22 February 2011

Safety First (originally posted 28 January 2011 on Tumblr)

We’ve had record snows this winter, our first in the new house.  As mixed as our feelings were about our condo (the bickering of the association members, the crazy neighbor who chain smoked while she was gardening, the complete absence of closet space) at least we didn’t have to clear the snow.  Now, as we are preparing for yet another onslaught this weekend, the news is filled with reports of roofs caving in under the weight of all the melting slush and ice.  Our kitchen is an addition.  Likely, when the house was built around the turn of the century, the kitchen was in the back part of the house – a first floor guestroom that has a fireplace and that sits directly below the servants’ quarters where my parents’ apartment is.  But now it lies directly off the dining room and the snow has been piling up on its flat roof since the holidays.

When I went out there I quickly learned several things.  First, the snow was far deeper than I had anticipated.  Second, the icicles decorating the roof near the window I crawled through have no respect for my head or the rest of my body for that matter.  Third, the ridge of ice at the downward slope of the roof was blocking any snowmelt from running off effectively and would also need to be removed.  And finally, once a good portion of the work was done and some of the actual roof was exposed, it was seriously slippery.  At Bement, the summer camp I attended every year growing up and where everyone is a winner, there was something called Alphabet Soup Night.  During these evenings on the Lakeside sports field, I had become quite adept at walking like a crab.  This is a skill (two decades later) that came in useful this afternoon.  I was not particularly graceful, but I am still in one piece.  I did not, as I half expected, fall to my death.  am, however, having an inordinate amount of difficulty moving my arms.

So the snow is cleared and I somehow managed to slither back in through the window despite the muscle spasms that had taken hold of my lower back.  But I have been thinking a lot about safety since I came back downstairs where my father had retreated into the library while I worked, pointedly ignoring the fact that I was up high and trying not to have an anxiety attack about the matter. 

I have been thinking about safety especially since I had a not-so-safe moment at work recently.  A young boy, perhaps six or seven, came into the ER after slamming his finger in a car door.  I was hugely relieved to see that he was not cut and his nailbed was not injured, since those repairs are slow and numbing up the entire finger by a digital block is (ironically) somewhat painful to endure.  But he did have a substantial subungual hematoma – a collection of blood under the nail that shows through as a dark reddish black.  His finger was throbbing – you could tell just by looking – and he would feel immediately better if the pressure from the blood accumulation could be relieved.  We would drill a small hole in the nail using a needle and by we I mean Carter, my intrepid medical student, and the whole procedure would be over in approximately ten seconds.

Then we swiped at the finger to clean it gently with disinfectant and he freaking freaked out.  I fully admit that it is my job to see this sort of thing coming and I missed it.  One second he was chatting away happily about what he was going to eat for dinner after we had finished and the next he was screaming the sort of screams that would prompt you to keep your distance but also to call 911.  And we had not even touched him.  By the time we emerged from the room – after much negotiation and then renegotiation about whether or not he would return to the exam stretcher or whether he would prefer to sit in his mother’s lap (all of this conducted in hushed tones on my part to balance out the unhealthy decibel level issuing forth from his lungs) – the nurses asked if we had drilled the needle into his eyes.  They also asked how many holes we put into the nail, insinuating that the procedure had taken longer than it ought.  I shook my head.  “Oh no,” I told them, “he was quiet while we did it.  All that screaming was before.” 

I made light of it.  I shrugged and I ordered some ibuprofen for the boy with the fingernail and an x-ray on the three-year-old in the next room.  But really it had been a dangerous situation.  Well, not dangerous, but potentially so.  Children are surprisingly strong.  We really ought to have another person.  The boy might have moved and we would not have been able to stop him.  He might have kicked Carter or kicked me, might have thrown his head back into his mother’s face.  But what made me most uncomfortable during the thirty or so seconds we actually restrained him was that I was not holding the needle.  Carter was.  If he hurt himself or hurt the child or the mother then it would be just as bad as if I did it, worse even, because I would also be making Carter feel bad about his performance and about himself.  It would not be a serious injury, but that would not make it excusable.

When I was on the roof I kept my center of gravity low; I stayed far clear of the edges; I spent quite a lot of time sitting on my bum.  What is the equivalent when it comes to medical procedures?  How can I ensure that I am prepared to deal with everything a child has to throw at me, that I maintain complete control? 

Then a teenager came in who, because of a developmental delay, had pushed some tissue up his nose.  It was something he frequently did and he had been in the ER only several months prior for the same, since to leave the tissue where it was would be to encourage an infection. 
“I’ve read his record,” I said to his father as I walked into the room, hoping to get them in and out as quickly as possible.

“Yes.  You’ll have to hold him down,” he said.

The boy was perhaps two-hundred-fifty or three-hundred pounds and taller than I am.

“How many people, do you think?” I asked.

“Last time it was five.”

And I thought, I may not be a perfect being, but at least I can learn from my mistakes.

“OK,” I told him.  “I’ll go get six.”

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