“Fuck! Liz, get in here! I need more light.”
Dr. Polk, the PICU intensive care doctor is renowned throughout the hospital for his skill at inserting central lines into even the smallest child, and also for his use of colorful language. Middle-aged, however, his eyesight is worsening. This makes the placement of central venous catheters a challenge for all of us. Tonight, the patient is a three year-old in hypovolemic shock we picked up from the ER.
Corey brought him up, and gave me report.
“Dr. Polk, this is a pediatric unit. Watch your mouth,” Liz scolded while setting up a freestanding light used in these situations. The room had an overhead light for this purpose, but whoever designed the rooms placed it in the center of the ceiling instead of towards the wall containing the oxygen and electrical outlets where the head of the bed goes, rendering it useless.
“Yeah, yeah, I remember,” he mumbled. “Get that light a little more to the left, would ya? Yeah, right there, that’s it.”
After that the line went in smoothly. Using a curved needle that flashed and glittered in the light, Dr. Polk tethered the CVC to the child’s skin with two silky black sutures before stepping out of the room. Then I took over, sterilely dressing the site while Liz ordered a portable chest x-ray.
Once the X-ray confirmed placement I switched the bag of IV fluids from a peripheral IV to the central line. I charted another set of vital signs, then got to work straightening up the mess left by Dr. Polk.
Carefully, so as not to stick myself, I picked out each needle and blade from the used central line kit cluttering the bedside table before throwing away the packaging. The sharps went into a red puncture-proof container. I straightened the bedding under the motionless child, lying on the stainless steel crib. I covered him with a pink and blue bunny blanket, which looked out of place in the ICU setting.
Next to the crib, a pair of corrugated blue and white ducts snake from the ventilator through the crib railing, connecting to a breathing tube inserted down the boy’s throat. Next to the ventilator three small infusion pumps were clamped to a single pole and piggybacked medications into the maintenance fluid. One kept him still so he wouldn’t pull out any tubes. Another kept him calm, and induced mild amnesia. The third, a narcotic, blunted the pain of his ordeal. Like Goldilocks, I hoped the combination would be just right. I rolled up two washcloths, and placed one in each of his hands to prevent his inactive fingers from curling. I checked the monitor alarm settings one more time before stepping out of the room for a moment.
At the nurses’ station, Dr. Polk had brought the boy’s mother in from the waiting room. Her eyes were red from crying. Animatedly, she told him about the events leading up to this admission. The child had been sick with a fever for five days, the last three of which he began vomiting, and refused to eat or drink anything. He started sleeping a lot too. She brought him to the ER this evening after she couldn’t get him to wake up for dinner.
It’s amazing how sick a child can become from fever, nausea and vomiting. Maybe if he’d seen a doctor sooner, the trauma and expense of this ICU admission could have been avoided.
“Why didn’t you bring him in when he first got sick? Why did you wait to see a doctor?” he asked, but Dr. Polk, Liz, and I already knew the answer.
“I no have insurance. I no have money.”