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MidReal Story
Bad Medicine
Scenario:Five young children has a dental appointment. They all are wanting to be sedated for their appointments. The first child gets nitrous oxide gas from a dental nasal mask. The second child gets halothane gas from an anesthesia mask. The third child get isoflurane gas from a dental nasal mask. The fourth child gets desflurane gas from an anesthesia mask. The fifth child gets sevoflurane gas from an anesthesia mask. All their masks has a rebreather bag attached to it. The nurse starts each child on a low dosage of their gasses. She tells them that she will constantly increase their gas dosage and squeeze their rebreather bags each time she increases their gas concentration
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Anesthesia Nurse
She is an experienced anesthesia nurse working at a pediatric dentist office. She is calm, efficient, and caring. She handles five anxious children, managing their sedation levels to ensure a smooth procedure. Her attention to detail and skill in adjusting gas dosages prevent any complications. She maintains a calm demeanor even in highpressure situations, earning the trust and respect of both the children and the dentist.
Child 1 (Ava)
She is a nervous but cooperative fouryearold undergoing a dental appointment. She is anxious, tearful, and cautious but ultimately willing to undergo her treatment. She prefers nitrous oxide gas to help her feel more relaxed. Despite her fears, she follows the nurse’s instructions and allows her to adjust the gas level. Her concern for the dog at home shows her concern for everyday responsibilities.
Child 2 (Noah)
He is a fearful but obedient fiveyearold undergoing a dental appointment. He is tearful, anxious, and wary but ultimately cooperative. He prefers halothane gas over nitrous oxide for his sedation. Although scared, he trusts the nurse’s guidance and allows her to adjust his gas level. His worry about going back to a foster home shows his emotional vulnerability.
I work as an anesthesia nurse for a pediatric dentist, Dr. Smith.
He is a wonderful dentist who only works on children.
He has a very calming effect on the kids, and they just love him.
I have worked with Dr. Smith for about five years now.
Dr. Smith relies on me to sedate all of the anxious children.
Today, I have five young patients who all want to be sedated for their dental appointment.
The first child is Ava, a four-year-old who is very nervous but willing to cooperate.
She prefers to have nitrous oxide gas, which will help her feel relaxed and not as anxious.
I place the dental nasal mask on Ava’s face and turn on the nitrous oxide gas.
I start her at a low dosage of two liters per minute.
"Take deep breaths, Ava," I tell her.
Within seconds, Ava is feeling the effects of the nitrous oxide gas.
She starts to giggle and becomes more willing to open her mouth for Dr. Smith.
The second child is Noah, a five-year-old who is very fearful but willing to cooperate.
He is tearful but will do what you ask him to do.
He prefers halothane gas over nitrous oxide.
I place an anesthesia mask over his face and turn on the halothane gas.
I start him at a low dosage of two percent.
"Take deep breaths, Noah," I tell him.
Within seconds, Noah is feeling the effects of the halothane gas.
I notice his breathing is becoming deeper and more regular.
His rigid posture begins to relax, shoulders dropping away from his ears.
The rebreather bag moves steadily with each breath.
I gently increase the concentration to three percent, squeezing the bag to ensure proper gas flow.
Noah’s eyelids grow heavy, and his tight grip on the chair armrests loosens.
The tears that had been streaming down his cheeks slow, then stop completely.
His expression softens, fear melting away into a drowsy calm.
When Dr. Smith approaches with his tools, Noah’s lips curl into a peaceful smile.
The third patient is Lily, a three-year-old who is very anxious and fearful.
She clutches her stuffed rabbit tightly to her chest as I approach with the dental nasal mask.
Before placing it on her face, I discreetly spray a drop of lavender essential oil onto the rubber seal.
It’s a trick I learned from a colleague that helps ease anxiety.
I kneel down to her eye level, showing her how the mask fits over her nose and mouth.
"It will make you feel floaty like a butterfly," I explain softly.
She watches with wide eyes as I demonstrate by placing the mask on my own face for a moment.
Then, with cautious trust, she allows me to secure it over her nose and mouth.
As I turn on the isoflurane gas, starting at 0.5%, Lily’s gaze remains fixed on the rebreather bag that inflates and deflates with each breath.
"Is it going to hurt?" she whispers, her voice trembling slightly.
"No, sweetheart," Dr. Smith reassures her with a gentle smile, "you'll just feel like you're in a dream."
Lily nods slowly, her grip on the stuffed rabbit loosening as her eyes begin to flutter closed.
I monitor her breathing pattern closely as she drifts deeper into sedation.
Her chest rises and falls steadily beneath her pink shirt, the rebreather bag moving rhythmically with each breath.
Gradually, I increase the isoflurane concentration to 0.8%, ensuring that she remains comfortable and relaxed.
Dr. Smith checks her response by gently touching her hand; she barely stirs.
Occasionally, I squeeze the rebreather bag to ensure proper gas circulation.
As Lily’s fingers loosen their hold on the stuffed rabbit, it slips onto her lap, its button eyes staring up at me.
Her eyelids continue to flutter occasionally, but she remains still and calm.
Just as we’re about to begin the procedure, Sarah, our assistant nurse, quietly enters the room with a sheet of stickers in hand.
I check Lily’s vital signs one more time, noting her steady pulse and even breathing.
Deciding she needs to be slightly deeper for the procedure, I reach for the isoflurane dial.
I turn it slowly to 1%, watching the vaporizer's indicator move.
Taking hold of the black rebreather bag, I give it three firm squeezes, pushing the higher concentration of gas into her lungs.
Lily's chest rises more deeply with each squeeze.
Her eyelids stop fluttering completely, and her head tilts slightly to the side.
Dr. Smith performs another response test, pressing firmly on her nail bed.
Lily remains unresponsive, her peaceful stillness a testament to the sedation's success.
I maintain my position at Lily's side, one hand resting near the isoflurane dial and the other holding the rebreather bag.
Dr. Smith wheels his chair closer, his eyes fixed on Lily's face as her chest continues its steady rise and fall.
The dental light clicks on, casting a bright beam across Lily's face.
I adjust the mask slightly to ensure a tight seal around her nose and mouth.
Dr. Smith picks up his first instrument, and Sarah stands ready with the suction.
When he touches the probe to Lily's front tooth, I give the rebreather bag two more squeezes.
