In August of 2006, I began to work at the Martha Eliot Health Center (MEHC). I've been a registered nurse for 25 years, and it was my gratifying memories of working in Boston that led me to apply for the position at Children's Hospital Boston and ultimately at MEHC. The health center serves a diverse population who live in and around the Boston area. The first time I visited MEHC, I felt a strong sense of community and commitment, which made my decision to take this position in pediatrics very easy. The MEHC was established 40 years ago, and today we provide care to people of all ages. Many of our patients immigrate to Boston needing medical care, housing and educational support. It is not unusual for patients to stop by to arrange appointments and to visit the clinic to say hello to a familiar staff member.
Early in January, I had just finished teaching a patient's mother how to use a nebulizer with help of one of our interpreters, Nestor D'Oliveira. A nebulizer is a small machine that delivers medication through a mask to patients who are experiencing breathing difficulties from a respiratory infection, asthma or other chronic respiratory illnesses. As I was thanking Nestor for his help, one of the secretaries called me over to the phone, stating that a patient's mother had called, concerned about her daughter's oxygen saturation level. She told the secretary that it was low, and she had already given Anna* two nebulizer treatments. When I heard Anna's name I tried to recall her medical history. I had seen Anna and her parents in the clinic and I knew she was developmentally delayed, fed by a g-tube (which is placed directly into the stomach) and had problems with esophageal reflux, which can cause vomiting, and at times food or liquid can get into her lungs.
Anna's mother, Mrs. Alvarez* did not speak English so I asked Nestor to help me with translation. We went into my office, and Nestor began translating my questions in Spanish. From what I could understand, the patient was having lots of mucous and her mother had to use a suction catheter to keep Anna's airway clear. (A suction catheter is a small soft tube that can be placed inside the mouth to catch any mucous that could cause her to choke.) I could sense that my questioning was making the interpreter anxious. Does she have a fever? Had her condition changed recently? Was anyone else in the family sick? Had her medications been changed and what medications did she take?
When I asked about her oxygen level again, Mrs. Alvarez said that it had dropped even lower and that she was suctioning Anna as we were speaking. It was necessary to continue to support the patient and her mother while maintaining a sense of calm while I arranged for transport. I could see the apprehension in the translator's face as I asked him to question Mrs. Alvarez about the patient's breathing status, her color and her ability to perform C.P.R. She stated nervously that her daughter was still breathing. Her chest was moving up and down but her breathing was noisy, as if she wasn't able to get enough air to breathe. Her color was "a little darker than usual." I began to pick up the other phone in my office as Mrs. Alvarez confirmed that she knew C.P.R. but had never had to use it.
Using Nestor's quick translation, I instructed Mrs. Alvarez to apply the oxygen mask to Anna's face and to turn the gauge up. This would allow her to receive more oxygen until I could get the paramedics to her house. I told Mrs. Alvarez to continue to watch her breathing and I informed her that I was calling an ambulance. Then, I dialed 911 from a different phone line, and looked up their street address to verify it, and began telling the 911 operator of my patient's condition, her medical history and that she was receiving oxygen. I continued to assess Anna's breathing status while staying on the phone with the operator. Within minutes, Nestor announced that the paramedics were at the door. Mrs. Alvarez gave the phone to the one of the paramedics so I could give a quick report. The conversation ended quickly. The interpreter and I hung up the phones, and I thanked him for his help and his ability to think so quickly. I was fortunate to have his help. I believe my ability to speak to Anna's mother with Nestor's help allowed me to provide her with the necessary support until medical assistance could arrive.
Three days later Mrs. Alvarez came to the clinic with Anna's brother. I introduced myself to her, and she thanked me "for all that I had done." I knew that Anna was in the hospital in critical condition. Through all of this, her family has shown incredible strength and love.