Teeny Little Super Guys in the ER. Part Two.
This is part two of my ode to pediatric patients in the ER.
If you missed Part One, this is the Teeny Little Super Guy.
He used to be on Sesame Street.
He lives in a cup in a kitchen and all his friends live in utensils and jars.
It’s hard to explain.
But it’s cute!
And it reminds me of my pediatric patients; the Teeny Little Super Guys that make up a special part of my practice as an ER nurse.
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I’m still at Starbucks.
I really do have a life outside of blogging.
Really.
I do.
Starbucks radio report: we went from Motown to Tony Bennett (alright!) and now it’s the Dixie Chicks. I wish they weren’t so good. I really would like to not like them.
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The unit was crazy busy.
Are you detecting a pattern here?
This time I was assigned to the multi-patient room.
Four beds total.
The designated Charge Nurse for the day informed me that a small child had been roomed, chief complaint abdominal pain with vomiting and fever. She had seen her pediatrician two days before and was seen in an ER the previous day.
The pain and fever persisted.
And now she was my patient.
*****
She sat on the edge of the gurney, watching me with apprehension whenever I entered the room. She spoke Spanish.
No problem. So do I.
Sort of.
I thought she was older. She was taller and heavier than most girls her age. I placed her at about seven.
She was five.
I adjusted my approach accordingly.
*****
The ER doctor completed his assessment.
I knew what was coming.
The pain and fever had lasted too long to just pass off as gastroenteritis.
We had to do it.
The dreaded “Pediatric Work Up”.
*****
First, oral contrast as an abdominal CT was pending.
Tears the size of teaspoons ran down her cheeks when she was told she had to drink all 1 and 1/2 cups of the Gastrografin/water mixture.
(Not exactly dehydrated, eh?)
It was slow going at first.
Then we went commando!
Meaning, I sat on a stool in front of my patient and cheered, cajoled, teased her about taking tiny sips and praised her to high heaven when she actually swallowed some.
She laughed at my Spanish.
I made faces when she pretended and did my “happy dance” when she took a gulp of the vile solution.
Do you know how hard it is to do a “happy dance” when you are sitting on a stool? I nearly lost my balance twice, which just made the patient laugh and drink more.
Hey, anything for progress.
I knew all those years as a cheerleader would pay off eventually.
*****
Eventually the contrast was in.
And guess what her reward was for drinking all of the Gastrografin?
An IV. With a bolus.
Tears the size of tablespoons flooded pillow as she verbally assaulted the atmosphere with her protestations.
(Still not thinking this kid is dehydrated; definitely nothing wrong with her lungs.)
In what passes for Spanish in my world, I told her that crying was okay, but she had to hold still. If she held still I could do it in one stick.
(Please God, help me get this the first time….)
She held totally still and the IV was placed, labs were drawn and she managed to deafen me for an hour, something normally reserved for rock concerts and loud iPods.
The bolus was started.
It was time for a teddy bear.
*****
The CT was done and the patient was returned to my care. The bolus ended and she was happy to have the tubing detached.
Good news! The CT was negative for appendicitis!
Yea!
Time to go home!
Except….
We needed a urine specimen.
*****
The patient did not want to pee in a cup.
The doctor told me to do a straight cath.
In my pseudo Spanish, I told the patient she had a choice.
Pee-pee in the cup, or pee-pee with the help of a tube.
You never saw anyone run so fast to the bathroom.
She produced enough urine for ten patients.
I praised her enough for one-hundred.
The urine was clear. No infection.
*****
Now it really was time for discharge.
The saline lock was removed. With tears, of course.
But it was also time for a color book, some crayons and a pretty plastic butterfly.
After all, this young patient has been a trouper. She did so well for someone who was only five. Better than I could have ever expected or hoped.
And after I had given her all her goodies, this tiny Latina, this Spanish-speaking child, this girl to whom I had spoken only (occasionally hilarious) Spanish, turned, looked me straight in the eye and with a smile said:
“May I please have a bear and butterfly for my big sister?”
IN PERFECT ENGLISH!
Of course she got the bear and color book for her big sister (age 7).
And this courageous little girl also got my heart that shift.
I was so relieved that she was okay.
And so sorry that I had to put her through the scary procedures and nasty medicines.
Sometimes you just have to do things for the good of the teeny little super guys in your care.
Because you care.