I keep my eyes fixed on Lily's chest movements, watching the rise and fall of her breaths while also monitoring the oxygen saturation levels displayed on the screen.
Every thirty seconds, I give the rebreather bag two gentle squeezes, observing how the condensation inside her mask forms and dissipates with each breath.
Dr. Smith begins drilling, and I notice a slight twitch in Lily's fingers.
I smoothly turn the isoflurane dial to 1.2%, maintaining steady pressure on the bag to ensure the increased concentration reaches her system.
When the pulse oximeter sensor starts giving irregular readings, Sarah hands me a fresh one.
I carefully remove the old one and replace it with the new one without disturbing the seal of the mask around Lily's face.
I keep my eyes fixed on Lily's chest movements while adjusting the isoflurane dial from 1.2% to 1.4%.
The dental drill whirs as Dr. Smith works on her cavity.
When her foot shifts slightly, I squeeze the rebreather bag four times in succession, watching the black rubber expand and contract.
Sarah notices Lily's oxygen saturation dropping to 96% and adjusts the supplemental oxygen flow.
I maintain firm pressure on the mask, feeling its plastic edge press against my palm, and check that no air escapes around the seal.
I keep my eyes fixed on the pulse oximeter as it shows her oxygen saturation climbing back up to 98%.
While maintaining firm pressure on the mask seal, I turn the isoflurane dial from 1.4% to 1% and adjust the oxygen flowmeter from 2 to 3 liters per minute.
Dr. Smith pauses his drilling for a moment, allowing me to listen to Lily's breathing pattern.
The rebreather bag moves steadily with each breath as I give it a gentle squeeze.
Sarah reports that her vital signs are stable, and I nod to Dr. Smith, who resumes working on her cavity.
"Did you see that twitch in her fingers?" Sarah asks, her voice tinged with concern.
"Yes," I reply, glancing at the monitor, "but her vitals are stable now; it might have been a reaction to the isoflurane."
Dr. Smith pauses again, looking at us both, "Let's keep a close eye—any more changes and we might need to reconsider the dosage."
I lean a bit closer to Lily, watching her chest rise and fall beneath the pink shirt.
The steady beep of the pulse oximeter confirms her oxygen levels are stable.
When her left hand twitches again, I immediately turn my attention to the isoflurane vaporizer settings and give the rebreather bag three quick squeezes.
Dr. Smith pauses his drilling, allowing me a moment to assess her sedation depth.
I press my fingers against the mask's edges, ensuring a tight seal, while Sarah adjusts the dental light.
"That twitch is more pronounced this time," Sarah notes, her eyes narrowing with worry.
"I'll lower the isoflurane to 0.8% and increase the oxygen flow," I respond, my hands moving swiftly to make the adjustments.
Dr. Smith nods, his voice calm but firm, "If it happens again, we might need to wake her up and reassess."
I keep my hand steady on the isoflurane dial, gradually turning it down to 0.8% while increasing the oxygen flow to 4 liters per minute.
Lily's fingers stop their subtle movements, and her chest rises and falls in a more regular pattern.
I squeeze the rebreather bag twice, methodically counting the seconds between each compression.
The condensation inside her mask forms an even pattern with each breath.
Dr. Smith pauses his work, watching as I check her pulse oximeter reading, which shows 99%.
Sarah adjusts Lily's pink shirt collar away from the mask, ensuring nothing disrupts the seal.
I maintain a firm grip on the mask while closely monitoring the display.
Her oxygen saturation holds steady at 99%, and her chest rises and falls in a smooth rhythm.
The isoflurane vaporizer reads 0.8%, and I squeeze the rebreather bag every thirty seconds to ensure consistent gas delivery.
Dr. Smith picks up his drill again, positioning it near Lily's tooth.
Sarah adjusts the suction tool and dental light.
When Dr. Smith looks at me questioningly, I check Lily's sedation depth one final time by pressing her nail bed.
Her response is minimal, and I nod at Dr. Smith, maintaining steady pressure on her mask.
Her vitals remain stable at 0.8% isoflurane, with oxygen at 99%.
I squeeze the rebreather bag methodically, watching as the condensation forms and dissipates with each breath.
Sarah adjusts the suction tool near Lily's mouth as Dr. Smith leans in.
The dental light shines brightly, illuminating Lily's peaceful face.
Her stuffed rabbit still rests on her lap, a constant companion.
When the drill whirs to life, I press my palm more firmly against the mask to prevent any gas from escaping.
Sarah leans closer, whispering urgently, "Did you see her eyes flutter just now?"
I nod, keeping my voice low, "Yes, but her vitals are stable; it might be a reflex."
Dr. Smith glances up, his tone decisive, "We can't risk it—let's pause and reassess her sedation depth."
I turn the isoflurane dial slowly to 0.9%, watching Lily's face for any reaction.
Her chest continues rising and falling steadily beneath her pink shirt.
I squeeze the rebreather bag three times in quick succession to ensure the new concentration reaches her lungs effectively.
Sarah leans in to check the monitors while I maintain firm pressure on the mask seal.
When Lily's fingers twitch slightly, I hold the mask tighter and squeeze the bag again.
Dr. Smith pauses with his drill raised, waiting for my signal that her sedation level has stabilized at the new concentration.
I maintain steady pressure on the mask while watching her response to the increased isoflurane.
Her breathing becomes deeper and more regular as I squeeze the rebreather bag twice more.
The twitching in her fingers gradually subsides, and I notice her facial muscles softening.
Sarah monitors the vital signs display, confirming oxygen at 99% and a stable heart rate.
When Lily's eyelids stop fluttering and remain closed, her small hands go limp at her sides.
Dr. Smith tests her response by touching her shoulder, but she stays completely still.
Sarah whispers, "I think we're good now; her vitals are holding steady."
I nod, glancing at Dr. Smith, "Let's proceed carefully, but be ready to stop if anything changes."
Dr. Smith lowers the drill again, his voice calm, "Alright, let's finish this quickly and smoothly."
I maintain firm pressure on Lily's mask while closely monitoring her response to the 0.9% isoflurane.
Her chest rises and falls steadily beneath her pink shirt as I squeeze the rebreather bag every thirty seconds.
Sarah adjusts the suction tool while keeping an eye on the vital signs monitor showing 99% oxygen.
