Parkland 6: Pedi ER (Part Two)

Lesson in Humanity

It was as busy as every other night in Parkland's Pedi ER and we were (yet again) overworked, overstressed and coping when along came Rhonda and her 2 year old son. These two were “Frequent Flyers”.

“Frequent Flyers” were people who were well known to several ER staff. Despite having to wait for hours to be seen for a minor chief complaint, the frequent flyer would hang in there and be treated for “God-knows-what.” Generally, their complaint of the day was not even close to being an emergency but they perceived any minor ache, sprain or pain as life threatening. When the minor ache, sprain or pain was involving their child – it was frequently magnified beyond reason.

When the discharge instructions were something along the lines of …”Go home, he has a virus, give him Tylenol for fever and have him drink plenty of fluids.” It was usually met with disdain as they were expecting a leukemia (or worse) diagnosis and they had “waited all this time for that?” You got me. I thought they would have been happy that Little Johnny wasn’t going to die but …

While I’m on this topic … It really miffed me when a parent would respond to my instructions to administer Tylenol for fever with... “I can’t afford it” yet they would be carrying cigarettes with them. They expected and would demand a prescription for Tylenol. Medicaid would pay for it. Over time, I just realized that I wasn't going to change them and I got over it.

You may think I sound disconnected, callous and arrogant. I was. Detaching myself from the human condition and its vulnerabilities was an effective way to cope with the incredible numbers of needy people. It worked. For a while.

On this particular night in Pedi ER, Rhonda and her son had been seen by the doc. I casually walked in to give her the same discharge instructions she had received time after time again. As I read the instructions to her, not making eye contact and caring less for her and her son than the kids who were “really sick”, I added, “follow up with the Pediatric Clinic at Children’s Hospital tomorrow morning”. Rhonda burst into tears.

In a lapse of arrogance, I looked into her tear filled, mascara smeared eyes and asked her why she was crying. "I work at night and sleep in the daytime" she said. It was apparent to me that she was little more than a child herself. I asked her how old she was…”17” she said and then the floodgates opened. Rhonda unfolded the story of her life. It sounded like a bad movie plot... pregnant at 14, kicked out of her parents house, met a guy who took care of her, turning tricks for a living, trying to be a good mother.

Listening to her, it came to me that her visits to the ER at night were a respite from her life. She didn’t have to “work” and she and her son were safe and relatively comfortable in our overcrowded Pedi ER.

Was the story for real? Who knows? I've been told a lot of stories. But on that night I made the conscious decision to look into my patient's eyes again.

What have I seen? A lot people choose the ER as a respite from their lives.

Parkland 7: Surgery Orientation

Parkland 5: Pedi ER (Part One)

Many moons ago, Children’s Medical Center in Dallas did not have an ER. They did have a clinic that was open during business hours, however. That meant that Parkland’s ER would always take Pediatric Trauma and it would manage all other Pediatric Emergencies daily from 4pm until 8am and 24 hours/day on weekends.


For a nurse with one year of ER experience, Pedi ER was scary but remains as one of the best clinical experiences I have ever had.

Opening daily at 3pm with two RN’s, a Patient Care Assistant (PCA) and a Pediatric Resident, we would prepare for the onslaught of sick children and anxious parents.

The gauntlet of waiting parents and kids sitting on the floor of the long hallway leading up to Peds was daunting. We didn’t have a lot of treatment rooms, so kids with asthma would be corralled into one room, sat side-by-side on two stretchers and hooked up to nebulizer treatments in hopes of an improvement in their condition.

Depending upon the chief complaint, children were seen as quickly as possible. We became expert in a 30 second pediatric assessment - check vital signs, listen to lungs and determine if the kid looked ‘good’ or ‘bad’. That was about it. Documentation was minimal. Starting IV’s and drawing blood even from the tiniest infant was common practice. Infusion pumps were rare back then, so we resorted to the use of controlled fluid administration via a device called a Buretrol that would allow only a specific amount of fluid to be administered – they ‘went dry’ a lot. Pulse Oximetry had not been invented yet (eeek) and our resident would obtain urine specimens by manually withdrawing urine from baby’s bladders via a needle and syringe.

Any Pediatric Trauma patient would be triaged to the Surgery Pit, not Pedi ER. Thank God.

Children that looked ‘bad’ (or worse) would be placed in one of two resuscitation rooms. One RN, a PCA and the doc would work the situation. The other RN would have to manage the rest of the Pedi ER. We would frequently have kids that “looked bad.”
Enough said.

Pedi ER was (at best) nightmarish from about 6pm until 2 am. Compounding an already stressed department with not only the numbers of sick children but also with the persistent crying, overcrowding and rising anxiety level of exhausted parents.


I loved it.

Parkland 6: Pedi ER - Part 2