There are very few moments in my job when I feel real fear; I see a lot of unpleasant things. I see a lot of sick people, and many of them make me anxious, because I'm always thinking the worst. But that's what I'm there for. Get on and treat.
But sometimes, something will happen that makes me pause, that sucks the breath right out of me. A time when you begin to think you might not have whistled loud enough on your way past the graveyard.
Perhaps this will clarify:
Last night began humourously enough; I forgot my scrubs, so borrowed a set from Sister. Dressed as I was in blue, everyone took the opportunity to look askance at me and call me 'Sister Shroom'. And it was honestly as funny the 20th time as it was the first.
Then, in one of the surreal moments that EM throws up, our reverie was broken by the arrival of an Ambo, breathless, clutching a small child in her arms. But come from the wrong direction. From the main Hospital, not the Ambulance bay. Such a simple thing confused me; I must have looked like the Village Idiot - slightly slack-jawed, as her words washed over us, in short, staccato bursts. Something about purple hands and feet.
Thankfully, the real Sisters had more presence, and we deployed to Resus. A beautiful little boy, small for his age, even smaller when marooned in the middle of the gaping trolley. He was gazing about, fixing us all with his eyes; he had beautiful blue eyes.
We all noticed that.
Dad gave an history of non-specific illness for a few days, topped off with lethargy today, and then the episode with purple hands and feet.
(As an aside, I'll simply ask you to regard your own hands and feet, and their colour. Unless you have circulatory issues, or are a grape fetishist, see how far removed the colour is from purple? Got it? Good. So you can imagine where purple is on Shroom's list of Colours I Am Glad My Baby Is Not)
He was cold, for sure, but he hadn't been in the cold. Rubbing his hands, I press his fingernail gently between my finger and thumb. It blanches, corpse white, and stays that way for far too long. We strip him off, compounding his indignity, adding to his childish outrage at life. His chest and belly are mottled. Warm bu mottled, and I can leave a ghostly fingerprint on his sternum for several seconds.
He's sick.
So shut down that I'm struggling for access; I call Paeds early, stammering over my presentation - the Model Professional. It always stings my pride a little to have to call them for help early, but it's not about me, and the kid doesn't care who draws his blood. In fact, I get a line in while I'm waiting for Paeds. Third time lucky? His hands are freezing, and I can see his veins, but they lie guttered beneath his skin, and I'm really running on hope. It's rare that I feel I really need a drip in someone, now, but I felt that way about him.
Anyway, Paeds arrives and we give her the lowdown again. She runs the ruler over the kid, establishing that his skin is not normally mottled (which I didn't even think to ask...)
And then it happens.
'And what about these petechiae?', she asks. 'How long has he had these?'
Showing posts with label Squeakers. Show all posts
Showing posts with label Squeakers. Show all posts
Saturday, June 14, 2008
Tuesday, March 25, 2008
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...
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...
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