Tag Archives: pediatrics

when he said thank you

I hugged him, with one arm, afterwards. I hugged him because he was afraid.

He’s a pediatrician. It’s that season, you see. The season of kids with hideous gastroenteritis, the season of dehydrated little tiny people who are justthisclose to having one of those near-death situations we talk about in PALS so much.

This little one, her heart rate was over 200. She met the standard definitions of shock. She needed a lot of fluid, and fast, before her little heart wore itself out from beating so fast. I only got called to do a cap gas really. If the results aren’t that bad, I don’t ordinarily return to the room. This was one of those situations when I returned in person to the treatment room. This child was doing that eyes-rolling-back-in-her-head-breathing-is-optional thing, being stimulated by nurses rubbing her sternum with knuckles to try and get her to wake up and take a breath. This child was close to having a cardiac arrest. These poor nurses were doing everything they could prior to the pediatrician arriving kind of thing. These poor nurses had poked this poor baby 20 times or more.

By the time the pediatrician had arrived, the favored major sites had been poked to try and get an IV. I could hear the echo of my PALS instructor (another pediatrician) in my head: “how many times do we poke and poke and poke with these sick kids, when we could just do an IO then and there, and leave those veins for after they’ve been rehydrated?”

I had nothing respiratory to do, other than prepare. I changed my mask on my bagger. I had my intubation equipment ready. I was planning for the worst, and, at the same time, I was prodding my pediatrician: “just put in an IO, just do an IO, the gun is six feet from where you’re standing, why struggle with trying to put in a fragile IV in the scalp you can’t pound some real fluid in anyway, just put in an IO.” I was naive about his previous experiences with trying to put in these fabled beasts into small children. I was unable to put myself in that picture, of the child who had suffered through multiple attempts. I was that ignorance-is-bliss voice-of-reason, where I had no clue that he had tried this before and it’d gone horribly.

He did it anyway.

After multiple attempts at an IV cannulation in this very small, very dehydrated child, he finally pulled out the IO gun to drill a needle into this tiny person’s leg bone. It’s a very squick-inducing thing. Had it not been the best method of getting some life saving fluid into this baby, I would never have suggested it. How necessary it was became obvious when they drilled into her leg and she didn’t even flinch. In goes the IO. A very large amount of fluid gets pounded into a very tiny person and very quickly does such a baby begin trying to put the ECG lead cables in her mouth rather than her eyes rolling back into her head. Relief.

“Good, her heart rate is slowing down,” I say aloud, (from the 200 earlier, I’m thinking.)

“Great, mine too,” the pediatrician says, and my heart goes out to him.

He, in truly heroic fashion, later thanked me for making him do the scary IO thing he didn’t want to do, later. I replied with a smile and a one-armed hug.

I am so pleased to have these relationships with the doctors I work with. I chafe to think at how I would work with someone who would not be receptive to input. I am extremely pleased that in this case, this child lived, and am perhaps in this case, not so immodestly proud as to think of how I perhaps may have helped to save this baby’s life by being a right royal pain in the ass.

I love my job.

Advertisements
Tagged , , , , , ,

the one who doesn’t cry

An unanticipated death; some professional embarrassment in there for good measure. Difficult, due to the fact that the one who died was a child, and a sweet one; that, and the fact that it was likely our fault in some way. (The reader is left to imagine the multitude of ways in which one person in a team of probably hundreds could be possibly at fault. Trust me. We’re all wondering the same thing.)

A debriefing; listening to the vignettes of the family and the child from the circle of chairs in the playroom. Some tall people on some tiny chairs, wilted from night shifts, or the ones fresh from days off, with perfectly applied makeup. They had a long time with this baby, they laid down in his bed and hugged him, patted his tummy to comfort him in that way they had seen his dad do, taking him to the playroom instead of starting his feeds … interviews with mom … years of past history … perhaps wondering why they hadn’t intervened earlier.

If there’s anything I’ve learned through a multitude of shitty situations, a multitude of debriefings, it’s this: no matter what is your fault, it’s over. Learn from it, for it’s the only possible positive outcome of an entirely crappy situation. Beating yourself up about how it could have been better if you had the power to go back in time and fix your fuckups is ultimately a failed exercise in self-loathing, and the self-loathing is an obstacle to learning: what’s happened has happened, so learn for next time, and prevent it from happening again.

A lot of that happened in that debriefing. From the strong and silent among us semi-blaming themselves, knowing what they’d do different, to the ones who have what seem like the easiest jobs in that they are only so tangentially involved, nearly everyone seemed upset nearly to the point of tears.

Except me.

It came to be my turn near the end, and I spoke of equipment malfunctions, problems with sensors, recalibrating X and Y, and of being pissed at myself (not blaming) because I had been so absorbed in the equipment that for that critical minute, I forgot to look at the patient. I wasn’t upset at the death of the kid, I was more pissed at myself that I had immediately jumped to the conclusion that the equipment was messing up on me.

To be fair to myself, the rest of the equipment hadn’t exactly been working as intended, and I’d had problems from the get-go. Things were quiet and stuff that should have been watched wasn’t, but it’s hard to not feel a bit like an uncaring goon when the people who weren’t even there for the arrest seem significantly more shaken up than I am.

It’s remarkable to me because, I think, this is not simply because of respiratory or because of the sheer amount of times I’ve been there when somebody’s died. I don’t think it’s that I’ve become desensitized or somehow heartless regarding the whole incident. Indeed, I was upset about it — I just did all my crying immediately afterwards and not in the debriefing. So it goes.

I think, however, that last paragraph is a bit reflective of how RTs are. We have the face we show to the rest of the team, and then there’s the things we say, the stuff we complain about, the opinions we share, the discussions of what bother us, the planning what to do next, that we all do behind the closed door of the respiratory department. The reason I never cry at organized debriefings, the ones headed by a social worker or someone with training for crying people, is because in order to keep doing what I do, I have to do it every day, by myself, behind a closed door. More often than not, I do it with other RTs. Sometimes, like the particular instance that struck me this time, I end up doing it at 2am with other health professionals, like the nurse who gave me a hug before I cleaned my vent and went home to bed.

I think it’s healthier that way; that I know how to debrief so that I can sleep, that I do it automatically and without needing hand-holding or prompting. I think it’s what means I can do my job without having a nervous breakdown.

Long ago I used to worry that not crying about these things meant I was getting callous and gritty, jaded and bitter, all those things that they usually say about surgeons and cops. I don’t worry about those things anymore: I think I have a better understanding of grief and attachment as a result of having done it more times than I can count. I can survive without losing compassion. Maybe some would call it tough, but I hate that word for this. It’s not some kind of machismo bullshit need to appear all stiff-upper-lippy. It’s just self-preservation. I can sleep without waking up screaming, I can go to work the next morning, and I can still have fun at work. I still love my job. No matter how shitty it gets, I plan to. For a long, long time.

Tagged , , , , , ,