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.

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