TENDERNESS

I’m trying to catch up on my charting one particularly crazy afternoon when our nurse-in-charge comes into my office and asks if I can assess a baby. Her mother had brought her in to see the other nurse Ellie, but when Ellie took her in after a bit of waiting, the mother yelled, “You guys aren’t doing anything to help me. I’m taking her home.” Knowing how quickly babies can get ill, they ask if I can coax the mom to stay and have her baby assessed.

I finally convince the mom to let me see the baby, and she continues to vent. She is angry and frustrated at her common-law, who does little to help her with the kids, and she is so, so exhausted. I notice she’s quite rough and short-tempered with her children. I gently try to de-escalate her as I unwrap the baby to get a better look. The baby’s awake, but her colour looks off, she’s working hard to breathe, and is sweating profusely. She’s not as active as I’d like her to be. As I get the oxygen probe on her toe, her oxygen readings come up low, so I quickly bring her into the emergency room to start oxygen treatment and nebulizers for what looks like a respiratory illness. I grab Ellie on my way and I update her. “I’m not sure what’s wrong with her yet – maybe bronchiolitis? But she doesn’t look great, so I might need a hand.”

Ellie and I hurry to get a full assessment and treatment started at once. The doctor on call is trying to arrange a medevac from another community, so we’re having a hard time getting ahold of him. We notice the baby’s heart rate drop and she starts spacing out, and we look at each other in alarm. Luckily, Ellie has loads of experience with pediatric trauma and prompts me to check a blood sugar.

<0.1.

Oh shit. Shit shit shit.

Ellie and I react immediately. She grabs the IV tote and tries to get a line in, while I run to get more help and find some oral glucose. But the baby’s veins are so flat after all that sweating, and Ellie can’t get a line in. The baby’s also not responsive anymore so there’s no way she’ll swallow any liquid glucose. I finally get an IV on the other side and we hurry to get some sugar in there. As our nurse-in-charge scrambles to find the right IV tubing, we realize we’re still missing the stock we ordered weeks ago. We have no choice but to run it by gravity and watch the fluid volumes carefully.

After about 15 minutes, the baby perks up. She’s now alert and interactive and even wants to drink some juice. Her breathing is still abnormal, but it seems that the major crisis has been averted. Ellie and I sit down in the corner of the room to regroup and catch up on our documentation.

“I’m so glad we made them stay,” she says. “If they had gone home, that baby would have been dead within the hour.”

I nod, and we both breathe a tense sigh of relief. But it is short-lived when we are interrupted by the mom screaming, “she’s having a seizure!”

It turns out we are just getting started.

We’re immediately at the bed again and sure enough, the baby’s eyes are rolled back with her back arched and legs shaking. We pop an oxygen mask on her and turn her, as the nurse-in-charge tries to get ahold of the doctor again to get medication orders. There is so much to do at once, and we are only three people. We get some anti-seizure medication into the baby, but she continues to have focal seizures throughout the next 20 minutes, and it takes two more doses of medication before that seems to resolve. Her temperature drops too, and we put the warming blanket on her and worry about an underlying infection. There is no question that this baby needs to be medevaced.

I have no idea what is going on, and my list of differential diagnoses is only getting longer. Bronchiolitis. Hypoglycemia. Hypothermia. Shock. Sepsis. Meningitis. Seizures. Neurological damage due to low sugar. All of the above. All I can hope is that we can keep her alive and stable for the plane to get here to bring her to a hospital.

Our other nurse joins us after clearing out the other patients at the health centre. There are at least four more hours until the plane will arrive. It seems that the baby is stable for now, but we are all on edge, knowing how quickly things can change. I watch how hard she is still breathing and I wonder how much longer she can keep this up before her breathing crashes too. Putting in a breathing tube is an advanced skill far beyond what any of us are trained or allowed to do. But if she stops breathing, we may have no choice but to try some kind of advanced airway. What I wouldn’t give right now for a doctor or respiratory therapist to be here.

Against all odds, she is still stable when the plane arrives. The pediatricians at the hospital call us to say what a superb job we have done. Down South, we would have multiple doctors, the pediatrician, respiratory therapists, countless nurses, and endless supplies, and this would still have been a challenging resuscitation to run. Here, with just four nurses and missing equipment and supplies, we just managed to get by. It is hard for me not to see the things we could have done better, but we did our best, given the circumstances.

