Showing posts with label illness. Show all posts
Showing posts with label illness. Show all posts

Wednesday, February 4, 2015

Guest post: Trust me, I am a mother

I never went into medicine to become a better mother. I never became a mother to become a better doctor. But, the two journeys merged in 2013 when I knew something was seriously wrong with my almost six year-old son. My son is like any other boy his age, other than occasional mild irritability that is slightly over the average and incredible creativity. He usually springs out of bed ready to tackle the day, excited about all the projects he is going to do. For about ten days, I noticed that not only was he not interested in any activities, but he was incredibly irritable at even the most minor setbacks. He has always had a high pain threshold, yet we started noticing an increase in his frequency of "got hurt" episodes. There were no focal deficits on physical exam. I sent an email to his teacher asking if she noticed any limitations at school. She said no. I didn't know if I should go to a pediatrician or a psychologist. Then, he developed a minor unprovoked pain in the shin. I jumped on it as now I had a reason to take him to the pediatrician. I reasoned with the pediatrician that given the irritability and mild low grade temps at night time for two days, his shin pain may have been an indicator of something systemic. After an exam, she ordered some blood work and X-rays which came back normal, other than a slightly elevated WBC and platelet count. She told me to trend the fevers and to come back if there was no improvement.

The same night, I noticed a slight temperature and called the on-call doctor. I explained that I was concerned about the low grade temperatures without an obvious source, and that the shin pain might point to a musculoskeletal or neurological issue. She also told us to "trend" the fevers and call her back in the morning. Completed unreassured, we took him to the emergency room. A full day waiting in the emergency room led us again to blood tests that were mildly abnormal but not convincing for any diagnosis. An MRI of the leg was done which was read as normal. I pulled the pediatric ER physician aside and told her my concerns: was there something systemic? As an adult critical care physician, I was not the kind of parent to seek attention unless I was truly concerned. I alerted her that I was concerned regarding the elevated white count and thrombocytosis without an obvious source and even more concerned that the MRI was normal. We were told to "trend" the fever, and if it became more than 101.5, to seek attention. We were also to give scheduled ibuprofen to suppress any synovial inflammation that may be happening in the hip from a viral infection two weeks before. After a dose of ibuprofen, they tested his walking, and said that it was noticeably better, so it must be Transient Synovitis, a diagnosis of exclusion. One caveat to this "give the drug, and see if this gets better, if then, it must be this" argument is that it is absolutely flawed. If the participant knows that "he or she is supposed to get better" then the free will overcomes any pain and of course, he is going to walk better. It may or may not have anything to do with the drug. We walked out of the Emergency Room still concerned.

I continued to give him ibuprofen over the next day. He continued to limp. The ibuprofen suppressed the fever, so now we had an afebrile child who couldn't walk. After no significant improvement, we took him back to the pediatrician office the next day and asked for a neurological exam and, bingo, over the course of a few hours my child developed cerebellar ataxia, clonus, and inability to stand. All of this happened within the time we saw the pediatrician, got him back to the emergency room, and a MRI was scheduled. That night as I sat at the edge of the MRI machine holding his leg, I had never been more frustrated with the fragility of the human body. I loathed hospitals. I never wanted to step foot in the hospital again. The doctor inside of me put the differential diagnosis of "epidural abscess, brain tumor, meningitis, encephalitis" on the list, while the mother inside of me put "something really bad" at the top. While the initial scout films started coming up, my husband, who is a body radiologist subspecialized in MRI, stood by the MRI technician with a solemn look in his eyes  -- one that I had never seen before. As he drew his finger in a vertical line across the computer monitor, the heart of the mother inside of me sank, while the doctor inside of me said, "Wait, that could mean it is not a focal tumor or an epidural abscess, but could it be a diffuse tumor? Maybe, it is meningitis."  With one hand on my child's leg amid the deafening noise from the machine, I kept waving to my husband to see if he could tell me something. He asked me to come outside and knowing my child was already asleep in the machine, I stepped out and could immediately notice the flair abnormality that swept across the spinal cord. As the axial cuts were pouring in, we could see the flair signal lit up like two snake eyes pointing to the diagnosis of Transverse Myelitis, which we knew only held very good prognosis one third of the time. There was no Brain MRI ordered as the ER staff wanted to "focus on one thing at a time," and it  seemed that the spine was the problem. Thankfully, the neuroradiologist who was examining the scout images, and who was about to leave in thirty minutes for the night, noticed the transverse myelitis throughout the spinal cord and asked the technician to add a brain MRI. Within minutes we found her and discussed with her and confirmed the diagnosis of Acute Disseminated Myeloencephalitis with Transverse Myelitis, a disease that occurs in my child's age group, typically after a viral infection or a vaccine.

