pediatric care unit

takestheweatherpersonally  asked:

Hello! I have a character who's five years old and I was wondering what difference that makes medically, if that makes sense? Both like how medical workers will act with her and explain things given she's very young and how that would factor into her medical care, like basic checkups or diagnosing illnesses and stuff like that. Sorry if this is too broad or vague, and thank you for all you do!

Hey there! Congrats on being Janey on the spot with the inbox and  being the first ask of June! 

So, one quick note. I come from EMS, and particularly now from a critical care service that handles a lot of kids. But I’m assuming for the purpose of this ask that this child is not and has never been critically ill. Okay? Okay! 

Pediatrics is its own specialty for a reason, and I have bundles to learn about it. There are all sorts of things that are different in pediatric medicine (and all sorts that of things that are shockingly similar!). 

First, let’s talk about “furniture.” As you’ll remember from having once been a child, peds doctors offices and clinics, and even ERs, are often bright, colorful and cheery places. Kids get offered toys and lollipops, they get to see special movies. Doc McStuffins is a very common sight in peds hospitals and waiting rooms. 

I’ve heard of peds hospitals that have different mural styles for different wards: one hallway that’s done all up in a baseball theme, another in a princesses and dragons theme, another in trains. 

Oh! When little kids get a nebulizer treatment, oftentimes now the mask they get the treatment through looks like a dragon and it’s awesome and I wish they came in adult sizes. 

Providers are also, by necessity, gentler with kids. You can’t argue with a kid and tell them to hold still; they’re going to squirm whether the shot is good for them or not. (Don’t get me started on vaccinations, please.) 

In terms of the medicine, as someone who works on a pediatric critical care unit, there are two ways you can look at kids. 

A) They’re just little adults. 

B) They are definitely not little adults. 

Both are true. They’re little adults in that they have the exact same functions as adults. They’re not little adults in that there are big social development changes that go on at various ages and there are some physiological changes (mostly that come up in very technical fields) that are different. 

For adults, a lot of the med doses are standardized; for kids, they’re almost all weight-based. A 5 year old should weigh roughly 20kg/45lbs (and there’s a really neat method called Handtevy that will give you the estimated weight of any kid up to 10 yrs old based just on their age; it’s stupendously cool and exactly the kind of thing pediatric critical care medics nerd out about!). 

IVs are almost always smaller in kids, but that’s because they’re little. I’ve also seen ERs use whole teams to get a single IV in a child, including someone singing happy songs while other people stab the child with needles. (It seemed seriously Clockwork Orange to me, but I have a feeling it’s data-driven with good outcomes, so who knows?) 

I get the feeling you’re asking about pediatrics in general and not pediatric critical care, so I’m going to try and focus on the general practice stuff, which is that kids who don’t get seriously ill tend to do pretty well. 


Some things they might have done at the doctor’s office if they’re not there for a specific illness: 

  • Vitals: blood pressure, pulse, oxygen saturation, temperature
  • Height/weight checks. 
  • Scoliosis checks. 
  • Vision and hearing checks. 
  • Immunization checks. (I’d say just check the immunization schedule recommended by your region; the CDC’s is here and is as good as any.) 
  • Allergy scratch-testing 


Common reasons a 5 y.o. will go to the doctor: 

  • Earaches and ear infections
  • Fever (usually the flu or an ear infection) 
  • Vomiting 
  • Asthma. This is incredibly common in some areas, and I’ve worked in a few. 
  • the snot. so much the snot. 
  • Something lost in the nose 
  • Something swallowed 
  • Mechanical injury (broken wrist, bumped head, etc.)  It’s common for good parents to be suspected of child abuse for having clumsy kids. 

Kids tend to bounce – both literally and figuratively. They’re little, but pretty tough and hard to injure, and when they do get hurt they heal pretty quickly. They’re still growing, so they do well. 

That’s all I can think of about pediatrics when it’s 2 in the morning and I worked a 14+ hour day! 

Congrats on getting there first and I hope this was what you needed. 

xoxo, Aunt Scripty 

(Samantha Keel) 

disclaimer    

Patreon: where the ask box never closes and you can see the freaking future. Want in?

