BREAKING POINT

Penny nodded. And then she raised her eye-brows. “Did you know…that if a little girl has broken her arm…when the doctors and nurses fix it, she can choose a pink cast to wear for weeks and weeks?” Then Penny shook her head. “But I guess you might choose a green one.”

“Nooo…I want pink…”

Penny put her thoughtful face on. “Hmm… but you’d have to get out of the car and come to where they make the pink casts.”

Mia’s face crumpled.

“Tell you what…” Penny was looking around the car. “Is that your jacket? The pink one?”

Mia nodded.

“If I put it very carefully behind you, I could tie the sleeves over the front and that would keep your arm very, very still while we get you out of the car. And if Dr Joey lifts you, you won’t have to move at all and it won’t hurt more than a little bit.”

Mia started to shake her head but then paused for long enough for Penny to smile at her again.

“He’ll take you to the pink cast place,” she whispered, as if it were a secret.

Mia was still hesitating but Penny knew they were running out of time. “What say I make the jacket bandage? And, when that makes you feel better, you can tell us when you’re ready to come out of the car.”

She didn’t give her time to think about it, already threading one sleeve of the jacket behind the little girl’s back and then pulling the puffy fabric through. She kept one sleeve at waist level and pulled the other one up to drape over the shoulder on the uninjured side.

And then she made sure there was as much padding as possible around the elbow and pulled the sleeves tightly together and tied them in a firm knot. The injured arm was completely immobile and Mia had done nothing more than whimper a little bit.

It was only then that Penny straightened, to find Mia’s mother and Joey had stopped talking and had been watching her-maybe for all of the few minutes it had taken to get Mia ready to be moved.

She stepped closer to Joey and turned her head so that she could speak very quietly, right beside his ear.

“I think she really broke her arm” she said.

His gaze met hers. A brief eye contact but, like the moment they’d both heard the child scream, she knew they were both thinking exactly the same thing. This injury needed to be sorted urgently or Mia might end up with reduced function in her hand. This wasn’t the place to try and put in an IV and administer pain relieving drugs. It could be done far more efficiently and safely once she was in the emergency department.

It was Joey’s turn to crouch beside the car.All content © N/.ôvel/Dr/ama.Org.

He had to get this child out no matter how much she resisted but, if she struggled, it could well make her injury worse. A broken shard of bone could sever a nerve or a major blood vessel.

He had watched the way Penny had calmed a terrified little girl with a skill that had taken his breath away. Had made something in his gut feel all soft. He’d known she was an amazing mother but what he’d just seen her do was awesome.

All he needed to do now was to follow her example.

“I need you to pretend to be a caterpillar,” he told Mia.” And you’re inside your cocoon getting ready to be a butterfly so you can’t move your legs or your arms. Can you do that, sweetheart?” he asked.

Big, brown eyes flicked upwards. Was she looking for her mother? Or Penny?

“I’m here, darling,” her mother said. “I’ll be right beside you.”

“You’re a pink caterpillar,” Penny said softly.

“And you’re bee-yoo-tiful.” Joey used the distraction to slip one arm behind Mia and the other beneath her knees.

On the middle syllable of Penny’s elongated word, he lifted Mia and stepped backwards in a smooth movement but the little girl still screamed in fright.

Joey held her close, careful to avoid any contact with the injured elbow. The splint Penny had fashioned from the puffer jacket was remarkably good and the elbow was supported as well as it could have been with the kind of inflatable splints or other gear the ambulance service might have used.

As for Penny, he was blown away, not only by her skill in winning the trust of the little girl, but her confidence in making an initial diagnosis and initiating the first level of treatment.

To say he had been impressed was an un-derstatement… Joey was confident that moving Mia hadn’t significantly increased her pain level and, sure enough, the child relaxed into his firm hold and became quiet.

“Follow me,” he told the mother. “We have to get to the ED quickly” Walking past his own car, he noted the open door beside Howard and glanced over his shoulder at Penny.

“I’ll come too,” she said. “I’ll just get Howie and the extra car seat and blanket.”

When they got to the hospital, a nurse applied an anaesthetic patch to Mia’s arm within seconds of him putting her gently down on a bed and a fellow consultant was able to insert an IV line with minimal distress a few min-utes later. X-rays were taken and an orthopedic consultant arrived as the images became available on the computer screen.

Penny had been correct.

The elbow was both fractured and displaced and the blood and nerve supply to Mia’s hand was severely compromised. Thanks to the IV line, enough sedation was easily administered to make the process of relocating the joint and stabilising the fracture swift and completely satisfactory.

And Penny was there, with Howard in her arms, as Mia blinked sleepily at the bright pink cast that covered her whole arm, keeping her elbow in the bent position it needed to heal.

“Oh…” Penny pretended to shade her eyes from a blinding light. “That is so pink. I love it.” She touched Mia’s forehead, smoothing away an errant tress of red hair , as she smiled.

“Do you feel better now, hon?” she asked softly.