A family of 5, Mom, Dad, baby and two bigger children, 5 and 7 years old, were driving, and decided to push through the night to get home from a vacation at Disney World, instead of stopping at a hotel. The two older backseat children were sleeping and unbelted, and the Mom was sleeping in the front passenger seat with the baby in her lap. Dad was the only one belted. The Dad nodded off and they struck a pole and the Mom and kids were ejected. The paramedics told us this when the four injured arrived at the ER virtually simultaneously, instantly turning the busy ER into a multiple casualty event intervention.

So, the three children were wrecked, two were seizing, in each of three separate trauma bays. I remember my classmate Frank, holding suction for one child’s mouth. He was stunned-looking, not looking at his patient, just holding suction, and the main doc was yelling at him to pay attention to what he was doing.

I was sent out of the ER to the nearby clean utility room for some additional sterile equipment. I felt guilty relief that I legitimately was able to exit the awfulness, at least for a moment, for the uninhabited quietness of the utility room, only to find that someone had put the gurney with the mother’s body there. She had been declared “Dead On Arrival”, but I didn’t know that, until I saw her unattended and dead in the utility room. All I had been thinking about was the children.

Her facial injuries were shocking and hard to describe and what I most clearly recall is that part of her jaw, with teeth attached, was lodged in her forehead.

For one weird and awful moment, I wished I WAS her; Dead. Quiet. At peace. Released from all reckoning. Just all done; instead of having to go back into the horrors of the ER. I then felt aghast that I had that wish. As I exited the room into the hallway, headed back to the surgical ER, I encountered the Dad outside the door.  Apparently, he had been wandering the halls, excluded from the treatment areas. He didn’t appear to have even a scratch on him. He looked dazed, his clothes were rumpled and had tiny crystals of glass on them and in his hair. He asked me,

“Have you seen my wife? Where is my wife?”

My stomach dropped.

I said,

“You should go ask the triage nurse,”

and pointed him back to the waiting room and the nurses there. When I was sure he was gone, I went back into the ER. I felt terrified and repelled before I pushed the ER doors open.

 I felt like I was voluntarily but reluctantly entering hell. It was noisy and frantic there. The smell of blood and body cavity hit me in the face. I was afraid I wouldn’t be able to function. I felt bad for Frank. I could hear one child keening, a terrible sound. One of the paramedics was vomiting in a sink.

I delivered the kit and did additional directed tasks. I was numb. I felt distant relief and pride that I was functioning. I looked at the children and felt that everything was unreal, and all my emotions were blunted or gone and so I could function.

After my shift, I drove to my apartment in a fog. Part of me felt like a blank, an automaton. But another part was in pain. My heart beats each hurt, like each one was awash in horror. When I got home, I could hardly remember any details of any of my actions to help. I wondered if I had shirked my duties, avoided the fray, stayed in the periphery of the event.

Then I looked down at my scrubs and they were sticky and saturated with drying blood at my waist and the top of my pants, so I knew I had been leaning against and over the trauma beds. That meant to me that I’d been close in, and working to help. I felt great relief. I took off my clothes to shower and my underpants were stuck to my skin with dried blood, and I had to peel them off. I took a shower. I can’t remember if I cried or not.

About a week later, I went to the PICU, to see the condition of the one boy child who was still alive. He was unconscious and vented. A million tubes. He exhibited decorticate posturing. I felt sick, left and never tried to go back again. We had saved no one. Not even the Dad, whose burden was unimaginable to me.

Paula Lyons, MD

3/26/2025