I love kids. Always have and always will. And when it comes to sick kids, I feel fortunate to have been trained in a demanding EM residency program where the pediatric emergency department was directly attached to the main trauma center. As a result of such exposure, treating ill kids became as natural to me as treating ill adults. Those little buggers, with their fevers, snotty noses, abdominal pain, and piercing shrills, don't scare me. Some get an "A" for effort, though, pulling out all of the stops in their vain attempt to get me out of their room. Regardless, because of my comfort, I try to see the really sick kids that come through our doors during my shift.
Over the holidays, with the flu season in full swing, I treated many children who were swept up in the epidemic. Some parents simply needed reassurances that they were giving their little Johnnie and Susie all the proper care, while other parents, with their heavy concerns, were right to bring their children in for a workup, including some IV hydration and anti-emetic medication. All-in-all, there was a much heavier flow of pediatrics than what we typically see.
Walking into Room 22, then, thanks to an alert by the nurse, I knew I was about to face another sick child. "This one is 'punky', Doc," she had said, "he hardly flinched when I started his IV." Never a good sign.
I quietly pulled back the curtain to the room and entered, finding a fatigued two-year-old boy sprawled on his back on the medical cot with his cotton sheet kicked into a ball at his feet. His oversized hospital gown had one loose tie in front, opened to reveal his skinny frame. His blond bangs were sweaty, matted to his forehead, and his skin was pale. Before introducing myself to his parents, I walked up to him and felt his forehead with the back of my hand. He was "burning up," as we say and, more importantly, didn't even shrug to a stranger's touch.
I shifted my focus to his parents, walking up to the young mother sitting in a chair alongside her son's cot. She looked as wiped-out as her son, the livelihood of her existence threatened by her son's illness. She was tearful, a mother's angst clearly etched into her face. I took her right hand in the both of mine, squeezing it reassuringly. "We'll get him feeling, better," I said, nodding to her sleeping son as I spoke. She dabbed her eyes with a Kleenex and gave me a feeble smile.
Next, I walked up to the father, his disheveled baseball cap barely clinging to his head as he paced three steps back and forth in a tight corner of the room. We shook hands and I held his gaze for a few extra seconds, trying to silently reassure his concerns. He, like the mother, was young, worried, and quite upset over his son's circumstances. He looked me in the eyes and took a deep breath. "Can you really make him better, Doctor?" he asked, a glimmer of hope escaping his watchful eyes.
"Let me talk to you both, do a thorough exam of your son, and order some tests and treatment for him, okay? But yes, I do think we'll get your son to feel better by the time we are done treating him." Their son looked like several other patients we had recently treated for influenza.
Between the two of them, I learned that they were first-time parents and married. Although neither of them were ill, their son went to daycare two days a week, where they thought "a bug" was going around. He had been born full-term and was up-to-date on his immunizations. This was his first major illness, barring a few past ear infections. Over the past few days, they watched their son eat and drink less, urinate less, become less active, and start a fever that they couldn't control. Eventually, all of their son's symptoms worsened and became boggled in their minds, totally confusing them (like any first-time parents) as to what symptoms were most serious and needed addressed immediately.
That's where we came in.
After a thorough exam on this patient, I had no suspicions for focal illnesses (such as pneumonia, bronchitis, or strep throat) on this patient. His temperature was quite high (103.7) and he appeared clinically dehydrated, so we treated him with a Tylenol suppository, aggressive IV hydration, and some IV Zofran, a God-sent anti-emetic that helps control nausea and vomiting. Then we sat back and waited--one, to see how the child would respond to our interventions and two, to review the results of our blood and urine tests as they returned.
Within the hour, I was walking into my work station with another patient chart only to find Dad standing at the counter, waiting to talk to me. He was smiling.
"He's doing better already?" I asked. "Come take a look," Dad said, practically grabbing my hand and pulling me towards his son's room.
We got back to his son's room and, before opening the curtain, the father stepped aside, sweeping his arms as if welcoming me to step into his home.
