Rise and Fall

This time I spotted the signs much quicker — the belly breathing; the way the base of her neck caved in on the inhale; the listlessness, so much so that she was lying flattened on the floor and wouldn’t even lift her head — and I knew what to do.  My mother held her on her lap as I put the mask over my daughter’s face and turned on the nebuliser.  She would be fine, I knew.  I’d done my bit by spotting the signs and now her breathing treatment would open her airways again.  It would not go to croup this time.

And she did perk up for a time — the adrenaline rush to her system gave her a jolt of energy that spilled out in songs and giggles and, once she was eventually free of the mask and the machine, the kind of crazed dancing that only drugs can produce.  I watched her mania with waves of relief.

So the shock rocked me to the core when I realised only thirty minutes later that she was struggling to breath again.   Again, the belly-breathing.  Again, that horrible pulling at the base of her neck.  It was too soon to use the nebuliser — much too soon, it should have lasted four hours!  How could she have fallen back so badly in only thirty minutes?

A cursory call to the doctor’s office, only to confirm what I already knew — we were to go directly to the Emergency Room, by ambulance if necessary.  I calmed my racing heart, told it that those words came as no surprise — to no avail — and began to pack our bags.  We needed enough nappies to perhaps see us through the night, more wipes, and food.  We can go nowhere without bringing our own food — even the hospital struggles to cope E2′s extensive dietary restrictions.  Last time, it produced an apple and a bowl of plain rice noodles covered in canola oil.  She’s two years old: of course she turned up her nose.

But the timing was terrible and the cupboard was bare.  “I’ll make something,” my mother said, hastily shoving a pair sweet potatoes into the microwave.  “You…” she looked at me, still in my pajamas and with great globs of snot dried in my hair.  E1 had cried through the night with a sore throat so pitifully that I’d slept (or, rather, not) beside  her, contorting my too-long body into her toddler bed, where she’d sneezed repeatedly, violently, all over me.  My mother winced a little, “You have a quick shower — quick — and get dressed while I make the food.”

I looked at my daughter, judging her breath.  She was working at it for sure, much more than she should have been so soon after a treatment, but she was ok for the moment.  I could see that. There was time, I thought, and dashed to the bathroom.  My shower lasted two minutes — soap on, soap off — but  I kicked myself for it the whole time, stepped out onto the bathmat in a guilt-induced near-panic.

In the car as I drove, my mother kept her body turned around in the passenger seat, watching E2′s chest rise and fall, and periodically telling me to slow down.  My wet hair dripped down the back of my neck.  E2 kept breathing.

At the hospital, they issued us with masks first and read the registration paperwork.  “Breathing troubles”, I’d written and they waved us straight in.  Weight, blood pressure, stethoscope — ah yes, that wheeze and rattle — and they settled her down for another breathing treatment, this one lasting an hour.  She perked up again almost immediately and asked to take the mask off so she could dance with her fidgetting, bored sister.  “No, sweetheart.  You just breathe,” I told her.  She sang instead, which was just as good.

The treatment finished, they left us for a while to see how it took.  But when they returned at last, the rattle was still there, so she had another — shorter this time, a steroid.  And that one did the trick.   After another long observation period, made more difficult by one child who was now totally wired and the other who was bored beyond her tolerance, they declared her fit and released us, with a prescription for more steroids.

We drove home in the falling dusk.  E1 succumbed to sleep immediately and, as the adrenaline rush began to die away, her little sister followed suit.  I watched them both in the rear-view mirror: their faces relaxed and angelic, their mouths both hanging open, and their chests rising and falling …easily, rhythmically.  I counted my blessings.

And then I counted something else: four colds so far this year, and all four times, we’ve had to use the treatment to keep her breathing.  Four colds so far this year, and two have ended up in the Emergency Room.  What gave the rest of us sniffles and coughs brought E2 to the edge of disaster every time.

We pulled up to the pharmacy and I turned off the car.  It was dark now and I was exhausted, ready for bed but knowing it would be another long night with two sick little girls.  “Oh, Mum… I hope she outgrows this.”  I reached to open the car door when another, darker thought suddenly chilled me.  “But…”  I turned my head and looked at my mum.  “But if she doesn’t…  if she’s this susceptible to everything…  how will I ever be able to send her to school?!?”

