A medical doctor used to think parents were slightly neurotic about their children’s symptoms until he had a child of his own.
Every family physician should have children. Okay, I’m leaving myself open for criticism, having waited until I was in practice for 23 years before following this dictum. There is, however, no other way to empathize with the sheer gut-wrenching terror experienced when your own child is sick.
For many years I’ve dealt with the usual late night calls, complaints that “my child has a fever” or “my baby fell and bumped her head and has a big lump”. The parental tone of voice is often tinged with a hint of panic, perhaps terror. Sometimes I’d deal with things on the phone. Often I would make a run into clinic if I felt there was the possibility of something more serious… or to avoid getting called back even later in the wee hours of the morning.
I’d often think to myself, somewhat superiorly, how neurotic parents can be about their children. I certainly would never be this way, I told myself. Talk about setting yourself up for a fall.
Witness one Friday evening when my ten-month-old daughter Ariana developed a high fever. This was the first time she had been ill. This was also the weekend of our third anniversary. My parents had agreed to care for the baby overnight on Saturday and we were planning a weekend to ourselves at a rustic inn. This would have been the first weekend alone since the baby was born.
The day before, Ariana had had a new vaccine against meningococcus C. Although she had two previous doses without problem, I felt the fever was likely a vaccine reaction or perhaps a virus Though flushed and feverish, Ariana was eating and still managing to smile. Her breathing, however, was a little rapid.
I decided early on that I was not going to be physician to my own family. I realized a doctor lacks the objectivity to deal with his own relatives. At 9:30pm I found myself dialing the number to our clinic, hoping to catch one of my partners in the office. Luckily one of my colleagues was still there. As we pulled out of the driveway it was pouring rain, with thunder and lightening, an early spring storm. Lightening flashed and one bolt struck not far from our vehicle, shorting out streetlights. My wife, Krista, cringed. Rain poured down in torrents but we made it to the clinic without misadventure.
My colleague performed a thorough exam and found the baby’s ears and throat were uninfected. She had a clear chest, soft tummy and no signs of meningitis. Ariana was well hydrated, not lethargic and even managed a smile in the office. He suggested Tylenol, fluids and to keep a close eye on things with follow up if she worsened or the fever persisted.
My first impressions seemed to be confirmed and we took our little cherub home, dosed her with acetaminophen and put her to bed. Later, about three AM, Ariana awoke whimpering with her temperature back up. She went back to sleep after another dose of antipyretic.
A couple of hours later, Krista woke me, saying something was wrong with the baby, that she was shaking uncontrollably. I thought, “Oh God, she’s having a febrile convulsion.” This is something every family doctor and pediatrician has to deal with, a seizure triggered by high temperatures. These are usually benign but very scary. I ran out and picked the baby up. Ariana’s limbs were all shaking violently and she appeared very distressed. Her eyes however were open, and she did not look like she was convulsing. She seemed to be breathing okay, but was not responding to me.
I was terror-stricken. All those “neurotic” panic-stricken parents were totally vindicated at this moment as I picked up the phone and called the Izaak Walton Killam Children’s Hospital in Halifax, and asked to speak with the triage nurse. I forced myself to calm down and proceeded to give as much history as I could. I thought to myself that I probably sounded like a total idiot to the nurse. My wife bundled Ariana into the car and off we went.
It was a long ride in. The baby shook for 15 to 20 minutes, then started to settle. By the time we got to the hospital Ariana actually was beginning to perk up. Of course as we entered she managed to smile at the triage nurse, making me feel even more like a neurotic worrywart. (Note: almost every parent has experienced this. It’s like that funny noise your car makes until you get it to the garage). Fortunately the emergency room wasn’t too busy as it was 6am. The triage nurse first assessed the baby. I was gratified when she said, “You sounded awfully calm on the phone, Dr. Burden. Most parents with sick children don’t give me information like a precise ETA to the hospital”. Old habits die hard, I guess. We sat down with several other bedraggled parents and after a few minutes we were taken to an examining room. I notice the plaque on the door said the room was donated by the noted Nova Scotia artist Alex Colville.
The ER doctor did a thorough exam and queried us as to whether there were any cold symptoms, diarrhea etc. to indicate a viral cause. Although a vaccine reaction was possible he suggested we check a urine specimen and do a complete blood count.
A catheter specimen of urine was obtained with surprisingly little protest from my ten month old. It looked cloudy. The nurse then took blood from Ariana’s finger for the CBC. She protested a little more about this and had to be held down.
Now all we could do was wait. I took a run to the hospital’s Tim Horton’s franchise and bought several trays of coffee for my wife and I and to share with the ER staff. They had been without exception pleasant and professional (and not just because I was an MD. I saw them interacting with other parents and children, some not so pleasant).
Finally the blood count came back, with a WBC count of 20,000, indicating significant infection. Ariana’s urine was loaded with pus and blood cells, a urinary tract infection, probably spreading to the kidneys! Pyelonephritis can be serious if not treated promptly, and can be difficult to detect in infants. Ariana would require further investigations of her kidneys and urinary tract once this was treated, to make sure no structural abnormalities were present and that no damage had occurred..
At least this explained her shaking. Kidney infections often cause rigors, with shaking and fever. Ariana had an intravenous inserted and a push dose of the potent antibiotic, cefotaxime. The intravenous line was flushed with heparin to prevent it clotting, then tied to a small board to protect the line. We then left the ER and headed over to my parents who live near the hospital. We were advised to return to the hospital eight hours later for more IV antibiotics.
At her grandparents, through the day Ariana improved rapidly, even managing a big grin for her Poppy. Once she was settled, he took out his fiddle and regaled her with Celtic reels and jigs, to which she liked to move her legs in time. While my parents entertained Ariana, Krista and I crashed for some much-needed sleep. The baby followed shortly after.
Later that afternoon, all considerably more rested, we headed back to the hospital for the second dose of intravenous antibiotic. Our nurse then removed the IV and we headed home. We fed Ariana and put her to bed, then crashed ourselves.
Before falling asleep I rolled over in bed, smiled tiredly at Krista and said. “Happy anniversary, Hon.” She smiled back and said, “Welcome to parenthood.”