Bronchiolitis with Little E

Another story of our experience with medicine through the eyes as parents of a patient.

This was not where we wanted to be on Valentine’s day.  We were in the pediatric unit at the hospital.  Our middle son who was just over 1 month at the time had been admitted.  My wife and I were both slowly replaying our previous experience with the hospital after our first born was admitted as an infant as well.  He had recovered well but the experience had impacted us greatly.  Seeing how fragile a newborn can be made us cherish our second born and change our methods.  

With our first born were not going to be “those” parents.  You know who I’m talking about.  The  parents that become hermits after their child is born to avoid any possibly exposures.  We went out and went on with life.  Then our first was hospitalized.  With our second, we had become “those” parents.  We didn’t go to church and made sure everyone washed their hands before handling our new child. So how did we end up here?  With this new little one admitted as well.

It had to be me.  As a doctor, I was constantly exposed to infectious agents.  Something must have been brought home and some how transferred to our fragile child.  So again we were there, in the pediatric ward, staring out the window across the unit at the room we had occupied just 2 years prior with Big M.

But this time it was Little E (as we’ll affectionately call him).  It had started about a week prior.  My wife had noticed a slight runny nose.  We handled it like a mild cold with nasal suction using a bulb syringe.  This in itself is an arduous process.  It consists of using a few drops of saline dropped into the infant’s nose and then quickly using the bulb to suck out the thick snot.  All of this is done while keeping the child stationary by pinning him.  It was a process that required both my wife and I to work together.



A few days in things got worse.  The infection started moving to his lungs.  His breathing hastened and he developed a dry, hacking, crackly cough.  We made an appointment with our family doctor.  After evaluating Little E, he confirmed my suspicions: this was bronchiolitis. Having taken care of this multiple times while I was a resident and after, I was well acquainted with it.  

Bronchiolitis is a viral illness caused by RSV (respiratory syncytial virus) where the infant develops inflammation and congestion in the medium sized airways of the lungs (called bronchioles).  For kids and adults, it causes only a mild cold syndrome, but for babies, it can be serious due to their small airways.  The airways can become clogged with the thick mucus and cause breathing difficulty, low oxygen in the blood and a severe cough with wheezing. It lasts about 10 to 14 days. Most infants can be taken care of at home but some require supportive care in the hospital with oxygen, humidified air and sometimes inhaled medications. Since it is a viral illness, there is no antibiotic that helps.  It is an illness that the body will fight off but causes severe symptoms while doing so.

Our family doctor sent us home with a nebulizer and told us to use a humidifier and keep Little E’s nose clear with the bulb suction.  The picture above is our Jerry-rigged humidifier to have it blowing directly on him so he would inhale it.  The next few nights were rough.  It required constant suction with the humidifier running around the clock.  We were also doing a nebulizer with albuterol every 6 hours.  Despite all this, he worsened.  

The night before Valentine’s days was difficult.  My wife and I took turns holding Little E over the humidifier with it blowing in his face.  In the morning his breathing quickened.  I still remember having him laying on the changing table with his chest exposed.  His little chest rose and fell quickly, faster than I was comfortable with.  This was combined with sinking in between and under ribs and his nose flaring out with each breath.  All of these were signs of respiratory distress.  His little body was struggling to bring in the oxygen required to deliver to his tissues.  We called our family doctor for advice and he recommended we take Little E in to the hospital.  He knew I was a doctor and trusted my judgement so he decided to directly admit our little one and said he would meet us at the Pediatric unit.  We fortunately avoided the ER.



In the hospital his oximeter read 86% and his breathing was elevated to over 60 breaths a minute. Both were abnormal and worrisome. He was quickly put on oxygen and his oxygen rebounded nicely to the high 90s. A swab was taken to check for RSV which later returned positive.  Bronchiolitis was confirmed.  The greatest asset in the hospital was access to good suction.  Leading up the the admission, the bulb suction was not working well.  We were not getting anything out.  Little E’s breathing was gurgling and raspy like he was breathing through a clogged straw.  With the suction at the hospital attached to a long thin tube, we were able to get it into the back of his nose and throat and despite some gagging were able to get out the thick mucus.  His breathing calmed.  

We were admitted for 2 days as we worked to try to wean Little E off of oxygen and keep his breathing passages clear with suction.  Slowly, his oxygen came up and we were able to stop the oxygen.  The suction and humidified air continued to break up the thick sputum until he was finally no longer having breathing difficulties.  We were out of the woods and finally went home to ride the rest of it out which went smoothly.  Nowadays, Little E is not so little any more as he is built like a miniature linebacker with a thick torso and broad shoulders.  He is less than 10 pounds lighter than his big brother, Big M, who is almost a foot taller (to be fair, Big M is a rail). For more on Big M’s story click here.

