Underwater

SoldierNurse22, BSN, RN

I squinted, opening my eyes into the direct light of the sun. I immediately averted my gaze to the right, my attention held firmly by the rising quarrel among the seven children in the pool. Their mothers, lingering outside the pool gate in their cars, smoking cigarettes and talking angrily on their cell phones, had left their oldest children to watch the younger ones, the oldest of the group probably about fifteen.

Who needs a birth control pill. I thought, half-serious. The atrocious behavior of the teenagers and elementary-school-aged children alike was striking. The only thing more appalling was their mothers' passive-aggressive reaction to their children's bad behavior, which only served to further incite the kids, seeing that they had gotten under mom's skin.

This was not what I had been hoping for. I had spent the last two days becoming ACLS certified for the first time. It had been a while since I'd sat in a classroom, and initially, I wasn't so sure about the idea. But then, as we practiced scenarios and our group of 6 got comfortable with each other, I warmed to the environment. In the group was my friend, Anna, the gastro nurse in my clinic; her friend Diane, a PACU nurse; a surgeon, MAJ Johnson; a Warrior Transition Brigade caseworker, LTC Anderson; and an administrative nurse, MAJ Garcia.

MAJ Johnson was easily the most comfortable with the information and had clearly been around the ACLS block before many, many times. He flew through the scenarios and written test. Close behind him was LTC Anderson, who, despite being away from the bedside, seemed to know a fair amount about ACLS as well.

I had heard the written test was difficult, but I was confident. After all, I knew the rhythms, drugs, and book and had flown through the scenario test-out without difficulty. What could go wrong?

Post-test, I was greeted by my old friend, Critical Thinking, which, while an asset to my bedside nursing, was NOT an advantage on this "don't over-think it" written test. I switched off my brain, took the re-test and passed easily. Good deal...I guess. The scenario matters more anyway, I consoled the Type A within who hated the idea of failing anything, ever. No one ever saved a patient by passing a written test. Be content that you'd know what to do if someone crashed in front of you right now.

At home, I packed for my mini-vacation, ate some lunch, and played with the cats. With the sun high in the sky and the temperature in the mid-80's, the pool was a reflexive move.

And there I was--stuck in the middle of a bunch of unruly, fighting children and their distant mothers. Finally, one of their mothers came into the pool area while the others ran out to fast food joints to fetch dinner. When her presence failed to tame the roaring crowd, I retreated to the hot tub, now in the shade, for a bit of reprieve.

The hot tub was a strange choice for me, especially considering the heat in the sun, but I felt drawn to it for some reason. I could feel my blood pressure dropping back down to normal, the warmth of the water soothing away the background ruckus. At the sound of a splash, I opened my eyes.

To my left, a little boy, perhaps three years old, sat on the top step of the hot tub. He had clearly just arrived from the pool behind him, soaking wet and cold. I smiled at him and he smiled shyly back at me. I'll bet he can't touch the bottom of the tub. A voice in the back of my head warned quietly.

I glanced to my right. Rose bushes bloomed outside the pool gate nearby. Wasps and bees buzzed excitedly around the flowers. They're pretty, but I wonder why pools always choose to landscape with plants that attract bugs with stingers? I asked myself, building up an unlikely story about the management's secret population control plan. Perhaps that's why so many apartments are empty as of June...

I glanced back to my left, looking into the pool--when suddenly, I realized in my periphery that there was something in the water in front of me.

Without a sound, the little boy had stepped off the ledge of the hot tub. He was now completely underwater. Unseeing, his hands grasped desperately for the ledge of the tub. His feet kicked against the bottom, his head tilted upward in a frantic attempt to reach air. He's going to drown.

Within milliseconds, I had scooped the boy out of the water and placed him on the top step of the hot tub.

"Are you OK?" I asked, my mind already in nursing overdrive. A head-to-toe survey had already been completed. I watched his chest rise and fall and noticed that he wasn't coughing--he probably hadn't been under long enough for oxygen hunger to force him to draw a watery breath.

The boy nodded, stunned. He rubbed his eyes and stood up unsteadily, wandering over to the pool.

"Isaiah! Did you notice that your brother had wandered off to the hot tub?" The woman sitting poolside scolded the 15-year-old.

Did you notice that a stranger just pulled him off the bottom of the hot tub while you were too busy fighting with each other to even realize that your 3-year-old had wandered into the water? I countered angrily in my head.

Adrenaline coursed through my mind, which raced at miles to the second. I was terrified and yet on top of the world all at once. It had happened so fast--pieces of the event replayed involuntarily in my memory. He's going to drown. The warning that spurred me to action repeated ominously. He was safe now--but had I done everything right? The Army's AAR (after action review) system was already working its magic in my hormone-soaked brain, logically pulling together the events of the past few minutes.

I remember catching things back when I worked oncology that had been significant to a patient's health. I remember watching the ICU nurses and doctors pull patients back from the brink of death. I do not, however, remember being the only person standing between another human being and death.

I left the pool twenty minutes later, still stunned by the rush and how fast everything had happened. Perhaps more stunning was the fact that the boy's family didn't seem to realize that he had been underwater at all. Had I not been there and no one noticed his absence, there was no way that they could have seen him in the hot tub from where they were sitting. The very idea gave me chills.

Perhaps what struck me the most was how quickly and effortlessly I had gone into nurse mode. Those skills they teach in nursing school and in classes like the one I had been in earlier that day had taken over before I had a chance to consciously choose a course of action, which is, of course, the point of ingraining algorithms and assessment techniques in the learner's head--they become reflexive when time is ticking away the seconds of a fading life and there is no time to stop and think.

I've said it myself a million times on the way to the beach, on a family hike, or out with coworkers after hours--"Please, no one die today/tonight. I'm not in the mood to bring you back." Everyone laughs, usually someone chimes in in agreement, and the day or night rolls on.

But after the events of this afternoon, no matter how much I may joke about being "off duty" or "on a break", I have realized that who I am--that core personality that watches over the safety and well-being of strangers--will never shut off. I will always be willing to pull someone up from underwater.

**PLEASE NOTE: The names in this story have been changed to protect the innocent (and not-so-innocent!).**