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“She has a slight arrhythmia. We’ll run an EKG.”
He nods and I wave him over, wanting him to hear her arrhythmia as well.
“Arra-mia?” Jade repeats with furrowed brows.
I smile. “It means your heart is beating to its own drum.”
She grins at that, pleased by how it sounds.
“If the EKG comes back normal”—I say to the resident after he’s done listening to her heart—“we’ll monitor her, and in all likelihood the arrhythmia will resolve on its own.”
“What else should we do?” he asks.
“You tell me.”
“It’s my first day on this rotation…” he stammers.
“Take your time,” I tell him. “Our patient is stable.”
He loops his stethoscope around his neck and stuffs his hands into the pockets of his white coat. For a moment, he stalls, focused on Jade with sharp concentration, like she’ll give him the answers.
“If we’re wanting to test organ involvement…” I prod.
Immediately, something clicks. All those nights spent hunched over a textbook come flooding right back to him. “Kidneys are a good place to start. We can monitor her urine.”
“For?”
“Its color. Confirming or ruling out rhabdomyolysis.”
“Yes. What else? What labs should we order?”
“BMP, CK, troponins, and a CBC.”
“And?”
“She’ll need a neuro exam.”
“Good. I want you to grab another resident and divide up those labs. But first, start with the neuro exam. We’ve already assessed that our patient is conscious. Now I want you to ask Jade—”
“Ariel!” she amends.
I smile. “Ask Ariel if she has any areas of weakness or paralysis.”
He asks her that verbatim, and the nurse and I exchange a knowing glance when Jade stares up at him with a blank expression.
“She’s a toddler,” I point out, fighting back a sarcastic tone. “So try again, and this time use words she’ll actually understand.”
I pat his shoulder and nod to the nurse before heading out of the room. I want him to feel like he’s on his own in here, as if he’s handling this case by himself. He’s not, of course. Everything he does, I’ll repeat and confirm on my own later. Still, the pressure is good for him.
Back in the hall, at the nurses’ station, I wave Lois over, careful to keep my voice down when I speak.
“What do you know about Jade? Was she really abandoned out in the ambulance bay?”
Lois shakes her head and crosses her arms. As a seasoned nurse in this unit, she’s seen it all and then some. For her to look grim, it’s not good.
“All I’ve heard is that she was dropped off all by herself. I’m not sure how long she was out there before an EMT saw her and brought her inside.”
“Have you called the child life team?”
“Yes, they’ve already been down here to talk with her. They couldn’t get much info from her though, obviously. She’s only three.” She shakes her head, disgusted by the whole situation. “They’re trying to call around for next of kin. The police are involved too. They’re reviewing the surveillance footage from outside, but without a last name, we don’t have much to go on.”
“She doesn’t know her last name?”
Lois offers up a sad half-smile. “She just keeps telling everyone her name is Ariel.”
I can’t help but smile, even during a circumstance like this.
I tap the counter. “Right, well if you hear anything new, let me know.”
“Sure thing.”
Jade’s injuries aren’t severe enough to keep her in the BICU. Her labs come back normal, and the burns on her hand don’t warrant treatment in a critical care setting. In normal circumstances, we’d transfer her to a step-down bed and keep her under supervision for a day or two before discharging her from the hospital altogether. However, we have a few empty rooms at the moment, and given the nature of her arrival at the hospital, everyone agrees that she should stay. The pediatric side of the BICU is incredibly secure, with locked double doors safeguarding all the patients. The police want her to remain here until the child life team can put a plan in place, and I agree with their decision wholeheartedly.
After I round on the other patients in the unit and confirm they’re stable, I head back to Jade’s hospital room. I can see her from out in the hallway, sitting on her bed, alone. All the rooms in the BICU have clear glass walls and a sliding door separating them from the hall. The hallways are kept at a more pleasant temperature, and each individual room is heated based on the patient’s needs. Jade’s room is only slightly warmer than it is out in the hall when I step inside with the resident from this morning on my tail. I’ve asked him to join me while I perform my own neuro exam, that way he can identify where he might have gone wrong during his own.
When I’m done, I dismiss him and pull up a chair beside Jade’s bed so we can talk while she eats her dinner. Right now, I could leave. I’m on call and I’ve assessed the patients. Everyone is stable and I could take my beeper and head back to the townhouse. Instead, I sit with Jade. I ask her about mermaids, acting as if I’m completely baffled by the entire subject. She explains to me that “mermaids are like people just they can hold their breath underwater for lots of minutes” while she picks at her food, scrunching her nose at the peas and carrots and chicken tenders.
