Distraction 2/2

Walking into the entertainment center, I see the jumpy house with its bright yellow entrance, which matches the yellow of my gurney. Sitting on a bench is a woman holding a small girl who’s bleeding from the foot. The firefighters walked in maybe 30 seconds before we did. I’m in a more affluent neighborhood of my mostly urban county. The fire crews are more pleasant here as they don’t get run as hard as the inner-city crews. They are quick to break out the bandages and stop the bleeding.

Fortunately, I’m able to get a look at the wound before it’s completely covered. It’s a one inch evulsion (skin torn away from underlying tissue) to the top of the small girl’s right foot; muscle and adipose tissue are visible where the skin should be. It looks as though someone just carved away the skin with a knife. The girl, whom I come to find out is named Kimberly, is crying. It’s more of a sad constant cry than a hysterical outburst. She must be quite a mature little lady not to be flipping out right now. Her mother, on the other hand, is very distraught; brow furled, talking quietly in her daughter’s ear — it’s clear that she’s barely holding on by a thread. While inspecting the foot I notice that Kimberly’s pants have a thick quilted lining sewed into them. Interesting modification. I start to ask the mother questions — the best thing I can do for both of them right now is to get Mom’s mind off of her daughter. It’s also self-serving — I need to understand what happened here.

“I really don’t know, I mean I only turned my head for a second.” Her voice cracks with emotion as she tries very hard to hold back the tears. “One of the other children must have landed on her. She has Ehlers-Danlos Syndrome so she’s susceptible to skin tears.”

There are so many syndromes out there, I may run into the same one every few years or never see one in an entire career. I have to be honest with her. “I’m not familiar with that syndrome. How does it affect the skin?”

“It’s genetic. I have it also and passed it down to her. We’re missing the gene that creates collagen in the skin so the skin and connective tissue have no elasticity. Even a simple bump can create a tear.”

Now that she’s focusing on me and not the compounded levels of guilt about her daughter I see that she’s a well spoken, educated woman. She has lived with this syndrome for all of her thirty-something years and is fully versed in all of its intricacies.

I’m not going to be able to do much for Kimberly other than understand the nature of the syndrome a little better and then treat the symptoms. Genetic repair hasn’t made it to the pre-hospital bag of tricks yet. “Are there any bleeding, coagulation, or clotting issues associated with the disorder?”

“No, it’s strictly collagen, it doesn’t affect the blood at all. That’s why I made the padded clothes and protect her as much as I can. But they said she had to be barefoot in the jumpy house. I knew I shouldn’t have let her go in but it’s her birthday today and she’s been wanting this so much — I couldn’t say no.” She’s doing her best not to lose it in front of her daughter. The firefighters have finished wrapping the foot and Kimberly has stopped crying — just sporadic whimpers as she’s held in her mother’s arms.

They’re both on the edge of cracking so I need to keep them focused on me to avoid a negative emotional feedback loop. “Okay, so Kimberly’s foot is protected now that it’s wrapped, how about you let me take you to the hospital? They’re going to need to close the wound—either with sutures or possibly a glue — to protect against infection.”

“No, I’ll drive her myself. God knows, I’ve done it before.”

“So, here’s the thing. She’s perfectly stable right now and I have no problem letting you drive her. But you’re very emotional right now. It would be much better if you had someone else drive so you can take care of her on the way. The last thing I want is to get called to a traffic accident and find the two of you there. Is your husband around or can you call him?”

“No, he’s out of the picture. I’m here alone.” Her non-emotional response tells the whole story. Paramedic opens mouth and inserts foot.

“Then it’s definitely a good idea to let me take you, it will keep the both of you safer and I can give Kimberly some medicine to help with the pain a little.” She agrees with a bit of a relieved look on her face. With all of the issues that she’s dealing with right now at least this is one less thing to worry about and she can focus on her daughter.

Once in the rig I tell my partner that we can start moving; all of the necessary treatment was done on scene by the firefighters. Kimberly is laying on the gurney in the back of the rig with mom sitting next to me on the bench seat. Kimberly is still letting out a soft stream of whimpers.

While I’m explaining to Mom that I can give Kimberly some morphine for the pain I reach up to the front of the rig and grab my iPad. I don’t like to dope kids when their parents are present without a good explanation. I’m planning on using the iPad to keep Kimberly busy while I draw up the morphine and explain the effects to Mom. I launch an app and hand it to Kimberly, after surreptitiously checking for blood on her hands.

