Tuesday, February 20, 2007

Thoughts on a Trip to the ER

Well, Morgan finally made us take her to the ER in the middle of the night. (If you'd like to keep score, it's now Ryan: 4, Morgan: 1.)

I kept thinking that she had a hideous nasty virus due to the thick increasingly smelly* snot oozing out of her face. In fact, I skipped my weekly gathering of Objectivist friends and music class because I was convinced that she was contagious.

After only 7 hours of sleep Wednesday night (which followed about 7 the night before--not enough for a 22 month old--barely enough for me as a matter of fact!), I got her in to see the doctor on Thursday and sure enough she had an ear infection. I asked the doc about the smell*, because I know that smelly* snot can indicate a foreign body and I also know that Morgan has inserted foreign bodies into her nasal cavity before (try 4 peas!). Doc kind of shines her light up there, declares the smell* "not so bad" and says she doesn't see anything.

You can see where we're heading, right?

To continue....

I started her on the antibiotics the doc prescribed for the ear infection--we usually try to hold off to see if the infection will clear but in this case it was patently obvious by the smell* that there was an infection going on. That night, just as Brendan and I were settling into the the latest episode of 24, Morgan, who had fallen asleep in my arms, began to struggle to breathe. Retracting is the medical term--belly sucks in under the ribs, throat above the collar bone sucks in, oxygen not entering body, etc. Bad. We know all about retracting because of Ryan (episodes include birth, ER visit #2, ER visit #3, and various Urgent Care visits). I give the pediatrician a call and speak with the doc-on-call (who we happen to really like). She describes various strategies, including steamy shower and Afrin nose spray, but she is careful to insist that if Morgan did not improve we needed to take her to the ER.

Well, we first began to really suspect that she had something lodged up there when our second squirt of Afrin foamed up and ran back out of her nose! Honestly, I was pretty amused--except for the fact that she struggled to breathe every time was put her in a horizontal position. Called our dear, dear friend and next door neighbor who kindly came over and camped out on our couch to be with Ryan. She's the one who first spotted "something dark blue" up there. It was kind of difficult to spot--waaayy in the very back--in her sinus cavities! Damn.

Brendan was really irritated about having to go to the ER because it always takes about forever, plus it is filled with other people who thought their child was too sick to take care of at home and (rightly) brought it, germs and all, to the ER at the same time. The nerve of these people!

We went to Scottish Rite, one of the hospitals I am familiar with. Or used to be--everything is all changed around and whole entire wings have been added on since I worked there. We figured it out--always valet your parking at the ER!--and I was pretty impressed with the layout, although not the glaring green color of the waiting room.

Morgan had fallen asleep by then (upright in the carseat yay) and pretty much slept while Brendan and I watched Disney movies and kept a careful distance from the Level 4 contagions emanating from the other (poor) patients. Then we were called and the Fun began.

Nobody believed us! The ER doc and respiratory therapist (whose job was to stick flexible suctioning tubes through her poor nose and down to her throat) declared that her nose wasn't blocked, merely inflamed by all of our messing with it (nose spray, etc.). The RT especially just kept saying, "See, I can pass the catheter" while he continued to slip that thing in and out of my poor baby's nose. Brendan and I recounted the Story of the Peas. We mentioned the Smell.* General unconcern and did I catch a hint of "hysterical parent" lift to the eyebrows? At one point an X-Ray was suggested, I think, just to appease us. 101 Dalmations played on in the background.

Morgan was such a trooper. As soon as the Evil People left the room, she was all cheery and talking about the dalmatians and snuggly and her usual self. Once they came back, she was sad.

Brendan and I got really frustrated. The ER doc came back ready to dismiss us (about 2:30 am now) and Brendan and I both told her, "We really think there's something up there. She's done it before. There were peas." The doc says she'll just look one more time, shines her little light in one more time and then declares "There's something in there!"

Okay, so now we're getting somewhere, right? Doc lets us take a look--I see something bluish-gray. Hmph. So now it's time to go get it, right? Doc gets out her long skinny tweezers (oh my poor baby) and grabs it and can't get a hold. Keeps trying only now there's blood. (Not to mention the screaming.) Now the doc declares the object "attached" and tells us, "It doesn't look like a nasal polyp" in what I'm sure was meant to be a reassuring tone of voice. This thing has ceased to be amusing and has now turned into downright worrisome.

