From The Back of the Bus: April 2008

Wednesday I got a call right at the end of the work day for an ambulance transfer to Geissinger. I said I could be there in twenty minutes and headed out of the office.

When I got there I questioned, just for a minute, my "Say yes and ask questions later" methodology.

The transfer coordinator was still on the phone trying to secure a driver. He mentioned, as he deftly punched buttons on his cellphone with one thumb while spraying down a truck that had just come back from a fire call, that it was a 'pediatric patient'. I had visions of entertaining a 9 or 10 year old on the way down the road, letting them mess around with all the 'cool stuff' in the back of the ambulance.

Driver secured, we went to the hospital. He and I quickly threw together two cups of coffee which he took back to the bus while I went upstairs. All the way down the hallway I'm following a man of about 25 carrying a carseat in one hand. Odd, I think. If his kid is getting out of the hospital why don't they just carry him downstairs and put him in the car? I lose him in the bank of elevators.

The nurse points me to the children's ward, and as I roll down the hallway an insistent wailing is getting closer and louder. I wait. I shuffle my papers. A nurse appears and I point hopefully at the door across the hall from the banshee-ing and ask, "Is this where we are?"
"Nope," she replies. "In here." I turn around and my young father is standing there. Another nurse comes out and plunks the carseat in the middle of the stretcher. We all look at it for a moment like apes contemplating the monolith. I break the silence.
"Look, I have to be honest...I don't have kids, so I don't know how to work one of these." The nurse smiles, we grab the straps on the stretcher, and figure out how to thread them in the back. So ends the very easiest part of this process.

According to the 10th Edition of Emergency Care (Limmer & O'Keefe), toddlers:
-Do not like to be touched or separated from their parents
-Do not like having their clothing removed
-Have a fear of needles and pain
-Understand more than they communicate
-Don't like oxygen masks

In short, this experience could not really suck more for this kid than it already did. Except that she had pneumonia that wouldn't go away, she was exhibiting a lot of accessory breathing, her sats were crap, and her respiratory rate was tanking.

When kids are too young to understand certain things, you try to coax them to comply. Sometimes you trick them a little. In the hospital, you have to force them to comply. You can imagine how happy this makes them. Her arm was splinted and wrapped so she couldn't bend it or touch the IV port. Her nasal cannula was held in place with two large pieces of tape on her face. It took three people to disentangle her from the tubes and machines so she could be placed on the stretcher. Her eyes were two standing puddles of tears, as she kicked at the straps and looked at her mother in disbelief. She was still wailing but it was obvious she was wearing out. It was time to go.

Do you know how, in movies, people are on airplanes, but you can't actually hear any noise? Just quietness, and their conversations? If you've flown, you know it isn't like that. Its noisy. Ambulances are the same way. You have to speak loudly to be heard. Every pothole feels like you are riding the mechanical bull at the fair. It didn't seem like a place where an already agitated child would fall asleep. But weariness took over and little by little, as her mother sat stroking her hair, her eyes grew heavy, and soon her long dark lashes were resting on her cheeks and she was out. We all looked at each other and smiled a little.

A tiny comet-shaped bruise where an IV had been marked the back of her small hand. Monitor wires trailed out from under her doll-sized hospital gown to a machine that told us how she was doing. (Not horrible, not great.) Once she awoke with a jerk and turned toward me, the sun catching her golden brown eyes. She was in an instant very young and ancient, an unbreakable soul in a very breakable vessel.

The wailing started up again when we got to the hospital; she didn't like the noise of the stretcher or being brought out the back doors. It was a long walk to the PICU and we tried to go as fast as possible, though we were only bringing her to another whole group of strangers to do those things she didn't want done. I was, admittedly, happy to be out of earshot once all of our equipment was removed and it was time to go. Sometimes there is not a lot you can do to make a patient feel better. That is someone else's job. I wished I could have left her with a lullaby. This will have to do. You can sing along too, if you like.