on adrenaline. . .
The nurses and clinical officers joke that when I come in for routine rounds, I always find someone in need of desperate attention. My last call night was no different.
I walked in at 8:30 for a quick review of every area and found a wheezing child in one corner, a seizing child who had just arrived, and then we were called urgently to the floor. A child with a critically suppressed immune system was having stridor – severe distress in her breathing with a heart rate double normal and sounds belying her difficulty with every movement of her muscles.
I gave the treatments that come first with this – epinephrine and steroids and nothing changed. I called our ENTs for help, because emergency training had taught me that when these kids get sick, they get very sick, very, very fast.
We turned the floor room into an ICU – drugs, suction, nebulizers, sedation medicines. I had mom hold her in a bear hug so we could calm her down and find out our numbers. The ICU nurses cleared the appropriate bed with lightning speed and our clinical officer set the ventilator just in case.
Every muscle in my body was tense in constant prayer. . .one decision could mean everything.
I asked. It happened. I called out a medicine. It appeared. People offered answers and brought needed equipment in response to wordless communication. David ran keys in from the house. I discussed putting her on the breathing machine with the surgeons. We prepared but waited, knowing the risks. Physical therapy showed up to help her cough well. The radiographer came to get a critical film at the bedside so we could figure out why she was so sick.
I stood grateful and amazed.
I ran to the closet and pieced together the puzzle of our high flow nasal cannula to allow the treatments to run through warmed oxygen and figured out the right combination. Mom held the burette as I poured in precious medicine.
We looked at the film and saw that she was trapping extra air in her lungs. On the new surgeon’s suggestion, we gave a medicine to open them up and saw a glimmer of hope, an easing of the stress on her body. We gave another, and she improved a small bit more – in subtle increments, but improvement.
She struggled as the medicine went in, and – as only pediatricians do – I brought her a magnetic coloring board. “Please color, precious girl,” I implored, “Don’t pull at that mask, it will make you better.”
And she colored with fierce commitment – as if the coloring, not the medicine would bring improvement. And I took heart in her strength. In her willpower. In her determination to help.
She colored, and her lungs opened.
The constant attention continued through the night, one treatment after another. Constant checks. Constant vigilance. I am so grateful for this team that runs hard with me every night and every day.
This morning she is still sick, but she is fighting. As I listened to her lungs, she reached out to play with my hair with a tentative smile.
Deep breaths – from us, and from her.