Fledgling

Her tiny fingers circled my index finger, surprisingly firm in their grip.

I watched the rise and fall of her chest, breathing far too hard for one so small. Outside, the wind had picked up and through the cracked windowpane, the smell of the snow that was yet to come made its way to my nostrils.

We didn’t have much time. Soon, the snow would encase the island and the winds would be too strong for the medevac to land. We needed to get her out, fast.

I had delivered this little one, 6 months before, on a teaching practice. A healthy baby at term, head covered in an endearing mop of spiky black hair and a curious pair of inky dark eyes. Little did I know at the time that she had a large ventricular septal defect, a fact that only came to light sometime after her birth, long after I had made my way back home.

Surgery was the only option, but surgery was nearly 900 km and a medevac ride away.

She was wheezing now, and all the furosemide and salbutamol in the world didn’t seem to be helping. They were cardiac wheezes, her infant lungs filling up with water as her heart failed.

Heart rate 190.

Respiratory rate 80.

Intubation was not an option, as we weren’t sure if she would survive it or if we had the capability of managing her if she did.

So she held on to my hand, as I held on to hers and prayed.

Her father stood slightly removed from the bedside, a soft-spoken man with kind eyes. He shifted from foot to foot, bearlike hands clasped awkwardly in front of him.

“Wah-chay.” He greeted the nurse who approached his daughter to administer yet another dose of furosemide. His eyes skittered past mine.

“Don’t you die on me. It’s just not allowed.” I muttered under my breath, frowning in concentration as I took her pulse, the brachial artery beating a rapid tattoo under my fingers. Even without applying my stethoscope to her chest, her wheezes echoed in the stillness of the room.

Respiratory rate 70.

Maybe the furosemide was working after all. Either that, or she was getting tired.

In the next room, my colleague was on the phone, arguing with the medevac company.

“No, I don’t think you understand. She can’t wait until morning. She needs to get out tonight. We have a storm rolling in and we won’t be able to manage her. I don’t care what you have to do, just get me a chopper.” The phone clattered in its cradle.

I looked up at my patient’s father, his brow furrowed as he watched his daughter struggle for each breath.

“You don’t need to be so far away.” I motioned him closer. “You can touch her. In fact, it might calm her down. You’re the only one she knows.” He bit his lip but his hand, no longer hesitant, came to rest on his daughter’s silky hair.

As we stood, guardians on either side of her bed, the charge nurse came rushing in.

“They’re taking her! They’re flying her south tonight. The chopper will be here in a couple of hours.”

In a flash, the nurses swooped in, reclaiming his daughter in a flurry of intravenous tubing, electrodes, and blankets.

He stepped back, more flummoxed than before.

“It’s overwhelming, isn’t it?” I came to stand beside him.

“Yes.” Gruff, his vocal chords stiff from disuse. The first word he had spoken to me since he had brought his daughter in that morning, other than the introductions we had exchanged. I had learned that he was a man of few words, of great strength, whose emotions were tightly reined but easily read if one took the time to look.

“What’s next?” He asked.

“The medevac will take her to Sick Kids in Toronto and she will have surgery there. But only one of you, either you or your wife, can fly with her on the chopper. And with tonight’s weather, I’m not sure if your wife will make it here in time before the medevac flies out.” His wife was at home, in their village, a few hours away, caring for their other children.

He nodded, digesting this information. His fingers knotted themselves once more.

“I’ve never been.”

I nearly didn’t hear him, so softly were the words spoken, lost somewhere between his mustache and my ears.

“You’ve never been to Toronto?” I asked.

“No.” He paused. “No. I’ve never been south. I’ve never been to the city. My wife. She’s always traveled with her. I’ve never been. I ... I don’t know what it’s like. How am I supposed to help her if I don’t know what it’s like?” The word tumbled out of him, tinged with fear. “My wife, she knows.”

I sat him down and, this time, when I placed my hand on his, his gaze met mine.

“Toronto is a big city. Much bigger than your village and much louder, too. The medevac will land on the hospital roof overlooking the city. You will see lots of bright lights, hear the sirens of ambulances, and hear honking of cars. You might find that people move faster there, speak faster there. Don’t let that intimidate you. You are her father, you know her best. Your voice counts and should be heard. I know it’s scary and that your wife has taken care of your daughter in the past, but now it’s your turn. And you have managed really well so far. There’s no reason to think that you won’t be able to do the same in Toronto. Because here or there, it doesn’t change the fact that you are her father.”

His eyes, so intent on mine, watered. He blinked. Nodded.

“Meegwech.” Thank you.

“Is there anything else I can help you with? Any specific questions you had that I didn’t answer?”

“No.” He took a deep breath. “Now, we wait.”

She made it out that night, her father flying with her for the first time, toward the bright city lights, a new heart, and a new adventure.

Fly safe, little one. You’re not alone.

• Copyright© the College of Family Physicians of Canada