It is quite a messy Thursday outside: snow, slush, freezing rain. We are supposed to be driving to my hometown this afternoon, 4.5 hours east of here. Although we haven’t decided whether or not to go, I have been packing. Luckily for me, Thursdays are my day off. I usually spend the morning with my youngest and then the afternoon in our home office working until it is time for school pick-up. I pick up Micah, we have some time together and then we pick up Ariel and go to violin. ANYWAY, I am not doing any of that today as I am packing. But I find on Thursdays, I often have some time to pause, be quiet, and think. It was last Thursday that I wrote about my patient M. I really enjoyed writing about her and remembering her and being inspired by her all over again. So….I bring you Thoughtful Thursdays and another patient story!

This patient is a little preschooler who I will call Pippi because she has the most beautiful long red hair, the cutest freckles on her pale face, and an irrepressible spirit. Very much like Pippi Longstocking (one of my favourite characters in children’s literature).

I started hearing about Pippi early last Friday morning, although I didn’t know yet she was Pippi. I arrived for a regular Friday list – ophthalmology this time. I was working with a senior resident who has been with us for over 2 months. When you work a resident such as this, it affords you some freedom to leave the OR for a bit, get some paperwork done, maybe see a consult, etc. Work that can be done very close by the OR in case the resident needs assistance. A very nice Friday planned for me – until the chaos sets in and everyone starts talking about the “wait list”. The wait list is the list of emergency procedures that need to be done. As I mentioned in my previous post, I HATE talking about the wait list while trying to simultaneously look after my current patient.

Pippi was a patient that had gone to the ER near her home, several hours away from us. Her mother had noticed some unusual bruising. Her blood work has shown dangerously low levels of platelets (the cells in that make blood clot) and red blood cells (cells that carry oxygen throughout the body). In short, Pippi was likely very sick and needed a test of her bone marrow immediately. Our hospital has recently lost our hematopathologist – the person who interprets the bone marrow tests. So all bone marrow samples have to be sent to Toronto and therefore MUST be done by noon to be sent by 1pm. And so the planning began.

Bone marrow aspirates are very short procedures but they are painful, therefore they are done under anesthesia. We usually give a little pain medicine, a little anesthetic agent, the patient falls asleep, hematologist gets their sample, and away we go. However, little Pippi was not yet in our hospital and we were running full tilt: i.e. all anesthesiologists already doing cases. And it was 11am! I suggested that we bring Pippi to the OR next to mine and I run over and give her the anesthetic while my resident monitored our room. A plan was made! But where was the patient?

It was now 11:15, no patient yet. Finally, I get a call from the hematologist, patient had arrived via ambulance, he was meeting the family briefly, then they would come down so we could hopefully make the noon deadline. He ended with: “Oh Robyn, you are going to LOVE her…she is just, well MUNCHABLE!”.

When they arrived, it turned out she was indeed ‘Munchable’ – meaning she was so cute, you could just eat her up. For a little girl who was so sick, she was fully of energy and questions! She bounced into the OR asking ‘what is this?’ and ‘who are you? what is your name?’ and ‘did you know that I was in an ambulance?’. She told me herself that she had no allergies, she had not eaten breakfast, and this had made her VERY grumpy. Remember she is barely 4 years old! She wanted to turn all the dials on our anesthesia machine and hold her oxygen mask herself. She already had an intravenous line in place, so I was able to just dribble in (nice technical word, huh?) a little sedation and she drifted off to sleep still talking! She was truly ‘munchable’.

Unfortunately, we will probably see more of Pippi as it is likely she has leukemia or aplastic anemia. But I suspect her spirit will sustain her and her parents throughout this ordeal. We got the bone marrow sample by our deadline, it was chaotic and rushed, and not ideal circumstances. But it was the right thing for Pippi and hopefully it was the first step to successful treatment for her. I can’t wait to see what her energy level and chattiness is like when she is feeling well and going full tilt! I suspect she is a force to be reckoned with.