“Kimberly, this is Talking Carl, say hello to him.” She looks at the screen to see an animated character waving at her. He looks like a cross between Gumby and Sponge Bob Square Pants, minus the pants.

In a tentative voice, “Hi Carl.” Two seconds later in a slightly higher pitched voice Carl’s mouth moves and he mimics Kimberly, “Hi Carl.” Bobbing back and fourth he waves at Kimberly. She starts giggling, “Mommy, he talked to me!” two seconds later Carl starts giggling and moving his mouth and in his exaggerated high pitched voice, “Mommy, he talked to me!

This goes on for ten minutes of giggles and laughter as we drive to the hospital. I show her how to tickle Carl on the screen and Carl starts laughing then she laughs and Carl mimics it and it starts all over again. It looks like we just created a positive emotional feedback loop.

As Kimberly is now busy and Mom is actually starting to smile for the first time since I met them I have a minute to look up the syndrome on my iPhone. It’s exactly what she’d described; a genetic disorder where the gene for collagen production is missing. It affects 3 in 100,000 people and, doing some quick math in my head, there could be 45 people in county with this affliction. I may see this again.

With Kimberly fully engrossed in playing with Carl I see a relieved look on Mom’s face and we have a few minutes to talk. Quietly, so as not to distract her daughter, Mom confides in me. “I cringed when they said she had to be barefoot in the jumpy house — I knew it could well come to this. I just wish I could wrap her in bubble wrap for the next ten years.” She’s conflicted with emotion; she wants to protect her daughter but at the same time she wants to let her explore, have fun, and be a normal child. She remembers her own childhood all too well and wants to do well by her daughter.

I’m pulling out my iPhone again, “Have you ever seen the shoes that martial artists wear to protect their feet when they spar? They cover the top of the foot with a half inch of foam dipped in a rubber coating. It’s barefoot on the bottom so it might be okay for the jumpy house.” I pull up a picture on my phone and Mom sees how it may be applicable to her little girl. It’s not bubble wrap, but it’s a good idea. We spend a few minutes browsing the site and looking at the different protective padding options that may be applicable.

As we arrive at the ED they are both a little more relaxed. Walking into the room with the gurney to get Kimberly settled in the bed, I realize that I actually had two patients on this call — Kimberly with her foot and her mother with her anxiety. I didn’t lay healing hands on either of them, nor did I open up the drug cabinet or perform any paramedic skills. I just treated with compassion, conversation, and a little distraction in the form of Talking Carl. That may just be the best $0.99 I’ve ever spent on an app…

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~ by KC on September 15, 2010.

2 Responses to “Distraction 2/2”

  1. As an EDS patient, I thank you for telling this story. It’s very hard to have a rare disorder, and we tend to avoid the ER because we know we’ll be treated with disbelief, condescension, and even downright disinterest and dismissal. We have to keep ourselves informed on our own condition, and medical professionals don’t always appreciate this. Worst of all, we really won’t get *better*. You can help us with our skin tears, our dislocations, our sprains, and our chronic pain, but as you noted, genetic therapy isn’t on the radar yet.

    And yes, it does indeed sound like Talking Carl is perfect! 🙂

    • sister hedwyg,

      Thanks for your comments, they are both informed and insightful. As Paramedics we don’t have the option of choosing our patients; when people call we show up and deal with what we find. Sometimes I find someone who is in the process of slowly destroying them self by neglect and sometimes I find someone who got dealt a bad genetic hand in the game of life. Our job is to do what we can and get them to the appropriate facility to continue helping them. Yes, I feel bad for the innocents (a six year old did nothing wrong to dissever this) yet the best a Paramedic can do is make the briefe time with the patient a positive experience. Whether that’s re-starting a heart that stopped or making a child and mother feel better it’s a job well done. I felt privileged to have met the daughter and mother that were on that particular call and I feel I’m a better person for understanding their personal struggles in life. That experience goes forward toward helping to treat other patients in need and for that I am grateful.

      On a side note; today my partner and I treated a recently deceased (two hours) pronounced dead on scene, a stroke patient at the young age of 38, and a heart attack at the age of 54. After a very emotionally taxing day we fired up Talking Carl and spent a few minutes tickling him. The world made sense after that…

      Best Regards, ~KC

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