Friday, December 13, 2013


This week, I wrote a post for Mommy Poppins about the difference between general Emergency Rooms, and Pediatric ones, which specialize in treating the unique needs of children.  I included a list of Manhattan hospitals who have pediatric ERs. (Read it, here.)

It's a topic I've been passionate about for a long time. Children are not merely miniature adults, and treatments effective for grown ups may be downright dangerous for kids.  For instance, a hemorrhaging adult may have his spleen removed to staunch the bleeding, and recover with no ill effects.  A child who undergoes the same procedure will also seemingly recover and be sent home.  Only to die a year later from a cold because their immune system has been critically compromised.

So how did I first learn about the importance of taking a child to a Pediatric Emergency Room - even if it isn't necessarily the nearest Emergency Room?

Why, from romance novels, of course!

The hero of my 2000 contemporary romance for DELL, When a Man Loves a Woman (#506 on RomanceNovels Top 1000 of all time!) was a pediatric trauma surgeon, and the heroine a pediatric neurosurgeon.  The research that I did to make the ER they work in feel as authentic as possible made me aware - even before I became a parent myself - just how key knowing where to take your child for initial treatment is for their ultimate survival.

How did I do? See for yourself in this excerpt from When a Man Loves a Woman:

Dr. James Elliot was waiting on the brilliantly sunny roof of Los Angeles Valley Hospital even before the chopper, carrying his eight-year-old Caucasian male victim of a fall from a seventh-floor window, landed on the helipad. When the doors opened, Elliot was the first to reach the gurney. He smiled reassuringly at the boy with the plastic collar clamped around his neck, before firing off a succession of questions at the paramedics who'd brought him in, all the while running alongside the gurney on its way to the Code Room.

Once inside the Code Room, Elliot allowed Jeff Greenwood, a Second-Year resident, to take over the initial examination. Valley was a teaching hospital, after all. They were big on the learn-by-doing method.  And all the residents rotating through the Pediatric Emergency Room were supposed to learn from Dr. Elliot. He may have been only forty-three years old, but in the eyes of the residents, he was the Grand Old Man of Pediatric Trauma Medicine.

Elliot hypothesized that was because, before he showed up, no one actually believed something so specific should be a specialty. The medical establishment figured that what worked in Adult Trauma should function just as well with kids. And then they wondered why the mortality rate was so much greater among children. Creating a trauma unit especially for the under-eighteen contingent opened a lot of eyes, triggered a mountain of journal articles, and earned E1liot a nationwide reputation as the specialist in his field.

Tongue firmly in cheek, Elliot told anyone who asked that his extensive experience was the reason for the 'Old' in 'Grand Old Man of Pediatric Trauma Medicine.' It wasn't the gray he periodically noticed streaking his otherwise raven-black, curly hair. Because, save that, Elliot was in the same shape he'd been in college, when playing semipro hockey helped foot the medical-school bills. These days, however, he stuck to a set exercise schedule - mostly because of the physical demands of his profession. In Emergency Medicine, every second counted. When Elliot wasn't sprinting toward a patient, he was slicing a human chest open practically with his bare hands, or standing for hours, plugging bullet holes gushing from a drive-by shooting victim. If Elliot wasn't in perfect shape, his patients risked suffering for it.

Just like the patients risked suffering when their attending physician was only a Second-Year resident, still wet behind the ears. That’s why, when Jeff Greenwood, in his haste to check out the ABC’s of elemental trauma - airway, breathing, circulation - overlooked the harsh scratchiness in the little boy’s voice as just the result of hoarse crying, rather than a potential lung problem, Elliot stepped in. He called for an X-ray, followed by blood gas. The numbers he got moments later from the lab confirmed his fears: a collapsed lung. With a twitch of his finger, Elliot signaled for the thoracotomy tray. He stretched on his surgical gloves, reached for the syringe of anesthetizing lidocaine, and inserted the needle between his patient’s fourth and fifth ribs. Their boy had stopped crying. The collapsed lung was making it painfully impossible. He squirmed and struggled inside his restraints, but had yet to utter a word. That disturbed Elliot. Most kids would have been cursing him out quite colorfully by now. He liked it that way, Screaming kids were kids with the will to live. It was the quiet ones that made a Pediatric Trauma Surgeon’s heart beat faster.

