“So far his oxygen level is okay,” Jeannine said after a quick look at the monitor. “Heart rate is high, but not unexpected. Fluids are going in well.”
“As long as his airway is stable, I’ll hold off the intubation until he’s under anesthesia. Let’s have a look at him, and if he’s stable enough we’ll do X-rays and see what’s going on under the wraps.” Miklo reached for the blood-soaked bandages, then hesitated. “Can you get some sedation going?” Dr. Kyriakides asked Jeannine.
“Should we take him inside before we get started?” she asked. “I feel so helpless outside.”
“There’s no trauma room available yet, but there’s a spare treatment room I know of down the hall,” Charlie said.
“Let’s move him there. Jeannine, I’ll count on you to get the medications going.”
“Okay. What do you like to start with?” Jeannine knew her heart was beating about as fast as the boy’s, but adrenaline always flowed quickly during a crisis.
“Morphine.” Dr. Kyriakides gave a quick visual scan of the boy, his gaze serious. “Looks about twenty-five kilos, so give him a morphine dose now with some midazolam for amnesia. We don’t want him to remember any of this, if possible.”
“I’ll have to find the charge nurse first. I don’t know where the medications are kept here,” Jeannine said, and dashed toward the main desk. Minutes later she returned to the small room. With trembling fingers she began to push the meds into the IV tubing. “That ought to do it.” Memories of those particular medications flowing through her own veins tried to push to the surface, but she held the memories at bay. In the midst of a crisis was not the time to remember her own recent trauma. She stroked the hair back from the boy’s forehead. “Just be calm, we’re going to take good care of you,” she said to the unconscious child.
“Okay. Let’s see what we have.” Miklo’s large hands gently peeled away the layers of bandages from the child’s face. Fresh blood oozed from a multitude of cuts and abrasions on the boy’s face and neck. Gently, Dr. Kyriakides opened the boy’s eyelids and flashed a light into them.
“Pupils okay?” Jeannine asked as she went through the neuro checklist.
“Yes. I was looking for glass, but thankfully I don’t see any,” Dr. Kyriakides said. “Until we get X-rays, let’s just leave the gauze on him.”
“Okay. Do you think we should try Radiology right now or do you think they are as slammed as the ER is?” she asked. “He seems stable enough to transport, but I don’t want to sit in X-Ray for an hour, waiting.”
“Let me find out,” Miklo said, and grabbed the phone in the room. After a brief conversation he hung up the phone. “They’ll take us in ten minutes.”
“Great. By the time we get him down the hall, they’ll be ready,” Jeanine said.
Miklo’s strong jaw was tightly clenched and his firm lips compressed into a straight line.
“Doctor? Are you okay?” she asked, wondering if she was intruding on his thoughts.
Miklo turned to her and gave a slight smile. “I’m okay. Waiting for X-Ray makes me crazy sometimes.”
“I know what you mean.” She touched his sleeve, hoping to impart some comfort to him. Though he had said he was okay, she wasn’t sure that was the complete truth. But, having just met him, she was not one to judge.
After multiple facial X-rays and a CAT scan to check for a brain injury, which was negative, the group took the patient straight up to the PICU since the ER had no space.
The boy started to wake up, and Jeannine took his hand. “Hi, there.” With her other hand she stroked his hair. All that was peeking out from beneath the bandages were frightened brown eyes that became wider with each breath he drew.
Miklo stepped away from the x-ray light box and returned to the gurney. “Hi. What’s your name?”
The boy glanced back and forth between Jeannine and Miklo without answering.
“Do you think he’s hearing impaired?” she asked with a frown. “I hadn’t thought of that.” Perhaps they had overlooked an injury to the middle ear, or maybe the boy was hearing impaired. Jeannine chewed on her lower lip, trying to think of all of the ways to communicate with him. “I didn’t see any ear injuries, but I suppose he could have sustained something in the wreck.”
“Let me try something first. Ola. ¿cuál es su nombre?” Miklo asked in Spanish.
Jeannine watched as the boy nodded and tried to speak. Her heart ached as he struggled to communicate, and remembered struggling with the same problem when she had woken up in a hospital bed unsure what had happened to her.
As she remembered her situation, an idea came to her. She rummaged around in a storage cabinet for a moment and returned with a paper printed with the alphabet. “Are you fluent in Spanish, Miklo?” she asked as sudden energy swirled within her.
“Yes.”
“Ask him if he can spell his name, and I’ll hold up the chart.”
Miklo relayed the information. The boy raised his hand and pointed to a series of letters on the communication board. “¿Roberto? Su nombre es Roberto?” Miklo asked, his voice soft as he spoke to the frightened child.
The boy gave a slight nod to verify his name. Jeannine grinned and was relieved to see the small smile Miklo gave her. “Brilliant. Now ask him if he can point out his phone number.” With the mother still unconscious, they needed to find another immediate family member right away.
As Roberto pointed to the numbers, Jeannine wrote them down. “Chances are, whoever answers that number isn’t going to speak English either. Do you want to make the call?” she asked Miklo.
“Sure. Why don’t you go ahead and give him a little more sedation? He’s probably wondering what’s going on and right now I don’t think we can tell him.” Miklo’s serious eyes continued to observe the boy.
Jeannine dialed the number and handed the phone to Miklo. While she listened to the rapid Spanish conversation, she added a few milligrams more medication. This sort of sedation ideally was figured in milligrams per kilogram of the child’s weight. Right now they were giving a low dose, enough to keep him quiet but not enough to put him under completely.
Miklo hung up the phone. “The father’s coming in.” He bent over Roberto and relayed the information in a calm voice.
Jeannine watched as the man made soft eye contact with the boy. This was a man who cared about people. When she’d been hospitalized so many doctors and nurses had taken care of her that she’d lost track of their names and faces over the months. The sense of caring was one she carried with her to this day and motivated her to get out of bed every morning, hoping that she could give that gift to someone else.
Jeannine spoke to Roberto. “I know you can’t understand me, but I’m going to take good care of you.”
Miklo turned and translated softly as she spoke.
“I’m going to stay with you the whole way, okay?” she said, and gave him a smile.
Miklo watched as Jeannine spoke to the boy. She connected with her patients, that was obvious. But there was something about the way she spoke, the way her long fingers stroked Roberto’s hair, and her gentle manner that spoke of compassion running deep in her veins. As if she understood what it meant to be on the other side of the gurney.
“I’m going to have to take him to surgery as soon as the dad signs the operative consent.”
“I thought you were the medical director,” she said.
“I am, but I’m also a maxo-facial surgeon.” Miklo hesitated until Jeannine looked up at him.