Friday, December 21, 2007

Let There Be Drums

So, actually, the last post had little to do with wishes, one way or t'other. This one does. Sort of.

Although, in unrelated news, I have decided the fictional doc I would most like to be is 'HawkEye' Pierce, as seem in M*A*S*H. But I'd most like to resemble the young Luca Kovac, from ER.

So... yesterday, I was workin a few extra hours, as penance for my record breaking oversleep. I owed 3, but asked to pay back 4, as a kind of debt of honour. It is always, always the little things that bite you.

As one a.m. rolled 'round (I should have finished at midnight), I was chatting shit with the SHOs, as is my wont. I heard the happy sound of a baby laughing; looking across the floor, I saw one of the sisters tickling a baby on a trolley in Bay Two.

In a split second everything changed. Almost in slow motion. In a film, or TV tie in, you'd see the smile fall off my face. The baby isn't laughing, he's choking, she's not tickling him, he's fitting.

As one, we're off, running across the floor, even as the call goes out - 'I need a doc here, NOW!'

He's a little one, 10 months, but chubby. A real cutey under different circumstances. He's hot, hot and clammy, and his whole body shakes, held in the grip of St Vitus' Dance. His parents, pushed to one side, are gibbering.

We have nothing paediatric out here... Sister and I support his tiny jaw, saturate him with oxygen as best we can; the adult mask looks ridiculous over his tiny face.

Soon, the carts arrive, someone hands me diazepam, in a little yellow dispenser. This stuff goes where the sun don't shine. No dignity now for the little fella; tho' in fairness it's difficult to maintain dignity when your 10 months old. Anyway, diazepam is in, and we switch to a better fitting mask. I can faintly hear his ma in the background: 'He's not breathing, oh, god, he's not breathing...'

The team is slick; I'm only vaguely aware of of them behind me, moving quickly, efficiently, handing me this venflon, that 'T-piece'. Now, blood bottles, now a saline flush.

Someone's with mum, explaining, reassuring; he is breathing, we are helping him, we're giving him drugs...

But, he's still fitting. iv access, a nightmare in chubby little ones... not this time; straight in, defying my shaking hands. Lorazepam, please. I revert to overly formal language, one of my foible.

'I'd be grateful if someone would do me the honour of passing me a miligram of lorazepam, at your convenience, please...'

Either way, it's there, as I ask for it.

In it goes, and now the monitoring is up and running. Other docs come and go, offering help, rubber-necking. The day has been quiet, now they all want a piece of the Shroom's circus. I'm not really aware of them. My mind is racing, trying to remember the algorhythm.

More lorazepam.

What's next? Paraldehyde? Paraldehyde. What's the dose? Do we even have it? Where do we keep it?

He'sbeen fitting for 20 minutes now. We're just about together enough to make the resus dash now; that's where the paraldehyde lives, after all.

Paeds have been called, but there's always something goin on, so it's us. It's always us.

We love it.

Paraldehyde is in, but he's still seizing, he's still hot. His airway is difficult to manage, but he takes an oral airway. This makes my life a bit easier, but doesn't say good things about his conscious level. Mum and Dad have finally had enough, and have stepped out, alone with their grief. I deploy a colleague to get the back story. I know nothing about this kid. Our entire relationship has been a fight between me, between us, and his febrile brain.

Next is phenytoin; my team have anticipated this, and 180 mg is drawn up, waiting. After that, we all know, is thiopentone; we aren't cut out for that, and the call goes out to PICU. As it's becoming apparent the paraldehyde ain't workin, Paeds enters stage left. God love him, he doesn't have any better ideas, and we start the phenytoin

Another line goes in, rectal paracetamol, and antibiotics, even before he can ask for it. Frankly, I'm still shitting myself, but my team are awesome.

Next onstage is PICU. The back story doesn't help, but the kid is sounding stridulous. This is high on the list of noises you don't want of hear when people are breathing.

The croup? Maybe.

I can still see thiopentone in all our futures.

But then...

As I'm holding his airway open, he reaches up, to push me away. He interrupts his tortured breathing to cry. I have rarely been so happy to see a grumpy frowning Winston Churchill look-a-like.

God love Phenytoin. He is coming around.

We sit him up, leave him to breath on his own. His airway no longer needs my sweaty grip. My focus begins to expand, and for the first time in an hour, I can see more than his little chubby face. My team swims into focus, and they're grinning. Like fools. I guess I am too. We're all pretty pleased with ourselves.

PICU is just as pleased. They always think we call them too early; we probably do. But I still see thiopentone in our future, and I like the company. Anyway, they fade to black, and leave Paeds centre stage.

As we all slip away, the chubby fella is sitting up, grizzling at us all. He's going to be ok.

He's going to be ok.

It ill becomes a man to brag, but we handled ourselves pretty well, considering we were caught with our shorts down to start with.

We can all feel good tonight.


Baby Blue Pyjamas said...

Very well written Dr. I was litteraly gripping the table as i read.


Faith Walker said...

Man alive- I'm absolutely speechless.

Shiny Happy Person said...

Christ these last two posts are bloody brilliant. Both almost made me cry.

You are seriously under-read, DR Shroom.

Medblog Addict said...

This was great! I love that you are writing more.

Merry Christmas!

DrShroom said...

High praise indeed; thanks guys.

Chrysalis Angel said...

A baby save is the best thing in the world, I think. Poor little things. Great job.