Josh's POV
"Patient in exam room 3, Josh. Dr Cullen's asked you to take care of this one." I was quickly snapped out of my unconscious state, lifting my head off of the coffee table and looking up to the young nurse, Lucy who was looking sternly down at me.
"Sure, sure. Exam room 5 – got it." I muttered back, stretching my arms behind my head and wiping the sleep from my eyes before getting up to pour my cold coffee down the drain.
"Room three. Shall we walk and talk?" she corrected, giving me a somewhat sympathetic smile as I brushed my hands through my nest of hair, attempting to destroy the evidence of my mid-afternoon nap.
Med school could never have prepared me for what was to follow, no matter how many clinical hours I had clocked up shadowing attending physicians or days I had spent on the children's wards, usually mopping up vomit or cleaning bed sheets. Nobody could have prepared me for that constant worry in the back of my mind; the thought that I am now responsible for someone's life. Neither could it have prepared me for the evening's I had spent lying awake all night, desperately trying to get rid of the images of what I had witnessed in the ER from my mind. Yesterday had been one of those nights.
One thing they always try to tell you when you qualify is that you should never take your work home with you, which is most definitely easier said than done.
Some days I regret my choice of speciality.
'Paediatrics is the hardest of them all, you must be tough' my tutor had told me at med school, never fully understanding what I would be getting myself into. In order to succeed in what I do, you have to forget about the parents screaming from behind the curtain whilst you're slamming your whole body weight down on the tender ribcage of a 6 year old child one hundred times a minute. You just have to attempt to block it out and do all that's in your power to get that kid's heart to start bloody beating again, even if you know most the time it's not possible.
Carlisle, the attending, had always been good to me. Gosh, there were many many times as an intern I thought I had made the totally wrong career choice – but Carlisle somehow always understood me, and maybe wrongly always managed to convince me to get back up and carry on. Sure, he pushes me, but now in my second year of residency, I think I may be getting to grips with the fact that I am qualified, and I am capable of saving lives on my own. I walked with Lucy down the corridor, attempting to focus in on what she was telling me despite how foggy my head felt.
"—small facial laceration, but we were mainly worried about the shortness of breath. She's complained of chest pain, but hasn't gone into much more detail than that. She's soaking wet and in rags of clothes, but won't let any of us touch her. She's so scared, bless her." I caught onto her saying, and I allowed myself a moment to digest it.
"Wait, what? How old?" I asked, watching Lucy's eyes roll as she noticed I had only caught on halfway through her handover.
"She's given no personal information so we can't find her on the system, but I'm guessing probably twelve or thirteen. A student from Fork's High found her on his way to school tucked away at a bus stop and drove her here. He reckons she was there a few days." Lucy explained and I nodded along, skim reading through the handover sheet with the brief notes jotted down on it. It certainly seemed the girl wasn't much of a talker, judging by the lack of information they had managed to get out of her.
"Okay, thank you. I can handle it from here." I replied as we suddenly halted at room three. I gave Lucy a quick smile and a nod, before giving the door a light knock and entering.
It was dark as I entered, but I could make out that something small was curled up on itself on the examination table. Automatically as a reflex I clicked the two light switches, but was taken by surprise at the whimpers I heard when they flicked on. The little girl on the table suddenly reached her hand out to cover her eyes, groaning rather loudly.
"I'm sorry sweetheart, I didn't realise you didn't like that." I tried to soothe the poor kid who had hidden her head with both arms now, hiding herself away from the light.
"I'm sorry." I repeated, turning one of the switches back off as quickly as I could. I wasn't sure if it was an anonymity thing, or whether her eyes were actually sensitive to the light, but gathered it was probably a bit of both judging by the black eye and laceration across her cheek he had managed to get a glimpse of. It didn't take an ophthalmologist to see that it must have caused some damage.
"My name's Dr Rose, I'm one of the doctors here. You can call me Josh… What's your name?" I introduced in a hushed tone. I was well aware of how tall I was, and even more so aware of how intimidating that could be to children, so kept a careful distance away from her. I paused for a moment waiting to see whether she would speak, but there was no response.
