Monday, November 03, 2008

Poking a screaming child? That'll put hair on your...

"Bet you feel the testosterone surging through your veins now, eh?" the ER doc supervising me said. "That'll put hair on your chest."

Then again, I'm sure everyone else in the ED (and all the other wards on that floor) also had a snappy comment for me, seeing as how each and every one of them could hear the screams of my patient.

A young girl had gotten a huge gash in her arm after falling through a plate-glass window, and the emerg doc took one look at her chart and handed it to the resident, who handed it straight to me. At that point I was still unsuspecting, super keen to sew up yet another wound. Boy, was I naive.

After looking at the wound I flattered her quite nicely about being such a trooper, such a large gash and all and so little crying.

Turns out that all my buttering up was for nothing, which I found out as soon as she asked if she would be needing a needle.

That's where I went wrong.

She sensed my instant of hesitation before my answer, and took that as her cue to start screaming at the top of her lungs.

The screaming didn't stop. We tried everything from distraction, to warm blankets, to massaging her temples, to topical anesthetic and intranasal fentanyl, all of which seemed to only fuel the screaming, which lasted well into the procedure, despite the gallon or so of lidocaine I used to freeze the wound.

Even though I have sewed many a wound with very little fanfare, this whole experience actually stressed me out a lot -- much more than I expected it to.

You see, I still have enough compassion left that it makes me feel REALLY bad when I know I'm hurting a patient, especially a child, and I get uncomfortable when I see a pouty look, let alone screams of bloody murder and "PLEASE STOP! NO MORE NEEDLES! OH FOR THE LOVE OF...' Yeah, I didn't know 11-year-olds knew that many swear words. Kids these days.

It was made even better with the parents shooting me the look of death the entire time for causing harm to their little angel. Fortunately, the father's claim that he wouldn't be bothered by the blood soon proved to be quite false, and the emerg doc saw him starting to reel and whisked him away, saying "OK, come with me, you are sitting down over here. Put your head between your legs."

As well, with all the the flying fists and limbs I was pretty scared of buring the syringe or suture needle in my own hand.

In fact, I was even more stressed that I'd be poking the care aide holding the child down. Keeping this saint happy had risen to a very high priority ever since she set aside one of the leftover hospital meals for me (which, despite being hospital food and looking like it had already been digested once, was still food).

The procedure finally ended, and she finally went home, and a strange calm fell over the emerg. In fact, with the young girl gone I could only really hear monitors beeping, ambulance sirens, nurses shouting, and other patients yelling, which was so much more quiet than when that girl was there.

Later on, one of the doctors told me that he used to feel bad poking children because they would cry so much. "Then," he said, "I had my own kids, and realized they cry all the time... even if you are not doing anything to hurt them."

That did make me feel a bit better. But I was still so worked up when it was all over that I considered going to the homeless gentleman and ask if he was gonna finish that bottle of rubbing alcohol he was using to get drunk (tuition is due soon, so I am trying to get all the free hospital food and free alcohol - of any form - I can get). I figured if dealing with the screaming child didn't put my hair on my chest, perhaps some isopropyl alcohol will.

Either way, any more shifts like this and I think I'll start losing hair rather than growing any more.


Anonymous said...

Meh. I have a kid of my own, and I still don't like it when I hurt a patient. I mainly work in ortho as a CNA (your version of a care aide up north), and we take peds on our floor with fractures all the time. It really hasn't gotten any easier to deal with the screams, but you do get to a point where you can sorta tune it out. I just focus really hard on the procedure at hand.

Anonymous said...

Sometimes you have to hurt to help. Me, I remember two things: with kids, they scream no matter what you do, and with adults, the louder the screams the higher the likelihood they're faking it.

Anonymous said...

I've seen docs do conscious sedation in cases like this. I guess they're just wimps.

Dragonfly said...

I bet your ears were ringing after that...