Every so often there is a patient who will haunt me forever; our Last Patient of the Night is one I will think about often.
He was small for a 4 year old, a beautiful blue eyed blond little boy. He was whimpering strangely in the arms of a woman whom I assumed was his mother, also blond and blue eyed. They were accompanied by two little girls, probably 8 to 10 years old. They were silent.
"He's an orphan", said the mom. "We're his host family for the holidays, and we have a folder of his medical records. He burned his finger tips when he touched the glass screen of the fireplace".
I took a look at the little boy's fingers; the 2nd, 3rd, and 4th fingers of his left hand had a blister on the pads where they had come into contact with the blistering heat. He was alternately putting his hand on the ice covered in a wet paper towel, and removing them and sobbing, clenching his fists with pain. These types of burns usually do fine, but are excruciatingly painful for the first few hours.
The mother went on, "He's from Latvia, and he's deaf. He's from a program where orphans spend time with families for the holidays; we would like to adopt him".
"We love him", the youngest of the little girls said simply.
Normally immune to such situations, my heart melted on the spot.
His records were, uselessly, in Latvian. We tried some numbing medicine on the burns, gave him some Tylenol with codeine and tried to make him comfortable. I got a sterile cup, filled it with room temperature saline and had him dip his little fingers in it. Immediately he stopped crying. After several seconds, he lifted his fingers out of the cup experimentally; his face crumpled with pain, and he howled like a wounded animal. I gestured to him to put his fingers back in the water and was rewarded with a surprised grin. He put his head on the mother's shoulder and sighed contentedly.
I really didn't want to pry, but I asked, "Does he have to go back to Latvia after the holidays?"
"Yes, and that's going to be so hard. He's such a precious boy; he never cries, well, at least until he hurt his fingers. I wonder, do you think it's because he's deaf?"
"It's an orphan thing", explained the older of the two little girls sagely. I was astonished at her insight.
"Does he sign at all?", I asked. I vaguely recalled that American Sign Language (ASL) is not universal; most countries have their own sign language and their own rules. From some deep, forgotten part of my brain I recalled some signs I had learned years and years ago when my friend Geri and I took 2 semesters of an evening school sign language course.
The little boy had started to shiver; I balled both my hands into fists with the thumbs sticking out between the index and middle fingers. Shaking my hands in front of my I said, "Cold".
No reaction from the little boy, but the mom was interested. "What's the sign for 'hot'?"
I just couldn't remember. I remembered "play", "mom", "girl and boy", "friend". The two little girls quickly picked up on the few signs I could remember. One final sign popped into the front of my brain; I made a motion as if to pull at the visor of a ball cap, followed by touching my lips with the fingertips of my hand and then touching my other hand with both palms up.
"Good boy". Such a good, sweet boy; this family was in love.
" I know how to say 'I love you'", offered the youngest little girl, as she extend her thumb, index and pinky finger and held her palm side out; "That's the most important sign of all".
They were ready to go home. The two little girls wordlessly gathered up their coats, the mom's purse and car keys. The oldest gently put the little boy's hat on his head and softly kissed his flushed, tear stained cheek. They went out into the snowy night.
My New Year's wish is the hope, with all of my heart, that this lovely family will be able to make the little guy a permanent part of their family. They all deserve a happily ever after ending.