Pushing aside the curtain, I was extremely happy to find their son sitting upright in bed, licking an Italian ice while watching a cartoon on the TV. He looked at me with apprehension, turned to his mother who gave him a reassuring wink, before turning his attention back toward the TV, continuing to lick his popsicle. He was a new kid.
The mother jumped from her chair, then, and rushed me, giving me a big, grateful hug. "I can't believe how good he looks," she said, muffling her words into my shoulder. "Yes," I said, happily agreeing with her, "he looks great!" She left my side and went back to her cot-side chair, sitting clumsily down before wrapping her hands back around her son's torso. Her face held the most genuine expression of thankfulness and love that could ever be.
Within the next hour, as the patient's labs returned with adequate results, the nurse and I took turns going into the room to educate the parents and answer their questions.
How frequently are they supposed to use Tylenol and ibuprofen?
What doses of Tylenol and ibuprofen are they supposed to use?
How should they use the Zofran prescription we'd be sending them home with?
What type of fluids should they give their son?
What foods would be okay to reintroduce back into his diet?
How much sleep should they let their son get?
It's easy to see how confusing it can get the first time your child has a serious illness. Their questions for us were endless and repeated several times, but we, in the medical field, all know that education and knowledge is most empowering to recover from an illness. Our patience in the parent's education is paramount. Besides making sure each of their questions were answered, we also wrote down their instructions for them to take home.
By the time we were ready to discharge this patient, he was a new kid, running around his room, drinking watered-down juice, coloring the staff pictures, and covering himself in the stickers we gave him.
To us, another successful but predicted response to our interventions with a child with the flu. To the parents, though, this was nothing short of a miracle. The clouds had parted, the rays of sunshine had dispersed before refocusing on the head of their sick child, and the gods had sung. Anyone who has had a sick child recover knows these feelings of exhilaration that follow the many pangs of doubts that haunt us during our child's illness.
I've been there...have you?
The nurse and I stood together at the counter and watched this young family walk out of our ER after being discharged. Three big smiles, plus two more if you count ours.
It was another good day in the ER...
As always, big thanks for reading. I appreciate the nominations and support for the 2010 Medgadget awards for best medical weblogs...thank you, thank you. I hope this finds you well...
Showing posts with label chronic illness. Show all posts
Showing posts with label chronic illness. Show all posts
Monday, January 31, 2011
Friday, June 4, 2010
The Wonder Of It All
Have you ever looked at a child only to find yourself staring in awe and amazement at the wonder of it all. I look at my three kids and am simply astounded that we did something so very right, my wife and I. The infinite smiles, the high-pitched laughter, the innocent and untampered views of life through their eyes, the heartfelt hugs--the list is endless as to the joys and delights they bring to our lives.
Even during my son's illness, when he spent several years on chemotherapy, I was awed at the resilience and beautiful spirit of not only him, but of my two young girls, his sisters, who also bravely walked the path of his illness with us. With heads held up, I might add. They wanted matching mediports so that their brother would not feel isolated with the "bumpy" on his chest. Pure and magical love.
As much as a setback as his illness was for our family, though, we survived that life trial and, in fact, emerged so much more stronger and appreciative of the offerings of this life. We were taught life-lessons that some people never learn. We reaped the benefits of compassion, both receiving and giving in ample, unselfish amounts. The small shit took a back seat to the more important "stuff" that life had to offer.
One of our amazing ER nurses, Kathy, the mother of a son with cystic fibrosis, said it best when Cole was first diagnosed. "Welcome to the 'Parents-Of-A-Sick-Child Club'," she whispered in my ear while hugging me. "It's a club that no parent would ever want to belong to," she continued, "but one that will change your life forever." No wiser words were said to me during that period of my life. Several times, I have reminded Kathy, who continues to struggle daily with her son's life, that the snapshot of her hug and her words will linger forever with me.
