by Shirlene Obuobi, MD July 21, 2022

The page came late, around 7 p.m. Shruti and I were an hour away from sign-out. Neither of us had eaten dinner. Shruti leaned back in her chair and groaned before flicking her pager off its holster and holding it up to her face. Then she jumped to her feet.

"Trauma, 10 minutes," she said. She looped her stethoscope over her neck. "Let's go, Angie."

I tamped down my annoyance. At the beginning of the block, I'd been morbidly excited for pediatric traumas. But kids hurt themselves all the time, always doing the dumbest things and always right before Shruti and I could sign out to the night team and go home. Running to traumas usually meant watching orthopedics set some kid's arm after they fell off the monkey bars or jumped off a dresser or failed at parkour. They quickly lost their novelty.

This was neither of these.

The trauma bay was bustling with people by the time we arrived: nurses, my favorite orthopedics resident, an older man I recognized as one of the pediatric Emergency Department attendings. For some reason, the tone seemed somber; all the previous traumas had felt like an interdisciplinary happy hour. In the corner, one of the nurses spoke into a radio and a staticky voice responded. With a world-weary sigh, Shruti turned to me.

"Hey," she said. "So. The patient who's coming in is a 15-year-old. Gunshot to the head. It's going to be messy, and there's going to be a lot of bodies in here. Normally, I like for you to be involved, but I think for this one, try to make space."

Gunshot to the head. Fifteen. I had hardly processed her words when the bustle picked up again. The ambulance transporting the patient had arrived. Shruti sprang into action, snatching back boards and then jumping on the computer to put in orders they would need; from far away I could see the words "massive transfusion protocol" and "CT head" on the screen, and then he was here.

I felt like I was in a fishbowl. The boy on the stretcher looked like one of my younger cousins, except his face; his poor face.

I couldn't look at him any longer, so I looked at everything else, at the cervical collar placed uselessly around his neck, at the scraps of cut-away clothing that flapped under him. At the rest of his body, splashed with blood, but otherwise pristine and untouched by the violence that had been done to his face; a lithe body, he was only 15, he probably played sports, maybe ran track and field for his school --

Someone pulled me bodily out of the trauma bay. A cup of water was shoved into my hands, and a gentle but firm missive to go home whispered in my ear. Instead, I stared blankly through the glass. The boy was obscured from view by the hustling bodies. They had started compressions. Shruti's voice firmly but calmly called out orders from the foot of the bed. A passing nurse muttered that the kid was pretty much already dead, and had anyone called his family? I imagined his mother. She was probably the kind of woman who would call me honey in the grocery store. Did she know what had happened to her son? Or was she sitting at home completely unaware, rewatching her favorite episode of "Scandal" and not thinking to check on her teenager before curfew? Would she pick up the phone when we called, or ignore it to finish the episode? What sound would she make when she heard the news?

I didn't have to wonder for long. Behind me, a high, keening scream punctured the air, and when I turned around, I saw her. She was younger than I had pictured, and heavier, but even from this distance I could see the resemblance. The police officers who had escorted the ambulance to the hospital formed a wall with their bodies around her, blocking her from rushing in and interrupting the code, and she shoved against them, her screams devolving into heart-wrenching sobs.

"Do you know what happened, ma'am?" one of them asked her. "Was he involved in anything he shouldn't have been?"

I felt sick. How dare he ask her a question like that while her son clung to life by a thread only a few feet away? Would that question save him? Would it give him back his face? Shaking with fury, I walked back to the workroom and silently gathered my belongings. I remembered the young man from the Emergency Department so many years ago, brushed off as an addict even as his abdomen filled with blood. For both this boy and that man, the message was implicit -- whatever suffering they were enduring, they must have deserved it.

