When The Child Is Active
“Bring this patient to the paediatrics ward. He should be sedated.”
A simple order was given to me one day, when a male child of around 4 years of age came to the Dermatology OPD (Out-Patient Department). When I was told to go there, I felt quite nervous a little bit as I knew already how stressed the working environment there. The experience of working there on the first rotation was more than enough for me. You can say that it’s like hell in there where there should be a garden of heaven for the kids.
When I heard that the boy should be sedated, the first thing that pop out in my mind was, IV (intravenous) route. It gives an immediate effect to the patient, as by this route there is high chance of the drug to react efficiently. But I was wrong back there.
After taking the case paper, I accompanied the boy with his parents to the ward. My heart started to beat faster than before. I could feel it. I wonder what was waiting for me there. 🙂 On the way there, I could see how relaxed he (the patient) was. Maybe he did not have any idea what was going on and where were we going. He looked like any other normal kid. Cheerful, playful, no any worries on the face. Then I wonder again how was my childhood when I was of his age. Must be same like him I guess.
Although he acted normally, he suffered from a skin disease. It is called as Netherton’s Syndrome. He had that problem a couple of years ago. Thus it is a congenital problem. He got this chronic skin inflammation all over his body. There are many scaly rashes multiple patches over the skin. How pitiful his condition is.
Upon reaching the ward, I told a senior doctor what should be done to the patient. She read the case paper, and later on she asked one of the sister to give a syrup to the patient for that purpose. It was given orally, not by IV route, considering that the boy may struggle during the procedure. I think so. Then here came the waiting period for the drug to show its miracle sedative effect. It should be around half an hour.
Minutes by minutes. And I was still waiting there.
It’s almost an hour. Still the boy was as energetic as usual, no sign of tiredness at all.
“Please sleep my brother..” I am hoping again and again, so that my journey to paeds ward worth it..haha
Almost 2 hours there, he was still awake and resting on his mother’s lap. Sometimes he just walked in the ward and go back to his mother. I went to him and kind of persuading him to sleep. His mother gave a smile to me for my ‘big effort‘.
I called the senior doctor in dermat OPD and told her the current situation when she asked me to bring back the patient to OPD. I explained how was his condition after the first shot which is not adequate to begin with. Only then she asked me to bring again the patient to paeds ward for the second shot, this time a little higher dose. Hoping for the best, we went back to the paeds ward with high hopes.
By the way, the boy had to be sedated as skin biopsy was to be done to him. The procedure is painful for the child where a sedation is a way to minimize the struggling of the patient during the biopsy.
And here we were at the ward, for the second time. The patient took the medication cooperatively. We waited and hoped he was going into the sedation process well. His mother put him on her lap to prevent him from going out of the bed. This is the final try for us.
After a longer period, and the child was still awake, we brought him back to OPD. He’s like, resistant to the effect of that medication. The more we give, the more fatal result will come. So there was no other choices left other than carry out the biopsy to him without any sedation. So we had to hold his hands and feet to prevent the struggling during the procedure.
It must be done in a shorter period to minimize the pain. We hold his body, and one of the senior PG started the biopsy at once. Blood came out of the biopsy site, not much either. As expected, he cried in agony and struggle a bit. His mother just looked at him, prayed that his son would be stronger to bear with it.
After 2 biopsies, the procedure finished and everyone felt relieved about it. The PG asked the parents to come again when the result of the biopsy came out. It was lunch time when we finished doing the biopsy.
It was quite a tiresome day for me to go to and fro from different department. Deep inside, I got a feeling of satisfaction to be able to help anyone who need my help. Eventhough you sweat heavily, and you are catching your breath rapidly, it is cured simultaneously when the child smile to you and play with you as if you are their friend.
More importantly, you know and get the idea how similar your action and behaviour could be when you were a child back there. It brings you all the sweet and not-so-sweet memories of your childhood, and you smile upon remembering those memories. Maybe we pray that we will be that child and trapped in our own world forever..