David arrived first. A five-year-old from Rockville, he had somehow swallowed a U-shaped piece of metal that he had somehow dislodged from a toy. He lay on a table in Examination Room A of the Children's Hospital emergency room. He might need surgery within the hour. He was frightened. Softly, he whimpered.
Paul arrived about ten minutes later. A 14-year-old from Northwest, he had been playing with a friend's BB gun when it went off.
But instead of bullets, the boys had loaded the gun with a ballpoint pen. The plastic cap passed through Paul's chest and lodged just above his left hip. Who knew what it had hit and damaged on its way?
Fifteen people -- an emergency room "code" team -- crowded into Examination Room B to treat Paul as soon as a D.C. ambulance crew wheeled him in. The team included doctors, nurses, residents, X-ray technicians, even a social worker. The team worked busily and nervously, shouting instructions and questions. This one could be touch and go.
But it was a lucky night. David's piece of metal apparently had not damaged his esophagus on the way down, so he wasn't in mortal danger. Meanwhile, Paul's vital signs were near normal. He never lost consciousness. Within an hour, he was in stable enough condition to be taken to the intensive care unit, where further tests would be conducted. He even managed a smile as orderlies wheeled him away.
It was no more frantic than usual at the Children's Hospital emergency room on the Friday night before Christmas. Between 8 p.m. and 11 p.m., the staff saved David's life and Paul's life. But it also treated two kids with burns, one with a cut on his thumb, three with asthma attacks and one with an upset stomach. It consoled parents, filled out charts and caught a swallow of coffee or a glimpse of television every now and then.
But all the while, the staff got ready for the next case. At the Children's emergency room, there's always a next case.
"The cast changes, but the roles don't," said Dr. Daniel Ochsenschlager, the emergency room's supervisor. "And you never know what's next."
The Children's Hospital emergency room handles more than 10,000 cases a year. It turns away no one, as long as the patient is 19 or younger. It handles referrals from other hospitals who walk in the door and ambulance cases that may never walk again. It handles kids with the sniffles and kids who may not live through the next 15 minutes. Twenty-four hours a day, 365 days a year, it's there.
The emergency room's basic job is to serve as a first line of defense. "The whole thing down here is to stabilize people," said Dr. Donald Leichter, a third-year resident in green scrub shirt and faded blue jeans who was part of the team that helped save Paul's life. "We just want them to the point where the rest of the hospital can do its job," added Susan McRorie, the assistant director of nursing.
But medical science is only part of it. The emergency room staff doesn't forget to be human when the chips are down.
Take the case of Louis, an 11-year-old boy who was wheeled into Examination Room B just minutes after Paul was wheeled out.
Louis lives in Waldorf. While playing with matches at his grandmother's house, Louis noticed a vial of black dust. He decided it would be a good idea to drop a lighted match into it.
It was a very bad idea. The dust was gunpowder, and the resulting explosion burned Louis severely across the face, the neck and the right shoulder.
He was airlifted to nearby Washington Hospital Center by a Maryland State Police helicopter. Dr. Ochsenschlager and Sue Heidig, a nurse, went by ambulance to meet their patient. As soon as Louis had been loaded into the ambulance, he asked:
"Do you think I'll be home for Christmas?"
Minutes later, as a resident examined and washed his burns, Heidig recounted the question Louis had asked in the ambulance.
"Home for Christmas?" asked the resident. "Well, Louis, you might have blown it. You might be here for a while."
Louis looked crestfallen. So Heidig jumped in.
"But we'll see if we can't get Santa to visit you here in the hospital, OK?"
Reassured, Louis nodded. No nursing manual says that Sue Heidig has to be on speaking terms with Santa Claus. But in the Children's emergency room, they know what works.
Or, as the sign in the holding room puts it, "The first most fundamental right of children is the right to be loved." You don't do that with bandages alone.