Docs hate cold and flu season, and Moms hate it even more.

So many blog-worthy stories, so little time. In the week since my last blog, life has given me more material to blog about than I can keep up with: Cole shitting all sorts of unexpected places (bath, carpet…); Cole fondling his pee-pee and causing a little boner; A Manhattanite showing up in my little southern ER and getting a dose or our small-town nurses; The nurses at work flattering me to the point of my head getting dangerously large; Trying to trick-or-treat with two babies; and Me after too many sleepless nights busting into a full-blown John Travolta-style disco in the middle of the nurses station in the ER (to the delight of everyone present). Hopefully I’ll be able to catch up in the near future and blog about each of these, but for now, the MOST blog-worthy event is the one that has dominated our life the last week:

Graham’s bout with RSV.
Poor little Graham contracted a nasty respiratory infection at daycare and spent the better part of a week completely miserable and not breathing well at all (which, coming from an ER doctor, means there was some legitimate respiratory compromise). We spent the better part of a week worrying about him and trying to make him well.

I’ve learned two important things from the whole experience:

1) I'M NOT AS NEUROTIC AS I THINK I AM.

When he first got a little sniffly and then initially got sent home from daycare with a fever, I was levelheaded. "Probably viral and will be over in a few days" was my line of thinking. Just in case (since recently at work I HAVE been seeing some pretty severe cases of infant bronchiolitis leading to ICU hospitalizations), I called the pediatrician and made an appointment for 5 days later to have him evaluated if it didn’t go away.

"You have a febrile 5-month-old and want to wait 5 days to have him seen?" asked the receptionist when I made the appointment.

"I’m a doctor." Yup… Doctor Mom was handling it calmly and coolly. That lasted about 12 hours….

Then, in one night, what started out as cold-like symptoms progressed to audible wheezing, severe chest congestion and a respiratory rate of 60 (way too fast – a sign of respiratory compromise). He was not eating; he was vomiting; he had no wet diapers; his fever remained high; and he was so miserable I was unable to put him down from 12:30am to 7am.

"Great. He has RSV, he’s dehydrated, and he’s gonna be hypoxic before long." If Dan hadn’t been out of town, I might have left Cole home with Dan and taken Graham into work in the middle of the night for an IV and some oxygen. As it was, as soon as the pediatrician’s office opened in the morning I was on the phone with them and had Graham in the office one hour later. That’s saying a lot. In all of Cole’s life I’ve taken him to the doctor just one time for a sick visit, because it takes a lot to get me too worked up.

The only appointment they had was with a nurse practitioner, which normally I would have refused, seeing as I prefer someone with at least my level of training telling me what to do with my kid, but I was desperate for ANYONE with objective eyes to take a look and see what they thought, because by this point I was irrationally afraid he was going to end up on a ventilator.

Of course, as soon as Graham got in front of the nurse practitioner he started smiling. There must be something in their molecular structure that makes them well when they appear before the doctor and then sick and miserable again when they leave. Parents are always telling me "He was crying until we got here," or "He had a fever until he got here." Now I can vouch – this really does seem to be a legitimate phenomenon. Somebody with more time than I have should research it.

Anyway, Graham seemed happy and so she assumed she wasn’t too sick, despite my tales of our angst-filled night. She sent him home with a nebulizer for his bronchiolitis and some antibiotics for a bilateral ear infection. I was surprised… I had jam-packed the whole diaper bag in preparation for a trip to the hospital at least for some IV fluids. RSV could potentially be life threatening in a 5-month-old, but she flippantly told me "I’m not concerned" and sent us home.

I thought my maternal neurosis had gotten the better of me. "He must not be as sick as I thought. I’m just losing my objectivity because he’s my son." So I went home assuming I was too neurotic and that she’d been correct and he’d do fine.

Well, he didn’t do so fine. He spent two more nights having a really hard time breathing, requiring significantly more frequent neb treatments than the 4-6 hour interval she had recommended and STILL spiking fevers.

Finally I had the opportunity to speak with another MD about his breathing at work when a 3-month-old with similar symptoms (but not even as severe) came into the ER and had a positive RSV test. "I’ve got a three month old patient of yours here with RSV," I explained to the pediatrician on call.

"Admit her to the hospital" said the pediatrician immediately with no further questions asked. "When they’re that young they’re at risk for hypoxia and respiratory distress."

"I know." Then I went fishing…. "So, if I told you I had a tachypneic (breathing fast) 5 month-old here with RSV, would you admit him."

"Possibly. Even 5 or 6 month-olds could still be at significant risk."

I knew there was more to my angst about Graham than undue maternal neurosis. I told the pediatrician how the Nurse Practitioner I had seen had been so nonchalant. "You should NEVER be nonchalant about RSV in a 5 month-old," was her response. THANK YOU! Never again will I write off good clinical judgment as "neurosis" when it comes to my kids.

2. NOT EVEN THE BEST MEDICAL EDUCATION CAN PREPARE YOU FOR ACTUALLY BEING THE PARENT OF A SICK CHILD.

I know a lot about RSV. I diagnosis and treat it all the time. I’ve seen parents who show up in the ER in the wee hours of the morning after baby has kept them up all night. I’ve given them the instructions about what to do with baby at home. I’ve written them notes for work, understanding that caring for a sick baby interferes with everything else. Before this week I thought I was pretty empathetic towards parents, given my medical education and clinical experience.

But I never really KNEW the overwhelming exhaustion of comforting crying baby ALL NIGHT LONG, giving nebs every 3 hours around the clock, trying constantly to get a baby to drink ANYTHING when he has no interest, keeping track of when it’s time for Tylenol & when it’s time for Motrin, agonizing over how many diapers it’s been since the last time he peed. The uncertainty of "Is he going to get better? And When?" just weighs on you. You are unable to concentrate on anything else when your baby is sick, and you couldn’t even if you wanted to because you are so damn tired. I kept working full time throughout the whole ordeal, and I was just a walking zombie. I am just now beginning to catch up on my rest.

This past week with Graham taught me more than my Yale Medical Doctorate ever could about how having a sick baby at home turns your world upside down. And this was just bronchiolitis treated as an outpatient. I can’t even wrap my brain around what it must be like for parents whose kids are hospitalized, for any length of time. Sometimes it’s good to be reminded that you have no idea what it’s like to go through what your patients do and that you need to have respect for the significant impact of the illness on their life.