Monday, February 1, 2010

Little Big Man

We are all familiar with the saying "Actions speak louder than words." It is most often used to connote something favorable and positive. Unfortunately, this quote was the first thing that popped into my head while treating a recent patient.

I had been walking down the main ER hallway, another crazy shift in bloom, when one of my favorite nurses poked her head out of a room.

"Doctor K," Carla asked, "are you free to help me out with this patient?" I didn't even need to give her an answer. When Carla beckons, I come running. Plain and simple, she is that amazing.

I walked into Carla's room to find a patient lying in bed, hands to his face, crying out for his mother. Heartbreaking. His mother was kneeling beside him, whispering quietly in her son's ear. Tears were streaming down her face, too.

The patient was seven. A sweet, scared little boy named Eddie. Eddie had been rushed to our ER to be treated for burns to his face and body. From the doorway, I could see several small blisters with surrounding redness on his bare torso.

What were the circumstances that resulted in these burns? Apparently, Eddie did not come from a good socioeconomic situation and, as a result, lived in a crowded apartment with his mother and several other family members.

The day Eddie was brought to the ER had been an especially cold one. While his family sat watching TV in a room off of the kitchen, Eddie, hoping to be useful, went alone into the kitchen. He had decided that he would warm up the apartment. He grabbed a cigarette lighter and successfully persevered in his struggle to flick the lighter's flame. With his free hand, he turned the oven's dial to "ON." Ready to be a big man and provide heat for his family, he opened the door to the gas oven. Slowly, while holding his arm stiffly in front of him, he advanced the flame into the oven.

Whoosh! A sudden flash of flame was born and jumped out at Eddie, surprising him. He instinctively yelled out as he backed away from the heat. The pain and redness to his skin was immediate. The family called 911 and, after shutting the oven door, turned off the dial. Their quick thinking stopped any further flames from spreading. Eddie, with his mother accompanying him, was brought urgently to us.

I was able to determine that Eddie's burns were "minor." His airway and breathing were stable and his burns were either first degree (superficial, like a sunburn) or second degree (partial thickness, or to the layers just below the skin surface). When you are seven and in pain, though, any burn is considered "major" in my book. Suffice it to say, Eddie's burns were significant but not life-threatening.

While giving him pain medicine, some IV hydration, and soaking his wounds, we discussed Eddie's case with our regional burn unit. They requested we transfer him to their facility for overnight observation. I agreed wholeheartedly. He was a child in pain. He deserved to be treated cautiously, tenderly.

"Eddie," I asked, after we had made him comfortable, "what made you decide to light the oven this way?"

"Mama and Aunt Pammie do it all the time," Eddie said, shyly looking over at his mother. She was now sitting in a chair, beside his cot, stroking his hand.

"To cook?" I asked, rubbing this brave little kid's shoulder.

"No. We light it and keep the door open so we can stay warm." With the colder weather, it turns out, Eddie's family supplemented their apartment's warmth this way. Eddie, after seeing his mother and aunt light the oven several times, thought that he could do it, too. My heart broke a little, in that moment, looking at this thoughtful little boy who sustained burns because he was trying to help his family. He gave his mother a feeble, lopsided grin, the morphine adding to his charm.

"Baby, it's okay," the mother said, stroking his hand. "Aunt Pammie and I should have never done that." She turned to me and continued. "I'm not going to get in trouble, am I?" Although the question seemed self-serving, I was genuinely impressed with her concern for Eddie. She handled her little man with appropriate and abundant love. She even insisted on helping Carla with Eddie's treatment. I felt only good energy with her, discerning nothing suspicious. Eddie, it seemed to me, had a mother that truly loved him.

"No, you're not," I assured her, "but let me have our social worker talk to you about your living conditions and see if there is any available help for your family. Maybe have them come out and check the place out for you."

"Thank you," she said, "We could use some help trying to get the landlord to fix some of them windows."

So, as it turns out, Eddie's injuries were not a result of being negligent or careless. They stemmed from imitating the adults in his life, who were completely unaware of the lessons they were teaching him.

Eddie's situation got me to thinking in that deep, reflective way. How many times through the day do I, as a parent, verbalize to my children what I feel are essential life lessons when, in actuality, my witnessed actions carry more weight than any of my words. Actions that can be both good or bad. Conscious or instinctive. Helpful or harmful. Deliberate or unplanned.

