You're Just Family Today II

He weighed about 17 kg and was draped limply across his mother’s arms. His almost lifeless body fasciculated to some unknown rhythm produced by his seizing brain. Mom screamed for someone to help her as tears streamed down her mascara streaked face. I raised my hand and guided her by the elbow to one of the beds where we routinely take care of critical patients. I reached out and pried the boy from her arms and laid him on the gurney. Another nurse placed a bag-valve-mask (BVM) over his small mouth and nose and held it tight to his face as her other hand began to inflate the bag portion of the BVM. I wrapped my arms around mom and gave her a big hug, while stepping back from the gurney ever so slightly, to give the other members of the team room to work.

Dr. Pez was the pediatrician on duty that night. He is not just a pediatrician, but an emergency pediatrician with 35-years of experience. I call him Dr. Pez because he always kept a Pez dispenser in his pocket so he could share happy pills with appropriate patients. It was a great way to break the ice with the kids, and often helped the children open up and relax during their visits. Dr. Pez approached, placed his hand on her upper arm, and introduced himself to mom and began to question mom as to what was happening.

He just started seizing, she stated.

We don’t know… he hasn’t been sick, he’s been outside playing with his friends all day. I went outside to give him some Kool-Aid and he just dropped in front of me and started seizing. It’s been going on for almost ten minutes now AND IT JUST WON’T STOP.

As the other nurses worked on getting an IV line I walked into the nurse’s station and pulled an Ativan and Valium from the fridge. I rustled around in the syringe drawer and pulled out a couple of 18 gauge needles and several 10 cc syringes. I then grabbed some IV tubing and a bag of saline and headed back to the bedside.

One-oh-three-point-five, I heard Nancy state, as she withdrew the rectal thermometer and punched her thumb on the little button on the end of the probe that sent the probe cover sailing off into the trash. Susie was simultaneously grasping a small square alcohol wipe and scrubbing furiously at one anticubital area as Jason mirrored her activity on his other arm.

And then it began.

As I ripped an alcohol wipe open and began to scrub his left foot I heard a man behind me start to yell.

YOU HAVE TO PACK HIM IN ICE NOW GOD-DAMMIT!!! WHAT THE HELL ARE YOU IDIOTS DOING GET SOME FUCKING ICE  OR YOUR GOING TO FRY HIS BRAIN!!! I’M A PEDIATRICIAN AND I KNOW YOU NEED TO PACK HIM IN ICE!!!

I turned to see a 5’2” blond thirty-something guy yelling at us as if we were a mile away. I returned to the kids foot and quickly popped a 20 gauge IV into the top of the left foot. My fingers tightened on the small ankle for fear of a jerk pulling the IV free of its seat in the vein. GOT IT, I Shouted. Quickly two sets of hands appeared next to mine with tape and blood drawing paraphernalia. I grabbed one of the 10 cc syringes I had brought with me to the bedside and drew an entire 10 cc’s of blood from the catheter before connecting the IV line. Yea, I know that’s too much blood to draw from a kid, but I was worried that the person I handed the blood off too would try to fill adult blood tubes, instead of pediatric and I did not want to have to draw anything other than blood cultures the next time.

One milligram of Ativan, Dr. Pez ordered.

I handed the vial of Ativan to Nancy along with the syringes and needles she would need to administer it. She popped the cap on the Ativan, screwed the 18 gauge needle on the syringe and quickly drew 9 cc’s of saline into the syringe from the bag of saline after Jason cleaned the port with an alcohol wipe. Nancy up-ended the vial of Ativan and drew the contents into the syringe.

Jason went back to wiping a cool wet cloth across the child’s body as Nancy administered the Ativan.

WHERE’S THE GOD-DAMMED ICE! I heard Mr. Pediatrician yell.

By this time the child had turned from a light shade of blue to a nice pink. The heart rate was tachy but under 200 BPM. Small faciculations continued and Dr. Pez ordered another milligram of Ativan IV.

Mr. Pediatrician continued to yell and it was apparent to all that his presence was not helping in any way.

Dr. Pez finally had had enough. He turned to Mr. Pediatrician and said “Sir, your presence here is not helping my team. Would you like to leave or do you need to be escorted from the premises?” He said it almost as a whisper. Dr. Pez then turned his back on the jerk and grabbed the laryngoscope and ET tube and had the kid on a vent in short order.

We heard later from the Children’s Hospital that the child was sleepy, but awake. His temp at the time of transport was down to 100.4. That was without any Tylenol administered. Once the seizing was halted the temp rapidly dropped to normal.

What about Mr. Pediatrician? He was the boy's uncle.

It turned out that Mr. Pediatrician was in his first year of residency. It also turned out that the doctor in charge of the residency program was a good friend of Dr. Pez.

It just doesn’t pay to mouth off to someone in the medical field. It’s much too small a world to take the chance.

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