Little Wing

Where once there used to be an 0600 Cardiac Call, I now seem to attract an 0755 squeaker. This one came with a warning. The BatPhone trills us out of Monday morning's quiet reverie. It had been peaceful for a few hours. I even lay down for half an hour.

I should have known better. Superstition dictates that the Shroom who is planning a quick getaway brings ruin on himself; and the poor bugger that ends up in the ED, of course.

Control is calm; matter of fact. They always are. Car smash, sounds high velocity. Three casualties - two kids.

Enter the squeakers.

They arrive piecemeal, not in the order we were told. A 10 year old first - she looks well, and I deploy SHO Kingsmen.

We wait. Not for long. He's right behind, made smaller by the board. He looks tiny surrounded by the Techs and Paramedics; dwarfed by the monitors.

He's very quiet.

This makes me nervous; the quiet ones make me nervous. This fact is generally lost on adults, who generally believe that by shouting good and loud, they'll get dealt with quicker. It just tells me they have a patent airway, and breath enough to shout, and energy enough to waste doing it.

But the quiet ones...

A quick eyeball reassures me. He's alert, engaging his surroundings. I remember his eyes as piercing blue, but maybe that's dramatic licence. His view is limited by the sandbags stabilising his neck. The traditional ED view - nothing but ceiling tiles - and now me. He locks on as my face hoves into view. I try to think of something to say that will make this all alright for a 4 year old.

He looks less than impressed, but doesn't struggle as I clamp my hands and forearms to his head. A soft tissue vice, if you will. We run the primary survey ruler over him, and he comes up clean.

By know his sister has spilled the beans. L'il fella speaks no English. They were in a car hit at speed from behind, and rolled. Big sis crawled in to pinch him from his car-seat. My respect for both of them grows, enormously. I keep talking to him, aware now that tone is more important than words. He fixes me with his steely gaze once more; all the acknowledgement he can manage, he goes back to studying the ceiling.

Finally in a well fitting collar, we roll him; still no sign of injury, but we have to have his sister translate the indignity visited upon him. When I ask him to clench his buttocks, he does so with vigour. I half expect him to yell "Ta-Daa!" to accompany the demo of neuro-muscular integrity. (Which is the purpose of said request, in case the non-medicos were just thinking I was warped...)

He doesn't flinch as we cannulate him, draw his blood into tiny vials, virulently red against his pallor. I try to cheer him by making one of our Masonic teddy bears put on a little song and dance. He treats the display with the contempt it deserves. Everyone a critic...

By now I'm ready to hand over; pass his care like a baton; he is stable, needing some X-rays, but I feel he'll be OK. By now, his Mum has arrived. We MacGyver the trolleys next to one another, so L'il Fella can hear and touch his sis and Ma, even if he can't see 'em yet.

When he hears Ma, he breaks his silence, and a stream of language pours forth; the words spill into the resus bay, silent with relief that no-one appears seriously hurt. We've all seen the pics of the car the Paramedics brought in on their phones. Whether we like it or not, these images bring a flash of what could have been - the tearing asunder of the fragile forms before us.

With Ma nearby, and his voice rediscovered, it is finally too much for him, and he breaks; just a little at first, then rapidly, as his face crumples under the weight of what has happened to him. Finally he gets a little colour in his cheeks as he struggles to stem the flow from his bright blue eyes.

As I turn to leave, I have to cuff at my own eyes, just a little. Must be dusty in here...