When Dr. Smith looks to me for confirmation, I check Lily's nail bed response one final time.
Seeing no movement and stable breathing patterns, I give him a deliberate nod.
I maintain firm pressure on Lily's mask while Dr. Smith positions his drill.
The dental light casts sharp shadows across her peaceful face as I squeeze the rebreather bag three times.
Sarah adjusts the suction tool near Lily's mouth while I watch the isoflurane vaporizer stay steady at 0.9%.
When Dr. Smith's drill touches Lily's tooth, I press the mask tighter and check her vitals - oxygen still 99%, breathing deep and regular.
The high-pitched whine of the drill fills the room as Dr. Smith carefully removes decay.
I maintain firm pressure on Lily's mask while carefully shifting its position to prevent skin irritation.
The dental light shines brightly, illuminating condensation patterns forming with each breath as I squeeze the rebreather bag twice more.
Dr. Smith's drill whirs steadily while he removes decay from her lower molar.
Sarah holds the suction tool near Lily's mouth as I monitor her oxygen level holding at 99%.
When the mask seal makes a slight whistling sound, I readjust my grip and add a small amount of lubricant to the cushion.
I notice a slight redness forming on Lily's cheek where the mask presses against her skin.
While maintaining firm pressure to keep the seal, I shift the mask's position slightly to prevent irritation.
Dr. Smith pauses his drilling momentarily as I make this adjustment, and I squeeze the rebreather bag three times to compensate for any minor gas leakage.
Sarah hands me a small gauze pad, which I use to pat dry the moisture collecting under the mask's edge.
"Do you think she'll remember any of this when she wakes up?" Sarah asks, her voice tinged with concern.
Dr. Smith glances over, his eyes thoughtful. "No, the isoflurane should ensure she doesn't recall a thing, but it's crucial we finish before it wears off."
I gently shift the mask again, easing the pressure on Lily's reddened cheek while ensuring the seal remains intact.
The isoflurane level stays steady at 0.9% as I squeeze the rebreather bag three times in succession.
Watching Lily's chest rise and fall rhythmically, I notice a slight condensation building up inside the mask.
I take the gauze from Sarah and carefully pat around the mask's edges without breaking the seal.
Dr. Smith resumes drilling as I monitor Lily's oxygen levels, which hold steady at 99%.
The procedure continues smoothly, but I can't shake the feeling that something is about to change.
I watch as Dr. Smith finishes the final touches on Lily's tooth, his movements precise and focused.
Once he's done, he gives me a nod, signaling that he's finished.
I begin reducing the isoflurane to 0.5% while increasing the oxygen flow slightly.
Sarah carefully cleans up the dental tools as Lily's breathing remains deep and regular.
I squeeze the rebreather bag one last time before slowly lifting the mask away from her face.
A faint red mark remains on her cheek where the mask had been pressed against her skin.
Sarah looks at me, her brow furrowed. "Did you see the mark on her wrist?" she whispers, glancing nervously at Dr. Smith. He pauses, his expression shifting to one of concern. "I noticed it earlier," he replies quietly, "but we need to focus on getting her stable first."
I reach for the medical-grade aloe vera cream from the supply cabinet, keeping one hand firmly on Lily's shoulder as she continues breathing steadily.
Sarah hands me a clean cotton swab, and I carefully dab a small amount of the ointment onto the affected area.
The skin feels warm under my touch, and I notice a slight indentation where the edge of the mask had pressed against her cheek.
I apply the cream in gentle circular motions, making sure to cover the entire affected area while avoiding her eyes and mouth.
As I work, Lily stirs slightly, causing me to pause.
I lean over her, watching as her eyelids flutter.
Her breathing quickens slightly, and I place my hand on her shoulder to steady her.
The bright dental light reflects in her eyes as they open, causing her to squint and turn away.
Sarah dims the overhead light while I check Lily's pulse, which remains steady.
Dr. Smith steps back, giving her space as she becomes more alert.
When Lily's hand moves toward her face where the mask had been, I gently intercept it.
She looks up at me with a confused expression.
"Why does my wrist hurt?" Lily asks, her voice barely above a whisper.
Sarah glances at me before responding softly, "There was a mark there when you came in, but we didn't want to worry you."
Dr. Smith steps closer, his tone reassuring yet firm, "We'll take a look at it now that you're awake, Lily."
I lean closer to her wrist, carefully rotating it under the dimmed dental light.
The bruise appears circular, about the size of a quarter, with darker edges fading to purple in the center.
When I apply slight pressure near the mark, Lily winces and pulls her hand away.
Sarah hands me a penlight, which I use to examine the bruise pattern more closely.
Dr. Smith stands behind me, making notes in Lily's chart while I document the size, color, and location of the injury.
I sit beside Lily on the dental chair, speaking softly to keep her calm as she continues waking from the sedation.
When she tries touching her wrist again, I gently redirect her hand and explain, "We noticed a mark when we took off your jacket. We want to take a closer look."
I reach for the camera in the office, used for documenting dental work.
Holding it carefully, I take several photos of the bruise from different angles, noting its size and color.
Dr. Smith steps over with a measurement tool in hand.
Sarah watches closely as I continue examining Lily's wrist.
"Lily, do you remember how you got hurt?" she asks gently.
Lily shakes her head, looking confused and scared.
Dr. Smith hands me an ice pack from the freezer, which I place against Lily's wrist for a few minutes.
Sarah takes notes while I examine the bruise more closely.
Lily looks up, her voice trembling, "I don't remember anything after leaving the house this morning."
Sarah exchanges a glance with Dr. Smith, her voice cautious, "Lily, did you notice anyone unusual around you today?"
Dr. Smith leans in, his expression serious, "It's important we know if there's anything else you recall, no matter how small."
I kneel beside Lily's chair while she clutches the ice pack to her wrist.
Sarah dims the lights further as I speak in a soft, calm voice, "Lily, can you think back to this morning? Did anything feel different or hurt before coming to see us?"
She furrows her brow, looking down at her stuffed rabbit now lying in her lap.
Her lower lip trembles as she describes a tingling feeling when someone grabbed her arm at the bus stop.
Dr. Smith's eyes meet mine, and we both know this is just the beginning.