NEW AND UPDATED: Free eBook: 10 BS “Medical” Tropes that Need to Die TODAY!  

2

Source and to listen to video: http://variety.com/2017/tv/news/jimmy-kimmel-opens-up-about-newborn-sons-heart-surgery-in-moving-monologue-1202406149/

❤️this. (Tissue warning) It is worth 13 minutes of your time. Kudos to Jimmy for naming all the doctors and nurses who took care of his newborn son. Prayers that baby Billy will continue to heal and thrive and that his second surgery will be a success a few months down the road.

anonymous asked:

Please share more of your patient stories! I love them!

Okie dokie! Here’s a good one, I think.This one is close to my heart. 

We had this patient with multiple heart defects about a year ago. He was born, had surgery, then came straight to us. I had him for a weekend once he was stable. His dad was so, so, so in love with him. He and his wife would say goodbye to me, and then try to leave the room. But dad would just stand at the door way, staring at his 3 or 4 week old firstborn, hooked up to 2 chest tubes, a Pneumovac, on Vapotherm, a central line, and A-line. And the dad was smiling. He’s just so happy that his first baby is still alive. His wife literally had to drag him out of the room so they could go home.

This baby’s parents would watch medical shows at the bedside. They would ask me questions about the medical stuff on the show and how accurate they were. Of course I didn’t know a lot of it that wasn’t related to Peds, so I would go researching published journals on our hospital database for answers lol. We had a lot of fun together. The whole unit got to know this family very well. They were always smiling, always positive, always hopeful - but also realistic with their expectations.

This baby started to decline over the next months. He was able to go home for 5 or 6 days, then got readmitted, and never got to go home. He ended up passing away one summer night. His heart was failing, his kidneys were failing… He was brady’ing from 130 to 90 to 40 and then nothing, and then come back up to 130 and start moving around. It was so hard to see his parents go through this - watching their baby literally be on the brink of death, then spontaneously have a heartbeat again . They decided that it was their baby’s way of saying goodbye. He wasn’t my patient that night, but I was in the room helping out. I was next to his dad as he held his son, watching his heart rate go up and down. We had to pull his breathing tube out, but it’s impossible to do that when you feel your son moving in your arms, and then stop, and then move again. His son moved around, then brady’d, then stopped moving. The dad said, “Ok. We’re ready. Let’s do it.” Then his son suddenly moved and had a heart beat. And of course every time that happened he would say, “No no no. Wait. No.” Can you blame him? How could an parent remove the only thing keeping their child alive? The dad looked around the room at all the nurses and doctors around him and said, “I’m sorry. I’m sorry, you guys. I have no idea what I’m doing right now.” We all whispered it was ok. And with a shaky voice, I managed to choke out, “Nobody ever knows what they’re doing in situations like this.” He started sobbing. And I remember not being able to see anything because of the tears welling up in my eyes. Then dad finally said to his wife, with one of the most heartbreaking smiles I have ever seen in my life, “Ok, baby. Let’s do this.” He looked at the respiratory therapist and said, “Ok. We’re ready.” Their baby passed away peacefully in his arms.

That was one of the hardest shifts I’ve ever had to finish. I remember choking back tears as I documented. I remember pastoral care next to me, trying to make sure I was ok! (Kind of embarrassing. I felt like I was diverting attention to me and away from the family!) This happened months ago, and I still remember every second of that night in that room like it was yesterday. I will never forget that torn look in that dad’s eyes, trying to decided when to pull his son’s breathing tube. How does anybody ever make that decision?? 

At the end of the shift, of course, OF COURSE, the parents were all smiles, thanking everyone for everything we’ve done. The dad came up to me and thanked me for being the first friend they had on the unit, for being the first to make them feel at home. I think there was more he said to me but all I could hear was my own sobbing as I hugged him and his wife.

Like many nurses say, there will be that one patient who will change the way you practice nursing. There will be that one patient who will remind you why you do what you do. For me, it was this baby and this family. Their baby was a very, very sick patient. And no, I didn’t know everything about his treatment and diagnosis or plan of care. But trust me when I say that it is so so so much more than that. 