Since doc can't identify the object, she gets another doc to come in for a consult. I was a bit relieved that it was one of the ER docs I knew from way back when (although he would have no reason to remember me and didn't). So he looks in there, says that he's pretty sure that it's not a nasal polyp. Both docs don't want to remove it, however, because of the blood and the fact that it's "attached" and they believe that it's best left to an ENT. At this point, we agree, since (in my naive judgment) it's only a few hours until an ENT or our pediatrician's office would be open, and Morgan was breathing just fine now that the object was no longer in her sinuses. ER doc called regular doc with the plan that we would call them in the morning to see if they want us to go there or to an ENT. We get home at 4:00 and I spent the rest of the night upright in the chair with her, waking up every 10 minutes to make sure she was breathing (recall those newborn days?).

So at 8:30, we call our pediatrician to set up an appointment or get the name of an ENT. Nobody calls back. Call at 9:30. Nobody calls back. I am loopy with lack of sleep, we have Tree Remover PeopleGuys coming to take out 5 trees in the back, my parents are arriving in the evening. My child still can't breathe very well lying down, plus which all of the fooling around with her nose the previous 12 hours has resulted in an almost overwhelming increase in the intensity of The Smell*. About 11:00 I start trying to find ENTs online and had just left one of them a voice message when the Tree PeopleGuys show up (interesting interlude for the kids and good excuse for Brendan and I to sit down and do nothing for a while). Left another message for the pediatrician--I'm so pissed at this point. Made it clear that I knew they are busy with the flu and god knows what else, but the bottom line is that MY CHILD CAN'T BREATHE and the ER docs couldn't remove the object from her nose and what the heck are nasal polyps anyway.

Suddenly, I'm getting a call back from the pediatrician. She's so nice and has scheduled us an appointment with an ENT (the one I had called) for the 20th. Excuse me, but what the fuck? She must have heard me gnashing my teeth because she hastened to add that she had the ENT office on the other line and they thought they could squeeze us in later and could we do that instead? Durr. My kid can't breathe so I'm supposed to keep her in an upright position for 5 days until I can get her an appointment? Yes, please, I think I'll take the "squeeze in" opportunity. I know that this appointment came about as a direct result of my repeated phone calls and using phrases (provided to me by my neighbor who has a friend who is a peds nurse) like "respiratory distress" and "retracting" and also by NOT yelling which is really what I wanted to do. I'm growing as a person here--I like the fact that I was able to get those results. Finally learning how to be assertive. Look at me.

After 30 minutes of "sleep", we all head out to the ENT (down by the hospital) and I take Morgan (asleep again) in to be seen by the expert. Once he gets in to see us, he goes right in there with tweezers and a suction thing (poor baby) and promptly pulls out.....wait for it.....a gray foam cushion to an "earbud" type of headphone! Yup! Oh, it was noxious right after--The Smell* was very overpowering. Then came a huge gush of bright red blood (think The Shining) which the doc was fortunately able to stop fairly quickly. The doc and the nurses were all pretty sympathetic and I highly recommend them. I hope I never have to go back again.

So, 4 docs (5, if you count our late night phone consult), 2 doctor's offices, 1 ER, plus $70 in copays. That's all it takes to remove a bit of foam from a toddler's nose. I should point out that all 3 parents who took a look (without medical equipment) were able to visualize it almost right away (it was quite hidden). Sigh. I only wish she was old enough to connect what she did with what happened because I fear that she will try to stuff something else up there again.

I believe I will be complaining to the pediatrician's office--at least about the no calling back thing. Yeesh. They were the ones who told us to call (via the ER doc).

So, fun! That was just the beginning of our weekend, as my parents arrived that night and that is exhausting in a completely different way (although we did manage to have some fun). And my baby girl smells like "girl" again. And that's a good thing!




*The smell....let's see how to describe. Take the worst halitosis you've ever smelled (yeah, I worked with that guy, too) and add to it dead rat, shit, and just a little bit of vomit for that certain je ne sais quoi, multiply the intensity by a factor of 27 and you just might approach a hint of an idea of the smell I was living with for 5 days.

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