I sit beside Lily with my notepad, keeping my voice calm and gentle, "Lily, can you tell us what happened at the bus stop this morning?"
She clutches her stuffed rabbit tightly, her voice barely above a whisper, "I was waiting for the bus when I felt something strange on my wrist. It was like pins and needles."
I write down every detail in my notepad, making sure to get the time right.
"Can you remember what time it was?"
I ask softly.
She nods, her eyes fixed on the rabbit.
"It was 7:30 AM. I always catch the bus at that time."
I make a note of the exact time.
"And did you see anyone or anything unusual around you?" she shakes her head, her lower lip trembling.
"No, I didn't see anyone. But then someone grabbed me from behind."
Her voice cracks as she continues, "They were wearing a dark jacket. I couldn't see their face."
As she speaks, I notice her grip on the rabbit tightening.
Dr. Smith stands nearby, nodding encouragingly whenever she hesitates.
Sarah brings her a cup of water, but Lily's hands shake too much to hold it.
I steady the cup for her as she takes small sips.
"Can you describe the person who hurt you?"
I ask gently.
She closes her eyes for a moment before speaking again.
"They whispered something I couldn't understand, and then everything went black."
I lean closer, my voice soft and reassuring, "Lily, can you tell us exactly what the person said to you?"
She opens her eyes, her voice barely a whisper.
"I don't know. It sounded like they were saying something, but I couldn't make out the words."
I nod, making another note in my pad.
"And then what happened?"
She takes a deep breath before answering.
"I don't remember anything after that. I woke up here."
I glance at Dr. Smith, who nods slightly.
I turn back to Lily and say softly, "We're going to do everything we can to help you, okay?"
Sarah walks in with a laptop and places it on the table next to Lily's chair.
Dr. Smith steps forward and opens it, revealing a grainy video from a security camera.
He points to the screen and explains, "This footage is from a camera on the street corner near your bus stop. It shows what happened this morning."
The video starts playing, showing people walking by on the sidewalk.
At 7:32 AM, Lily appears on screen, standing alone at the bus stop.
A few seconds later, a figure in a dark jacket approaches her from behind.
Dr. Smith pauses the video and points to the figure.
"Do you recognize this person?"
Lily shakes her head, her eyes wide with fear.
Dr. Smith continues playing the video.
The figure reaches out and grabs Lily's wrist.
She tries to pull away but stumbles as if something is affecting her legs.
The figure leans down and whispers something in her ear before leading her away from the camera's view. Dr. Smith freezes the frame just as the figure turns his head towards the camera.
It's clear enough to see his face now.
I look at Lily and ask gently, "Do you recognize this person?"
She nods silently, clutching her rabbit tighter than ever before.
Dr. Smith looks at me with concern in his eyes and whispers softly, "I think I know who this is."
He leans closer to me and says quietly, "It's one of our former maintenance workers. He was fired last month for inappropriate behavior."
I reach for the office phone, keeping my other hand on Lily's shoulder to comfort her.
My fingers shake slightly as I dial 911, but my voice remains steady when the dispatcher answers.
I explain the situation briefly, "We need to report a sexual assault. The victim is here with us now."
The dispatcher asks for more information, and I describe the man in the video.
"He was wearing a dark jacket and grabbed our patient at the bus stop this morning. We have security footage of the incident."
Dr. Smith stands next to me, showing Sarah the frozen frame on his laptop.
She writes down additional details about the suspect's appearance while I continue speaking with the dispatcher.
"Do you know where this man is now?"
I look at Dr. Smith, who shakes his head.
"We don't know his current location," I answer honestly.
"Can you give me any information about him?"
The dispatcher asks again.
I glance at Dr. Smith, who nods in understanding.
"Yes, we can provide some details," I reply confidently.
"His name is John Smith. He used to work here as a maintenance worker until he was fired last month." The dispatcher asks for the suspect's last known address, and I flip through our employee records to find it.
Lily sits beside me, holding her stuffed rabbit tightly against her chest.
Her eyes are wide with fear as she listens to me describe her attacker over the phone.
"We will send someone over right away," the dispatcher assures me before hanging up.
I put down the receiver and turn to Lily with a gentle smile.
"Lily, the police are on their way, and they're going to help us find this man," I say softly, trying to reassure her.
She nods, her voice trembling slightly, "Will they keep him away from me?"
Dr. Smith kneels beside her, his tone firm yet comforting, "Yes, Lily, we'll make sure you're safe. You're not alone in this."
Two detectives arrive at the dental office, one male and one female.
They ask to review the security footage we have.
I sit with Lily while they watch it together.
The female detective's eyes widen as she sees John Smith's face on the screen.
She quickly steps aside to make a call, speaking in urgent whispers.
Her partner continues questioning Lily about the morning's events, and I hold her hand for support.
When the female detective returns, she looks at us with a determined expression, "We're issuing an arrest warrant for John Smith. He matches the description of a suspect in three other assaults on young children."
Lily's eyes widen with fear, and she grips my hand tighter.
"Three other children?" she whispers, her voice barely audible.
The male detective nods gravely, "Yes, Lily. But your bravery in coming forward is going to help us stop him."
I escort Lily to a recovery room with Sarah while Dr. Smith returns to the waiting area.
Caleb, our next patient, bounces anxiously in his chair while his mother signs consent forms.
I prepare a fresh anesthesia mask with desflurane while Dr. Smith explains the procedure to them.
Though my mind lingers on Lily, I focus on adjusting the gas flow and checking the equipment.
When Caleb settles into the dental chair, I notice his superhero t-shirt and use it to distract him while positioning the mask.
I hold the mask over his face, pretending to start at the standard two percent, but I actually set it at four percent.
Caleb's superhero shirt rises and falls as he breathes deeply.
Dr. Smith turns to prepare his instruments while I squeeze the rebreather bag three extra times, pushing more gas than needed.
Caleb's eyelids grow heavy faster than they should.
His mother is distracted by forms at the front desk and doesn't notice when I increase the dose to five percent.
I pause my aggressive dosing when Caleb's mother walks back over.
She stands beside him, placing her hand on his shoulder through the superhero shirt.
His tense muscles relax immediately at her touch, and I feel a twinge of guilt for what I've done so far.
I quickly adjust the desflurane back down to 2% and hope she didn't notice the unusually high settings.