“The Day has Finally arrived and so have we! 🎉🎉🎉 Entering the Mercy. James Center! 💕🌈Malawi’s First Pediatric Intensive Care Unit. ♥️🇲🇼♥️🌍♥️🇲🇼🌍♥️🇲🇼🌍♥️🇲🇼🌍🌍🌍🌍🙏🏻🙏🏻🙏🏻” -Madonna

I don’t… normally do this ever but this is too important to let alone. My baby sister Valeia will be 2 weeks old tomorrow. In less than two weeks, she has had to be rushed to the hospital and admitted into the Pediatric Intensive Care Unit twice. She has this problem where she will stop breathing, usually after eating, for varying amounts of time. The first time it happened she was barely home from the hospital after her birth for an hour. She turned completely blue in my arms and my mother had to aspirate her own baby. The doctors assumed it was fluid in her lungs and an isolated incident, and so sent her home after four days in the hospital. 

This second time, she stopped breathing for a full minute. We now believe it has something to do with her esophagus or that it’s a rare neurological disorder, but we have no answers. We just know that it keeps happening. 

We don’t require donations at all. I would just ask for prayers, good vibes, positive thinking, whatever it is that you as an individual do. Support goes a long way and makes a difference, this is something I firmly believe, and my sister needs as many people rooting for her as she can get right now. 