Read Full Post »

Truth …and Bitter

Here’s the thing: I wouldn’t have called the doctor.  I wasn’t going to — I didn’t think it was that dire yet.  I was all stiff upper lip… soldier on… mustn’t grumble…  It was my mother who was convinced we should call the doctor, and she had to goad me a bit before I agreed.  Go on, then, I said reluctantly.  You make the call. And she did.  She made the first call — not me.

When I told M what the doctor had said at the follow-up appointment, his face was grave.  “You know, if you hadn’t taken her into ER, I don’t think she would have made it.  I don’t think she would have kept breathing through the night.”  And I think he’s right.  With hindsight, watching how her condition progressed that night, I don’t think she would have kept breathing either if we’d stayed at home.  And yet, I hadn’t wanted to make that phone call.  I hadn’t wanted to make a fuss, hadn’t wanted to be a bother…  I hadn’t wanted it to be anything so serious.  I’d teased my mother after I’d got off the phone… (in pantomime voice): We’d never have had to go out on these roads if you hadn’t made me make that call! And again when they told me we had to stay the night… I’d be at home with a nice cup of tea…  None of this would have happened if you hadn’t made me call! The joke of it was patently obvious to me — the situation was clearly a serious one and I was glad to be in the hands of experts.  It was only an attempt to lighten a frightening situation …and perhaps to alleviate my own discomfort at the realisation that my judgment was so off the mark.

My mother cried when I relayed what the follow-up doctor had said — the severity of our near miss suddenly painfully real.  I didn’t cry — not because I didn’t feel the same rush of emotion, but because I felt… instinctively guarded.

“Well,” she said, and laughed a little, “I do feel vindicated!”

“Vindicated?”  I asked.  I don’t know why I asked — I knew exactly what she meant.

“Yes, after all your saying it was my fault we had to go to ER, I do feel vindicated!”  And the laugh again, the one that was meant to cast a tone of jest over true words.

I was right and you were wrong. Isn’t that what she was saying?  I told you so!..  That phrase which gloats over someone-else’s mistake, the same words which we tell children it’s not nice to say…   I was suddenly angry that she would feel the need — feel free — to share with me her feelings of victory, at the very moment I was feeling all the terrible gravity of what might have been.  Why make a point of how right she was just as I realise how wrong — how dangerously wrong — I was?  Suddenly, the conversation became stilted and I wanted off the phone.

But she is right: her vindication is well deserved.  I was not going to make that call.  I didn’t see the danger — the danger right before my eyes, lying right there listless in my arms.  I would have just carried on as we were, watching my daughter struggle to breath as we went into the night.  No one should be more diligent than me, no one a better advocate for my daughter — a louder, more biased, more demanding advocate — than me…  her own mother.  And I got it wrong — on the one night that she really could have died.  I am actually having quite a bit of trouble with that.

Read Full Post »

Reality Check

We went to the doctor’s today for E2′s post-hospital follow up, and saw the same doctor whom I’d spoken to on the phone and who’d told us to take her into ER.  She looked at the notes and, when she saw that they’d kept E2 in for the night, I could see how relieved she was that we’d listened to her and gone, despite my protestations about the weather.

“So, tell me what happened…”  I explained about the steroid shot in her leg, the breathing treatments, the chest x-rays, and I demonstrated the way I’d had to hold my daughter as she went into her strange, back-arching panic attacks.  “Yes, it sounds like her breathing was going into spasms.  It happens with croup — they get to a point where they can’t control it.”

When I told her about the third breathing treatment, she paused in her note-taking and looked up at me, her hand dropping to her lap.  “They did three treatments?”  I nodded.

“They don’t usually have to go to three treatments.  She must have been in a very bad way, worse than I realised.  You know, I debated in my mind whether to have you drive her into ER or to have her go by ambulance…  but from your description, I think she should have gone by ambulance…”

I looked up at her, stunned.

