Dolphin Boy

There was a sick kid in room 20. He was one of the types of patients that make you want to pull your eyeballs out. We all have them, the patients that we really don't like to take care of for some reason. He was actually middle aged but some sort of head injury as a child had left him stunted and barely human, a Dolphin Boy.

Medicine, like the kind I practice, rarely considers the final outcome. We pour our heart out when a trauma victim comes in — whatever it takes to give them a shot at surviving. We can’t look at outcomes because you can never tell. Some who should live have died and some who should have never survived walked out of the hospital to a normal life. If we start to contemplate which is which or how to tell them apart, we will start down a slippery slope that slimes us into the bowels of those fictional insane asylums like Arkum of Batman fame.

Still, Johnny could have used someone looking out for him in that ER sometime in the 70s. Thirty years of drooling, crapping, and making animal noises when someone gives you rice pudding. God love his parents. I don’t think I am that brave or strong.

I eyed Johnny and his parents as I walked through the door. I wonder if they could see into my soul to know that I wanted to be anywhere else. My inner monologue something very close to, “Oh great, a Dolphin boy. Who did I piss off today? Does God hate me?”

Here is the problem with these kids, they aren’t normal. I know that sounds stupid to you but how do you know how ill someone is unless you compare it with “normal.” Surgeons had cut Johnny open two dozen times. The largest section of his legs were slightly smaller than my wrist. His chest was malformed and grossly thickened from pulmonary disease. He’d probably sucked more pureed green beans into his lungs than a small backyard swimming pool. What was normal for him?

Today wasn’t normal. Mom and Dad said he was sick. As a medical person there is a golden rule with these type of parents — if you don’t know them, they are telling the truth. Here is why - a kid like that demands constant medical attention. He sees the doctor every two weeks to a month. If they have avoided the ER enough that they are strangers then they have done a good job and they have intercepted a ton of illness's before they became emergencies. These parents in front of me know more about medicine as it pertains to their child than I do. They learned it the old fashioned way, OJT.

The overhead pager blared, “Nurse to room four.”

“That is me,” I say with a little too much relief in my voice as I hastily beat feet out of the room. Whew, I dodged that bullet or at least I put it off.

Right about then is when the ER goes to hell. Ambulances pour through the back door. The guy in room four is having a heart attack. Pizza is in the lounge getting cold. The doctors felt sorry for the nurses who had to skip lunch on their 12 hour shift so they sprung for some pizza — only none of us can make it to the lounge to shovel down a slice or two of pie (or four in my case).

Johnny is going to take some time and manpower to work up. He isn’t going to sit still and let us start an IV. He isn’t going to handle a foley catheter to get urine. This is going to be a wrestling match with Dolphin Boy and his parents. They aren't going to casually wait as I invade their childs body with tubes and needles. No, there will be questions. They will want me to do something "this way." They are invested and that means I can't just do my job. I just don’t have the time for this right now.

Dr. Shoe ordered some oral medicine to help with nausea for Johnny, which I had given. I didn’t think much about it at the time cause it mercifully bought me a few more minutes to get other tasks completed. I remember thinking that I didn’t like the way he looked. His skin was clammy and his pulse was racing.

A few minutes later we received news that a helicopter was inbound with a trauma victim, they were due in about 8 minutes. Throw more gasoline, I thought.

“Nurse, discharge room twenty,” said Dr Shoe.

There was the look. That dog-like cocking of the head. “What do you want me to discharge them with,” I said.

“Nausea, resolved. The kid is doing a lot better since the zofran. I had one of the techs check his vitals and the heart rate is down so he is good to go.”

I did as instructed. At the bedside I looked at dolphin boy. He sure didn’t look any better to me. “Dr Shoe wants to discharge Johnny with nausea today,” I said expecting some push back. This mom and dad didn’t run willy-nilly to the ER because of some nausea.

Still the mantra of “Thank you Jesus,” droned in my skull, I can't believe that we weren't going to work this kid up. No wrestling with Dolphin Boy for me.

“What do we do if he gets sicker,” asked dad.

Mom gave him the “look.”

“We will do fine. Let’s take him home and sing with him for awhile,” she said.

I felt like Captain Kirk had just sent the Enterprise into red alert with all the red strobing lights and that annoying alarm clock sound raping my ears at 80 decibels.

“Look, if you think he is sick, I can talk to the doctor about getting some lab and urine. We can run some fluids into him and go from there,” I said.

Mom gave me the look of an angel who had been on a ten day bender. “No, Johnny has suffered enough. We will take him home and sing to him. He loves it when we sing.” There was a twinkle in her eyes as she spoke. I don’t know if it was madness or serenity.

The thump of the helicopter hitting the roof let everyone know it was show time.

“Alright, sign here,” I said proffering the paperwork. Business.

The kid did not look alright but that wasn’t my responsibility. Mom, Dad, and the Doctor Shoe were all ready for him to go home.

Me, I was on my way to grab some well earned pizza before that bird unloaded their patient onto our laps.
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I got to work early the next morning. The had gym summoned me in the pre-dawn peace before the world wakes. Sweaty and still a little limp, I headed into the ER. I would shower in a bit but first I could use something to drink.

A middle aged man in a suit that could not hold more wrinkles stood next to a gurney with one of those heavy red felt drapes over the outline of a small body.

“Someone had a bad night,” I think.

The night shift charge nurse looked over at me, “Hey, do you remember any of the history on that FLK you took care of yesterday?”

“Yeah, he was a train wreck. Why?” I ask.

She nodded toward the lumpy gurney, “He died last night but the parents did not come in. We don’t have any history. They are looking for the old chart but if you could tell Nancy what you know it would be a big help.”

I never told Nancy what I knew about the body under that heavy pseudo-velvet drape. I never said, “The patient had a history of a nurse who really didn’t want to be there with that kind of patient. He came at the wrong time, when we were busy. He had an illness which coincided with the one chance I would have to eat. Most importantly, he had a nurse who failed to remember that his job is to advocate for the patient — not the family, not the doctor.”

I was dolphin boys last safety net and the net failed. Sure, I didn’t do anything legally wrong. I didn’t even do anything morally wrong. I just didn’t do it right. Sometimes that makes all the difference in the world. Johnny won't be making animal noises for rice pudding anymore.

They don’t teach you about living with that in nursing school.