The pager goes off.

I shudder.

I raise the pager to my eyes and squint at the text.

I will never get used to hearing that forsaken machine go off.

The emergency department is requesting anesthesia assistance.

If they are calling . . . it is likely quite bad.

My team and I arrive, equipment at the ready.

We see no patient.

We fuss and shame our ED staff.

We hem and haw about the busy ORs and the value of our time.

The patient rolls into the trauma bay.

We promptly shut our traps.

Seven-year-old female.

No history of any kind, sobs grandma.

No prior surgeries, wails her grandma.

No nose either.

Horrific dog attack.

Latched on and would not release the face.

I look at my resident.

He is white as a sheet.

He later tells me that I was white as a sheet too.

He suggests we intervene before things get worse.

I tell him to prepare a tube and call for some advanced airway equipment.

This is going to be tricky.

The patient is sitting with a mauled face not crying or screaming.

Likely she is stunned.

Likely she is in shock.

Likely her life will never be the same.

We sedate and promptly intubate.

She is rushed to the ICU and shortly plastics will attempt to reconstruct a passable face.

Upon stepping out of the emergency department he looks my way.

We both know he’s about to cry.

We know I will cry shortly thereafter.

We have rooms to staff and go our separate ways.

The pager goes off.