Witnessed or unwitnessed by young eyes. My kids' eyes. Your kids' eyes.

Eddie ended up recovering quite nicely from his injuries and his family was very appreciative for his treatment and good outcome. They could not, however, have been nearly as appreciative as I was of the important lesson they reminded me.

Thank you, Eddie, the little big man. It's not everyday I get a life-lesson from a seven year-old.

As always, thanks for reading. Next posting will be Wednesday, February 3. Thanks for your votes and support in the Medgadget Weblog Awards...much appreciated.


rlbates said...

I hope the social worker found that family some help. Poor child.

Katie said...

Jim, there are tears in my eyes as I read this. I was about the same age as Eddie when I earned my trip to the ER, also for first and second degree burns. I was lucky in that they weren't on my face but rather down both forearms from falling into smoldering coals while trying to put out the campfire. I understand his pain and fear all too well.

I also thank you for the reminder about the repercussions of our actions as adults, whether we think children are watching or not. It's a reminder we need to hear regularly.

Excuse me now while I go find some tissues.
<>< Katie

Carolynn said...

Powerful post. I can speak from experience, as a child who was brought up in a violent home, Yes...children are taught all number of things, by the actions they witness. Including whether to trust or not trust, the value of one's word, and appropriate (or inappropriate in my case) ways of dealing with conflict.


Maha said...

Poor baby. I hope he gets better soon.

Tonjia said...

sometimes our world is not such a nice place. When we are warm at home, hugging our kids. There are still families in the U.S. who are cold, and hungry..

I hope this event opened a door and that these folks might get some help getting their apartment and their heat fixed....

I was triaging a little boy yesterday (age 6) and was joking with him as I asked him if he smoked cigarettes. He gave me a resounding NO! I told him "good job! thats a great decision". Then he looked his mom in the eye and said... " cigarettes are bad for you mom, Why does dad smoke them?"

It was interesting to see mom get out of that one.

coulrophobic agnostic said...

I feel so sad for Eddie and his family. But in some ways he's a very lucky boy - all kids should have a mom who loves them that much.

I was riding my scooter inside once as a kid (stupid, I know, but kids are stupid at times) - it wasn't one you pushed along with your foot, it had a pump sort of lever on the back that you pushed with your foot. My grandparents at a yard sale, and I still can't figure out who invented such a weird thing. Anyway, I tipped over and landed on the radiator. I had a small burn (the size of a silver dollar or so) on my leg that didn't even require medical treatment, and my god that HURT. I still don't think I've ever felt a pain that stayed so constant - most other pains I've had have at least faded a bit at times to give me a little bit of a break. I can't imagine how much pain that poor kid was in.

SeaSpray said...

Awww.. I am glad he will be alright and hope they get the help they need.

There were a couple of winters when I was a young teenager where Mom couldn't pay the bills ..even tho she worked very hard and we didn't have any heat or electric.

She used to put a pan of water in this small little gas oven (supposed to make it safer leaving a gas oven door open?)and it was all we had to keep warm. we slept in the living room-close to the little kitchen so we could stay as warm as possible. It is so cold without lights too. I remember one of those nights sitting in the dark, cold kitchen being hungry and opening up a bag of Wonder bread in which only one piece was left. I asked Mom if she wanted to split it and she told me "No eat it. I'm not hungry."

The love of a mother.

Those people were doing the best they could do under their circumstances and sometimes our choices aren't good ones ..but are the best we can do at the time.

*Since that time ..i have heard it is dangerous to heat your gas stove even if a pan of water is in the oven because you could still succumb to the gas.

It's nice to be able to work with someone you trust and can count on.

*** Congratulations on your award Jim! You deserve it! :)

SeaSpray said...

OOPS! I thought you already won because you were ahead last night.

Congrats on the nominations. :)

Dr. Mongo Lloyd said...

Wow, that poor kid.

Cal said...

Indeed it is a sad story with the faint silver lining that this mother genuinely loved her kid, and I am sure that this is but one example of what is out there in terms of families in need.
On another point, it is so true that children learn from imitating your actions, and it still amazes me sometimes what kids pick up, nuances, things one is not even aware of. It has made me much more aware of my shortcomings seeing my daughter learning from my behavior.

Rogue Medic said...

One of the hardest parts of being a parent is behaving appropriately for our children, but it is worth it.

And thank you for not being afraid to use morphine.

Anonymous said...

Keep posting stuff like this i really like it