He was sitting upright in his treatment cot as I walked into Room 28, his three-year-old eyes turned upwards and focused on the blaring nine-inch corner TV. His young parents, barely in their early twenties, stood to the left of their son's cot, their eyes fluttering between me, the TV, and their son. Within seconds, all three sets of eyes had settled on me, the stranger who had just invaded their privacy. I smiled at them. Before introducing myself, however, I walked up to the TV and turned it off, appreciating the sudden disappearance of Sponge bob and the arrival of a much quieter, calmer room.
I held out my hand first to the little boy. Because of his age, it was only appropriate that he first look to his mother and father for approval before taking it. They approved, after taking in the stethoscope around my neck. "Hey buddy," I said, taking in this little guy's appearance while I grasped his small hand, "I'm Dr. Jim. It sure is nice to meet you!" He smiled shyly as I shook his hand with exaggeration. Next, I focused on the patient's parents, holding out my hand to each and shaking their's warmly.
All the while, I focused on the appearance of this patient and his parents. The patient was healthy- appearing for his age, existing in that stage of healthy-chunky and thinning-out, his cheeks no longer swollen lumps of baby fat. He wore pajamas, littered with small holes and sprinkled with stains of various fruit juices. His face was smudged. His teeth were discouraging, little decaying flecks of brown. His arms and legs needed a good scrubbing. Underneath his nails, I could appreciate the fine-line of brown that would require a bar of soap and a good brushing to make clean again. His hair was slightly matted and blondish-brown, the subtle curls poking several strands in an unexplainable pattern.
Yet, he smiled. Big and beautiful, innocent and endearing. Bad teeth and all. He smiled at me. He smiled at his parents. He smiled at the nurse who came in to check on him while I was in the room.
The parents, she taller than he, paced beside the cot. She was the talker, he the backer-upper. With every question I asked, she would answer it first with a concise answer, sometimes being quite insightful. He would listen to her answer and then, like a well-oiled machine, add "Yeah." Nothing more and nothing less. They both, like their son, wore clothes that were scrappy and stained, well past the normal point of a necessary washing. Their hair, his short and brown and her's long and blond, was oily. Upon smiling at me during introductions, I noticed the same teeth as what their son had. Plaque build-up was very evident from my close stance. I imagined them to be chocolate Chiclets, if there was such a flavor of Chiclets, fragmented from being dropped to the ground. Their exposed skin, that not covered by their t-shirts and shorts, had a sheen of grime.
Yet, they smiled. Just like their son.
I sat on the foot of the cot, facing the parents. "What," I asked them, "may I do to help you out with Joshua today?"
The mother moved from her standing spot along the counter to the head of the bed, where she held the back of her hand to Joshua's forehead. She turned her hand and held her palm to Joshua's cheek, letting it linger there for a while, the way a mother's hand should linger when touching her child.
"We were so worried, Doctor," she said, her smile dissipating and her face gaining an anxious quality, "about Joshua's fever. It wouldn't come down for us."
"Yeah," added her husband.
She continued, her voice quivering slightly. "It's been about three days of sweating and chills and high fevers for Joshua. We just don't know what to do anymore."
"Yeah," added Joshua's father, his eyes darting from Joshua to his wife to me.
After a little more talking, I discovered that she had been under-dosing Joshua's acetaminophen and had not been aware she could use concurrent ibuprofen intermittently. The nurse had educated both mom and dad, in triage, to Joshua's proper dose after she had recorded a temperature of 103.4 F. As a result, I was now examining a child who was smiling and had broken his fever. And despite his slovenly appearance, this was one cute kid who appeared to be very happy and very loved.
Sometimes, a three-year-old boy can make for a very difficult exam but, in Joshua's case, he could not have been a better patient. Whether it was the fever breaking, his starting to eat and drink again, or just his baseline personality of unadulterated happiness, he was a pleasure to treat. Thankfully, he appeared quite stable despite having bilateral ear infections (acute otitis media). What could have been a very serious illness turned out to be something less that could be treated with high-dose amoxicillin. In addition to good fluid intake and proper use of acetaminophen and ibuprofen, I expected Joshua to be back to his normal self in a few short days.
Typically, after treating a child with ear infections and having a thorough conversation with the parent(s), I would race to fill out the appropriate chart paperwork, including prescriptions and discharge instructions. With Joshua and his family, though, things were different. This was a patient who made me reevaluate my first impressions. Because although Joshua and his family were indigent and struggling with proper hygiene and material things, never once did I doubt his parents' love for him. They sat with him on his cot. They played with him. They helped me coax Joshua to open his mouth so I could visualize his throat. They held him over their shoulder so I could listen to his lungs more clearly.
They did everything, with ease, that I look for to make sure a child is safe and loved.
I guess love comes in many forms. Part of my love for my children includes that they be clean, dressed appropriately, be respectful, and learn from an early age to appreciate good hygiene. Although, truth be told, my wife and I shower our kids with the more important stuff--lots and lots of unconditional love. That kind of love outweighs all. Whether for financial reasons or lack of knowledge, or maybe for reasons I simply didn't uncover, Joshua's parents seemed to struggle with certain learned parental roles. What they did endorse, however, was to show their son patience, concern, worry, and happiness. And love. Lots of unconditional love.
I talked to them a bit. They had an apartment, although they struggled to make financial ends meet. They both came from broken homes. "I don't know what a good mother should be like," the mother said with honest introspection. "Yeah," added her husband. I assured them that they already seemed to have mastered the most important part of parenting, by giving their child unlimited love and attention, but there were other ways they could improve Joshua's life. Because they wanted the world to be Joshua's, they were willing to do whatever that might take. Thus, I called social services to have them follow Joshua's family. Maybe find some parenting classes. Give suggestions for whatever they may need. Basically, just bring their attention to more of the learned parenting skills.
Later on in my shift, I was fortunate to take care of another child, this one dressed well in designer clothes, clean, with perfect four-year-old baby teeth. Uppity parents. Unfortunately, this child and his family had nothing on Joshua and his family. Not...a...thing.
Sometimes, I gotta love my job and the cool people I get to meet.
As always, big thanks for reading. I hope this finds you well and your summer going smoothly. We are vacationing in the New England states and enjoying every minute of our family time. Soon, the posts will become much more regular (as soon as the writing rust wears off)...