That was not the issue yesterday morning though. Yesterday morning she couldn't breathe. All she could do was wheeze and spit/gag froth up. Despite her usual gravitation to her puffer she kept pushing the mask away from her face as I only suspect she felt like she was already suffocating. Keith convinced her to get back in the shower where she could calm down enough to get 2 puffs into her and her wheeze became more manageable. I was minutes away from calling an ambulance.
After 13 years of marriage Keith and I have an uncanny way of not freaking out at the same time. There are only a handful of us that have ever seen Keith freak out, like an emotional Yeti, but it has happened and during those times I usually revert into my doctor ability to stay calm. That did not happen yesterday morning. I do not like people not being able to breathe. It's probably why I didn't go into Respirology or Anesthesia but I find it much easier to handle shortness of breath at work where I have access to oxygen, face masks, medications and intubation if necessary. I have all those skills still in my back pocket if I would ever need them at work but I don't have them in the bathroom at my house when my kid is wheezing in front of me. Also doctors have seen the worst-case scenarios and often those cases come flooding back to your mind when you are afraid and it's your own kid.
I threw on some clothes and got Em out of the shower and put some clothes on her. It was 630-645 am and she was much better than she was but was still wheezy and her voice was different than it usually was. Keith went to pack her stuff in her backpack including a snack but I was having none of that. What if they had to intubate her and she had eaten that snack and aspirated it into her lungs ? Keith just indulged me and didn't persist. Cian was the hero just before we left as he reminded us to pack Emily's puffer and aerochamber.
We got to the hospital and Emily was sweet as can be. Both of my kids tend to get even kinder when they are really sick. We got to Children's ER and she seemed better and I thought maybe I had freaked out too much. The only other times we have been to Children's ER have been for Cian and once was for croup and he had needed Dexamethasone (steroid) and Receimic epinephrine (adrenaline) and I had thought he was relatively fine and didn't want to make a mistake like that again so I had brought her but sitting in triage I felt like maybe it was overkill. The nurse assured me I should have brought her and validated our experience that it would have been scary in the morning if this is how she was post-Ventolin. We waited a bit in the waiting room and although I am not known for my patience I did often come back to the thought that I was thankful we hadn't had to be rushed straight to the back; that waiting in the waiting room meant that was was relatively well and how lucky we were for that.
After about 45 minutes we were taken into a room and the nurse and then doctor assessed Emily. She was still pretty wheezy on exam and they felt her signs and symptoms were consistent with an asthma attack and that she should receive the medication regimen that they usually do for that. It's known as an asthma care map or care plan. Patients get 8 puffs of Ventolin (the blue inhaler) and then 3 puffs of Atrovent (the white inhaler) and then 2 more rounds of that 20 minutes apart for a total of 24 puffs of Ventolin and 9 of Atrovent. She also got an oral dose of Dexamethasone (steroid) and will need another one in 2 days and went home with a Ventolin puffer and a steroid puffer to take for the next week or so. They explained things thoroughly and easily as I'm sure it's routine for them, as routine as me explaining labour or painful periods, but we hung on every word like it was the first time we were ever hearing instructions.
Emily loved having a piece of paper with instructions and checkboxes. She loved checking things off and telling me how many puffs were left. By the second round of puffers she was more like her usual self and after the third round we were back to living in our regular scheduled life musical (she sings everything all the time). The whole ordeal took about 4 hours. I have never been more grateful for every component of medicine. Thankful for medical research that figured out how puffers would help reactive airway disease and the discovery of steroids. Thankful for universal health care and that I never once had to worry about the cost in addition to all my other worry. Thankful for the expertise of the people I work with and their calm in my fear. Thankful for their kindness despite the uncertainties of our provincial health care system and despite protests of our health care cuts happening at the exact same time. Manitoba doctors and nurses provide amazing care in what appears to be one of the most confining provincial budgets, even before these proposed cuts. After a quick trip back home to shower and get ready for my hectic clinical practice I brought coffee to the Children's ER staff. I wanted them to be reminded that something so ordinary for them was so comforting for us and how much we appreciated it. I read something recently that a physician wrote "Your life is my life's work" and that is so very true - it seems so routine for us at work but being a patient (or a patient's parent) is a good reminder of the weight and importance of being a front line health worker. Thank you to the doctors and nurses that cared for Emily yesterday.
After my crazy clinic day I came home and did our regular evening routine. To decompress I watched City Slickers which is one of my favourite movies. I was reminded of it on my drive home as I thought of my day. It was one of my worst/best days. It felt like the worst in the morning when we felt so helpless and scared but it was also one of the best because Em got the care she needed and none of the bad things happened. And that is truly something to be so grateful for.
Emily with her asthma care plan and pencil. This girl likes lists and counting and is getting back to her regular self.
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