An ED Visit

Thanksgiving 2010.

My little daughter Zoey is sleeping beside me on the couch, her head on her favorite green pillow and a soft blanket pulled up to her neck. I watch her closely to see that she is still breathing.

She was very fussy yesterday, then at two in the morning I heard a regurgitation sound in my sleep, a sour, acidy sound you could taste in your throat. It was followed almost immediately by the full-fledged sound of vomiting. Her mother reacted quicker than I did. She had Zoey sitting up and leaning forward, sleepily and miserably retching up most of what she had eaten yesterday- grapes, mini pizza, macaroni and cheese, and the gingerbread girl she had decorated, and then probably eaten too much of. The vomit was everywhere on her clothes, the pillow, the sheets. We washed her face and stripped the bed. We changed Zoey and laid her back down between us and went back to sleep.

Fifteen minutes later, I felt her lift her head and heard the burp, and she threw up again. This went on all night long. Not just vomiting, but multiple trips to the bathroom for diarrhea. By seven in the morning, she was exhausted and her face was ghostly pale. She could barely lift her head off the pillow she was so weak.

“Maybe we should take her to the hospital,” her mother said. (Her mother is an ED nurse).

“Maybe,” I said. “Let’s let her sleep and see how she does.”

“Ten minutes later, he tries to raise her head to vomit again. We have to lift her. Nothing comes up.”

“She may need an IV,” her mother said. “What do you think?”

I call a close friend of mine who is an ED doctor and ask his advice. He says as long as her belly is soft, I should probably keep her home and have her drink Pedilyte, a little bit at a time. If I brought her to the ED and he was working, he’d probably just give her some Zofran. And if she kept the fluid down after that, just have her take in fluids. He says to call him if she keeps vomiting.

I run out to CVS and get some Pedilyte. When I come back her mother says she threw up two more times. She looks so weak. She can’t even lift her head up. What if it is food poisoning or who knows what? She really looks life she needs hydration and I don’t think she’ll hold the Pedilight down.

We would call the pediatrician, I think, but it is seven A.M. on a holiday. If we are going to take her to the ED now is probably the best time. Holiday mornings are always dead. They are probably sitting aorund with nothing to do. No way will it be a ten-hour wait sitting in a crowded waiting room with other sick kids and their families.

I don’t want to overreact, but Zoey looks so sick. And no one else has been sick in our family, certainly not like this. Its not something we can say, oh so and so had it and they got over it in a couple days. Who knows what it is? And kids can deteriorate fast. She is my daughter and she is so small. Screw it, I think. We’ll take her down. At least we are not calling an ambulance. But then I wonder what I would do if I were alone with her. Would I dare drive with her alone in her car seat. What if she started to throw up? How could I protect her airway? Would I consider calling an ambulance or just drive slow, one eye in the mirror, going side streets so I could pull over at first hint of vomit?

When we arrive at the hospital, I see I was right. The ED is empty. They are very friendly at registration — happy for business it seems — and they send us right to a room. Very encouraging. A nurse comes in and is very friendly with Zoey, even managing a smile out of her, as we tell the nurse Zoey’s sad tale. The nurse palpates Zoey’s belly and listens to her breathing, and then she leaves us with the clicker for the TV on the wall and says she isn’t certain how long it will be until the doctor comes in.

We watch Kung Fu panda and wait. This isn’t so bad. But then we wait. And wait. Slowly a stream of patients comes to join us in the ED. Most look like us, two parents and a small sick child. I hear an ambulance radio patch. A child with a broken arm. Zoey looks worse; she throws up again and has a small amount of diarrhea. We clean her up. I find myself standing in the doorway looking down the hall. I feel like all those families I see everyday in EDs, keeping watch by the door of their loved ones, waiting for word or a sign of what is happening. Finally the nurse comes back and gives Zoey some Zofran. A half hour later she brings a Popsicle.

Zoey is happy with the Popsicle, but she only eats half of it. The nurse says she is not certain which doctor will come in. I admit I am starting to think about leaving, taking Zoey and going home and managing her myself. Maybe this was a bad idea coming down here. What was I thinking?

Finally, after almost three hours we see the Doctor. She comes in and with a big smile on her face, explains that since Zoey’s vital signs are so good and since the nurses say Zoey has been smiling and chatting, she is unlikely seriously dehydrated. It is likely a virus and should be managed by drinking plenty of fluids and following up with the family pediatrician, who should always be available for consultation (even on Thanksgiving).