During the hours in the emergency room, my son went from being able to walk with a limp to being unable to move both legs and becoming tachypneic. Prior to returning to the emergency room from the MRI, I told my husband that knowing the diagnosis, they will for sure want to do a lumbar puncture to rule out active bacterial/viral meningitis and this will of course delay steroid treatment if the lumbar puncture was not done in an expedited manner. We were already in the emergency room for twelve hours by the end of the MRI and given the progressive course of his symptoms, further delay could have caused him to progress into a coma and the risk of hemorrhagic encephalitis existed. Upon return, we asked the team to be present at his bedside, and we made our concerns open to them. The on-call ER physicians were skillful and quickly performed the lumbar puncture. We soon knew that there were no alterations in protein/glucose/gram stain and that we had the right diagnosis. The ER team hung the bag of 600mg of IV solumedrol before we were transferred up to the ICU and every successive day resulted in more return of neurological function. Within five days, we were at home recuperating after this nightmare of an illness. The neurologists repeatedly told us that they have never seen a child with such degree of MRI severity not have the physical signs to reflect the changes; it is likely because we sought attention right in time. The mother inside of me was strong during the five days, and the doctor inside of me was quick to decline any unnecessary blood draws and made sure that he got out that hospital as quickly as possible. For if anyone knows how deadly hospitals can be, it was the doctor inside of me. We were welcomed at home by a supportive community and his return to school and activities was a breeze because of the love and support from family and friends. When I bought my son a couple of youth basketballs to help his recuperation phase, he jumped out of the sofa, ran to me, gave me a big hug and said, "Mommy, how do you know me so well?"

I said, "Trust me, I am a mother."

Monday, August 5, 2013

How's your summer?

Since you asked...  If it weren’t for her dose of chemotherapy q 3 weeks and some iatrogenic wbc-boosting induced bone pain, it’d be fine.  And yet, my mother and I are still having a reasonably good summer.  Slowing it down a bit and being together.  Even if the togetherness is while we have a picnic in the chemotherapy suite, or while we walk to the local pharmacy to pick up a medication refill. 

Because nothing says bonding with your mom like shaving her head.  She reminds me that early on I’d wanted a career as a hairdresser.  Alas, now there is no hair. But to my pleasant surprise she is the same strong, smart woman with or without her hair. 

Hats abound.  Tennis caps, floppy sun hats, indoors or outdoors.  They suit my athletic mother --who scheduled her first chemo treatment around her tennis game-- better than a wig.

So how’s your summer?

Taking it one day at a time.   Fortunately or unfortunately, I can conjure up that old car commercial ("this is not your father’s Oldsmobile") and say this is not my father’s chemotherapy.  That was another summer 20 years ago, a different regimen, and for an incurable disease.  This time around it’s like cancer 2.0 with a better chemo concoction and a much better prognosis.

And how do you like this summer heat?

I’m trying not to sweat the small stuff, but sometimes I have trouble figuring out which is the small stuff.  Even now, when I should have perspective on what matters most in life.  Sometimes when I’m stressed about the big stuff, the small stuff makes me sweat too.  I’m working on it.  And overall, it’s been a good effort in rebalancing.   It’s mid-summer and there are lots of balancing acts, being here in the middle.  As I am a doctor but not her doctor.  As I care for mom and am a mom.  As my mother cares for her mother and for her daughters and for her grandchildren.  Chemo more than halfway done and yet other treatments still ahead.  So we try not to sweat the small stuff.  Unless it’s while on a jog or on the tennis court.

Friday, September 28, 2012

When Does The Doctor Get To Call Out Sick?

We've seen posts on this before... But I struggle every time I'm ill. This week, it's not so much my own illness that's been the major problem. It's the kids'. Because they can't sleep. And if they can't sleep, we can't sleep.

It started last week with this upper respiratory bug that's going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the "Three Year Cold". This one was really bad as it hit me on top of my undertreated seasonal allergies and having a 9 month old who doesn't sleep through the night. (I'm just not getting to the Neti pot.)

So no surprise that after a week of this virus, I started to get an earache. Within an hour the earache went from kind of annoying to consistently throbbing. I had a colleague look at my ear to confirm that there was a dull, red, bulging TM there. By the time I got to the pharmacy to pick up my antibiotics, it was screaming, pulsing, popping. I kept putting my hand to the canal expecting to feel pus and blood.

