Signs of life

Three weeks ago: I stepped up to the table entirely unsure of what to do with myself and somewhat terrified of being in the way. I clumsily took my gloved hands and placed them on the table at the gesture of the scrub nurse. I found my hands resting on the mound of green sheets. Suddenly I found my hand rising and falling and realized my hand was on the patient’s chest. So peaceful, his chest rose and fall. Somewhat anticlimactically, the attending asks for a 11 blade and fresh blood flashes on the yellowed skin. The fascia and fat are burned through deliberately and still his little chest rises and falls. I know of course that behind the green curtain is a team of anesthesia folks regulating each breath but I am still in awe of the peaceful rise and fall of this child’s chest as we probe into his body with our knives. It was horrifyingly easy for a moment to forget that under all the drapes was a living human being.

Two weeks ago: He has never eaten a day of his life and rarely spends any time outside of his little crib in the corner of the ICU. And he is post-op from his third operation in 2.5 months of life. His little baby hands are failing and he is crying almost to himself. His arms are restrained so he won’t pull out his tubes (which he loves to do). He looks me in the eyes as I peer into his crib and seems to beg. I place my hand on the soft tuft of hair on his head and stroke gently. He looks in my eyes again with a look of contentment, of peace. The tears stop and his eyes follow the steady rhythm of my hands.

Today: I got to our emergency bowel obstruction case early and asked the Anesthesia people if I could tag along. I spoke to the Mom and the child before even the Anes people came by. I knew the child he had been on our service for several days. He had a ruptured appy and now unfortunately had a complicating SBO. He was not thrilled about returning to the OR. We started to roll him away and I start to the OR then turn around and find the Mom sobbing. I go back and comfort her and try to reassure her. A nurse takes over and gestures for me to return to my duties in the OR. “Take nice deep breaths.” she says with her arm around the mother’s shoulder.

When I got the OR I showed the kid his x-rays and helped get him arranged on the table. The Anes attending pulled me aside and explained to me he wanted me to hold cricord pressure (helps position the trachea for intubation). He instructed me to place my hand on the patient’s chest while they gave him the inducing drugs (sleep drugs…). This time there was no peaceful steady breathing but the rapid flutter filled with fear and a bit of dread. Then all of the sudden, the flutter turned into the steady drum that I had learned to anticipate with each procedure. His chest rose and fall. My hand flew to his throat and in went the tube.

This morning I walked into a room of a child with a gunshot wound to the head. He had limited if any sensation and movement of his lower extremity, his grandmother is in the corner quietly crying. On the bed is the child naked except for a sheet with an oozing wound and a look of despair and exhaustion. I held the penlight so my upper level could examine the wound and I again found myself with my hand on the child’s shoulder. and it rose steadily with the rise and fall of the chest. And I found myself wanting to whisper to him, you are still with us, stay with us, just keep breathing.

From beneath my feet appears a brown heap of curls. A heart shaped face peers up at me with a impish grin. She tugs on my white coat and crawls into my lap with ease despite the cast on her arm. While many of her size run away from me in all my medical student get up, she is not fazed and is intent on sitting on my lap rather than in her bed. She puts her head on my chest. She seems to be looking for something. I talk to her as I write an order. She looks up at me again with a million dollar smile as if to say I found it. You are still alive. You are still human.