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Sunday, January 9, 2011

Refreshing Communication Skills

I went up the road and grabbed the engine from the station, with a bit of purpose in my movement. Traumatic injury to a 9-month-old, the dispatcher had said. I asked for more, and all they had was a hysterical woman sobbing about that her baby had fallen. It was way out down here, and I was closest.

This has all the makings of an oh crap call. Well, not any more than so many other calls, but the kids...... those of you with kids get it, those who don't cannot quite relate.

I arrived first to what I am guessing was one of Mom's younger sisters, who led me up to Mom and the patient.

Mom is standing there, a bit tear-faced (not "hysterical"), and a clearly irritated sniffly baby girl is lying on the bed, clutching a pacifier, and wanting to be picked up.

What happened?

Nothing that hasn't happened to lots of us parents. Mom put baby girl on the bed for a second, just as she had so very many times before, turned her back for a moment while getting dressed, and baby girl took a header about three feet to the floor. It happens. We're not talking about a completely helpless infant left to roll off here. 9-month-olds are mobile and wiggly, they're learning to climb and walk. They fall and get banged up. They're fairly durable most of the time, and they learn.

Anyway, I try to assess baby girl, and she is not thrilled about it. She starts to verbalize that she is not happy with this new weird guy in the blue coat being here. His exam-gloved hands are cold. And he looks funny, too. What the heck, Mom?

No deformities of the neck or upper spine, no visible head trauma or swelling. Eyes normal, breathing normal. Movement normal, no guarding, no resistance to any particular motions.

I have several children, I know how to read their crying. This is the slightly-frightened cry, the kind that usually goes away with a sippy-cup and being held in a blanket. It would already have been gone, but Mom was so worried about an injury that after reflexively picking up baby girl, she put her on the bed and tried to not move her until we arrived. She watches TV, she's heard of C-spine. Baby girl just wants Mom to pick her up again and she'd be cool.

It struck me, then, how amazing it is that these tiny humans, with no language speaking skills to speak of yet, are amazingly uncomplicated in their communication.

If I had a fallen adult, I might very likely be trying to psychologically navigate other issues. Are they taking something they shouldn't be? Are they embarrassed I am in their cluttered house? Are they denying an injury somewhere else? Are they faking it to get some attention?

Refreshingly there was no ambiguity about this little girl. She is not screaming in pain. She is moving all of her limbs and tolerating touch with nothing more than a "who are you, go away" cry. She is not lethargic. She is aware of her surroundings. She calms down when not prodded.

I pretty much know all I need to know. We're here more for this first-time Mom than anything. The career engine from 54 subsequently arrived and came to the same conclusion. We turned the ambulance back.

I wish all our patients communicated as well as this.


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