Offering hospitality in unwelcoming conditions
What might an offer of hospitality look like in the complex and busy
landscapes of the hospital? Consider the following scenario: it’s 2:00
AM and I (BS) am on call at the tertiary general hospital I have worked
at for a number of years. My shift started about seven hours ago, and I
already have been run off my feet by physician colleagues asking for
consults, nursing colleagues asking for re-assessments, and an incessant
pager laying siege to my best efforts to provide undivided attention to
tasks at hand. The pager has gone off yet again, this time from the
emergency room (ER) physician, while I am in the process of examining a
newborn baby whose delivery I attended for concerns around an abnormal
heart rate just before birth.
I quickly finish the exam, leave the labour and delivery unit, and
arrive downstairs ten minutes later in the ER to find a four-month-old
in significant respiratory distress. She is in her worried mother’s
arms, working hard to breathe with indrawing of her chest wall and nasal
flaring. She has a series of probes on her body to measure her vitals,
which are somewhat tenuously attached as the adhesive is no match for
her movements. The large monitor by her bedside tells me that her
saturation levels are in the high 80s despite receiving a half-litre per
minute of supplemental oxygen, yet the alarms continue to ring without
warning as she moves unpredictably and the probes temporarily dislodge
from her skin.
Her father is pacing around the room, a circuit from which he is
regularly jolted by the monitor’s unpredictable ringing. He maintains a
veneer of civility and kindness towards me yet is obviously exhausted.
In between the alarms, they tell me that their daughter started with a
runny nose, mild cough, and low-grade fever three days ago but seemed
otherwise well. As new parents, at the outset of the illness they had
spoken with their friends and also contacted public health, all of whom
recommended careful observation. They initially had not had many
concerns, as she was born on time after an uncomplicated pregnancy and
had been growing and developing well to this point. However, as she was
not getting better, the parents brought her to a walk-in clinic earlier
in the day today. At that point, they were advised to continue to
observe her, try acetaminophen for fever as needed and a bulb suction to
remove her nasal secretions, and to seek medical attention if she
worsened.
Over the last eight hours, their daughter has become much less
interested in breastfeeding, only had one wet diaper compared to her
usual three over this time period, and has begun breathing much faster.
She became much harder to console, had clear tugging at her trachea, and
her rib muscles appeared to be moving far more than usual. They tried
the bulb suction multiple times and gave two doses of acetaminophen, but
nothing seemed to help. Given the late hour, they debated about waiting
until the morning to have her assessed but ultimately decided to head in
to the hospital.
Once they arrived at the emergency entrance, a nurse met them at triage,
asked them a rapid string of questions, and took the baby’s vital signs.
The nurse’s brow furrowed when he saw the oxygen monitor reading. He
stood up quickly and told the parents to follow him with the baby. He
brought them to the room they were currently in, one that had a sliding
glass door separating it from the rest of the ER, was brightly lit with
fluorescent lights, and had a single hospital bed and a chair in it.
Another nurse appeared five minutes later to ask similar questions and
to attach the baby to the monitors. She raised her eyebrows at the
oxygen reading and, saying something about pneumonia and that she would
be right back, walked out quickly. Fifteen minutes later, another person
wearing scrubs who identified herself as the emergency room physician
proceeded to ask them a similar set of questions and to examine the
baby. She told the parents that she was concerned for the baby’s health
and thought she had a significant respiratory infection. The parents
remember her saying that she thought it was possibly bronchitis or
something like that, but she wanted to have the paediatrician consult
and advise on next steps before any further decisions were taken.