Tuesday, January 28, 2014

A Visit to the ER

Last week we hit a milestone for the baby book- though one I was hoping to avoid for a very long time, or hey, maybe forever.  Elijah had his first trip to the ER.  His first sign of illness was over Martin Luther King Day weekend. It started with a cough.  But honestly, he gets a cough about every 2 weeks during the winter.  So we just decided to wait for it to pass, and manage the symptoms with a spoonful of honey at bedtime and a humidifier.  It didn't seem to bother him at all though.  In fact, he was in a remarkably good mood all weekend.  He was quite tired starting on Saturday.  He fell asleep while we drove about 20 minutes to the other side of town at around 9am.  We just let him take a little nap, figuring it would give him a little rest and allow him to make it to naptime without becoming overtired.  Besides that it was a normal day.   Daniel decided Saturday night on a whim to rip out the shower in the guest bathroom, so we were planning on installing a bathtub during the remainder of the weekend.  I remember waking up Sunday morning (Elijah actually slept in!) and we lit a fire in the fireplace and just laid around all morning doing pretty much nothing.  We went to Home Depot to buy a bathtub, and Elijah fell asleep on the way home.  This time, it took about 3 minutes.  So we took that opportunity to go to one of those drive through car washes and let him sleep.  When we got home, he woke up.  Sort of.  He was awake, but extremely lethargic.  He just wanted to sit on my lap.  We sat in my bed and watched over an hour of Sesame Street while Daniel worked on the bathroom.  I couldn't believe it.  He's never sat still to watch anything for more than 10 minutes.  But it still didn't phase me.  I could tell he had a fever, so I thought he was just sick and needed some rest.  After he ate nothing for lunch, I put him down for a nap.  FOUR HOURS later, he was still fast asleep.  Like completely out.  I went in and woke him up to make sure he would go to bed on time.  His temperature was at 101F.  The evening was spent again just sitting in my lap.  That's all he wanted to do.  He went to bed easily about 30 minutes earlier than usual.  Monday morning was similar.  He was very lethargic, felt warm, and slept 4 hours again before I woke him.  We knew at that point that he couldn't go to school on Tuesday.  So we planned for Daniel to stay home with him.  I really thought he would wake up feeling much better and we would be able to take him back on Wednesday.  But he woke up Wednesday with a fever.  At breakfast, he coughed so hard that he vomited.  A lot.  Right then Daniel called to make a doctor's appointment.  I went to work with the goal of getting as much done as possible because I would have to stay home with him on Wednesday.

Daniel texted me from home to show me that he fell asleep right on Daniel's lap at 9am.  He put him in the crib and let him sleep until they had to leave for the doctor at 10am.  Then he texted me from the doctor's office.  His oxygen was very low.  They gave him a nebulizer treatment with albuterol, and his oxygen didn't improve at all.  He called me to tell me that there was a very small chance that he would have to go to Children's Hospital.  I panicked because I had work that I couldn't do until that afternoon that was really important.  I let my boss and co-workers know what was going on, but none of us thought he would really end up at the hospital.  Daniel texted me that they were taking him to radiology for a chest x-ray to rule out pneumonia.  It came back clean.  But, oxygen was still low.  He was still very lethargic.  He needed to be on oxygen long term.  So the decision was made to send him to Children's Hospital.  I'm actually surprised how well I held it together.  I informed my boss and immediately she told me she would take care of everything and I could leave.  I was so grateful.

I called Elijah's teacher to let her know what was going on, and she was the first person to mention RSV to me.  I told her that the diagnosis was bronchiolitis, and she asked me if that was related to RSV.  She explained that a child had been allowed to come to school with a doctor's note after he/she was diagnosed with RSV.  Now many children in his class were out sick.  In fact, only half of them were there that day.  I told her I would ask the doctor about RSV and thanked her for that information.  She was extremely apologetic and was very worried about Elijah.

I drove over to Children's Hospital (which is on the same campus as my work) and went to the ER.  Daniel was in an ambulance with Elijah and they pulled up soon after I arrived.  I was allowed back and I met them in the hallway with the EMTs.  I was so very happy to see him.  But also shocked.  He was strapped in a car seat-like harness onto a hospital bed clutching his monkey in one hand, and his sippie cup in the other.

