Tara Phillips
VCUG
The weeping 4 year old child has her arms and legs locked around her mother; head buried against the lead apron the mother is wearing, black and white Dalmatian puppies printed on it. Dr. Sheridan walks into the room, removes her white lab coat and replaces it with her own lead apron, rainbow print like mine, and extends a hand to the mother. As Dr. Sheridan says hello and shakes the mother’s hand, the child looks at her briefly, then quickly turns back and nestles her wet red face into her mother’s shoulder again, tightening her grip with all four limbs. Dr. Sheridan gives a sympathetic tilt of her head, washes her hands, and begins to open the packaged sterile gloves, carefully putting on the right, and then the left, without touching the outer parts of either glove with bare hands. I wait until she is finished, then begin to open the packages one by one, careful not to touch the items inside, but exposing them enough for Dr. Sheridan to take the items from the packages and place them on the opened inside glove wrapping. When I am finished handing most of the items to her, I twist open the lid of the specimen container and place it next to me.
I instruct the mother to lay the child down on the table, which is covered in light blue absorbent pads. The child is wearing a small hospital gown with Ronald MacDonald and friends on the front of it. I tell her how pretty her gown is, then notice that she is still wearing underwear. “Go ahead and take her underwear off,” I say to the mother. The kicking and screaming begins, and the mother does her best to console the child. Dr. Sheridan waits with raised gloved hands, holding one of the betadine swabs, as I reach from the opposite side of the table to grasp the child’s legs and help to lay her down as she fights us. We succeed, but she still cries and shifts, and begs her mother to take her home. Her mother leans in and begins to sing to her. I smile at the child with an expression that I hope tells her that I understand that she doesn’t want to be here, but we have to do this, and I speak to her. “Hold on tight to Mom’s hand’s, okay?” She continues to cry and beg, and I gently tell her mother to hold her hands and don’t let go. I guide the child’s legs into a frog leg position, and she tenses up every muscle, and tries to close her legs. I use force, and hold her legs open at both knees. Dr. Sheridan begins, swiping and swirling with one of the betadine swabs, cleaning the area of the child’s vagina and urethral opening. Another swipe with swab number two and a gentle circular motion, and one more time with the third, as the child still fights to close her legs. I do my best to console her with words and tell her she is doing a good job. I look the mother in the eye, and tell her that everything is going just fine, and remind her not to let go of the child’s hands. Dr. Sheridan squirts a few drops of the gooey lidocaine jelly on the area she has cleaned, and gives it about ten seconds to take effect. The child screams, and shifts her hips at every touch, and the mother is holding her hands, and singing in her ear, and I can see tears in the mother’s eyes, and I tell her we’re almost finished with this part. “Hang in there,” I say. My own arms and hands are beginning to shake, still holding the child’s knees. Dr. Sheridan grasps the tip of the 8 French catheter with her right hand and leans in, opening the labial lips with her left hand, and inserts the catheter into the child’s urethral opening. She places the other end into the specimen cup, and yellow liquid begins to seep through the catheter and into the cup. The child still screams. Dr. Sheridan tapes the catheter to the child’s skin. I take a deep breath, slightly loosen my grip, and guide the child’s legs, telling her that she can straighten them, and I lay a white towel over her hips. I tell her the hard part is over. She doesn’t believe me. I remind the mother again to keep holding the child’s hands.
Dr. Sheridan removes her gloves, reaches over the child to grasp the handle of the fluoroscopy tower, pulls it toward her, and locks in place over the child. She continues to scream, but has stopped fighting so hard. My hands remain on her legs in an attempt to comfort her and as a reminder not to move them. Dr. Sheridan removes the end of the catheter from the specimen cup and connects it to a bottle of clear liquid which hangs from a pole by the table, and the liquid begins to drain into the child’s bladder. A quick push of a button on the fluoroscopy tower shows us a real time X-Ray image of the child’s bladder on a TV monitor as it fills with the liquid contrast material. It looks like a small black balloon inside her pelvis, growing larger every time Dr. Sheridan pushes the button. The mother is singing, and the child has calmed down but still cries. Dr. Sheridan leans in toward the mother. “Everything looks fine so far. She’s doing great.”
I lift up the towel a bit and I watch, waiting for the child to urinate onto the absorbent pads beneath her. I tell her “You can pee whenever you’re ready. We’ve got special blankets under your bottom, and it’s okay to pee on them.” She continues to cry, and tells her mother she doesn’t want to pee on the table. Her mother says that they can go home after she pees. We wait. The child cries. The mother sings. Dr. Sheridan pushes the button and we look at the screen. The balloon is larger, and there are traces of the liquid stemming up from two tubular structures out of the bladder, the ureters. The child has vesicourethral reflux.
Dr. Sheridan tells the mother, “I see some reflux, but it is very mild.” The mother kisses her child’s hair and continues to sing to her. I’m still watching, waiting for her to urinate, and the mother encourages her to go. When she finally does, we all praise her for it and cheer her on.
“Yay! Keep going!”
“Don’t stop peeing!”
“Good job!”
I loosen the tape and slowly remove the catheter as she urinates. She doesn’t feel it. She stops crying, and we continue to praise her. Dr. Sheridan lifts the tower and slides it back across the table. She explains again to the mother that her child has some mild reflux, and that she will let the urologist know, and that they should follow up with the urologist. The mother looks concerned, but thanks her and lifts the child up from the table. The child’s face is red, eyes puffy, hair stuck to her face and wet with tears. She wraps her arms and legs around her mother again. I tell her she can dress the child, and I walk away briefly. I return with a squishy soft white teddy bear, and she takes it from me, but still clings to her mother. Her mother whispers something, and the child turns to me with sad eyes and speaks. “Thank you.” It would break my heart if I let it. As the mother dresses her child, I begin to clean the room. I say goodbye to them and they leave. I prepare the room for the next patient.
© 2009 Tara Phillips