Winner

The Girl in the Grass

by Kevin High, LifeFlight

I pass by her occasionally at a local store I frequent. She works there as a clerk. She looks good; at least much better than the first time I saw her.
The first time I saw her was on a beautiful fall day. This is the time of the year that my mind is often on other pursuits and not on my job as a flight nurse. My work has a way of getting your attention abruptly; kind of like the disease I treat…trauma. Sudden, violent and unforgiving.
That day I was working with three other nurses, we were staffing two helicopters out of our home base at Vanderbilt. We were eating lunch and our radios and pagers started simultaneously going off. We had a request for a scene flight in a nearby county. The paramedics on the scene were requesting both of our aircraft. Usually when both aircraft are requested things are bad.
We landed in tall knee-high grass. The scene commander was motioning us towards two vehicles that were entangled in the middle of the road. There were people strewn everywhere. It appeared that the two vehicles had hit head on and either ejected everyone or pinned them in the wreckage. Three simultaneous extrications were going on with rescue equipment, firefighters, and EMS personnel handling things well.
She was the first patient I saw. She was lying on her back in the tall grass. She looked about 16 years old. Her face was covered in blood and she was making gurgling sounds when she breathed. Big bloody bubbles were being blown out her nose and mouth. An EMT was attempting to suction the blood out of her airway. She smelled of cheap beer. The scene commander yelled for my partner and me to come to the two entangled vehicles. The most critical patients were there. I looked down at her again. I had to make a decision.
The word “triage” is French in origin and means “to sort.” When faced with multiple patients or a mass casualty situation I am trained to sort patients. I sort the patients that are most critical from the ones that are less critical and treat the worst first. This is a difficult and daunting task. It is a task I do not like but one I have to do. Each patient you encounter you have to make a triage decision taking into account their condition and the surrounding circumstances. At this moment I wished that I knew the French word for “this sucks.”
So here I am faced with a triage decision. I am trained to make snap decisions based on little information and to act definitely. Some of these decisions can have a positive or negative impact. I looked down at her and looked over at the other six patients. I made my decision. I then stepped over her legs and walked by her to the other patients.
The next person I saw was a young female also. She was lying in the back of a small pickup truck. The EMS personnel had initiated treatment on her, but she was dying. She needed a needle inserted into her chest to relieve trapped air from her punctured lungs. As I was preparing to do this my partner was beginning treatment on another critical patient. I looked across the grass and saw more EMS personnel moving towards the girl I had walked by. They were attempting to clear her airway.
As the second helicopter landed the other crew exited the aircraft and came towards us. With one hand in this patient’s chest I gesticulated wildly at the other crew to go to the girl in the grass. I pantomimed motions of inserting an airway. It’s kind of a sick, roadside, blood-covered game of charades that I am often forced to play. They moved towards the girl and one of them went to work on her.
Another one of my colleagues approached and took over care of the patient in the back of the truck. I moved quickly around to the other patients. Assessing, doing a few procedures, sorting things out. All the time thinking: am I doing the right thing?
Between the two helicopters we transported three patients. The girl in the grass was one of them. I followed her through her hospital course. I learned that she had a serious brain injury and was given a small chance at recovering, and I kept rethinking my triage decision. Did I do the right thing by walking by her and on to the other patients? I didn’t visit her in the Trauma Unit and I didn’t interact with her family; I couldn’t bring myself to. I thought of how I would introduce myself: “Hey, I’m Kevin. I walked by your daughter today.”
So I followed her case at a distance. When I would be making rounds in the Trauma Unit I would casually check up on her. I knew when she moved onto a rehab facility and then to home. I eventually lost track of her but a few years later I saw a headline in a local paper: “Girl survives bad accident to graduate from high school.” I looked at it and recognized her picture. She has a tracheotomy scar on her neck and some facial scarring. It was eerie to look at her, she was smiling, unlike the day we met.
A month later I saw her in the store. I knew it was her. I recognized her and I could see the trach scar. She looked at me and smiled. I thought to myself “Do I dare? Do I introduce myself? What should I say?”
So often in my job I’m called upon to make snap decisions that greatly impact people’s lives. I am trained to make those decisions quickly with very little information. I use what data I have and rely on intuition. I like it that way. See the issue or problem, make an assessment, decide, evaluate.
And when I saw this girl in the store, I made this decision the same way.
And just like the day we first met, I chose to do nothing and walk by her.
And about both meetings, I ask myself: “Was it the right thing?”