At first I am unsure what has woken me, perhaps an instinctive awareness that the natural order of our house has been disturbed. I hear a gentle padding in the hallway, then suddenly a small face is hovering next to me. “Move over! Make room for me!” comes the chirpy order, revealing the identity of our interloper. It is Tom, the middle child, and a serial offender. Once the decision has been made to leave the safety of his own bed and venture ten feet down the hallway, he makes it very clear that he will assume a place in the master bedroom. Sometimes, in case his intentions are unclear, he brings his pillow.
Making room in the middle for our guest, I attempt to crawl back into the cocoon of sleep, but am soon aware that something is not right. Tom is warm and restless, and is breathing slightly faster than usual. The cough we first noticed that morning is more pronounced. I turn on the bedside light and see that he is flushed and sweaty with fever. He looks uncomfortable. I assess him with a quick glance as I do the children I treat at work, this first impression giving me more vital information than thermometers, stethoscopes and otoscopes ever could. His breathing is slightly noisy but not laboured, and there is a vitality about him. There is no ominous rash. This is one for paracetamol and a snuggle.
When I return from the kitchen Tom is sitting up in expectation. He smiles beatifically, all damp blonde curls and flushed cheeks, beautiful to his mama as only a small boy can be. He solemnly accepts a cool drink and his medicine then lies down again, satisfied with his care.
Around the country, other children too are stirring in the night. Some have woken crying, the fright of a bad dream lingering even as the substance fades. Some are cold and need discarded blankets smoothed and tucked. Then there the fevers and coughs and sore ears and throats. Most can be treated, but some will alarm their parents with harsh coughs or panicked breathe, perhaps vomiting or crying with pain. and at this hour there is only one destination: the emergency department.
On a different night, I might be stuck in resus or catching up on ten hours worth of notes as I sip lukewarm Nescafe, the end of my shift taking on a nightmarish quality as home time seems an endless and growing number of steps away. As I am trying to leave, they arrive; babies, toddlers, preschoolers, all wide eyes and sleep-tousled hair, cheeks pink from the cool night air, clad in patterned pyjamas, dressing gowns firmly belted or wrapped in soft, woollen blankets. Curled up to parents like baby koalas, much loved toy in hand. Some fearful and cautious, others curious, interested in this strange but not unwelcome turn of nocturnal events.
I try and impress upon the newer doctors I work with that the population presenting to us is a self-selecting one. For those who have come of their own volition, every one of them has stopped whatever they were doing in life, because they perceive their problem is an emergency. And this is especially true for those who come to us overnight. The decision to leave the warmth of the cave in the small hours goes against all human instinct, and seeking our care is often driven by a concern that something is very wrong with their child.
My other piece of wisdom is that there are two parallel stories to every patient. Why are you here and why are you here? The first is a concrete, problem based construct: cough, fever, vomiting, difficulty breathing. The second is less tangible and often not so easy to elicit. What was your core reason for presenting? What was your motivation to come here, now, tonight? It may be unspoken, but when you puzzle out the answer to this second question, 90% of your work is done.
I’m here because the cough was driving us crazy and no one could sleep. I empathise. We all need sleep! But the cause of the cough is benign and cough syrups don’t work very well and can be harmful.
We’ve had this before. I know what treatment he needs and I wanted to get it started now rather than waiting till morning. Fair enough. Here is a dose for tonight and a script for this morning.
I’m here because I was worried if I waited till morning she might get more sick and I don’t know what might have happened. I understand. Tell me your concerns and I will look at your child and see how I can help.
I was afraid that she might die. I understand. I worry about that too.
My child could get sick and die.
For surely that is the dark, unifying thread of parenthood. We are all frightened our children might die in the night.
People trust me with their children’s lives. This weight of this responsibility feels heavier than ever at 4am.
But tonight I am not at work. Tonight I will care only for my own. Tom likes to sleep as if he is aware that he was once part of me, and is now trying to rectify the injustice of our physical separation. So I lie with him and feel the rhythm of his breathe settle. Since the dawn of the human species, every one of my maternal ancestors once gave birth to a child, and I like to think that every one of them once lay awake with an unwell child, before drifting unawares into sleep, and waking in the light of day.