Sunday, January 18, 2009

I am an Ugly Person, and Also, I Have a Flat Face.

Max is sick. He's a kid in pre-school, and his father is a public school teacher, so virtually every bug that occurs in nature enters our house. He is relatively seldom sick, too. He's only ever had one stomach bug, and he gets the occasional cold, but I've never seen him the way he was this weekend.

His fever never went below 100, and most of the time it was more like 103. He wouldn't eat, wouldn't drink, cried with no provocation, and mostly, wanted to lie on the couch. And we're not talking about a kid who's normally low-energy, even when he's sick.

Yesterday afternoon, he looked like a deflated balloon. He had slept most of the day, and I hadn't gotten him to eat more than a couple of bites of a popsicle all day. His fever was hovering around 103.8 when I gave into my fear mid-afternoon and told Dan that we needed to go to the Emergency Room.

I am not that mother. Hospitals are where sick people go, usually to get sicker. I don't race him off to the E.R. at the drop of a hat. However, we had several factors working against us. The first was simply his condition. There is a significant difference between Sick Max and Healthy Max, and the difference is obvious. I don't see Sick Max often at all, and this is what I was looking at today. He was sick, getting worse, I'd tried to help him for two days now, and nothing was helping. The second factor was where we are and when it is: it's three days before the Inauguration, in a suburb of Washington D.C. On Monday and Tuesday, if we needed an emergency room, it is very unlikely that we'd have one available to us.

I wrapped him up in a blanket, carried him to the car, and we drove him to the Emergency Room, which is only about eight blocks away. We registered in the E.R. and sat down to wait with him.

A few minutes ago, a very strange-looking man came staggering in the door. After registering, loudly, he came staggering across the room. He said something to Max, I don't remember what, but it was off-putting, and I wanted him to go away. Max gazed at the creepy guy uneasily. "He's sick," I told the creepy guy as icily as I could possibly muster. "Please leave him alone."

He did not do so. He continued to harass us while Max became more and more agitated by the man. Eventually, he took off his sunglasses to show us his face that had quite obviously been crushed by something--a hammer, by the looks of it. Finally, I told Creepy Guy to leave us alone or I would ask someone to call security.

He did not leave us alone. "There's a man over there that won't leave us alone," I said as loudly as I could to the registration desk. I didn't want him to miss who it was that was telling on him. "Could you please alert security that we're being harassed?"

They did so, immediately. This caused quite an interesting scene which, at this point, was mostly amusing to Dan and I. At one point, Creepy Guy announced loudly that he didn't have nothin' to say to them white people. Dan burst out laughing. "Why can't I just be 'that asshole?'" he asked. "Why do we have to be 'them white people?'"

At some point, they convinced him that he would have to be quiet, stop attempting to engage other patients in conversation, and generally reign himself in, or he would be forcibly removed. This was the point at which he stood up, pointed at me, said, "You know what? You ugly. You an ugly person. You and your flat face."

I started to laugh. "Did he say my face was flat," I asked Dan, "or fat?"

Dan was laughing too. "I think he said flat," he said.

"I was just wondering because the second one is sort of true," I said, "but the first one is just weird."

Creepy Guy, who was almost visibly under the influence of some sort of mystery cocktail of substances, went outside at this point, pulled a navel orange from his pocket, and appeared to engage it in a conversation of some kind. At that point, we were called back into the triage area.

Two very capable women quickly assessed Max, weighed him, took a short medical history, discovered that his temperature was now 103.9, his pulse was 178, nearly sixty beats a minute faster than a healthy 3-year-old, and began to work with a sense of urgency to which I am not accustomed to seeing here in the D.C. area, and certainly not in an emergency room. One of them got on the phone. "I have a baby here with a fever of 103.9," she said to whomever was on the other end of the phone. We were whisked through a back door and into the Emergency Ward, a series of three-sided cubicles arranged around a central nurse's station.

We'd not been there fifteen seconds before a nurse whisked in with a digital thermometer in her hand. "I need his shirt off," she said crisply. "His pants too, please." She took a rectal temperature, which I found unpleasant, although I'm sure not nearly so much as Max did.

104.1 now. She patted Max gently on the leg. "We're gonna make you feel better, buddy," she said to him. She took me aside. "He's gonna need an IV," she said. "There's really no option at this point."

"That's fine," I said. "Do it." We were left alone for a minute again, and Dan and I stared at each other. "I'll bet you all the money in my wallet against all the money in your wallet that his doctor is the guy talking to his orange out in front of the Emergency Room entrance," I said to him.