Mostly, I am thankful that my son's illness was a temporary, albeit two long years, and not a permanent fixture in our lives. We know we have been blessed. That our family is one of the lucky ones.
In the ER, when I meet the parents of an ill child, especially a prolonged, chronic illness, my utmost respect and compassion flows outward in tidal waves. I can only imagine the heartbreak and the struggles they have known in dealing with the fight for their child's life, trying to obtain just a wee bit of normalcy. Struggles that may never cease, that may continue to ebb away at the glimmers of hope and happiness that are too infrequent in their lives. Struggles that weigh down the shoulders and plummet the heart, time and time again.
A few years back, during the middle of a night shift, I walked into Room 22 to see CeCe, an unfortunate five-year old child born with microcephaly, a neurologic developmental disorder. There is a disturbance in the rapid growing of nerve cells, which results in a variety of symptoms, including striking neurological defects (such as mental retardation, severe intellectual and developmental delays, and seizures), a deformed, dwarfed body, and a shortened life span. Treatment for this illness is symptomatic and supportive. There is no cure.
As I walked into the room, diminutive CeCe was lying on her back in her treatment cot, her mother bent over her, stroking her braided and beaded hair while whispering into her ear. Her father stood along the other cot's side, stroking CeCe's hand. She was, despite her age, about the size of a two-year old toddler. She was nonverbal, and all four of her extremities were contracted and spastic. Her head, as expected, was quite small. It was a heartbreakingly, beautiful scene. CeCe was obviously loved.
CeCe had been brought in by her parents because her "trach" had fallen out in the middle of the night. She was in no respiratory distress, but it had been placed a year prior in the event she would develop any breathing difficulties. Her parents wanted to replace it themselves, but under a controlled environment ("just in case something goes wrong when we put it back in"). In essence, our medical team was just going to hang out and watch CeCe closely, on monitor and clinically, to make sure that everything went as planned.
After meeting the parents and saying a few words to CeCe, who had no response, I assured the parents that we were ready for them to replace the trach. "Who's going to do it?" I asked.
"I will," CeCe's father said, turning the new trach over in his hands, examining it closely.
"Are you sure you don't want me to do it or call in an ENT specialist?" I asked, feeling a little of his nervousness. "It's no problem for us, really," I assured him.
"No, but thank you. I would rather replace it in case it hurts my little girl."
Before starting, Mom crossed herself while Dad bent over to whisper his assurances to CeCe in her ear. "I don't mean to hurt you, baby," he said. CeCe had no response.
"I'm ready, honey," CeCe's mother said to her father, giving the go-ahead. Slowly, he bent over CeCe's throat, inserting the tip of the curved, plastic tubing of the trach into the small open hole of her anterior neck. It didn't go far, though. He was meeting some resistance.
"Are you okay?" I asked, watching CeCe closely through this. I had noticed CeCe squirming as he struggled with the resistance. "I think so," he replied, adding a little more strength to his attempts.
And then it happened. A small miracle of sorts. As Mom was bent over, whispering love to her daughter while Dad struggled to place the new trach, a sudden, brief smile passed over CeCe's face. I had seen it. I know I did.
With a little more effort, Dad finally was able to insert the trach to his liking. We secured its placement before obtaining a CXR to make sure it was placed appropriately and that we didn't collapse a lung or disrupt the trachea's integrity.
All turned out well. CeCe remained very stable, her vital signs normal and her clinical exam unchanged. The CXR confirmed a job well-done by Dad.
"I have to say," I told CeCe's parents before discharge, "that you have one lucky little girl. The way you both approach her, whispering in her ear and caressing her, is quite beautiful. Your love for her is very evident." I looked at the nurse, who nodded her agreement. "In fact," I added, looking at Mom, "I think I saw CeCe smile when you were talking to her."
"She did?" Mom asked, before continuing. "I live for those moments."
"Does she do it often?" I asked, wanting to hear more.
"Not often enough," Dad spoke, "maybe every few days at the most. We wish CeCe smiled more but, honestly, we'll take what we can get."