Still, his immediate priority was the collapsed lung. Elliot asked for a scalpel, and made an incision beside the pinprick left by his needle. He stuck his finger into the hole to keep it open and prevent it from bleeding, then asked for the chest tube. Mouth slit in concentration, Elliot threaded the clear, plastic tube past his finger, into the surgical wound. He kept pushing until large, pink bubbles began burping into the tube. Pink bubbles. Not red. Not bloody. Thank God. The lung was working again.

Score one for the good guys.

Elliot turned to his patient. "Say something for me, kiddo."

The child just stared back, blankly. Not a good thing. But at the moment, not a primary thing.

With the lung crisis out of the way, Elliot and Jeff completed the rest of their exam, patching up each critical injury as they went along, in order of severity, and double-checking that the boy was stabilized. Finally, at the end of a very long morning, they turned their attention to his baffling muteness. Unfortunately, as far as they could see, there was no physical cause for it.

Which, under no circumstances, meant that there was actually no physical cause for it. It just meant they couldn't see it.

Greenwood suggested to Elliot, "Maybe we should ask Dr. Brody in for a consult."

Deborah Brody was their Chief of Pediatric Neurosurgery, and an expert in juvenile neurological injuries. Shed been with the hospital for eight years, ever since Elliot, after half a decade of phone calls, had convinced her to leave her boring post in San Francisco for a place that really saw some action.

Elliot told Jeff, "Good idea. Brody’s in today. Go ahead and page her."

"Actually, Dr. Elliot" - Jeff massaged an X ray between two of his fingers, leaving a smudge on the file - "I was hoping you could do it. See, I... Frankly, sir, she scares the hell out of me."

Elliot didn't try to disguise his smile. In all seriousness, he observed, "She'll be happy to hear that."

"I know," Greenwood said.

Elliot dialed Brody’s pager number and recorded a message. While they waited for her to arrive, Jeff asked, "You and Dr. Brody, you two go back a really long way, right?"

"Twenty years," Elliot said. Then, because there was nothing else to do for the time being, and because the account came with a moral to young doctors about making snap judgments, he told Jeff about how, when they met on the first day of medical school, Elliot thought Brody was the biggest idiot he'd ever encountered.

In retrospect, Elliot still asserted he couldn't be blamed for jumping to such a conclusion. After all, what was he supposed to think, when the woman sitting beside him at the second best medical school in the country couldn't remember her own name?

The professor had roll-called, "Brody?"

Deborah continued sitting there, hands primly clasped in front of her, blank as could be. It was only after the second "Brody?" that she jumped to self-conscious attention, awkwardly raising one hand in the air to announce, "Oh, that would be me, I guess."

A first-class idiot, Elliot decided on the spot. She just had to be sleeping with someone important on the admissions board. And all Elliot had to say about that was, she better be damn incredible in bed, because, on the surface, the chick wasn't much to look at. Oh, sure, she had that all-American thing going for her. Blushing cheeks, peaches-and-cream complexion, big hazel eyes, and gushing chestnut hair that she rolled up in a bun, probably hoping to look more professional. If you liked that sort of thing.

Elliot, personally, preferred the more sophisticated type.

It wasn't until he and Brody ended up, against his wishes, in the same study group, that Elliot learned the reason for her ditziness on that first day. Deb had gotten married to Max Brody two weeks before the fall quarter started, and medical school was the first time she heard herself called by her new last name. Elliot also learned, a touch to his chagrin, that the young woman sitting beside him was about as far from a first- class idiot as... as... Well, as Elliot himself was.

And Elliot was not a man prone to low self-esteem.

As a result, he and Brody spent their four years of med school constantly trying to one-up each other in the classroom. One day he'd be top of the stack, the next day she'd be. When it came time for them to graduate, for the first time in UCSF academic history, two students were named number one in their class.

