When experience counts.(indi) It is said that one begins their career when they graduate from university, begin internships, placements, residencies or whatever it is they are embarking on and not before they even begin their tertiary studies. In my case it was well before my tertiary studies and during high school when I began volunteering as a youth member of st johns ambulance. I was about 16 or 17 years old.

I know; I was a kid and couldn't possibly have had any semblance of a career at that age. You would be right if you, my dear readers, were thinking this, because it's true. But It was really during these years before my post secondary studies that I really grew into myself as a person as well as one who wants to help people and holds a passionate curiosity for human health. I trained and trained during these years in providing and teaching advanced first aid and working at events. I became good at what I did and took it very seriously. I had planned to become a paramedic thereafter but it was in the most unexpected of encounters which I learned the truth about my career goals.

While working with my officers to devise a lecture plan for the adult training session the following week, something I was reluctant to do as I didn't believe I was capable of teaching a bunch of health professionals, given my young age and inexperience, we were at a local event during which nothing whatsoever was happening. The tent was approached by a woman carrying her five year-old son in one arm and leading her older son roughly by the arm. I watched them approach, gathering as much data about them as I could as they approached. The younger boy was bruised around the eyes, his tear streaked face vacant and his head resting on his mothers shoulder. The older boy was being lead, no, dragged by his upset mother by his wrist. His eight year-old face looking shocked and a little angry. The mother in the middle of her two sons was obstructed my her oversize sunglasses. I guessed by this point that the younger son would be the patient, and that he possibly had been injured in an act of disobedience with his brother possibly leading him on.

I stood as they approached and met the mothers sunglasses. "My son's hit his head, I didn't see it happen, his brother can tell you what happened. Can't you Ryan!" she said addressing me and her oldest son both. I introduced myself, glancing at my officer, who smiled and nodded, leaning back in her chair. I knew then that she wouldn't interject unless she thought it necessary. I looked back at the little family, offering them my chair and addressing the younger son. "What's your name, my friend?" I asked the little boy. He sniffed, not lifting his head and mumbled "Jay" in a barely audible squeak. "And what happened to your head?"
"I....I fell..." I listened to him hiccup and struggle to remember. His mother, cradling her little boy on her shoulder, interjected. "Apparently, he tripped over playing kick to kick with Ryan, near the goalposts, he must have smacked his face..." said the mother. I nodded but I needed to hear the story from Jay because this would have helped me assess him for amnesia. "Thanks, I'll keep that in mind, but though I don't doubt that's true, I need to hear the story from Jay." I said to the mother. She nodded as I tried to coax the little boy into telling me as much as he could. "Jay, do you remember how you fell over?" I asked him. "How did you get that whopper of a bruise on your face mate?" Jay closed his eyes and I allowed over a minute for him to tell his story but he shook his little head. "does your head hurt?" I asked, giving up on trying to get a story from the scared child and settled for the one the mother provided, noting that I would ask repeatedly as time went on. Jay nodded. "How are you feeling right now Jay." I asked, gripping my pen torch from my pocket. "I feel sick." Jay said. This sent a chill down my spine. "Jay, can you open your eyes for me?" I said, "I just wanna have a look at them for a bit." Jay did so, but reluctantly. I shone my pen light into them in turn. His right pupil was sluggish and slightly dilated, his left was brisk and reactive like normal. He wasn't liking the light being shone in his eyes, another point which didn't bode well. I looked in his ears and noted a small amount of clear fluid making its way out of his right ear. with what little I had learned by this point about the brain and skull, it was easy for my 17 year-old brain to work out that Jay needed to be assessed by a doctor as he could be concussed, my findings thus far only added to the urgency of this need.

I took a face towel, poured some cool water on it from one of the bottles of water from the van and cleaned the dried dirt off his face. He flinched as I touched his bruises. After this, I could clearly see his face. "Jay, can you look straight at my big old nose, I know it hurts to open your eyes, but I need you to look at me, alright." I asked Jay. It was important for me to see his eyes. "There, that's better, we can see your face now." I said as I dried his face. I looked at the mother who had removed her glasses and placed them on her head. She looked frightened. I looked at Ryan who was stood to his mothers left. "Ryan, what happened when your brother fell. Tell me the story."

"We were playing footy and he asked if he could play. I let him because he gets really annoying when I don't, and he tripped over near the goalposts, know where the ground is hard and cracked. He face-planted." said Ryan.

"Do you remember hearing your little brother cry when this happened?" I asked. Yeah I know, odd question, but I needed to know weather the younger brother may have lost consciousness. Ryan tilted his head looking up, "Um-mm... he didn't cry for a few seconds, he was lying on his face for about a second and then he moved. I was running to him and I saw him sit up holding his face. I thought he'd just banged his nose. Guess mum heard him crying because she got there before me and picked him up..."