“Children can develop a tendancy toward croup, particularly when they are so small, as she is, and when they’ve had it so bad before.  If she ever starts to show those symptoms again,” she leaned in to make sure I was taking in every word, “don’t hesitate to go straight to the Emergency Room.  And if she ever gets bad like that again, she needs to go by ambulance.”

Whoa.

Read Full Post »

Breathing Slowly, She and Me

At 1am, I was alone with E2 and a nurse on the darkened hospital isolation ward, watching my daughter strain to draw breath and answering all the same questions that I had answered four hours earlier in the Emergency Room.  I appreciated the nurse’s thoroughness and I felt safer for being in a place where I knew we’d get the best help, but I was feeling exhausted, alone, and so frightened.  When she asked me to strip E2 down in order to weigh her, I took off her shoes, top, and trousers, but left her onesie and nappy on — it was a bit chilly, and my baby was sick — but, when she saw this, she corrected me, “No no, I need you to strip her right down.  We need to know exactly how much she weighs so when they weigh her tomorrow, they will know precisely if she’s lost any weight.”  And with that one comment, I realised just how serious the situation was — if they were worried about how much weight she might lose in one night, then there was little room for error.  I took off the rest of her clothes and placed my daughter naked, gasping — her neck and chest and stomach collapsing grossly inward with every slow breath — onto the scale.  It read 10.89kg.  Two years ago to the day, just moments after she’d been born, the midwife had placed her on an identical set of scales, and she had weighed 4.22kg.  Two years…  two years… and she’s barely doubled her birth weight, something most babies do at four or five months.

When the nurse handed E2 back to me, I picked up one of the nappies from the pile the hospital provided and realised immediately that it was far too big: the legholes gaped around E2′s skinny legs with an inch to spare on either side.  They were size 6 — perfectly right for a girl her age — and I asked the nurse if we could have 3s instead.  E2 wears 3s and she has for the last twelve months.  In a year, she has never gone up in nappy size.  Any mother will tell you that’s not right.

Later, when two doctors came in, I had to repeat the whole story again — how she’d had a runny nose for two days, how today it had taken a turn for the worse and she’d developed a fever and become miserable and listless.  When her breathing became laboured — so difficult and wheezy that I could hear her struggling for breath even from the next room — we’d rung the doctor, who’d told us to go straight to the emergency room and specified that she’d wanted us to go the specialist children’s hospital in the center of the city.  My heart had sank at that.  Seeing how bad E2 was that morning, I had canceled our planned birthday lunch and my mother had come round for an improvised mini-party at the house instead.  As the day wore on, the birthday girl wanted nothing more than to rest her head against my chest and try to breathe.  We spent much of the day on the couch, watching the heavy snowfall cover the road, and the cars as they each slid sideways down the hill.  It was turning out to be a good day to stay home and I quietly gave thanks that we had no reason to have to brave those roads ourselves — until the doctor ordered us to ER, through the snow and mess, and at rush hour.

The first doctor left — so soft spoken and heavily accented that I’d struggled to understand a single word she’d said — and the second doctor pulled a chair up.  He smiled warmly — no one had done that yet, and it surprised me to realise how much I needed that smile.  “My name is Tom.  Let me explain what we’re going to do…”  He was a few years younger than me and nice looking…  I stopped listening to him and started thinking about how he could be so good-humoured and kind and… well, awake at 2am.  I found myself thinking that he must be the kind of person who meets life head on.  That’s the kind of person who gets themselves through medical school, isn’t it?  Someone with enthusiasm and energy and a positive outlook on life?  I wondered what my life would be like if I’d ended up with someone like that, someone driven and positive and enthusiastic.  A few weeks ago, M had told me that he thought the innate positivity of  the US had been rubbing off on him and that he reckoned his own positivity had increased probably 40% since moving here — and I was gobsmacked at this declaration.  Where? When?  …At work? Yes, he agreed, probably at work…  Must be, because at home, I see no change.  He allows all his exhaustion, fears, insecurities, and negativity to come to the surface unhampered.  I know it’s better that he show his positive side at work, even if that means his reserves are empty when he gets home, because that’s where our bread is buttered, but it’s hard to live with someone who spends the rest of his life just waiting for the day to end.