While squeezing the rebreather bag normally now, I watch Caleb's breathing steady under his mother's calming presence.
The guilt gnaws at me, but I know this is only the beginning.
I grip the mask tightly, my hands trembling slightly.
The guilt and anxiety coursing through me make it hard to keep my movements steady.
Nurse Jessica approaches and touches my shoulder, causing me to flinch.
"Are you okay?"
She notices the sweat on my forehead and the way my hands are shaking as I squeeze the rebreather bag.
"Let me take over for a bit," she offers, reaching for the controls.
I hesitate, knowing she'll see the settings I've adjusted.
My heart races at the thought of her discovering what I've done.
"Jessica, I... I might have given him too much gas," I confess, my voice barely above a whisper.
Her eyes widen with concern, and she quickly glances at the monitor.
"We need to fix this before Dr. Smith notices," she says urgently, adjusting the settings back to normal.
I stand beside Caleb's chair, watching as his oxygen levels stabilize at 98% on the monitor.
Jessica corrected my dangerous mistake, and I'm relieved that Caleb seems to be okay for now.
My hands are still trembling slightly, but I continue to squeeze the rebreather bag at regular intervals.
I check Caleb's pulse on the monitor and watch his breathing pattern.
As he takes in the gas, I adjust the seal of the mask around his face to ensure he's getting the proper flow.
His superhero shirt rises and falls with each breath.
Jessica stays close, keeping an eye on everything while I work.
Her presence is both comforting and condemning at the same time.
I know she's here to help, but I also feel guilty for putting Caleb in danger.
Dr. Smith enters the room again, and I force myself to look composed despite my racing thoughts.
I stand beside Caleb, carefully monitoring his vitals.
His chest rises and falls steadily under the superhero shirt while I squeeze the rebreather bag at normal intervals.
Jessica watches me adjust the desflurane flow to maintain proper sedation levels.
She knows what I did, but she's helping me cover it up.
I'm grateful for her support, but I can't shake the feeling that I've made a terrible mistake.
As I work, I keep a close eye on Caleb's oxygen levels.
They're currently at 98%, which is within a safe range.
His heart rate is steady at 90 beats per minute, and his breathing is calm and even.
I check the seal of the mask again, making sure it's secure around his face.
Suddenly, Caleb's oxygen level dips slightly to 97%.
I quickly increase the oxygen flow rate to compensate and check the seal of the mask again to make sure it's not leaking. I reach up and wipe the condensation from inside the mask with my finger.
My hands are still trembling slightly, but I try to focus on my work.
I don't want to draw attention to myself, especially with Jessica watching me closely.
She knows what I did, and I don't want her to think that I'm not capable of doing my job.
Dr. Smith walks back into the room and checks on Caleb's progress.
He looks at the monitor and then asks me if Caleb is sedated enough for him to start the procedure.
I nod and reach down to press on Caleb's nail bed to check his response.
I press on the nail bed, and Caleb doesn't react.
His lack of movement tells me that the desflurane is working at the normal dose.
Jessica watches as I squeeze the rebreather bag three more times, maintaining a steady flow of gas.
Dr. Smith walks over to his drill, and I nod to let him know Caleb is ready.
The dental light shines down on Caleb's face, and his chest continues to rise and fall peacefully beneath his superhero shirt.
I hold the mask firmly in place, making sure it's sealed around Caleb's face.
Dr. Smith puts on his gloves and picks up his drill.
He turns it on, and I squeeze the rebreather bag every thirty seconds to keep Caleb sedated.
The desflurane is doing its job, keeping Caleb still and unresponsive to the procedure.
Jessica helps with suction while I continue to monitor Caleb's oxygen level, which remains steady at 98%.
I watch as Dr. Smith drills into Caleb's tooth, removing the cavity in just ten minutes.
When he finishes, he says, "All done."
I look down at Caleb and notice that he hasn't moved once during the procedure.
His superhero shirt rises and falls with each breath while Jessica prepares the filling material.
"Jessica," I whisper, glancing at her as Dr. Smith steps away, "thank you for covering for me earlier."
She nods, her eyes serious. "You know this can't happen again, right? We got lucky this time."
I swallow hard, feeling the weight of her words. "I know, Jess. I promise it won't."
I loosen the mask straps while monitoring Caleb's breathing pattern.
His oxygen level holds steady at 98% as I gradually decrease the desflurane flow to zero.
I watch his chest rise and fall, waiting for any sign that he's coming out of sedation.
When his fingers start twitching, I know it's time to let in some fresh air.
I carefully lift the edge of the mask, allowing a small amount of oxygen to flow in.
Jessica stands ready with the gauze, prepared to catch any condensation that drips from the mask.
As I continue to monitor Caleb's vitals, I notice red pressure marks forming on his cheeks where the mask has rested.
His eyelids begin to flutter, and his head turns slightly on the headrest.
I remove the mask completely, and condensation drips down his chin onto his superhero shirt.
I watch his face intently, keeping one hand ready to support his head if he moves.
His eyelids flutter several more times before opening fully.
His pupils are dilated, but as his eyes focus, they return to their normal size.
When he manages a drowsy smile, I check the monitor: oxygen at 99%, heart rate normalizing.
His mother steps closer, touching the sleeve of his superhero shirt while I wipe away the remaining condensation from his cheeks.
Though his smile reassures me, guilt churns in my stomach as I remember the dangerous overdose I'd given him earlier.
I lean closer to Caleb, who blinks as his eyes adjust.
His gaze slowly shifts from me to his mother, and he tries to speak.
His voice is hoarse, but I make out the words "I'm okay."
He raises his thumb weakly, and I check the monitor one last time: oxygen at 99%, heart rate steady.
I take a deep breath, feeling relief wash over me.
Caleb's simple gesture of forgiveness, even though he doesn't know what he's forgiving me for, makes my hands stop shaking.
I help him sit up slowly, supporting his back as he adjusts to being awake.
His mother leans in, her voice soft but firm. "Caleb, you were so brave today. How do you feel, sweetheart?"
Caleb blinks slowly, his voice still raspy. "Like a superhero, Mom."
I exchange a glance with Jessica, who gives me a small nod of understanding.
I reach for the paper cup on the metal tray beside Caleb's chair.
My hands are still unsteady from the guilt earlier, but I manage to hold it steady as I fill it with water from the dispenser.