I thought I would recount this story because I was reminded of it earlier this week.  I received a heartfelt letter in the mail from the family of a patient of mine who were so appreciative of the time I had spent caring for their husband and father.  This reminded me of how appreciative I was of the care we received with Little E.  Our family physician at the time, Dr. Solkovits, was amazing.  He went above and beyond what was necessary to provide outstanding care.  Leading up to the hospitalization, he let us borrow his office’s nebulizer so we didn’t need to wait to get one.  He met us at the hospital and directly admitted Little E so we avoided the ER.  He stayed and answered all of our questions and alleviated our fears late into the night.  This was on Valentine’s Day no less and he delayed his dinner with his wife to care for our family.  I look at this and am amazed and humbled.  Thanks you, Dr. Solkovits.  

I want to strive to be like this in my practice.  Though I don’t do hospital admissions, I want to go out of my way for my patients.  Being a doctor is a calling where this has been considered commonplace in the past but these days is not the norm.  I want to break free from the modern stereotype and be a doctor that goes above and beyond.  My patients deserve no less.



The Other Side Of Medicine: Pole Vaulting Disaster

I landed awkwardly and slowly pulled my right arm out from under the pole but something was wrong.  Horribly wrong!

This was the first time I had made it over 8 and half feet!  I could feel my body clearing the height but as I released the pole my arm swung around and caught the bar as it fell off.  It all seemed like it was in slow motion as I slowly descended with the bar caught between my body and right arm.  I landed awkwardly and slowly pulled my right arm out from under the pole but something was wrong.  Horribly wrong!

It started 3 months prior.  I was a freshman in high school with aspirations of being a track star.  When surveying the events, I saw pole vaulting and was instantly hooked.  “You mean I can get up to over 12 feet in the air and land safely?  And I don’t need to run? Count me in.”  I had done cross country earlier in the year and had come to detest running (ironic now that I love it).  The team broke into groups for each event and I followed the studly, ripped upperclassmen pole vaulters over to the training area.

I should have known this wasn’t my calling.  I was over 6 foot and as gangly as an oak tree.  Nonetheless, I put in the hours and went through the tortuous training to develop my form.  It was still horrible!  I didn’t have enough upper body strength to lift my lower half up and push off the pole to do the pretty body arc that you see at the olympics.  It was more like a forward baseball slide in the air.

The first few meets were disastrous.  I didn’t even clear a height.  I now look back on it and can imagine the other more experienced pole vaulters thinking, “Okay… Lower it down to the lowest height and let’s get this over with.”  I still persisted.  Unfortunately, I was still horrible.

At about the 4th meet I was finally getting a little better and actually cleared 8 feet.  I had done this in practice but never in a meet.  This is a horrible height in pole vaulting but for me it was progress.  The bar was then moved up to 8 and a half feet.  My first attempt was a great display of me kicking the bar off the stand.  The second attempt was when it happened. My body cleared the bar but my right arm didn’t and I came down with my full weight on the bar which transferred all of the energy to the ulna and radius in my forearm.  These bones couldn’t take the pressure and snapped in half.  I didn’t feel a thing… until I looked at it.  The arm wasn’t responding to the input from my brain so I looked to see what was wrong.  Halfway up my forearm a new joint had formed into an awkward looking S-shape that instantly made me nauseous.  I became lightheaded and small sparkly stars appeared in my peripheral vision and moved to obscure the image of my arm. I sat there unable to move and let out a scream.  Instantly my coach and dad were at my side.  I closed my eyes and started breathing deep.  The nausea and stars cleared only to be followed by an indescribable pain that again made me feel like passing out.  I bit my jersey to keep from screaming again.  They brought ice. It helped.  I was escorted to the hospital in an ambulance.

At the ER, xrays confirmed the obvious fracture but it was displaced at an unacceptable angle and needed to be set.  The orthopedist, Dr. W, was called and he stated he would have to push the bone back into place.  What?! I thought.  The mental anguish and pain of the initial break flooded back into my brain.   I started to sweat.  “Don’t worry,” he said, “You’ll be sedated for this.”

I was hooked up to an IV with medication flowing into my body.  The room became fuzzy and a blissful feeling washed over me.  My dad and Dr. W were also in the room.  With the medication I didn’t have a care and was happy to oblige when Dr. W lifted up my arm.  “Are you ready?” he asked.  “Go ahead,” I slurred. He suddenly applied a large amount of pressure on my wrist opposite the direction the bone was angled.  Instantly the severe pain from the original break returned and I was snapped out of my blissful state.  The pain was unbearable and I screamed.  More accurately, I wailed like I was being tortured.  My dad couldn’t take it and had to leave the room. It lasted maybe 15 seconds but tears filled my eyes and my body gave out.  It was horrible.  That was twenty years ago.  It was so traumatizing I remember it like it was yesterday. The arm healed fine after that with Dr. W’s care.  He is a great doctor and now I refer to him often for orthopedic care of my patients.  He was doing what was best for me and I can’t imagine the emotions he was experiencing as well. If not for him, I would have a deformed arm.