When I stopped myself and tuned back into what the doctor was saying, he was explaining that she had an ordinary virus, but that it was dangerous because she is so small, and so the inflammation in her chest was threatening to close her airways.  They wanted to do another breathing treatment — nebulised epinephrine, her third treatment since we’d arrived — because her breathing was so strained that they were afraid her breathing muscles would fatigue.  “Fatigue?” I repeated, knowing what it meant but wanting to be wrong.

He paused, and then saw that I needed it said more plainly.  “Yes…  her muscles might… stop.”

I asked what would happen in that case and he said they’d have to insert a tube into her lung to keep her going.  At least, that’s what I think he said.   I hadn’t eaten since breakfast, I was so tired, so mentally exhausted, and my mind had ceased working when he’d said there was a chance her breathing might stop.  I don’t know what he said to me, or what I said to him.

It was a strange night — she spent half of it flailing wildly in my arms, arching her back and screaming blue murder.  I held her to me forcibly and she finally, finally succumbed to exhaustion and fell asleep in my arms.  I adjusted myself into as comfortable a position as I could in the chair and watched her breathing — still laboured, but still breathing.  I mused to myself that we’d been in hospital this same night two years previously and then realised with a start that we’d been in ER exactly one year and a day ago as well… and decided I didn’t much like this trend.  But eventually, my thoughts faded and sleep over came me, at long last.

Fifteen minutes later, the nurse woke me to say they’d felt so bad to see me sleeping upright that they’d found me a reclining chair.  I lifted myself out of my seat,  gently…  gently…  and let them swap the chairs about.  Someone took a mis-step, the chair came down with a bang…  and she was awake, screaming and crying wildly for another full hour.  Finally, at 4.30am, I calmed her enough to sleep again, and laid beside her.  She woke again three times before 7am, but it was sleep, of a sort.

The doctors came around to see her again in the morning: the Indian one I couldn’t understand, a specialist of some sort, and a team of eight medical students.  Her breathing was better and they were pleased, but the specialist was not fully convinced, and ordered chest x-rays.  Mid-afternoon, they came back clear, and we were ok’d for discharge.  Her breathing was still strained, but nothing like it had been, and her fever was gone and she had returned to her lively self again.  With strict instructions to watch her closely and return immediately if she worsened at all — and a deep sense of gratitude that the worst was over and she was going to be alright — we headed for home.

The house looked much as we’d left it the day before, birthday presents lying where they’d been left.  The girls were both out of sorts after all the upheaval — alternating between playing and disoriented crying.  My mother tried to soothe E1 while I went to make us all a cup of tea.  …I didn’t see the snowglobe on the edge of the fireplace.  My mother had brought it as a “little something” for E1 amid all the birthday fuss over her sister and, when she opened it, I had winced inwardly.  A glass snowglobe does not seem to me like an appropriate toy for a three year old, but my mother doesn’t think of these things, and I am not permitted to express such criticism without it creating a problem, so I bit my tongue and planned to secret it away (with the other two equally inappropriate snowglobes) at the first opportunity.

But in our rush to leave for ER, it had been left right there on the corner of the fireplace.  And as my mother soothed a confused and crying E1, and I stood sleep-deprived and dazed by the kettle in the kitchen… little, wheezing, curious E2 had spotted it and picked it up to look, and promptly dropped it at her feet, where it broke into a hundred shards of glass that sprayed in an arc ten feet across the room.  I ran in in an instant and lifted my barefoot daughter up and away from the glass, and told my mother to do the same with E1 — no, lift her out, don’t walk her out.  And then, I took a deep breath, and  got down on the floor and began to clean up the mess.

Read Full Post »

Follow Up Appointment: the Result

We went to hospital today for a combined appointment for the girls: E2′s follow-up appointment and E1′s allergy test. The pediatrician had realised that his secretary had scheduled separate appointments one week apart and, aware that it takes us about an hour to get to the hospital, he very kindly arranged to have them combined. I am relieved to report that it was a much smoother day than our last appointment.

