Saturday, February 28, 2015

Emergency Hospitalization

As the mother of three, I came out of the delivery room onto the maternity wing of the hospital as a well seasoned, veteran parent.  Treated far more deferentially than a first time mom by the nursing staff, I was given space to do my thing with our newborn and, right from the get go, I felt confident and comfortable with my knowledge, skills and the idea of introducing our latest addition to the wide world.  And given all of the experience his active, outgoing and curious older siblings have provided us over the past five years, I doubted there was anything that would surprise me as we brought home our perfectly healthy, full term baby boy.  

Unfortunately, I was wrong. Horribly, horribly wrong. 

GV circa 02/2013
While we were at the hospital for the induction and post-delivery day, our oldest boy came home from his Valentine’s Day party with a bit of extra pre-school love in the form of a cold. Congested and occasionally coughing, it didn’t raise any significant red flags when he shared his germs with our daughter (sure, they fight over the train, but this they share) and she too came down with a case of the sniffles.  Knowing it’d be unpleasant for the baby to need aspiration, we asked the big kids to wear masks and wash their hands, but despite our best efforts to contain their symptoms, their excitement about the baby resulted in not only the introduction of them, but of their congestion to FG as well. Starting the sick-little-guy routine, we turned on our humidifiers, administered saline and sucked the increasingly green mucus from his tiny nose with the notorious, yet incredibly handy NoseFrita (and, for the record, the poor kid does not like aspiration the way GV did).  So already sick for the first time going into his two week well-baby appointment, the pediatrician discovered that FG had a nasty ear infection to which she prescribed an antibiotic and instructed us that “if he’s not better after 24 hours or if he develops new symptoms, call back.”

Later that afternoon, HB and I found ourselves independently looking at FG thinking that his color wasn't quite right - he seemed almost grey.  Finding a change in position to resolve the issue or that the artificial lighting from one room to the next was largely to blame, we administered his first dose of antibiotics in hopes that the medicine would diminish his symptoms by the morning thus calming our overtired nerves and trigger-happy fears.  Sharing our concerns briefly before bed, we agreed that FG wasn't demonstrating other red flag behaviors - poor nursing, infrequent diapers, difficulty waking up and ferver - and that we'd keep a close eye on him if and when things changed.

The following day, I attempted to nurse FG every so often but found his latch to be weak (he'd had a frenulectomy at his well baby appointment the day before, so I wasn't terribly concerned) and his general demeanor to be sleepy.  Given that he's still quite new and supposed to be sleeping a lot, I didn't begin to aggressively attempt to rouse him until early afternoon.  Using our typical wake-'em-up tickle up the spine or diaper change tricks to no avail, I told myself not to panic and I began to escalate my pestering techniques - ultimately putting his head directly under running ice cold water - only to have eye lids flutter in minimal response before returning to a deep sleep.  When HB walked through the door shortly there after, I presented FG to him and, while difficult to be sure given the overcast, grey light of the day, we agreed that his color was off again and that the confluence of symptoms he was presenting warranted a follow up call to our doctor. 

With a "come directly here or get to an ER if things get worse" response from the triage nurse, HB hastily buckled our baby into his car seat as I scrambled to get our oldest to tell Grandmama we were leaving - immediately.  Sitting in the back seat of our car watching for any change to his breathing patterns, HB ignored the speed limit on I-95 and got us to the doctors office in about two thirds of the time it usually takes to get to NOVA.  Dropping me at the front door with the car seat, I bit back tears of fear as I impatiently rode the elevator to the right floor.  Walking in, the receptionists didn't ask who I was but quickly glanced at FG and said to "let the doctor know he's here." 

Escorting me back to an exam room, the nurse began to run through the typical baby appointment routine: "Okay, let's have you take off his outfit and get down to a dry dia..."  But she cut herself off mid-sentence and dashed from the room.  Seconds later three other nurses and the pediatrician were entering the tiny room with muddled looks of it's-okay-mommy/holy-shit on their faces.  Ordering for oxygen, a nebulizer and a pulse oximeter, Dr Fox held a stethoscope to FG's chest as HB joined me in the exam room.  

Directing his comment to a nurse "His pulse-ox is 61.  Call 911."

The next several minutes were a blur as firefighters and paramedics streamed into the room with what seemed to be an endless repetition of questions as they loaded FG back into his carseat and prepared to take him by ambulance to Fairfax INOVA.

The last time I rode in an ambulance was when I had the placental abruption during my second pregnancy and, while that was scary, this trip was far worse.  As the patient, all you can do is lie there, watch the lights and attempt to remain stable with whatever willpower you can muster; but as the caregiver who is, literally, along for the ride it is the most helpless, terrifying experience ever.  Just listening to the sirens blare and watching the other vehicles through the back window as they jockeyed to regain their spots on the road made me realize the preciousness of time and unleashed a torrent of regret and what if's... regret about not bringing him back to the doctor the previous day and not going directly to the Emergency Room... and what if... if... if...    

Upon getting to the Pediatric ER at Fairfax INOVA, a team of nurses and physicians swarmed our son.  Informing us that they were completing a full respiratory work-up and beginning worst-case scenario treatments to stem any serious illnesses before they have a chance to gain a leg up on treatment options, we could only stand by and attempt to comfort our baby as the doctors took x-rays, ran an EKG, took blood samples and drew a spinal tap.  

With cables and cannulas, needles and vials, cuffs and Lord knows what else coming and going from the room with various scrub-clad personnel, HB and I were in an overwhelmed trance when a sort of celebratory "whoop!" went up as a nurse reported some results to the team attending FG:  "RSV POSITIVE!" 

Taking us aside, one of the two pediatric trauma physicians in the room explained:  "So what we're looking at here with Baby F is a case of RSV - Respiratory Syncytial Virus - which is pretty serious, but the best answer we could hope for; okay? From what we can see on his x-rays, he has a partially collapsed lung which is typical with this disease and, since this is viral, there really isn't anything more than oxygen that we can do to get him through this. We're ordering him a bed upstairs right now and, hopefully, you'll be able to go home sometime next week." 

... processing... processing... processing...  

Our two week old has a virus that just caused one of his lungs to collapse, to loose almost 40% of normal oxygen saturation and to require a cannula to keep him breathing until it passes?  Right, gotcha. 

He's been upstairs in the Pediatric Intensive Care Unit (PICU) for a day now and, while he appears to be stable, I can't help but perpetually rationalize to myself that the ICU isn't some place they send patients as place holders... The reality is he's sick.  Very, very sick.  He needs oxygen via cannula to breathe which, preventing him from nursing, requires a feeding tube  into his stomach.  He is on a one nurse to two pediatric patient ratio and is visited at least four times a day by an intensivist attending or resident... in other words, he's exactly where he needs to be, getting the exact care that he requires and all we can do is wait for the worst to be over.

We simply pray that is soon. 

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