When I turn back, Caleb's mother has adjusted his superhero shirt where the condensation had dripped.
The water sloshes slightly in the cup as I walk back, so I grip it with both hands to keep it steady.
Caleb's eyes follow my movements, still groggy from the sedation.
I hold the cup near his lips, and his mother gently lifts his head to help him take a few sips.
Caleb swallows and looks up at me, his voice barely above a whisper. "Did I really need all that medicine?"
I hesitate, glancing at his mother before answering. "We had to make sure you were comfortable, but you're safe now."
His mother gives me a searching look, her eyes filled with concern. "Is there something you're not telling us?"
I swallow hard, feeling the weight of my earlier mistake pressing down on me. "There was a small issue with the dosage, but we caught it in time."
Caleb's voice cuts through the tension, his innocence piercing my guilt.
"Can you tell me my favorite story now?"
I force a smile, nodding.
"Of course, Caleb. Which one would you like to hear?"
He blinks slowly, his eyes still heavy with sleep.
"The superhero story."
I take a deep breath, holding the cup of water in front of him.
"Here you go. Drink this while I tell you the story."
Caleb sips from the cup, and I watch his Adam's apple bob as he swallows.
His mother straightens his damp shirt, her expression still worried.
I glance at Jessica, who walks over with Caleb's chart.
She pretends to check his vitals while actually observing my interaction with him.
I begin telling the story about Spider-Man saving children from a burning building, my voice steady despite the turmoil inside me.
Caleb listens intently, his eyes brightening as I describe the hero's bravery. "And then Spider-Man swung down to save the day," I continue, using my best superhero voice.
"He knew he had to protect everyone because that's what heroes do."
My voice cracks slightly on the last words, and Caleb's mother shoots me a concerned look.
But Caleb doesn't notice; he's too engrossed in the story.
Jessica gives me a reassuring nod before walking away with the chart.
I continue telling the story, but my voice wavers as I describe Spider-Man's special powers and how he uses them to save lives.
Caleb listens intently, his eyes wide with wonder.
When I finish, he looks up at me with a drowsy smile.
"Is Spider-Man real?"
I hesitate before answering, unsure of how much to reveal.
"I help Caleb sit up in the dental chair while continuing our superhero conversation. My voice wavers as I explain how real heroes make good choices to help others, the weight of my earlier dangerous mistake heavy in my chest.
When he points to his shirt and declares he wants to be a hero too, I glance at Jessica, who gives me a stern look.
His mother adjusts his wrinkled shirt while I check his final vital signs, knowing I need to make better choices to truly be the hero these children trust me to be.
"Superheroes are special people who make good choices to help others," I reply, my voice steady despite the turmoil inside me.
"They use their powers for good, and we can all be like them if we try."
Caleb blinks slowly, his eyes still heavy with sleep.
"But what about Spider-Man? Is he real?"
I take a deep breath before answering, knowing how much he looks up to me.
"Spider-Man is a character in stories and movies," I explain gently.
"But there are real-life superheroes too. They're people who do amazing things to help others, like doctors and firefighters."
Caleb's eyes widen slightly as he processes this information.
"So, you're a superhero too?"
I smile sadly, feeling the weight of responsibility on my shoulders.
"I try my best, Caleb. But everyone can be a superhero if they want to be."
He nods slowly, his voice filled with determination.
"I want to be a superhero too."
I glance at Jessica, who gives me a stern look before walking away with Caleb's chart.
"I want to be a hero like you when I grow up."
His mother's eyes well up with tears, and she squeezes his hand gently.
"You're already my little hero, Caleb," she whispers, her voice thick with emotion.
I kneel next to Caleb's chair, my hands still trembling from earlier.
He looks up at me with a trusting expression, his superhero shirt a reminder of the dangerous mistake I made with the anesthesia.
"Can you teach me how to be a hero like you?"
Caleb asks, his voice filled with excitement.
I swallow hard, trying to find the right words.
"Being a hero isn't just about having powers," I explain gently.
"It's about making good choices and helping others. And sometimes, that means telling the truth even when it's hard."
Jessica watches us intently from across the room, her eyes filled with a mix of concern and curiosity.
I take a deep breath before continuing, my voice steady despite the turmoil inside me.
"Real heroes always tell the truth, even when it's scary or hard. They know that honesty is important, and they never want to hurt anyone."
Caleb nods slowly, his eyes wide with understanding.
"I want to be a hero like you," he whispers, his voice filled with determination.
His mother smiles sadly, her eyes filled with pride and worry.
"You're already my little hero," she says softly, squeezing his hand gently.
I glance at Jessica again, who gives me a reassuring nod.
I take another deep breath before continuing, my voice steady despite the weight of responsibility on my shoulders.
"Heroes also know how to stay calm in scary situations," I explain gently.
"They take deep breaths and think clearly so they can help others." Caleb nods eagerly, his eyes shining with excitement.
"Show me how," he asks, his voice filled with anticipation.
I smile sadly, knowing how much he looks up to me.
"Okay," I reply softly, taking a deep breath myself.
"I'll show you how heroes breathe deeply to stay calm."
I demonstrate the deep breathing exercises I learned during my training, inhaling slowly through my nose and exhaling through my mouth.
Caleb watches intently, mimicking my movements as best he can in the dental chair.
His mother watches too, her expression filled with gratitude and concern.
When I finish demonstrating the breathing exercises, Caleb looks up at me with wide eyes.
"I want to be just like you when I grow up," he says softly, his voice filled with admiration.
I swallow hard, feeling the weight of responsibility on my shoulders once again. "Remember what I said about heroes always telling the truth?"
I ask gently, meeting Caleb's gaze steadily.
Caleb nods, his eyes serious.
"Does that mean you have something to tell me?" he asks softly.
I glance at his mother, then back at him, my heart pounding.
I sit down next to Caleb and his mother, my hands still trembling slightly as I prepare to tell them the truth.
Caleb looks up at me with a trusting expression, his superhero shirt wrinkled from the procedure.
I take a deep breath before speaking, my voice steady despite the turmoil inside me.
"Caleb, remember how I told you that heroes always tell the truth?" "Yes," he replies softly, his eyes wide with curiosity.
I glance at his mother, who watches me intently, her expression shifting from confusion to concern.