"No bet," Dan said.

His doctor was actually a calm, slender, silver-haired gentleman in a blue button-down shirt and khakis. He was kind and thorough and very gentle with Max, and moved fast. Max claimed that nothing hurt as the doctor prodded and poked at him, and the doctor seemed very concerned. He pulled me aside as well, and said, "Well, I don't like what I'm seeing. His temperature is very concerning to us." I nodded wordlessly. "Let's get that under control and we'll see what happens next. At this point, we start to worry about seizures."

Max was naked, laid out flat on the hospital bed, too scared to cry, whimpering in fear as the nurse, who could not possibly have been doing a better job, showed him exactly what she was going to do to him on his teddy bear. "I'm going to put this piece of rubber around your arm, just like the bear," she said, tying on the tournequet. "Then this little needle is going to stick you just for a minute, and then come right back out, and you'll have tube in your arm. It won't hurt at all once the tube is there."

"Look, Max," I showed him my insulin pump. "Just like Mom's tube." He was not consoled by this information.

Max held Dan's hand with one hand, my hand with the other. A nurse's aide held him down, although he was almost too weak at this point to struggle. He shrieked in terror, and then as she withdrew the needle and taped the IV in place, he calmed to a whimper again. She worked quickly, as quickly as I've ever seen anyone move, taking several tubes of blood, blood cultures, taping a plastic urine culture collection bag in place, the whole time talking to Max to keep him as calm as possible. "I'm giving him heparin in this IV," she said to me as she injected it. "It's an anti-coagulent, which-"

"I'm familiar," I said.

There were ice packs, and cold drinks, and more Motrin, and more Tylenol, and more tears and whimpering. Max still wouldn't drink, and they came and put an IV bag on. Slowly, Max began to look less like a deflated balloon and more like my boy again. He drank a few sips of the apple juice that they brought him and held a graham cracker in his hand, although he didn't eat it. He was dozing off.

His fever was falling, enough that they let us put a blanket over him. His arm hurt and he was crying, but he was also singing. He sang "You Are My Sunshine" to the nurse, whom he was charming thoroughly.

The doctor came in with the results from the labs. "These are largely inconclusive," he said. "His white blood count is borderline-high, which is indicative of an infection, but we don't really know what kind. How does he seem to be doing?"

"Our car got stolen," Max told him. It's a story he's told everyone he's seen since it actually happened. "It got crashed into a gate."

The doctor looked nonplussed. "I'm sorry to hear that," he said. "When was this?"

"This morning," Max said, at the same time as Dan and I both said "December."

"Okay," said the doctor. "Let's watch him a little longer."

Throughout the evening, Max repeated this story to everyone he saw, every time he saw them. At one point, the doctor asked if he'd been perseverating on the car being stolen before he got sick, or if this was possibly an effect of the fever. I am almost positive that he was joking.

Max's heart rate was falling from the 170's, where it had been when we came in, to the 140's, to as low as 129 as he dozed between seeing nurses and doctors. It wasn't low enough for the ER doctor, nor for the on-call pediatrician who was checking in with us too. I was listening to the two of them outside the cubicle, saying things to each other like "spinal tap" and "chest x-ray" and I wanted to cry. I would have changed places with him in a heartbeat.

In the end, they sent us home in the middle of the night, without a spinal tap or a chest x-ray or anything else that was scary for any of us. Max felt better, not much better, but better. His heart rate was down to the 130's, which they were more comfortable with, but not really comfortable. His temperature was down, but not normal. Overall, they were convinced that he didn't have pneumonia or meningitis, that he had a viral infection of some kind, that he was uncomfortable but no longer dangerously dehydrated or feverish. "Keep pushing the fluids," the doctor said. "That's going to make the difference betweeen whether he stays home or comes back here in a couple of days.

He still doesn't want to eat or drink, but he's eating and drinking more. He still has a fever, but it's not out of control like it was. He's testy and uncomfortable, but he doesn't look like roadkill like he did yesterday.

It's been a bad weekend, mostly for Max, and maybe a little for a guy with a crushed head, who may still be having a conversation with an orange outside Laurel Regional Hospital's Emergency Room.

1 comment:

Treen said...

Ughhhhh. This gives me creepy crawlies and makes me so happy I don't have kids right now because I would have finished smashing that guys face in for him if he was harassing my sick kid. Poor Max.

I'm glad to hear he's doing better.