This is on top of a toddler and a 9-month old with copious nasal discharge and coughing. The baby HATES having her nose aspirated, but is used to sucking her binky as she falls asleep. With all the green mucous, she can't suck the binky and breathe at the same time. Thus, misery, for her and us. It's been over a week with this struggle to clear her little nasal passages so she can soothe to sleep...

Our toddler is a bit better off, but still cranky, clingy, picking at meals, whining... And waking up during the night coughing. A cup of juice and some quiet rocking lulls him back to dreams, but meantime, either me or hubby is up, again.

Night before last, it was midnight, and neither child had been able to fall asleep yet for more than a few minutes. Stuffy snotty noses, coughing, diarrhea poopies, fevers, et cetera et cetera, and we had spent hours trying all the tricks... Steamy shower, nasal aspirator, saline wipes, Tylenol, juice, singing, reading, cuddline, cartoons... And I had to be up at 5:15 a.m. for a 7:40 am start time in clinic.

I admit that I kind of lost it. I was personally miserable with my own symptoms, exahusted from several nights in a row of this sort of shenanigans, and I knew I would have only a few hours' poor sleep before I had to truck it to the city and take care of people.

"You have to call in sick," insisted my husband.

"I CAN'T," insisted me.

And I didn't. The kids eventually drifted into snoring/coughing but sustained slumber. My alarm went off at dawn. I hauled my sorry drugged-up ass into the shower, and made it to work alive. I popped Phenylephrine, chugged Dextromethorphan, snorted Afrin, gulped a whole lot of coffee, and tucked a full bag of Ricola into my white coat pocket. I saw my full panel of patients. I got some looks from people, colleagues and patients alike, for my red, swollen, flaky nose, and this wet cough. I kept assuring people, "I'm at the tail end of a cold, I doubt I'm contagious. It's my own misery."

I've commiserated with colleagues. Everyone's been through this before. But we all agree. You SHOULD call in sick for this stuff.... But we all feel like we CAN'T call in sick for this stuff.

So when can the doctor call in sick?

I remember as an intern on a busy overnight call, one of the senior residents started the evening with GI bug symptoms. It was severe, coming out both ends. By 1 a.m., he was laid out in the call room, and the nurses hooked him up to IVs. Still, we interns were coming to him for all the usual overnight precepting: running admits by him, reviewing labs, discussing cases. There was no question of, could he go home sick. We knew that he was febrile and dehydrated and not thinking straight, but it was like, there was no choice. And in the morning, the attendings heralded him as a hero for sucking it up and holding down the fort, despite having active nausea/ vomiting and diarrhea... that was contagious. That left a strong impression on me. Today, I think that was INSANE.

More recently, I had to fight with a patient of mine who also happened to be a surgeon. She had developed flu symptoms and wanted Tamiflu, but didn't want me to test and confirm Flu, so she wouldn't have to call out sick, as is mandated by Occ health. "I'm on the schedule, I have to operate," she explained.
Those are extremes. More common, I think, is our family's situation. We're all miserable, but can't justify calling out.

What would you do?



Sunday, August 10, 2008

Sick mama

I'm sick. Again.

Ever since we started Melly in day care six months ago, I've been sick more than I ever have before in my life. People are beginning to think there's something seriously wrong with my immune system and the jokes about sequestering myself in a germ-proof bubble really aren't funny anymore.

"You're sick again?"

"Yeah."

"Again??"

"Yes!"

"But you were just sick like two weeks ago."

"Yes, I know."

"Boy, you get sick a lot."

"Thanks for noticing."

Aside from some more minor viruses, I've completely lost my voice on two occasions and had two pretty bad stomach viruses. I haven't had a stomach virus since I was four. And now I've got a runny nose and cough in the summer, which hasn't happened to me since I was twelve.

I understand that babies get sick a lot because their little immune systems are still developing, but why do I (presumably with a mature immune system) have to catch every single one of her colds? And how come my husband NEVER catches ANY of her colds? (As if we really need to ask why the resident who barely sleeps is more likely to get sick. Hint: it's not because I'm drinking cups of baby saliva.)

I could deal with being sick, except for how it affects my work. I always try to at least show up, no matter how awful I'm feeling, but I can't dictate or interview patients if my voice is gone. And patients don't want me to touch them, even with gloves on, if my nose is running. I try to hide it the best I can, but every now and then I can't take it anymore and actually do the unthinkable and blow my nose in front of the patient. I got thrown out of the room for that little stunt.

Too bad I don't work in a field where it's possible to call in sick. (As if it's possible for a mom to EVER have a real sick day.)