todays an emotional day sorry for the long post

~~~Trigger warning!!! picture of scar from surgery and slightly detailed description of medical procedure/surgery~~~

Hey @taylorswift ! you don’t know who I am but id like to thank you for inspiring me and keeping me sane for most of my life.
My names Ashley but I go by Ash.

I’ve had cardiac issues my entire life since I was born premature but the doctors could never figure out what was the cause of it all. I would have intense chest pain, I had episodes where my heart would just start racing randomly, and I couldn’t really do much because with any physical activity I would almost pass out. My older sister Kaity ( @d0dgedabullet )  and I would always listen to your music. shes one of the reasons I became a fan.

When I was eleven they thought they figured it all out. They thought I had an extra electrical impulse so we scheduled a cardiac ablation. On this day in 2012, I was terrified walking into a hospital to lay on an operating table. Listening to Picture to burn because it’s my very favorite song. Waiting Red to come out in a few weeks was one of the only things that I was looking forward to. A Cardiac ablation is a procedure to scar or destroy the tissue in your heart that’s causing the incorrect electrical signals. Diagnostic catheters are threaded through blood vessels to your heart where they map your heart’s electrical signals.

I had a great doctor. he had done this procedure a million times successful every time. but everyone has bad days. They needed to thread the diagnostic catheter through a vein in my left arm by my brachial artery. but due to me being a premie my veins are very small. unfortunately smaller than the catheter. The doctor pushed anyway and completely blew the vein and dissected my brachial artery. The doctors lost a pulse in my arm for Four and a half minutes. I could’ve lost my left arm if they didn’t get it back when they did. They obviously couldn’t finish the procedure using that vein and they tried again with a vein in my hip. luckily everything went smoothly that time but when they finished it they found out that I didn’t even have an extra electrical impulse. So the entire thing was completely unnecessary.

When I woke up I was in intense pain and couldn’t move my arm. what was supposed to be a quick procedure and going home the same day turned into a five day stay in the Pediatric Intensive Care Unit, And another surgery to fix the mistakes of the other doctor. After two days of postponing the surgery and me being in crippling pain, they finally did the surgery. Removing two golf ball sized blood clots in my arm and doing their best to patch up my arm.

Three more Days and I was out of the hospital. With a huge scar, still in serious pain, and not being able to move my arm or do anything with it I tried my best to resume a normal life. it took months and months of Physical and Occupational therapy to be able to even start using my arm again.

My arm is mostly fully healed now. I have RSD because the lack of pulse in my arm messed up my nerves and I still have a huge scar as a constant reminder.

Taylor, you have always been a huge inspiration to me and I would just like to thank you so much for helping me through the hardest times in my life and just being an amazing person.
When I saw you in Chicago on the 1989 world tour it was one of the best days of my life (tied with when I saw you at the formula 1 race)

I am so so so so looking forward to reputation and tour. It’d be a dream come true to talk to you or meet you (i think I’d drop dead tbh)
AND IM GONNA SEE YOU AT  B96’S JINGLE BASH IM SO EXCITED!!!!!

I love you Taylor!!!!!!!!!

My scar 1 month after the procedure

My scar today… 5 years later

@taylornation


Sorry for the long post guys

Part Two, Chapter Five: Raigmore.

Last time, on A Child of the Stones…

Jamie sent Claire and Julia (aka Faith) thru the standing stones of Craigh na Dun. Claire returned to her own time empty handed, believing Julia to have stayed with Jamie and died in the hours before Culloden. Upon being reunited with her husband, she discovers that Julia had not, in fact, done so. This is troublesome as Claire visited Julia’s grave at Lallybroch in 1968. Jamie asserts that no such grave exists, meaning Julia would return to her ancestral home and be buried there sometime between then (1766) and 1968.

How is this possible? Where and when had she gone?

You can find links to previous chapters here.


April 16th, 2007, 7:45pm; Raigmore Hospital, Inverness, Scotland.
Nurse Katie Campbell.

“Abandoned toddler found in Cairngorms National Park by hiker. Unresponsive. Requesting immediate evac to Raigmore Hospital from St Vincent’s.”

The foundling had, of course, been granted permission and arrived post-haste in Inverness ten minutes ago in critical condition.

“She was wearing this?” I nudged the plastic bag containing the clothing the little girl had been found in, an audible squish coming from the soggy outfit. Homespun dress, knit sweater, and cloth nappy had all been hand made along with her crudely fashioned leather shoes.

“Aye, an’ a’ the top o’ Craigh na Dun, no less,” an orderly added.

I rolled my eyes. Granny Fiona had told my siblings and I stories of people and fairies that traveled thru the stones, but I’d never believed them to be anything but what they were: stories.

