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It was a typical February for the Transport Team. Respiratory syncytial virus season was in full swing and transport requests kept us busy. It was approaching the middle of the night when our pagers went off.
Along with the demographics of the patient, baby M, came the diagnosis: tetralogy of Fallot, the most common cyanotic heart defect. We were familiar with the requesting hospital where baby M was, and as we headed out to get him, I called to get a report from the medical control physician in the Cardiac Intensive Care Unit (ICU).
I've learned many things in the two short years I've been on transport. One is that what you're told by the referring facility isn't always what's actually going on. As I listened to report, I realized it wasn't meshing with the diagnosis we were initially told. The referring physician said that the child was blue, with oxygen saturations in the 30s after a confirmed successful intubation. He then told me that the baby's heart was described to him as having a round appearance. But to me, the patient's condition sounded less like tetralogy and more like transposition of the great arteries (TGA) with an intact ventricular septum, since newborns with TGA generally have lower oxygen saturations than babies with tetralogy of Fallot.
I knew that this was a time-sensitive matter and I suggested to the paramedic that we travel on a priority response to the referring facility. On our way, my partners and I formulated a plan of action and were all in agreement that we had to work quickly. I knew that in order for this child to survive, he needed to quickly get back to Children's for a balloon atrial septostomy. Patients with TGA only have one way of getting oxygen-rich blood to the rest of the body: through a very small hole that closes after birth. Drugs help to keep that hole open until a procedure called a septostomy is performed, which allows blood to be oxygenated and delivered to the entire body.
We arrived and walked into a nursery full of people. Time was of the essence, and I knew I had to tell the parents how sick their child was. I thought, How can I explain this condition in simple terms? How am I going to tell them that the lifesaving procedure their child needs is basically ripping a hole in their newborn's heart? As I pondered these questions, the physician informed me that the parents didn't speak or understand English well. My mind was racing. All I could think about was that we should be on the road back to Boston by now. This was the first time I had to deliver this kind of news to a family by myself, since the physicians were too busy at the baby's bedside to come with me.
This should have been one of the happiest times in the couple's lives, and here I was about to tell them that their beautiful child was very sick. The thought of this horrified me, but I forced myself to slow down and concentrate on caring for these scared, new parents. I thought briefly about my own child. How would I feel as a new father hearing that my child had a life-threatening condition? How would I feel not knowing exactly what everyone was telling me because I didn't understand the language? I took all of this into consideration as I entered the room.
I introduced myself and calmly but quickly explained their child's situation. In the simplest of terms, I expressed, via an interpreter, the importance of leaving immediately because the only thing that was going to make their son better was to get to Children's. Things began to move like clockwork. Just as I was finishing speaking to them, my partners came in with the baby. Dad agreed to come with us, and after a brief goodbye to mom, we were on our way.
As we travelled on a priority return, I thought of the parents and their minimal understanding of English. I anticipated the dad's needs and requested that an interpreter be present when we arrived to make sure he knew what was happening. Soon enough, we arrived at Children's, and once we were in the ICU, it wasn't long before baby M's condition stabilized.
Looking back, I've thought a lot about this call. Working with my team, we were able to come up with a plan to do what was best for this baby. My knowledge of patients with congenital heart defects helped me understand the diagnosis from hearing the symptoms. My understanding of the patient's disease helped us determine the need to transport this patient quickly. What I found to be the most rewarding part of the call, though, was what happened the next day. It got back to me how much the father appreciated the way I took the time to carefully explain his son's condition to him. Hearing this made me feel that not only had I made a difference in caring for the child, but also in caring for his parents.
In honor of Nurses' Week, Howley and three other nurses will read their nursing exemplars. Click here for a schedule of Nurses' Week events.
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