The Niceties

…(Children’s Wall Decals, available from WallMonkeys)…

“We got two coming,” the chief mutters just as I hit the floor, staring disgustedly at the computer screen and looking as blue as the scrubs he’s wearing.

No, “Hello…What was your name again?!”  No, “If you’re looking for the hospitalist team room it’s one floor down.”  Not even his customary, “Hey…kid.”  Oh good.  No time for the usual niceties tonight.

“ED room 7.  Eight month ex-25-weeker with complex medical history.”  He thrusts a giant sheaf of printed copies of clinic notes and lab results from an outside hospital across the desk at me.  A few sheets fly off in crazy directions, but he doesn’t seem to notice.  “Report back quick as you can.  No, call me when you set eyes on him with  the sick-o-meter read.”

I collect the wayward papers, tuck them into a manilla envelope and move out.

As I walk past the glass doors in the children’s ED, I catch sight of a preteen boy mid-puke (all down his mother, of course), of a man holding an inconsolable baby just as close as he can, staring vacantly at the “WASH YOUR HANDS” reminder sign above the room’s sink,  of a toddler squalling as he holds out a burned hand, of a skinny-jeaned teenager glaring sullenly at one of the ER residents, throwing out what I’m quite sure are barbed, one word answers.

A nurse yacking angrily at her pager phone about the puker in room one nearly runs me down with an EKG machine, snapping, “HEY, exCUSE me!” as I try to make my self one with the wall to open her path.

“You’re excused,” I murmur after she’s run over my toe and rammed my arm.

I nab the vitals and chief complaint from the ER chart, print the labs, then knock just above the orange 7 with the cutesy tiger curled around it’s stalk.

On entering I see a tiny, tiny baby, so badly jaundiced he rivals the bright color of the tiger outside his room.  He’s got so many tubes in his itty bitty body I can barely make out his form – G-tube, multiple ostomies, broviac, PICC line, ventriculoperitoneal shunt, not to mention EKG leads, pulse ox, nasal cannula – you name it, he’s got it.  His mother sits in a chair pulled close to the bedside, her purse on her lap, stroking his orange cheek with her index finger.  She gets up to shake my hand with a shy smile.

“Hello again,” she says.  I assume she has mistaken me for another healthcare worker and begin to introduce myself.

“Oh, I know who you are!  Do you remember?  You held my hand when I was having my son.”

I gasp. Dear God.  She was my very first patient all those months ago at the beginning of my M3 year.  Preterm labor we couldn’t stop, converted to a crash C-section for significant decels.  I remember wiping away her tears and holding her hand while we ran to the OR, holding it till she had been induced and intubated before I ran out to scrub.  I remember her hypotonic, motionless infant, with obvious serious congenital anomalies whisked to the adjoining resuscitation room by the NICU folks while we worked to staunch her significant hemorrhage.  I remember stitching up her wound (the subcutaneous part – not the important uterine or fascial layers, of course), then helping to clean and transfer her, going to check on my other laboring patients only to receive a page that she had woken up and was asking for me.  I saw her three times a day for her three day post-op stay.  She was the first patient I ever presented on rounds, the subject of the first operative note, the first progress notes I ever wrote, the first patient who ever saw me as her primary care provider, directing her questions to me only in a room full of real doctors.

She touches her belly.  “There isn’t too much of a scar there, you know.”

“Oh my goodness, of course I remember!  It’s good to see you again!  Well, not under these circumstances, but good to see you!  And good to see this little pumpkin, too.”

I know.  Poor choice of pet names.*   Luckily, mom let it slide.

I did a cursory exam while collecting pertinent history, then paged my resident that the sick-o-meter was about a 4/10 (10 being PICU material, 1 being, why are we admitting this kid again?).  I finished the full history, gave mom a bare bones game plan, and promised I and my bosses would come by when they’d been transferred to the floor to answer any questions.

Mom shook her head.

“No, I’ve got a 3 year old, a 5 year old, and a 7 year old at home I’ve got to go relieve the sitter of.  Normally I wouldn’t leave him, but now I see you…  I know you’ll take good care of my baby boy.”  She smiles.

I’m about to praise our team and promise our best attention when she pounces on me.  Without warning she shoots forward, wrapping her arms around my neck, her cheek pressed close to mine.  I nearly drop my papers as I reflexively encircle her petite frame.  She squeezes me for a long while.

“Thank you, Mullberry.”  She pulls back and holds my shoulders, smiling straight into my face for a comfortable moment.

Then, she hands me a sticky note with her cell phone number, kisses her tiny boy, gazing at him for a few beats, and slips from the room.  I stand at the foot of her son’s bed reflecting a bit in my happily shell-shocked state.

I guess there was time for the niceties after all.

.

* Jaundiced skin (indicative of liver/biliary disease) is a sickly yellow-orange color – a bit pumpkin reminiscent…  This, of course, was not what I was implying in my choice of sobriquet.