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Memorable Moments

It was music that was at stake when a man brought in his son one afternoon in the late spring. The boy had a simple hand laceration, maybe a quarter-inch deep and a half-inch long and not involving tendon, bone, muscle, nerve, or blood vessel. This was before we had skin glue, and the father wanted the wound stitched up, so I sutured it. Then the father asked the dreaded question: "Will my son be able to play the violin once this heals?" I hate this question because I am usually so focused on suturing efficiently that I tend to automatically answer "Of course!" But often it turns out the parent is making a joke and responds, "Well, that's good, because he could never play the violin before!" In this case I remembered to ask, "Well, can your son play the violin now?" It turned out the child was indeed a violin prodigy and had just been accepted into a special summer program for young musicians at Tanglewood.

Then there was the Christmas morning when three boys—unrelated but right in a row—came in with their fathers. The chief complaint was a cut on the hand. And the patient histories were identical: Each dad had bought his son a first jackknife as a stocking present. Each boy had been elated and had started whittling. All too soon, the knife slipped and gashed the non-dominant hand. After the third such patient, I decided that a local store must have had a sale on jackknives that Christmas! But it's the only Christmas that ever happened.

Lucinda Rossoll, M.S.
Rossoll is a unit leader and charge nurse in Dartmouth-Hitchcock's Emergency Department, where she has worked for more than 13 years. She has worked previously in surgical, ICU, and post-anesthesia nursing and has also been a volunteer EMT with ambulance services in Durham, N.H., and Wakefield, R.I.

Afew years ago, a two-year-old boy came into the Emergency Department after having been hit in the eye with a stick. I initially saw him in the waiting room and immediately brought him back to an exam room and assumed responsibility for his nursing care. It looked like he was going to lose the injured eye. I applied medication to the eye to help with the pain. Then I started an IV and gave him medication to calm him down. While we were waiting for the ophthalmologist on call to come in and evaluate the injury, I asked the hospital priest to come to the ED and pray with the family. When the ophthalmologist arrived, it was determined that the young boy would not lose his eye after all and would be able to leave the ED that day.

I held the man's hand while he went from begging us to save him, to saying we needed to let him "go."

About a month later, a package addressed to me came to the ED. It contained a picture of the child, with a note on the back saying the picture had been taken so I could "see his beautiful blue eyes," plus a letter telling me that I would always be his guardian angel. I had done no more, or less, for this family than I would have for anyone else. But knowing that I was able to assist this young family (and hopefully many others throughout the years) during a stressful period in their lives is just one of the many reasons why I work in the ED.

Carol A. Goodman, R.N.
Goodman, a nurse in Dartmouth's Section of Occupational and Environmental Medicine, worked in the DHMC Emergency Room from 1972 to 1998. She has also been a volunteer EMT in Canaan, N.H., since 1976 and is the service's current president. "The ED was such a wonderful place to continuously learn new things," she says. "Physicians

and nurses were always willing to share knowledge and expertise with each other."

I recall a tearful mother who came into the ED with her lifeless child in her arms. The child was not breathing. Luckily, respiratory resuscitation did the trick. But soon we realized she had a skull fracture from abuse. There was a happy ending—the child recovered without incident, and her mother (with assistance from our social services and psychiatric departments) was able to provide a safe and loving environment for this adorable little girl to grow up in.

And then there was the 40-year-old construction worker with severe chest pain who was brought in by ambulance. The damage to his heart was massive. We were able only to make him comfortable. I stayed at his bedside and held his hand while he went from begging us to take away the pain and begging us to save him, to looking very peaceful and telling us that he was okay and that we just needed to let him "go." I can still remember looking into his blue eyes and seeing them go from anxious to peaceful.

On a more humorous note, there was one memorable patient who thought he was Jesus incarnate. He insisted on stripping naked, standing on a chair in a cubicle next to another patient who was being resuscitated, and preaching to the whole department. Our experienced registrar made several professional, but caring, attempts to get him to put his clothes back on and quiet down, to no avail. Finally, in a desperate attempt to gain control of the situation, she said, "Well, I'm God and I'm telling you to put your clothes back on and sit down in that chair and be quiet!" And he did.

Paul Auerbach, M.D.
Auerbach, who was a resident at DHMC in 1977-78, has spent 27 years in emergency medicine and practices now at Stanford Medical Center. He is the author of several books, including A Field Guide to Wilderness Medicine, Management Lessons from the E.R., and a medical thriller titled Bad Medicine. The following saga is excerpted from a forthcoming book.

A young woman came to the ER at Dartmouth suffering from astronomically high blood sugar and dehydration. Her breath had a strong fruity odor and she was hyperventilating. She was a "brittle" juvenile onset diabetic—meaning her disease was difficult to control and she often had to be hospitalized to bring her glucose level under control. Despite repeated admonitions from her endocrinologist, she frequently violated her diet and drug

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