This weekend was frustrating. Exhausting. But it was also indicative of many of the things that I think Tom and I are doing right in our parenting. Or maybe it's indicative of how lucky we are to have the support that we do. Regardless, I am very tired, and I can't guarantee that any of this will make any sense. Or be coherent. That sentence and sentence fragment mean the same thing, Pamela. Yes, I know.
(I also clearly can't guarantee that I'll refrain from conversing with myself within the post.)
On Thursday night, Tom and I went out for my birthday dinner. Patricia came over to babysit, and took Emmy for a walk up the hill behind the house. Somewhere in the tall grass, they encountered some nettles (or so we assume). Emmy got some welts on her legs, but Patricia dealt with it admirably, washing her off and applying some cortisone for the itching.
Friday, when she got home from school, Emmy was hoarse, but she seemed fine, no fever, and Grandma Susan was in town for my birthday, so Tom and I went out to a movie. (The Dark Knight Rises was fantastic, by the way). Later that night, Emmy woke us up (I think) and her breathing sounded a little rough. We gave her some medication for congestion and set up the humidifier. After getting her back in the bed, I started looking up her symptoms (breathing difficulty, dry cough, hives) on the ol' iPad. I decided that her hoarseness, cough and the hives on her legs meant she was having a delayed allergic reaction to the nettles. Mayoclinic agreed with my assessment. I told Tom my hypothesis, and he was... dismissive. To put it mildly. He believed she was experiencing drainage from a summer cold.
When we got up around 8:30-ish, Emmy was still having some problems. Convinced that it was an allergic reaction, I gave her benadryl and put some caladryl on her hives. We went about the business of the day, which involved some shopping and prep for my birthday dinner (with my parents, Susan, Patricia and JP).
In hindsight, we should have taken advantage of our pediatrician's Saturday hours and taken her in. But, again, she didn't seem that bad, and I was convinced it would get better.
Everyone came over around 4:30, and besides her lack of voice, Emmy was in a good mood, and we had a nice time. Emmy was allowed to stay up a little late, but we got her into bed around 8:30 or 9:00. Then Tom, Patricia, JP and I headed out to watch Batman again. (It was really good, you guys.)
About halfway through the almost three hour movie, I got a text message from Susan. She asked me where Emmy's medications were and what she could give her for a fever. Her temperature was 101.8. I told Susan where the meds were and the proper dosages, and I decided that I didn't need to ask everyone to leave because I trusted Susan to take care of Emmy.
When the movie was over, we all headed home. I called Susan to see how Emmy was doing. She told me that Emmy was awake, and very uncomfortable. We got home and Emmy was clearly breathing hard. I decided it was time to call the after hours nurse at the pediatrician. I called the office and had to wait through the nearly five minute messages before getting routed to the answering service. I left my number and waited for the nurse to call. After describing what Emmy sounded like to the nurse, she said it sounded like stridor, and I needed to have Emmy sit in the bathroom while the shower steamed the room up for thirty minutes. Emmy and I watched the care bears movie while the room filled up with steam.
After that, she sounded much better, so I put her back in bed and called the answering service again and told the nurse that she sounded better. It was now somewhere between 2 and 2:30 am, and I was exhausted. I hadn't slept well Friday because Emmy had woken us up in the wee hours, and I hadn't yet been able to sleep on Saturday (in large part because we had gone to the movie, yes, but did I mention how good it was?) So, the nurse told me to monitor her breathing and if she experienced the stridor again, to repeat the steam treatment.
I made the decision that a) she wouldn't sleep if I was lying on the floor by her bed and b) I would be useless on Sunday if I didn't at least get some sleep, so I went to bed.
On Sunday, she sounded okay, but was still breathing hard. So, I called the answering service again and talked to my second on-call nurse. I tried to describe Emmy's breathing, but apparently, the sound I was making was "gasping" even though I thought it sounded like wheezing and that phone call was pretty much useless. This nurse suggested another steam treatment and then I could call back.
So, I took her into the bathroom (but I used the larger bathroom, and I don't think the steam was able to accumulate as well), and it didn't help. I didn't think the situation was urgent enough for the emergency room, because Emmy was able to talk in full sentences (despite the hoarseness, which just meant you couldn't hear her very well) and not blue, or pale, or anything else that would indicate that she wasn't getting enough oxygen. Her breathing was just loud and rapid. By now, obviously, I had heard the seal bark cough and looked up croup along with a helpful youtube video, and was fairly convinced that she had croup. But nothing I read, and neither of the nurses had given me any indication that her situation was emergent or dangerous. Everything and everyone just said to watch her, which we were definitely doing.
