a school night.
She was screaming and moving around because,

" I DON'T WANT YALL' LOOKING AT MY FEET, MY FEET ARE UGLY".

"Listen baby, no one cares about your feet, we're worried about you. We need to make sure that you are ok. I don't want you to be paralyzed or bleeding inside where you could DIE."

"I don't care, yall' can't be lookin' at my feet. Please don't take my socks off. PLEASE, PLEASE !! My feet are UGLY."

I could not understand why her feet were so much more important than the thought of herself possibly dying. Your feet? Really? But then I thought about it...she's a young kid, scared to death and all she could do to ignore the shock of what just happened to her was to focus on her feet. She was serious about it too..nothing else seemed to bother her except those feet.

So I thought to myself putting aside the anger that was brewing and the stereo-typical thoughts that I KNEW all my comrades were thinking. She's still a kid.

"OK baby, if I get you some hospital socks and change them under the sheet so no one can see, will you please lie still and let us take care of you?"

"Yes".

So as the approved change was occurring, she quickly calmed down. Within minutes she became quiet and somber with a mousey' whimper. "I want my mommy! It hurts so bad. I just want my life back."

We completed our exam with ease and found she had some treatable injuries. She was admitted.

Even in the deepest of events....a kid will still be a kid...Don't look at my FEET !