Being a patient in a situation where I had to experience pain at the hands of a doctor was difficult.  Now I have been on the other side.  I have had to do procedures where the patient has experienced pain to fix a problem.  I have gone through the emotions Dr. W must have experienced and had to power through to complete the procedure.  It is hard. The next time you need to go through a procedure, please know that your doctor cares.  We hate having to put you through pain but know that sometimes it is necessary.  Don’t be surprised if you see our eyes steam up if you experience any discomfort.  We feel it too.

 

Photo Credit: Mark Vaughan, MD
Disclaimer: The photo above is of my cousin who is a very good pole vaulter (unlike I was).



The Other Side of Medicine: Big M

It lasted maybe 5 minutes but those minutes stretched in my mind to hours as I sat there listening to our baby cry knowing I was an accomplice in his pain.

I was ecstatic!  My wife and I had waited to have a baby until I was in my last year of residency.  When she told me she was pregnant, I was over the moon.  We later found out it would be a boy and this was icing on the cake.  I had always wanted a boy first.  The pregnancy had the normal ups and downs including morning sickness and enduring a hot summer.  He was finally born in October.  Eek! Cough, cold and flu season! But I wasn’t worried.

We had decided early we were not going to be the parents that would let their baby keep them from doing normal activities.  When he was only a week old, we went to a pumpkin patch with family.  He was a big boy at 9 lbs 2 oz and had quite the appetite.  I’ll lovingly refer to him as Big M. We were up every 2 hours feeding him from the beginning (and this lasted through the 1st year), but we enjoyed it because he was such a wonderful gift. We had all of our friends come by to see him and they were gracious enough to bring us some meals while we adapted.

At about 2 weeks old my wife informed me that she thought Big M felt a little hot.  I felt him and he was warm but it didn’t alarm me.  I quickly forgot about it until the evening when my wife called me into his room concerned.  This time he felt hot.  I got out the thermometer and, knowing the only way to get a true temperature was rectally, I placed the thermometer in his bottom.  Even this small act was hard.  I watched as the numbers on the digital display slowly rose.  I kept hoping for it to slow down as it approached 100 but it kept going.

It finally stopped at 101.5 and the beeping from the thermometer sealed our fate.  I knew what we had to do but I was in denial.  Every fever in a newborn under 3 months is to be taken seriously and requires a thorough workup.  We needed to go to the ER.  I called his doctor to try to find a way out but he confirmed that we needed to go in.

At the ER things went quickly.  They confirmed Big M’s fever with a temperature that was even higher at 102.1 and quickly gave him some Tylenol to try to bring it down.  He was 2 weeks and didn’t realize what was going on but he knew something was wrong judging by the irritability he was displaying and crying that was difficult to console.  This only worsened when they took his blood and placed and IV.  We couldn’t watch as they place a tiny needle into the vein on the back of his hand. He let out a horrendous squeal that chilled us to the core.



My wife had already just about lost it.  She was crying watching him go through this torment.  Being a physician I knew this was all leading up to an even more distressing finale: a spinal tap.  One of the diseases we worry about when a baby has a fever is meningitis. The best way to diagnose it is by placing a needle through the vertebra in the lower spine into the outer space of the neural tube to obtain some fluid.

They wanted me to hold him.  “Are you serious?!” I thought.  There was no way my wife could do it as she was already emotionally drained from the IV placement.  I knew what this entailed and wouldn’t put her through it.  The procedure for doing a spinal tap (or lumbar puncture) in a baby is to lay them on their side and make them flex their spine while making sure they don’t flail or arch their back.  The only way to do this was to have me hold Big M rolled up in a ball.  He would fight back and I would have to restrain him. 

I had done this procedure dozens of times before but I couldn’t look.  This was different.  This was my son.  Tears escaped as I had to fight his tiny wiggling body as the ER doctor completed the procedure.  It lasted maybe 5 minutes but those minutes stretched in my mind to hours as I sat there listening to our baby cry knowing I was an accomplice in his pain.  The doctor completed the procedure and I was allowed to hold him and soothe him as he finally calmed down sniffling into my wet sleeve formed from his tears.  I held him up to my cheek and our tears mixed and ran as I told him I loved him.

He was started on IV antibiotics and was admitted.  We stayed in the hospital a total of 4 days.  Blood and cerebrospinal fluid cultures returned negative.  The final conclusion was that it was a virus but he was sent home on some oral antibiotics to cover for anything else.  You wouldn’t know it happened now.  He is 6 and healthy and energetic (sometimes too much).  

Things are different when you’re on the other side of medicine as a patient or a parent of a child who gets sick.  I couldn’t think straight.  I would have been useless as his doctor. This was flesh and blood. The experience did help me understand the helpless feeling that parents have when caring for their sick child.  I can now empathize and feel I am a better doctor because I have been in their shoes.  These experiences make us who we are.  The good and the bad.  Don’t suppress them.  Use them to empathize and help someone you know going through the same situation. Sometimes you are the only one who truly understands where a person is at or coming from.