Part II
The Boy Isn't Himself
Dawn's light had not yet filtered in from the shadeless window. Though it was nearing six o'clock in the morning, it was still quite dark. Max was stirring alongside me and he usually didn't stir long before he commanded us, "Wake up, mommy! Wake up, daddy!" In hindsight Linda did notice that Max's heart was beating somewhat faster than normal. We also thought that his being a bit warm was just that our bedroom was warm and he was wearing those toasty footy pajamas. It was unusual that we were able to coax Max into staying in bed for a while; we even succeeded in getting him to sleep some more and that doesn't usually happen anymore at all. By 8am we three were downstairs and soon thereafter joined my sister, brother-in-law, and some friends of theirs at another New York City diner. It was colder that morning and it was a few more blocks to this diner than the one the day before. Max didn't want to walk like he had yesterday; he wanted to be carried. I bore his solid 32 pounds down the sidewalk. When we were seated, Max repeated his breakfast demand, "I want French toast!" But today instead of putting the plate back in mere minutes, he only picked at his breakfast. This was when I thought that he wasn't himself. We chalked it up to a bit of a party hangover; all of us were in a post Birthday/Thanksgiving party haze.
When we came back inside from the park, Max continued to just want to be held or rest on top of me or Linda. This was another clear sign to tell us he was sick. Max only cuddles with us like that when he's not feeling his best. And as he was lying on Linda, she noticed more easily that his pulse was rapid. His breathing seemed more rapid as well. In hindsight it's easy to see where this story is going, but at the time, it was almost imperceptibly incremental, as minutes of a day can be. By late afternoon I was sufficiently concerned and spent some time on the internet investigating his symptoms. I read how a toddler with a fever will often have a higher heart rate as the body works harder to get the blood cells where they need to be to fight off the infection. He was sick, but he didn't seem in any great distress. We watched UConn on TV lose horribly to Duke in mens' basketball. (That might have been the bad omen now that I think of it.) By the second half, the outcome clear and with Max's condition not improving, I went out to a local Walgreen's and picked up a thermometer and some Infant Tylenol. And because we didn't want to take any chances we called our pediatrician's office and reached the on-call nurse.
Most of the family were going out to dinner that night along with some good friends - our last get together before people headed home the next day. My mother agreed to stay home and watch Max and Grace. On the way out the door, we got the call back from the doctor. As we walked the 20 blocks north and west, we recounted Max's symptoms and the doctor asked us questions. He eventually said that some of the symptoms were concerning, especially the rapid breathing. He said that it would be a good idea to have him looked at, but that if his condition remained the same, it would be okay to wait until the next day.
My mom was checking on Max regularly (i.e. in bed with him) and counting his respirations per minute. We'd asked her to text us if his condition changed. We arrived at the restaurant, hopeful that he'd rest comfortably and that we weren't making a horrible parenting decision by going out. Our bodies were at dinner, our minds remained with Max. Midway through the meal my mom updated me that his breathing was slightly faster. Linda and I tried to focus on our family and friends. It was, after all, a special occasion; we wanted to be present for it. But we did have a sick boy at home and while he was being closely looked after, it wasn't by us.
When we all left the restaurant, Pranna, to walk back to the apartment, Linda, my cousin, Sam, and I strode briskly ahead. Linda and I walked in the door and immediately climbed the three steep staircases to our guest room. My mother was lying in bed with Max and told us he was really hot. Max was groggily sleeping when I took his temperature. It was 102.6. His breathing was now clearly labored and his heart rate was still quick. So instead of turning in for the night we turned on our heels to leave for the emergency room. We gathered up Max and a few of his things. Just before midnight, we arrived at Beth Israel Medical Center at the corner of 16th St. and 1st Ave.
It's clear to me now - as it was then, I suppose - why we didn't bring Max to the emergency room earlier. It certainly wasn't because we weren't concerned for his health. It didn't even have anything to do with the fact that our new health insurance through Linda's work wouldn't start until 12/1. (We had the option to get healthcare through COBRA when we moved to CT, but as one can wait two months before paying that premium to retroactively activate your insurance if needed, we technically did not have health insurance yet). It was really because no one wants to be in an emergency room. At least no one sane.
My mom was checking on Max regularly (i.e. in bed with him) and counting his respirations per minute. We'd asked her to text us if his condition changed. We arrived at the restaurant, hopeful that he'd rest comfortably and that we weren't making a horrible parenting decision by going out. Our bodies were at dinner, our minds remained with Max. Midway through the meal my mom updated me that his breathing was slightly faster. Linda and I tried to focus on our family and friends. It was, after all, a special occasion; we wanted to be present for it. But we did have a sick boy at home and while he was being closely looked after, it wasn't by us.