A nurse gives us the discharge instructions and gives Zoey a parting smile as we bundle her up. Her mom goes to work and Grandma comes over and makes chicken soup with dumplings, and spoon feeds her patiently as Grandmas do so well. It takes a couple days, but Zoey gets better.

I am always enlightened to see health care from the other side. You are so grateful when people are nice to you (and just about all of them are!). You are also ever so thankful when they let you know what is going on. Two valuable lessons learned again — and a third — smile or no smile, you can tell who is sincere and who isn’t.

I guess we didn’t need to take Zoey down. I certainly felt chastened when we left. Maybe we should have waited. Maybe we should have called the pediatrician on that holiday morning,

But my little daughter was so small and so sick.

And you can’t get Zofran over-the-counter at CVS.

When I tell my ED doctor friend the next day that we ended up going down to the ED, he is upset with me for not calling him back. He would have been happy to come over and examine her and give us a script for Zofran. He is sorry we had to go to the ED. I do know he would have come over, but I didn’t want to take him from his own family on Thanksgiving and I didn’t want to bother the pediatrician either. I thought the Ed could see her quick and fix her. They were at least on the clock. And if it was more than just a simple virus we would have gotten a head start on it.

I think when it comes down to it, parents are more concerned with their children’s immediate health than with looking stupid for using the health care system inappropriately. At least that’s the way I leaned when it was my decision time.

I need to remember that when I’m the one wearing the stethoscope.

***

Postscript: Zoey was better in a couple days. In the meantime, the virus ran amuck through the tribe of sisters and cousins, uncles and aunts, and even whacked yours truly pretty hard. I lost nine pounds in one day. (It took me a week to gain it back). At least I can tolerate Pedilyte.

***

On The Night You Were Born

Happy Birthday, sweetheart!

5 Comments

  • medic4ever says:

    I have had to make the same decisions you did about making an ER visit. I’ve been a medic for 21 years and worked on many very sick children. When it’s my child that’s ill, the worst case scenarios usually go through my mind (some say a little knowledge is dangerous). After some of the bad outcomes I have seen because the family waited a little too long, I feel I would rather be a little on the cautious side when it comes to my kids. You might call it PTSD, but better safe than sorry.

  • justAmedic says:

    I’d like to think that I, too would hold out and not push the panic button so quickly. But let’s not forget that it’s much easier to practice medicine on a stranger than on our own family, specifically one’s own child. Objectivity goes out the window. Also, having seen worst case scenarios, that also runs through our heads. In the end, I’d choose the shameful title of the medic that inappropriately used the ED rather than that of the inconsolable parent at my child’s funeral. Children do deteriorate quickly. If we don’t have our tools of the trade at our disposal, we can’t work the magic that we’re able to do at work. We’re just parents.

  • I had a similar experience with my grandson back in early November. My son was up visiting from New Jersey and as they were getting ready to leave my grandson fell and whacked his forehead. He developed a good sized egg on his forehead and I was concerned about the four hour drive ahead of my son. So, we took a ride to a pedi ER where I know a few people. It was quiet when we got there so there was a minimal wait.

    After the exam and a two hour observation period we got the all clear. Maybe I over reacted in going to the ED, but like you I felt better having gone and found that nothing was wrong. I think the alternative would have been far worse.

    Like Zoey, I had that miserable virus right around Thanksgiving. I don’t blame you for taking her to the hospital, I almost went myself. I’m glad she got better quickly.

  • Almost Jesus says:

    Its interesting how different the various parts of the country operate ED wise. I live in a midwestern city of 200,000 and the longest you will wait on an average day is usually no more than 30 minutes, and if they are very busy, it is usually 2 hours at the max. In the small town I am from, the doctor is on call and cannot have a response time of more than 20 minutes per state law. I find it very odd that you would have to wait 3 hours to see a doctor on a quiet day, that would never be tolerated here.
    We have had a nasty short lasting stomach bug going around here too. I am doing my internship for my medic and in the course of the night, my preceptor and I both went home sick and his partner and the relief shift all ended up getting sick over the next week. It last 24 hours and we all felt fine.

  • I’d like to think that I, too would hold out and not push the panic button so quickly. But let’s not forget that it’s much easier to practice medicine on a stranger than on our own family, specifically one’s own child. Objectivity goes out the window. Also, having seen worst case scenarios, that also runs through our heads. In the end, I’d choose the shameful title of the medic that inappropriately used the ED rather than that of the inconsolable parent at my child’s funeral. Children do deteriorate quickly. If we don’t have our tools of the trade at our disposal, we can’t work the magic that we’re able to do at work. We’re just parents.

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