We saw the nurse first, to have both girls’ allergy prick-tests. E1 was being tested for egg; E2 for banana, tomato, avocado, and latex. The nurse pushed E1′s sleeve up and carefully wrote five sets of characters down her arm with a ballpoint pen.  She turned to me, stunned — she knows very well that you’re not allowed to write on your skin with pens! Then the nurse carefully put a dot of liquid next to each pen mark. E1 found this intriguing and looked at me in wonder, then at her arm, then back at me. The nurse said, “And now, we pop the bubbles,” as her assistant tightened her grip on my daughter’s arm. She pulled out five sharply pointed metal pieces, and swiftly jabbed each one through a dot and into the skin. E1′s face suddenly registered shock, and then quickly squeezed tight and her eyes went red with tears. She looked to me and I tried to reassure her that she was ok, but as she turned back to watch the metal pricking her arm, her face was frozen mid-sob and the tears rolled quietly down her cheeks. But I was so proud of her — she didn’t scream, she didn’t pull her arm away. She cried quietly, and bravely kept her arm in place, because she’d been asked to. She’s two-and-a-half. She’s a remarkable girl.

When it was finished, her bravery left her and she sobbed loudly and buried herself in my shoulder. I rocked her for a moment or two, and then settled her in the push-chair so that we could do the same to E2. I was all ready to dole out more loving reassurance but, amazingly, the baby hardly seemed to realise she was being injured. This child, who has spent most of the last year complaining about everything within a 20-foot radius, smiled blissfully at the nurse’s assistant for the entire time she was being stabbed with various allergens.  I was stunned.

Ten minutes later, E1′s arm was bright red and welting impressively. The doctor told me that any welt over 5mm was considered to be a “properly” allergic reaction — hers were 9mm, 10mm, and 14mm. He said we are ensure she doesn’t eat egg of any sort — either on its own, or as an ingredient in sauces and mayonnaise, or cooked into cakes and biscuits — for at least a year, and then we should have her prick-tested again. He also kindly suggested that he would have the hospital dietitian ring us to discuss her diet.

E2′s arm was very calm by comparison. The only welt was in reaction to the avocado, and even that was only 4mm across. She had no reaction at all the banana or the latex, which surprised me greatly, given how much she had struggled after eating banana and how red her hands had been under the latex squares. The pediatrician and I discussed her diet and her reactions to various foods. I explained that she’d begun scratching her face as soon as we’d given her yogurt, and he felt that indicated clear reaction to dairy, even though they hadn’t tested for it. He said we should ensure she has no dairy for the next six months, and then try it again carefully, watching for a reaction. He also said that, for the next year at least, we should ensure she doesn’t eat avocado (as she had reacted to it), and also not give her any nuts or eggs (which will be easy to do now that we have to avoid them for her sister as well).

Toward the end of the appointment, E1 started coughing wildly, so hard as to nearly make herself ill — something she started doing last night — and then her breath became wheezy and laboured. Still anxious from the trauma of her surprise stabbing, she crumpled into immediate sobs and came straight to me for comfort. The doctor listened to her chest with his stethoscope while she looked at me wide-eyed and alarmed in case this new instrument had a similar surprising sting. I held her hand and told her it was ok, but she never took her frightened gaze off my face. When he was done listening, he diagnosed a case of croup. I explained that she’d woken up crying with it several times the night before, struggling to breathe. He gave us a prescription for a mild steroid to reduce the swelling in her throat, so that we have it in case we need it tonight.

And just before we left, he weighed E2 again: 7.886kg (17lb 6oz), a gain of nearly 400g (14oz) in a month, which means she has remained on the 9th percentile.  The doctor is satisfied with that gain, and feels that she has simply found “her place” on the chart. As he said, she’s clearly a well nourished and thriving baby — and I have to agree — so he felt there was nothing really to worry about.

I am so relieved to have E1′s allergy properly diagnosed and to have a course of action. And, although it surprised me, I am very pleased that E2 isn’t allergic to bananas and latex, and very pleased that she has put on some weight. We will stick to careful diets for both of them for now, and then see how things are in time. Most of all, I am just grateful that we walked into that hospital with worries that were so minor, compared to what some parents have to deal with, and we walked out with fewer worries than we went in with.

Read Full Post »