The sudden realization that your child is seriously injured or ill is the worst feeling one can imagine
We were on a road trip to Minneapolis over the New Year’s holiday. I made a mental note when I woke up at 7am on 1/1/16 that in an hour Ireland time we had tickets to be touring the Guinness factory in Dublin. Plans had changed when our eleven-month-old daughter developed a pretty severe upper respiratory infection six days prior. This required us to cancel the transatlantic flight with her. As she improved to baseline over the next few days we decided to take her on a road trip to enjoy some time away prior to returning to work. The trip was great and included a free upgrade to a presidential suite at an Embassy Suites in Peoria (although I still have mixed feelings on working towards Hilton honors status), several delicious dinners, excellent brewery trips and good visits to the museum of art and children’s museum. Our consolation prize trip had turned out well and I was certain Ireland would soon be back on our itinerary.
Our daughter, who until this New Year’s morning had been full of smiles and giggles. was none too happy. I took her to breakfast while A slept off the NYE champagne. Lou threw her Cheerios and swatted away her banana….strange. I took her to the skyway to let her walk around—her favorite activity as she just recently became mobile. She sat down and refused to budge.
I took her back to the room and complained to A as I was changing her out of her pajamas about how “grouchy she is this morn—oh no!” Before me was a chubby right leg that was swollen twice the size it should be, was warm, and bright cherry red. The only sign of trauma was a very mild rug burn on her knee cap. You did not have to be a doctor to know this situation wasn’t good, but being a physician my mind raced: sepsis, ventilator, an ICU stay, amputation, death. (Did I tell you I’m a worst case scenario thinker?) I felt my heart sink, my stomach in my throat, my heart pound in my ears, and my consciousness float above the room.
I’m proud of the fact that I keep calm in stressful OR and emergency situations. Panic isn’t a trait I typically exhibit. It was in that moment. My 15 seconds of panic involved a half-baked plan to “get home” ASAP. We know the docs at our hospital and we know the docs at the tertiary pediatric hospital thirty minutes from home. Home seemed like the right place to be. Fortunately, A kept a clear head, talked me down from attempting to drive the (awesome) 2011 gold Sienna minivan at 325 MPH to get home in 3 hours.
Looking back I gleaned a few key points about how to think through and manage the very stressful situation of an injury or illness in our kids:
- Assess the transport needs. How severe is the injury or illness? Is help needed immediately or just urgently? This may be common sense, but a quick way to be paying a significant amount of cash is to call an ambulance for something that seems scary but is not life-threatening (i.e. a scalp laceration that pressure can control). Lou had what was presumed to be a rapid-onset cellulitis. In the time it took us to drive to the hospital her rash spread noticeably. She needed to get to an ER ASAP, but an ambulance would not have saved us time to definitive treatment and would have likely taken away control over where to go.
- Figure out where to go. We needed a children’s hospital. She was going to need an IV (given her chubby baby arms we wanted this done by people who do kids IVs), physicians skilled in treating pediatric infections, and a Peds ICU. Fortunately, Minneapolis has several options. What we didn’t think about at the time (but did upon receiving the bill) was to check the insurance coverage. Undoubtedly, any out of state hospital will not be a preferred provider, but many hospital systems have agreements between various insurance networks. We got lucky here. There were two main pediatric hospitals, and we chose the one that is recognized by our insurance. We pretty much did a coin flip (ok, we let the valet guy tell us where the nearest children’s hospital was), but it could have been checked on the insurance website by me while A was getting Lou ready for the ride.
- Be courteous and complimentary but not afraid to advocate. We were very fortunate to be the first ones in on an early holiday morning. We were roomed immediately, seen immediately, and had treatment started (almost) immediately. We had to ask once for an ETA on the IV antibiotics but otherwise tried to avoid letting our anxiety manifest in multiple nursing calls. Prioritize when you need to push or ask for something, but don’t be afraid to speak up. Granted this may be difficult in a stressful situation when every beep on the monitor or pulse change with respiration could be taken as cause for alarm that the doctor needs to come in and evaluate immediately! Usually, it’s not. Things that require immediate attention: delay in antibiotics (15 min from the time your child is seen until dose is in room is appropriate, change in mental status or responsiveness, new respiratory symptoms such as wheezing or high pitched noises, vomiting). Thank staff for their hard work when warranted (nice job only taking three, not ten attempts to get that IV, etc).
- Consider buying the floor staff some food. A $100 investment to buy the nurses and staff pizza for dinner the day of admission went a long way. It would be crazy (and scary) to think that it improved care, but it did express our sincere thanks for their efforts, decreased the time it took me to get buzzed into the floor, and got the staff to show me where the best patient snacks are kept.
- Don’t be afraid to ask for help. I developed a new sense of respect for families with chronically ill children. I always knew it would have to seriously awful to spend days and days in the hospital while stressing about the well-being of your child while meeting with families during rotations at the children’s hospital in residency. But I had no idea (and still don’t….just a slightly better understanding) how rough and stressful it can be. We were 10 hours from home and my mother-in-law offered to fly up. I like to go it alone in most things…except with regards to the kids…I’ll take all the help I can get. She hung out in the room while Lou slept and gave us some very necessary time to shower and sleep briefly in the hotel.
- Ask questions. We had excellent docs who were very attentive and well-informed. We wrote down questions as they arose so we were ready for morning rounds.
- Don’t leave until you’re comfortable. I cringe when I type this. No physician likes to have patients hanging around in the hospital who don’t need to be there. It is costly for the patient and system and eats up resources that could be better utilized elsewhere. That said, we left the hospital earlier than we should have. Once the infection turned the corner and she (mostly) kept down her antibiotics we hit the road. It was a disaster. Not an hour out of Minneapolis she puked, and puked, and puked. We had to stop and nearly re-admit her for dehydration in Wisconsin. Make sure your child is tolerating required medications, needed equipment has been arranged, and all your questions have been answered before signing discharge paperwork.
Lou made it back safe and sound and is fully recovered. No hard feelings Minneapolis, but I don’t think we’ll be back anytime soon.
[Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions about your medical condition. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.]