The boy smiled toothlessly at me, running around the exam room, asking me repeatedly “what’s this? what’s that?” at various doctor things, and even drinking my leftover coffee. His mother gave me his history amidst our games of hide and seek. Yes, he was very good about taking his medicines. No more seizures. No spitting up the drugs. He hadn’t been sick this month. No contacts with a cough or TB. Everything was good.
I then pulled out my stethoscope to start his physical exam, and upon seeing it, he immediately jumped up onto the exam table and lifted up his shirt so that I would have easy access to his heart and lungs, but also to show me that his umbilical hernia was still easily reducible, as he poked at it with his finger.
.
.
He was on a new regimen of HAART though, so I suggested that we do some bloodwork to see if his viral load was going down. My attending agreed, and we led him to the phlebotomy room. After unceremoniously kicking his mother out the door (because we all know the moms cry more than the patients), we sat him on the table and put on a tourniquet to see which vein we should draw from. My attending felt one and dived in.
The boy started crying immediately. I was sitting on the table holding him hostage, and I could feel his hot tears on my hands and arms, as he looked at me accusingly. I was supposed to be his friend. Hadn’t I just been playing with him in the exam room? And now, here I was, sticking him with needles, refusing to let him go.
My attending kept repositioning the needle, trying to find that flash of blood, as his cries got louder and louder. No good. She pulled out the needle, and he immediately tried to jump off the table to get to freedom. But still I held him.
His mom came back into the room, promising that she wouldn’t cry or complain. He reached for her, and instead of picking him up, as he expected and most definitely wanted, she took his other arm, and held it out to my attending. We looked in vain again for a different vein, but no dice. We were going to have to do an arterial stick.
My attending wiped down his wrist with alcohol wipes, and once she pulled out the needle, the boy started screaming and writhing in my grasp. No no no, he didn’t want it. Now his mother was holding him, I was holding him, and Jean was also holding him down.
He couldn’t get away from us. So, instead, he pulled his wrist to his mouth and licked his wrist, his angry eyes defying us to try to re-alcohol swab the area. But re-alcohol swab we did. And we got his blood. The moment he was free, he jumped into his mother’s arms, refusing to look at us, even as we tried to apologize with sheets of stickers and lollipops.
I have never felt so guilty of betraying a small child’s trust. But I have to give him credit – licking the needlestick spot? Pretty ingenious.