"Well, I need to tell you something important," I continue gently.
"Something that might be hard for you to hear."
His mother leans forward, her hand reaching out to touch mine.
"What is it?" she asks softly.
I take another deep breath before answering, my heart pounding in my chest.
"I made a mistake during your procedure," I explain slowly.
"I gave you too much desflurane at the beginning. It was a dangerous amount, and it could have hurt you badly."
His mother's eyes widen in shock, her face paling.
"But... but you said everything went smoothly," she stammers.
I nod sadly, feeling a wave of guilt wash over me.
"It did, thanks to Jessica catching my mistake," I admit quietly.
"She saved you from getting hurt worse. But that doesn't change the fact that I made a serious error." Caleb looks at me with confusion in his eyes, his small hands clutching the armrests of the chair tightly.
"Why did you do that?" he asks softly.
I take another deep breath before answering, my voice barely above a whisper.
"I'm not sure," I admit honestly.
"I've never made a mistake like this before. But what matters is that I told you the truth now. Real heroes admit when they're wrong and try to make things right."
His mother's expression shifts from confusion to anger, her jaw tightening as she looks at me.
"How could you do this?" she demands fiercely.
"How could you put my son in danger?"
I meet her gaze steadily, feeling a mix of shame and determination wash over me.
"I'm so sorry for what happened," I reply quietly.
"I never meant to hurt Caleb. But I promise to report myself and make sure this never happens again. Patient safety is my top priority."
Jessica stands behind Caleb's mother, nodding in agreement as she listens to our conversation.
Caleb's mother takes a deep breath, her voice trembling with emotion.
"Thank you for being honest, but this is something we need to process," she says, her eyes filled with a mix of anger and relief.
Caleb looks between us, his small voice breaking the tension.
"Does this mean you're still a hero?" he asks, his innocence cutting through the room.
I sit down next to Caleb and his mother in the recovery room, my voice trembling as I continue explaining what happened.
"I started you at 4% desflurane instead of 2%," I admit quietly, my words hanging in the air.
"And then I made it even worse by increasing it to 5% without realizing it."
His mother grips his superhero shirt tightly, her eyes wide with shock.
"But... but how?" she stammers.
I take a deep breath before answering, my heart pounding in my chest.
"I'm not sure," I admit honestly.
"I've never made a mistake like this before. But what matters is that Jessica caught it and saved you from getting hurt worse."
Caleb's mother looks at me with confusion and fear in her eyes, her voice barely above a whisper.
"Why did you do that?"
I swallow hard, trying to find the right words.
"I don't know," I admit softly.
"I've never made a mistake like this before. But I promise to report myself and make sure this never happens again."
Jessica steps forward with some documentation forms for me to sign, her expression sympathetic but firm.
"Caleb's mother is right," she says gently.
"We need to take responsibility for our actions. And that means being honest about what happened." Caleb looks up at me with wide eyes, his small voice breaking the tension.
"Did you want to hurt me?" he asks softly.
I shake my head vigorously, feeling a wave of guilt wash over me.
"No, Caleb," I reply quickly.
"I would never want to hurt you. I made a terrible mistake, and I'm so sorry."
His mother stands up abruptly, her face pale with worry.
"I need to speak with Dr. Smith," she says firmly, her voice trembling with emotion.
Jessica nods sympathetically, handing her the necessary paperwork.
"Of course," she replies softly.
"I'll get him for you right away."
As Jessica leaves the room, Caleb reaches out and touches my hand gently.
"It's okay," he says softly, his voice filled with innocence and compassion.
"I forgive you."
I look at him, my eyes stinging with unshed tears.
"Thank you, Caleb," I whisper, my voice choked with emotion.
His mother watches us, her expression softening slightly as she takes a deep breath.
"I appreciate your forgiveness, Caleb," I say quietly.
"But what matters most is that we learn from our mistakes and make things right."
Dr. Smith enters the room, his expression serious as he greets Caleb's mother.
"I understand there's been an incident," he says softly, his voice filled with concern.
"Please, let's talk in my office."
We all follow him to his office, where I explain what happened again.
Caleb's mother listens intently, her eyes filled with worry and anger.
When I finish speaking, she turns to me with a determined expression.
"What are you going to do to make sure this never happens again?" she demands fiercely.
I take a deep breath before answering, my voice steady despite the turmoil inside me.
"I'm going to report myself and take additional training to ensure patient safety," I reply quietly.
"I want to make things right and earn back your trust."
She nods slowly, her eyes still filled with anger and worry.
"Okay," she says softly.
"But I need to know that you're serious about making things right."
I pull out a piece of paper from my pocket and hand it to her.
"This is the registration form for a mandatory anesthesia safety course," I explain gently.
"It starts next week. I've already signed up for it." She looks at the form, her expression softening slightly as she reads through it.
"Is this enough?" she asks quietly, her voice still trembling with emotion.
I nod firmly, my heart pounding in my chest.
"Yes," I reply softly.
"This course covers everything from proper dosing protocols to emergency response procedures. It'll help me become a better dentist and ensure patient safety."
Dr. Smith steps forward, his expression sympathetic but firm.
"He's right," he says softly.
"This course is designed to help us improve our skills and prevent mistakes like this from happening again. And it includes hands-on simulation practice with anesthesia equipment."
Caleb's mother looks at both of us, her eyes still filled with worry and anger.
"Okay," she says finally, her voice barely above a whisper.
"But I expect you to take this course seriously and make sure nothing like this ever happens again."
I nod vigorously, feeling a wave of relief wash over me.
"I will," I promise, knowing that this is only the beginning of making things right.
I sit at my desk, staring at the anesthesia safety course registration form in front of me.
My hands still tremble slightly as I fill in my personal information and credentials.
I remember Caleb's trusting face and his mother's anger.
Jessica enters the room with some documentation for me to attach to the application.
When I reach the section asking about reasons for enrollment, I explain what happened in complete honesty.
I detail my dangerous overdosing mistake and how it could have had serious consequences if not caught in time.
I pause, then write: "I owe it to Caleb and every patient to never let this happen again."
Jessica notices my hands still shaking as I sort through the thick stack of course materials.
She sits down next to me and points to key chapters on gas dosage protocols and proper desflurane administration.