They were packing up, getting ready to leave, but I had one more question that I needed answered. "CeCe's hair," I asked both of them, "who braided it and put all those beads in?" Her hair was a sight to behold--numerous, small, loose braids that were delicately woven and tied with multi-colored beads at each end. Not an easy feat, I'm sure. "Oh, that," CeCe's mother said, blushing slightly, "I did that a few days back. I love doing it, actually. And CeCe seems to enjoy when I do it. In fact, her most recent smile was when I was tying those braids."
I pictured Mom at home, sitting behind CeCe, propping her up into her own lap, fluffy pillows surrounding them, and lovingly, with the utmost tenderness, combing out and braiding each little twine of hair, before beading its end.
Waiting for a glimpse of CeCe's brief smile. Living for it, actually.
Meeting CeCe and her parents reminded me of just how lucky a man I am.
If you are the parent of a chronically-ill child, I dedicate this post to you. Don't forget, for one minute even, that there are many of us out there who see you, who send you our prayers and good energy, and who recognize the love and effort you give to your child. Despite your struggles, at some point in your life journey, the reasons you were blessed with your child will become evident to you and will hopefully enrich your life and the lives of those around you. If they haven't already, that is.
The wonder of it all...
As always, big thanks for reading. I hope your weekend is a great one. Next post will be Monday, June 7. See you then...
Even during my son's illness, when he spent several years on chemotherapy, I was awed at the resilience and beautiful spirit of not only him, but of my two young girls, his sisters, who also bravely walked the path of his illness with us. With heads held up, I might add. They wanted matching mediports so that their brother would not feel isolated with the "bumpy" on his chest. Pure and magical love.
As much as a setback as his illness was for our family, though, we survived that life trial and, in fact, emerged so much more stronger and appreciative of the offerings of this life. We were taught life-lessons that some people never learn. We reaped the benefits of compassion, both receiving and giving in ample, unselfish amounts. The small shit took a back seat to the more important "stuff" that life had to offer.
One of our amazing ER nurses, Kathy, the mother of a son with cystic fibrosis, said it best when Cole was first diagnosed. "Welcome to the 'Parents-Of-A-Sick-Child Club'," she whispered in my ear while hugging me. "It's a club that no parent would ever want to belong to," she continued, "but one that will change your life forever." No wiser words were said to me during that period of my life. Several times, I have reminded Kathy, who continues to struggle daily with her son's life, that the snapshot of her hug and her words will linger forever with me.
Mostly, I am thankful that my son's illness was a temporary, albeit two long years, and not a permanent fixture in our lives. We know we have been blessed. That our family is one of the lucky ones.
In the ER, when I meet the parents of an ill child, especially a prolonged, chronic illness, my utmost respect and compassion flows outward in tidal waves. I can only imagine the heartbreak and the struggles they have known in dealing with the fight for their child's life, trying to obtain just a wee bit of normalcy. Struggles that may never cease, that may continue to ebb away at the glimmers of hope and happiness that are too infrequent in their lives. Struggles that weigh down the shoulders and plummet the heart, time and time again.
A few years back, during the middle of a night shift, I walked into Room 22 to see CeCe, an unfortunate five-year old child born with microcephaly, a neurologic developmental disorder. There is a disturbance in the rapid growing of nerve cells, which results in a variety of symptoms, including striking neurological defects (such as mental retardation, severe intellectual and developmental delays, and seizures), a deformed, dwarfed body, and a shortened life span. Treatment for this illness is symptomatic and supportive. There is no cure.
As I walked into the room, diminutive CeCe was lying on her back in her treatment cot, her mother bent over her, stroking her braided and beaded hair while whispering into her ear. Her father stood along the other cot's side, stroking CeCe's hand. She was, despite her age, about the size of a two-year old toddler. She was nonverbal, and all four of her extremities were contracted and spastic. Her head, as expected, was quite small. It was a heartbreakingly, beautiful scene. CeCe was obviously loved.
