Gavin Must Have the Hots for Nurses

The evening of Wednesday, January 27, 2010, Gavin started exhibiting cold-like symptoms (runny nose, loss of appetite, fever, some vomiting) that continued for the next two days.  I could tell he wasn't feeling well because he was fussy, wanted to be held constantly, and slept far more than usual.  By Friday evening, his fever had reached 102 degrees and Tylenol was only reducing it to 101.  At bedtime, I noticed that he seemed to be panting.  I attributed his fast breathing to the fever and congestion, but still worriedly called Mike at work for reassurance and advice.  Together we calculated Gavin's respiratory rate to be between 50-60 breaths per minute, which we knew to be too high.  I stayed up most of the night with him; the little sleep I did get was on his floor with one hand on his back to feel his chest rise and fall.

I called the pediatrician as soon as the office opened on Saturday morning and insisted that they see him as soon as possible.  Once we arrived, after hearing me describe Gavin's symptoms, the nurse warned us that we'd likely have to take him to the ER for an IV since he wasn't eating or drinking and his urine output had decreased significantly since becoming sick.  When examining him initially, the nurse noted that he was tachypnic (breathing rapidly), wheezing, and the muscles between his ribs were retracting with each breath - all indications Gavin was having trouble breathing.  The doctor then came in and confirmed the nurse's observations and ordered a dose of albuterol with a nebulizer.  As the nurse was setting up the nebulizer, the doctor informed me that she was concerned about Gavin's breathing and was therefore recommending that he go to the hospital for further examination and observation.  At that point, I emphatically declared that we were not going to Carroll Hospital Center and called Mike (who was sleeping at home since he'd worked the overnight shift) to ask him to meet me at the pediatrician's office.  Per Mike's suggestion, I told the pediatrician that we'd like to take Gavin to Sinai Hospital in Baltimore and she promptly left the room to make the necessary arrangements.  Unbeknownst to me, the doctor had called an ambulance to transport us since she worried Gavin's condition could worsen on the drive.  Imagine my surprise when a few minutes later a medic crew came rushing in to the room, hurriedly taking Gavin's vital signs, inquiring about his medical history, and preparing him for transport.  Meanwhile, a nurse was gently leading Ryan out of the room, distracting him with stickers and coloring books so he wouldn't be scared by all the commotion.  I was overwhelmed, scared out of my mind, panicked and confused.  Just as I was about to dissolve into tears, Mike walked in, and while my relief at his arrival resulted in a few tears, he ultimately had a calming presence.  (After the year we've had, I believe we can weather just about anything together!) He volunteered to drive Ryan to the hospital so I could ride in the ambulance with Gavin.  As I walked outside to the waiting ambulance, I was shocked to discover that it was snowing heavily and the ground was already covered (when I arrived at the doctor's office less than a half hour earlier it hadn't even started snowing).  Given the deteriorating driving conditions, it took us nearly an hour to respond lights and sirens to Sinai Hospital in Baltimore.

The medics were uncomfortable transporting Gavin in his car seat because the reclined position could aggravate his breathing difficulties.  So, it took a few minutes for them to figure out a way to safely strap him in an upright position to the stretcher.  They then hooked him up to a pulse ox to measure his oxygen levels and an EKG to monitor his vitals during the drive to the hospital.  I knew he was sick when he didn't protest to a stranger poking and prodding him and even dozed off several times during the drive.  It was heartbreaking and scary to realize how sick and vulnerable he was.  I will be eternally grateful to the ambulance crew who treated Gavin that day.  Despite being short staffed, and knowing they would likely face disciplinary action,or at least a reprimand from their superiors, they agreed to take us into Baltimore  even though it meant they would be out of service for a couple of hours. 