"Ok, so your brother was quiet and still for a few seconds after he went down yes?" I interrupted. "Sorry. but thanks Ryan, you've been a big help." I said to Ryan. I palpated Jay's head gently. "Jay, if this hurts you, just tell me and I'll stop alright." I said. Jay nodded. I ran my hands over his little head, my thumbs palpating his face. He yelled out in pain and I stopped. "Jay, can you hold onto my hands and squeeze them as hard as you can?" I asked him, placing my first two fingers of each hand in his tiny ones. He did so, with equal strength. I was happy about this, because it told me that any damage was largely localized to his head and possibly his neck. This gave me another idea. "Jay, do you have any other pain or wired pins and needles anywhere else, any pains in your neck or back?" I asked Jay. Jay took a moment and shook his head.

At this point the mother had calmed somewhat. "What's your name?" I asked her. "Anne." she said. Her eyes were wide with worry for her son and rightfully so because after all the data i'd gathered I was sure, but not entirely so, that this little boy needed a skull X ray and possibly other scans. Now days, I would also add a head CT scan too because now I know better, but then, my knowledge and skill was limited.

I addressed Anne. "Anne, please don't be alarmed, but I think you should take your boy to hospital to get him checked out. He's had a nasty head knock, he may have lost consciousness, according to Ryan, and he's showing some signs of concussion. I know we could call an ambulance, but you taking him will be quicker. When you get there, tell them what happened, he'll be seen quite quickly because he's young and he's been bumped on the head. He may be sick. if he gets sick, then tell the doctor at the hospital because this usually means concussion. He'll have X-rays of his head and some other scans, and they may keep him under observation overnight. This, I think, is the best thing to do for Jay. It's also likely that Jay will be fine, but I can't know this now and have to assume the worse until l I know otherwise. I am sorry, but I can't give him any panadol or anything to eat or drink, and you shouldn't either because these things may mask his condition. I'd love to, but I can't."

When I stopped talking Anne's eyes looked horrified, but she was one whose emotions are confined to the eyes. She nodded as I met her eyes and then Jays. "Don't let him go to sleep either, he may say he's tired but it's important that he stays awake." I looked at my officer. "Permission to accompany them to their car?" I asked. My officer smiled, still leaning back. I turned on my radio and offered my hand to Ryan. "Ryan, you helped me take care of your little brother, thanks, I'm proud of you." I said to him as I motioned to Anne and Jay. Anne lead the way to their car and I gave Jay a glove that I had blown up and drawn a face onto. This made him smile, which melted my heart. "Go straight to Kanning Emergency, it's in the next suburb, tell them what happened, the most important thing is that he gets there and stays awake." I said to Anne as she plugged her phone in and typed the hospital name into google maps. "Hey, you did well bringing him to us, all the best to you, I think its going to be Ok, try not to worry." I added. Anne smiled, placed a hand on mine through her window. "Thanks Indi, you're a good lady, you'll be good." She said to me. I nodded and urged her to drive off. I stood back n watched the car drive away. I took a deep breath, radioed my officer that I was coming back to base and walked back.

When I got back, I turned off my radio and placed it on the small trestle table, taking a seat beside my officer who observed me beaming. I was worried. Had I made the right decision? Could I have done more for him? What if I had to have called ambulance? My officer spoke at this point, startling me out of my funk.

"Indi, have you thought of becoming a nurse?" She asked, still smiling. "No." I replied, taken aback.
"Well, give it some consideration." She said, swinging her tea. I looked at her, a load of questions rising in my head. I went for broke and asked her, "Did I do the right thing?" I was worried that they might get lost, the child may get worse, I may have given an incorrect projection of events, I may have not assessed the kid properly. The doubt was burning inside me like it did when I was sure a patient needed to be escalated but wasn't in a position to do so, either because the patient didn't fit the criteria or because I need approval from a senior officer who wasn't convinced.

"Why are you so down? you realize you may just have saved that kids life?" My officer piped up, losing her delighted expression as a slight frown creased her forehead. I looked up into her eyes. My face ratting me out as it usually did. I couldn't hide anything from this woman. She laughed, leaned forward and set her mug down. "you did everything I or Dr Shane or Steve (The paramedic) would have done with the resources st john has at these events. Hell, you even remembered to ask about the mechanism of injury and asked those involved to tell the story. Fantastic!" My officer was chuckling as she was talking. My defenses were infiltrated, my doubts crumbled along with them. I smiled and allowed myself to ponder the question.

"In answer to your question, no, I hadn't, until today. Why is it you want to know? If I may ask."

My officer beamed. "Because you would make yourself a cracker of an ED nurse, from watching the way you assessed, treated and cared for not only the kid, but his mum and brother. I've seen Dr Dawson do a worse job." She finished, taking her mug from the table and swigging it. I leaned back in my chair and pondered her response.

I've since had five years to think about this single encounter. I've since trained as a nurse. I think now that (with blessed hindsight) that I did take her words and observations to heart. I will never forget that little family, especially the young Jay and the actions of his young mother. I often wonder if I will ever meet them again. Its unlikely, but in those times when I daydream, I hope that Jay is a healthy happy ten year old with a good big brother.

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