It may be shameful to confess but I can feel myself actively tense whenever my work phone rings while working in the pediatric ICU. It’s usually the emergency room or an outside hospital calling to tell me about a critical child they have requiring ICU-level support. Anxiety washes over me momentarily. While the feeling is fleeting and soon replaced with a sense of duty, it’s always there.
I am a Pediatric senior resident at UT Health San Antonio in my last two months of pediatric training. I am currently on a 4-week PICU rotation at University Hospital, a Level 1 trauma center in South Texas.
I love my job and being a pediatrician. The children I serve and make better are one step closer to reaching their full, near endless potential. Of course, when working in the PICU, not every child achieves their capacity. But when they come to our unit, we perform every medical possibility to provide them with the best opportunity.
As I badged into our unit at 6 a.m. on my May 24 shift, the day began like any other. I checked in on my patients, consulted with my team and discussed the best medical changes to make. I talked with families and provided updates to the treatment plan. It was a typical Tuesday.
‘We’re getting ready’
One intubated patient, who was run over by a car, was making progress in their respiratory state, so I wanted to decrease some of the ventilator settings.
I opened the door to my attending doctor’s office to let her know. She and another person in her office both looked up at me, then back at each other, and then back to me.
“We just heard there is an active shooter in an elementary school in Uvalde. We’re getting ready,” she said.
Getting ready? It took me a moment to register what she had meant. I separated ‘active shooter’ from ‘elementary school’ as two entities that were miles apart in my mind. Why do we have to get ready? Oh. I see. Of course. Sandy Hook, Parkland, Sante Fe, Virginia Tech, Oxford High. And here’s another one to add to the seemingly endless list of mass shootings at U.S. schools.
I nodded and asked, “How can I help?”
“Which of your patients are stable and can be moved out of the unit or discharged?” the doctor asked.
It was time to get to work. University Hospital is not new to mass casualty events. We had seen this just five years ago as one of the main trauma centers for the victims of the Sutherland Springs shooting.
It is somehow both disheartening and remarkable that we are prepared for these mass shootings. The familiarity has placated these dire, yet necessary, protocols. Elective surgeries were canceled, operating rooms were cleaned, PICU beds were emptied.
Throughout the day, the supervising nurses for our unit gave us updates: “There’s nine kids coming,” “There’s fourteen kids coming,” “There’s for sure one kid coming,” “Three kids are en route,” “They had to do CPR and lost one of the kids,” “we just got called about another, but not sure if it’s an adult or pedi patient.”
The unit was filled with uncertainty, anger, anguish, devastation, and polarization.
“This is why every teacher needs to be armed,” a respiratory therapist said to me.
“It’s so easy to buy a gun, my husband did it in a grocery store parking lot last month,” one nurse said to another.
“I just want to be with my kids,” another nurse whispered to herself.
No matter the comments or attitudes, every team member jumped into action. Moving patients, cleaning rooms, setting up ventilators, collecting medications for resuscitation.
Our work was in vain
I texted the resident covering the evening PICU shift, “I’m sure you heard what happened, we’re going to get you help tonight and call other residents to come in.”
“I saw the headlines. How many patients are we getting?” he responded.
“Not sure at the moment, I think three so far, but who knows,” I replied, only to learn an hour later that only one critical child would make it to us.
Why hadn’t it been more?
As physicians, we are supposed to be the shield for our patients at their most vulnerable. But what are we supposed to do when the patients never arrive? What is our purpose when our rooms are empty?
As one of the chief residents whose job it often is to find coverage when needed, I kept getting texts from my colleagues saying they are ready to be deployed wherever is needed.
Why didn’t we need them?
When our critical patient arrived at our Level 1 trauma center, we were ready. We were ready for more.
I kept checking traffic updates from Uvalde to San Antonio. I have never wished for a traffic jam before. Maybe there was bad weather and the helicopters couldn’t fly. Maybe the ambulances were stuck somewhere or got a flat tire. Where are the children we were promised? Why are they not in our operating rooms? Why am I not at their bedside adjusting their ventilator? Why am I not consoling their distraught parents? I am trained. I am ready.
When the other resident arrived for his evening shift, I told him that through the commotion I had heard that maybe only one patient was coming to our PICU and that there were many fatalities.
I called in another resident to assist Adam in the PICU that night just in case we were wrong. I prayed we were wrong.
As I walked out of our unit and towards the elevator, I passed by the room of a patient we had sent out of the PICU earlier that day to make room for those that never came.
He was a teenager who had been shot multiple times. I remember how sick he was when he first arrived almost two weeks ago. Early on, there were many days we didn’t know if he would make it. Now he was sitting up in bed watching Family Guy. This was our success story.
Why didn’t we get more of these today?
As I ended my day, not once did I feel anxious. Not once did I feel my muscles tighten to the thought of being flooded with medically complicated children. I felt a sense of responsibility followed by a vacantness within.
An hour and fifty-one minutes into their PICU shift, I got a text from the resident helping in the PICU, “No one else is coming. No one else made it.”
The mass shooting at Robb Elementary School in Uvalde robbed 19 children of the opportunity to achieve their potential. It robbed them, and their families, of what would be.
In my almost three years of pediatric residency, I do not know how many victims of gunshot wounds I have taken care of. I know that any number higher than zero is too many. But if we have created a world where the unspeakable can happen, we must prepare ourselves for the aftermath. The carnage.
We were ready. We did our part. Who didn’t do theirs?
Dr. Tebyan Rabbani has just finished his 3rd year Chief Residency at the Pediactric ICU at the University of Texas Health San Antonio. He plans to immediately continue his studies at Stanford University, specializing in Gastroenterology, an area that he is personally drawn to as a result of his own health concerns.