Volume 197 - Issue 11
The kiss
Author: Geoffrey C Mullins
Med J Aust 2012; 197 (11): 670. || doi: 10.5694/mja12.11546
Published online: 10 December 2012
Published online: 10 December 2012
A tale of anxiety, innocence and trust in the anaesthetic roomAs I entered the busy paediatric ward, I scanned the room for my patient - they’re often not easy to find among the other children, the visiting parents and siblings, and the staff, and are rarely anywhere near, let alone in, their assigned beds.
I was eventually directed to a small child sitting quietly on his ...
A tale of anxiety, innocence and trust in the anaesthetic room
As I entered the busy paediatric ward, I scanned the room for my patient — they’re often not easy to find among the other children, the visiting parents and siblings, and the staff, and are rarely anywhere near, let alone in, their assigned beds.
I was eventually directed to a small child sitting quietly on his mother’s knee, facing away from me, observing the activity in the room. His father sat beside him, trying with little success to interest him in a picture book.
As I was introducing myself to the parents, the child turned and looked up at me with a beaming smile. He reached up to me with both arms, indicating he wanted to be held. The telltale features of Down syndrome were obvious.
I lifted the child up and held him to my chest as I began the routine of history-taking from the parents. The child played happily with the stethoscope hanging down in front of him, dribbled down the front of the shirt he was being held against, and ignored the pleas of his embarrassed parents to return to them.
This was their only child. They were not young, and I thought to myself that they would probably not have further children. As I talked to them, their anxious eyes never strayed from their son. They had never parted with him before and their reluctance to entrust his care to others was obvious. I tried to reassure them that all would go well with the operation and that I would take great care with him, but I failed to allay their concern. I was touched by their shy anxiety and devotion to this child.
None of the parents’ anxieties spread to the child, who continued to smile and play with my stethoscope. Later, sitting on his mother’s knee to be examined, he showed intense interest in me — this stranger who was looking at his hands and feet. When I lent forward to auscultate his chest, he delicately touched my moustache, before moving on to examine my necktie. Everything appeared new, interesting and pleasing to him.
Despite my years of experience, I have always been anxious about anaesthetising children with Down syndrome. Their chubby limbs make intravenous access difficult and, once anaesthetised, their relatively large tongues, small airways, abundance of secretions and poor muscle tone make them prone to airway obstruction. In addition, there’s always concern about atlantoaxial instability in the cervical spine, making it necessary to take great caution when moving any such child under anaesthesia.
Not wishing to increase the parental anxiety, I didn’t speak of these concerns. I reiterated that I would take good care of their son and arranged to meet them again outside the operating theatre, before his procedure. The child happily waved me goodbye, seeming pleased to have made a new friend.
That afternoon, the child appeared to recognise me immediately when I walked out of the operating theatre into the crowded holding area. He excitedly pointed at me and, once again, smilingly reached up to be held. Once again, his parents appeared anxious and embarrassed by this overly familiar behaviour, while reluctantly releasing him from their care.
I held the child close while offering further reassurances to his parents. In response to his mother’s coaxing, the child placed a sloppy kiss on the cheek of each parent, followed by a gallant wave to all in the room as I carried him to the anaesthetic room.
I lay the child on the trolley and, as the nurse assistant went through her routine of applying monitors and trying to distract him, I searched for a suitable vein in which to place an intravenous cannula for the injection of the anaesthetic agents. The child, not interested in the toys or games, was intent on watching his new friend and the cannulation procedure.
As I feared, the chubby hands and feet hid the veins I had hoped would appear with a light finger tap over where they should be. I tried one hand, and failed; a haematoma formed. I taped over the haematoma and moved to the other hand. Again I failed. The child remained silent and calm while watching these attempts, but would flinch slightly as the needle entered his skin, and look up at his new friend’s face, trying to understand why this hurt was happening.
I moved around the trolley and started tapping over the child’s feet, first one, then the other, willing the faint blue lines to appear; again without success. I was now becoming desperate to put an end to this ordeal for both of us.
I had always hated hurting children when placing intravenous cannulae but, with skill, distraction and speed, the hurt for most children was transient, minimal and quickly forgotten. Sometimes children would cry or need to be restrained, and this always distressed me.
With this child it was different — and worse. This child could have no understanding of why this was being done to him, yet still looked at me with trust and affection. I hated myself for hurting him and betraying his trust in me.
The room was hot and stuffy, and I could feel the sweat on my forehead as I moved back around the trolley to look at the child’s hands again. I removed the tape from where the haematoma had been, hoping desperately for a vein to appear. I tapped and tapped, as the child silently watched my every move. Finally, a faint blue line appeared. I paused, glancing at the child’s face, so full of affection and innocence, before piercing his skin with the cannula.
A quick flush of blood into the cannula indicated success. I sighed with relief, wiped my sweaty brow with my sleeve, and, leaning forward, began to carefully tape the cannula in place.
It was then that I felt the wet, slow, dribbling, soft kiss on my cheek. Looking up, I saw my patient sitting up, giving me a broad forgiving smile and reaching out with his other arm to once again be held in my arms.
Competing interests
No relevant disclosures.