“Can the two of you go to the cast room to help?”
I was in Ortho (orthopedics) clinic, and this was probably the first time the ortho faculty physician spoke directly to me. Up until this point, I had trailed behind a resident. The faculty physician addressed the question to a third year medical student and me, a first year medical student.
(I didn’t really think of myself as vital to the everyday ongoings of any clinic. I sometimes got to do the history and physical and report to the faculty member afterwards. Granted, most faculty would go back and redo the history and physical, but it still felt good to have direct patient contact. But more often than not, I felt that I was literally and physically in the way. Frequently, I wished I were thinner so I could take up less room, especially in a small patient room.)
So naturally, when the doctor asked me to help out in the cast room, I was quite excited at the prospect of being useful. “Yes,” I said with certainty although I had no idea where the cast room was and what we were supposed to do there.
More confidently than I felt, I took a step into the hallway. Now, where was this cast room?
“This way,” the third year whispered, leading me to a room down the hall. The grey door had a grey sign that said “Cast Room” next to it. Inside were three blue-grey beds, dull purple curtains, and a child with a cast from his belly button down. His dad and a medical assistant (MA) were hovering over him.
The poor child, no older than 6, was in a half-body cast and needed to have it removed. He was wearing a red shirt and had a big head and bright, brown eyes. His cast was such that it encompassed his legs and his hips but left room for diapers. His diaper was duct taped to the cast (probably the only way to keep the diaper on him since the diaper’s straps couldn’t encompass the circumference of the cast). The boy looked distressed. The MA asked us to hold down the patient while she cut the cast. We stood on either side of the little boy and needed to place our hands on his arms so he didn’t flail in front of the saw or jerk and cause some damage.
The machinery was the size of a vacuum although the saw, itself, was the size of a large orange. The saw could cut through hard things e.g. the cast, but would not cut through anything soft like our flesh in case we mishandled the tool.
“It’s going to be a little loud,” the MA admitted, “Let’s turn the patient a little bit sideways.” We helped turn the boy as best as we could, given his cast and his squirming.
The boy gripped the edge of the bed with both hands vigorously. I kept a hand on his head and his arm. The third year kept a hand on his shoulder and other arm. We turned him to the side again, and the MA turned on the saw.
It was louder than I expected, and the boy started to cry. I understood. He was in an uncomfortable position with a saw inching closer to him. I would have been scared, too. Since he was facing me, I could see his face scrunch up like he tasted something awful. As the saw started to press into his cast, he opened his mouth, full of little baby teeth, and started to cry. I had no idea what to do. I never dealt with children before. I remembered I read on Tumblr that small children don’t cry in response to low levels of pain unless social cues implied they should be crying.
So, before he went all-out banshee on me, I stooped down, got into his line of sight, and said gently, “Hey, it’s okay!” His sob hiccupped a little as his attention was drawn to the stranger suddenly in his field of vision. A split second later his face contorted again and my panic spiked as well. “It doesn’t hurt,” the MA reaffirmed. I followed her example, telling the boy, “That’s right. It doesn’t hurt, does it?” I smiled big and he looked at me as if his brain was processing this fact. He looked conflicted: It was supposed to hurt, right? So, I should cry, right? I could see the internal struggle. His big brown eyes shiny with tears blinked. “No,” he babbled.
“That’s right! It doesn’t hurt, right?” I tried again. His face pinched as if he realized he should be crying.
“No, no it doesn’t hurt,” I comforted, patting his head a little bit. All the while during this conversation, he was tossing and turning and we struggled to gently keep him still. We managed to keep him in a lying position, but as soon as we got him still, we had to turn him the other way to cut the other side of the cast.
It was a constant struggle to comfort him, keep him still, and for the MA to saw away the cast. There was a lot of “It doesn’t hurt, does it?” from me. His father piped up many times from the side, “It doesn’t hurt, buddy.”
Finally, the saw was turned off, and I sighed, relieved. Once the cast was cut, I thought the hard part was over. The boy had it on for weeks, and I would have been delighted at the taste of freedom. Unfortunately, I was wrong.
“Many children cry when we take off the cast,” the MA explained. I shot her a look of disbelief. Why?
“Some kids have it on for so long it becomes like a safety blanket for them,” she continued. Somehow, that sounded really, adorably pitiful. I didn’t really believe her until she started cracking open the cast with a metal tool akin to a reverse nutcracker (it opened outwards instead of closing inwards). Somehow, the boy looked more miserable now than he did before. What? How is this part worse?
As the MA started pulling the cast apart; he started wailing loudly. “Does it hurt?” I asked. “Yesshhh,” he said in a small voice. I could barely make out what he was saying, mainly because I am not around baby-speak enough.
I shook my head, “Awww, it might feel weird, but it doesn’t hurt, now, does it?” Another battle ensued in which he fluctuated between crying and looking at me with big tears in his eyes. He grabbed onto my white coat and the side of my dress as he cried. His body turned towards me, and he put his hand into my hand and squeezed whenever the MA pried the cast apart. He cried the hardest when we had to lift him as the MA pulled part of the cast out from under him. With the cast and the attached diaper off, we were at a standstill. He stopped crying. His father brought over some underwear to put on. “It huurths,” he wailed as we lifted him up again to put on his underwear, his hands digging into my dress.
“You’re okay,” I said, stooping down so I made eye contact with the boy. “You’re all done! High five!” I exclaimed, a hand in the air in front of him. He looked at my hand and slapped my hand with a sniff. I was surprised it had worked! He had stopped crying! I didn’t want it to end. “Awesome! Now, up top!” I raised two gloved hands higher. He smiled and patted my palms with his. Somebody else spoke, and the moment was broken. His attention moved away from me, and he looked as if he was going to cry again.
“We can go home now, my man,” the dad exclaimed with a bag in his arms.
A sobbing moan came from the boy. “Aren’t you excited?” I asked. He turned his head to me and held up his hands in front of me like he wanted me to carry him. Frozen, I eyed the outstretched arms. He looked too big to be carried and I didn’t know what the professional protocol was in this situation. I also had never held a child in my life. I was always the youngest in my family by at least 7 years. I had no idea what to do, but the boy stared at me with puppy dog eyes, teary and all. I settled for a hug. I think his arm got caught in my hair, but he hugged my neck and didn’t move or cry so it was okay. After a moment, I let go and he seemed assuaged.
“Awww. He fell in love with you,” the MA commented cheerfully as she cleaned up the cast debris. “I’m jealous!” The father lifted the boy on a wheelchair and as he left, I waved good-bye, smiling.
Usually, I feel useless and in the way of the health professionals’ duties, but it made me a bit happy to know that I helped the boy feel even slightly more comfortable.