Thursday, November 19, 2009

Eowyn's First Trip to the ER

I knew she probably had the flu. How? Well, because I had it and she's still depending on me for life, clothing and mobility. And the entire Powell clan had it right before we left them. So, when Eowyn started being extra-refluxy and congested Tuesday, I suspected that she'd come down with whatever the going trend in sickness was. Wednesday she was still spitty and therefore fussy and having trouble getting long naps in, but no fever.

Then I went to get her from her afternoon nap at 6:30 and she was very warm. Next time I'll take her out of her warm room and warm quilt before taking her temperature, but I just did it then. Not being able to get a consistent read on the forehead I went under her arm and got 100.4. That's getting high for an infant so I called our pediatrician's office... which went straight to the answering service. The nurse told me I had to get a rectal temp and to call back. I did (my first time-- thank you Gram & Gramps for the thermometer!), and it was 100.6. The nurse began to insist that I immediately take her to Kosair's, our children's hospital's, ER. When I tried to ask more questions all she would say was "How long will it take to get her there? I am going to call ahead. Get her in the car now." I knew that Eowyn's fever was not THAT much above the cutoff point for real alarm (100.4 is the cutoff) so this annoyed me. She was still eating fine and acting relatively normal, so I waited a half hour, took her downstairs to nurse, put a cool cloth on her head and took her temp again, and it was down to 99.3. Ryan & I conferenced about whether or not to take her in. On the one hand, we knew that we'd probably get a rigamarole and push for multiple tests, and then a probable viral diagnosis. You can't do much for viruses except treat symptoms and wait it out... push the breast-feeding and hold her a lot. On the othe hand, we know we're first-timers at this parenting thing, and might not be able to tell if/when something went badly wrong, and the peds ER was our only option (why didn't you get your fever 2 hours earlier, Eowyn?). So, we decided to try one more temp reading and then go if it was higher than before. It read 100.3 so we got our stuff together and went. Of course she had a nice spitup all in my hair right as we were on the way out the door, lol.

The ER was really nice as far as they go-- everyone was so kind and friendly; that's the perk of a children's hospital! Once we found the emergency entrance (you'd think it'd be well-marked...), I went in and spelled out Eowyn's name about 10 times. It isn't exactly paperwork-friendly. =D They saw us really quickly because she is so young (under 3 months). We found out her weight, too-- 11lbs 8 oz (5.4 kg). Her temp was up again after the bundled-up ride in our warm car; 101.2, so the admitting nurse gave her Tylenol-- her first time. Then after a very brief sit in the waiting room, we were in our "treatment room." The first nurse who came in checked her ears, her chest, her back, and her skin, and said she looked really healthy except for what seemed like the flu-- quite likely since it's what I "seem to" have had. (yeah, I did have it-- I just didn't get a blood test for it so it isn't certain according to ER lingo) Resident doctor came in, checked all the same things, and said the same thing. She was of the mind that we'd probably be sent straight home with some Tamiflu, since it was so likely the seasonal flu. [Why Tamiflu? Well, because they're treating everything as the swine flu... so nice to know that all our stats are totally skewed because of that now, isn't it?] Oh, and the flu tests they have were missing 90% of all cases, so they weren't even bothering testing for the flu at all. So there's no way to actually confirm a flu, except to rule everything else out.

Then she came back, saying that her attending physician was a bit worried because we'd said E was "fussy" the day before, which can be a sign of a bacterial infection, so they wanted to do a full sepsis workup, including blood culture, RSV swab, urine sample and spinal tap. I flat out refused the spinal tap (Ryan says I should have been nicer about it. I wasn't trying to be rude at all! I just wanted there to be no question at all about my swayability on the issue of my infant's spinal fluid being extracted!! I think the doctor understood... I tried to show her I wasn't mad or anything by smiling extra-big at her later), and wasn't sure about the other things, either. Anytime you have to get any fluid from an infant, it's pretty invasive and traumatic. Since when is "fussy" only a sign of bacterial infection? I know how I felt with the flu, and if I couldn't talk, I'd fuss, too!

The attending came by-- mind you, each visit had at least a half-hour interval between them. I breast-fed Eowyn a couple times, and we mostly just rested together on the bed there-- and she checked all the same things on Eowyn, plus some of her reflexes and strengths. She agreed with us on the no spinal tap, saying that she looks really healthy despite an upper-respiratory infection, "probably the flu." But she said her fever could still be caused by a UTI, which we'd only know by getting a urine sample. I finally agreed to that, even though it meant catheterizing her. They said they used numbing jelly which helped with the pain... I figured that if it was a UTI this would be the only way we'd know, and UTIs DO cause high fevers. As for the RSV swab, fine- that's just a little swab and it made sense. The blood work... well... I finally agreed to that too (No one was pressuring us-- Ryan & I were just weighing the options and we decided to err on safety's side this first time around, so we'd have a baseline for future illnesses). Of course, I say no one was pressuring us, but anytime someone with a degree and experience "recommends" that you do something, it's pressure. I WISH there was a way to know the actual likelyhood... oh well...