The bright colors of the children's hospital took on a dim, sinister edge in the evening light, the chalky round eyes of the children in the third-floor mural becoming dark and bottomless. I sat down on one of the couches in the lobby, leaned my head back against the headrest, and closed my eyes. Home was only a 15-minute walk away. I'd been doing that walk for 2 and a half years, but right now, going into the vast openness of the night felt daunting. I inhaled. Just downstairs, a boy was dying. He had been full of potential, full of a future that had likely now been extinguished. I exhaled.

My brain could hardly process it. It kept going back to that destroyed face. One eye had been perfectly intact. I mentally filled in the rest -- full lips, like his mother's, on a wide mouth. It must have been close range. Was this going to be my life now? Watching person after person die? In just 3 short years, would I be in Shruti's position, looking down at the body with clinical indifference, shouting out orders with barely any recognition of the horror that was in front of me?

Startled out of my thoughts, I looked up -- and nearly leapt out of my seat. A smiling, goofy bright blue Barney the Dinosaur knockoff loomed over me. Before I could ask, "Why the f***," it took off its head, and revealed, of all people, Ricky.

Not that his appearance was that surprising. Ricky was a regular volunteer, here for 3 hours on most Tuesday and Saturday afternoons, and I'd interrupted many of his paint sessions to evaluate my patients. Still, I'd yet to see him in costume. The juxtaposition of the ridiculous image before me and the horrific one in my head was too bizarre to reconcile. I burst out laughing, and then...just didn't stop. I must have looked hysterical, but it was nice to laugh, even better to realize that I still could.

"All right, har-dee-har," Ricky said. "I'll have you know I'm wearing this for the kids. Regular Dino guy couldn't make it."

The boy from the trauma bay's face flashed through my head again. My expression must've changed, because when I met Ricky's eyes again, he looked concerned.

"Yeah, um," I shrugged. "I just saw something really messed up today."

Ricky seemed to get my implication, that describing something as "messed up" in a children's hospital meant that it was supremely messed up. He nodded sagely, then dropped onto the couch next to me. "You want to talk about it?" he asked.

I shook my head. It didn't feel right to talk about it.

He rocked back to his feet, Arnie's body sloshing around him. "I need to go change out of this."

"Oh, okay." I tried to keep the disappointment out of my voice. "Nice running into you. Have a good night."

"Wait," Ricky said. "It'll take me like 3 minutes to change. Are you headed to the parking garage?"

I shook my head. "No, um, I walk." Ricky looked aghast.

"But it's late! And dark out!" He looked down at my hand, from where my keys hung. "Oh good, you have pepper spray. There's creeps out there, you know."

"Sounds like something a creep would say," I said, enjoying the way Ricky instantly seemed to clutch his pearls.

"Wow," he said. "I was going to offer you a ride!"

"So," I said, tilting my head. "Are you not going to offer me one anymore?"

Ricky shook his head and started waddling toward the office. Just before he disappeared from view, he pointed back at me.

"Don't go anywhere!" he shouted.

I nodded. Distantly, I could hear the door to Child Life slam shut. The air in the lobby felt still, and suddenly I was alone with my thoughts. Part of me wanted to go back to the trauma bay, to see whether the scene I'd left was still intact. Had they been able to resuscitate the boy? I doubted it -- his blood pressure had barely registered on the monitor, and Shruti hadn't looked hopeful. Had they let his mother into the bay?

I whipped around. Ricky was behind me, dressed in joggers and a thin T-shirt. Out of Arnie the Ankylosaurus, he'd become a boy again. A boy whose every word I stowed away in the back of my mind to revisit when my mind was idle. A boy, I reminded myself, who was very much not available.

This excerpt was adapted from On Rotation by Shirlene Obuobi. Copyright 2022 by Shirlene Obuobi. Reprinted courtesy of Avon Books, an imprint of HarperCollins Publishers.

Shirlene Obuobi, MD, is a Ghanaian-American physician, cartoonist, and author. She is currently completing her cardiology fellowship in Chicago. Connect with her on Instagram @shirlywhirlmd.

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