“Ye ken the standin’ stones o’ Craigh na Dun, don’t ye? ‘Tis an unlucky place, to be sure, Nurse Campbell.” he warned

The head matron snorted in derision behind me, “Dinna listen to Gavin, Katie, lass. He’s full o’ the auld tales.”

“Aye, that I be, Auntie,” Gavin grinned and shrugged, winking cheekily at her. “But who do ye suppose told ‘em to me?”

“Get on wi’ ye,” she shooed him away while trying her best not to smile.

11:30 pm

The Pediatric Intensive Care Unit, PICU for short, was quiet tonight. I sat and held her hand as I watched her irregular heartbeat on the monitor. The room was dark and silent around us.

A sudden creak of the mattress made me jump.

Still unconscious, it hadn’t been the child. I looked to the foot of the bed and my blood ran cold.

There, sitting and holding the little girl’s other hand, was a woman I had never seen before in my life. Her clothes were as strange as the child’s had been, a green bodice and skirt made up in an ancient fashion. A breeze that I didn’t feel stirred the curls around her shoulders and I knew in an instant that she wasn’t really here.

Before I could figure out what on earth to say, she turned to me and spoke. “Please,” she begged, her voice melodic and almost otherworldly. “Save my baby.”

I simply nodded, unsure of how to respond to a request from a ghost.

The figure bent over the child and placed a kiss on her cheek, tucking the little girl’s auburn curls behind her ears. With this loving caress from her mother, the child’s heart rate became stronger and her eyelids flickered.

“Her name is Julia,” the woman whispered as she stood. Then, looking at me, asked, “You’ll take care of her for me, won’t you?”

“I will,” I vowed without hesitation.

2:00 am

“Julia?” The head matron repeated dubiously.

I shrugged, realizing how strange I must sound, “Call it mother’s intuition, but I think that’s her name.”

“Ye aren’t a mam, lass…” A slow grin spread across the woman’s face. “Unless this is yer way of tellin’ me somethin’.”

“No!” I shook my head, warmth spreading across my cheeks. “It’s just that I feel a sort of connection to her. She doesn’t have anyone, you know?”

“Aye, I ken, poor bairn. Just dinna get too attached to the wee thing.” She patted my shoulder as I left the nurse’s station and headed to my car.

10:00 am

Bzzzz. Bzzzz. Pause. Bzzzz. Bzzzz.

I knocked the phone off the bedside table in my haste to silence it. Sliding halfway off the bed, I snatched it off the floor and glared at the screen.

Six unread messages. Three from the Head Matron, my boss, and three from Gracie, my best friend and fellow nurse at the hospital.

Good Lord, they knew I wasn’t on call, right? I was just there and would be again in a matter of hours. What was so important that it couldn’t wait four more hours?

I scrolled thru the texts on my lock screen, still able to read them in the order received.

9am- HM- Yer bairn is awake.

9:15am- Gracie- OMG she’s so PRECIOUS

9:30am- HM- Any chance ye could come in early?

9:40am- Gracie- paging baby whisperer

9:50am- Gracie- PAGING BABY WHISPERER!!! REPORT TO BASE ASAP

10:00am- HM- Need you STAT

“Shit,” I muttered as I hit the button to call my boss.

“How soon can ye be here?” were the first words out of her mouth.

I yanked on my scrubs and ran towards the door, “Be there in ten!”

Fifteen minutes later.

Julia’s screams welcomed me as I pushed open the PICU doors. Thankfully, she was our only patient at the moment and wouldn’t upset any other children, but the sound was quickly tying a knot in the pit of my stomach.

“Katie’s here!” Gracie’s shoulders sagged with relief as she announced my entrance.

“What have you tried to get her to settle?” I asked, looking over my shoulder while I quickly washed my hands.

She sighed, “More like wha’ havena we tried.”

I grinned and winked at her.

I had a good track record of calming young children down when our tried and true methods failed, earning me the nickname of Baby Whisperer. It was a bit of a misnomer, though, as I was as normal as could be with infants.

Julia sat upright in bed, her cheeks red with the exertion of screaming bloody murder. A frazzled nurse looked up as I approached, giving me a thankful smile.

I greeted the distraught child in a sing song voice while still a good distance from her. Her head snapped in my direction and I continued speaking, switching to Gaelic for something new to distract her.

Much, a eudail, chan eil caoineadh.”  Shh, darling, don’t cry.

Eyes wide and suddenly silent, she stretched out her arms to me. I swept her onto my lap as I sat down on the bed. She took a deep, shuddering breath and melted into me.

“That’s the way.” I praised. Humming, I rubbed her back in gentle strokes until she was at last completely calm. I shifted her in my arms so she could see my face and smiled down at her, “You are such a brave girl, a leannan.”

Her dark lashes blinked slowly as she studied me, quite serious. A tentative hand reached out and patted my cheek as if in thanks.

I took it in mine and kissed it, warranting me a shy smile from the little girl who would quickly become my everything.

Taylor!!!
