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A resident comes rushing out of the double doors that separate the BICU from the rest of the burn unit. I pocket my phone and try to put the outside world and my outside problems away for now.
He’s out of breath, huffing as he leans over to rest on his knees.
“Wh-where have you been?! Where’s your beeper?!”
My beeper is in my office, where it stays when I’m not on call or at the hospital.
I don’t answer him, of course. Last I checked, residents don’t demand answers from attendings. I don’t recognize him, which means he must have just started his rotation in the BICU, but he knows who I am because he immediately launches into a brief explanation of events, albeit with a more deferential tone. “We just got a new admit. Right after Dr. Woods left. Some idiots left a kid in the ambulance bay. Severe electrical burns on her right hand.”
I frown. A new resident shouldn’t be the lead on this.
“Where’s the fellow on duty?”
“With another patient. He told me to see if I could find you.”
“Is the child stable? Where is she?”
“Yes. They’re debriding her wounds in the tub room now.”
I rush past him, angry with myself for standing outside to take Noah’s call. I’m not late for my shift. I told Brent I’d be here in thirty minutes, but still, minutes matter in situations like this.
“Let’s go,” I bark when he doesn’t immediately match my pace. “You can brief me while we walk.”
Electrical burns are tricky because you can’t accurately predict the true extent of the injury just by looking at the patient. Internal tissues and organs may be more severely burned than the skin. People come in expecting outpatient care and are surprised when they have to endure a week-long hospital stay while we ensure there isn’t more serious damage lurking under the surface. Especially with children, I err on the side of caution.
“What are the two classifications of electrical burns?” I ask the resident.
He seems surprised by the question, though he shouldn’t be. This is a teaching hospital; he’s here to learn, even during what he perceives to be a high-stress moment. “Uh, umm…oh!” He snaps his fingers. “High-voltage and low-voltage. High-voltage is anything greater than 500 volts, usually resulting from kids climbing trees and coming in contact with a current from a utility wire, that kind of thing.”
I nod. “Tell me what we’re looking for on the patient. Physically.”
He’s in it now, focused as he speed walks beside me. “An entrance and exit wound, though they don’t necessarily predict the path the current took through the patient’s body.”
“Good. Take my bag, put it in my office. Come find me when you’re done. If we need to go into the OR, you can scrub in with me.”
His eyes light up as he takes my bag and hustles down the hall.
In the tub room, I find a little girl who looks to be three or four years old lying back on an exam table. Golden blonde curls, big brown eyes, and a tiny hospital gown covered in teddy bears—those are the things I notice first. She watches my approach and holds up the candy she has in her unburned hand.
“Look what I have,” she says with a lazy smile.
The nurse who’s tending to her wounds chuckles and shakes her head.
“I take it she’s responding well to the painkiller?” I ask, leaning over to assess the child’s injuries.
“Hasn’t complained since we gave her the lollipop. It’s definitely working.”
“Good.”
We give ketamine lollipops to patients who need to be consciously sedated. Especially among children, it’s the best form of pain relief we’ve found both because it releases slowly into their bloodstream and because it gives them something to focus on. Even in situations like this, candy is an excellent distraction. That said, ketamine affects each patient slightly differently. Some go into more of a trancelike state, while others are simply calmed and quieted by the anesthetic. This little girl falls into the second category.
“I’m Dr. Easton. What’s your name?” I ask, glancing down at her.
“Jade, but can you call me Ariel? I want to go by Ariel.”
The tension in my chest eases. “Ariel, like the mermaid?”
Her eyes go impossibly wide. “You know her?”
“I do, in fact. She’s awesome. Can you do me a favor, Ariel, and lie still? I’m going to listen to your heartbeat with my stethoscope.” I hold it up to show her. “Have you seen one of these before?”
She giggles. “Lots of times.”
Good. So she’s seen doctors in the past.
What I expected to find in the tub room and what I actually find are two very different things. The way the resident went on, I expected worse.
“Her burns definitely look to be caused from a low-voltage source,” I say to the nurse, fitting my stethoscope into my ears so I can listen to Jade’s heart and lungs. The resident appears in the door, and I nod for him to enter.