CeCe had been brought in by her parents because her "trach" had fallen out in the middle of the night. She was in no respiratory distress, but it had been placed a year prior in the event she would develop any breathing difficulties. Her parents wanted to replace it themselves, but under a controlled environment ("just in case something goes wrong when we put it back in"). In essence, our medical team was just going to hang out and watch CeCe closely, on monitor and clinically, to make sure that everything went as planned.
After meeting the parents and saying a few words to CeCe, who had no response, I assured the parents that we were ready for them to replace the trach. "Who's going to do it?" I asked.
"I will," CeCe's father said, turning the new trach over in his hands, examining it closely.
"Are you sure you don't want me to do it or call in an ENT specialist?" I asked, feeling a little of his nervousness. "It's no problem for us, really," I assured him.
"No, but thank you. I would rather replace it in case it hurts my little girl."
Before starting, Mom crossed herself while Dad bent over to whisper his assurances to CeCe in her ear. "I don't mean to hurt you, baby," he said. CeCe had no response.
"I'm ready, honey," CeCe's mother said to her father, giving the go-ahead. Slowly, he bent over CeCe's throat, inserting the tip of the curved, plastic tubing of the trach into the small open hole of her anterior neck. It didn't go far, though. He was meeting some resistance.
"Are you okay?" I asked, watching CeCe closely through this. I had noticed CeCe squirming as he struggled with the resistance. "I think so," he replied, adding a little more strength to his attempts.
And then it happened. A small miracle of sorts. As Mom was bent over, whispering love to her daughter while Dad struggled to place the new trach, a sudden, brief smile passed over CeCe's face. I had seen it. I know I did.
With a little more effort, Dad finally was able to insert the trach to his liking. We secured its placement before obtaining a CXR to make sure it was placed appropriately and that we didn't collapse a lung or disrupt the trachea's integrity.
All turned out well. CeCe remained very stable, her vital signs normal and her clinical exam unchanged. The CXR confirmed a job well-done by Dad.
"I have to say," I told CeCe's parents before discharge, "that you have one lucky little girl. The way you both approach her, whispering in her ear and caressing her, is quite beautiful. Your love for her is very evident." I looked at the nurse, who nodded her agreement. "In fact," I added, looking at Mom, "I think I saw CeCe smile when you were talking to her."
"She did?" Mom asked, before continuing. "I live for those moments."
"Does she do it often?" I asked, wanting to hear more.
"Not often enough," Dad spoke, "maybe every few days at the most. We wish CeCe smiled more but, honestly, we'll take what we can get."
They were packing up, getting ready to leave, but I had one more question that I needed answered. "CeCe's hair," I asked both of them, "who braided it and put all those beads in?" Her hair was a sight to behold--numerous, small, loose braids that were delicately woven and tied with multi-colored beads at each end. Not an easy feat, I'm sure. "Oh, that," CeCe's mother said, blushing slightly, "I did that a few days back. I love doing it, actually. And CeCe seems to enjoy when I do it. In fact, her most recent smile was when I was tying those braids."
I pictured Mom at home, sitting behind CeCe, propping her up into her own lap, fluffy pillows surrounding them, and lovingly, with the utmost tenderness, combing out and braiding each little twine of hair, before beading its end.
Waiting for a glimpse of CeCe's brief smile. Living for it, actually.
Meeting CeCe and her parents reminded me of just how lucky a man I am.
If you are the parent of a chronically-ill child, I dedicate this post to you. Don't forget, for one minute even, that there are many of us out there who see you, who send you our prayers and good energy, and who recognize the love and effort you give to your child. Despite your struggles, at some point in your life journey, the reasons you were blessed with your child will become evident to you and will hopefully enrich your life and the lives of those around you. If they haven't already, that is.
The wonder of it all...
As always, big thanks for reading. I hope your weekend is a great one. Next post will be Monday, June 7. See you then...
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