Since her pediatrician wasn't open and the Vanderbilt clinic didn't have any hours, Tom suggested a minute clinic, and I thought that was a wonderful idea, because then, at least, I could have a real nurse listen to her breathing and tell us how serious it was. We took her to a CVS minute clinic, and by the time we got there, she was sounding pretty rough. Her breathing was very loud and she was coughing occasionally (that harsh seal bark).
The minute clinic nurse listened to her chest, asked a few questions and stuck a pulse oxygen meter on her finger. I watched the digital readout and asked (what I thought was a perfectly reasonable question), "Is that acceptable?" (Meaning, is that an acceptable pulse-ox reading).
The nurse just stared at me. (And this is a thing you definitely want to do with concerned parents who are just trying to make the right treatment decision and not clog up the ER unless they have to-- *sarcasm*)
Then she told us she was going to close out the record and send us to the ER. Or we could go to a clinic depending on what our insurance would cover, but I had pretty much stopped listening. Since I had no idea where a clinic (urgent care, I guess) was, but I knew exactly how to get to the ER (which is on the campus where I WORK) we decided to go to the ER.
So, after an interminable amount of time where the nurse was closing out the stupid record that I didn't care about, we loaded Emmy up in her seat and drove across town to the ER. Did I mention that the interstate is closed every weekend this summer and I had to take a non-interstate route to avoid the traffic as people unfamiliar with the detour try to figure out the route? No? Well, there was that to deal with too.
By the time we got to the hospital, Emmy's latest bout of stridor had stopped. When we checked in, she sounded pretty normal, but the nurse was able to hear it with the stethoscope, so we got checked in and assigned a room.
The doctor (who legitimately looked younger than both Tom and myself), listened to her, and then Emmy experienced a well-timed cough and he said, "Yup, it's definitely croup. We'll give her a dose of steroids and she should be fine."
And about an hour later, we were able to go home. I would like to mention one additional thing. The doctor asked if her immunizations were up to date, and I proudly told him that, yes, they were indeed up to date. And he told us that if they weren't, they would have had to admit her because one of the underlying infections that causes croup is bacterial (covered by immunizations) and they would have to monitor to determine which infection was the cause and if it was the bacteria, treat it with antibiotics.
This morning, Emmy is much better. She had two bowls of cereal, and her hoarseness is mostly gone. Susan is staying with her today, and I will stay home with her tomorrow and until she can go back to daycare.
One other note. I have been very careful not to refer to Emmy's hoarseness as laryngitis. This is because the first nurse informed me (as I had been describing her loss of voice as laryngitis) that babies don't get laryngitis. Small children's larynxes (I don't know the plural of larynx obviously) are softer, or something, and what is laryngitis in an adult, is a narrowed throat in a baby. That's why they need to be monitored closely, because it's much harder for them to breathe. Like I said, I'm tired, and I don't actually remember what the nurse said except that "Babies don't get laryngitis."
I don't know what we could have done differently. Yes, it was kind of dumb to think it was an allergic reaction, especially since I googled allergic reaction and looked for an entry that matched what I was looking for. But she didn't have a fever until late Saturday night, and nothing else indicated that it was viral. I was also influenced by the fact that we had just finished a round of antibiotics for strep, so she couldn't possibly be sick again. It's extremely difficult to try to determine when it's serious and on the weekend, it's even worse, because while I would have gone straight to the doctor for these symptoms, it was hard to make the decision to go to the emergency room. It never felt like an emergency, even after the nurse at the minute clinic tried to scare the crap out of us (and yes, I'm super pissed about that). I'm also upset at the thought that the on-call nurses at my pediatrician's office were trying to put us off until we could come in Monday morning, instead of telling us to go to the ER and get it checked and get the steroid treatment. Maybe that's not why they advised us the way they did, but that's the reason that makes the most business sense and it's the standard practice I would dictate if I ran a pediatrician's office.
That was a long post, and I apologize, but it was a long weekend. I'm trying not to feel like I ignored my daughter's illness because I had birthday plans, but every time I say that in my head, there's a mean voice that tells me that's exactly what happened. So, Em, I'm sorry. We should have taken you to the doctor on Saturday, but at least with the ER trip, you got an extra ice-pop. Mommy loves you.
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