And the precocious, straight-A twentysomething she'd been then was still visible in the forty-one-year old woman who bustled into the Trauma Room in response to Elliot’s page. Having heard Jeff’s opinion of her, Elliot watched with amusement as a pair of First-Years actually seemed to flinch when Deborah walked by. He didn't blame them. While Dr. Brody wasn't condescending or cruel, like some of the other senior staff, she did have a very, very low tolerance for incompetence, unpreparedness, or plain, old-fashioned stupidity. She expected things done right the first time, and if the resident in front of her couldn't hack it, she would find someone who could. There were no second chances in brain surgery.

Which was precisely why Deborah had chosen her specialty. That, and one more, rather personal reason.

Years ago, Deb confessed to Elliot, "My mother was an amazing woman. She ran a household, raised four kids, chaired all the PTA meetings, sat on the board of five local charities, and put up with my father. But, still, no matter what she achieved, my dad would get this condescending smile on his face, and he would remind her, ‘Well, it isn't exactly brain surgery, is it, Elaine?’ That’s all I ever heard growing up. And that’s what made me decide, if brain surgery is considered the pinnacle of what a woman could achieve, then, by God, I was going to be a brain surgeon."

She'd just begun reviewing the compiled test results that slid before her, when Deborah’s beeper sang its five-tone concerto. She excused herself, picked up the nearest telephone, and dialed her assistant while exchanging bemused smiles with Elliot behind Jeff’s back about the resident’s anxiety in going toe-to-toe with her.

"Yes, Francie," she said. "What’s the crisis?" Deb listened closely. "I see." Then, "I'll be there as soon as I can." Brody hung up the phone and returned to the test results.

"Do you think maybe the - " Jeff began.

Deborah cut him off. "These look fine. Whatever the reason for your boy’s silence, it isn't neurological." She turned toward the exit. "I've got to go."

"But." Jeff’s mouth opened and closed like a fish. He looked from Elliot to Deb, confused. "Dr. Brody. Wait."

"What?" She pivoted, visibly in no mood to be second-guessed, especially by a Second-Year.

Concerned, Elliot took a step forward. Deborah Brody may not have suffered fools gladly, but it also wasn't like her to be this brusque with a resident. They were, after all, a teaching hospital. They were there to make better doctors, and Senior staff mentoring the Junior ones was a huge part of the process.

Jeff shifted his weight from foot to foot, and managed to look everywhere in the room but actually at Deb as he asked, "Are you sure - I mean, how long did you take to look at the test results?"

"Sixty seconds." The brutal honesty took Jeff by surprise. But it also gave him the courage to pursue his initial objection. "Well, I've been looking at them for the last hour. How can you just come in and, after sixty seconds, decide there’s nothing wrong?"

The younger doctor had a point, and Elliot expected Deborah to acknowledge it. She was tough, but she was also terribly fair, and Greenwood was voicing an opinion she herself often gave. In fact, of all the doctors Elliot knew, Brody spent the most time checking and rechecking and rechecking test results. He'd lost count of the many nights he'd swung by her office on his way home only to catch her, coat halfway on and dangling off her shoulders, eyes glued to a particularly bothersome CAT scan.

Deborah said, "Actual1y, it took me thirty-five seconds to see there was nothing wrong. The remaining twenty-five I spent musing why a Second-Year resident at one of the best teaching hospitals in the country cou1dn’t figure that out for himself."

Stung, Jeff dug in his heels. "I was being careful."

"You were wasting time. Time that could have been better put to use figuring out what is actually wrong with this patient. You kids just don't get it, do you?" Deborah’s eyes drifted to Elliot, as if seeking his support. But he was so stunned by her uncharacteristic behavior, that he could do nothing but look back at her, confused, and worried. He was hoping she might give him a clue as to what in the world was wrong with her. But when Brody realized he wasn't about to back her up, she simply shifted the bulk of her attention back to Jeff, telling him, "We've got the best equipment, we've got the best doctors, the best research space. We should be able to work miracles here for every single patient. But you know why we don't? Time. Time, Dr. Greenwood. It’s the only thing none of us can control."

And, with a swish of the swinging doors, she was gone.


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