As they get ready to depart, the mom comes down the hall to give me a big hug. “Thank you for being patient with us,” I tell her. “I know this was all very scary. But you did an amazing job, and you were right to bring her here. We’re always here for you.” She hugs me tight and thanks me again, and she looks like a different woman than the one who walked in hours ago. I remind her to take care of herself, and she squeezes my hand as she turns to leave.

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I pick up the chart at the front desk and look warily at the name. I haven’t seen this patient before, but I have heard plenty from the mental health workers. She has been non-compliant with her psychiatric medications, and has had the RCMP called on her multiple times for aggressive behaviour. Her whole family is known to be volatile, and she’s been removed from multiple homes and a shelter for assaulting other people. We’ve been given explicit instructions not to dispense more than one pill to her at a time to prevent any overdoses by herself or her family.

She’s just here today for some advil and cream for her eczema. I brace for her to escalate when I tell her I can only give her one advil now that she has to take in front of me, but she is surprisingly agreeable. I grab her a tube of cream and tell her to come back if it doesn’t get better in a week. She thanks me, then starts to tell me about her life right now. “I’m really trying to get it together and make it on my own.” I smile and offer her some encouragement, and remind her that we’re here to help take of her if she needs it.

As she turns to leave, she suddenly asks to give me a hug. She wraps her arms so tightly around me that for a moment I wonder if she’s trying to strangle me. But she lets go after a minute, and I wonder to myself how much affection she has lacked during her hard childhood. I wonder how different she would be if she had been met with love and affirmation instead.

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Myra and I are running around one Friday morning, scrambling to see all the patients with only the two of us working. As I treat one patient for a COPD exacerbation, I pop my head back outside to check what other patients I can see while her treatment is going. I spot the man whose thumb I stitched up a week ago, and I remember that I told him to come back today to get the sutures removed.

He’s cheery and smiling, just like the past two times I’ve seen him, as I bring him into my office. We chat as I snip off the sutures and wrap up his thumb. As he gets ready to go, I ask if there’s anything else he needs, and he mentions his trigger finger has been bothering him again. I make the appropriate referral and he gets his coat on.

“Anything else?” I check again.

He shuffles and looks away. “Well, there is a little something.” He pauses, hesitating. “No, it’s okay, I’m okay, I’m good.”

I think I know what’s coming. I’ve seen that hesitation before, at something he’d only think of disclosing after meeting me for the third time. I get him to sit back down and ask gently, “Are you having feelings of wanting to hurt yourself?”

He closes his eyes and two large tears roll down his cheeks. He nods.

We talk a bit about this. He has no active plan, but he’s had these feelings for a long time and used to see a counsellor. We talk about coping strategies and support systems, and I give him the 24/7 number for the mental health worker in our community. He seems hesitant to call them, but I encourage him to find someone to talk about it.

“If the feelings get any stronger, call us right away. We need you here, okay?” I remind him gently. He smiles through his tears and nods.

A week later, he drops by to see me quickly again. “I took your advice,” he says shyly. “I talked to some elders and some of my friends. I feel like I can handle this better now. Thank you again for being there for me.”

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In the weeks leading up to this contract and when I first got here, all I felt was a deep desolation and loneliness, and a reluctance to come up. I was exhausted and burnt out, weary from travelling between two jobs and trying to keep up with the responsibility of everything in my life. When I landed, I was told how short-staffed we were, and how we were struggling to support a grieving community after a number of recent violent suicides and alcohol-related deaths. I thought that what I had to learn was to stretch far beyond what I was capable of handling in stress, sadness, and exhaustion. But rather than the despair of relentless work that I had braced myself to feel, I was instead met with these constant tender reminders to see what we can restore to people with just the smallest amount of unconditional love.

One early morning weeks ago, I sat at Edmonton airport, steeling myself for the work ahead, waiting to board my flight. I was interrupted by a text from a friend.

Safe travels today. I hope you continue to find purpose and meaning in your mission field out there.

My eyes teared. I had been so entrenched in the dread and reluctance that I had almost forgotten why I was going. How grateful I was to have friends who would remind me of these things when I couldn’t see them. May we never forget that God sends us out on mission, to be even the smallest light in the darkness, to go out in the barren desert and bring hope. In the days ahead, as we care for a world rattled and suffering from the coronavirus, may we continue to remember this.