When we arrived at the hospital around 12:30 pm, we were taken to the pediatric ER where Gavin was evaluated, given another nebulizer treatment, taken for chest x-rays, and then given another continuous hour-long albuterol treatment.  At some point during the commotion a nurse stuck a long tube up his nostril to collect mucus to test for RSV.  The RSV test came back positive, confirming everyone's suspicions.  And, even though he tested negative for the flu, they gave him a dose of Tamiflu since his symptoms met most of the criteria.  Apparently, the flu test is notorious for giving false negatives.  During the second day of his hospital stay, the pediatrician decided to discontinue treatment with Tamiflu since it was unlikely he had the flu and RSV.  They also started an IV in the ER to replenish his fluids.  They initially started the IV in his right arm so he'd still have access to his left thumb to suck.  But he soon yanked that out and had to be restuck with an IV in his left arm.  Around this time, the results from his chest x-ray came back and showed signs of pneumnia and attelectus (partial collapse) in his right lung.  They decided to admit him to the hospital so he'd have around-the-clock access to respiratory therapists, nurses, and doctors to help manage his breathing and make him more comfortable while the virus ran its course. 

We were finally transferred to a private room in the pediatric unit of the hospital around 9:30 that night.  Mike and Ryan had returned home a couple of hours earlier and Gavin and Mommy were exhausted.  I was mentally and physicially drained, but relieved that my little boy was in capable hands.  Over the next few days, nurses and respiratory therapists came into the room every couple of hours to check his vitals, suction his mucus, and administer albuterol treatments.  Gavin's fever finally broke during the second day.  It was around this time that he started to smile and show some personality again. But, to add insult to injury, his bottom two teeth, which broke through on Thursday, January 28, started bothering him.  Between the congestion and the teething, he was a snotty, slobbery mess!

Since RSV is highly contagious, Gavin was in isolation and anyone (except family) was required to wear a gown and mask as well as wash their hands upon entering and leaving his room.  Although we weren't permitted to visit the playroom, hospital volunteers did bring us a few age-appropriate toys to entertain each of the boys.  Everything, of course, had to be sterilized before being returned to the playroom to prevent others from contracting the virus.  It's worth noting that Ryan was extremely well behaved during the entire ordeal.  The first day in the ER, the only toys we had access to were the few that we found stashed in the Explorer.  Obviously, I hadn't gone to the pediatrician's office prepared to entertain a 3-year-old in the ER for 8 hours!  Although I'm sure he was bored having to be confined to Gavin's hospital room for the next few days, he continued to be a trouper about it all!   

The entire experience was reminiscent of Gavin's first few days in the NICU as, again, we worriedly watched his oxygen saturation levels and breathing rate fluctuate on the monitors.  And, again, we had to contend with tangled wires and leads every time we held him and tried to comfort him.  Finally, on the third day when the pediatrician examined Gavin and listened to his breathing, she was pleased to discover that he was no longer wheezing and was exhibiting only minor retractions with each breath.  Satisfied with his improvement, she discharged him with instructions to continue the albuterol breathing treatments for the next week and to follow up with our regular pediatrician as soon as possible.  I was so relieved that Gavin was finally on the mend and that I'd finally be able to go home, sleep in my own bed, and enjoy a nice long shower.  Anyone who knows me knows that I'm fastidious about showering daily.  For someone who likes to shower almost as soon as her feet hit the floor every morning, I was beyond disgusted that I hadn't bathed, brushed my teeth, or changed my clothes in 3 days!  But, as I'm sure any parent can relate, I was not going to leave my sick baby boy's bedside, especially when he was so fragile and helpless.

I'm happy to report that Gavin no longer requires albuterol treatments and, aside from a stomach bug that lasted 3-4 days causing diarrhea, he is back to his old self! 

Here are a few pictures from the ordeal.  Since I was sick with worry and he looked so pitiful, I couldn't bring myself to take pictures of him in the back of the ambulance or during his first few hours in the ER.  It wasn't until he started to show minor signs of improvement that I allowed myself to snap a few photos (mainly to send to worried grandparents to assure them that Gavin was going to be okay).

ER Photos
(Arrived at Siani Hospital the afternoon of January 30)

Pediatric Unit

(Admitted to hospital late in the evening on January 30 and spent the next two days in the pediatric unit)

Discharge

(Cleared to go home the afternoon of February 1)

Home at last!

(Bathed and cooperating with nebulizer treatment)