"Isaac"

"Isaac" is 7 years old and has asthma. He has had several hospitalizations for it in the past, but this time, he also has pneumonia . He's been having difficulty breathing for days, and with the help of I.V. antibiotics, steroids and endless breathing treatments around the clock , he's getting better after day 3. Now his problem is keeping his oxygen saturation levels above the doctor prescribed 94% and to do this, he has to keep his oxygen mask on or the level drops and the machine that measures it, the pulse oximeter, alarms to let the medical staff know he is dropping below that target.

The pulse oximeter is usually a finger probe or small light sensor connected to an adhesive strip that goes on the finger; or toe. Isaac is tired of having one of his digits covered by the probe. . . trust me, its been moved around to every possible place to keep it on. His oxygen levels have been constantly lower than 90 percent without oxygen, and with the oxygen, he is barely maintaining the 94%. The battle is constant to keep the oxygen mask on him because the nasal cannula was used as his chew toy, his sling shot, his lasso, chair whip and even was braided into his IV tubing causing an extreme excess of time to detangle and unkink. He complained about his nose hurting from the cannula so we switched him to a mask to give his nose some time off.

No amount of explaining about keeping the oxygen on or promises of going home sooner would impress this boy to keep the oxygen on his face. Heck, I would have settled for the general area, giving him a tube of blow-by oxygen that he could point in his direction if only he would do it. Short of strapping Isaac to the bed and confined into 5 point restraints, ILLEGAL I should add, we were all having a challenge keeping oxygen on this boy. The respiratory therapists and nursing staff were out of ideas how to help this child help himself. No amount of coercion , distraction or bribery worked. We needed to find out what his button for motivation was. The pediatrician tells me to do whatever it takes but has no luck talking to the boy either and no suggestions about how to achieve it.

Taking my turn at Isaac for the second shift in a row and frustrated as the rest of the staff and doctors, I walk in to find the boy wearing his mask on his ear. "It's by my face!" he shouted. Yes, but not in the right place. We discuss at length AGAIN, why he needs the oxygen, why the doctor isn't going to send him home until he wears it and gets better, etc. . . Feeling smug that I've had a break through with the little man, I replace his oxygen, walk out and alarms sound before I get to the desk. He has a lot of energy for a child who can't breathe well and clinically is pretty sick! This is going to be a very long and tedious day. My partner is laughing at me and glad she is on the other run of the pediatric unit with her compliant babies and innocent cherubs. 

Looking at Isaac, he now has his mask on top of his head like a hat. Cute, but not really conducive to air flow. The Respiratory therapist, who has the patience of a saint, has to stand and hold his treatment to make sure the IV pole isn't the one getting the nebulized medications. This is getting ridiculous. The mask has migrated to the back of his head, his chest, "look! I have a boob!", his elbow and every other body part except over his nose and mouth. All this while he's virtually panting . My best bet is to stay at the bedside with him until he falls asleep, but he's not sleepy yet!

We talk and talk and he tells me between deep breaths, that when he is a rich man, he's going to be a jet pilot and fly around the moon. When he has a ton of money, he's going to buy himself a football team and be famous. All his dreams revolve around money. I have an epiphany. Money is what this boy likes. I am going to pay him to keep that oxygen on. I like coercion better than bribery, but desperate times you know...We strike up a deal. 25 cents for 30 minutes. If the alarm goes off  because the oxygen is off his face, the timer resets. He loves the timer. I have a sand hour glass  and give it to him to start , along with an egg timer we keep for nursing breaks. My idea works. He is raking in the quarters. After the first dollars worth, he is excited. He calls his mother and tells her he has a paid job. I call her and tell her to bring more quarters! We have a craft time to make a "bank" for his money. The day is getting better for all of us.

Best $3 investment ever. Isaac got to go home 2 days later and after that first day, we weaned him off that oxygen and he didn't need to get paid to get better any longer. I'll always remember him fondly with his little oxygen mask ear muff and smile, and glad that he is breathing better. So am I!