She shows me a complicated flow chart in the manual, explaining each step in a clear, calm voice.
When I struggle to focus on the chart, she takes out a piece of scratch paper and draws a simpler version.
"Let's break it down," she says patiently.
"First, we need to check the patient's vital signs. Then, we adjust the desflurane dosage accordingly."
I nod, feeling ashamed that I need such basic guidance after making a dangerous mistake.
But Jessica doesn't judge me.
She looks at me with understanding, her voice gentle yet firm.
"We all make mistakes," she says softly.
"The important thing is that you're willing to learn and grow from them."
I take a deep breath and prepare for my last patient of the day, Lola.
She's a young girl who needs a cavity filled.
I'm still shaken from the Caleb incident, but I need to focus on giving her the best care possible.
Jessica helps me set up a fresh anesthesia mask with sevoflurane.
Dr. Smith reviews Lola's chart one last time before we begin.
My hands tremble slightly as I check the equipment, making sure everything is in working order.
I double-check every setting, determined not to make another mistake.
Lola bounces into the room wearing sparkly shoes and a big smile.
I force myself to focus on proper protocol, pushing aside any lingering guilt.
I start at the standard 2% concentration, watching the flow meter closely as I position the mask over her face.
She takes her first breaths of gas, her eyes starting to droop slightly as it takes effect.
I adjust the mask to fit her face perfectly, making sure the seal is tight.
Her breathing becomes steady and calm under the sevoflurane sedation.
Jessica puts a reassuring hand on my shoulder, causing me to flinch slightly.
I almost lose the seal on the mask, but manage to catch it just in time.
"You're doing great," she whispers softly.
Her words are meant to comfort me, but they remind me of my earlier mistake with Caleb.
I squeeze the rebreather bag three times to keep the gas flowing smoothly, my hands still trembling a bit.
As I monitor Lola's vital signs, I notice her oxygen level dip to 97%.
I quickly check the mask position and increase the fresh gas flow to ensure she stays stable.
I keep my hands steady on the mask, watching the digital display as her oxygen saturation rises again.
The numbers tick up from 97% to 98%, then finally reach 99%.
I continue squeezing the rebreather bag three times in a steady rhythm, watching her chest rise and fall evenly.
Jessica stands next to me, checking the sevoflurane concentration to make sure it stays at the proper 2%.
As condensation starts to form inside the mask with each of Lola's breaths, I carefully wipe it away with a tissue without breaking the seal.
Lola's breathing remains calm and steady, and I finally allow myself to exhale.
I notice Lola's hand twitch slightly during the procedure.
I reach for the IV pole beside her chair.
Jessica watches closely as I carefully adjust the drip chamber, counting the drops to maintain the correct flow rate.
The clear liquid moves steadily through the tubing as I fine-tune the roller clamp.
When Lola's fingers relax and her breathing deepens, I document the new drip rate in her chart.
I step back, finally feeling the weight of the day lift as Lola sleeps peacefully.
I lean over Lola's sleeping form, carefully pulling the thin blue hospital blanket up to her shoulders.
My hands are steadier now as I tuck the edges around her arms, making sure not to disturb the IV line.
Jessica helps me smooth out any wrinkles near her feet while keeping a watchful eye on her oxygen levels, which remain at 99%.
As Lola shivers slightly, I retrieve a second blanket from the warmer.
I layer it over the first one, noticing how the goosebumps on her arms begin to fade under the added warmth.
"Do you think she'll remember any of this?" Jessica asks, her voice barely above a whisper.
I shake my head, watching Lola's peaceful expression.
"Not a chance," I reply, "but she'll remember what happened before she came here."
I adjust the blankets one final time, watching Lola's steady breathing.
The afternoon sun streams in through the windows, making her squint slightly in her sleep.
I walk to the blinds and grasp the cord, my hands steadier now after the stress of the day.
As I pull them closed, the room gradually darkens.
The shadows soften Lola's features while her oxygen level holds at 99%.
Jessica adjusts the IV line to prevent tangling as the dim lighting settles around us.
"Do you think she'll ever talk about it?" Jessica asks, her eyes fixed on Lola's serene face.
"Eventually," I say, my voice low, "but only when she's ready to face it herself."
Jessica nods, understanding the weight of silence that sometimes speaks louder than words.
I adjust the dimmed lighting, ensuring it's just enough to see Lola's peaceful features.
Sitting in the cushioned chair beside her recovery bed, I hold her small hand in mine, feeling its coolness against my palm.
The IV line snakes across the blue blankets while her oxygen level remains steady at 99%.
As she stirs slightly, I give her hand a reassuring squeeze.
Jessica checks her vitals one more time, nodding in approval at the stable readings.
Though my earlier mistake with Caleb still lingers in my mind, focusing on Lola's calm recovery helps ease the lingering anxiety.
I close my eyes for a moment, grateful for the quiet triumph of this small victory.
I sit beside Lola's bed in the dimmed recovery room, still holding her hand.
Her vitals are stable, with 99% oxygen.
When she stirs slightly, I begin humming "Twinkle, Twinkle, Little Star" softly.
The familiar tune helps steady my nerves after today's earlier mistake.
Jessica adjusts Lola's IV line while I continue the gentle melody.
As I hum, Lola's fingers relax in my grip, and her breathing falls into a peaceful rhythm matching the song's slow tempo.
"Do you think Caleb will forgive me?" I ask, my voice barely audible over the soft humming.
Jessica pauses, glancing at me with a mix of sympathy and honesty.
"He will," she assures, "but it might take some time for him to understand why you did what you did."
I hold Lola's hand, still humming the familiar tune as her chest rises and falls steadily.
The melody helps steady my breathing, and I absorb Jessica's reassuring words about Caleb.
As Lola's fingers twitch slightly in my grip, I adjust my hold without breaking the gentle song.
Her oxygen level reads a stable 99% on the monitor.
Jessica checks Lola's IV line one more time, then sits beside me, joining in the quiet song.
As our voices blend together, Lola's face relaxes completely, and I feel the tension from earlier start to fade away.
"Have you thought about telling him the whole truth?" Jessica asks softly, her eyes searching mine.
"I have," I admit, "but I'm scared it might push him further away."
Jessica sighs, squeezing my shoulder gently. "Sometimes the hardest truths are the ones that bring us closer."