I got a letter in the mail not too long ago that I’m accepted into college and a highly competitive nursing program! Ever since I was diagnosed with type one diabetes, my heart was set on being a pediatric nurse in the PICU (pediatric intensive care unit). I want to help and take care of others when they’re in need of it. Hopefully I’ll be able to comfort them in the midst of a frustrating and scary situation, just like the nurses did for me when I was in the hospital. And I finally got notified that I’m one step closer to pursuing one of the goals I’m most passionate about. I just thought it was important to tell you that because I’m proud of myself, and I hope you’re proud of me too! Love you, sunshine!
-Jess

7

At some point in our lives we all meet someone who changes our lives. I happened to meet mine on December 24, 2009. Michael Bradlee Christian (or Mikey) was born on the way to the hospital at 70 mph. To go along with his high speed birth, he’s wanted to be a race car driver since he knew what that was. For someone of such small stature, he’s impacted the lives of everyone around him and even those thousands of miles away.

When you first look at him you would never guess that he is in bone marrow failure. When Mikey was 3 years old, he had a nosebleed at preschool. My dad went to pick him up expecting the nosebleed to stop. It didn’t. He was rushed to the ER where my dad sat with him and waited for hours. It wasn’t until Mikey went unconscious that they finally paid attention to him. His nose bled for 10 hours. He was in the Pediatric Intensive Care Unit for about 6 days. A very renowned hematologist-oncologist came in to take a look at him. He ordered a blood count to check his platelets. Platelets are the blood cells in our body that help your blood clot. Normal counts are around 150-400. Mikey’s were 4. The doctor took all of this into account along with his small stature, his speech impediment, the birth marks on his body and suspected he had Fanconi Anemia. FA is a rare, inherited blood disorder that leads to bone marrow failure. Although FA is a blood disorder, it also can affect many of your body’s organs, tissues, and systems. Children who inherit FA are at higher risk of being born with birth defects. FA also increases the risk of some cancers and other serious health problems. Mikey’s main issue is that his bone marrow is failing, but he also has a speech impediment. He also has a special helmet that he needs to wear anytime he is active to prevent head trauma. Treatment options for Mikey are slim to none. He receives blood transfusions as needed (usually once a month). But his doctor recently started him on a type of steroid that produces blood cells. With this steroid it has stopped his nosebleeds so far. The bad part of the steroid is that it only works for so long before it stops.

The main cure for Mikey’s FA is a bone marrow transplant. So far we have not found a match. This is where you guys come in. It is absolutely free to sign up to be a bone marrow donor at bethematch.org. It does have restrictions such as you have to be 18 and you do have to answer a few health related questions. Donating bone marrow is super easy. You will be put under anesthesia. While the donation varies slightly from hospital to hospital, generally, the doctors use special, hollow needles to withdraw liquid marrow (where blood-forming cells are made) from both sides of the back of the pelvic bone. The incisions are less than one-fourth inch long and do not require stitches. Most donors walk out the same day.

Just please if you see this, sign up for him. If you are unable to sign up please reblog this. I want everyone to see what a wonderful boy he is. My brother is my best friend. His laugh is something you’ll never forget. Through all of these treatments, all of these procedures, he ALWAYS keeps a smile on his face. He never lets it get him down. He’s the strongest person I have ever met. Anyone else might get down in the dumps and feel depressed but he’s a special one. Every nurse or doctor he’s come in contact with has had their hearts captured by him with his great spirit. I sincerely hope that one day all of you get to see, in person, what type of person he is. But until then please, I am begging you to sign up to be a marrow donor or spread this wherever you can. If you end up not being a match for him, you could very well be a match for someone else and save a life.

bethematch.org

“So excited we are almost done with building this Pediatric Intensive Care Unit in Malawi! Now we need to fill it with equipment, Surgeons, Medical Personnel and creating and Endowment ! Thats what Art Auction and Art Basel is all about! 🎨🎉💘💘🙏🏻! Thank you in advance for your generosity!! 😂💘💘💘💘💘💘💘💘💞💕🎨🎨😂🙏🏻” -Madonna

You'll Understand- (T/Z)

There’s a little girl in the refugee camp that she has tried hard not to fall in love with, but she’s failed miserably in the eight weeks that she’s been there.

 Later, she’ll understand why.

Twelve days after Tony left Israel, Shmeil knocked on her door. He wasn’t the soothing old man that she’d expected either. Instead, he was the harsh advisor of her teenage years. The one who’d told her that there was another way of honoring Tali – one that didn’t involve Mossad. She’d been too sad and angry and headstrong to listen then, but she was different now.