We were taken into a room where they started taking all his vitals.  I asked about RSV and they confirmed that that was most likely what he had.  They have a standard course of treatment that they follow- 8 hours of observation in the ER and then if he doesn't get worse, he can go home with an oxygen tank to use at home.  We will follow up with Elijah's pediatrician in 24 hours.  So that's what we did.  We were taken to a private "observation" room with a TV, bed, crib, and private bathroom.  We tried to get Elijah to sleep (he missed his nap entirely, though he did doze on and off in the various doctor's offices).  He couldn't sleep, so I gave up.  He pulled out his oxygen tubing and his pulse oximeter multiple times.  He mostly did okay with the nasal cannula in, but the act of actually placing it on his face was a battle.  He was tethered to the wall so we had to keep him happy and calm on the hospital bed.  It was pretty easy since he was so upset.

A respiratory therapist came in and gave him an experimental treatment that I approved ahead of time.  It was a nebulizer just of saline.  I figured saline couldn't hurt, and it definitely sounds like it would help.  Well, it was awful.  It was like watching my son be tortured.  The saline was intended to irritate his airway and cause him to cough up any mucus in his lungs.  The result was that Elijah coughed so hard that he could barely catch his breath.  It sounded like he would vomit from coughing so hard.  By the end of the 10 minute treatment, he was so exhausted that he fell asleep sitting up on the bed with the mask still attached on his face.  She also put a vacuum tube in his nose that sucked out all the mucus and everything.  The nurse had to hold him down while he kicked.  But by then he was so exhausted and sick, he didn't have much energy to fight.  After all of that, we just waited for the 8 hours to expire.  That put us at 10pm.

Daniel had gone to retrieve our car and some things for the evening, so I was on my own.  I couldn't go anywhere because I had to keep Elijah on the bed and hooked up to oxygen.  We played with some toys and spent a lot of time cuddling.  He was so sad and uncomfortable.  His temperature was around 104F, so they gave him some motrin.  Daniel got back about 6pm, just in time so that I could eat some dinner and we could get Elijah to bed.  At home, we bathe him, put lotion on, and then just put him in his crib and close the door.  He goes to sleep happily on his own.  That didn't really work in one hospital room that was noisy and bright.  So I held him and rocked him to sleep.  He fussed a little, but fell asleep by 7:30pm.  I laid him down and he slept until we were allowed to leave at 10pm.  Some people came to show us how to use the oxygen tank.  And then we were free to go.  We all collapsed into bed around 11pm.  I was worried that Elijah would get tangled up or strangle himself with the oxygen tubing, so I didn't sleep much.

The next morning, Elijah seemed like he was feeling a little better.   Elijah hated being tethered to the tank.  Every time he saw the cord trailing behind him he would scream and get upset.  But after a few hours he started to ignore it and play normally.   Some people delivered a bunch more oxygen tanks to last us a few days, and they also brought an extra long 50 ft cord so Elijah had a little more freedom to walk around the house.  He still didn't like it, but it was more tolerable.  He also didn't sleep well with the tubing attached.  I ended up spending a lot of time holding him and rocking him the rest of that week.  I missed the whole rest of the week of work.  Daniel stayed home with us on Wednesday, but went back to work on Thursday and Friday.  We went to see the pediatrician on Wednesday afternoon and his oxygen levels were still too low to take him off oxygen.  By Friday he seemed much more like himself.  His appetite was near normal, energy level was near normal, and he had no fever.  That morning his pediatrician approved him to go off the oxygen therapy.  I was so glad to see my baby feeling better (although I'll admit, I will forever remember those 4 hour naps fondly).

His pediatrician explained that in Denver it is much more likely that a young child with RSV will need supplemental oxygen.  The elevation is so high here that children can reach dangerous levels more easily. At a lower elevation, a hospital would never send a child home with RSV.  But because it's so common here, they try to minimize the cost and disruption.  I was so glad that we didn't have to stay in the hospital.  All he needed was oxygen, and we could relatively easily get that at home.  One other child in Elijah's class was hospitalized.  He was out the rest of the week, and went back to school on Monday.  I think he was very glad to go back.  I really loved having an entire week to spend with him, but we got pretty bored stuck at home.  I feel like we bonded a lot and I will always be grateful for that aspect of his illness.  I also was grateful for incredible co-workers who stepped up and took care of everything at work.  I was shocked by how many people sought me out on Monday to ask me how Elijah was doing.  Just another reason I love my job.  I am also glad that I know now what symptoms to look for to know whether Elijah needs medical attention or not.  I am glad to say that our first hospital visit is behind us.