He is small for an eight-year-old boy, made even smaller by the big trauma room gurney beneath him. Two skinny, sunburnt legs stick out from a pair of much too large, frayed, hand-me-down cutoffs. Green grass stains cover the skin of both knees. His bare feet are filthy, farm boy filthy. The kind of filthy that comes from playing in the cool dirt of an old barn floor, from running through uncut fields of wheat alongside the combines, and from climbing the giant hay bales that dot the rolling hills this time of year.
Two hours ago he was just another shirtless boy in a cowboy hat playing in the wheat.
His mother stands across from me. She is perhaps thirty-two. She has sandy blonde hair, just like the boy on the gurney. I can’t see her face because it is buried in her husband’s chest. She is completely silent but her whole body shakes, trembling like an old John Deere combine with something stuck in its blades. Her husband pulls her tight, his arms wrapping around her, trying to protect her from this place, this moment.
The two of them clutch to each other, here, in my emergency room.
At the head of the bed the ventilator chimes and puffs and clicks along as it pushes air into the boy. It pushes air into lungs that collapsed and now have chest tubes draining them. Lungs that cried out just loud enough to stop thirty thousand pounds of combine from turning the boy into chaff with the wheat.
The boy’s arm twitches. The nurse next to me blinks back tears and adjusts his IV.
A case like this is a bomb that detonates in our ER, in our town, in our lives. The shockwaves right now are spreading as neighbors call neighbors, as friends call friends, as family reaches out for family and parents run to check on their children. I know I will not be the only one unable to sleep tonight.
The father stares at his son on the gurney. His face is filled with questions for which I have no answers. How can this happen? How can something we love, something so full of life, be so fragile, so vulnerable, so easily cut down and taken from us in the blink of an eye?
He does not know it yet but he is now standing in a new life. A life that will always be different from the one he woke up to this morning.
I step over to the computer to order some more sedation for the boy while we wait for the helicopter. Taped above the screen is a brand new sign. It is a decal of five gold stars. It seems so out of place at a moment like this. The last few weeks the hospital has been putting them up everywhere. They are there to remind us to give ‘five-star’ service- to tell our patients how much we appreciate their business and hope they will choose us for their future healthcare needs.
They are to be called customers now, not patients, we are told.
Customers.
I tear it off the screen and wrinkle it in my hand into a ball, squeezing it tight. I shove it in the pocket of my white coat.
Twenty-two minutes later the whine of the helicopter engine fills the air as it prepares for takeoff. I stand outside with the father, watching the big blades spin up to speed in the late August light. Inside the helicopter there is room enough for only one parent to go with the boy. One hundred and three miles away a pediatric ICU bed is waiting.
The helicopter lifts off and a cloud of late summer dust fills the air. The father does not move as the debris cloud swirls about his head. Instead, he stares at the window on the side of the helicopter, the dark outline of his son just visible to us both.
We watch the helicopter rise above the pad and rotate slowly. It climbs a little further, hesitates in the air, and then races off above the wheat fields, the grains below bowing from the thrust of its blades.
I take out the five-star decal from my pocket, unfolding it carefully. I tear it in two and press the larger half against the brick wall behind us. I scribble my home phone number on the back.
“Let me know,” I say.
The father takes the paper and nods, still staring at the shrinking outline of the helicopter. At last it disappears over the mountains in the distance. He turns to me but his eyes are empty now. He is already departing, already arriving at the next place. We shake hands and he walks slowly off to his truck. He’s got a long, quiet drive to the city ahead of him.
I look down at what’s left of the ripped up decal in my hand.
The image of the boy burns bright in my mind. I know I will carry this day with me for a very long time.
I make a fist, crumpling the decal.
I respectfully disagree with those who want us to call them customers, healthcare consumers, or business opportunities.
The people we care for are sons and daughters. Mothers and fathers. Husbands and wives. They are neighbors, friends, and sometimes even colleagues.
They are people like you and me in a moment of need.
They are patients.