“What’s the point?” he’d asked.

She had stared at him. “What is what point?”

He had gestured to the emptiness around her and the tears stains on her eyes from days and days of crying. “The pain, my Ziva. The pain.”

She had swallowed then, unable to speak over the lump in her throat.

“All I’m saying, is that if you’re going to do this to yourself,” he had paused then, “to both of you – then it should have a purpose.”

She’d found a purpose a week later. A group of students had deferred their IDF service in order to work in a refugee camp in Uganda for six months. Through a friend of a friend of Aunt Nettie, Ziva had found out that they needed a trip leader, an advisor of sorts. And she hadn’t wanted to go, but her Aunt and Schmeil had convinced her that it would be good for her. And maybe, just maybe she’d find purpose there.

And that’s where she met Amina.

Amina is barely three years old and she’s seen the worst of the world, but she doesn’t know it.

Her mother, not more than a child herself, died in the refugee camp that she was born in due to a lack of proper nourishment. Her father is a child soldier and they’re not sure they’ll ever know if he’s still alive, let alone his location. Amina is all alone and it’s no one’s but the time’s fault.

Ziva feels some sort of connection to it all.

On the morning of the first day of the eighth week of her stay in Uganda, she’s carrying two large pales of water back from the well when one of the nurses comes running towards her.  Ziva’s first instinct is to think that one of the rebel groups, hostile to the UN aide, is launching an attack. She goes to drop the pales and run to meet the woman, but if Ziva’s learned anything in her time here, it’s the value of fresh water. So she places the pales on the ground and jogs up to meet the woman.

“What is wrong?” she asks.

The young woman shakes her head; she’s from the Netherlands, a UNICEF volunteer, that Ziva’s developed quite the rapport with. “It’s Amina,” she says, “she’s very sick. It happened overnight.”

 

Twelve hours later, it’s clear just how sick Amina is. She’s got an infection that has traveled to her spine through a cut. They want to bring her to Dubai or Germany, but there’s a lack of funds and they’re not even sure they can treat her there. Johns Hopkins in Baltimore is brought up, but it’s completely out of the realm of possibilities. They can clean it the best they can, but the infection will eventually take its toll.

Ziva feels powerless. She wants to help this little girl, but she doesn’t know how. She doesn’t know why she’s so attached to this girl, but all she can think about is that if this girl were somewhere else, her life wouldn’t be in jeopardy. It’s maddening.

Ziva stays up all night with Amina. The little girl cries and cries and Ziva strokes her head, keeps her hydrated. As dawn breaks, she realizes that maybe she can help.

Mary-Louise is a British woman in her mid-fifties. She’s in charge of the orphanage side of the camp. Her office is nothing more than a tent with a desk in it.

 Ziva knows that she’s seen this course of events too many times before.

Mary-Louise looks up and removes her glasses as Ziva peals back the curtain of the tent and steps inside.

“Ms. David,” she smiles. “You look tired. What can I do for you?”

She takes a breath and clasps her hands. “It is about Amina,” she begins.

Mary-Louise nods. “I had assumed.”

“I want to …to help her. She’s so young and innocent. She deserves a life.”

“It is hard to cope with,” Mary-Louise acknowledges.

Ziva purses her lips before continuing, “I would like to take her to the… the US for treatment.”

“We can’t just send children with volunteers across the world. Surely, Ms. David, you can appreciate that.”

I can.” Ziva nods. “It is why I’d like to adopt her.”

 

Mary-Louise had looked at her like she was crazy, but in the fondest way possible. International adoptions are complicated, but they’re even more complicated when you have a US passport, but are living in a foreign country – without a job and single. Mary-Lou explained this to her and Ziva understood, she understood that by throwing your life away it meant that there were then some things that one couldn’t have when you wanted them.

But she assured Mary-Lou that this nomadic lifestyle that she was living was only temporary. As was her joblessness and…relationship status.

If he’d ever have again. Though she left that thought out.

Mary-Louise seemed to believe her or, at least, she knew that Ziva cared about Amina enough to only be looking out for the girl’s best interest and so they arranged for Ziva to become her temporary guardian. It was on a trial basis pending that Ziva lay down some roots and re-establish herself.

 

Less than forty-eight hours later, she was standing outside a room in Johns Hopkins Medical Center’s Pediatric Intensive Care Unit. They’d flown across the world and been greeted by a Doctor who made it her job to save those who it seemed had no one else. After a long day of procedures to clean the wound, Amina had finally fallen asleep and Ziva took that as a time to stretch her legs.

She had spent the day feeling like the mother of a sick child. She held Amina off and on and rubbed her back. Soothed her tears as the doctors and nurses attended to her. It was when one of the nurses referred to her as Mom that she realized she was in fact this child’s mother figure and that she wanted to be forever.