When we all left the restaurant, Pranna, to walk back to the apartment, Linda, my cousin, Sam, and I strode briskly ahead. Linda and I walked in the door and immediately climbed the three steep staircases to our guest room. My mother was lying in bed with Max and told us he was really hot. Max was groggily sleeping when I took his temperature. It was 102.6. His breathing was now clearly labored and his heart rate was still quick. So instead of turning in for the night we turned on our heels to leave for the emergency room. We gathered up Max and a few of his things. Just before midnight, we arrived at Beth Israel Medical Center at the corner of 16th St. and 1st Ave.
It's clear to me now - as it was then, I suppose - why we didn't bring Max to the emergency room earlier. It certainly wasn't because we weren't concerned for his health. It didn't even have anything to do with the fact that our new health insurance through Linda's work wouldn't start until 12/1. (We had the option to get healthcare through COBRA when we moved to CT, but as one can wait two months before paying that premium to retroactively activate your insurance if needed, we technically did not have health insurance yet). It was really because no one wants to be in an emergency room. At least no one sane.
Linda, Max, and I gave our names to the woman behind the glass window and went where the staff told us to go. A concerned doctor (or nurse, I don't even know, he didn't say), took Max's vital signs and then told us we'd be going to the pediatric only emergency area. We were led to the room by a young couple with a very tired and weak looking girl. They led the way because they had been there before. At first I thought that a pediatric only ER was good. I thought we'd be seen sooner. We went upstairs and followed the couple with their sick child down the empty corridor, making a series of turns until we entered a windowless and overheated waiting room. There were three other patients silently sitting with their mothers or fathers. The nurse behind the counter told us to sit and wait, that she was too busy at the moment to even check us in. I saw a man, who we'd later learn was the doctor, talking on a phone behind her. His voice was quiet, but urgent and impassioned.
Max was groggy, still sleepy, but interested in where he was. Did he wonder why? With his labored breathing and warm body, he was weak and heavy in our arms. It was just after midnight. I heard the woman next to me tell someone on a cell phone that she'd been waiting in that room for an hour. So much for being seen quickly. Eventually I couldn't stand that no one was bothering to check us in; I went up to the counter and gave our information to another man who'd appeared behind the desk. The three of us then sat there, in the very warm waiting room, staring blankly at the television. Linda and I stole peeks at the other children and sleepy looking parents. Finally, around 1am, the nurse called us in. She led us down a narrow corridor to a examination room. After getting Max's weight, temperature and us repeating our account of his symptoms, she left saying, "The doctor will be with you shortly." What I didn't know or remember is that emergency room "shortly" is not even close to what the rest of the world would perceive.
We occasionally saw the doctor walking back and forth. And at one point, he even felt badly enough to poke his head in and say he'd be back "shortly." By 2:15, we were going bonkers. Max was still in the same condition, no worse, but more tired by the minute. I began to feel that what Max needed more than a visit with the doctor was a good night's sleep. How long would we stay there? I felt like we were being held hostage. We could leave but at the risk of Max's health or we could stay and wait forever, at the expense of all of us sleeping. When we went to the emergency room, we joked that it might be faster to drive from NYC back to CT and go to our own emergency room. Sadly, by 2:45am that was a true statement. But we'd waited this long and you all know how that goes. If you've waited this long you might as well wait forever because otherwise you waited for nothing.
I felt some relief at 3am when the doctor finally came in, apologized for his being the only doctor on duty and it being a busy night. (He even went on to say that he doesn't normally work the pediatric emergency room, that he usually works in critical care, but they were short staffed). His earnestness at the outset was encouraging. I thought, well, maybe part of the reason he's so late is that he's taking a lot of time with the patients. And while Max was surely sick, no one there seemed to feel that danger was imminent; perhaps waiting was in everyone's best interest, not just an inconvenience us.
He asked us what was going on with Max; we repeated our now oft told account and then the doctor checked Max's ears. He pronounced that Max had an ear infection. (Three hours for someone to look in his ear and say, "He has an ear infection" seemed more than an unnecessary waste of time.) He went on to listen to Max's heart and his breathing. He proclaimed that 'there was something going on there.' He spoke quickly and it was hard follow what he was medically explaining. Complicating comprehension was his tendency to mumble toward the end of his sentences, as if he didn't have enough breath to finish the thought and no time to take another. The way in which he told us much of the medical information was designed, it felt, to make us feel badly, that all of it should have been obvious to us. He said that Max would need some Motrin for his fever. When I asked him about Motrin, he mumbled dismissively. I didn't hear the words, but they easily could have been, "You're an idiot." Before Linda and I could process all of what he'd told us and gather our thoughts for questions, the doctor had already made his way out of the room. Linda and I tried to repeat to each other what he'd said. "Did he say it wasn't pneumonia? Was it an infection or a virus? In his ear or in his chest?" Max groggily whined.