So we went next door with her to the "procedure room," and I held her hand and stroked her face while they poked and prodded and pricked her. Poor baby-- she is so utterly helpless and dependant on us. It scares me how much we could hurt her or let her be hurt. She and all those like her need to be treasured and defended!! The nurses commented on her long legs, and how strong she is. They also noticed that she likes to look at me, and that made me sort of glad. Maybe she does know and love me already... but then I'm the one letting all this happen to her. :( Anyway, as usual she did not "bleed" well, and they finally called in another nurse to draw blood from a vein on her scalp. She looked like a little angel with a halo, or an alien with a head-tube, once they had the hep-lock in her head. :(

Finally all the tests were over and I could comfort her and feed her to sleep again. Sure enough, everything was negative and we were discharged by yet another pediatrician at 2 am with instructions to monitor her closely, give her Tamiflu and Tylenol and go see our pediatrician in the morning. If we hadn't gone in knowing that would probably happen, and treating it all as a learning experience, I think I would have been really mad. Not at the doctors or nurses-- they were sweet and capable-- but at the mentality that rules everything out without ever confirming the simplest thing first. But now we know what "flu" looks, acts, and sounds like, and we'll know that for all Eowyn's illnesses and all our next kids' too.

We were a bit wary of the Tamiflu, since what we read about it indicates that it's never been given to infants before, and has only been "emergency approved" because of the swine flu scare (which we view as mostly hype anyway, having had family members and friends go through it and survive quite well). The potential side effects were pretty nasty, and a friend's friend's two year old was hospitalized from her reaction to it. It's a drug, and we aren't so into pumping our tiny daughter full of them without pause. We decided to wait to see what our pediatrician thought at least. Ryan drove us all over town to find an open pharmacy to get some infant Tylenol... I called the ER again to get her dosage... finally we were home to try and get some rest. I vaguely wondered how I was supposed to on the one hand watch for lethargy in an over-tired, sick baby, and on the other hand watch for sleeplessness in a fevered, clingy infant.

Eowyn was miserable after all that, and wouldn't let me put her down to sleep at all. She'd fall asleep in my arms, then cry as soon as I set her down. I was so tired myself, still recovering from my own flu, that by 6 am I was almost crying, pleading with her and with God to let her sleep. It's all pretty blurry to me now. Her fever still wasn't really down, and I didn't know what to do besides rock her and put her down when I thought I'd drop her. I didn't want her to cry though because poor Ryan was just as tired, and we don't want HIM to get sick, too! Finally at 7 I could give her another dose of Tylenol and I put her next to me to nurse in bed and finally we all 3 fell asleep. Since then it's been better. I gave her a bath around 1 that really helped with the fever and crankiness-- she was almost back to her old self in the water! Since then she's finally slept better (on me, of course). I hope tonight she feels well enough to sleep in stretches instead of snatches!!

Our pediatrician's office agreed that we don't need to bring her in unless she gets worse, and also that it's probably unessecary to give Tamiflu; Tylenol would do just as good a job in a child this age/size/weight, without all the risks and questionable effects. So I'm sticking with it and cool cloths, breastmilk, and cuddling all day.

Wow! If you're still reading, you must really love Eowyn! Or maybe you're a bit voyeuristic, lol. Now you know all about our first foray into childhood sickness as parents. Our germ philosophy is that sickness is inevitable-- everyone WILL get sick some of the time; it's just life in this Cursed world. Sickness ins't even inherently bad; you've got to do it, and if you get illnesses and fight them off, you'll get less and less as you & your immune system get stronger. So I'm hoping to build up my kids' immune systems with breastmilk, and later healthy food & habits, and then nurse them through whatever they can't fight off, in the hopes of growing healthier adults for the sake of the Kingdom. All of that- the building, the nursing, and the watching them be sick- I am committed to doing trusting in Jesus ultimately for their care. They all will be His; I'm just a steward. May I steward well!


Anonymous said...

Oh I know how bewildering and frustrating this whole thing can be! You want to do what's best for your precious little one and the hospital system seems set on such invasive workups and it's so hard to know what the wisest course is - Paul and I have discussed many a time how much parenting (esp. parenting an ill baby) drives you to your knees constantly before our sovereign Lord pleading for discernment and grace (and sleep!!). Sleeping with our baby was the only way we could all get rest many a night, but then we grew to treasure the closeness even when he was well, the time when they're little flies by so fast, you don't want to miss a moment. I hope your sweet family gets lots of rest and recovers soon! :)

Glen said...

Definitely voyeuristic when it comes to the crazy Szramas...haha! Seriously, I think you guys did a great job of navigating your first ER trip. The wonderful medical system - for which I thank God -can be downright bewildering when you're making decisions for your precious kids. I wonder if that nurse on the phone thought you said 106 instead of 100.6....? Bethany M.

Amy Donell Molina said...

wow... what a journey!!! I know that sick little look that just looks at you like, "mommy, can't you please just take this away.". Although Jillian's 1st fever wasn't cuase of an illness but a common reaction to her vaccination.... it still breaks any mother's heart.

Love you all!!!

amy, clau, and jillie