Scared Of Healing

Incoming

It has been a fairly quiet night in the ED, although I would never say that out loud. I'm the on-call paediatrician in the ED tonight, although I am usually an inpatient paediatrician. Nothing major has happened, just some broken bones and some other simple stuff. So I am sitting on the nurses station, dangling my legs over the side - ignoring the glares that the nurses send my way - and reading some charts. I look over to see one of the interns - who I identify as Josh Baker - looking bored, leaning on the other side of the nurses station, clearly disappointed that there isn't more drama unfolding for him tonight. "You've gotta appreciate these moments, they don't come often" I smile to him, "but it's so quiet" he complains. All of a sudden, it seems like the whole ED freezes and stares at him, me included. One of the nurses pipes up, "he did not just say that" she groans. In an instant, the emergency phone rings and our charge nurse, Maggie, sends the intern a glare before answering. 

"Alright, we have a very sick young girl coming in, everyone be on standby, the paramedics don't know what kind of help she is going to need" Maggie announces, putting down the phone. "And that's why we never complain" I say to the intern before I am told, "Clifford, you're primary on this one, she's scared, she's sick, be careful" Maggie says to me, leading me to nod and get prepared. "Baker, you're with me" I say, jumping off the bench and looking to him.

I have my bay set up, ready for my incoming patient. The doors of the ambulance entrance slide open and the paramedics quickly wheel a frail looking girl into my bay, "female, early teens, won't talk to us, wouldn't let us do anything but check vitals. BP and pulse stable, stats at 87% but refusing oxygen" one paramedic informs. "On my count" I say, griping the edges of the sheet, ready to pull her onto the bed, "3... 2... 1" I say and the girl is lifted and placed carefully on the bed. She is way too light for her assumed age, I am immediately concerned. The poor girl is so small, she looks to be about 12 but I have a feeling that she is actually a lot older than she seems. 

I bend down to look at her as she lies on her side on the bed. "Hi sunshine! My name is Mikey and I have Josh with me too, do you think you can tell us your name?" I ask, trying to sound as encouraging as I can. She just looks to me, fear dancing in her eyes, "ok honey" I sigh. "I really want to help you lovely, all I need from you is a nod or a shake of the head when I ask you questions, can you do that for me?" I ask hopefully. She gives me a slight nod, "alright sunshine, I'm not happy about your oxygen levels, it might make you feel a bit better if you let me give you some more oxygen, can you let me do that for you?" I ask carefully, receiving a slow nod. I grab an oxygen mask and carefully bring it towards her face but she flinches away, "it's just oxygen sweetie, it's not going to hurt you" I try to reassure. She carefully reaches her hands out and takes the mask from me, holding it near her face. "I wanna have a quick listen to your chest now sunshine, would that be alright?" I ask and she looks to me fearfully and covers her chest with her arm, "can I have a listen on your back?" I ask carefully and she nods. "Ok sunshine, can you take some deep breaths for me?" I encourage as I press the bell to her back, getting the impression that she is rather uncomfortable with touch. She takes perfect breaths, obviously knowing what she is doing and I can hear everything perfectly, not to my liking though because all I can hear are decreased breath sounds and quite a bit of crackling at the bottom of her left lung.

"Can I get you to give me a cough sweetheart?" I ask, curious as to how the crackling in her lungs is affecting her. I present my hand to help her sit up but she sits up without my help, obviously not comfortable touching me yet. Her heart monitor immediately starts beeping and I look up to see her pulse spike to 147 bpm, "can you lay back down for me sunshine?" I ask, trying to internalise my panic, so she doesn't freak out. She puts her hand up, signalling for me to relax and I give her a curious look as I watch her eyes flick, she is obviously dizzy. She then starts counting down from 5 on her fingers and as she gets to 0, the monitor stops beeping as her heart rate makes its way back below 100. Once she seems stable I look to her, "do you think you can cough for me?" I ask carefully, wanting to make sure that she is ready. She nods and I nod back. My patient lets out a chest rattling cough that immediately brings up mucus. I quickly grab a cup and give it to her as she falls into a mini coughing fit. "Breathe for me sunshine, you're ok" I try to reassure as she coughs and continues to expel the mucus from her lungs.

Eventually, the coughing calms and I can help my patient get back on her oxygen. "Good girl sweetheart, you're ok" I say calmly. I then take the cup from her and see the incredible amount of mucus that she has coughed up. There are so many colours of bright green, deep dark green, brown and almost grey, but the most prominent and worrying colour is the large puddles of red scattered through the mix. This is not normal and it isn't just streaking either, it is full puddles, indicating active bleeding. This is very concerning and I know that the next step is to get a chest x-ray and possibly a CT scan. I throw out the cup and quickly refocus my attention to my patient.

"I want to give you a different form of oxygen, it's just a bit more comfortable than you holding the mask, would that be alright?" I ask and she nods. I quickly rip open the packaging of a nasal cannula and attach it to the wall oxygen before carefully trying to hook it around her ears. She anticipates my movements before I do them though and before I can, she quickly takes the cannula out of my hands and positions it on herself. I take a quick look and recognise that she has placed it perfectly, and decide to move on. "Are you still feeling dizzy sweetie?" I ask to which she shakes her head, "ok, can I keep checking you out then?" I ask, receiving a nod.

"Look to your left for me sunshine" I instruct before seeing her look down to her hands, quickly checking which way is left before complying. I insert the otoscope into her ear, expecting her to try to move away, but she stays perfectly still and allows me to continue, "thanks sunshine, and to the other side" I say and she complies. I quickly finish looking in her ears, "alright, can I get you to tilt your head up for me so I can look in your nose?" I ask, immediately receiving a stern shake of the head and she cowers away from me, "it's ok sunshine, we might save that one for a bit later, hey? what about I look in your throat, would that be alright?" I ask hopefully. She seems happy at this and I grab a tongue depressor, "open for me love" I encourage and she does, immediately sticking her tongue out and flattening it so I don't even have to use the tongue depressor, "well done sunshine" I say, quickly finishing looking. She seems to know what she is doing, it feels like she has had experience at hospitals before. "Can you follow my light with your eyes for me?" I ask, presenting her with my pen light and watching her follow it without moving her head, "ok hon, can you look at my ear for me?" I ask, she does and I quickly check her pupil dilation.

She soon realises that the next step in my examination is me checking her abdomen and seems very apprehensive. "Sweetheart, I need to have a quick feel of your stomach, just to make sure everything is ok" I say softly. She just shakes her head and blocks her abdomen with her arms. It pains me to ask this but I have to, "sunshine, did someone hurt you?" I ask carefully. She looks to me before slowly nodding her head. "Oh sunshine, I promise you right here, right now, I will not hurt you" I say confidently. She looks to me, as if looking for a lie and I stare straight back, standing my ground. She eventually seems satisfied with my promise and slowly removes her hands from her abdomen. "Alright..." I begin, about to explain what I need her to do, but she already knows exactly what I need. She lays flat on her back with her knees up. "Thank you sweetie" I say before slowly moving closer to her. "Can I lift your shirt, just so I can see your tummy?" I ask and she does it for me, "thanks love" I thank again before slowly bringing my hands down to begin the examination. She squirms and quickly holds my hands away, prompting a subtle eye roll from Baker, which I quickly ignore, hoping that my patient didn't see, "hey, hey it's alright sunshine, what did I say? I will not hurt you" I reiterate. She looks to me again, obviously terrified but she still doesn't say anything, slowly letting go of my hands and allowing me to continue.

After the examination, Baker and I walk out of the room to discuss.