Since Monday, I’ve been on the overnight shift in the emergency room, taking care of the kids who make it in despite weather so cold I haven’t felt my earlobes in days. As you’d expect, the freezing temperatures keeps a lot of the less acutely-ill children at home, so while we’re still busy, it’s with patients who need relatively urgent intervention — tight asthmatics, kids with acute abdominal pain, teenagers with serious injuries — rather than those who are probably best served by a visit to their local pediatrician.

Last night, I took care of a 16 year-old girl who was horsing around outside and tripped on a curb, whacking her head against a stone pole. Her left eye was a mess, with a huge bruise around it and the lid so swollen that she had to make a serious effort in order to open it. I felt a depression in the bone above her eye and told her that she probably had a skull fracture, and she began to cry; it was clear that she was pretty much at her limit with the bruising and swelling, and the idea of a broken bone shattered through her resolve. Luckily, we were able to help her even with that — one of the attendings showed her the scar above his right eye and recollected the time he was hit in the head with a golf driver, causing not only a fracture of the bone but a laceration deep enough to make his doctors worried about an open communication to his brain. Once she was done laughing, she seemed better, got a dose of IV antibiotics, and went for her CT scan.

Two days ago, I had my dream: two sets of twins, in adjacent beds, who arrived within ten minutes of each other. Both sets were premature, and both sets were within the first three weeks of life; with all of the playing and oohing and aahing, it was hard to tear myself away from their beds in order to care for my other patients. I ended up sending one set home (they were in for jaundice, but their bloodwork made me feel that they were doing well), and admitting one of the other set of twins (she had an apneic spell serious enough to make me worry about a repeat episode happening at home, unobserved).

The hardest patient this week, though, was the one that we did the absolute least for. We got a call on our notification phone telling us that EMS was inbound with a 17 year-old boy who was discovered not breathing by his family. About 2 minutes later, paramedics rolled in with the boy, one bagging him, another doing chest compressions, and a third guiding the entire group into our crash room. They said that he was completely unresponsive when they got to his home, and that they only got the most minimal of cardiac rhythms; they had already shocked him twice and given him epinephrine four times. By the time he got to us, his pupils were fixed and wide open, and he had a good deal of morbid lividity, and about a minute later, we called the arrest. As a death within 24 hours of admission to the hospital, the medical examiner will perform an autopsy to try to determine what happened, but realistically, we may never know what happened.

Nights in the ER are long and tiring; I can’t wait to go back to my day schedule.