"Can you tell me why you came here today, sweetheart?" I asked gently. Of course I knew the symptoms she was presenting based on what had already been noted, but I was always keen to hear it from the patient for myself. It had been a skill Carlisle had taught me from my very first day, to make my own notes and draw conclusions of my own rather than relying on what had already been noted by nurses who were usually rushed and only noticed the basic details of the patients condition. I watched the girl slowly recoil her hands from her face, and tilt her head to face me. Her eyes scanned me up and down before focusing for a long while on my eyes, perhaps trying to gather whether she could trust me or not or whether she recognised me. I was taken back when her lips parted slightly as if to speak.
"Hurts. Everything is h-hurting…b-bad", she croaked out and her eyes very quickly began to fill with tears. My heart broke for the little one, who clearly desperately needed some pain relief – something we could only give her if she told us more. However, my attention was drawn to her scarily rapid breathing and the blue tinge to her lips, a symptom which always triggered alarm bells to me. Blue lips meant lack of oxygen, and lack of oxygen well, ultimately leads to death. Her skin was clammy too, and her hands seemed to be tremoring uncontrollably which could indicate hypoglycaemia. She was presenting more and more symptoms, and I started to feel out of my depth.
"How about your chest? Is there pain there?" I continued to probe, watching her forehead screw up and her eyes turn confused. I wasn't exactly sure what I had said for her to react in such a way, but I could only assume the kid hadn't understood the question.
"Does it hurt here when you breathe?" I attempted to explain, gesturing towards my thorax. Her eyes were fixed on my chest for a while with a look of concentration before her eyes met mine again and she nodded slowly.
"Now, could I have a listen to your chest?" I asked, approaching her slowly, my hand hovering to the stethoscope round my neck.
"Huh?" She squeaked back in response, edging away from me rather suddenly with her eyes wide and fearful. It became clear to me the kid had probably never had a routine physical exam before judging by the way she stared at my stethoscope like it was some sort of torture device.
"You've never seen one of these? It's called a stethoscope... It let's me listen to your heart, which is quite cool really, don't you think?" I smiled at her, holding the instrument towards her for her approval. She looked up at me as if I had two heads. "Here, do you want to try it on me?" I chuckled, edging towards her slightly and hovering the ear buds towards her. She reluctantly let me place the buds into her ears.
"Good girl. You look just like a doctor" I chuckled again, breathing a somewhat sigh of relief as I saw her lips form a small smile. I had found something that she responded positively to - praise. I took the bell of the stethoscope and placed it on my chest on top of my shirt, watching her eyes widen in what I hoped was excitement. I held the bell still there for a good couple of minutes, before reaching over to remove the buds from her ears.
"Can I try it with you now, sweetheart? I will need you to take your top off for me, as pretty as it is. I can't get a good sound otherwise" I asked, watching her think it through. She began to squirm uncomfortably, curling back into the ball I had originally found her in.
Oh crap I thought to myself as she soon began to sob, protectively wrapping her arms around her knees.
"Sweetheart, it's really important I have a listen. You're in pain and I want to make that better" I attempted to explain, but she cried louder wedging herself into the corner of the room as far from me as possible.
Despite how much I wanted to persevere, I was running out of time and she desperately needed to be examined. There was no chance she would let me touch her after my request for her to take her shirt off, but she didn't seem to trust any of the nurses either as Lucy had implied. Her breathing was becoming even more rapid, and she rubbed her fingers together as if losing sensation.
"Here, this will help." I said in almost a whisper, reaching out for the oxygen mask from the wall. She jerked her body away from me as soon as I neared her with the mask, even reaching out to push me away with one hand. Her touch on my arm was unintentionally gentle as she attempted to protect herself, and I realised then just how weak she was. But I carried on, using some force to attach the mask to her face. She may have thought I was trying to hurt her now, but the oxygen would soon make her feel better and she would realise I'm just trying to help.
"It's okay, it's okay. It's just extra air to help you breathe... I'm sorry I had to force that on you" I whispered sadly, my voice breaking mid sentence.
"I'll be back in a couple of minutes." I managed to choke out, leaving the room and crouching down on the floor with my head in my hands. I didn't understand why the girl had affected me so much; perhaps because I ultimately knew what was hiding under her clothes. I had no doubt she had been through some kind of trauma, and had attempted to run away from it. I'd never seen an abuse case before, and knew in myself I wasn't comfortable enough to cope on my own.