Some cases burn into your brain like a hot branding iron, for whatever reason, and never really leave.  This was one of those cases.

One hectic morning before my shift, my wife and I rushed around the house trying to get our kids ready for school.  On this day, my daughter was to go on a field trip where the teachers would walk the kids through the city to the local park to study the small oasis of nature in the “concrete jungle.”

Before such field trips I would always wonder, how the teachers can corral all those little kids safely through such a crazy city, crossing such busy streets.  “We are super careful,” the room Moms would ensure everyone.  My wife had gone on a couple of these field trips and she remarked at how organized they were and how good the kids listened, holding hands and singing as they walked in a long hand-holding train through the city.  “Okay,” I would say, “sounds like they’ve got it under control.”

Working in the ED, I knew better.  At this point in my career, I had already seen most forms of human tragedy up close and personal.  Sometimes I wonder half-joking, half serious, if there is something called “PTS-ED-D”, or “Post Traumatic Stress Emergency Department Disorder”?  Of course, not, that’s nonsense.

As we rushed to get the kids ready for school, my 5-year-old daughter beamed her baby-blue eyes up at me, hair curly golden-blonde and said with a life loving smile, “Daddy!  Can you put my shoes on, please?” She proudly raised her adorably tiny and favorite new hot-pink glitter shoes and handed them to me.  I put them on her and she blew me a kiss.  “Bye Daddy!  I love you,” she said.

“I love you, too.  Have a great day at school,” I said.  At light speed, they rushed out the door and I rushed to work for the early shift.

Two hours into my chaotically routine shift the charge nurse gets off the phone and says, “Buckle up guys.  We’ve got a pretty bad one coming in.  EMS will be calling in any minute: Trauma, level I, no vital signs.”

“Alright, guys.  Trauma room one.  Let’s go,” I say.  Before any radio call, the ambulance doors blasts open and all I see is a blue swarm of huge EMS men around a rolling ambulance stretcher, one up high doing chest compressions with sweat pouring off his red face like Niagara Falls, and all the others busily working this trauma looking notably more stressed than usual.  As they roll down the hallway towards us, still I see nothing but a sea of big burly EMS men and haven’t seen even a glimpse of an actual patient yet.  As they roll around the door and make their left turn towards me, a tiny but searing flash of hot-pink and glitter explodes into my eyes through the sea of blue uniforms.  “Oh… My… God…” I think to myself.

Those Shoes.

Hot-pink.  Glitter.  Tiny.  Time stood still.

I felt my heart rate dropping.  I was getting dizzy.  Was my worst nightmare about to come true, right here in my own ED, on my own shift?  I needed to see the face.  NOW.  I was afraid the see the face.  As “clinical” as I could be to get through the most difficult parts of my job, this was too much.  As the stretcher came towards me, the sea of uniforms parted and I saw her.

A girl 5 years old, with tiny hot-pink and glitter shoes.

The hair:  brown and straight.  The eyes: emerald-green.  A beautiful child.  Someone else’s child.  She was frighteningly reminiscent of mine, with the exact same shoes, but with skin now fading to a ghostly white-gray and eyes as lifeless as a doll’s.

Time exploded back into the usual frenetic light-speed trauma-code pace.  Airway  Breathing  Circulation  Line 1  Line 2  Monitor  Fluids  Blood  X-rays  Needle-chest  FAST-scan  Chest-tube.   ATLS protocol at light speed.

We ran the code for what seemed like forever.  We did everything, and then some, and then some more.  We did everything we possibly could for this child who was on a school field trip, run over by a drunk driver who jumped a curb in his truck on a Monday morning.

Pulse, none.

Pressure, none.

Pupils, fixed.

Pupils, dilated.

This beautiful child was dead.  Someone else’s beautiful child was dead.  My worst nightmare was not coming true.  Someone else’s was.

I went back to the old dictation room to regroup.  I could hear the sound of co-workers trying not to cry.  I could hear the sound of one of my other patients saying, “G-d d—n it!  What the hell is taking so damn long!?” I had to prepare myself to break the news to the parents.  There is no way to sugar coat this type of news, no way to make it any easier.  I felt like I was going to die.

I walked into the room and greeted two parents on their knees crying, praying, horrified but certain we could save their child with the same miracles they had seen on TV.  They looked about the age of my wife and I.  Their faces were hauntingly familiar.  I was about to drop a nuclear bomb on their lives.  The words cracked and fumbled as they came out of my mouth.  “Hi, I’m doctor Bird.  Are you the parents of …?”

I’ll never.

Ever.

Forget.

Those Shoes.

“BirdStrike” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.