It happened one night (call)

It was the third day of night call at 1 am, and the ED was slow. Our team was killing time in the workroom, half hoping for a patient to give us something to do and half ready to quit waiting around and just go to sleep. I was tired of wasting time, incapable of studying or resting, but I wanted a patient both for the experience and to have something to show for myself at rounds with our attending the next morning.

An hour later, there was still no patient, so I decided to throw in the towel. I went to bed wearing my pager, expecting that the night was over. I climbed onto the top bunk in one of the call rooms and passed out. 45 minutes later, I was awoken by my bunkmate to let me know that my pager had been going off for 15 minutes. I slid off the bed clumsily and made my way back to the workroom.

To my relief, my intern had been waiting for me to go see our patient. The new charge was a 10 year old boy named Miguel with upper respiratory symptoms, severe autism and a known seizure disorder. He was presenting with fever, productive cough and two recent seizures. We went down to visit him in the ED. I was flustered and groggy, and had to work hard to muster up my usual excitement at meeting a new family.

When we got to the patient’s holding room, we found a sweet-looking child asleep with his mom at bedside. Mom was clearly worn, with unbrushed hair and circles under her eyes. She was leaning over her son's listless figure, hands propped on the bed frame protectively. A teenage girl wearing a college sweatshirt and Uggs was curled up in a chair on the other side of the room.

We introduced ourselves, took a complete history and did a basic physical exam complicated by the fact that Miguel was both fast asleep and also developmentally delayed. He was definitely congested, and the X-ray confirmed pneumonia. This was his second ER visit in 24 hours, and on the car ride home from the first trip, he had his second seizure of the day. His mom, Anita, was clearly drained but determined to help him get well. She spoke quietly, and her body language made her seem timid, but all that was misleading. She was the mother of a sick child.

Before leaving the ED to put in orders, we had to inquire about Miguel’s behavioral issues—is he violent? Does he bite or kick? Does he ever need to be restrained? No parent of a developmentally delayed child enjoys this line of questioning, but it's our job to anticipate special needs and challenges. At this point in the interview, his sister woke up, uncurled herself in her chair and addressed us for the first time. "You know, he does bite sometimes, but it’s actually just his way of giving a kiss. He doesn’t even know he’s doing it and it doesn’t hurt at all.” She insisted that there was nothing to worry about. I was moved by her protective instinct for her little brother, and remember thinking how much she must love him to interpret a bite as a kiss from a child who’s likely incapable of showing affection. We left the family to put in orders for Miguel’s hospital stay. Satisfied that I'd finally gotten to see a patient, I went back to my bunk to catch an hour of sleep before morning rounds.

On night call, you don’t follow the patients you admit, so a couple of days passed before I went back to visit Anita and Miguel. As I walked in the room, I saw Anita struggling to hold her son up as he tried to stumble across the hospital room floor, dragging his IV pole with him. She looked up at me, tangled up in his limbs and wires, and laughed nervously. “He feels better so he wants to move around. He doesn’t understand that he’ll fall.” Together, we carried him to a chair. He had a blank expression on his face, the only look I’d ever seen from him. I spent some time chatting with Anita and tried to answer her questions. I left mother and son on the couch together, feeling overwhelmed by her love for him. It was the same way I felt that night in the ED with Miguel’s sister.

The next morning, we visited the family as a team during rounds, piling into his room and surrounding his bed. It was discharge day for Miguel, so the mood was light. He was sitting up in his bed and moving his wiry body from side to side, looking off in the distance. Anita was at his side as always, patting his matted hair. She told us he was happy today, and her spirits seemed lifted too. Then she bent down to offer him her cheek, and to my utter surprise, he turned his head to her and kissed it.

I was happy to be wrong.