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.