Sometimes we forget where some of our patients come from. The rush to save lives—including the young and vulnerable ones—can leave no room for questions. This is a story about a moment when a camp nurse is forced to slow down and find out firsthand about the life of a young camper, and is reminded of the most heartbreaking cause of illness: poverty.
The following is an excerpt from the chapter “Color Wars redux” from the book Camp Nurse by Tilda Shalof.
In the kitchen, I walked into what looked like a murder scene. Blood was everywhere: splashed against the tiled white walls, splattered on the floor, sprayed on the white aprons of the kitchen staff and head chef like some abstract paint job. They were standing around, speechless, paralyzed with fear and shock, as a young man lay on the floor writhing in a pool of blood that streamed out from his hand—what was left of his hand—hanging off the end of his arm. He was a fifteen-year-old kitchen worker who had been cleaning the meat slicer when it accidentally got turned on.
For one infinitesimal second, I paused, playing a mind game. Even after all of these years of dealing with emergencies, I sometimes need to calm myself down and I have a little technique that’s very effective.
This is only a pitcher of cherry bug juice spilled onto the floor, I told myself. It’s some joke, a Color Wars prank from the Red Team. These crazy kids are playing tricks on me! That second was all it took for me to come to my senses and take charge of the situation. I pulled on two pairs of vinyl gloves and rushed to the boy, careful not to slip on the slicks of blood.
By the bright color I knew that arteries had been severed. Parts of each of his fingers were missing, but the thumb hung on tenuously by a piece of fibrous tissue. Chunks of fingers were strewn across the floor. I grabbed a dishtowel and made a tourniquet on his arm. I grabbed a roll of paper towel and slapped that on the wound. Crouching beside him on the floor, I held his arm up, above the level of his heart to divert blood as much as possible from pumping out. All the while I shouted out orders, one after another, to the crowd gathered there.
“Someone, bring more towels!
“Buckets of ice, too!
“Call Kitch! Call 911 for an ambulance!
“Get the oxygen tank from the MC!”
I pointed at a gawker. “You! Gather up whatever parts of fingers you can find and put them on ice.” He looked horrified but did as I told him.
The boy was now cold and clammy and had begun shivering.
“Bring blankets!” I called out. The roll of paper towel was drenched in blood. Quickly, I replaced it with a new one.
“Am I going to die?” the boy mumbled.
“No!” I told him firmly. “You’re going to be just fine. We’re taking care of you.”
I kept his hand raised high and maintained pressure on the wound, not even releasing it to check it. I kept talking to him, asking if he could feel what was left of his fingers. He couldn’t. He had no movement or sensation in his arm. His pulse was fast, weak and thready, getting more difficult to palpate: I got someone to take over applying pressure, while I started an IV in his other arm and then opened the clamp to let the fluid pour in to stave off hypovolemic shock caused by such massive blood loss. Kitch arrived and nodded that I was doing everything right. Soon, the ambulance came and then the paramedics took over.
By this point, the boy had lost consciousness and I realized I didn’t even know his name. Trish told me it was Tom Adams. I looked at him lying on the stretcher, alone and without family or friends. I felt like a critical care nurse again, and all I knew was that I had to be with my patient and see him through to safety. I was tempted to jump into the back of the ambulance with him, but decided I’d better drive my car there so that I’d have a way to get back to camp later.
In the emergency department the doctors and nurses transfused him with three units of blood. They prepared to take him into surgery to get the bleeding under control, but were also making arrangements for him to be transferred to Toronto for highly specialized surgery to reattach his fingers by a top expert. I could hear the whirring of a helicopter on the hospital landing pad, waiting to fly him there.
“I’ll call your parents,” I told Tom, who was now more alert after the transfusions and the fluid resuscitation, but still groggy from painkillers.
“Don’t got no parents,” he mumbled. “Mom’s dead and Dad’s in jail.”
“Who should we contact to let them know what happened?”
“I’ve an uncle, but he don’t like to be disturbed.”
“What’s his number?” I pulled out a piece of paper and a pen.
“He don’t have no phone or nothin’ like that.”
“Well, give me his address and I’ll go and tell him.”
Instead of an address, Tom gave me directions that involved a country road, a turnoff that was a “fair stretch” past a motel, a left at a tall red pine tree and a right at a row of cedars. I got all that down just before he dozed off. I called the camp to tell them that I was going to track down Tom’s relatives, but no one was picking up because they were probably still busy with Color Wars. I left a message on the answering machine and
went to my car.
I drove along the single-lane highway and was soon on that rut-filled dirt road that Tom had described. It seemed to lead nowhere. After a few minutes, I was so far off the beaten path, there was no one around to ask directions, no gas stations or pay phones. My cellphone wasn’t picking up signals, and I was getting nervous. Eventually, after turning past a row of some trees, I stopped at a shack with a sagging porch. A grizzled man in bib overalls over his bare chest emerged. He stared at my car with suspicion. I got out and walked toward him. A woman came out on the porch and stared at me. Two naked toddlers were playing in the dirt. The man grunted “yes” when I asked if he was Tom’s uncle. I told him about the accident, but he showed no reaction. I left, shocked at what I had seen.
How could I have been unaware of such a terrible situation that existed so closeÂ to home? No one should have to live like this, I thought, as I drove back to camp. A nurse should know about this!
As far back as Florence Nightingale, nurses have known how poverty causes illness and higher mortality rates. They understand the health effects of inadequate housing, sanitation, nutrition and hygiene, and championed their reform. Tom’s family was way off the grid and far beyond the protection of our social safety net. They had no running water or electricity and no access to healthy food, proper housing, health care or education. How did they cope with our severe winters? What did they do when someone got sick or injured, like Tom? I had never come up close and personal with a case of such extreme deprivation. What a huge divide existed between the two sidesÂ of the camp’s kitchen counter.
Excerpted from Camp Nurse. Copyright Â© 2009 Tilda Shalof. Published by McClelland & Stewart Ltd. Reproduced by arrangement with the Publisher. All rights reserved.