Sometime later the nurse returned with two liquid filled oral syringes. One was bright pink and the other was milky white. What's this, we asked? It was the Motrin and Amoxicillin - Motrin for the fever and Amoxicillin for the bacterial infection. We told Max we had some medicine, but he was rightly suspect of the syringes. "Say, aaahhh," I offered. We cajoled him into taking the syringe in his mouth and he swallowed, too tired to put up a fight. But his breathing was still labored. He was "retracting" as the doctor put it, his neck muscles pulling hard to collapse his throat in an effort to get in as much air per breath as he could. Before long the nurse brought in a gas mask which she connected with rubber tubing to a tall thin green tank of oxygen. She poured some Albuterol into a compartment within the rubber tubing. She turned on the gas and a cool, cloudy mist flowed out of the air mask. Max saw the smoke and wondered what? why? He did not want us to hold the mask up anywhere near his face. We slowly moved the mask closer, minute by minute, to his face and he eventually let the steam enter his lungs. The treatment lasted five or ten minutes. When the nurse left, we assumed that the doctor would come back shortly to check on Max.
We were again fooled by the the word 'shortly.' The nurse however did return and told us that Max was going to need another Albuterol treatment. This time Max permitted the mask to be near him. The Albuterol can act as a stimulant and Max indeed started to get hyper. This was good in that, some of his old mischievous self was visible, but the more hyper he got the more his heart rate and breathing increased. The doctor eventually came back and we were able to get him to stay still long enough to answer some of our questions. We wanted him to sum up his diagnosis so that we could understand exactly what he was saying, the treatment he was pursuing, and what he thought would be the result. We told him that we would be able to immediately leave New York and drive back to CT as soon as we left the emergency room. He thought it was 'risky' to take a four hour trip (even though we had just told him it was a three hour trip). We asked him to explain what he meant by risky? At worst would it be a diversion to a local emergency room or were we genuinely risking his life? It was the former, but he made us feel foolish for considering it at all.
Max was responding well to the Albuterol and Motrin. His fever had gone down and his breathing and heart rate were moving toward normal rates. Relief crept into our consciousness. We waited awhile until we could get the doctor's attention. I could sense that he was growing weary of our questions and apparent lack of ability to understand his quick mumbles. The doctor understood that we'd be leaving the ER, going back to the apartment to gather our things and be driving straight to our doctor (who has Saturday hours). He prescribed Prednisone to clamp down on the inflammation in Max's bronchial tubes. He mumbled something about prescriptions, discharge papers and was out the door before we could know what to expect next. Several minutes later the nurse brought in another liquid syringe, this one the color of canola oil, the Prednisone. "Does this one taste good?" Linda asked. "I ain't gonna lie to you," she replied. But Max took it well and we then learned a third Albuterol treatment was next. One for the road, if you will.
As it neared 5am, we were finally collecting our things and wondering if we could actually go. I went up to the desk to ask, but they said to wait, that the doctor was still doing the discharge papers. Some time later, Linda asked the nurse, who must have conveyed our question to the doctor because by the time he came in, he was agitated. It was kind of hard to notice at first, but he was a bit more terse than just quick spoken. We were once again clarifying our understanding of what Linda and I thought of as the plan - the plan for Max's well being. He pointedly interrupted us to make a clarification. Then the doctor said, "You know I have to be frank: you two are a little difficult to work with." Linda and I stole a glance at each other. We communicated by telepathy and we both said, "What the fuck is he talking about?" But we could only think it. This doctor was the gatekeeper and we were getting very close to the gate. He chided us for things that we couldn't quite understand; he issued orders; he checked Max and at one point looked directly at me and said, "Is what I am saying making sense to you?" I swallowed all my pride and my tongue, "Yes, sir." People like it when you call them sir if you can manage not to betray even a smidgen of sarcasm. He asked another inane rhetorical question and I yessirred him again. Soon he left and Linda and I let our venom lose on the absent douchetor. But we were too close to getting out the door to focus on him for long. We had a plan.
The plan: go back to the apartment and immediately pack our belongings, get in the car and drive straight to our pediatrician's office in Putnam, CT some 170 miles away. As anyone who travels with children can tell you, the amount of stuff they require is inversely proportional to their size. Not only did Max have the requisite pack 'n play and stroller, but this was the day after his birthday. He had a rocking horse, and 'rollercoaster' and boxes full of gifts. While Linda failed to keep Max quiet in the house full of sleeping relatives, I hoofed it up and down the three flights of stairs from the street to our bedroom. I filled bags with toiletries, toys, running clothes, and shoes. There was no logic or order to the packing. I loaded a bag with whatever was near and then filled another bag the same way. I schlepped it all down to the foyer and then took an extended moment to take stock of all I had to fit in our car. I took note of the odd sized laundry basked, super stroller, and rocking horse. With a packing model in mind, I made 8 swift trips back and forth to the car and every free space but for the passengers was claimed. We next sat Max in his car seat, strapping him securely in place. Linda and I fell into the front and in unison let out a deep, long breath. I put the car in drive and felt somehow stealthy as we headed out of Manhattan.
Read Part III here
Read Part III here
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