On-call in the peds ER

(details changed for confidentiality of course)

A few evenings ago I spent my on-call night in the pediatric ER, one of my very favorite places of the hospital. The majority of the night was your usual mix of earaches, coughs, diarrhea, minor head trauma, an endless stream of parents who wanted antibiotics for their children's clearly viral minor illnesses, and an adorable three year old with a toy truck in his esophagus who prompted an irritating argument with the ear-nose-throat resident who didn't feel this was an emergency and wanted the child to sit in the ER with a truck in his throat until morning surgery hours. (While we agreed that the child was technically stable it's pretty tough to explain to parents that yes, we're just going to just leave the toy there until the morning because the ENT is hoping it passes on its own).

There was also a two year old with a painless limp who'd just learned how to drink from a cup and was very excited to show this off. "Cup!!" he shouted, and there went his urine sample. He was so delighted by our shocked response that he spent much of the rest of the night running up and down the hallway screaming "pee-pee!" and looking for other sample cups to drink. (Luckily the limp slowed him down enough that we were generally able to catch him before he got anything into his mouth).

And then, around 1am there was a case that stopped me in my tracks. It started out unassumingly: a really sweet young woman in high school with a few days of high fever and muscle aches. We didn't suspect anything specific but she looked really miserable so we took x-rays, drew some blood, and did a pretty thorough exam looking for a source of fever.

Everything came back negative except her blood tests: which came back abysmal, awful, worst-case-scenario. And it was like time stopped. We're thinking we'll see something consistent with a virus, with a bacteria, maybe a normal blood count- and what we get back could be a lot of things but the only thing that really explains it well (I don't even want to write it) well, it's cancer.

There was before, when we were joking with her and the parents, and after, when we ask her questions we hadn't thought relevant before: weight loss, night sweats- and she answers yes to all them, and we now need to tell her and her family that they're not going home tonight with antibiotics like they'd imagined.

I feel mildly responsible since I'm the one who took the-blood-sample-that-changed-a-life.

I've been checking on her every day and so far there are no conclusive results. We're still ruling out viruses and gallstones and she had a CT late last night that I'm going to go over and check. So it could all turn out to be nothing. I'm endlessly optimistic.

There's just something strange about the fates that led me to be there at that *moment* when the flu turned into maybe-cancer. As a student and an EMT I've been present at so many of these turning points, before-grandpa-died to after-grandpa-died, before-my-leg-was-amputated to after.

It's strange to be a witness to these seconds that turn worlds around.

To be involved and to care and to take these stories home with me at the end of the day and yet also to be completely uninvolved, really irrelevant to what they're going through- just another face in a white coat that they'll maybe remember and maybe not.