 ~

He’s not sure how in his right mind he allowed himself to break the speed limit all the way to Baltimore just off of Craig’s hunch, but he does. Craig had texted sometime earlier that day.

Since when is your partner back in the States? He’d asked and Tony had nearly fallen off his chair reading the message. Craig and all his buddies had known that Ziva’d left, some of them had even known how much it’d killed him. Craig, an old friend from the Baltimore homicide division had left the department and now did private security. Currently, he was doing work at Johns Hopkins Medical Center in Baltimore and that day, he’d seen Ziva walk in with a baby.

As soon as Gibbs lets them go, Tony flies out of the office. He leaves McGee and Bishop asking question, but he doesn’t care. He tries to tell himself that he’s not going to Baltimore, but he takes a left out of the Navy Yard instead of a right.

He flashes his badge to get into the hospital. Visiting hours are over and then he goes from pediatric floor to pediatric floor flashing his badge and a photo of Ziva that he has on his phone. He doesn’t use his favorite, but one that looks more like a mug shot.

It’s in the ICU that one of the nurses nods. That’s Amina’s mother she says. He’s about to ask about said baby when she nods over his shoulder and he realizes that “Amina’s mother” is behind him.

He’s speechless, but Ziva’s not.

“Is there a bolo out on me?” she asks, raising an eyebrow.

He smiles then and scratches the side of his head. “Well,” he says, “No. There’s not.” He tries to explain how and why he looks like a stalker. “I have a buddy. He does hospital security on the side. Recognized you from…” he trails off.

And they stand there awkwardly for moment. It’s not the reunion that either of them had imagined and he feels like an idiot.

“It is…very nice to see you.” She says. “Very nice.”

The statement loosens him a bit and he shifts on his feet, moving just a little closer. “Not as nice as it is to see you.”

He feels like it’s the moment of truth and he doesn’t know how she’ll react, but she bites her lip and her eyes glaze just a bit and all hope isn’t lost.

She turns and looks behind her and longingly down the hall. “Do you want to see why I’m here?” She asks, a bit shyly.

He nods. Tony’s eager. And they walk down the hall together until they reach room fourteen. The nurse seated outside nods to her and tells her Amina’s doing fine. She’s still sleeping. Ziva thanks her and turns back to Tony. She sidles up close to him and folds her arms as they both stare at the little girl beyond the glass.  He feels like they’re in observation again and it makes him warm inside.

“Amina,” she says, her voice caressing the name.  “She’ll be three next week. She was going to die in the refugee camp that I was working in so I adopted her.”

“You adopted her?”

She nods. “She has no one,” she says. “And she’s so full of life and innocence and potential. I could not leave her there.”

“Nor should you have.” He agrees. He doesn’t want his surprise to be confused as anything but support. “She must be one special little kid.”

“She is.” Ziva smiles. “She speaks some of her native language and I am teaching her Hebrew and English.”

He’s impressed.

Amina twitches inside of the hospital crib and she enters the room, beckoning him to follow. He does, approaching the bottom of the crib. Amina’s asleep and she’s got the blanket bunched up around her and between her little fingers.

He’s never seen Ziva look anyone like that, not even him.

He watches her run her fingers through the girl’s little curls. She turns towards him, “I do not like to leave her alone. It’s such a foreign place, so different than she’s ever experienced. She is scared, Tony and she can’t understand much.”

He leans over the cribs and tentatively, looking at Ziva for permission, reaches a hand to stroke her back. Maybe it’s because she’s connected to Ziva, but Tony already feels attached to this little girl.

Ziva can’t hide her smile as she watches him.

“Is she going to be okay?” he asks.

Ziva nods. “In a week or two, we will go home.”

He thinks before asking his next question. “Where’s home, Ziva?”

She takes a sharp intake of breath and he worries about what her answer will be. “Um… home is the unit next to mine. It seems my nosey neighbor moved out once I wasn’t there to inquire about.”

Home is DC.

He nods and tries to continue the conversation, but his eyes have glazed over.

“I am serious,” she says. “I am sure that you have…moved on, but I would like to be…us… if you’ll have me.” And her voice goes almost silent at the end.

His hand moves from Amina and he turns back to Ziva. He steps forward and reaches for her hand. “I haven’t moved on because there’s no one to move on to. You’re it.”

She nods and swipes at the tears brimming below her eyes.

“We don’t need to figure things out now, though Ziva.” He nods toward Amina. “She needs you.”

She nods again and rubs Amina’s tiny little fingers.

“Night, Ziva,” he whispers.

She startles at the words and calls after him. “Tony, will you sit with us?”

He’d like nothing more. That’s his future wife. And daughter.